Wellness

Dr. Andy Roark takes more questions from the mailbag!

Questions in this episode:

How involved should associate veterinarians be with boarding in the clinic?

Phone etiquette when trying to help non-clients on the phone who need assistance but they can’t be seen due to lack of appointment availability

What are the best things to do for your staff on one of those crazy days when everything is on fire to keep them motivated ?

What’s the best thing to do when you’re feeling overwhelmed?

What advice would you give those that have trouble making boundaries at work?

How do you bridge the gap between “front and back”?

How do you coach someone that gives very blunt delivery of feedback and rubs people the wrong way?

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LINKS

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All Links: linktr.ee/DrAndyRoark

EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I’m back experimenting. This is Part 2 of my recent experiment of live streaming the podcast into the Uncharted community and so, I got questions from the Uncharted Veterinary community. If you’re not familiar with those guys, you can check them out at unchartedvet.com. It is where I spend a lot of time hanging out talking about leadership and communication and management and stuff like that that I love. But anyway, I’m here with these guys and just going to go through questions that I got from them and that will be it, so let’s see.
Yeah, I’d love to hear your feedback on this podcast. If you like it, you can send me an email at podcast@drandyroark.com. You can also leave me a review wherever you get your podcast. But I really haven’t decided if I’m going to do more episodes like this. I’m really kind of waiting to see if people tell me that they like them and I can tell you, I really enjoyed the first one, so this has been really fun.
If you’re listening and you’re like, “Man, these questions where Andy is just talking through problems that people ask him about, I really, really love them,” I have another podcast, it’s called Uncharted Veterinary Podcast and I do it with my friend, practice management goddess, Stephanie Goss. And that’s all we do there, is breakdown questions about practice that people ask us. So, if you really love this, no matter what, you can have more of me talking about problems at the Uncharted Veterinary Podcast, which is the other podcast that I do. All right, let me go ahead and let’s get into this episode.

Kelsey Beth Carpenter:
(singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to The Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark:
All right, everybody. So, the first question is an anonymous question. This is from a veterinarian. She is a veterinarian that has a boarding facility built onto her practice and she says that, a little backstory, she had a dog that had a medical problem. It was some sort of like a chemical burn or something when it left the boarding facility. She ended up looking at it and then the client ended up bashing the boarding facility and specifically, this vet who’s like, “I didn’t do any… I didn’t have any idea what was happening,” is basically it.
And so her question is, if a dog is being boarded with a vet clinic, how involved are veterinarians in the daily care and monitoring of the pet? If I’m unhappy of the vet with the care that a dog received and don’t think the issue was handled appropriately when I brought it up to the practice manager, how should that be handled? Meaning, if I don’t like how this went and I said so to the management and they ignored me, what do I do about it?
All right, cool. Let’s do the first one first and let’s talk about the boarding, that’s in boarding, okay? How involved should vets be in the boarding that the clinic does? First of all for me, I guess, there’s not a right answer. There’s only clear expectations and so, there are clinics that the vets are very involved. That’s not wrong. And there are clinics where the vets are not involved at all. They’re barely aware that the boarding is happening in the building. That’s not wrong either.
As long as everybody is clear and honest about what is happening and how involved the vet is or how involved the vet is not, the pet owners should not think that their pets are being examined twice a day by the veterinarian if that’s not happening at all. That’s only setting the vets up to get hammered. They aren’t doing anything. And at the same time, if the pet owners think they’re just dropping off for boarding and their pet ends up doing a bunch of medical stuff and then they’re surprised when they come back and find that out, that’s also really bad.
And so, it’s really about what are the expectations here about how involved the vets are with what’s happening ? Ad is the clinic communicating that to the clients and do they communicate that to the vets? Because I will tell you that boarding can burn vets up. I have seen vets that are absolutely ready to mutiny over boarding because they’re like, “This never ends.” And I’ve worked at some of those practices. It’s never real bad, but I can definitely see how it gets bad.
But it’s just there’s times that you’re a vet and just the number of little problems, torn toenails, diarrhea, coughing dogs, kennel cough, people coming back with kennel cough, things like that, it can suck up your time and suck up your time and suck up your time. And if you are the doctor and that’s not accounted for in your schedule if you’re not getting compensated for that, if these are no charge appointments because the pet started coughing on boarding and things like that, if that hasn’t been discussed with the veterinarians, they can get really resentful and it’s not hard to see why.
At the same time, if boarding is part of what your clinic does and you want to be a good team member, you got to support the team. And so, there is a part where you say, “Hey, we should all be supportive of what the practice is doing to pay our paychecks and to serve the community.” And so, it really, it’s a give and take and that’s why I said there’s not a right answer. There’s clear communication. There’s clear expectations. If you are working in a practice and this goes to the second part where she says, “What do I do when this wasn’t heard?” Talk about it.
If you’re a vet and you’re like, “This is eating me up and this is taking so much time and it’s really frustrating, “you need to have that conversation. And not in like an, “I’m angry way,” but in a, “Hey, we’re in a relationship together and part of the relationship is knowing where the other person is. And so, I want to let you know that this is kind of where I am. And I’m not resentful, but I can see resentful from here. It’s just kind of over the hill.” I think you should say that.
And my question is always what is kind? Do the kind thing? It’s not kind to keep your mouth shut until you’re really, really angry and then blow up on the practice that you work at. And if you’re the practice, it’s not kind to keep your mouth shut and go, “Well, maybe she won’t notice how much work she’s doing.” And just hope that it all works out and the other person doesn’t notice that they’re dealing with a lot of cases from the back. So, anyway, there can be some real drama with boarding.
That’s just my thing is clear expectations, clear communication to the client and between the practice and the doctors. If the doctors are expected to contribute to the boarding, you just need to talk that through and everybody needs to be okay. No surprises. And as long as it works for everybody, I think that’s the best thing. I think that’s the best that we can do.
All right. I got a question Kyle Ann. She says, “Do you have tips on phone etiquette when trying to help non-clients on the phone who need assistance, but they can’t be seen due to a lack of appointment availability?”
Okay. I think a lot of us are dealing with this, so we have people on the phone and we can’t get them in and that is a problem. Now, I would say this writer makes this pretty easy for me because she says non-clients. And so, this is not a person that has been coming here, this is not a long-term client. What do you do in helping this person who needs assistance, but we can’t get them in? I just said clear is kind and I go back to it. Clear is kind.
I said, what is kind? Clear is kind. That’s what is kind. Clear is kind. We need to tell people that we don’t have availability and don’t beat around the bush, don’t act like, “I don’t know. Maybe we can do this or maybe we can do that.” And I understand. We don’t like to tell people things that they don’t want to hear. And so, it is hard to say to someone, “I’m sorry. We can’t get you in.” Clear is kind.
Set expectations and the expectation is “I can’t get you in.” The longer you wait to say that, the more you’re going to frustrate this person. And so, the first thing is be honest, be clear, and then be polite and be firm. And I think a lot of us really struggle with this and we end up, we cave. We fold like origami. We’re like, “I don’t have any availability but I don’t want to tell this person they can’t be seated, so I’m just going to through strength of will make this happen.” And I go, “That’s ridiculous.”
I’m talking a lot these days about capacity and teams and if your team is working as hard as they can work every day and they’re burning out, you can’t just want to do more work and make it happen. You’re pushing your team into the red and there’s going to be consequences. And there are going to be possibly your staff leaving and then you’re more shorthanded. And so, by pushing this far, you’ve limited your ability to do work for the foreseeable future because it’s the hard hire. And so, you have pushed this to a point that you have damaged your long-term potential to do good in the world by trying to squeeze in this short-term thing.
The other thing is even if they don’t leave, you burn these people out. You end up with just people who are tired. They’re grumpy, they’re angry, your practice culture suffers. You are running a sprint every day and that’s ridiculous because this is a marathon and so, pace yourself for a marathon. And you just have to be honest about what your team can do. And then here’s the thing, you got to let it go. You’ve got to process your lack of responsibility here.
One of the big things for me is, look, if there’s something and I didn’t want it, I don’t have control over it. I can’t make it stop and I don’t benefit from it, I’ve got to step back and say, “I’m not responsible for this.” And that’s the case with our overwhelm a lot of these practices. “I don’t want this, I didn’t make it happen. I can’t fix it and I don’t benefit from it because my people are burning out. It doesn’t help me to turn people away. That’s not helpful.” And so, at some point I have to say, “Well, if all those things are true then I’m not going to hold myself responsible and beat myself up about it.”
I hear from practices that are like, “Our front desk just apologizes all day long.” I’m like, “You have to stop. That’s not healthy.” It’s not healthy for practices to be on the phone apologizing all day long. It is what it is. I didn’t want this to be the case. The honest truth is we’re not taking new clients. Just say it and be kind and be firm. And then facilitate this person getting seen somewhere else. And that doesn’t mean you have to call and try to get them an appointment, give them a recommendation. If you can’t see them then tell them if you were them, where would you go?
And this idea that we don’t refer to other general practices, that’s ridiculous. That doesn’t make any sense. That is pennywise and dollar foolish. We are trying to do good in the world. We’ve got more business than we can do. Take care of the people who come to your practice and help other people get seen elsewhere. And feel good about yourself and go on with your life and stop burning yourself out and burning other people out.
Hang up the phone. Practice saying no by saying yes. And so, this is the one piece of phone etiquette is be clear. “We cannot do this. We are not doing this. I have some recommended practices you can call who do good work,” and say it. Don’t tell people what you can’t do for them any more than you have to. Tell them what you can do. When they say, “I need to get in,” we’ll say, “I can get you in. It’s going to be in January,” to get in to start a new client relationship here. And that’s not saying, “No, I can’t see you.” It’s saying, “I can see you in January.”
And if they want to do that, they can, that’s fine. If they say, “I can’t do that,” and you say, “Great. Well, I can refer you to another vet practice?” And I’m trying to tell you what I can do for you, but ultimately I’m not going to waiver. These are the boundaries. And so, I know that we struggle a lot with the desire to get people in and help people and I know that it feels awful to send people away. These are things that we have to do right now, guys.
It really is a question of do you want to do a good job today or do you want to do a good job in your career? Because if you “do a good job” by squeezing everybody in today, you’re not going to do a good job in your career because you’re going to be short-staffed, and you’re going to be burned out and you’re going to be angry and you may end up depressed. And so anyway, that’s my thing. Clear is kind. Be honest. Facilitate them as best you can in getting seen and that doesn’t have to be at your practice. And tell them what you can do as opposed to just focusing on what you can’t do.
Jodi asked, “What are the best things to do for your staff on one of those crazy days when everything is on fire to keep them motivated?” I’m getting a lot of questions like this. “How do we keep morale up? How do I keep people motivated? How do I make people feel appreciated?” I love this question. Here’s the answer. I have no idea. I have no idea. Here’s why because I don’t know your staff and every staff is different and that’s not good or bad, it’s just the truth of the matter.
And so, you say, “What are the best things to do for your staff on those crazy days?” My advice to you is ask the staff. Ask them what they want. Ask them what makes them feel good on those crazy days. Now, you have to ask it in a certain way because what I’ve found is if I go to the staff and I say, “Guys, when we are crazy like this, what would make you feel better?” They have no idea.
And of course, they don’t because if I came to you and you had a really bad day and I was like, “What would make you feel better?” You’re like, “I don’t know.” The truth is ask them and ask them when things are not on fire. So, at the end of the day when they’re exhausted, asking them what they wish is just another mental burden to put on them. And most people have a hard time asking those questions.
The questions that I really like are, “Tell me about a time that you were stressed out and someone did something that made you feel better. What was it?” And so ask them questions like that. “Tell me about a time that you felt really appreciated.” I love those questions. “What’s your favorite snack? What’s your favorite candy? What’s your favorite music? What’s your language of appreciation?
And there’s a book, it’s called, The Five Languages of Appreciation in the Workplace. It’s written by the guy, who wrote The 5 Love Languages. They’re the same book. Just so you know, they’re the same book and one of them is just work appropriate, but it’s good stuff. If you want a quick read, there’s five languages that make people feel appreciated. I’m going to try to rattle them off, but it’s words of affirmation, it’s service, it’s quality time, it’s gifts, and it’s physical touch. Bam, nailed it. That’s the five. But anyway, and you can dig into. It’s a good book for anyone in management and motivation to read and you can skim through it and get the gist of it pretty darn fast. But those are the things you say. And what resonates with my people?
I really like the idea of having a sheet that, and you have to update this every now and then. You can’t be like they filled out a sheet when they came to work here and I’m like, “When did they come to work?” And you’re like, “Seven years ago.” I’m like, “How do you know they still Butterfinger?” It’s like, “Who stops liking Butterfinger?” People’s preferences change and so, just update it. But some questions like that, not when things are on fire. Those things are good, but it helps you figure out what motivates people, so that we can do those things.
One of the things you can always do in the moment, always in the moment, is when people are really working hard, go the extra mile to make them feel seen. It doesn’t cost anything. You don’t have to buy anything. It’s just taking a moment to say to somebody, not I appreciate you or thank you because those are just really generic.
It sounds something like, “Hey I want to tell you, I saw earlier today when we took that patient out of its little den and you dove in there and just cleaned it out and wiped it down and you were just on it. And I just want to tell you, I recognize how hard you work around here. And I recognize that you could have been like, ‘That’s not my job,’ and backed away, but you didn’t. And I just, it’s hard for me to express how much I appreciate you and what you do here.” And if that sounds heartfelt, it’s because it is because I’m imagining one of my techs.
And you go, yeah. It’s not buying anything, it’s not having anything, it’s not planning anything, but sometimes people just want to feel seen. And that is something that we can always do, but you got to be present. You got to be on the floor. You got to be paying attention and you have to set out to do it and you can’t do it for the whole team at once. It has to be a thing where you catch people, who are really going to town. But anyway, that is something that even if you’re unprepared, you can make people feel seen, but you have to give it a little bit of thought and you have to get their attention if to talk right to them, look them in the eye, and make them feel seen.
Jen asks, “What’s the best thing to do when you’re feeling overwhelmed?” She has a follow-up question, which is, “What advice would you give to those who are having trouble setting boundaries at work?” I’m going to take the first one first. “What’s the best thing to do when you’re feeling overwhelmed?” I think a lot of us are feeling overwhelmed. I’ll run you through my list.
Number one is make a list. I think of like Dumbledore is pensive. A lot of times, we’ve got this nebulous list in our brain. And I tell you that’s the worst part for me of feeling overwhelmed is the emotional feeling of, “I just have so much to do,” and you’re like, “Andy, what exactly do you have to do?” And I’m like, “I don’t know. Just everything. I just feel like I have to do everything.” I think a lot of us get that place. You got to get out of there and the quickest way to get out of there is you have to crystallize what you’re up against.
You have to turn this nebulous cloud of stress and anxiety into something tangible that you can look at and measure up and make some plans about how you’re going to address it. So, the first thing is just get it down. You can use a to-do list app. You just write it on paper, but you’ve really got to take the floating anxiety in your mind, which is driving that feeling of overwhelmed. You’ve got to translate that into something tangible that you can actually see.
And then you look at this list and you ask yourself what here is actually on fire and what’s just smoking from the things around it? And I think a lot of us struggle with that. We say, “Everything is on fire.” It’s like, “No,. Everything is not on fire.” You got a couple of things that are on fire and you maybe have one significant fire. Everything else is just reefed in smoke from those burning fires, but it is not actually on fire, which means those problems can sit until tomorrow and you should feel okay with them.
I’m a big fan of everyone, people make to-do lists and they’re like, “This is what I have to do today. And if I don’t do this today then I’ve failed.” And I go, “That’s ridiculous.” It can’t be about what you did today. It’s got to be about, “This my to-do list and this is what I’m going to do today. And this is what I’m going to do tomorrow. And this is what I’m going to do next week.” And you’re already lifting that overwhelm off your chest just by saying, “I see this and I’m saying it’s important and I commit to doing it next week.” And you can do that.
And I think we have this horrible tendency as a human being species to wildly over imagine what we can do in a day. And we under imagine what we can do in a year or in five years or in 10 years. And so, the biggest problem is we look… I mean, how many of us have had these to-do lists and we have 10 things on them and we’re like, “Yeah, I’m going to do this today.” No, you’re not. You’re going to do three things on that list or maybe five things on that list and then you’re going to feel defeated because you didn’t do 10 things.
And I would say, “That’s ridiculous. You did five things on your to-do list today.” That’s bonkers. If you do three things on your to-do list and keep a clinic going and keep a family going and feed yourself and wear pants, then you have succeeded in the day and you should be happy about that. That’s what you should do with your to-do list. So, what here is actually on fire? And then what’s just smoky from the things around it? What’s mission critical? What’s causing the most pain? Meaning, what is bothering me the most?
Some of this is mental health stuff, where it’s like, “I understand organizationally what the top priorities are, but this squeaking chair makes me angry every time I sit down in it.” And I would say, “That’s causing you pain.” Yes, there’s other things that are important, but that squeaking chair is bothering you every time you sit on it. And it’s affecting your head space and your enjoyment of being here, and so, for me that is a thing that’s actually bothering me more than anything else. So, fix the chair. Just grease the chair. If it’s causing you pain, then fix it.
And the last thing is what will free up my capacity? And so, I’m looking at my to-do list, what is mission critical? What is bothering me the most? And the last thing is what will free up my capacity? Meaning, I want to prioritize the things that are going to give me more time to deal with the other things.
And so, you might have something on your task list and say, “This is not super important but it takes a ton of time and people keep asking me about it and asking me about it and asking me about it.” And I go, “Well, if you got that off your list then people will stop asking you about it and you would have time to do the other thing.” So, even though it by itself is that important, getting it done will free up your capacity. And so, anyway, those are the ways that I look at being overwhelmed. I hope that that’s something helpful.
The second follow-up question is, “What advice would you give those people have trouble making boundaries at work?” And I kind of touched on this when I talked a little bit earlier about the phone calls and people wanting to get in and us not having space. The big keys for me in setting boundaries at work is you need to make boundary decisions intentionally and when you’re not in the moment. The biggest way that we fail in personal boundaries is we are like, “When it happens, I will say no.”
No, you won’t and that’s okay. It’s because you’re a good person and you want to help people and if you have not clearly committed to what you’re going to do, then it’s a toss up in the air. And if it comes down to looking at this person who’s got tears in their eyes and saying, “No, I’m not going to help you,” and that’s boundary setting, then you’re going to fail every time and you probably should because it means, again, that you’re a good caring person. The only way to make this stuff happen, guys, is to think about the boundary failings that we have.
Where do we fail to set boundaries? How do people set us up, so that we say yes and then we regret it or we’re resentful later on? If you were having those experiences where you say, “I feel I say yes and then I’m angry about it later,” I would say to you, my friend, that’s resentment. You are feeling resentment. And the fact that you did this and you felt resentful of it, to me that means you need to fix the problem for next time. And that is about making decisions when you’re not in the moment. Moral decisions made on the floor are a real problem and they’re one of the big problems in why we don’t have good boundaries in vet medicine.
Because we’ll say things like, “Oh, when the client comes in at the end of the day and if they get in the door before we close it, then it’s up to the doctor whether or not we see them.” And I say, “So, you’re going to see them is what you’re saying?” Because the doctor is almost certainly not going to be able to look at this person who says, “Please don’t make me leave. I drove all the way over here and my dog is sick. And please don’t turn me away into the cold.” They’re going to say yes, because they’re good people.
And make the decision ahead of time. “We close at 6:00. We don’t take walk-ins after 5:30.” And it’s not a question of asking the doctor because the doctor is not empowered to make that decision. Has a policy decision that was made and we will apologize and let them know where the emergency clinic is. That’s it. Maybe one of our techs can look and say, “Yes, this could wait until tomorrow,” or “No, it needs to go to the emergency clinic.” But that’s as much as they get, but that’s a policy decision.
I mean, I know it all comes from a good place. It comes from us saying, “Well, I want the vets to be able to look at this.” And try to take care of our clients. Nobody is bad here, but at some point you got to look and say, “In this world where people are burned out and they’re overwhelmed and they’re working and they’re working and they’re working, if that’s the reality in your practice, you, my friend, you need to set policies that protect your people.”
Now, in 10 years when there is a global pet shortage and you got nothing but free times, you can change that policy and say, “No, when they come in, we’re seeing them. You know why because we only see five appointments a day?” Then that’s a whole different thing.
I’m not saying you have to do that, but you can. Things change. And the fact that you make a policy right now doesn’t mean you’re not going to relax that policy when you hire the three doctors you’ve been trying to hire for the last two years, then you can make that adjustment. But right now, you got to make the decision, make it ahead of time, make it with clear eyes, make it non-emotionally and just make it. In order to do that, because a lot of people go, “But this is painful, Andy. I feel bad turning people away or setting these boundaries or telling people no.” There’s really two mental shifts that have to happen if you want to feel okay with this, in my experience.
The first is you have got to stop thinking in the short term and think in the long term. I alluded to it earlier, but if you look at everything that walks in your door and say, “I’m thinking about this today and the good that I can do in the world today,” then you are going to suck it up and you’re going to see every patient that comes in and you are going to take every phone call that rings through. That’s not healthy because the goal is not to be successful today. The goal is to be successful for 30 years or for the rest of your career and so, you need to look at it long term.
And so, if you say, “I need to do maximum good in the next couple of decades,” then pacing yourself makes sense. And you say, “Well, I’m not going to stay tonight and take extra cases because I need to rest, so that I can continue to keep this up for the next year as it’s hard to hire people. And as we continue to be so darn busy, I’ve got to pace myself.” And so, I’m not thinking about today. I’m thinking about this year or the next five years or the next 10 years or whatever. But if you’re only thinking about today then you, my friend, you are in a sprint mindset of go, go, go, go. Fall into bed, jump up tomorrow, and go, go, go, again. And that’s not sustainable guys. It’s a marathon. It’s not a sprint.
And the other mental shift I think that people need to get comfortable with is switching from fixating on the person in need to thinking about everyone affected. And so, when the pet owner comes in and they say, “Please, don’t turn us away. I know you’re locking the door and the staff is trying to leave, but we need to get seen for this itching,” if you think about the individual affected, which is the pet and the pet owner and you say, “Ah, it’s help them or it’s don’t help them,” that’s a really hard mental place to get out of. And morally, you think, “Oh, I need to help them.” But those are not the only people affected, are they?
Your staff is affected. Your staff wants to go home. They want to go see their families. They want go home and recharge. They have hobbies that they are looking forward to doing. They want to rest. They want to do whatever they want to do. It’s their life, but they want to live their life. So, if you say yes, it’s not just about you and this pet owner, it’s about you and the staff and doctor and payroll if you put people into overtime. And more importantly, it’s about your family at home and the time that you’re not getting to spend with your kids and your spouse or doing your hobbies or relaxing. What does your boyfriend think about you staying late every night? If he has concerns, then he’s being negatively affected by you saying yes.
I’m not saying you say no. I’m not saying you say yes. It changes. But what I’m saying is when you make these decisions, you need to not think just about the person in front of you who’s asking for help. You need to try to balance what is being asked across all stakeholders, which is them, which is the staff, which is the doctors, which is the practice, which is your friends and family who are waiting for you to get home or your pets who need to pee because they haven’t been let out since lunchtime.
All those things matter and it’s a whole lot easier to set boundaries if you look at everyone’s needs and how everyone is affected and go, “Just I can’t do this. This is not in balance. There’s too many ripple effects from this.” And again, this math might change in the future. If you never come home late and somebody shows up and says, “Please squeeze me in,” then maybe you do that and it’s because it’s a rarity, but if it happens every day then it’s okay to say no now. It’s just interesting. There’s no all or none, but it’s about being healthy and being intentional about where you are.
And the last thing that I’ll say about setting professional boundaries, and this is kind of hard to hear, and I just want you to sit with it a little bit. And I hope that neither of these things is true for you, but if you have to make a boundaries decision and the decision comes down to feeling guilty or feeling resentful, choose guilt. Choose it every time.
And what I mean when I say that is if your choices are to set a boundary and say, “No, I can’t do this and I’m going to go home and I’m going to feel guilty about it,” or to say, “I’m going to make this happen. I’m going to stay and do this. I’m going to sacrifice this boundary. I’m going to make this exception and then I’m going to be mad about it. And I’m going to go home and I’m going to be angry at myself and at my staff and at my job.” That anger eats you up. It will.
Go home and feel guilty because that beats the heck out of going home and feeling resentful and angry because that’s a path to a dark place and you don’t want to be there. I hope that you can rationalize in your head. That’s why I talk about thinking in the long term, thinking about everybody infected because I want to help you deal with that guilt. But if it comes down to it, you got to choose guilt or resentment. Choose guilt.
Okay. Jody asked, “How do you bridge the gap between the front and the back?” It’s probably one of the most common management questions I get. There’s a lot of communication issues between the front and the back. And people always ask, “How do you,” when she says, “bridge the gap?” Generally, it’s making these people know and respect each other. It’s making them assume good intent about each other. Meaning, the front assumed that the back is trying their best and the back assumes the front is trying their best. How do we make those things happen? How do we make these people, who are physically separated? Generally, they’re in different parts of the building. They’re having different problems. “How do we get them to bridge the gap,” as Jodi says?
And the first thing is I think is really important is a shared mission. We need to talk about what we’re doing here. What are the core values of our practice, of our clinic? Why do we come into work? It’s not to make money. That’s not why anybody’s here. I mean, maybe some of us, but those people made bad choices, but it’s here. We have a mission that we are pursuing and we are a team. And the front and the back are 100% both pursuing that mission and they are both required mission critical for pursuing our mission.
And so, make sure you’re talking about the mission. Make sure you’re pointing to the North Star that your whole team is rowing towards. And if I believe that they’re working in a different place and they’re doing things differently, but they are committed to our mission and I am committed to our mission, suddenly that commonality that brings us together and it makes it easier for me to assume good intent. And if I have conflict, it’s easier for me to talk it through when I believe that we’re both ultimately working for the same outcome and we both are trying to get the same place. So, the shared mission is important.
Focus on interdependence. I want to continue to emphasize again and again to the team that they need each other. The front needs the back and the back needs the front. I think a lot of times, people just like the… I think it happens more in the back. Maybe it’s just because I’m back there and I’m not up at the front. But in the back, I think there’s this idea that the front is just in the way of getting things done, and that’s nonsense. That’s foolishness.
The truth is they are handling the clients and the communication and the phones and the checking in and checking out and they are completely a 100% in this trench with us. And they are helping us do the things that we need to do, and we need them. We need them and they need us. And I think that that’s language that we should use and remind people of is, “Hey, guys, we need the front desk and we need them to be happy. And we need them to help us take care of these clients because without them, all this communication falls back on us and we cannot keep up. We need them. They have a great impact on how our day goes and we need to support them and we need to try to make their jobs better. And they’re going to work hard to support us and try to make our jobs better.” But it comes down to that focus on interdependence.
And the last thing is knowledge about what the other group is doing. Oftentimes, the people in the back do not know what’s happening at the front desk and they do not know what they’re up against and they don’t know the headaches and they don’t understand what it’s like to sit up there and have a waiting room full of people staring at you and they’ve waited 35 minutes and they’re getting frustrated. But that’s just is an experience.
And so I think talking about those things and pointing out to people and say, “Hey guys, it’s hard up front.” And the same thing at the front, they don’t know what we’re doing in the back. They don’t understand why suddenly there’s a huge log jam and it’s like, “Well, they don’t know that the procedures that they brought in these specific ones take a lot of time. And our regular procedures, they don’t know maybe what goes fast or slow or maybe they just don’t know that one of the doctors got caught on a phone call and couldn’t get off and couldn’t get off and now, we’re behind.” If you don’t have a way to communicate that, then they don’t know it and so, make sure that we’re trying to talk about that.
And a lot of people will say, “Cross-training, cross-training, cross-training.” To me, cross training is knowing what the other group is doing and I think that’s good if you can do it. If you can get some of the technical people back up to help with the front desk and answer phones, that’s great. And if you can get some of your front desk people CSRs trained as assistant, so they can come back and help hold pets and participate in the back just for that experience, that’s great. I think that those things are really good.
The bigger thing is good communication. It’s about these people knowing each other as people. And it’s just about them being able to talk about issues before they become big screaming issues. When there’s mild frustration being able to come together and say, “Hey, let’s talk about what’s happening and why it’s happening and what we’re going to do about it.” And that’s just good ongoing communication in the practice. That stops us from getting to the place where we build walls and where we split into groups. And us versus them is a very powerful, very simple way to divide people.
And in practice, if we start having that type of language where there’s us in the back and them in the front or vice versa that leads to division really fast. It leads to a lack of assumed good intent and that leads to anger. So, anyway, those are my big things on bridging the gap between the front and the back.
And then the last one, Jackie asks, “How do you coach someone that gives very blunt delivery of feedback and rubs people the wrong way?” All right. I like this question. This, I get this a lot. How do you coach someone who gives very blunt feedback? I don’t find this to be particularly hard feedback to give. I really don’t. I like it. And so, the big thing is, let me go ahead and frame this up.
So, the first thing that I want to do there, there’s really two kinds of corrective feedback that you can give. The first is critical and the second is developmental. And so, if you give critical feedback then what happens is that’s me saying, “Hey, you messed this thing up yesterday and I want to talk about how you messed it up. Okay?” And so, that’s critical feedback.
Developmental feedback is me saying, “Hey, I want to talk about where you’re going and what I want to see from you in the next six months. Hey, I want to talk about your developmental pathway and what I see as the next big steps for you to take, to move onward and upwards, to be even more fantastic at your job than you are. I want to talk to you about the things that I’m really looking for you in the next year as far as your own personal leadership development.” And that’s developmental feedback and it feels very different.
It’s not me saying, “Let’s talk about how you screwed these things up.” It’s me saying, “Let’s talk about the future and what we’re going to do in the next year.” And so, this type of blunt feedback, I’m not going to hold it as a trial and be like, “Come back in here. Now, you’re going to sit here. I’m going to bring in the first witness to talk about your bluntness when you said, ‘That’s not what I asked for.'” I’m not going to put him on the spot. We’re not having a trial. We’re not doing any of that.
And so, “Hey, I need to talk to you. I want talk about what I want to see from you in the next year as far as your leadership development and where I see potential for you to really blossom.” And then I talk not about them giving blunt feedback because blunt feedback is very subjective. It’s very subjective. What I consider blunt feedback living in the Southern United States my whole life is very different than what my friend, who lives in New York City considers to be blunt feedback. What he considers to be normal communication. I would like, “Oh, my God. You said that?”
It’s a cultural thing. And yeah, I say that with love, but there are places where very direct communication is just the norm and there’s other places where that’s just not how we talk. And so, this person may fit like a glove in another place. I don’t want to lose this person, but what they’re saying is not wrong. It’s just it’s being received in a way that they do not intend. And I talk a lot about how the person is being perceived. Not what they’re doing and that’s big important point in coaching people.
If I say, “Hey, you are doing this wrong,” that’s very different from saying, “Hey, I understand where you’re coming from and I appreciate you enforcing our policies and giving clear feedback. I do and I do not want that to stop. I want to work on how that feedback is being perceived because some people are hearing it as very blunt or they are taking it in a way that is probably stronger than you intend. And so, I want to work with you in how we can deliver the feedback in a way that’s not going to be perceived as over the top or aggressive. I want you to work on softening your delivery, so that it is as effective as you want it to be.”
And that’s how I put it. And really, I hope you can kind of hear that I’m really trying to take this away from being any sort of criticism of the person because it’s a skill criticism. And just say, “Hey, I want you to work on softening your delivery, so that your feedback is as effective as you want it to be. And we can talk about how to do that.” And if they want specific examples, I hopefully can give them and say, “Here’s some of the things that I heard.”
And it’s just, again, a lot of times, communication doesn’t happen at the mouth, it happens at the ear. And we don’t have a ton of control over what happens at someone else’s ear other than to receive feedback and make adjustments based on how they’re interpreting what we’re saying. That’s just life. It’s not a critique of you as an individual or your skill or your smarts or anything else. “I told you what it is. I gave you the feedback. This is where it is. Let’s just make some adjustments and go on. You’re doing great. I appreciate you.”
And that, I try to keep it low stakes and just give that feedback. If you want to unpack it some more, we teach a DISC in Uncharted. So, DISC is a very simple style of communication profile and so, basically people kind of fall into four categories. D is a dominant direct personality type and that’s often the ones that I get the feedback about, “This person is very blunt.” This person is probably just a D style communicator, which is I think it’s great. I’m very comfortable with these, but they are straight to the point. They don’t want details. They’re just, “Tell me what I need to know and I’m going to tell you what you need to know and let’s go on.”
And you guys probably work with those people. A lot of doctors are that way and they can be seen as uncaring. That’s not true. That’s not remotely true. It’s just that they are no nonsense, “Let’s go. Let’s get going.” And that’s their communication style. And what I love about DISC is it breaks people up.
And you can say, “Oh, I know those people. I know exactly who that is.” And I will say, “Great. Do you know how that person likes to communicate?” And you say, “Yes, they’re very direct.” And I say, “Great. Here’s a little trick. They also like to be communicated that way.” Which mean, and that makes the feedback even a little bit tricky if you don’t do it right, because the person is like, “I’m not blunt. This is how I would want people to talk to me.”
And that’s true. That is how they want them to talk. It’s like, “This is how I communicate. I told you what you need to know. Tell me what I need to know and let’s go our separate ways.” And that’s it. And so, anyways, like Ron Swanson from Parks and Rec, goes like, “Tell me what you want and I’ll tell you what I want.” And that’s it. Anyway, I don’t find it to be super problematic because it’s 100% just, “Hey. This is how it’s being received. We need to adjust so that these specific people are hearing what you’re saying and your feedback is effective. Can you work with me on that? Help me soften it.”
And they’re going to have to struggle because a lot of times they’re like, “I just want to say it and go on.” And I go, “I get that.” The worst case is I kind of have to get them to understand how blunt feedback does not save them time. They’re like, “I just tell them. It saves time.” I was like, “You just tell them, and then they come into my office and now, I’m talking to them and it takes me 30 minutes to talk them down. And now, you and I are having this conversation. And if it keeps happening, we’re going to have another conversation like this. And now, if you want to have a good relationship with this person, you may have to go and apologize and tell them that you didn’t mean to come off direct. And how much time does that waste?”
It’s like, “Just soften your delivery. And ultimately, it takes more time in the moment and saves more time in the long run by far.” And so, I might have to explain that. Usually, I don’t. Usually, I just say, “Hey, I want you to be more effective. This is what I need from you is just soften tone, so that people perceive it differently.”
Guys, that’s it. That’s what I got. Those are my questions that I got from the Uncharted community. Thanks to everybody there who dropped those questions for me. Gang, I hope you enjoyed it. It’s been a fun experiment. I’m going to go back to the lab and tinker around on this and maybe we’ll do some more of these. Maybe we’ll switch it up a little bit. I don’t know. We’re going to see what happens.
But anyway, gang, thank you guys so much for being here. If you enjoy the podcast, lead me an honest review wherever you get your podcast. If you’re watching on YouTube, click that Like and Subscribe button. Gang, I hope you all are well. Take care of yourselves. All right, talk to you soon. Bye.

Dr. Andy Roark does the FIRST EVER Live-Stream episode of the Cone of Shame. This episode was streamed into the Uncharted Veterinary Community and features a Q&A session.

Questions in this episode:

I’m overwhelmed. Do you recommend I just cut back hours and turn people away?

How do you tell an employee she/he has a “Resting B@#$ Face”?

What can you do to “reset” when you are spiraling into negativity?

What are the top 5 soft skills you look for in an employee?

What are your top 5 educational opportunities for CSR’s, Techs, Assistants, etc.

Do you have a script for an irate client on the phone?

Best decision making tool for prioritizing changes in a newly purchased practice?

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/on-demand-staff-training/

What’s on my Scrubs?! Card Game: https://drandyroark.com/training-tools/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome to The Cone of Shame Veterinary Podcast everybody, I am your host, Dr. Andy Roark. I am going to try something new today. So this is our first ever mail bag episode. I’ve been wanting to do one of these for a long time, I’ve just taken a little while and cranking out some questions from our audience. I went to the Uncharted community, so if you’re not familiar with Uncharted, it is a community and series of conferences live and virtual where we do leadership and development training and conversations and things like that. And so it is a super positive place, super active and engaged place, it makes me just happy to be there. It’s a lot of really great vet professionals who enjoy vet medicine. And so anyway, I opened up to them and just said, “Hey guys, I’m playing around with this idea, will you give me some questions that you would like for me to answer?” And boy, they responded and so I have got way more questions than I’m going to get through today, but I just wanted to jump on and take a crack at them.

Kelsey Beth Carpenter:
(Singing) This is your show, we’re glad you’re here, we want to help you in your veterinary career, welcome to the Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark:
Before I get started, I was just thinking last night, I was flying back from Indianapolis and I went to an event there. It was a wonderful event and I got to see a lot of my friends and I got to meet a lot of new people and it makes me super happy. Anyway, I’m sitting in the airport in Indianapolis, I’m looking around at the architecture and it’s amazing. And I just had to stop for a second and go, “Our world is pretty incredible if you stop and look at it.” But sitting in this building and it was this open sort of atrium area and there was a food court and the ceilings were like 60, 70 feet high and steel and huge glass windows and outside, these machines are landing and taking off into the air and flying and people are everywhere and it’s just people watching and just whatever you wanted to eat, it was all there and I was like, “This is incredible.”
If you took someone from 100 years ago and showed them that they would go catatonic, it’s so much to process. And I think that a lot of times we miss the wonders of the world and I was just thinking about that and I wanted to share that today. And I say it today because I’ve been thinking about what does that mean? I just decided to be in awe about what I was seeing and what I was doing. And I think we had the opportunity in vet medicine a lot, I think that it’s really easy to get sucked into just another day at the clinic. But I just wanted to point out for a second, what we do is amazing. The fact that we use an ultrasound and stick it on a pet’s abdomen and we can see what’s going on inside their body, that’s incredible.
The fact that we can take x-rays and see their lungs or their limbs, that’s amazing. The fact that we have medications like antibiotics, that’s not a given, that’s something incredible that we’ve come up with in medicine. And I don’t know it’s something that spoke to me. I think a lot of times how we feel about our position, it really matters, our thoughts matter and the way we look at what we do, it matters. And so I think that the idea in medicine, I think it’s good every now and then to look around and say, “This is amazing. I love that we get to do this job.” And so that was in my head and in my heart today and I go, “Man, the world’s pretty amazing. And just the fact that we have a job where we can put our hands on broken living animals and make them better, that’s incredible. What sorcery is this that we get to do?”
So anyway, I wanted to start with that. So let’s go ahead into the mail bag. So I got a question from Jody and she says, I have a question I’ve struggled to answer for a long time, she’s back to being a solo doctor. “How do I fit all the patients in and still have time to work on the practice?” So right now she has appointments four and a half days and she’s full from start to finish and booked out for a month. How do I manage the other time and shuttle two kids to five different sports with much help from her husband? And here’s the question, “Do you recommend to just cut back my hours and turn people away?” My charts and other doctor stuff other than appointments gets done over lunch and after hours. We’ve started giving clients colors so that we can start to weed out the bad ones, but I still have over 5,000 clients.
Okay, I love this question. I put it first here in the mail bag because it is the most common question that I’m hearing right now is people go, “I’m overwhelmed, Andy, what do I do?” And so there’s two things that I want to put forward that I think are really important as you start to answer the question of, do I just cut back my hours? You’ve got to get your philosophy right or you’re never going to be able to do this. And it should just be a math problem, but it’s not, it’s a moral problem for a lot of us. And so I think there’s two concepts that I need people to understand when they start thinking about, “We are so busy.” The first one is, what is your ultimate goal? The ultimate goal is to do the most good in the world that you can do during your career.
Okay, I need you to grab onto that because a lot of people are like, “It’s to do the most good I can today. It’s to meet all the needs that people have who call my clinic today.” And I go, “No, that is not the goal.” And that, honestly, and meeting all the needs of people that call today is in direct conflict to the real goal, which is to do the most good that you can do over your career. And I need vets and vet techs and just the whole profession, practice managers, owners, whatever, I need everybody to grab onto that and go, “Okay, seriously, what is the goal?” Because you’re going to approach your day very differently if the ultimate goal is to survive today, seeing everyone who wants to be seen or to stay in this profession for 30 years and not burn out and leave in two and a half years or five years or whatever.
So anyway, the first thing is, remember the ultimate goal. Remember that you only get to go through this life one time, which means your kids are only going to be seven years old one time. And these are thoughts that I have wrestled with many times as someone who has two kids and stays really busy with work. But your life is what you make it. None of this matters if you end up resentful to your profession. If you look back 20 years from now and say, “I hate that I did that, I am still angry that that was my life,” then no amount of good that you do today is worth it. It completely doesn’t work. And so that’s the first thing is, know what the goal is.
Number two is, we have to be honest about the idea of capacity. We can only do what we can do. And I’m just going to make it really simple for a second, imagine for a second we’re not talking about vet medicine, imagine that you run not a vet practice, but a factory that makes widgets and veterinarians are widget makers and the rest of the staff are widget technicians and widget assistants and widget front desk people, but we’re all working to make widgets. It’s a factory. If you can make 700 widgets in a day sustainably, that’s what you can make. And the fact that customers want 1,000 widgets in a day, that does not change the underlying truth that you can only make 700 widgets a day without burning out, without burning up your machines, without pushing your people to the point that they want to quit, without making your spouse resentful, without feeling angry that you’re not getting to spend more time with your kids.
You have a capacity, your practice has a capacity as it is currently staffed. And here’s another idea that blows people’s minds that shouldn’t. Sometimes your capacity goes down, sometimes you’re shorthanded, sometimes you had four widget makers and now you have two widget makers. Well, guess what, buddy? Your factory can’t make as many widgets as they did when they had four widget makers. That’s obvious, it’s common sense, just think about it for a second. But we really struggle with this. We have got to take a pragmatic view about widget making and own for a second that the demand that customers have for widgets does not change how many widgets we can sustainably create in our widget factories. And so there are things that we can do in our widget factories and say, “Wow, the demand for widgets is really high. Well, what can we do?”
Well, number one is you better get organized. We better pull our people in and train them so that they can help make widgets. There are things that we can do to create efficiencies. So training, strategy, organization, delegation, all those things are good and they can help us make more widgets to a point we can rest, we cannot burn our people out because if we push our workers to the point that they rebel or they quit or they go work somewhere else, we’re not going to be able to keep up our widget production. And so at some point, guys, this is just a math problem. It is what do we do to get widgets out the door? And the demand for widgets does not matter when we think about the honest realities of our factory and our capacity. And I think a lot of us, and we do it for a good reason, it’s because we desperately want to provide widgets to people.
And so we decide that yes, our factory honestly should be doing 700 widgets a day, but we are just going to push ourselves and our employees to make 1,000. And our machines are burning red and steam is pushing out the top of them and there’re bags under people’s eyes and they’re stressed and we go, “We have to keep going.” That’s not sustainable, your factory can’t do that. And so anyway, you’ve got to put the oxygen mask on yourself, this is ultimately a math problem. So coming all the way back around the question of, do you recommend just cutting back my hours and turning people away? Given that our writer is booked a month in advance and is working from the moment that she gets there until the moment she leaves and she’s running her kids around, the answer is yes. I do imagine that. There’s no other answer.
You can only make 700 widgets a day. The fact that customers want 1,000 widgets a day, it doesn’t change the fact that you can only make 700. And creating time to work on your business instead of in your business over the long term, that’s going to help you make more widgets. Stopping for a second and getting everybody on the same page and working behind the scenes over the long term, that’s the best play. It’s just deciding, this is not a daily sprint, this is a career long marathon and adjusting behaviors so that they match that goal, that reality. And if you adjust and you say, “This is a marathon.” Then you’ve got to stop, you’ve got to rest, you’ve got to hydrate, you have to make a plan for running this course. Where are you going to push yourself and where are you going to lean back? And how do you get organized and what’s your strategy? All that stuff makes sense.
But yeah, I think a lot of people are struggling with that and they want someone to give them permission, I’m giving you permission right here, right now, the answer is yes, you have to say, “I don’t have capacity to see these people.” And honestly, if you’ve had vets that leave or techs that leave, you are going to have to reduce your capacity. And when you think about widgets, that’s a really obvious thing, but it’s really hard when we think about pets. So anyway, that’s my thing. The answer is, it’s got to be yes. And when you do it, you need to set clear expectations, you need to say, “This is what we’re able to do, we’re booking a month out, we’re not taking new clients, we are not going to be able to get you in.”
And here’s where people really get upset. You’re going to have to be able to give people recommendations of what they should do given that you can’t take them. And that probably means referring them to another practice and saying, “Here’s three other practices that are good practices in our area that you can reach out to.” And people’s heads explode when I say that, but it’s what has to happen because you cannot make 1,000 widgets by strength and will, you have the capacity and you’re at it. And the other thing is, like I said, one last reminder, you only go through this life one time and ending up broken, depressed, resentful, that’s not okay, that negates the whole effort of all of this. So anyway, that’s it, I hope that helps, Jody.
Whitney says, “How do you tell an employee they have a resting bitch face or a confused face or one that looks like rage or disbelief?” So I love this question. I have had someone talk to me about this and I will tell you that my advice is, do what is kind. I’m a big believer in doing what’s kind and that just helps me to have hard conversations and I go, “Is it kind to not say anything to this person and have them continue to think that people don’t like them and then they have to deal and they’re like, ‘Why does this person react so negatively to me?'” And it’s like, “Oh, they think you don’t like them because they look at your face.” I will tell you guys, so I have lectured all over the world and I have had thousands and thousands and tens of thousands of people in the audience and I still look out at the audience and I will pick someone out who looks at me like they hate me. And I’ve seen people.
I remember one time I had this guy in the audience that I knew and I respected, I knew exactly who he was, he was a guru in management in the industry, he was someone I looked up to, he was a doctor of a massive practice on the West Coast and I knew exactly who he was. And I was young and I was starting out and he came to my sessions and I was talking about exam room communication, I was like, “Man, this guy’s been doing exam room communication longer than I’ve been alive and here I am up at the front lecturing on how to do this and what the research says.” And he looked at me like he hated me. But then he stayed for another session and he looked at me then like he hated me.
I’m like, “He’s hate listening to me, he’s that person who’s rage watching a Netflix series, he’s doing that with me.” And at the end of the day, he came up and he said the kindest things, the nicest things coming from someone who knows the stuff and he said the kindest things to me. And I, one, remember feeling so good to have this person I respected saying, “You’re doing a good job and the stuff that you’re sharing is really good and really solid and it was really valuable.” And then two, I’ll never forget the fact that all day long I thought this guy looked angry about what I was saying and that was just his face. And so it’s one of those things that’s just recognize this happens. So what do we do about it? I believe it’s kind to say something to somebody because I’m helping them, especially if they’re on my team.
And so I’ll tell you what people said to me. So I would be up at the front of the room getting ready to do a presentation and I would be stressed because it’s stressful getting ready to present. And I would be up there and I would be working frantically on my slides at the last minute and trying to get the projector to work and things like that. And I didn’t realize that people were coming into the room and I had this just intense angry face on while I was getting ready. And finally one of my friends who came into the lecture, he just said to me after it was done, he was like, “Hey buddy, just so you know, you look really severe when you’re focusing on the computer and then you stop and then you’re your normal smiley face. I think that’s probably jarring for people because they see this and then all of a sudden you’re super happy and they’re like, ‘I don’t know what to believe.'”
And I was like, “Oh, I had no idea I was doing that.” He was like, “Yeah, it’s just something to be aware of.” And that was all it was, he didn’t take that, he wasn’t like, “I need to come in here and close the door so I can tell you this.” Nobody wants to have a resting bitch face and nobody wants to be severe or angry or look confused. I would not say something that makes people feel bad, I’m not going to be like, “Hey, you’ll look like a doofus.” What I’m going to say is, “Hey, just so you know, sometimes when you’re thinking about things or when I notice you standing and processing, you’ll have a look on your face that looks severe. And I like severe, it looks like you’re unhappy and I know that you’re not, but other people who don’t know you as well may get that impression. I just wanted to bring that to your attention.”
And that’s usually all you have to do is just say, “Hey, I noticed this,” and bring it up. But most people, again, it’s not a judge of their character, it’s not saying that they’re being bad, really a lot of these things I lean into perception and say, “Hey, I know you’re not intentionally doing this, however, I noticed that it might look that way to other people and I just wanted to bring that to your attention.” And so I feel like it’s a fairly easy conversation, say it with love, say it because you want to help the person. And honestly, I find those to be easy, don’t make it a big deal, just mention to them, “Hey, I just want to bring something to your attention real quick. I just noticed this, blah, blah, blah, blah blah and so just be aware of it.”
And that’s it and then walk away and smile and then change the subject, talk about something else. Really low stakes feedback, but just say it with a smile on your face, say it because you care, say it not because the person’s doing something bad or don’t make them embarrassed, just say, “Hey, going forward, just be aware of this.”
Lilly asked, “What do you do to reset when you’re spiraling into negativity?” I think a lot of us get in this place where we get in these negative head spaces. Number one is you got to catch yourself. If you can’t identify that you’re spiraling into negativity, then you can’t get out of it. And so for me, I have flags that I have recognized when I’m going into negativity and you need to know what your flags are. Me, imaginary arguments are the key. When I find myself arguing with people who don’t exist or arguing with someone who does exist about a problem that hasn’t actually happened, I catch myself now and go, “Wait a second, what am I doing? This isn’t a real problem.”
If you’re having shower arguments, you need to catch yourself and figure out whatever your flags are that show that you’re drifting that way. If you find yourself rolling your eyes, that may be a flag for you that you’re getting into that negative head space. But if you can’t identify that you’re sliding that way, then you’re never going to be able to do anything about it. So you’ve got to catch yourself. Then you need to know what your triggers are. For me, tiredness is a big one and hunger is a big one.
And so if I’m starting to argue with people, I will stop and be like, “Hey, what’s going on here? Am I upset about something else?” And often that’s it, oftentimes there’s stress in my life and I am taking that stress and turning into negativity about other things. I think that’s a really common mental game that we play. Oftentimes, I’m just tired, I need to get better sleep, I need to go to bed earlier, I need to just know that I’m tired and adjust my behavior based on the fact that, “Hey, I know I’m grumpy, so I’m going to go extra hard today trying not to let that show to other people.” And then sometimes it’s just, I need some calories, I need some snacks. The last part of it is remember that your brain is made to have ideas, that’s what it’s made for and so don’t try to stop it. And I see a lot of people saying, “I need to stop having negative thoughts.”
And then it never happens. You don’t need to stop having negative thoughts, you need to redirect your thought generating machine down a different path because the battle to stop having these thoughts is almost impossible to win, in my opinion. Everyone’s brain is different so maybe it’s not true for other people, but for me it’s 100% redirection is my friend. It’s not trying to not be negative, it’s just flipping over and trying to find things to engage my mind that are positive. So big questions I always ask people, if you’re wrestling with negativity, what are you looking forward to? And everybody should have something you’re looking forward to. And it could be a holiday vacation, it could be family coming to visit, it could be something minor like this weekend I’m playing board games with my friends or I’ve got a craft project that I’m halfway done and I’m going to finish it up and I’m looking forward to it. It isn’t a big thing, it’s just a minor thing.And so when you cut yourself in negativity going, “What are my positives? What am I looking forward to?” I’m going to intentionally think about those things. What are your escapist hobbies? I really love the idea of escapist hobbies, which are just, what book are you reading? Let’s do a summary in our mind, let’s review. And I’m just trying to create something that my mind will grab onto and focus on and do that’s a positive thing because again, I can’t stop it, I just need to direct it over into something good. The last thing is that the best thoughts for getting my head out of a negative space are thoughts that are combined with actions. This is focusing on being present in an activity, this is the essence of zen.
Oftentimes, if I’m in the clinic and I’m just having a bad day, the best thing that I can do is pick up the chart for the next pet I’m going to see and really read it and review it and say, “I’m going to crush this appointment.” And then when I go in there, I’m going to focus on this person and I’m going to give them my full attention. And oftentimes that’s enough because here I am, I’m talking to this person, I’m putting my hands on my pets, I’m thinking about what I’m doing and the negativity slips away.
Where we get in trouble is when we hold onto what we were hanging on before and we go in the exam room and we ruminate and we’re not really present because we’re still angry about this other thing. And again, this is a discipline, it takes time, it takes effort to build these skills and these muscles. But for me, the game changer has been switching away from negative thoughts to different thoughts, especially things that I’m doing and just being like, “You know what? I am mega present right here in the moment.” And so Lilly, I hope that, that’s valuable.
Jen asked, “What are the top five skills you look for in an employee?” Yeah, I’ll give you my five. Number one is self-awareness. I think self-awareness is the most underrated soft skill that there possibly is. I think self-awareness is the most underrated leadership skill that there is. If people are not self-aware, meaning they don’t recognize that they make people uncomfortable or that they are dominating conversations or that they are rolling their eyes or they don’t recognize that they’re being negative or that what they’re saying comes off as critical or that they hurt people’s feelings, even though they never meant to hurt people’s feelings, if they can’t recognize that and see themselves and go, “You know what? I can be better.” Or, “I recognize that, that’s not my intention, but it’s being perceived that way.”
I can’t grow them, I can’t train them. The difference in someone who can thrive and grow and for whom in the sky is the limit often is self-awareness. The people I see who are most likely to get stuck in a rut and not be able to get out of it are people can’t see themselves, they can’t own their own mistakes, they look at other people and say, “Well, these people are just stupid.” And I go, “You clearly have the lack of self-awareness of your role in the situation right now.” And self-awareness just ties into ownership of challenges and if you take ownership of challenges, you have a better chance of being able to work through them. So number one for me is self-awareness.
Number two is the ability to own a mistake. And those things are interrelated, but there’s a lot of people can’t own mistakes, they immediately look to push the blame to somebody else. Number three is a positive attitude. Our job is hard, our profession is hard, I like people who believe that the sun will come out tomorrow or that things can be good or that our work matters and that we’re doing good in the world. I love that. Number four is desire to take initiative based on previous training. And this is especially true with support staff, this separates the goodish technicians from the amazing technicians. I think this is maybe for techs, this may be the number one skill for me, is the ability to anticipate what’s coming based on previous training. They know what we do and they know how we do it and they move independently and it is a thing of beauty, a doctor and a technician working hand in glove, that is incredible.
But a lot of people, it’s a confidence thing or sometimes it is the training or the doctors holding them back and these people have been trained to not exercise initiative. But to me that’s a huge one, I want my support staff to work independently to understand what we do and how we do it and why we do it that way. And if they do that, then they can go ahead and they can work ahead of me and things just happen and they enjoy their job more because they are making decisions, they are processing, they’re not standing and waiting to be told, “Go get me this and go get me that.” It reminds me of when I was a kid and I would help my dad with a car and he would just be like, “Go get this. Go get that. Hold this for me. Hold the flashlight. You’re not holding the flashlight in the right place.”That wasn’t fun, that wasn’t fun for anybody. I see those parallels in practice sometimes. And the last part, number five for me is commitment to the team. Can you get on board with the fact that we’re a team and that we take care of each other and we look out for each other and we’re all in this together? And so those are my five things, self-awareness, the ability to own a mistake, a positive attitude, the desire to take initiative based on previous training and then a commitment to we. So those are my soft skills. Obviously, there’s basic stuff like communication and things like that. It’s hard to just pick five, I’m pulling out the ones that I think really make a difference and they’re also hard to see, but you can see them.
So I guess that’s the next question that would obviously come is, how do you find these skills with people? I’m a huge believer in experiential interviewing. Tell me about a time that you learned something about yourself? I love that as an interview question. Tell me about a time that you made a mistake and what did you do about it? And if they’re like, “I don’t know.” Or they come up with some dinky, stupid thing, I go, “Okay, not impressed.” You know what I mean? You don’t have to ace every question, but if someone says, “Well, I’ll tell you about the time I made a mistake, here was something that I did that was a problem and I had to fix it.” I go, “Aha, that’s self-awareness and it’s the ability to own this mistake. I love it.”
Tell me about your favorite thing about the job? What do you look forward to when you come into the vet clinic? Those are positive attitudes. Tell me about how do you like to work? What’s your ideal working relationship with a doctor? How do you love to work with veterinarians? I’ll ask that. Or to the doctors, tell me about how you work with the support staff? What does the dream support staff look like to you as far as how you work with them? And I’m trying to get them to tell me like, “Man, this is how we do and this is my expectations and I like to be free and I like to know what’s coming and I like to be trained and I’m just looking for all those sorts of things.” And the commitment to a team is, tell me about a time you felt like you were really part of something that mattered?
And if they’re like, “I don’t know.” And they stretch for it, I go, “Okay.” If they say, “Oh, well I’ve been a part of this and a part of that.” And I go, “Oh, this is someone who integrates themselves into the team and what’s going on.” So anyway, those are the type of questions that I ask to try to get them to tell me stories from their life that illustrate those points to me. Because if you just say, “Are you committed to the team?” They’re going to say, “Yes.” And that’s not helpful.
Haley asks, “What are your top five educational opportunities for CSRs, techs, assistants, et cetera?” Okay, I’m a huge fan of training. I’m going to answer this question in a slightly different way, but this is honestly what I really love. I love training that the support staff leads, meaning I love training that they make. And you know why? Because they do the legwork of doing the research and putting the program together and coming up with what they’re going to teach to their peers. And the person doing it gets great expertise in this area, they often feel like they’re getting to use their knowledge in a really positive way that’s good for them. And then they get to work with their peers and the peers all get it together. And so that’s a big deal. My favorite training is training that one of the CSRs does for the other CSRs or one of the techs does for the other techs.
And people go, “Well, I don’t know how you learn cardiocentesis that way.” And I’m not talking about that, I’m talking about actually doing their job and doing the things that matter. And so really, it’s about trust. Man, it’s fantastic having the techs put on something for the whole staff and bringing the CSRs back, the CSRs learn what the techs are up against. And having some customer service stuff or things like that and having the techs in there, the techs see what the CSRs are up against. And so all this stuff helps build the team, helps build trust across the organization, all those sorts of things.
I love the training that they do and discuss together. And so a lot of times people will say, “Well, how do you handle when clients can’t get in for an appointment?” I will say, “There’s no right way to handle it, there’s some basic tenets that are really important. But for the most part, you need to figure out how to respond in a way that matches your clinic culture and who your people are.” And the way that one practice might do it might be totally different than another and it might be because of their values, it might be because of the community they serve of cultural norms of things like that.
It might just be because one clinic may have just rock stars, another clinic may have very inexperienced front desk people and they’re not going to approach this question the same way or do it in the same way, they’re going to do it in a much more simple way that’s less likely to cause problems. So anyway, it really is about, how do you guys do this? My favorite way to train is to have the people come together and say, “Guys, we have a problem, this is what I want to work on.” And so think for me about a time that this went really well. Why did it go really well? Or think about a time that client did this. What exactly did you say that they received well? And then just have them talk to each other about what they say. And guys, there’s so much power in someone that you sit next to everyday saying, “Well, this is how I say it,” compared to someone that you don’t know coming in from the outside and giving a script. I really love that.
Training that builds doctor trust is number three for me. A lot of support staff will say, “I’ve got this training but the doctors won’t let me do these things.” And often having training that the doctors come in and do with the staff that actually gets the doctor to let go a little bit sometimes. If I have doctors that are perfectionist and they say, “No, this has to be done just right and that’s why I do it myself.” Sometimes I can get those people to feel good about the fact that they did the staff training and now they’re more comfortable to just step back and let go a little bit. And so I think that’s really good. Number four, bite-sized training. I love standing huddle training. One of the reasons that we don’t get training done in the vet clinic is because we’re all super busy and we give this idea that training has to be 90 minutes at least, at minimum. And we go, “We don’t have that.”
It doesn’t have to be, we can 100% bite-size this. You can do 10 minutes of training, 15 minutes of training, just, “Hey everybody, this morning we’re going to come together, we’re doing our morning huddle. For five minutes, I just want to go around the room and talk about how we discharge at the end of the day. So when you are in charge of a patient and they’re going home, let’s just go around real quick, what do you guys do? How do you make discharges really go smoothly?” And then they just discuss it and I go, “Great, thanks everybody. That was really good. I picked up some things that I’m going to do differently, that’s fantastic.” Because that’s training, that’s all it is, that’s training and if you do it regularly, you make a much bigger impact than if you do that in a three hour block because they’ll retain that five minute conversation. But if you sit them down for three hours, they’ll retain the first five minutes and after that it’s all just a blur with crossed eyes and things like that.
So anyway, that’s one of the big things. And number five, if you’re talking about outsourcing training and things like that, there’s a bunch of people out there doing it, I don’t have a strong preference, I think just in no particular order, On the Floor @Dove, VetFolio, VETgirl, AAHA, VetBloom, those are all companies out there that have training. It really depends on what exactly you’re looking for and the style and approach that you like. But those are resources that exist right now. So anyway, those are my five educational opportunities, trainings that the people being trained lead, they build for their peers. Training that the group does together and discusses. Trainings that build doctor trust, meaning the doctors do it or the doctors help the staff build out a training thing.
So you say, “This person’s going to lead the training program and Dr. So and so, will you help them come up with what this should cover?” And the doctors don’t have to do it, but they feel very involved and it helps build that trust between the support staff and the doctor so they work better together. The bite-sized stuff, don’t overthink it, man. Five minutes on the regular basis, it beats three hours every six months, it really does. And then the last thing is you can reach out and outsource and there’s a number of different pathways for that.
Haley says, “Do you have a script for an irate client on the phone?” The answer is no, I don’t. And here’s why. Number one is we never really know what clients are going to be angry about, that’s the problem with dealing with angry clients, we don’t know what they’re calling about. And we know from the research that one thing that makes angry clients really mad is if they feel put into a box. If they’re like, “Oh, you’re angry about wait time. Let me get out my wait time script. Dear sir or madam, we are very sorry for the inconvenience.”
They don’t don’t like that. So what do we do? Do we just let them be mad and wing it? No, of course not. There are parts of this that we can plan for and so the part we can plan for is what’s generally called facilitation, which is getting angry people to the right person, having a plan and a system for how to handle them. We need to have some boundaries for the techs or the CSRs, whoever’s answering the phone. I want to prep my people on what their options are, if they cannot make this person happy, what happens? Can they get off the phone? Can they say, “I’m sorry sir, I’m not able to talk to you when you’re behaving like this, I’m going to hang up the phone now.” And hang up the phone. The answer for me is, yes they can. I don’t want my people to feel trapped on the phone.
And so some of that is having guidelines about when do they refer this to the practice manager? When do they refer it to the doctor? Can they hang up the phone? Are they allowed to hang up the phone? Do they know they’re allowed to hang up the phone? What can they say when someone’s being abusive or using profanity? Let’s come up with the phrase that we use when these things happen. The most powerful training in this is, again, it is very team based, is to sit down and say, “Hey guys, I want to talk about what happens when really angry people call. What do you say to those guys? Have you ever told someone that you’re going to hang up the phone? How do we tell people that they’ve gone too far and we’re not going to talk to them anymore?”
And sit down with your staff because every staff is going to have different language. We’ve all dealt with customer service people who have switched to the script and we have known that they switched to the script and it is frustrating. You’re like, “Oh, you just put up a shield, you have just put me into a box.” And so I don’t think that what you say is nearly as important as the team says it in their own voice and they feel empowered to say it and they have gotten to think about it outside the heat of the moment. So that’s my big thing in of coming up with irate language is just, how do you get off the phone? How do you escalate and when do you escalate this up to the practice manager?
And the other part of it is, there are general topics that people call about that they’re angry about again and again. One of my big sayings in practice is, “If you are surprised by something again and again, at some point it’s not a surprise, it’s your business model.” Which means if you are getting angry clients again and again and again about not being able to get in to see you, let’s just say that you’re like Jodie and you’re booked out a month and people are angry about it, stop winging it. At that point I say, “Okay guys, let’s get together here, this specifically is the problem. How are we going to tell people that we can’t get them in? And what are we going to offer to them? And no, we’re not going to apologize all the time.”
Because I see that, that’s just a side thing. And I see a lot of people are like, “We can’t get people in.” And I hear my front desk just apologizing all day long and I go, “Stop apologizing, it’s not your fault you’re shorthanded. You didn’t ask to be down to vets, you didn’t ask to have the highest caseload you’ve ever had and you didn’t ask for any of this.” And so you can be kind and can be professional, I mean, you don’t have to apologize and grovel all the time, that’s not a fun job. Just tell people, this is where we are and these are the options that you have and this is… Yeah, these are your options. And just be kind and then be done. So I don’t have specific, generalized irate client scripts and that’s for two reasons.
Number one, I need to know what specifically are we getting clients upset about? And then number two, what is the culture of your clinic? What is your professional voice? Because it needs to sound authentic and it needs to be something that your people feel comfortable saying, it has to feel right in their mouths. So anyway, some people say, “But Andy, how do I get that?” And I don’t mean to plug this, but if this is something that you’re looking at and you’re like, “I don’t know how to make these things happen or make these conversations happen.” I have a course, it’s at Drandyroark.com, it’s called Charming the Angry Client. And I made it to be watched with groups and it’s for this exact reason. And so I go through and I break down the different pieces of the angry client experience and why people are angry and then I ask these exact discussion questions so that you can have these conversations with the team.
And they’re broken up into five to 10 minute modules for the reasons I said earlier, so that you don’t have to close for a half day, you can if you want to and you just bang out the whole thing in two or three hours with really great discussion and be done. But you can also do a half an hour once a week and be done in five, six weeks and it’ll have probably even a bigger effect. So anyway, that’s at Drandyroark.com. I’ve got that and I’ve also got my exam room communication course toolbox. Same thing, it’s meant to be watched with groups. How do we say this in our practice? How does this work for us? And it’s really me trying to facilitate good conversations in your clinic so that people buy-in. And that’s also broken up into five minute module so you can do it in team huddles and short stuff like that.
So anyway, those are some of the things that I do. I think I’m going to take probably one more here and then I think I’m going to call it there. So anyway, Aaron asked, “What’s the best decision making tool for prioritizing changes in a newly purchased practice?” So you just bought a new practice and you got to figure out, how am I going to spend my time? What do I need to do first? I’m going to answer this, but I want to answer it in a way where it doesn’t matter if you’re a newly purchased practice, let’s just say you’re an overwhelmed practice because in a lot of ways, they’re really similar and the overwhelmed practices are much more common right now. So how do you set priorities?
For me, this is just getting real simple, down at the root of it. Number one, it’s time to make an actual list of things you need to do. And I see so many practices out there that are like, “I’ve got a ton of things to do.” And I say, “Have you actually written down all the things you need to do?” And they’re like, “No, they’re all in my head.” And I say to you, “My friend, you are living in a constant state of panic.” You are continuously mentally going, “Oh, I can’t or forget this and I can’t forget that.” It’s like Dumbledore’s Pensieve, you need to take those things out of your brain and put them down somewhere that you’re not going to lose them so that you can then relax and stop worrying about forgetting something.
So the first part of all this is run an audit. And this takes days. Get a piece of paper, sometimes I use… This is sad how big my to-do list is. I’ll use one of those giant flip pads, the ones that are like the big post-it notes that stick on the wall. I’ll use one of those and I’ll take three or four days and just keep a running list because you keep remembering things. But then I’ve got to tell you, the sense of relief I get when I feel like, “Yeah, that’s a pretty good list.” And if I think of anything else, I’ll just add it to that. That by itself is a great stress management tool. And then just get it written down. And once it’s written down, you can take a look at this thing. And so there’s three questions that I ask to set priorities for a new practice or for a practice overwhelmed.
Number one, what is mission critical? What has got to happen or we’re going to go out of business? That’s payroll, that’s your DEA license for the facility, it is mission critical stuff. What is mission critical? And you take that and that needs to go into the calendar. It needs to go into the calendar and needs to have a date on it. So again, you can relax, you don’t have to figure out, you don’t have to meet with your CPA today and you don’t need to stress out every single morning going, “I can’t forget to talk to the CPA.” You put on your calendar for three weeks from now and say, “On the 1st of December, I am going to have this call, I have already called the accountant and set up an appointment and at that time we will do that thing.” And now it’s out of your mind and it’s done.
So mission critical. What is mission critical? Is it on the calendar? And if not, let’s put it on the calendar as a block so you know it’s going to get done. And again, this is also lowering your stress. All right, That’s number one, what’s mission critical? Number two, which doors are holding the most people back? So in my mind, I look at tasks and think of each task as a closed door, the people who are not able to move forward because that task is not done, those people are standing outside the door. And so I look at my tasks and say, “Okay, these are all doors. What doors have the biggest crowds standing behind them?” And if I’m like, “Man, 10 people, the whole team could move forward and get things done if I open this one door for them.” That’s a high priority, that’s the thing that has to go at the top of the list.
And so there’s two pieces of how many people are standing behind the door and how far could someone run if I open that door? Meaning, let’s just say I have to do one thing and then Kayla will be able to take this project and run with it without supervision for months. I go, “Great. Yes, only Kayla is behind that door, but if I opened it, she could just go and go and go and that would be it.” Guys, a lot of our job as leaders is opening doors, we’re door openers, especially when you’re overwhelmed, the driving, in the moment emotion is, “I have to get in there with my team and see appointment rooms, I have to get in there and turn over cases, that’s what I have to do.” And I get that because that is the screaming, urgent, on fire thing, but the truth is, if you step back and look at your widget factory, and now I’m mixing metaphors, there’re doors in the widget factory.
If you step back and look at your widget factory, the smartest, best thing you can do is not jump into that exam room and see it, it’s opening doors so that the whole team can flood in and do the things that they need to do. It’s getting obstacles out of other people’s way. And so if you remove 10 obstacles so that the whole team can move forward in all these different ways, you’ve done way more good and way more value for your practice, way more value for the pets that you ultimately want to see in your career than you would have if you had jumped into the room. And guys, I see that all the time, it’s people going as hard as they can in the exam room and then ultimately feeling crappy about the fact that they’re still buried and that people are waiting on them to do things or remove obstacles. And I go, “Gosh, this is the pain of being a leader.”
The pain of being a leader is sometimes it’s not putting out the fire right in front of you. Let me say that again. The pain of being a leader is sometimes not putting out the fire right in front of you, it is having the discipline to look around and say, “I need to go deal with that issue over there and this fire, I’m going to let this fire burn.” And oh, that’s so painful. Sometimes you have to let the fires burn so you can step back and do the greater good. And I can’t think of a metaphor of what the greater good is. Sometimes you have to let this fire burn so that you can go get the plane that you fly over the forest fire and dump the stuff. I think we’re stretching really far here.
Anyway, you get the idea. All right, so what is mission critical? What doors are holding the most people back? And the last part is what can be delegated easily? And that fits into, what doors are holding people back? But if you make a list of all the things that you need to do, sometimes you just look and you go, “Well, I don’t need to be the one who does that thing and I know someone else who could absolutely do that. They have the knowledge to do it, they’ve done it before, they have the experience. I’m just going to take this thing off of my list and turn it to my friend, my spouse, my employer, someone that I outsource to, a professional bookkeeper and just say, ‘Hey, I need you to take this thing from my list and just do it and make it go away.'” And they’re like, “Great. I will take that thing and I will go to work.”
But you can’t hand the thing to them if you don’t crystallize the thing, if you don’t see it, if you don’t have it broken out where you are aware so that you can take it and you can hand it to someone else.
Guys, that’s it for today. I think I’m going to go ahead and stop there. Anyway, I hope this is helpful, if you guys enjoyed it, let me know. Leave me a review wherever you get your podcasts, I love that. If you’re watching it on YouTube, hit that like and subscribe button. Guys, if you’re in the Uncharted community, I’ve still got a big list of questions, let me know what you guys think. I know we’ve got a live audience here now watching through this, let me know, I’ll probably hang around a little bit afterwards and I’ll answer any questions that are there. If you guys have enjoyed this, let me know and we’ll do more of them.
So anyway, guys, it’s been a fun experiment, I hope it was helpful, I’m really open to feedback, we can do more of these, we can never ever do this again, just let me know. Let me know wherever you get your podcasts, leave me a review and let me know if you like it. All right, guys, take care of yourselves, be well, I’ll talk to you later on. Bye.