You Can't Make Everyone Happy

When you deal with clients it's impossible to make every single person happy.  No matter what you do, somebody isn't going to like X, Y, or Z and will complain.  This is as true in the veterinary profession as in any other business.

My practice has several locations and we utilize and outside survey service to measure our client service.  Like many businesses our receipts have a website where you can rate your experience and enter to win a prize.  The location I manage repeatedly has the highest service score in the area, so people like us and what we do.  On a less "scientific" basis I also know we have many loyal customers and our business is growing.

Even so we get upset clients.  Last week I had someone get very upset because her cat may have had a vaccine reaction.  It had diarrhea and vomiting after being in for kitten immunizations, which are potential signs of a reaction.  The diarrhea had started while in the exam room, something noted by one of my associates who cautioned the owner about reactions and offered to treat.  The next day the client called because the kitten still vomited some.  We told them to bring her in, but they went and had lunch instead and by the time they came in our doctor was at lunch.  Rather than understanding they got upset because they hadn't been told not to come in at a certain time, and wanted one of the techs just to give a shot.  They also didn't want to bother leaving the kitten with us for observation.  All of this was clearly documented in the pet's medical notes, so when she came back for boosters we expected to have her dropped off for premedication and observation (our practice's required protocol for suspected or known vaccine reactors).  The client got upset at this and refused to drop off, so I went up front and talked to her.  She was livid about the whole situation, even though I explained that we had documentation of all of the discussions with her (which she denied having had).  Knowing that this wasn't going well I said "I can see that we aren't going to be able to give you the care you want.  I'll be happy to provide you a copy of your medical records or send them to another vet."  She debated a bit but despite all of the complaints decided to leave the kitten with us after all...until she saw the costs.  Yes, we do antihistamine injections and place an intravenous catheter in cases like this, which the client must pay for.  Once the charges were rung up she took her records and stormed out....to one of our satellite clinics with the same policies and costs!

Another client had called to get her dog in for a routine rabies vaccine.  We had seen this dog a few times over the last year, so it was a normal set-up.  Apparently one of our receptionists made a mistake and accidentally misquoted one of the prices. The owner called up to confirm the appointment, spoke to my office manager, and was told about the mistake.  The person was furious, and began to yell about the situation.  My manager tried to get a word in edgewise and warn the client not to be loud or use that tone.  At one point she even offered to waive the office visit charge as a gesture towards rectifying the mistake.  Instead of taking this the client proceeded to register an official complaint with the practice owners, even saying that the manager was "screaming" at her.  Keep in mind that in over three years of working with this manager I have never heard her raise her voice to anyone in any circumstance and she is very good at client service.

Client's like this aren't just recent.  Many years ago I was doing routine vaccines on a dog and talking to the client.  The dog was well behaved and didn't flinch or react when I gave the shot.  I walked the client to the reception desk and then he suddenly accused me of not giving the vaccine.  I was surprised because he was standing across the table from me when I did it.  I tried to explain that I had used a small needle and it didn't always cause pain, so his dog simply didn't act bothered.  He didn't buy that and continued to press the issue.  I offered to re-vaccinate his dog with him watching at no extra cost, though I warned that this might increase the risk of a reaction.  He didn't want to do that either.  He paid the bill and left, still not seeming to believe that I could give a quick shot without him noticing.

So why am I posting about this?  Believe it or not I'm not trying to rant against stupid clients (at least, not this time).  I'm pointing out to anyone who has been or will be in these situations (vet students and new graduates, I'm looking at you!) that no matter how hard you try or what you do there will always be people that you can't please.  There will always be people that seem to have a chip on their shoulder and are ready to take offense.

Don't let them get to you.

One of the things I've learned in my 16 years in practice is to quickly get over these clients.  I know that the majority of people love us and what we do, so a cranky person here and there doesn't bother me anymore.  In fact, I get a little amused by them.  I wasn't always like this, as earlier in my career I took it personally or as a reflection on me.  Then I realized that the problem was actually with the clients themselves.  Sure, there is always room to improve client service, and I'm always on the lookout for these opportunities.  But some people just refuse to be satisfied.

One of my favorite websites is NotAlwaysRight.com.  I go there every day to see stories of other client/customer nightmares.  It helps give me perspective on my own job to see other people dealing with similar situations in different professions.

So once again advice to those new to the profession.  No matter how nice or good you are, you're going to get displeased clients.  Rather than getting depressed by their actions, recall all of the clients who really appreciate and like you.  The latter will outnumber the former.

If Dr. Seuss Was A Vet

A veterinary friend of mine sent this to me on Facebook and I fell in love with it.  Though I think only those who work in the veterinary field can truly appreciate it, I hope everyone else can see the humor also.  I'm not sure who started this so I can't give credit.


If Dr. Seuss Was A Vet
I won't dispense it, Sam I am,
I won't dispense without exam.

I won't dispense it to your dog,
Although you'll bash me in a blog.

I won't dispense it to your friend,
Who yells at me without an end,

I won't dispense it for the ear,
For the eyes, or for the rear,

I won't dispense it though you yell,
How mean I am the world you'll tell!

I won't dispense it to your cat,
to your bird, or to your rat.

I won't give in--I'm standing tall.
Although you'll whine and cry and call.

I won't dispense it, Sam I am!
You can't have meds without exams!

Dealing With Bored Dogs

Here's a great behavioral question sent from Nicole....

I have a roughly 9 month old border collie x blue heeler. On paper we probably shouldn't have such a breed- we live in a large capital city (Melbourne, Australia) in the inner city with a small block. However, Ted was a rescue pup, came to us very submissive and malnourished and in the 2 months we have had him he his confidence and personality have flourished, he has a thick healthy coat and he has developed into a delightful, confident companion.

I am concerned about what to do with him in the days we both work (usually only 2-3 days a week when we are both out but he is alone 8-10 hours). We walk him twice a day, every day for about 1/2 an hour each time (no matter how cold it is at 7am). He is attending obedience class once a week plus training him for short bursts each day. We stuff a kong with meat and have a treat ball containing kibble that we leave him with (measured amounts to ensure correct quantity). We have been leaving him with a bone 2 days per week but after seeing him strain and pass a small amount of bright red blood with a very hard bony poop we will not be giving him bones anymore- plus I read the posts on bones on your blog after this episode. He doesn't play with any of his toys unless we are there to throw them and on the days he doesn't have a bone to keep him busy he excavates the yard, remodels the outdoor furniture or spends the day trying to break in to the house (as evidenced by the tooth marks on the back door).

Is there anything you can suggest that I can safely leave him with to chew unsupervised (he is a BIG chewer and I have never seen any chewing behaviour that concerns me- he doesn't tend to swallow chunks)? And is there any other hints or tips or toys you can suggest?

Bored dogs are not unusual, especially in certain breeds.  While it may seem a bit silly to discuss boredom in dogs, Nicole has pointed out that this can be a big problem.  Take an active, young dog, give it nothing to do, and wait for the mess.  Dogs need an outlet for their energy and curiosity, and if those outlets aren't provided they will find some way to make it happen.  Unfortunately that tends to be very destructive behaviors, such as digging holes or chewing up things around the house.

One of the first things everyone should do is to understand their breed.  In Nicole's case she has two very energetic breeds mixed together.  Border collies and heelers are bred with a strong instinct to run around and herd.  This is natural behavior for them and results in dogs that tend to be quite active.  As she said, if given a choice a small inner city region is not the best location for such dogs.  However, given that this is a rescue situation we can skip that part as I'm not going to chastise anyone who has provided good health and home to a pet like this.

Obedience classes are a great start and I recommend that for every dog, not just those with behavioral problems.  But that's not going to be enough.  A 30 minute walk twice daily is also not sufficient if this is the only opportunity for exercise.  He is a young dog and comes from energetic breeds.  The idea here is to tire him out.  Basically give him as much exercise as it takes to get him worn out.  Instead of a walk, take him for a jog (assuming that you can do so yourself).  Try to find a park nearby that allows off-leash dogs and teach him to catch a Frisbee or ball.  If you are in an apartment building or have something like that nearby, take him up and down stairs several times.  Get creative, but you need to give him an outlet for that energy.

Okay, now for the chewing.  Kongs are great, so keep doing that.  For a heavy chewer young not going to find many things better, and they make them in various "strengths".  It doesn't sound like standard chew toys and treats are going to last long enough for him, so keep those to a minimum.  Besides the meat you can seal one end, pour cooled chicken broth in it, and freeze it until solid.  Rotate the types of things you put in there.

There are other ways to provide environmental enrichment when you're not home.  Look into puzzle toys.  These are balls, cubes, and so on that have a small opening or two to allow kibble or treats to fall out when the dog moves it a certain way.  The principle is that the dog has to spend time thinking and figuring out how to move it to get the treats out rather than simply chewing something up in a few minutes.  Another thing you can do is to take a cue from what zoos do to keep their animals engaged and active.  Find some areas where you can hide special treats, such as in a hollow stump, under a plastic flower pot, and so on.  Each day before leaving put some treats around the yard in specific places where he doesn't need to dig or be destructive.  He will have to use time and energy to search them out, thus keeping him occupied and have an outlet for his boredom.  Put them in different locations so he doesn't get used to a pattern.

Some of this may improve as he becomes and adult and gets older, but this kind of energy and boredom can be a problem for several years.  If the problem becomes worse, talk to your vet about antianxiety medications, though this should be a last resort and only after he has reached full maturity.

Abandoned After Puppies....Stupid People Part 2

Some people shouldn't be around pets, let alone have them.  Think yesterday's stupid person was bad?  Stick around and read about what I saw today.

This afternoon I saw a very sweet young female Siberian husky.  She weighed 37 pounds and should have weighed closer to 50.  The tips of her ears were missing, mangled, and bloody from suspected attack by another dog.  Her previous owner had let her outside and put her on the streets after she had a litter because the woman "had gotten what she wanted" and "didn't have a use for her anymore".  The dog was wandering the streets for a month before she was picked up by a shelter and identified.  The owner was contacted, which is when she casually admitted that she abandoned her.  She said that she only wanted the puppies so that she could sell them.  The shelter asked about any vaccines and the woman stated "yeah, I have the records but it's too much trouble to bring them to you."  

It's cases like this that make you loose faith in humanity.  Some people see a living creature and only think about what money it can make them.  Now don't get me wrong, I have no problem with livestock and production animals.  But even those should be treated humanely and slaughtered in an appropriate manner.  When it comes to a companion animal and pet I believe that the standard is even higher.  A person who would use a dog to get a litter of puppies and then turn it out on the streets should be strung up and prosecuted to the full extent of the law.

Thankfully there are also people who restore my faith in humanity.

This dog was brought in by a young couple who had seen her online and adopted her yesterday.  They weren't wealthy, but wanted to do everything they could to help her.  And they really meant that.  We did a fecal parasite exam, heartworm test, blood cell count, blood chemistry profile, and a very thorough exam.  Thankfully she was in surprisingly good condition other than a few signs of malnutrition and the wounded ears.  We dewormed her, prescribed antibiotics for her ears (the wounds were older and partially healed, so surgery wasn't indicated), started her on heartworm prevention, and discussed nutrition.  In a few months when she has gained weight and is in better health they are going to have her spayed.

All of this was great.  But what really set the new owners apart was how they handled the situation.  When they found out about the puppies and this situation they contacted the local Animal Control department, who went to the other woman's home and confiscated the puppies.  Those puppies are now being cared for by a local Siberian husky rescue organization.  

People like the dog owner yesterday and the original owner of today's dog make me wish you had to go through a certification process in order to own a pet.  However, what keeps me sane as a vet and makes me want to continue to help people are the clients like this dog's new owners.  They were wonderful, nice people who are truly putting themselves out there to help this dog.  With proper care and TLC I expect her to make a full recovery.  

See, not all clients are complete idiots!

Puppy Stuck During Birth? Let's Wait Until Tomorrow....

I haven't had a good rant about a client in a while, so now seems like a good time.

Today at about 15 minutes until closing one of my assistants takes a phone call and relays it to me.

Client:  "How much is a c-section?"

Assistant:  "I can't really say. It could vary quite a bit depending on the number of puppies and how much care is needed.  What's the concern?"

Client:  "My bitch has had two puppies and the third one is stuck halfway out and backwards.  I can't pull it out."

Assistant:  "M'am, you need to take your dog to the emergency clinic."

Client: "Well, I don't know if I want to spend that kind of money.  What time do you open in the morning?"

Assistant:  "M'am, this is a serious problem.  We close in 15 minutes so you need to take her to the emergency clinic right away."

Client:  "What about [satellite clinic of our practice that closes at the same time we do]?  I'm sure they'll see me tonight.  Is their number [phone number]?"

Assistant:  "Yes, m'am, that's their number but I can promise you that they won't be able to help you tonight either."

Client:  "Well, I'll give them a call." *click*

Really????  Your dog is in active labor with a stuck, backwards puppy, and not only do you not want to go to the emergency clinic, but you're wanting to know when we open the next day and maybe bring her in then?  REALLY?????

Some pet owners are simply stupid.  Yes, I said it.  Some people have no business owning pets and they are blatantly stupid.  Surprised to hear a vet be that blunt?  Believe me, every vet has clients like that and are frustrated by interactions like I described above.  Ignorance we can fix.  In fact, I really enjoy it when a client has genuine questions and wants to learn.  A client seeking knowledge is a joy, as they really want to learn more about keeping their pets healthy.  But some people are so lost in their stupidity and carelessness that we can't pull them out of it.

And this woman was breeding?  She had a pregnant dog and didn't have the concern to take it to an emergency clinic and deal with a life-threatening situation?  While I'm normally against too much government regulation and involvement in personal affairs, people like this woman really make me tempted to support movements to require a license for breeding.

This is the part of veterinary medicine that clients normally don't realize.  It's not just about healing pets, it's also about dealing with irresponsibility and stupidity from people.  Illustrating these daily situations of being a vet is a large part of why I started this blog.

Sgt. Stubby, An American Hero

My father sent me an email about this a couple of months ago and I thought this would be a great time to post it since America's Independence Day is tomorrow (or today by the time many read this).  I'm very patriotic about my country, especially with an immigrant for a father.  Even though I don't like everything out government does, I still love being an American.  On Independence Day we celebrate the start of the USA and all of the struggles we have been through.  We also celebrate those who fought to keep our country free.  So what better way for a veterinarian to celebrate July 4th than to highlight a dog hero?

The following text is from the email, and it has been passed around many times, so I can't give credit to whoever wrote the words or took the photos.  Read and enjoy, remembering that our four-legged friends can be heroes and serve our country as well as the humans in the military.

 

Meet America 's first war dog, a stray Pit Bull/Terrier mix, named Stubby. He became Sgt. Stubby, was the most decorated war dog of World War I and the only dog to be promoted to sergeant through combat.

One day he appeared at Yale Field in New Haven, Connecticut; while a group of soldiers were training, stopping to make friends with soldiers as they drilled. One soldier, Corporal Robert Conroy, developed a fondness for the dog. He named him Stubby because of his short legs. When it became time for the outfit to ship out, Conroy hid Stubby on board the troop ship.  To keep the dog, the private taught him to salute his commanding officers warming their hearts to him.

Stubby served with the 102nd Infantry, 26th (Yankee) Division in the trenches in France for 18 months and participated in four offensives and some 18 battles. The loud noise of the bombs and gun fire did not bother him. He was never content to just stay in the trenches but eagerly went out, searched and found wounded soldiers. 

Stubby entered combat on February 5, 1918 at Chemin Des Dames, north of Soissons, and was under constant fire, day and night for over a month. In April 1918, during a raid to take Schieprey, Stubby was wounded in the foreleg by the retreating Germans throwing hand grenades. He was sent to the rear for convalescence, and as he had done on the front was able to improve morale. When he recovered from his wounds, Stubby returned to the trenches. 

After being gassed and nearly dying himself, Stubby learned to warn his unit of poison gas attacks, continued to locate wounded soldiers in no man's land, and since he could hear the whine of incoming artillery shells before humans could, he became very adept at letting his unit know when to duck for cover. 

He was solely responsible for capturing a German spy in the Argonne. The spy made the mistake of speaking German to him when they were alone. Stubby knew he was no ally and attacked him biting and holding on to him by the seat of his pants until his comrades could secure him. 

Following the retaking of Chateau-Thierry by the US, the thankful women of the town made Stubby a chamois coat on which were pinned his many medals. There is also a legend that while in Paris with Corporal Conroy, Stubby saved a young girl from being hit by a car. A t the end of the war, Conroy smuggled Stubby home. 

After returning home, Stubby became a celebrity and marched in and normally led, many parades across the country. He met Presidents Woodrow Wilson, Calvin Coolidge, and Warren G. Harding. Starting in 1921, he attended Georgetown University Law Center with Conroy, and became the Georgetown Hoyas' team mascot. He would be given the football at halftime and would nudge the ball around the field to the amusement of the fans. 

Stubby was made a life member of the American Legion, the Red Cross and the YMCA.  In 1921, the Humane Education Society awarded him a special gold metal for his service to his country.  The medal was presented by General John Pershing. 

In 1926, Stubby died in Conroy's arms. His remains are featured in "The Price of Freedom: Americans at War" exhibit at the Smithsonian in Washington DC. Stubby was honored with a brick in the Walk of Honor at the United States World War I monument, Liberty Memorial, in Kansas City at a ceremony held on Armistice Day, November 11, 2006.

No Eyes? No Problem!

A couple of weeks ago I blogged about Diesel, a Siberian husky whose eyes I had to surgically remove due to uncontrolled glaucoma.  Last week I saw him for his final post-operative follow-up visit, and he is doing absolutely great.

He was wagging his tail and giving us kisses, obviously very happy with life.  His incision healed perfectly and he had no post-operative complications.  The owners said he was perfectly content at home and was taking stairs without stumbling or running into things.  They were surprised at how well he was maneuvering their home and were preparing to start taking him for walks around the neighborhood again.  One of their initial concerns was that he would be more cranky and nippy towards their young children, even though he was extremely docile beforehand.  But his personality never changed and he acted just as sweet after the surgery as before.

The owners are extremely happy with the procedure and his outcome.  He is no longer in pain and they don't have to put multiple medications in his eyes several times per day.  He can now go on to live a normal life as he is healthy in every other way.  The owners have their dog back with just a few missing eyes. They are very grateful that we were able to help him and that he is doing so well.

Being a veterinarian can be an extremely frustrating, draining job.  Every day we have to deal with clients that  refuse our recommendations, argue with us over costs, or simply don't want to do what's best for their pet.  We see pets and their owners suffer because they can't afford necessary treatment even though they want to.  We watch pets die and help people let go of their best friends.  I face bodily harm literally every day I'm at work as we always have dogs and cats that want to scratch or bite us.  The money isn't great for the amount of education and debt we have.

So why do it?

Because of cases like Diesel.

Here we had owners that really wanted to help their pet and followed all recommendations, even when it was frustrating giving all of the medications and they questioned if it was really necessary.  Spending the money on specialists and surgery wasn't easy on their budget, but they found a way to do it.  The dog was super-sweet, we got to do a very cool (to us) procedure, and he recovered perfectly.  This was one of the most rewarding cases I've had in a long time.  The pet was suffering and we were able to help the entire family.  Yes, it was radical surgery, but it made such a positive difference in his life and his humans that it was all worth it.  Writing about him makes me smile, and I know we'll be seeing him for years to come.

This is what being a vet is all about.