Pet owners can’t always be with their pets while they’re at the clinic, but what if that wasn’t true? Would it affect how you act treat any patients (or team members)?
[tweetthis]Practice like pet owners are watching… and eating popcorn.[/tweetthis]
Life With Clients
The Real Reason Your Wait at the Vet’s Office is So Long
I recently read a Huff Post article entitled “The Real Reason Your Wait at the Doctor’s Office is So Long.” Veterinary Medicine and Human medicine vary in a lot of very meaningful ways, but we are also often the same. And in this we share a common weakness—we sometimes run behind schedule. In fact, I’d wager to say we frequently run behind schedule.
So, when I saw this article, I expected to read a well-reasoned explanation of why this is the case by someone in the know. Instead, the article read more like one woman’s angry Yelp review. Many of the comments in the article espoused similar experiences with complaints that doctors don’t value their time, overbook to cram as many appointments in as possible just to make a few bucks, and are generally greedy, no-good, shysters with big egos.
As you can imagine, myself and many other health professionals took offense to this so I am here to tell you the REAL “real reason” your wait at the doctor’s office (be that physician, dentist, veterinarian, chiropractor, etc) is so long—we care!
[tweetthis]I am here to tell you the REAL “real reason” your wait at the doctor’s office is so long[/tweetthis]
We care about you and your pet and your health, and yes, even your time. We care, and we are people pleasers who try to make everyone happy. We do our best to schedule responsibly (although sometimes there are managers and administrators who have more of a say in this than we do) but as Robert Burns said, “even the best laid plans of mice and men, often go awry.” Nowhere is this more true than in medicine.
Things are always going awry. Sometimes it’s a true medical emergency—the dog that ran into the street and got hit by a car, the cat that can’t breathe because it’s having an asthma attack, the person who goes to their doctor for heartburn but is really having a heart attack. In these cases we have to stop everything we’re doing to care for this emergency and that takes a lot of time.
Sometimes the problem is our own inability to say no. We save that appointment slot for an emergency and then someone calls up because their dog has a painful ear infection. Sure, it’s not really an “emergency” but we can’t stand the thought of that dog suffering in pain until tomorrow, so we fill the slot.
Then the next thing you know, someone calls up because their cat has vomited 6 times in the last hour and really needs to be seen. Sure, we could say we’re booked and send them to the emergency clinic, but then the client will wind up spending twice as much and they have two kids in college and can’t really afford it. So we fit them in, even though there are no open spots and taking x-rays is going to put us even more behind.
We also get behind when simple appointments turn out to be not so simple. A client schedules a wellness appointment for vaccines and then “mentions” their cat is urinating out of the litter box, and can you check this lump and his breath really smells, and oh yeah, don’t forget to cut his nails. Or the patient I saw the other day for what the client thought was an eye infection but really turned out to be lymphoma. I’m not going to rush an appointment like that just because I’m afraid of getting behind.
Yes, I feel bad that I’m making the next client wait, but I know that if something terrible ever happens to their pet, they would want me to give them as much time and attention as they need, even if there are ten people in the waiting room who are just going to have to wait a little bit longer.
And sometimes it’s not terrible news I’m delivering, but just someone who has a lot of questions. Sometimes I have to have a lengthy conversation on weight management or dental health, or the importance of heartworm prevention, that runs long.
I could easily skip over these issues especially when I’m running behind. It’s not a problem yet after all. But instead, I take the time to make sure my clients are fully educated about their pet’s health so that down the line I can hopefully avoid discussing diabetes management or the heartworm treatment protocol.
All of these things aren’t a once-in-a-while occurrence. They happen on an almost daily basis in medicine.
The truth is, maybe I could be on schedule more often. I really do value your time, but I value your pet’s health more and if being better at time management means I’m going to be worse as a doctor, then I’m not interested.
[tweetthis]I really do value your time, but I value your pet’s health more[/tweetthis]
Reprinted with permission from laurensmithdvm.com.
The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.
The (Dorky) Free Gift Everyone Will Actually LOVE
OK, let me just say upfront that I am fully aware of how nerdy this gift is. However, I’m still going to tell you about it because it makes people feel great, it doesn’t cost a thing, and it might even help your clinic. So what the heck is this magical stocking stuffer? I’ll explain:
Last year, a young couple who had just moved to my area and were looking for a veterinarian brought their two Westies in to see me. They were about my own age, energetic and upbeat — I liked them immediately. Both dentists, they had bought a little dental practice in town from someone who was retiring; and their enthusiasm for their new business and the changes they were going to make was fun and contagious. Every time they came by with their dogs, it brightened my day. So I was genuinely happy when it came time for me to get my teeth cleaned. I headed over to their new office and had a wonderful experience.
Then I did something I almost never do: I wrote an online review. (I told you this was going to get nerdy.) Why? Because here these people were, working with all the determination, uncertainty, and hope that many of us have about our own businesses, and I had the ability to do one simple thing to help them with one of the biggest challenges they faced — reaching out to potential new patients. It only took me a moment, but I imagined it might make their day.
Think about it: How much do you love it when people say nice things about you in front of other people? That’s what it feels like to see a new 5-star review appear for your business. It costs the person writing the review absolutely nothing except a few minutes of thought, but the resulting joy and pride are huge. Writing a nice review for someone has all the hallmarks of what I’d consider a perfect gift, too. It’s unique and personal; it shows that you are thinking of the recipient; and you make it with your own hands.
[tweetthis]This gift makes people feel great, it doesn’t cost a thing, and it might even help your clinic.[/tweetthis]
And you know what? Sometimes this gift has a very nice way of coming back to you.
After I wrote a review for my dentists, I went on about my day with that warm feeling you get from doing something unsolicited and kind for someone else. I didn’t contact them or point the review out. I figured they would find it sometime in the future and have an especially good day.
About two months later, I got an alert from Google. There was a new 5-star rating for our veterinary practice. It positively glowed, and it mentioned me by name. I still go back and look at it every now and then when I need a little boost. You can guess who it was from, can’t you? My dentist friends. I wasn’t expecting it, and it made my day.
So this holiday season, think about whether any of your clients own a small business. They probably feel the same way about their bakeries, shops, garages, or dental practices that you do about your clinic. Why not pop in to visit and then leave a nice review? They may return the favor one day, or they may not — what matters most is that you’ll be spreading immeasurable good cheer.
[tweetthis]How much do you love it when people say nice things about you in front of other people?[/tweetthis]
Today I Lied
Today, I lied to a client. And I don’t feel bad about it, to tell the truth.
That’s not what I’m like, either the lying or the lack of regret. Like most veterinarians, I believe that telling the truth is an essential part of who I am, and what I do. Being honest is essential to building trust with our clients because their pets, our patients, cannot speak for themselves. We are advocates for these animals, and to accomplish this we must give their owners truthful health assessments and honest options based on our knowledge and experience so they can make informed decisions.
But it’s not just my profession that drives my veracity. My husband says I am the most honest person he has ever met; honest to a fault, sometimes. For me, lying triggers anxiety and sleepless nights.
Usually, sugarcoating the truth is the closest I can get to lying. But that wasn’t the case today.
Miss Midnight, a sweet cat as black as her name suggested and about as old as most cats hope to be – 16 – came in with her owner, Mrs. Johnson. (And, yes, both names have been altered.) Miss Midnight hadn’t eaten much in more than a week, and Mrs. Johnson wasn’t sure the last time she’d seen the kitten drink any water.
The ancient black kitty was skin and bones. Her eyes were sunken in, and she was too weak to stand up. I kept my professional demeanor in place as I observed that she was cold, her gums were pale. Blood tests showed only one abnormality, a marked nonregenerative anemia, which means the bone marrow wasn’t producing the red blood cells needed. Had I seen her earlier, she might have had a chance, and the thought made me sad, and angry. As we often say in veterinary medicine, old age isn’t a disease. The fact is that many things can be treated, and don’t need to be ignored because of an animal’s age.
As I have done so many times, I shared my professional opinion, and then discussed all the options. Mrs. Johnson couldn’t afford to hospitalize Miss Midnight, but she wasn’t ready to say goodbye. We agreed to try 24 hours of supportive care at home to see if Miss Midnight’s condition would improve.
Mrs. Johnson then told me she is a nurse in a home for senior citizens and would have to call in sick to take care of the cat. I was taken aback. A nurse? Working with elderly patients? How could she let this situation go on as long as it had? She surely knew better!
But I kept listening. She told me about Miss Midnight, how her son brought him home when he was a teenager and left her there when he went off to college. Miss Midnight had become her cat at that point, and was very much a part of her family. I could see the love she had for this suffering old kitty, and I could see the guilt on her face as we discussed how sick her cat was now.
That’s when it happened.
Mrs. Johnson asked, “Did I wait too long to bring her in?”
I watched the tears flowing down her face. “No you didn’t wait too long,” I lied. “She is just old.”
And I left it at that.
Why? I’ve thought about that a great deal, especially since I know many may disagree with what I did. The lying, and with my refusing to tell Mrs. Johnson that she was cruel and irresponsible to let her cat get this sick and thin without getting help for her.
I could have been honest and said, “yes, you did wait too long.” I could have then told her that I didn’t think it was right to let an animal get this thin and this sick without getting help for her. But it wouldn’t have changed a thing now, nor was it the best for either of them at this point.
Miss Midnight most likely only has a few days left, and she and her family deserve to cherish the time together. I know that Mrs. Johnson loves her cat, she really does, and I do not believe she should have her final memories of her special kitty tarnished with guilt.
Instead, she will remember how she spent this time hand-feeding Miss Midnight, snuggling with her to try warm her, and doing all she can before she says goodbye to her.
It was the best, most truly humane thing I could offer them, and that’s why I lied.
It’s also why I have no regret.
The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.
My Oversight Cost a Dog’s Life- and This is What the Owner Did
Although I’ve been a veterinarian for over ten years now and feel confident in my abilities, a few years ago I made an obvious mistake that I believe cost a young dog his life, and it left me devastated.
An aggressive Lab mix named Buddy was seen by my associate for not eating his dry dog food. The patient appeared healthy, and was still eating his treats, canned food and table scraps, but the doctor was unable to perform an oral exam due to his aggression, so he scheduled a sedation dental and bloodwork the day of surgery.
I remember that morning being very busy, and I also recall looking at the results of the bloodwork – I thought everything looked good, so we sedated him for his dental procedure. His teeth were perfect, so I checked the jaw for any problems and saw nothing. When the owner came to pick him up, he mentioned Buddy only wanted table scraps now, which led me to believe the dog was just being picky. I discussed feeding options with the owner and sent him home with his dog.
Five days went by and Buddy was back in the office, but this time, he was not eating at all and was unbelievably icteric. We ran bloodwork and found his liver values were extremely elevated; he was in severe liver failure. We started fluids as I tried to figure out what could have happened in the last few days.
As I was rattling my brain, another associate showed me his bloodwork sheet from the dental. The liver values were elevated even then, but I missed it, even though it was right there. How could I have missed this? Did the technician give me the wrong paper? Did I confuse the liver value for another value? I was shocked. What do I tell Buddy’s owner?
I talked to my insurance and was told not to claim guilt, but that didn’t mean I wasn’t going to do everything I could to help this dog pull through. I was out of town over the weekend, so I transferred Buddy to the emergency center and told the vet at the center not to let Buddy die.
I thought about him all weekend, and my associate kept texting me about how I needed to tell the owner, regardless of what the insurance company said. He was right; I had to tell the owner. My conscience could not take it. I made a mistake, an oversight, and now this patient was fighting for his life. If I’d caught this issue at the time of surgery, I could have started treatment on him right away. This owner trusted me, and I was a disappointment to him and his companion.
The weekend passed, and I told him the truth Monday morning. Through my tears, I told him about how the initial bloodwork showed a problem, but I’d missed it and so treatment was delayed. I prepared myself for the worst. I was ready for the yelling, storming out with his dog and/or threatening to get a lawyer involved. But I wasn’t ready for what came next.
I am not sure what his exact words were, but through his own tears, he told me that it was okay. That I was human and we all make mistakes. He consoled me instead of allowing me to console him. I believe there was even a hug involved.
Buddy’s owner forgave me when I couldn’t even forgive myself.
We came up with a treatment plan, and for the next few weeks Buddy was on fluids, antibiotics and liver support. He got a little better, but was not improving like most dogs would, so we performed liver biopsies and cultures. The culture came back resistant to most of the commonly used antibiotics for hepatic infections, and the histopathology revealed cirrhosis as well. His liver was shot. Bile acids confirmed this diagnosis.
We kept him on supportive medications and, for a few months, he did well. Buddy and I actually became great friends – I even watched Buddy one weekend when his owner went out of town.
When I euthanized Buddy, his owner and I cried together. The guilt that I had suppressed for those last few months came flooding back, and because I’d grown to care so much for Buddy over those few months, the sadness was irrepressible. And still, I remember the owner thanking me for all I had done for them and for giving him a little more quality time with his Buddy.
Several months later, Buddy’s owner was in with a new young adult Lab mix … and he requested me. Once again, I was blown away by this man’s forgiveness and trust in me.
I have a framed collage of Buddy pictures that his owner gave me. I keep it in my office, partly as a reminder of the strength of the human-animal bond, but also as a reminder for me to double-check everything on patients.
It’s also a great reminder to forgive others often, as well as forgive myself. None of us are perfect, so I forgive my clients for their shortcomings as owners, as well as myself for my own flaws. Forgiveness is truly a gift, and it’s one that should be shared.
The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.
Dr. Jamie Miller is an owner/veterinarian of a small animal and equine clinic in rural/suburban area in western Illinois. She lives with her husband and two small children on a farmette surrounded by numerous species. She enjoys showing her reining horses in her “free” time.
The 8 Hard Conversations You Need To Be Having Now
Today I spent the afternoon at a family dinner for my brother’s birthday. Gatherings with my family are always unique. My sister-in-law and I are both veterinarians, so if a meal doesn’t involve a conversation about poop or vomit, someone is off their game. This particular meal qualified in both categories.
On the dinner table was a pile of papers. My parents were redoing their health care surrogate paperwork. In our family, this isn’t the slightest bit weird to do at a birthday dinner (it’s one of the few times you can count on us all being in one room). My mom told us the story about my grandfather instructing the family that upon his death, their second job was to cry and mourn him. Their first job was to get to the bank and empty all his accounts before his death notice hit the newspapers. We’re a practical bunch.
I noticed that my mom’s chosen surrogates were my dad and me. My dad’s paperwork was blank. As he was filling it out, he hollered down the table at me, “Your mom picked you. Do you want me to pick your brother to make it fair?”
I answered through a mouthful of apple pie and ice cream, “I’m more likely to pull the plug on you. You decide.”
He picked me.
I make my living having uncomfortable conversations. This is ironic because I avoid conflict whenever possible. I hate arguments, debates and disagreements. When I first became a hospice veterinarian, I was extremely uncomfortable talking about euthanasia. Now, it’s the subject I’m most comfortable talking about. Why? PRACTICE. Every veterinarian knows that the more you do something, the better your skills. Conversations about end-of-life care are the same way. Whether you’re discussing a DNR order for a sick pet or bringing up the subject of euthanasia, the more comfortable you are, the more comfort you can give the family.
This isn’t rocket science. You don’t need a book to tell you what to say. Talk to your team and ask them what comforts them most to hear at the end of their pet’s life. Ask yourself what words bring you peace during a difficult time. Say those words to your clients. Listen and look for your clients’ reactions. Adjust what you say based on that.
Remember that for the most part, the decisions they are making are being made out of love. Even if they can’t afford their pet, they likely still love them. I would rather see a client euthanize a treatable pet than shame them into going home pretending to follow my instructions and letting that pet suffer.
Here are a few of the difficult discussions that we need to get comfortable having:
1) Risks of anesthesia. Don’t let surgery become so routine that you forget to educate your client. There’s no need to scare the pants off them, but they need to be aware of the risks and sign that they understand them. Have you ever read the paperwork before you had surgery? It’s terrifying but necessary. Let’s lay out the reasonable risks and explain them to our clients. Don’t just hand them a piece of paper that they sign without reading.
Here are a few of the difficult discussions that we need to get comfortable having.
2) DNR . This is especially important for elderly and very sick pets who will be left with you. If you can’t get in touch with the owner, what should you do? Even boarding pets need to have a plan in case the worst happens. I had a patient become agonal while the owner was away. The pet sitter called me for help. Because she had taken the time to talk with the owner and had written permission to do whatever was necessary, I was able to euthanize him and end his suffering without worrying what the owner would think when she found out.
3) Hospice care and euthanasia. Get comfortable explaining the different options of referral, aggressive treatment, conservative treatment, palliative and hospice care, and euthanasia. If the client gets upset, explain that you must offer all the options to make sure you’re doing right by the family. It is their choice to eliminate options, not yours.
4) Overweight pets. Your job is to educate the owner. If the client is overweight, that is none of your business. You’re not fat shaming anyone by telling them their pet is overweight – you’re being a good doctor! Handle it sensitively, explain the risks and talk to them about diet and exercise for their pet.
You’re not fat shaming by saying a pet is overweight – you’re being a good doctor!
5) Dental disease. While some clients are going to let their pet’s teeth rot right out of their head no matter what you say, some will do so out of sheer ignorance if you don’t educate them. Some are terrified about anesthesia. If you say the pet needs dentistry and they make a face, ask them flat out: “What it is about dentistry that bothers you?” If the owner refuses dentistry, treat the pet medically for pain. Sometimes just realizing that you feel the pet’s pain warrants medication is enough to make them reconsider. A little gabapentin can go a long way towards providing quality of life to a painful patient.
6) Wishes for the pet if the owner is incapacitated. If the owner is physically or mentally ill and will eventually be unable to care for their pet, have them make a plan and put it in writing so their loved ones know what to do for Scruffy. So many pets are foisted on hospice workers, veterinary teams and unsuspecting relatives because there was no plan in place.
7) Owners who can’t medicate or handle their pets. This is especially problematic in feline medicine. If we can teach clients to give a pill early on, we’ll all be so much happier. Giving Pill Pocket samples to clients at their kitten visit is a good way to introduce easy ways to medicate. If a client can’t or won’t medicate a sick pet, we need to be up front that euthanasia will likely be necessary earlier because of it. I’ve met several clients who said they couldn’t medicate their cat. When I dug deeper, I discovered they’d never even tried!
8) Pain management isn’t negotiable. It is now beneath our standard of care to fail to provide pain control for our patients. Explain to clients that you and your team will not allow pets to suffer. If they don’t want pain medication for surgery, they’ll have to have surgery elsewhere. Make sure you spend some time in pain management seminars at conferences. Every time I go, they transform the way I practice. We can extend both quantity and quality of life if we educate ourselves about pain.
Sit down with your staff and develop scripts for all of these scenarios. Role play. Change your intake forms to reflect the choices your clients have for care while their pet stays at the clinic. Create checklists for anesthesia discussions that both clients and clinic staff initial.
If a client declines a particular diagnostic test before surgery, type in and highlight on the intake form that they declined the test and understand that it may increase the risk of anesthetic complications. Have them initial the highlighted area. Never be afraid to decline to do surgery or anything else that makes you uncomfortable. It’s your license after all. Sometimes we have to take risks in order to provide for the comfort of the patient, but if your gut says “Don’t Do It” then don’t!
Clear, compassionate communication is by far the best way to protect your patients, your clients and your license. I once thanked my Dad for his excellent handling of the “facts of life” discussions when I was a kid. He snorted and told me his heart was pounding and he had sweat rolling down his back the whole time. I never would have known. His outward calm made me less uncomfortable and made listening easier. Force yourself to practice talking about things that are awkward. Eventually, the awkwardness will go away. Until then, approach uncomfortable conversations with confidence and wear a lab coat – hopefully it will help hide the sweat!
Clear communication is the best way to protect your patients and your clients.
The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.