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Monday, February 8, 2016

Being A Leader Vs. Being A Boss

Recently the leaders in my practice have been going through training to improve our leadership skills.  As someone who has long been a leader/manager and have always had someone higher than me in the chain, proper leadership is very important to me.  I have failed in being a good leader many times, though I think I've gotten much better over the years.  I've also had both great and horrible leaders/bosses, as well as those that fall on a spectrum between the extremes.
There is a big difference between a "boss" and a "leader". A boss is someone who directs and pushes people.  A leader is someone who shows people the way and presents themselves as an example.  Both personalities have to manage those under them in the hierarchy, handle bad situations, hire people, fire people, and otherwise make sure the business runs smoothly and appropriately.  But there is a big difference between some one who leads and someone who acts like a boss.

There are some great memes out there on this issue right now, so I'm not going to reinvent the wheel.  Here's the first one.

I like this one because it clearly illustrates the different characteristics of the two kinds of managers.  But I think it can be summed up even more simply.  This is my favorite image on the topic.

The above picture really does capture the idea of what a leader is supposed to do.

These themes resonate in any business and veterinary medicine is no exception.  Paraprofessional staff have managers and associate doctors have the lead doctor or practice owner.  The only time that a person in veterinary medicine doesn't have some kind of manager over them is if they completely own the practice themselves.  So trying to look at bosses versus leaders is very relevant in my profession, and is something on which I often ruminate.  I try to be a good leader, but sometimes creep into boss territory.  I like to think that my forays into "boss" are fewer than they used to be, as I have been able to develop effective teams over the years.

A veterinary practice is a business and has certain things in common with any business.  When the practice manager or owner is a good leader they will have a stable staff and a greater chance of a successful business.

Thursday, February 4, 2016

Stresses Of Being A Business Leader And A Vet

I manage the clinic location where I work, so I have responsibilities beyond being a veterinarian.  I work for a multi-location practice so I don't actually own my clinic (and have no desire to do so), but I am responsible for managing the doctors and medical side of things, as well as some responsibility for the business of the practice.  I have a office manager who does most of the business management, but it also falls to me to make sure we are running a responsible, profitable practice. 

There is a different sort of stress when you manage or otherwise lead a business.  And I think it's a bit harder for a doctor than the practice manager.  We already have a lot of stress from simply being a vet.  Every day we have to make decisions about animals' lives and health.  Our abilities as doctors and surgeons often determine whether a pet lives or dies.  That's a big responsibility and one we never forget!  Believe me, that's a sword hanging over our head throughout the day, and is one of the primary reasons for burnout in the profession.  When it comes to patient care the buck usually stops with the vet and it often weighs heavily on us, especially when we honestly can't figure out what is wrong with the pet or know we can't do much to help them.  Being an associate doctor is hard!

Now add onto that the additional stress of making sure that the business runs well and makes a profit.  No, "profit" is not a curse word in medicine and there is nothing wrong with a reasonable one.  That allows us to invest in newer, better diagnostic and treatment equipment and allows us to entice and hire higher quality doctors and staff.  To be perfectly honest, veterinarians MUST make a profit or they will close their doors.  There are no government-run veterinary facilities for the average pet owner so the only way a veterinary office can stay in business is to turn a profit.  Those who fail to do so end up closing, which doesn't help anyone.  So being profitable is vital to the success and growth of any veterinary practice.

As a business leader I have to help my office manager make sure our schedule is filled, that we're not over-staffed or under-staffed, that we're not ordering more supplies than we need, and that we're charging appropriately.  Thankfully the lion's share of this burden falls on the office/practice manager!  I couldn't function well if I didn't have a good one and she is vital to our success.  But it also falls to me to help motivate the staff, send people home when we're slow, push the front desk to call clients and make sure the come in for appointments, and generally help manage the whole clinic.  Additionally it falls to the clinic managers to handle most of the unhappy clients or any complaints (which are thankfully few in my clinic). 

There are days and weeks that we are slow and no matter how many phone calls we make or take we simply can't fill our schedule.  That doesn't happen often, but Winter is traditionally a slow season in veterinary medicine so it's been happening with a little more regularity in the last month.  I know this as I've seen it every year in my 30+ years in veterinary medicine.  But I still can't just shrug and say "Eh, it's the slow season and it will get better."  I still have to push to make sure that we're doing everything we can to support the business end of the clinic.  And believe me, when I have times that I go an hour without any patients to see I get stressed.  When that happens for multiple doctors on the same day it really makes my stomach churn.  All I see and think about is "are we going to make our financial plan for the week?"

They don't teach us how to do this in vet school!  There are little to no lectures on the business of veterinary medicine, even though the majority of graduates will end up working in a private small animal practice.  Even those schools who do give some instruction in business don't give you training on how to actually lead and manage a business.  So most vets who go into practice have minimal experience or even idea about how to be a leader and manager.  This lack of business training is probably one of the biggest faults in veterinary education, though it is somewhat understandable considering everything else that has to be packed into a four-year program.

Those who want to go into veterinary medicine need to realize that there is more stress than simply being a doctor, and you'll likely be ill prepared when you graduate.  But it is something that can be learned, and I've become pretty good at it.  I still become very stressed about our business at times, but we're successful much more often than not and over the years I've gotten better and handling this side of the job.

Sunday, January 31, 2016

Attack Of The Clones....or, When Everyone Picks The Same Name

Yesterday was very interesting in my clinic.  We had a busy day as is typical for a Saturday, and had many pets who dropped off for various kinds of check-ups and treatment.  As the day went on we started noticing a rather surprising pattern.  Multiple pets had the same names.  And it wasn't just a couple of them!  By the end of the day we had tallied the following: 

Two dogs named Sophie
Two named Luna
Two named Charlie
Two named Bear.....with the same last name!

That last one had us staying alert, because two dogs were in our clinic for the day, both named "Bear Miller"!  Yet neither family was related to the other.  It was just a weird coincidence that they shared a last name, gave their dogs the same name, and came in on the same day.

It really was quite funny.  But at the same time it could have been a disaster.  We had to be extremely careful to make sure that the medical notes were being entered on the correct patient (we use completely computerized record-keeping), the right vaccine or medicine was given to the right dog, and when the owners picked up that we brought the correct pet up front.  Having two black dogs with the same first and last name was especially concerning!

Thankfully all of my staff was at the top of their game and there were no mixups at all during the day.  Each pet got exactly what they needed and went home with the right family.

But believe it or not this isn't the first time something like this has happened.  It's rare to have two pets with the same last name from different homes, but it happens.  We also sometimes have more than one pet with the same name in a given day, especially with common names like Buddy, Bear, Bella, etc.  But having four sets of "clones" was pretty crazy!

In the spirit of the day, I'll leave you with this classic from Weird Al Yankovic....

Thursday, January 28, 2016

Vet Vs. Client Perspectives

Recently I had an email conversation with someone seeking some advice.  During the conversation he made the following statement:
I wouldn't have characterized this as a mild problem, but that is me. I'm very protective about my girls, and pride myself on being in tune with their wellbeing. I can't even imagine the condition that you see some animals coming in for the first time so it's probably a matter of professional perspective.
He brings up an excellent point, one that I think both clients and vets sometimes forget.  A perspective is very individual and is based on personal experiences in a given area.  What a veterinarian sees on a daily basis is very different from what the average pet owner sees.  We see the best, worst, and everything in between.  Even someone who owns a dozen dogs in their lifetime doesn't compare when we'll see twice that number in a single day.

Let's look at an average case of bloody diarrhea as an example.

Mr. Sanguine sees his dog, Squirt, having diarrhea and there are streaks of blood in it.  Later that day the diarrhea is more liquid and the blood is more noticable.  He worries about the possibility of something serious being wrong, as he's never seen blood in the feces of any of his previous five dogs.  Squirt is acting normal but that blood is freaking out Mr. Sanguine, so he brings is dog to the vet.

Dr. A. Gain sees Squirt.  She collects a stool sample and sees the blood that worried Mr. Sanguine.  But the dog is wagging his tail, bouncing around the room, and has no pain or discomfort on abdominal palpation.  This is the fourth case of blood diarrhea she's seen this week and the second one of the day.When she finds out that Mr. Sanguine gave a new kind of dog treat a few days ago she stops worrying.

Each perspective is correct in its own way.  Mr. Sanguine is justifiably concerned because bloody diarreah is certainly not normal and he's never seen it before.  Dr. Gain sees several cases like this almost every week and isn't worried because of the lack of other symptoms.  Each person is looking at it from their personal experiences, one who has never seen this before and the other who has seen it every week for more than a decade.

There is nothing wrong with either point of view.  The concern of Mr. Sanguine allowed Dr. Gain to properly evaluate Squirt.  Dr. Gain's experience and expertese allowed her to assess that there was nothing seriously wrong with the dog and he could be treated conservatively.  It could easily have been a different situation, where Mr. Sanguine ignored Squirt's problem or Dr. Gain discovered something more serious like early pancreatitis.

This kind of difference in perspective can cause problems, though.  I often have to remind myself that what is normal and common for me isn't for a pet owner.  So while the owner is worrying and possibly even crying I'm shrugging my shoulders and making light of the issue.  Taking too light of a stance can make me seem uncaring or heartless to a client who is really worried.  I may be completely justified in my assessment, but that doesn't help the relationship with the client. 

In a situation like this the ball is in the doctor's court.  It is up to the vet to empathize with the client and show understanding, all while trying to assure the client that it really isn't a big deal.  We as medical professionals need to keep in mind that the client's perspective is not the same as ours because they don't see the same things we do.  It is our responsibility to not make light of this situation and to do what we can to allay their fears.  I'll often tell clients that I see a given problem multiple times per week, as that seems to help them understand that it may not be as big of a deal as they thought.

It's really about being empathetic and understanding people.  Clients should appreciate the fact that vets really do see things differently because of our daily experiences.  But vets have a bigger responsibility to try and see things from their clients' perspective and relate to their fears.

Monday, January 25, 2016

A Year Without Soda

My daughter is pretty remarkable for such a young girl.  At times she can be rather flighty and whimsical, while at other times she can be the most determined and strong-willed person I know.  A year ago she saw someone on YouTube who had done a year-long "no soda" challenge.  For some reason my daughter decided that she wanted to do that also.  So beginning on January 5th, 2015 she decided that she would not drink any soda for a whole year.

My wife and I didn't think it would last.  While our kids don't drink soda daily they do tend to have it when we eat out.  We expected her to give in at some point and decide that she wanted to have some.  It seems that we underestimated her determination.  At every point she kept to her challenge.  No matter where we went or what we did she absolutely refused to drink any soda.  This turned out to be a bit of a difficulty at times!  For example, when we would go to the movies there weren't many choices other than soda if she wanted something to drink.

But she stuck with it through thick and thin.  Everywhere we went she would have water, tea, or juice.  And earlier this month she celebrated a year without soda!  Yes, she actually did it!  Pardon the poor quality of this video, as the light was brighter than I expected.  But her initial reaction is priceless!

I'm very proud of my daughter for having the willpower and determination to succeed in this challenge.  I asked her if she wants to try for two years, but she said no.

Friday, January 22, 2016

Miniature Cameras For Your Intestine

Recently I saw an advertisement in a veterinary journal for a new product.  It is the size and shape of a large capsule or pill and contains numerous miniature cameras.  The idea is that you make the patient swallow this device and as it passes through the digestive tract it takes photographs which can be transmitted wirelessly to a recorder.  In human medicine this is called "capsule endoscopy".  I knew that such things were being developed but I honestly had no idea that they had actually come to market, especially in veterinary medicine.  The Cornell University College of Veterinary Medicine even describes it on their website as a routine diagnostic tool.

Here are some images that you can easily find on the internet.

This is so cool!  It's exciting that this kind of thing is now coming into routine use and can give us so much information with no invasiveness.  Radiology and ultrasound are great and still very important diagnostic tools that we can't do without.  But they can't let us see the inside of the GI tract with our own eyes.  Typical endoscopes are very useful, but they simply can't look at the entire digestive system because of its length.  They also require sedation in human medicine and anesthesia in veterinary medicine.  With a capsule endoscope there is no need for all of that equipment and medication.  The patient simply swallows the capsule and it transmits images wirelessly.  This is an unprecedented kind of diagnostic instrument, and opens so many new options for diagnosing and treating diseases!

Here are some examples of what can be seen.

Obviously this is pretty new and so far only found in the hands of specialists.  With time I would expect the costs to come down and start to be reasonable for general practitioners to purchase and use.  When that happens we could make so many more diagnoses than is currently possible.

I'd be interested in hearing from any clients or veterinarians who have personal experience with capsule endoscopy.  I'm certainly going to be following this imaging modality with interest.

Tuesday, January 19, 2016

New Influenza Vaccine

Many people are aware that in early 2015 a new strain of canine influenza hit the US and hit it hard.  I wrote a few blogs about the disease and experience (look here) as I live and practice near Atlanta and we were one of the hardest hit areas in the country.  Thankfully the outbreak passed, but it is in multiple areas of the country and definitely can crop up again in my area.  It just popped up in Montana and is causing concerns there.
Last year we didn't have a vaccine against this strain.  Yes, we did have an influenza vaccine, but it covered the H3N8 strain.  What we dealth with last year was the H3N2 strain and the infectious disease specialists didn't expect there to be any cross protection.  So a dog vaccinated for H3N8 was still at risk for H3N2.  Many vets gave the H3N8 vaccine because we didn't have any other options.
Recently provisional approval was given to two manufacturers for a H3N2 vaccine.  This is good news!  This vaccine does address the risk of this newer, more contagious strain of influenza and will hopefully help prevent outbreaks like what happened last year.
The vaccine is approved for dogs six weeks old or older.  They will receive a vaccination and then a booster in two to four weeks, with annual re-vaccination recommended.  It is only recommended for dogs who are potentially at risk for contracting influenza.  This includes dogs who frequent public spaces such as dog parks, are boarded frequently, groomed often, or travel frequently.  A dog who pretty much stays in their house and yard is at minimal risk for influeza exposure and so wouldn't need the vaccine.
Here's one caution, though.  Neither vaccine is protective against the opposite strain, so if you want to be really thorough your dog will need to receive both.  Personally (I have no evidence of this) I fully expect there to be a multi-valent canine influenza vaccine in the near future that covers both strains.  Until then you should talk to your vet about whether or not your dog needs both.  Here in northern Georgia I'm only going to recommend the H3N2 vaccine because we've never seen the other strain in this area.
We are just now able to order the vaccine at my practice and I was reading an article about it in a recent trade magazine, so it may not be widely available and some vets may not be aware that it has come out.  If you are interested and your dog is potentially at risk, talk to your vet.