Secondary Pet Caretakers

We live in a busy society, and many people work when the can and as much as they can to make ends meet. Or maybe some people just find it hard to work their pet into their hectic schedule. In any case, it's not uncommon for someone other than the primary caretaker to bring a pet in for a veterinary visit. This might be spouse, child, grandparent, friend, or anyone else besides the person who normally cares for that pet. All of that is understandable, because at least the pet is coming in. The problem is that this secondary caretaker often doesn't really know what's going on with the pet.

With well pets we will generally ask people if they have enough heartworm prevention or flea and tick prevention. We may also ask about any health problems, what kind of food is being fed, and so on. If the primary caretaker isn't there the answer is often "I'm not sure" or "My wife normally keeps track of that".

The situation is worse if the secondary caretaker is bringing the pet in for health problems. Unfortunately, they often don't know the details of the history at the level that would be very helpful. This usually results in cell phone calls that will hopefully reach the other person. But it can be frustrating to try and diagnose a problem when we don't have all of the information. It's like trying to figure out a mystery image on a jigsaw puzzle without having all of the pieces.

So I would ask anyone taking a pet in to get all of the details. Even if it's not your pet or someone else in the family normally does most of the care, your vet will want to know what's going on. Do yourself, your vet, and your pet a favor and try to get all of the information before going in.

You Can Only Do So Much

Last month I showed an x-ray of a puppy with a badly broken paw. Unfortunately, we're having difficulties with the client, and it's a tough situation. Here's another view behind the scenes of running a veterinary business.

When we first did the services, the bill was over $500. They didn't have that right away, so we worked out with them that they would pay half that day and the remaining half a week later. If they didn't pay the remaining balance they would be sent to our collections department. When the time came they didn't pay, even though we gave them several extra days. Another few weeks later the puppy came in for a recheck and the paw was swollen, the splint was broken, and the whole thing had slipped down a little. We needed to replace the splint, but she didn't have the money for it. I was going to remove the splint but send her home without anything else because she couldn't pay for it. She said that she would check and see if she could borrow the money from her mother, and would let us know. We kept the puppy, heard back from her a few hours later, and she said to go ahead and do it. Then when she picked up, she didn't have the money to pay for it. So she got sent to collections a second time! And she was informed that from that point forward she would not be able to receive any services unless she paid for them in advance. Most recently she called me on Wednesday saying that the paw was swollen. I again discussed repeating x-rays, removing the splint, and checking the foot; I also repeated that she would need to pay for any services in advance.

Today I had to stay home from work and have another doctor cover for me because my daughter was running a fever and my wife was out of town helping with a church youth camp. This same person came in today, expecting to see me, and was upset when I wasn't there even though my receptionist explained why I was out. The office called me about this, and wanted to double-check with what I had told her about payment. The foot was very swollen and the dog needed treatment for it. Honestly, this dog needed surgery about a month ago. I'm not sure what ended up happening, but I'll find out tomorrow.

Situations like this are pretty tough. I want to be able to help this dog, but I can't do full treatment for free. The client has already defaulted on almost $500 worth of services that she had agreed to, and on one occasion deliberately deceived me. I know that she is trying to help her dog, but she's going about it the wrong way by lying to us and basically performing fraud. The splint isn't helping him, he needs surgery, and he won't get better because he's not getting proper care. I know the owner can't afford it, and that's not really her fault (though it illustrates a point I've often made about setting aside money for your pets). But as a businessperson, I can't do such extensive and expensive services for free. And the fact that she has knowingly reneged on her agreements makes us less like to want to help.

In the end, the pet is the one who suffers. And really I can only do so much. I feel bad for the puppy, but I don't feel guilty. The owner is ultimately responsible for what happens and any decisions.

Do It Yourself

Today I neutered my kitten, Tristan. To me it wasn't a big deal, and was a procedure that took only a minute or two. However, one of my staff questioned whether I would do it myself. That's not the first time someone asked me a question like that. I've neutered most of the cats I've had, and spayed my dog, Guinevere. I would have spayed Inara, but the shelter had done this before I adopted her.

This is strange to many people I've worked with over the years, and I can kind of understand it. Seeing your own pet that you know and love under anesthesia can be very strange. This animal that normally plays with or cuddles with you is lying there in a very unconscious state with monitors flashing and beeping. Then you take a scalpel and cut into that beloved companion, removing organs of some sort. And no matter how good you are, there is still that slight risk that something could go wrong. Those thoughts can be there no matter who the pet is. But when you have that personal attachment and connection, it can be a bit strange.

However, for doctors there is also the thought that you don't want to entrust it to anyone else. Even if I trust my associates and know they do a great job, this is my own pet's life and health, and I want to be personally responsible for it. The special connection with a pet works on several levels. And even though I would readily let a specialist do what was needed on my pets, for routine procedures I would prefer to do it myself.

So to any who ask, no I don't find it strange to do surgery on my own pets, and even prefer to do it. By the way, Tristan is doing great, and was purring just a few hours after surgery.

Spay? Spade? What The Heck?

I sometimes get random, strange thoughts, and today one occurred to me. I have been in veterinary medicine for about 25 years, and have always know that a spay is when you remove the reproductive organs from a female. I've always accepted that and never really thought about it. But today for some reason it suddenly dawned on me that the word didn't make sense.

The proper term for the surgery is ovariohysterectomy. Where do you get "spay" out of that word? A castration is called a neuter, and is used only for males. I can understand neuter, as you're kind of changing a male into a neutral. But what about the word spay? Word origins often interest me, so I tried looking it up. The problem is that it still doesn't make sense!

Here's what an online etymology dictionary has for "spay":
c.1410, "stab with a sword, kill," also "remove the ovaries of," from Anglo-Fr. espeier "cut with a sword," from M.Fr. espeer, from O.Fr. espee "sword" (Fr. épée), from L. spatha "broad, flat weapon or tool," from Gk. spathe "broad blade" (see spade (1)).

So basically the word "spay" refers to cutting someone. How this ended up being specific to removing a female animal's reproductive tract, I still don't know. And if anyone else knows, I'd love to hear from you!

Believe it or not, strange and random thoughts like this are not uncommon for me!

Quantity vs. Quality

Today I saw the most pets I have ever seen in one day...47! Considering that an average doctor should see 20-25 pets per day that's a pretty crazy number. Probably 40 of those I saw between 2:00 and 7:00, which averages 7-8 pets per hour. Again, that's a crazy amount to see. My practice has a policy that we will see any pet that needs to be seen. We simply don't turn people away. For the most part I agree with this, as it keeps pets from having any delay in diagnosis and treatment when they need it. However, at some point I think that pet care potentially suffers.

It's a question of quality versus quantity. And it really makes me wonder which people want. When I'm seeing almost 8 pets per hour, that averages to spending less than 10 minutes per pet. For a routine puppy booster vaccine this may be enough. But for a sick pet it definitely isn't. Personally I would rather give fewer patients better care. It would also improve client service, as I had several clients wait over 2 hours to be seen. Now, they were warned of the wait and they were happy to sit around, but I still don't like doing that to them.

So it's a bit of a conundrum. Do I turn some people away? The ones I turn away might need only minor care, or might turn out to be a serious case that needs immediate evaluation. Turning people away might mean better care for the pets I do see, but might mean denying care for other pets. Honestly, I've never worked at a location this busy before, so I've never been faced with this dilemma. It's great for business in the short run, but I also need to put aside the business at times and concentrate on being a doctor and providing the best care possible.

So now you can see the challenges of being a doctor and a hospital manager. I am continually weighing the business versus the medicine, trying to find a balance between them. And that brings me to my first ever poll! Look on the top right and let me know what you would prefer.

What Is Quality?

For the past week I have been in meetings to help improve the quality of service, medicine, and performance of my clinic. Having managed veterinary hospitals for the last 9 years, there wasn't anything earth-shattering that I learned. Definitely a few confirmations of what I believed, as well as some new hints and tweaks to my methods, and for that I am pleased. But another thought began to occur to me. How do we define quality veterinary medicine?

In reality, quality is pretty subjective. What might be good quality to one person may not be the same to another. "Quality" is a word that we think we all can understand, but really we need to define it. Is someone a high-quality doctor because they use all of the latest and best equipment? Does a vet give you quality service because they charge less than others in the area? Would someone who is a highly skilled clinician but has poor bedside manner be considered a quality veterinarian? What exactly does quality mean to each person? That's a hard thing to determine, and I have seen my clients vary in these opinions. One may see my need to run numerous diagnostic tests as a sign that I am thorough and consider every possibility to get to the bottom of what is wrong with their pet. The next person may see the same situation as an attempt to drain their wallet.

Since in the end I have to first and foremost answer to myself, I have to be comfortable with how I practice medicine. So here's what I see as "quality". A high-quality veterinarian is someone who puts the concerns and the needs of the pet as the highest priority, even over the needs of the client. This is someone who recommends the best medical care possible, even if the client can't afford it. However, that once the recommendation is made, that quality vet must then listen to and consider the client's desires and abilities (both financially and emotionally). He or she must be compassionate to the humans and animals, but also reserve a bit of detached clinical judgment, looking at a case as objectively as possible. A high-quality doctor is extremely knowledgeable about current medical diagnostics and therapy, and is not hesitant to go through the diagnostic process. Yet they are also very aware of their personal limitations and weaknesses, and will not attempt a surgery or case that would be better served by being referred to a specialist or someone else more skilled in that area. The high-quality vet charges for their services at an appropriate rate, realizing their own personal worth, and not trying to discount and be the cheapest. At the same time, they do not look at finances as the end goal, only a means to accomplish their medical efforts. In short, a high-quality vet is compassionate, knowledgeable, and skilled in modern medicine, considers the health and needs of the pet as their highest priority, and isn't afraid to stand by their diagnostic plans and charges in the face of some resistant clients.

Does that sound like your vet, or someone you would want to take your pet to? If not, why not? As I study ways to improve managing my own clinic, I have to worry about these issues and how clients will perceive them. Once I was told that clients have a choice. Their medical services can be fast, high quality, or cheap. The client can have two of those three choices, but not all three. Which would you choose?

Do People Still Fall For It?

Anyone reading this blog has at least a basic knowledge of the internet, email, and everything that entails. Which means you are also likely aware of the various email scams out there. Most of them come from someone overseas that needs help moving money, and promises you several million dollars (pounds, etc.) if you will help them. I receive those emails virtually daily on all of my email accounts (I have three). The one I use for my blogs isn't used for any other communications, yet I still get 10-15 per week.

Knowledge that these are scams is very common, and has been reported on the internet, TV, radio, and print media. There shouldn't be anyone using computers that doesn't know that these are bogus and are used to bilk people out of considerable money. Yet they are still ubiquitous on the internet. This must mean that there are still people out there who fall victim to these emails, or it wouldn't be worthwhile for the perpetrators to send them out. And that boggles my mind. I know that people want to get rich quick and want free money. But come on! How desperate, ignorant, or out-of-touch do you have to be to believe that these emails aren't scams?

It's sad to me that people are evil and greedy enough to submit these emails. They should be persecuted to the fullest extent of the law regardless of their country of origin. But it's even sadder that people still fall for it. Use common sense and just delete these emails!