Looking for new ways to drive your veterinarian over the edge? Take a look at this short video so you can be “that client.”
[tweetthis]Want to *really* annoy your #veterinarian? @Vetstreet #vetpractice [/tweetthis]
Life With Clients
Coping With Vet Shaming
One of the hardest things about being a doctor is constantly being told you are wrong. Our clients tell us that Dr. Google, the breeder or their mother says so. Our colleagues debate online as to whether allowing clients to decline presurgical bloodwork makes you a bad doctor. If you do shelter or spay/neuter clinic work, you are constantly shamed for all the horrors you must be committing. I am envious of my veterinary brethren who can let this go. I am not one of those people. I try not to take things personally, but sometimes the negativity is overwhelming.
Here’s the thing: none of those people have to sleep on your pillow at night. None of them have a care in the world about the protection of your license. None of them is technically able to “cast the first stone”. There will always be someone practicing better medicine than you. Someone, some where will also be practicing far worse medicine than you.
I’ve had clients try to shame me for refusing them a prescription without an examination or for refusing to prescribe inappropriate treatment. I explained that I don’t do those things for my mother, so I’m certainly not going to do them for someone I barely know. Some vets would do both of those things with no problem. If you are one of them, you won’t find any shaming here. I don’t worry about what everyone else is doing.
Ultimately, peer pressure isn’t going to be an acceptable excuse if my license comes under scrutiny. I told the University of Florida Vet School class of 2015, “If the explanation for what you are about to do starts with ‘Against my better judgment, I………’ – DON’T DO IT”.
As veterinarians, we seem to spend an inordinate amount of time trying to please people and trying to keep people from taking things away from us. I was always taught to act from a position of power. Neither of these stances are powerful. Instead, spend your time trying to be happy and achieve your goals – it’s a whole lot healthier.
My mentor has never once complained to me about shelters offering vaccines, low-cost practices, online pharmacies or new clinics opening down the street. Do you know why? Because she only worries about her practice and how to make it better. She participates in clinical trials (you wouldn’t believe what a benefit these are to vets and clients alike), practices higher and higher standards of care and is always looking for ways to make her clinic stand out as excellent. She doesn’t waste her time trying to figure out how to make other veterinarians look bad. Tearing others down doesn’t make you look better. Standing confidently no matter what everyone else is doing DOES.
We should all strive to be better doctors, but remember that there is no one out there practicing perfect medicine. There are a whole lot of things that get in the way of practicing “ideal medicine”. Vet school is like a self defense class – you can learn how to do it perfectly in theory, but when it happens in real life, things get ugly. I think that being a really terrific doctor hinges not on how you execute the perfect workup of a case but on how you handle the cases where you must act without all the information. If I could always run every test I wanted, medicine would be easier. If all my patients and clients did what I told them, medicine would be easier. If medicine were easier, everyone would do it.
If you are watching everything your nearby clinics are doing – stop. If you are struggling constantly to satisfy difficult clients – stop. If you are staying up at night worrying how you are going to keep the specialty practice, corporate practice or clinic down the street from stealing your clients – STOP. Instead, try one or more of these:
1. Fire clients that make everyone’s life miserable. Ask your staff – are there clients that make you not want to come to work? Here’s a hint – if their name on the caller ID causes a clinic-wide groan and coin-flipping for who answers the phone, that’s your target. Decide who gives you the biggest headaches, and let them go. Focus on spoiling your good clients rotten. Your staff can’t concentrate on retaining clients with excellent customer service if they are required to be abused.
2. If you aren’t recommending lab work with every annual examination – start. Many clients are happy to do what’s best for their pet, but you have to let them know what’s best. This improves your medicine, increases revenue and protects pets by catching problems early.
3. Recommend that pets with chronic disease (kidney failure, thyroid problems, diabetes, etc) come in a minimum of every three months for a recheck and labs. Call to remind their owners – your software can probably link a reminder to the “Kidney Recheck” exam so you don’t have to remember. Even if they decline the kidney recheck, blood pressure and urine sample and only come in for the labs (they should be weighed as well) – that’s more information than you would have had on that patient otherwise.
4. Get involved with clinical trials. This is time consuming and best for a detail-oriented team. It’s a way to draw patients to your practice and to help people with financial issues get free services without giving them away yourself. In addition, you can be part of getting new medications approved and know what’s ahead for the veterinary profession!
5. Weigh all of your patients at every visit. If the elderly cat is losing weight at her nail trim, that should trigger your staff to ask if the owner is trying to get the cat to lose weight. If not, they should recommend a workup.
6. You look over records from other veterinarians all the time. As you’re reading – see if there’s anything they have been doing that would be a good idea for your practice. If you hire a relief vet – look over the record of every patient they saw – any habits there that you could adopt? Search for ways to make yourself more successful as a doctor and a business person, and the clinic down the street just won’t matter.
The rule for athletes applies to us as well: You have no competition. Don’t compare yourself to others or try to be better than anyone except the doctor you were yesterday.
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.
Why Your New Puppy Might Need A Joint Supplement
This week, Dr. Roark talks joint supplements in puppies of breeds at risk for hip dysplasia, arthritis, and joint problems. Is there any benefit to getting young dogs on joint supplements when they show no signs of problems?
[tweetthis]Why Your Puppy Might Need A Joint Supplement[/tweetthis]
If you’re interested in learning more about joint supplements, why some of them work and others don’t, and/or how to pick a brand, you can check out this hilarious Cone of Shame episode as well!
Why We Fail Pets When We Judge Pet Owners
Years ago, I worked for a small animal clinic in Fleming Island, Florida. The area was becoming more developed, but there was still a lot of rural area around, with a majority of old country folks living there. Our clinic saw mostly dogs and cats, with birds and exotics making up the balance.
One day, an older lady showed up without an appointment. To all appearances, this lady didn’t have two pennies to rub together. Mrs. Strange was thin, with much-worn clothes and the sallow complexion of a lifelong smoker. The dog with her wasn’t much better off. The older black pit bull, Coal, was emaciated but with a swollen, pendulous belly and a wicked cough. It was clear, however, that she loved this dog with all her heart.
Coal was Mrs. Strange’s companion and protector while her husband drove a long-haul tractor trailer for days or even weeks at a time. The dog had even kept Mr. Strange from entering his own home one late night when he returned home from a run a few days early. Not until he reassured the dog, ‘Coal, it’s Daddy,” was the gentleman of the house allowed in.
Coal was somewhere around ten years old, and had never been on heartworm preventative. As a matter of fact, he hadn’t been seen by a vet since he was a puppy.
Certain that most of the diagnostics I offered would be refused, I was mildly surprised when Mrs. Strange agreed to blood work and a heartworm test. Unfortunately, we didn’t get as far as the ELISA test; a direct smear revealed more microfilaria (heartworm larvae) than red blood cells. And, just in case there was any doubt, Coal coughed up an adult heartworm onto the exam room floor. Clearly, the prognosis was bad.
Dr. Mike Ricker explained everything to Mrs. Strange and she opted to take him home and think about what to do. In as poor a condition as this dog was, treatment might even prove fatal. We offered to refer them to the University for a modified treatment that might be less stressful thinking anything we could do to help this poor, sick dog should be discussed.
Mrs. Strange’s husband was due home; She wanted him to be a part of the decision. We sent her home with medication to make Coal more comfortable, and she paid her bill in full with cash. We honestly didn’t expect to hear from them again, except perhaps to be told that Coal had died on his own.
The next day they called and scheduled euthanasia. Mrs. Strange and her husband came at midday with Coal. Mr Strange looked much like one would expect a long-haul trucker to look; long grey hair, ball cap, worn and faded jeans and a t-shirt advertising a far-away truck stop. We spent a surprising lunch hour laughing and crying along with them while they said goodbye to their Coal. Once again, they paid their bill in cash and took Coal to bury him at the only home he’d known.
Once more, we never expected to see them again.
In areas with rural residents who are used to doing for themselves, it’s not uncommon to have pets brought in at death’s door. The owners often hope we can work some kind of miracle to snatch their pet from the brink. They feed their dogs table scraps and Old Roy, get their vaccines from the feed store, and do their doctoring at home. Only when something is beyond their abilities do they seek help. Educating these people out of their self-sufficient mindset seems practically impossible.
Two days after Coal’s passing, Mr. and Mrs. Strange called to make an appointment for a new puppy. They came that very afternoon with the most beautiful red-nosed pit bull puppy I’d ever seen. Her name was Ruby and we all fell in love with her. No one was more smitten than her proud new parents.
We were told they wanted to do everything right by this dog. Ruby wanted for nothing; she was fully vaccinated and promptly started on heartworm preventative. Ruby’s owners followed our instructions to the letter, always grateful and appreciative of our help.
Over the next year, they presented us with two more red-nosed additions to their family. Both of them were accorded the same complete and loving care as Ruby. Mr. and Mrs. Strange became some of our favorite clients, and I looked forward to their visits.
Most of all, these people taught me a valuable lesson. Appearances are deceiving, sometimes in a good way. If we had all assumed that they were (and treated them like) uncaring pet caretakers because of their first dog’s condition, I’m willing to bet they never would have come back.
Never assume you know someone’s story just because of how they look or act. Coal may have been a medical nightmare, but he was loved. The feelings his owners had for him ensured his successors were the most pampered, healthiest and happiest dogs I’ve ever known. I was, and still am, grateful for the lesson.
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.
Debi Matlack is that rarest of creatures, a native-born Floridian. She still lives there with her husband, another Native Floridian, and four cats. She hopes that someday her writing might prove popular enough to support her in the manner to which she would like to become accustomed, probably becoming a crazy cat lady (but a well-financed one).
You can find Debi’s recent novel Old Dogs for sale here.
Stop Counting Victories in Saved Lives
Several days ago, a client was waiting for a procedure to be finished on her “therapy cat,” which she can’t be separated from. Interpret that how you will, but it’s safe to say this client would fall into the “high maintenance” category. To be honest, I am not sure she is from this planet originally.
Rather than waiting in our waiting room or on one of the several outdoor benches provided on the hospital patio, this client decided the front deck of my home would be a great place to set up camp and chain-smoke cigarettes while she waited. Granted, I do live on the same property as the hospital, but my house is across the parking lot with signs clearly marked “private.” I have never had a client be so brazen before. I love living on-site most of the time, but the lack of privacy during business hours can be challenging at times.
This intrusion really bothered me. I am self-confessed Type-A, moderate OCD, and a non-smoker. To be honest, I have been known to freak out a bit if a trashcan is turned the “wrong way” on the treatment cart or if surgical scrub gets missed when the counters are wiped down.
A few months ago I would have had a total tantrum and told her to get off the private residence property and “no smoking on grounds!” On this day (after a few fleeting seconds of internal irritation) I let my eyes wander to the gorgeous scenery and the sun shining… and decided it just wasn’t worth it.
This woman was the type of client that, if kicked off my porch, would likely just go bother someone in the waiting room. Some battles aren’t worth fighting.
Literally five minutes after this client left, there was another pet owner in my front yard with his dog. He was sitting on a bench in a small aspen grove. This gentleman was closer to the hospital than to my house, but he did have to climb up a rock-covered retaining wall to get where he was, so he must have known this was not part of the hospital grounds.
I felt like saying, “What the heck is going on? Is it ‘violate my privacy and wander all over the property day?’” Then I found out he was putting his dog to sleep and wanted to do it outside in the grass by the aspen trees rather than inside. My heart melted.
It truly was a serene way to say goodbye to his companion and something special our vet hospital can offer. I took a moment to look around at the beautiful place that I get to live AND work in, and counted my blessings. Perhaps during good weather, this could become a service that we actually offer to our clients.
It felt really good to overlook the intrusion of my first client and then see the beauty of one small thing bringing such joy and peace to this man and his dog.
As veterinarians we often count “victories” in saved lives. We also hold ourselves to an unrealistic standard where we see all else as “failures.” We lose sight of the small things that make an enormous difference to pet owners on a daily basis, and our own happiness suffers for it. Sometimes just being caring and sensitive to make a client’s experience a little brighter during euthanasia is a victory to cherish.
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.
ABOUT THE AUTHOR
Ashleigh Olds, DVM, DABVP (Equine Practice) owns and practices at Aspen Creek Veterinary Hospital, a four-veterinarian mixed animal practice in Conifer, Colorado. Dr. Olds particularly has particular interests in equine lameness, surgery, and dentistry. She can also be found treating dogs, cats, pot-bellied pigs, various small ruminants and camelids on a regular basis. She shares her home and hospital with dogs, barn cats, horses (can there really be “too many” horses?), and her amazing daughter.
The First (but not the last) Time a Client Told Me I Sucked
As anyone who’s worked in the clinic more than a day or two knows, client communication often plays out like a game of telephone, conversations warping and bending over each retelling into a final version that bears little to no resemblance to what we actually told the owner in the first place. In this excerpt from my book All Dogs Go to Kevin, I share the outcome of one such conversation that involved not only two owners, but an RDVM all too happy to believe everything they shared with him.
I have long held the opinion that crummy medicine is most often a by‑product of crummy communication. While some veterinarians may simply be poor at the task of diagnosing disease, the vast majority of veterinarians I’ve known are excellent clinicians, regardless of their personality. More often than not we are failing not in our medicine but in relaying to our clients, in clear and concise terms, the benefit of what it is we are recommending. Or even what we are recommending, period. Muffy was a patient I hadn’t seen before, a one-year-old Shih Tzu who presented to the clinic for sneezing spasms. They had started suddenly, according to the client, Mrs. Townsend.
“So he doesn’t have a history of these episodes?” I asked.
“I don’t know,” she replied. “I’m just dog-sitting for my daughter.”
As we spoke, Muffy began sneezing again— achoo achoo aCHOO! Seven times in a row. She paused, shaking her fuzzy little white head, and pawed at her snout.
“Was she outside before this happened?” I asked.
“Yes,” Mrs. Townsend said. “She was out with me for a couple of hours this morning while I was weeding the garden.”
Immediately my mind jumped to foxtails, a particularly pervasive type of grass awn found in our region. During the summer months, they have a nasty habit of embedding themselves in all sorts of locations on a dog: ears, feet, eyelids, gums, and yes, up the nose. Working like a one-way spearhead, these barbed plant materials are known for puncturing skin and wreaking havoc inside the body. It’s best to get them out as quickly as possible.
Unfortunately, due to the nature of the little barbs on the seed, foxtails don’t fall out on their own—you have to remove them. Sometimes, if you’re lucky, you can pull one out of the ear canal while a pet is awake, but noses are a different story. Unsurprisingly, the average dog has no interest in holding still while you slide a well-lubricated pair of alligator forceps up his or her nose to go fishing for foxtails in their sensitive sinuses. And it’s dangerous— if they jerk at the wrong moment, you are holding a piece of sharp metal one layer of bone away from their brain. The standard nose treasure hunt in our clinic involved general anesthesia, an otoscope cone functioning as a speculum to hold the nares open, and a smidgen of prayer.
I explained all of this as best I could to Mrs. Townsend, who eyed me distrustfully from behind her cat-eye glasses, blinking as I told her about the anesthesia.
“Can’t you just try without the anesthesia?” she asked.
“Unfortunately, no,” I said. “It would be impossible to get this long piece of metal up her nose safely without it. Her nostrils are very small and it would be very uncomfortable for her, so she wouldn’t hold still.”
“I need to talk to my daughter before we do that,” she said.
“I understand. Before we anesthetize her, we do need your daughter’s consent.”
Muffy left with Mrs. Townsend and a copy of the estimate. I was hoping to have them back in that afternoon so we could help the dog as quickly as possible, but they didn’t return.
The next day, Mary-Kate scurried into the back and came trotting toward me, loud voices pouring into the treatment area as the door swung shut behind her.
“Muffy’s owner is here,” she said. “And she’s MAAAAAD.”
I sighed. “Put her in Room 2.”
Like a game of telephone, trying to communicate what’s going on with a dog who can’t talk to owners who weren’t there via a pet-sitter who misheard you is bound to cause one or two misunderstandings. When Mrs. Townsend relayed her interpretation of my diagnosis to her daughter, the daughter rushed home from work and took Muffy to her regular veterinarian, who promptly anesthetized the dog and removed the foxtail.
“My vet said you are terrible,” said Muffy’s owner without preamble. “Didn’t you know foxtails can go into the brain? You nearly killed her!” Her voice reached a crescendo.
“I think there might be a misunderstanding here. I wanted to remove it,” I told her.
“The pet-sitter—it was your mother, correct? She said she needed to talk to you before approving the estimate.”
“That’s not what she said,” replied the owner. “She said that you said there was no way a foxtail would fit up there and we should put her to sleep. Well there was one up there! You were wrong and you almost put her to sleep because of it!”
I took a slow inhale and reminded myself not to sigh. “What I told your mother,” I said, “was that I thought Muffy had a foxtail, but there was no way I was going to be able to remove it without anesthesia. So I gave her an estimate for all of that.”
“Are you calling my mother a liar?” she demanded. This was not going well.
“No,” I said, “I just think that she may have misheard me.”
“OK, so now you’re saying she’s stupid.” I silently prayed for a fire alarm to go off, or an earthquake to rumble though. The waves of indignant anger pulsing from this woman were pressing me farther and farther into the corner and there was no escape.
“No, absolutely not,” I said. “I think maybe I just didn’t explain myself well enough.” I pulled the record up on the computer and showed her. “See? She declined the anesthesia.”
She thought about it for a minute and decided she still wanted to be mad. “You suck and I want a refund for the visit.” We provided it gladly.
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.