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.
Tuesday, June 30, 2009
Friday, June 26, 2009
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?
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?
Sunday, June 21, 2009
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!
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!
Saturday, June 20, 2009
Are You Ready For The Hair?
We're in shedding season, if you haven't figured that out by now. That makes me think about the type of fur pets have, and what people have to deal with. Personally, I would never have a long-haired pet because of the high maintenance. I have seen too many people come in with heavily matted dogs and cats, or have to get them groomed every month or two to keep the coat manageable. It's a lot of work! It's also important since a matted coat can trap dirt, cause skin irritation, and can be painful as the hair pulls the skin.
Thick coats can be as bad as long ones. Dogs like Siberian huskies and German shepherds have dense undercoats that will come out in clumps during the warm months. These coats require regular brushing to keep them from being a problem. Honestly, these dogs don't need to be shaved down, just brushed daily.
Unfortunately, many pet owners don't think about this when they get a pet. That little lhasa apso puppy is so cute, but the people don't know what it takes to manage the coat. It's a lot of time and cost, and not doing so can affect the pet in a negative way. It's an unavoidable consequence of these kinds of pets. Definitely think about maintinence when you pick a certain breed!
So keep up with those coats. Brush and see the groomer. Your pet will be better for it, and you'll want to be closer to your pet.
Thick coats can be as bad as long ones. Dogs like Siberian huskies and German shepherds have dense undercoats that will come out in clumps during the warm months. These coats require regular brushing to keep them from being a problem. Honestly, these dogs don't need to be shaved down, just brushed daily.
Unfortunately, many pet owners don't think about this when they get a pet. That little lhasa apso puppy is so cute, but the people don't know what it takes to manage the coat. It's a lot of time and cost, and not doing so can affect the pet in a negative way. It's an unavoidable consequence of these kinds of pets. Definitely think about maintinence when you pick a certain breed!
So keep up with those coats. Brush and see the groomer. Your pet will be better for it, and you'll want to be closer to your pet.
Wednesday, June 17, 2009
"That Flea Medicine Isn't Working!"
This time of the year it's a daily occurrence to talk to my clients about flea control. Here in the southeast US we have a lot of fleas, especially during the warm weather, so flea prevention is a necessity. Without using it, you're just asking for flea problems. However, many clients apply one dose, a week later see fleas, and complain that it isn't working. Last year I wrote an entry about flea control, which I wanted to remind everyone about (right here). But here's a quick review...
*A single dose of flea prevention will NOT get rid of your flea problem.
*Fleas have to jump on the pet in order to be affected by the topical preventions.
*You have to treat the house and yard in order to completely control the problem.
*Every pet in the house must be treated.
*You can't bathe your pet too often or you will cause the product to work less effectively.
*Once you start seeing fleas it will take you several months to get the problem under control.
*Flea medications work best as prevention, before you see fleas.
So basically you need to use the topical products from your vet very consistently every single month, treat the environment, and avoid overbathing. All of the current veterinary products (Frontline, Advantage, K9 Advantix, Vectra, etc.) are indeed effective, but must be used regularly and appropriately in order to work. Don't give up after a single dose!
*A single dose of flea prevention will NOT get rid of your flea problem.
*Fleas have to jump on the pet in order to be affected by the topical preventions.
*You have to treat the house and yard in order to completely control the problem.
*Every pet in the house must be treated.
*You can't bathe your pet too often or you will cause the product to work less effectively.
*Once you start seeing fleas it will take you several months to get the problem under control.
*Flea medications work best as prevention, before you see fleas.
So basically you need to use the topical products from your vet very consistently every single month, treat the environment, and avoid overbathing. All of the current veterinary products (Frontline, Advantage, K9 Advantix, Vectra, etc.) are indeed effective, but must be used regularly and appropriately in order to work. Don't give up after a single dose!
Monday, June 15, 2009
Can You Hear Me Now?
A stetheocope is a very important piece of diagnostic equipment that every physician and veterinarian uses. High quality ones can cost $200-300, so this is not simply a rubber tube, ear plugs, and a head. With a good stethoscope you can hear very subtle changes in the heart and lungs, aiding in the diagnosis of cardiac and pulmonary disorders. Very small differences and alterations can be difficult to hear with a lot of ambient noise, so we try to listen in quiet areas. To aid in hearing these faint sounds, the ear buds fit very snugly in the ear canals, keeping sounds from overwhelming what you are trying to hear.
Why am I describing this? Because I want you to understand that when we put the stethoscope in our ears, we are deliberately trying to filter out and elminate all sounds except those coming through the bell on the head. In fact, if we are using a high-quality stethoscope, it's difficult for us to hear anything except what's coming through the instrument. And why is this important to know? Because I constantly have clients try to carry on a conversation while I'm using it.
Yep, it happens every day. I will talk to a client, then pause to listen to their pet's chest. While I'm listening, I can see their lips move or hear a little bit of their voice. And what little I hear I try to ignore so I can listen for any abnormalities in the heart or lungs. I think that most of the time they don't realize that I can't hear them. I try to be polite, but sometimes it's hard to say "I'm sorry, I couldn't hear a word you were saying." Even after 12 years of practice, I still find this a hard thing to say.
So the next time you go to your doctor or vet, pause while they're using their stethoscope. They really can't hear you, even if they want to. Wait until they're done and then continue the conversation.
Why am I describing this? Because I want you to understand that when we put the stethoscope in our ears, we are deliberately trying to filter out and elminate all sounds except those coming through the bell on the head. In fact, if we are using a high-quality stethoscope, it's difficult for us to hear anything except what's coming through the instrument. And why is this important to know? Because I constantly have clients try to carry on a conversation while I'm using it.
Yep, it happens every day. I will talk to a client, then pause to listen to their pet's chest. While I'm listening, I can see their lips move or hear a little bit of their voice. And what little I hear I try to ignore so I can listen for any abnormalities in the heart or lungs. I think that most of the time they don't realize that I can't hear them. I try to be polite, but sometimes it's hard to say "I'm sorry, I couldn't hear a word you were saying." Even after 12 years of practice, I still find this a hard thing to say.
So the next time you go to your doctor or vet, pause while they're using their stethoscope. They really can't hear you, even if they want to. Wait until they're done and then continue the conversation.
Saturday, June 13, 2009
Good News....It's Normal!
Making a diagnosis and implementing a treatment plan is not something that happens instantly, but is a process. When we as doctors see a set of symptoms in a patient, we have a list of possible diseases or disorders in our mind. We then need to try and figure out which of those possibilities is the likely correct one. With many patients we can't determine which problem is the right one merely on symptoms alone. For example, let's say that a patient comes in for excessive drinking and urinating. Possible causes include diabetes, kidney disease, a urinary tract infection, or Cushings disease. Each of these are radically different disorders with equally different treatments. We can't simply try a treatment and hope it works. If we put a patient on antibiotics for an infection, we could be delaying needed treatment for diabetes.
So we run tests. Let's say that in this fictional patient the blood glucose and kidney values are normal, there are no abnormalities suggestive of Cushings disease, and there are bacteria and white blood cells in the urine. The conclusion here is that the patient has a urinary infection, and we place her on antibiotics. At this point some people would think that those other tests had been unnecessary, and might even ask for their money back. Yes, this happens, and it frustrates us vets. We have no way of knowing what the results would be before running them. Sorry, we usually forget to bring our crystal balls to work. The way I try to explain it is that these normal results are GOOD news. We have just ruled out the possibilty of several serious diseases, and this is something we should be happy about. The tests weren't pointless because we didn't know what the results would be ahead of time.
Coming to a diagnostic conclusion is rarely as simple as just examining a patient. Almost every symptom has at least a few possibilities, and we need to do tests to try and figure out which one it is. When we have those results we can determine which of our possible illnesses are more or less likely, and then proceed to the next round of tests or begin treatment. So when your own pet comes up with normal test results be happy about it, and realize that your vet is merely trying to help you by properly diagnosing the problem.
So we run tests. Let's say that in this fictional patient the blood glucose and kidney values are normal, there are no abnormalities suggestive of Cushings disease, and there are bacteria and white blood cells in the urine. The conclusion here is that the patient has a urinary infection, and we place her on antibiotics. At this point some people would think that those other tests had been unnecessary, and might even ask for their money back. Yes, this happens, and it frustrates us vets. We have no way of knowing what the results would be before running them. Sorry, we usually forget to bring our crystal balls to work. The way I try to explain it is that these normal results are GOOD news. We have just ruled out the possibilty of several serious diseases, and this is something we should be happy about. The tests weren't pointless because we didn't know what the results would be ahead of time.
Coming to a diagnostic conclusion is rarely as simple as just examining a patient. Almost every symptom has at least a few possibilities, and we need to do tests to try and figure out which one it is. When we have those results we can determine which of our possible illnesses are more or less likely, and then proceed to the next round of tests or begin treatment. So when your own pet comes up with normal test results be happy about it, and realize that your vet is merely trying to help you by properly diagnosing the problem.
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