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The Humble Feline

November 26, 2014 By: Dr. K Category: Opinion

A few weeks ago I examined a friendly indoor only cat for a several day history of not eating and vomiting. My examination didn’t reveal much of what might be causing her maladies, so I recommended we start with some laboratory work. Her owner’s reply left me speechless.

“This might make me sound like a jerk….” Uh oh. Experience told me that “might” is a great qualifier for “will” and I waited to hear what came next. “Well, you see, she’s a cat. I just don’t want to spend a lot of money on her, you know? I mean, if it were my dogs I would spend anything but, you know. Boy, you must think I sound like a jerk.”

Well, yes, kinda definitely.

So why the disconnect? Why is it that time and time again it seems dogs owners are much more willing to pursue veterinary care than cat owners? It’s not that Americans don’t love their cats – quite the opposite when you look at overall pet numbers and spending. Cats outnumber dogs in the United States by about 5,000,000 but are seen at the veterinarian about half as frequently. In addition, in 2012 the mean household veterinary expenditure per animal was $90/cat and $227/dog. Is feline veterinary care less expensive? Of course not.  Perception of dogs as “man’s best friend” and cats as “independent” definitely plays a role.

Below are a few myths surrounding felines. Feel free to add others in the comment section!

Myth #1. Cats are aloof and uncaring

My cats show me they care by saving intimate moments like bath time and anus exposure to quiet times on my lap while I am engaging in a desirable television watching activity. Nothing says they care more than the way like crush my cooking magazines under their fuzzy butts to prevent me from making that award winning chocolate lava mountain fountain cake and wrecking my diet. And believe me, the way they make sure to find the area rug with their projectile pica-driven dirt-ridden vomit is the definition of “I don’t want you to have to mop the hardwood because you just did it yesterday.” They care.

Ok, ok. I can attest my cats do not behave like Retrievers. While Miss Pigglesworth certainly eats like a Labrador, neither of my cats are people pleasers. They snuggle, use me for their grooming and petting needs, even mooch body heat on cold nights. Mine, like most cats, aren’t wired with the desire to please the way dogs are and, thus, the perception cold calculating murderers was born.

The truth is, cats do show affection through slow blinks, rubbing against your legs, cuddling, and playing. They don’t tend to fawn all over their owners. For me, that’s a plus. With a toddler tugging at my leg and the daily routine bogging me down, the last thing I need is an attention grubbing never-satiated dog under foot, or worse, tugging at my other leg.

Myth #2: Cats have superpowers

My cats think they have superpowers. Any self-respecting feline does. This is evident when a poorly executed furniture leap results in paw licking and coolness like it never even happened. But you know what power they don’t have? The power to keep themselves healthy and lick their wounds clean. C’Mon people! Do you REALLY believe cats have clean mouths and that licking wounds is the way a cat can “take care of itself?” I suppose if I cut my finger badly and it abscessed, I would just spit in the wound and gimp around for weeks until it scarred or I died from sepsis – whatever came first. Afterall, denial and deliberation makes more sense than seeking medical care, right?

For intelligent minds, the idea that any animal can care for itself when it is seriously ill is absurd and they seek veterinary care when kitty gets sick. Others really believe cats do not need veterinary care because…well…errrr…I have no idea why they think that. Cats are not self-healing magicians. If cat owners sought veterinary care when it was warranted, the mean annual expenditure would more closely match dogs.

(Aside: Many cats are part of multi-cat households. Some are part of multi-multi cat households – if you get me, crazy cat people.  Finances come into play when cat owner’s have to spread the care over multiple cats. My experience is when more than 3 cats live in a house at once: A cat is going to have lower urinary tract problems, another cat is peeing on the carpet somewhere, and someone always has upper respiratory tract signs. Crazy cat folk have a hard time keeping up with maintenance of the clowder, so many stop seeking veterinary care regularly to cut costs.)

Myth #3: Indoor Cats Don’t Need Vaccinated

1. Cats are the most common domestic animal in the United States diagnosed with Rabies.  An unvaccinated indoor cat that either escapes outside or is exposed to a rabid bat in the home is at risk and puts the owner’s life at risk. A cat or a human can be bitten by a bat and you may not be able to tell! Why risk it? Rabies kills!

2. The “Distemper” vaccine for cats, more accurately known at the FVRCP vaccine, prevents a fatal virus called Panleukopenia. In addition, even for cats who never go outside, the vaccine suppresses feline herpes virus infections from the 99.99% of cats who have been exposed and possibly carry the virus in a chronic state.

You might be wondering about that cat from the beginning of the post. Her owner consented to lab work and declined radiographs. The labs were normal and I sent her home on a cocktail of gastroprotective medications. I’ve received no updates and can only assume she tapped into her superpowers.

Another Veterinary Suicide Shines Light Into Dark Corner

October 06, 2014 By: Dr. K Category: Opinion

In the past week, the veterinary world lost another colleague to a brilliant mind, Dr. Sophia Yin, to suicide. Another high profile death shines the light in to the dark corner of the veterinary field the public knows little about; This profession can chew you and spit you out without flinching. Constant suffering, acting as the angel of death, and dealing with the owner economics in caring for a living being all press down firmly on our souls. Those more prone to depression can sink to the depths easily, without hope of rising above the clouds.

This article from Claws Carefully Sheathed highlights that weight we vets feel on a daily basis.

 

Other Useful Links:

Veterinary Suicide Rates

Burnout and Depression in the veterinary profession

Check out my previous post about Burnout that was published in Veterinary Economics.

 

I don’t have the answers, but I sure have a lot of questions and concerns.

Guest Column: Helping Your Veterinary Practice Navigate the ACA

September 13, 2014 By: Dr. K Category: For Vets, Practice Management

The Affordable Care Act affects many veterinary practice owners and it’s vitally important to stay abreast of new laws. In particular, mandates for insurance coverage and the advent of the health insurance exchanges have muddied the waters of understanding. Below a guest columnist, Monica Maxwell, SPHR, discusses the appropriate steps in navigating the ACA mandates.

Overcoming the uncertainty: Implementing a health care plan in a veterinary clinic
By Monica Maxwell, SPHR

Many veterinary practice managers, like managers in other industries, are looking at the changes brought about by health care reform and are uncertain about how best to implement a health plan for their employees. You probably didn’t enter the veterinary business because you are particularly interested in learning about health insurance, but you do care about your employees’ well-being, and you no doubt also know that health benefits are a great recruiting and retention tool.

So how do you go about finding a plan that meets the needs of both your employees and your business?

First, talk to your staff members and find out what is important to them. What if they don’t want healthcare? Or they prefer an option that will allow them to gain access to alternative care (like acupuncture). You cannot please everyone, but at least you’ll get an idea of people’s actual priorities rather than simply making assumptions. Also, if you have fewer than 50 employees, note that sometimes individuals can find less expensive or better-value plans on a health insurance exchange than a small clinic can offer its employees. The Affordable Care Act allows for companies with fewer than 50 employees to offer insurance on the health insurance exchange without penalty. It is a viable option for many, so you might want to consider referring them to an exchange if that makes the most sense.

After you have a clear idea of your employees’ needs, you’ll want to find a good health insurance broker. Chances are you don’t have the time or expertise to dig into the details of all the plan options and keep track of changing regulations. Choosing a broker is an important decision, so take the time to conduct a thorough search and interview process. Trust and rapport are critical. Ask potential brokers about trends they’re seeing in the industry and how those trends might affect a business of your size. Talk about the renewal process, communication styles, what you need from each other and how you see each other’s roles. Make sure your broker understands your needs and is willing to have a strategic discussion when it’s time to change your plan. They should be knowledgeable and flexible with you on the changing trends.

Once you choose a health care plan, make sure the company provides the service you require and expect. The network of health care providers (and the quality of care, of course) is important, but don’t underestimate the value of customer service. Quick answers to questions and timely payment of claims reduce administrative headaches and save everyone time and money. Benefits are important and ensuring your staff feels good about the quality and service they receive is absolutely critical.

Choosing a health care plan may feel daunting, but it doesn’t need to be overwhelming, and it’s not just a bureaucratic chore. A health benefit that helps keep your employees healthy and happy will contribute to your ability to attract and retain the best staff members, thus furthering your practice’s goal of providing exceptional care and service.

Porter & MM

Monica Maxwell is the program director for On the Floor @Dove, DoveLewis’s online, on-demand training website for veterinary professionals. Maxwell graduated from Sam Houston State University with a Bachelor of Science in psychology, and she has nearly 15 years of experience at both for-profit and nonprofit organizations. She shares her expertise with other veterinary practices through On the Floor @Dove.

Why Does My Vet Do That?

September 05, 2014 By: Dr. K Category: Opinion

As the years tick it’s easy to become a slave to routine. We do our jobs daily and soon a routine is formed. Over time I’ve become more engrained in my practice, adhere to the routine, and forget that many clients don’t understand why we vets do what we do during the course of an appointment! Wonder no more! I’ve compiled an explanation of some of the actions that may stupefy pet owners.

If I tell my vet my dog’s paw hurts, why does she look in his mouth?

Our critical listening skills are attuned, trust us! A thorough examination of every pet presenting with a problem is necessary to achieve a proper diagnosis. Did you know that a lethargic dog could have pale gums from internal bleeding or even red speckled gums from a platelet issue? Did you know we can look for jaundice in the gums and the whites of the eyes? I often reserve the “sore” limb for last so as to not develop a bias in my physical exam findings.

Why do they take my pet to the back for blood draws?

While some practitioners are comfortable and willing to draw blood in the examination room, oftentimes technicians and veterinarians will take your pet to the central treatment area for lab work. There are a few reasons for this. First, spare staff is typically roaming about and are readily available to provide an extra hand. Second, supplies and lighting are oftentimes better in the treatment area. Last, the techniques used to draw blood from domestic pets are not for the faint of heart. Typically, blood is drawn from the jugular vein when a larger sample is needed. I’ve been on the receiving end of a line-backer-sized man slumping down the wall in the examination room just from a peek at the syringe.

Why do they restrain my cat or dog even when he’s behaving?

For the safety of everyone in the room! My general rule of thumb is that if the animal has teeth he can bite, regardless of previous behavior. Pets in pain function on instinct and act accordingly. Proper animal restraint techniques can be misunderstood as being too “rough” or “hurting” the pet when in actuality handling techniques keep pets and staff safe during exams, vaccines, and blood draws.

Why does my vet require an examination for vaccinations?

Best medical practice means ensuring our patients are the healthiest they can be prior to receiving a vaccination. For vaccinations to reach full effect, the animal must be systemically healthy. We assess animals for signs of infection, disease, and fever. Giving a vaccination to a sick animal could be immunologically like not giving a vaccination at all. In addition, vaccinating a sick animal has the potential of exacerbating the disease – something none of us wants to see!

Why does my vet care so much about poop?

Your veterinary practice asks you to bring a stool sample to every annual examination but is it really necessary? YES! Dogs and cats, even indoor ones, can pick up intestinal parasites from a variety of locations including dog parks, walking trails, wild animals, consumption of wild animals, and insects. And did you know that tapeworms and roundworms can infect people? Hookworms can burrow in your skin! Veterinarians represent the front lines of public health and checking your animal for parasites protects both him and you!

Cutaneous Larval Migrans from Hookworms

Have wonderings? Ask in the comment section.

Is Your Vet Any Good?

July 13, 2014 By: Dr. K Category: Opinion

You’ve found a veterinarian who jives with your personality but wonder – Is she competent at providing the best care possible for your pet? There’s more than one way to practice veterinary medicine and provide good care. Then there are some practices that fail at the basics. I’ve assembled a non-exclusive list of what to look for to assure your practice meets the standard of care and a few red flags that tell you to take your business elsewhere.

Standard of Care

Cleanliness. All veterinary practices can have that odor from time to time, but it should not look dirty. If they can’t keep the waiting room clean, what do you think the surgery suite looks like?

Vaccinations. The widely accepted core vaccinations for dogs include Rabies and Distemper/Adenovirus/Parainfluenza/Parvovirus. Leptospirosis vaccines are part of the core dependent on where you live. Lyme and Bordetella vaccines are dependent on the individual’s risk factor and should not be administered to every patient. Core cat vaccinations include Rabies, Feline Viral Rhinotracheitis/Calicivirus/Panleukopenia, and for kittens, Feline Leukemia vaccine. The leukemia vaccine is only given to adult cats who go outdoors. Vaccination schedules are variable based on the individual states law regarding Rabies vaccination. Is your vet offering a Giardia vaccine? Coronavirus vaccine? FIV vaccine? Think again as these vaccines are recommended against by the AVMA and AAHA.

Stool samples, Heartworm, and Flea/Tick prevention. Your veterinary hospital’s job is to ensure you and your pet stay healthy. Proper parasite prevention is crucial, as a number of intestinal parasites are communicable to humans and disease carrying ticks can hitch a ride indoors on your pet. All pets should have routine screenings and preventatives they protect the pet and public health.

Pain management. If your new practice does not offer pain management with surgical procedures you need to find a new practice. The absence of pain management is barbaric and antiquated and shows the veterinary office is not following current guidelines and recommendations from governing bodies such as the AVMA and AAHA.

In-house diagnostics. Well functioning veterinary hospitals can perform radiographs and basic blood work and can easily acquire needle samples of lumps and bumps. I heard of one veterinary practice that does not perform fine needle aspirates of lumps and instead refers all of them. It takes very little skill to collect a sample, therefore even if your vet doesn’t read them herself, submitting the sample to the pathologist is the only other reasonable approach.  In addition, ear cytologies, skin cytologies, and urinalysis round out the list of diagnostics I expect all veterinary practices to perform.

Referral. Will your vet refer you to a specialist when it’s warranted? Referring complex cases for a more comprehensive work-up after you have exhausted their diagnostics is always in the patient’s best interest. Lack of referral reveals either an ego or financial issue.

Red Flags

Mean or disgruntled front-desk staff. My experience has shown that the receptionist staff is the canary in the coalmine for the temperature of the practice. If the front desk is unwelcoming and unaccommodating when you come in, it spells T-R-O-U-B-L-E with the rest of the staff.

Mean or disgruntled veterinarian. Sometimes we have a bad day but part of our job is to turn on our happy face with every appointment. If a vet can’t fake it for a 15 minute appointment block, we don’t deserve your business.

Hospitalization of patients overnight without supervision. This is tricky if you’re live in a rural area with no other options. However, I can attest  animals hospitalized overnight for “medical care” with no staff frequently experience the following complications: laying in urine/feces overnight, occlusion of intravenous fluids, and chewing out incisions and IV catheters with subsequent bleeding. Rarely animals with IV fluid lines can strangle themselves. If there is a referral or emergency hospital nearby, your pet will have more comfort and safety with a transfer to a 24 hour care facility.  If your pet will stay at a hospital that is unsupervised overnight, it is a veterinary hospital’s duty to alert you to the risks associated with doing so.

None of the exam is performed in an exam room. This goes two ways for me: 1. I know of a practice where all exams and conversations are performed in the waiting room while you are surrounded by other clients with their animals. 2. I know of multiple practices that take the pet to “the back” and return the pet when finished. Both of these scenarios are wrong. A thorough examination should be performed in front of the owner in a private exam room. This allows for conversation, follow-up questions, and peace of mind. The rare exception are dogs and cats who are so scared and aggressive that separation from their owner helps calm them.  All of this said, it is important to note that it is very normal for pets to be taken to “the back” for blood draws and, sometimes, nail trims. Frankly, our extra supplies and staff are there if needed.

Frequent misdiagnosis. We all miss a diagnosis from time to time. We have surgeries that don’t heal properly, swellings that shouldn’t be there, and treatments that don’t work. But if your veterinarian has repeatedly incorrectly diagnosed a common disease process you can rest assured the quality of medicine she is practicing is poor. Reference material, continuing education, and other veterinarians are great resources for any veterinarian. There are plenty of ways to reach an appropriate diagnosis even including the aforementioned referral to the specialist.

If your veterinarian meets the basics and no red flags have alerted, feel confident that you can have a good relationship with your veterinary hospital.

Cat Hero, Dog Menace

May 19, 2014 By: Dr. K Category: Opinion

The brave cat, Tara, blew up in the internet last week when a video surfaced of her attacking a dog that was attacking her owner’s child.

It. Is. Epic.

This video solidifies two things for me:

1. Cats are awesome. They tend to get labeled as aloof, indifferent creatures. Cat lovers know their cats have very individual personalities and love differently than dogs. Now the interwebz has proof that cats, really and truly, have deep affection and allegiance to their owners.

2. The dog is a menace. I have seen many social media posts from dog loving persons who bleat, “Blame the owner, not the dog!”

It is true this dog should never have left his yard and the owner will certainly be fined for “dog at large” and a litany of other offenses. It is highly unclear, unlike what you might read from animal activists, whether or not this dog has ever been mistreated leading to this behavior. When dogs act aggressively the owners are often blamed and for good reason. Many of the behavioral issues in our pets are directly related to how they are treated and trained. Yet, there are a small number of dogs who are unsocial-able and naturally aggressive. There exist breeds that are known to have a higher tendency to bite (and pit bulls aren’t on my list). Given he was reported as part Chow Chow, a distant and oft-times aggressive breed, it’s no surprise he would attack unprovoked.

Regardless of the owner’s responsibility in this dog’s behavior, the dog clearly stalks this child and attacks him completely unprovoked. I cut many dogs a break when children are tugging at them, jumping on them, or they attack our of fear during entrapment. That’s not the case with this dog. He poses a major threat.

My golden rule for aggressive dogs is this: He cannot be trusted no matter what medications or therapies he could undergo. Period. Perhaps he would be okay in an isolated home without children or other animals. But why risk the liability? All it takes is one incitement of the prey drive, one wrong movement, or one wrong pat and these dogs can bite again, sometimes with much worse outcomes.

I fully support euthanizing this dog, as is the plan following the mandatory 10-day quarantine. Too many nice dogs are euthanized every day in this country for this nasty menace to get a reprieve.

Open Letter to New Veterinary School Graduates

May 02, 2014 By: Dr. K Category: For Vets, Opinion

Congratulations! You made it through four hard, epically hard, years of veterinary school. You crammed, pulled all-nighters, learned many new skills, passed your boards, and survived job interviews. And here you are, ready to spread your wings and wear the title of Veterinarian.

Here are some pointers from a veteran to you newbies:

Savor the Ride

You’ve done so much work toward getting your veterinary degree. In the final weeks before you graduate and begin working, take a walk down memory lane. It’s hard to enjoy veterinary school while you are in it. Say goodbye to your favorite clinicians and technicians, enjoy time with your classmates. You never get this time back. And believe it or not, you will develop sentimental feelings. If not now, they will show up a few years out. Perhaps the hard labor of veterinary school equates to child birth – an oxytocin surge allows you to forget the pain and remember the fun!

Find the Right Job

Some practice owners don’t want to mentor. Mentorship is critical for a new graduate. But, it’s not enough that someone is willing to teach you. You need to make sure that new employer’s ideals and ethics jive with your own. One mistake I made was taking a position where it was routine to keep patients overnight without care. I compromised my ideals because I was an insecure new grad and regretted it multiple times during my tenure there. Have you considered what type of salary, hours, on-call, and tech support you’ll have? Will you have a good quality of life there?

Take Time Off

Unless you are scraping by financially and need to start work immediately following graduation, do yourself  favor and take some time off after graduation. You have the rest of your life to work and once you are in a contract taking a large lump of time off for yourself won’t happen. Travel, take a staycation, reconnect with loved ones – you will never regret it.

Know It’s Normal to Want to Run

You’ll pull up to your new practice on that first day of work and, more than likely, have emotions ranging from nausea to panic. Suddenly transforming from the student to the expert is scary. You’re not alone. We all did it and understand. But don’t run. You need to pay off those student loans.

Student Loans

Put them on direct debit and forget them. If you are lucky enough have extra cash laying around, pay those loans down sooner. But realize that car payments, mortgages, child expenses, and the unexpected will make that hard to do. Don’t stress over them and never, ever, look at the total balance.

Ok, just kidding about that last part. Kind of.

Don’t Expect Perfection…Ever.

The learning curve for a new grad is steep. So many veterinary students and veterinarians have Type A personalities: We expect perfection in ourselves and are very hard on ourselves when we don’t achieve it. You are going to ask a lot of questions, forget the dosing for amoxicillin, and bury your nose in the 5 minute Vet consult during your lunch. You will misdiagnose patients. You will offend clients. People will say mean things to you and about you. This is part of the professional pill that’s toughest to swallow.

You will never be perfect, no matter how many years in practice. Start your career off knowing that to err is veterinarian. Welcome to the best profession in the world!

Celebrity Kitty In The House!

April 23, 2014 By: Dr. K Category: Just For Fun

A few months ago I received a rather random email. My SPAM filter does a nice job at eliminating those pesky male enhancement ads and thwarts the Nigerian princes who will give me millions if I send them my bank account info. But it missed this one.

It read: “Could you get in touch with me about your video of Piggles in the garbage.  WAe [sic] would like to use it for a show that we produce for Animal Planet.”

Dubious to say the least. I used our trusty friend, Google, and found out that the person and production are real! After discussions with the producer, Miss Pigglesworth, a discarded cat at my clinic, is going to be a star!

Coming to a home near you this summer on Animal Planet’s Bad Dog:

How’s Your Quality of Life?

April 21, 2014 By: Dr. K Category: Opinion

These days veterinary magazines are bombarded with articles about balancing life and work, staying healthy, dealing with stress and burnout, and managing debt load. These articles are the canary in the coal mine indicating a stressed out, oftentimes dissatisfied workforce.

I’ve had the unique experience of working at multiple practices over the past several years while functioning as an emergency and general practice relief veterinarian. One thing remains constant in the spectrum of all practices: This profession chews you up and spits you out.

The practices with the worst policies and employee treatment churn through employees who leave due to dissatisfaction from dysfunction. Veterinarians in the best practices oft times struggle but know they are lucky when they hear the horror stories of the comrades abroad. Burnout is real and rapid. Why?

Veterinary medicine is not puppies and kitten, rainbows and unicorns. Period.

The field has been romanticized by the likes of James Herriot and Nick Trout (who I read and love), misrepresented by Dr. Pol, and placed on a pedestal by the general public. Practicing veterinary medicine in 2014 means many things to veterinarians:

1. We deal with money problems. And not just our own.

New graduates arrive on the scene with exorbitant amounts of student loan debt – sometimes surpassing $250,000. New graduate pay doesn’t come close to sustaining a reasonable standard of living when accounting for student loan repayments (which peskily knock on the door six months after graduation). Indebtedness looms large.

The general public has the impression veterinarians are rich. This is so absurd it’s laughable. I haven’t heard of too many human specialists get accused of being in it for the money.

Veterinarians are asked to perform services for free. Every day, many times a day. Giving away services is noble and self-sacrificing. And if I really cared about their dog/cat/ferret/stray I would do my job for free. I would ignore overhead, my loans, paying my employees, offering benefits, and keeping the practice cost effective for clients who are willing to pay for services…If only I cared enough.

The psychological battering sucks the life out of you. And it never ceases.

2. We see the worst in humanity far more often than we see the best.

No law prevents horrible human beings from owning pets. Too many animals are owned by people who intentionally neglect or harm them. Generally obnoxious, self-righteous people crank it up a notch when it comes little Fluffy.  The stress of making life or death decisions that are many times tied to finances cultivates the worst in people. I’ve been the recipient of more than one comment about stealing the food from a child’s mouth.

3. Semper Fi

Clients have expectations that we should always be available. This has led to late evening office hours, 12-16 hours days, and added appointments to an already full schedule. It is far too common for vets to work 50-60 hours a week or more, through the evening and weekend, and even in the middle of the night after a full day of work. I have had experiences with clients who are angry we are closed on a Sunday, angry I wanted them to head to a staffed emergency center at 3am for a blocked cat, and even angry because *gasp* I was a “lady doctor” and not that man doctor they usually see.

Battling fatigue is unhealthy for the body and the mind. Missing time at home is corrosive to families.

If it’s that bad, why am I even a vet?

Well, if we are honest with ourselves, we vets will admit we’ve asked ourselves this question on more than one occasion. So why do it? There are good cases, happy endings, excellent practices, loving clients. There are thankful employers, friendships built, and grateful pets.  There is an inherent “rightness” in what we do. And there is reward. For many, that is enough to combat the heaps of emotional (and sometimes literal) crap we wade through on a daily basis. For others, like a vet school classmate I recently spoke with, it was not.  She is now working outside of the profession and is happier because of it.

Can you have a reasonable quality of life when practicing veterinary medicine?

That’s up to you. My theory on having it all goes like this:

There are three things we all want/need to have a balanced life. Work, Family/God, and Sleep. It is easy to have two. The third is where it gets difficult.

I can’t imagine working full-time and taking care of my daughter/home/husband while also maintaining my sanity and not losing my identity. I’ve struck my quality of life balance by working part-time, raising my daughter, and getting the down time I need to still be me.

I’ve got it all together, don’t I? … Wait, did I say three things? Let’s not forget the fourth…MONEY! By working part time I sacrifice money. And there’s the rub.

We do the best we can in this profession. Finding a balance is tough. Maybe you need to cut your hours. Maybe you need to own your own hospital and set your own rules. Maybe you have a personality that lets the turmoil roll off of your back and you are unaffected. Or maybe you need to step out of the profession and see if the grass really IS greener.

You can’t have it all, no matter what job you chose. There is no magic equation. Some of the best advice I have ever heard came from the former CEO of Commerce Bank Vernon Hill.

If your circumstances aren’t going to change, you need to accept them or change yourself. It’s that simple.

And that friends, is how you get the quality of life you want.

One Decision Away From the Frying Pan

April 02, 2014 By: Dr. K Category: Opinion

The AVMA recently posted a story that gives me a sickening knot in my stomach. Find it here.

The summary of the story is this: A dog owner took her dog to the emergency clinic after she had been spayed that morning but her regular veterinarian because the dog was retching and her incision was bleeding. The emergency veterinarian believed the dog needed exploratory surgery and quoted the owner for the surgery and required half the amount as deposit. The owner had some money but not anywhere close to the deposit. She did not have a credit card. The owner and the owner’s sister were both declined Care Credit, a credit line for medical urgencies and emergencies. The veterinarian sent the dog home with a pressure bandage on her abdomen but the dog died overnight. The owner posted a grief-ridden post on Facebook that has been shared thousands of times.

A resulting maelstrom on social media has lead to death threats and harassing phone calls to the employees of the emergency clinic. And it affirms my feelings that we veterinarians are just one decision away from a social media lambasting that can forever affect our careers.

I understand both sides of the story in this particular case. I am not going to debate the virtues and faults of both sides in this post as nobody has enough information except the two parties involved. My own soapbox for pet ownership is well known but let me refresh you.

Pet ownership is a privilege, not a right.  When you decide to care for an animal you assume full responsibility for its care. I do not expect everyone to have the means to afford every treatment offered. It is highly unreasonably and irresponsible to expect someone else to foot your bill when you cannot afford the care recommended or required. If veterinarians discounted their services for everyone who had financial need, they would rapidly go out of business.

Veterinary medicine is a service AND a business. Businesses must make money to survive. Veterinarians offer many discounted services and have tens of thousands of dollars in veterinary care walk out of their clinics without a sniff of payment every year. It is horrible business practice to give away services regularly but we do it. While most owners are good for payments when extended a payment plan, many others are not. The appalled pet lovers are likely the ones who would have paid a bill if extended the credit. They don’t appreciate the concept of getting stiffed for an entire several thousand dollar bill. And until, as a business owner, you see how unpaid bills affects your bottom line and the ability to pay and you go through the arduous and oft times ineffective collections process – well – you just don’t understand both sides of the coin.

Every day practices are evolving to meet clients’ financial needs while providing the optimal care for the patient. Pets are property by law but have intrinsic value as living beings and family members and we veterinarians, more than any one else, understand this. It’s not a perfect system but most of the time payment plans and Care Credit make it work.

Soapbox dismount.

What concerns me most about today’s social media environment is angry pitch-fork yielding mobs can tear down a person or practice with little knowledge of the facts of the situation or the inner workings of a practice. And it’s all done under the anonymity of the internet resulting in some of the cruelest, foulest, uncensored vitriol posted for all to see. We veterinarians, as well as others in the public service field, have our reputations at stake and can potentially have them destroyed by one disgruntled client. It’s terrifying.

Have you seen this story about the veterinarian who committed suicide after an angry online mob drove her in to financial dire straights?

Every day I make the best decisions I can for my patients while working within a clients’ financial means. If I cannot achieve an outcome that jives with my standard of care, we have the adjust our approach to make it work even if that includes the option of euthanasia.

I fear for the future of good practitioners and public servants when it is so easy for information to pass from person to person without fact checking, intricate knowledge and understanding, and censorship. We will start to practice like we have one foot in the fire which will affect the practice, the client, and the patient. Everybody gets burned.