Some Things Can't Be Unseen

You never know what you're going to encounter and see walking into an exam room.

This afternoon I had a routine exam on a dog and a rabies vaccine.  My assistant went in, talked them into a heartworm test and and prevention, then came out to update me on the case.  She warned me that the client was breast-feeding in the room, something I've encountered from time-to-time.  So I gave it a couple of minutes before going in so the woman could finish.

When I walk in the room their baby is lying on the exam table getting his diaper change while the dog is sitting on the floor.  The parents are both there and mom is doing the change while dad is helping.  Definitely not a sight I was expecting!  Especially since I could tell pretty quickly that they had a boy and he was uncircumcised.  Did I really need to know that?

Being the professional that I am, and having children of my own, I didn't make a big deal about it and for the most part ignored the dirty diaper, concentrating on talking to them about their dog.  I made a joke about the dangers of changing boys but overall went on with the visit.  Their son started to cry and be fussy so mom said that he was probably still hungry.

Remember the whole thing about breast-feeding?  Yeah.  Let me also mention that the woman was not exactly tiny and had a rather ample chest.

Sitting on the bench in the room she pulls up her shirt and bra, her left breast spilling out for all the world to see.  Unfortunately that world included me as well as her husband.  I had a rather graphic view of the entirety of her breast and all of the details.  She started to adjust herself and her baby until he was latching on.  During the rest of the conversation she continued to feed him right there in the open, periodically having to shift herself or him on her nipple.

Please understand that I am not a prude, have no problems with the human body, and find breast-feeding very natural.  However, I think there are appropriate places and times to do it.  In an vet's exam room is NOT the time or place, especially when this is your first time meeting him!  I spent a LOT of time focusing on the husband and directing my comments at him, even though neither of them seemed phased by the events.

Was I uncomfortable?  Heck, yes, and it was a very awkward situation for me. I most certainly did not want to see their baby's genitalia or the size of the mother's areola.  But I think I handled myself well and hid my discomfort.

Yes, these kinds of things really do happen to veterinarians.

Pets As Romance-Killers

I've been married for 14 years and have two children, so it should come as no surprise that my wife and I can be....intimate.  Sometimes it's just lying on the bed talking or kissing, but sometimes it turns into more.  No, this isn't a blog about my "relations" with my spouse.  Rather, it's about how pets can ruin the mood.

We have two large dogs and three cats.  All of these pets have full run of the house and will sleep on the bed.  We have a queen-sized bed, so there isn't a ton of room when both of us are lying there.  Even besides the lack of space, the pets can sometimes interfere with our plans.  A dog will jump on the bed, trying to take a nap.  Another dog will peek her head up to see what all of the fuss is about.  A noise will cause them to start whining at the closed bedroom door.  Two cats will start to growl or fight under the bead.  One cat will decide that our hips are a good resting place.  Or the kitten will think that the feet moving under the covers is the perfect object upon which to practice his pouncing.

Yes, all of these things have happened to us.  And all of them have caused distractions, forcing us to push a pet off, yell at the dog, or otherwise break the "moment".  It has gotten to the point where we'll not only make sure that the kids are out of the house or asleep, but we'll kick the pets out of the bedroom!

And I am absolutely certain that virtually every pet owner has had the same or similar things happen to them.

Pets are wonderful and I couldn't live without them, but sometimes they're not exactly the best things to have around when you're trying to be romantic.

Veterinary Geekiness

Sometimes I can be such a geek about veterinary medicine and get excited about things that would make other people just scratch their head. 

Today I received a rodent dental pack.  Previously we had been using other instruments to file down or trim the teeth of guinea pigs, rabbits, and hamsters because we didn't see enough of them the justify $270 in specialized instruments.  You can get by with other tools, but it's so much easier with mouth gags, cheek spreaders, and rasps specifically designed for small rodents.  Business has been picking up with these cases enough that we made the investment.  When it arrived today it was like Christmas!  I opened it and was going through the instruments with a big grin on my face, telling everyone what each one was for.  I was actually dancing a bit and was quite giddy!  That may seem like something silly to be so happy about, but it's interesting for me and as cool as a new Star Wars toy.  Well, almost.

I remember several years ago when I diagnosed demodex mites on a hamster.  I had never heard of this up to that point and had to run to my text to make sure I had made the right diagnosis.  Sure enough, they could get those mites though it was uncommon.  I was so excited and telling everyone on the staff about it!  Many of us become equally excited about lancing abscesses or other things related to the field.

I'm sure everyone has things like this happen in their own professions.  Maybe a lawyer gets happy about a new legal precedent.  Perhaps a mechanic does a happy dance when a new set of tools arrives.  A computer programmer probably grins when a new type of software comes out and can't wait to dig into it.  When you're interested enough in a subject to pursue it as a career you tend to be easily impressed and amused by things that make other people simply shake their heads.

You're Nothing Without Client Service

When I was still in vet school I remember reading a survey that was done of existing practice-owners.  The surveyors asked what they looked for when they hired a new associate.  Absolute bottom of the list of responses was "knowledge of the profession."  Top of the list?  "Interpersonal skills."  This is a truth that has only grown more solid in my mind after 15 years in practice.

Years ago a vet in my community suddenly died.  I had heard his name but never knew him.  After his death his clients started going to other area vets, including my own practice.  I quickly started seeing major issues with this patients, as well as the fact that he never kept written records, practiced out of his garage, and many other rather scary things.  If he had been alive I would have very seriously reported him to the state veterinary board.  Despite the fact that he was breaking several practice laws and was guilty of malpractice, people loved him.  He was friendly and had great communication skills.  In fact, at one point there was serious talk of erecting a statue to him!

One of my associates is an incredible clinician with virtually encyclopedic knowledge of veterinary medicine.  I would trust her with my own pets' lives and usually wonder why she consults with me on some cases because she's generally right.  However, she is not the best communicator and doesn't always come across well to people.  Because of this some clients prefer to see me over her.

Why bring this up?  I attended a seminar today on how client experiences affect their perception of a vet's medicine, and therefore their attitude towards the practice.  All of this influences whether or not they come back to that clinic and what kind of reputation or "brand" that clinic develops.  I can't say that anything was really eye-opening, but it did help reinforce what I had personally seen over the years.  I also picked up some good techniques and hints on how to do better.

I think most people understand the need for good customer or client service.  They certainly know when they've had good or bad service, and will make decisions based on that service. Most people who receive poor service never complain, they just go somewhere else.  In today's economy, that can be disastrous, especially for a veterinarian.

I know I have many veterinary students who read this blog so take this as advice.  No client or employer is going to ask for your GPA or transcript from school.  However, they are going to pay attention to how well you communicate and interact with people.  More importantly, your clients are going to pay more attention to how you treat them than what technique you use to spay their cat.  Develop your social skills as much as you do your medical ones and you'll succeed as a vet.

When It's Your Own

Being a vet can be interesting and rewarding, though it's hard work and not for everyone.  Often cases aren't easy and you struggle to come to a diagnosis and choose the right treatment.  But the worst cases are when it's your own pet.

Long-time readers (and newer readers who have powerful search-fu) can remember cases where I've had to diagnose and euthanize my own dog, as well as do surgical procedures on my pets.  Being a vet in these situations is a mixed bag.  On one hand I don't want to give the responsibility of care to another vet, even though I fully trust my associates.  On the other hand you don't have the objectivity with your own pets that you will with client-owned animals and in a crisis situation can be too emotionally involved.

Earlier this week I neutered my kitten, Pippin, and did a dental cleaning on my dog, Inara.  Both were routine procedures and I've become used to seeing my own pets under anesthesia.  Neither procedure was difficult for me to handle since I've seen so many of these cases over the years and have done thousands of anesthestic procedures.  I've spayed and neutered most of my own pets.  Though I know staff and veterinarians who can't even be working on a day when their own pet is having this happen, it isn't something that has ever bothered me. 

However, Pippin started vomiting yesterday and I've been worried about him.  Intense periodic vomiting, dry-heaving, and a decreased appetite.  This is something that I can't handle well.  Of course my mind runs through the various scenarios and possibilities, quickly jumping to a risk of a gastrointestinal foreign body (he gets into everything).  Money is tight and even with my discounts a major surgery would be a big burden, plus there is the risk involved (see my recent post on GI surgeries).  I spent last night and all day today fretting over him.  I examined him at home and he seemed okay, and he's been acting normal otherwise.  But I've still been tied up with worry.  Thankfully I talked to my wife earlier and he seems to be doing much better.  He does have a habit of getting into dishes in the sink more than any of our other cats, and I'm suspecting that he merely had an upset stomach.

One of the greatest skills that doctors develop is the ability to remain somewhat clinically detached.  We need to be able to approach our cases from the perspective of the best diagnostic, medical, and surgical decisions, and maintain a calm emotional state.  Though we obviously still want to feel compassion and empathy, the job is much easier and we do better if we're not as emotionally involved.  That becomes almost impossible when the patient is one of your own pets.  And I completely understand my colleagues who can't work on their own animals.

Lack Of Problems Doesn't Make It Right

The week before last I received an email from Paul, responding to my comments on a recent post about table food for dogs.  Here are some snippets from his letter.

I liked this post -  it spoke to me.  For 19 years I had a border collie – a wonderful healthy and active dog all his life; dying of old age coming up to his 19 birthday – missing the day by a week.  This border collie drank – a pint of milk a day – diluted with water – sometimes with osterfeed thrown in for good measure (my brother was an infant and ends of his formula feed was sometimes added to the water and milk mix that my collie loved).  Never a problem – he never was sick after drinking it and although he also had a bowl of water always he rarely drank much of it.  He ate raw marrow bones regularly – several a week.  He got scraps from the table – only what we knew was not harmful – mixed with porridge, brown  bread,  potatoes, left over meat from meals (steak, chicken, liver, mince etc), cooked vegetables (his were always taken out before salting)  – mainly turnip, cabbage and carrots – he hated peas and parsnip!! – so he didn’t get those.  He had an egg every day and either braised chicken breasts or cooked offal  all in this mix.  He also got a bonio or two every day and every week  “bob martins – vitamin supplements”.  This dog had wonderful energy, fantastic coat and was never sick..........I am not saying I disagree with you with regard to feeding a dog non commercial dog  food (quite the opposite - animals need to be fed properly - correct quantities and right kind of stuff)  but I can understand where your original poster is coming from........As I say this dog lived to be 19 years old (well missing it by one week)and died of old age.  My dogs are now fed high end commercial foods - science plan - but the oldest they have lived to have been 11 and 12 - and that was with health issues a year or two before they died. So I can really understand where your poster Liz is coming from with her question - and while I agree with you that lots of people smoke and don't die of cancer - I have not come across many dogs living long and healthy lives - with no health issues like my collie did.

This is actually a great point for discussion as it addresses a situation I commonly deal with in all aspects of medicine.  I often get clients who think and even say "Well, I've never done it that way and my dog/cat has always been healthy."  I've had clients virtually gloat when their dogs come up negative on their annual heartworm test despite not being on preventatives.  There have been similar responses from people who have only ever had their dogs get rabies and have never seen them get sick from parvo.

Unfortunately people often assume that if the do things (or don't to things) a certain way and nothing bad happens it means that they're doing the right thing.  This couldn't be farther from the truth.  A similar situation would be have someone walk across a four-lane major highway, making it to the other side without injury.  Since they performed this task and weren't run over by a car or truck, they can conclude that it's safe to walk across highways.  Right?  Obviously not.  But that's the kind of logic some people are employing in regards to their pets. Just because someone isn't killed going across a highway doesn't mean it's safe.  And just because someone's dog doesn't get heartworms when they decline prevention doesn't mean that it's the right thing to do.

Heartworms really do infect pets and kill them.  People food and table scraps really do cause pancreatitis and gastrointestinal distress.  Home-cooked food really can be an unbalanced diet.  Parvo really does kill dogs.  All of the things we veterinarians try to talk to clients about really are intended to let pets live longer and healthier.  Discard and ignore our advice at your own peril.

Thinking Appointments Are Optional

One of the things that annoys veterinarians the most is when people seem to think that their appointment times are optional.  Virtually every day we have people come in for their appointment early, late, or not at all.  When I'm talking about early/late, I'm not talking a few minutes.  I'm talking about an hour or more!  It gets really bad when you have an appointment show up an hour late, one show up an hour early, and the appointments scheduled for that time are also there.  Yes, this happens!

It's not like we don't try on our end.  We have set appointment times that allow us to space things out, allowing us to have time to do each appointment, drop-off patients, surgeries, and the walk-ins that inevitably show up.  Our receptionists are trained to work the schedule for the client's benefit, but also for ours.  We give them a reminder card if they make the appointment in-person, and then the day before the appointment we call to confirm the appointment time and if they are actually coming in.  Even with all of this we have clients that seem to come in or not come in at their leisure.  What is really bad is the occasional client who then complains because we don't get to them right away even though it's not technically their appointment time.

One of our clinic policies is that we will get just about anyone in the same day they call, though they may have to drop their pet off and allow us to work it in between other appointments.  But these are last-minute calls usually for sick pets that we don't want waiting.  I'm okay with these appointments and am glad to offer them.  That's different than the routine cases that I'm talking about.

No, we don't charge people for these missed appointments, though I have colleagues who do.  I don't think that the precedent is there and the economy is tough enough on vets.  But I've been tempted, as a missed appointment has taken that slot away from someone who might have actually shown up on time.  We DO charge for missed surgeries because those appointments are more limited each day.  And we'll sometimes force a client to reschedule if they come in late and we're busy with other procedures or patients.  But regardless of whether or not there is a charge, I think it often comes down to a lack of courtesy on the part of the client.  Yes, there are sometimes extenuating circumstances or the client legitimately forgets.  But most don't fall into this category.

Let me make a plea to all pet owners on behalf of all veterinarians.  Please be there on time for your appointments.  If you're going to be more than a few minutes late or have decided to not come in, please call and let us know that.  We don't mind you being early, but try not to be too early, and have patience if we make you wait until your scheduled time.  Things are much smoother for everyone involved if appointments are kept.  We schedule them for a reason.