VMDiva

The focus on client/patient care should comprise the majority of focus for the staff at a veterinary hospital. The same is true for the practice owner, but with one caveat. If a practice owner desires the best care for her clients, she must provide the best care for her employees. In an effort to focus solely on client care, employee relations can get tossed by the wayside.

Many employees go through motions day to day without an understanding of why and how their tasks improve patient care. What type of message does it send to employees? If you repeatedly send the message of dispensibility, you cannot cultivate loyal employees. Loyal employees are the key to practice success. Attitudes toward their boss and work, for right or wrong, affect the very behavior the employees bring to the table. If a boss has not earned employees’ trust and respect (that’s right bosses, you’ve got the earn it),  they are more likely to under perform.

Practice owners struggling with income need not worry. Not every “perk” requires significant monetary investment. I am no subscriber to kumbaya-type community builders. I seek realistic solutions. Some simple (and not so simple) steps can cultivate a culture of practice loyalty and pride that will transfer down to where it matters most – the client.

Be Kind and Approachable

All staff members deserve respect no matter what level of education or proficiency. Kindness and interest in staff members personal lives speaks volumes. Get to know a little bit about them and do something to remind them you listened.  Acts of kindness are as simple as assessing personal comfort. I often ask technicians if the table height is appropriate for them during an exam because too many times I see the short staffer on her tiptoes restraining a struggling dog.

Never forget to compliment a job well done.

Pay ‘em what they’re worth

This is usually more pay than what many technicians and receptionists currently receive. One of the surefire ways to make staff feel under-appreciated is to pay less than the average salary for the geographic area. Performance review based pay raises help ensure incentive to maximal performance.

Training and Follow-Through

New employees, especially those less familiar with the ins and outs of a veterinary practice, are typically overwhelmed. Climbing through mountains of medical jargon, procedures, and policies make them cringe. Training is essential. Follow-up meetings are also essential. New employees need regular reviews of their progress and mile markers. This is their chance to talk about what they want to improve upon and also brings any gap in training to the forefront. The time and effort put into training and following up with new employees speaks volumes for commitment to employee happiness.

Continue the Education

Veterinarians are not the only ones who need CE. Licensed vet techs are required to complete CE, but many unlicensed technicians and assistants fly under the radar of licensing boards. This staff still requires continuing education for a practice to continue to provide optimal care. Fruitful staff, committed to learning and developing new skills, are invaluable assets to any practice. Fruitful employees who see how their jobs make a difference are more committed to their position and the practice. Many drug representatives offer lunch-and-learn sessions about new medications, common disease processes, and technology updates. Who wouldn’t enjoy a free lunch, some swag, and an education all in one hour? Make the time to educate the staff.

Additionally, the onus is on the veterinarians of the practice to teach technicians skills and medical knowledge. Take every opportunity to instruct. Better education equals better medicine. Period.

Regular Staff Meetings

Including all staff in regular meetings builds a sense of community and togetherness. Staff meetings allow the practice to work through logistical issues between front and back office staff along with clarifying performance expectations. The feeling of inclusiveness goes a long way in creating employee loyalty.

Lighten’ Up

Practices that are all business all of the time are oppressive. Fun, laughter, and a little bit of chatting can go far in keeping employees happy (of course, all things in moderation). An occasional potluck, party, or birthday cake brings the crew together and builds camaraderie and trust, and therefore, increased job contentment.

Above and Beyond

Exceptional practices provide bigger perks like:

• Gym memberships or on-site exercise equipment
• Periodic massage days
• CE stipends for all technicians
• 401k and profit sharing plans for all employees
• Uniform allowance
• Performance-based bonuses
• Practice-wide community service days
• More low-cost perks
• Recession friendly perks

In the age where any Joe can have a blog, website, or informational page, pet owners need to practice extreme caution when gleaning information about their pet’s health. I think most people realize the internet is full of misinformation. That’s why most pet owners who’ve done their research online bring a pile of it to their appointment. I help them sort through the facts and fiction and in due time we come to a conclusion together. While “I read on the internet” can sometimes make my eyes roll, I do enjoy a pet owner who is well informed. I do not, however, enjoy a pet owner who has been handed a bunch of opinions disguised as facts and, despite an education from yours truly, still trusts her online support group more than her veterinarian.

Such was the case I was presented with this week. A senior cat was diagnosed with end stage kidney failure. I was the third veterinarian to see him at our practice and the also the third veterinarian to explain chronic renal failure, treatment options, and quality of life issues. At this stage in my career, I think I have renal failure down pat, but my friend Justine Denial had lessons for me to learn. I walked into my appointment and encountered what I like to refer to as “The Scroll”.

The Scroll is the sheet of paper that has every question, topic, and reference the owner found on infallible sites like Wikipedia, Ms. Kitty Purrfect’s Blog, and Josey Magoo’s facebook page. The Scroll, mind you, is very different from the list of questions many responsible pet owner’s bring to their appointment. The Scroll, on the surface, seems to have been derived from willingness to learn. Explore deeper, however, and I realize it’s a trap. It’s an amalgam of misinformation that challenges the very education I’ve had as a veterinarian.

Ms. Denial informed me she had joined an online renal failure support group and they recommended “slippery elm” supplements for the cat’s constipation. While I am not adverse to herbal therapy, I know nothing about this slippery supplement and let her know I would look into it. I also discussed the constipation issue is due to the chronic state of dehydration and will be something we would battle continually as the cat deteriorates. I was met with a blank stare. I suppose the support group hadn’t told her that. We talked more about quality of life and what to expect as her cat became sicker.  Another blank stare. Hmm, perhaps she wasn’t understanding this is a progressive, always fatal condition? One more try and I realized she just wanted to stick with the scroll.

We charged forward into a headache-inducing discussion about SQ fluid choices because she heard from her support group that the cat should be getting one specific type of fluids. Trying to explain acid-base balance and electrolyte abnormalities to a lay person who didn’t want to hear what I had to say was maddening and a monumental waste of time. I recommended a fluid and we settled on it.

Finally, Ms. Denial rattled off a list of parameters she’d liked checked, including creatinine, potassium, calcium, “anemia”, magnesium, and vitamin B12. When I offered explanations that most of these parameters were included in labwork from several days ago and were normal, she still wanted them checked because her support group said she should have it done. I offered Ms. Denial a renal panel, at the cost of $80, that would allow me to check many of her required values.  “Well, I don’t have THAT kind of money.” I could feel the aneurysm bulging behind my eyes. We finished and I decided I’d rather shove a pencil through my nose than sit through an appointment like that again. Two hours later Ms. Denial called asking to exchange her fluids.

Side Note: Slippery Elm is a safe fiber supplement for cats with questionable efficacy for constipated cats with renal failure.

A few weeks back I highlighted my current case of a 6 year old golden retriever, Goldie Hawn, who I diagnosed with bone cancer in her femur. Her x-rays were pretty convincing for cancer and I performed biopsies. Bone biopsies can result in inconclusive answers a third of the time. Sure enough, the bone biopsies came back as “new periosteal and endosteal growth and proliferation.” In other words, not completely normal but the pathologist could not call it cancer. This is a very frustrating situation for veterinarian and owner alike.

X-rays on 2 different dates showed a progressive lesion. The scenario went as follows: We had a highly suspicious lesion in the distal femur, one I was was convinced was a particularly aggressive form of cancer called osteosarcoma. We could rebiopsy, but the chances of getting a diagnoses were no greater than the first biopsy. We could send Goldie to a specialist who would evaluate her x-rays and most likely recommend biopsies. We could repeat x-rays in a couple of weeks to see if the lesion had progressed. And finally, we could amputate the limb in hopes to catch the cancer early prior to its spread to the lungs.

It was an agonizing decision for both the owner and me. The owner knew waiting on a potential aggressive tumor could mean the difference between life or death. However, without a definitive biopsy there was a very real possibility we would amputate a leg that didn’t have cancer. We walked through the surgery and options at least three times leading up to the decision. I reradiographed the limb one more time, saw even more changes in the femur, and the owner very nervously elected amputation.

The permanency of amputation gives me agita. I thought about the surgery in the weeks leading to it, the night after, and the waiting period for biopsy results. Goldie’s case kept me up multiple nights. My biggest fear was getting back an inconclusive biopsy report and having nothing to show her owner. After a three week wait on pathology results, we got our diagnosis of very early osteosarcoma. I was relieved then saddened with the diagnosis.

This case reminds me medicine is a process that doesn’t have all the answers. As much as we want it to, disease doesn’t always follow the textbook. I frequently tell my clients that just because it looks like a duck doesn’t mean it quacks. Sometimes we’ve gotta put a little faith in our instincts and other times take that educated guess.

This time of year reminds me of the nerve wracking process of job interviews and trying to find my place in the veterinary world after graduation. Most new vet graduates, the 60% or so who choose to become general practitioners immediately following vet school, are knocking on doors in search of the ultimate vet practice. The strained economy makes openings at the best practices hard to come by but a little bit of knowledge can go a long way in guiding a new vet toward a good practice. Of course, the list of things to look for in a practice are also the same things pet owners should look for in a hospital. Pet owners don’t necessarily get the “inside scoop” but simple observations can help them make a decision.

For Vets

Standard procedure for the interview process involves a tour of the practice, a meet and greet with all veterinarians, head technicians, and business managers at the practice, an interview, and lunch/dinner. The last one is actually pretty important. Practices unwilling to “court” their prospective associates are either cheap, too informal, too understaffed, or just lacking in business etiquette.

Know your values and personal standard of care. Have a problem with unsupervised overnight hospitalization? Want to refer complicated cases? Oppose declaws, ear crops, tail docking? You’d better ask what the practice policy is and if you are expected to perform any of these duties.

Do vets share cases or will you need to figure it out on your own? Is there continuity of care? Is your boss willing to mentor you? I remember my very first interview where the owner told me, in more explicit terms, that he hated seeing the term “mentorship” in a cover letter. Red flag. New graduates need a support network.

For Vets and Pet Owners

Looks matter. Are the buildings and grounds well kept? Does an odor smack you in the face when you open the door? Well maintained practices indicate a higher level of dedication and pride in the practice which can translate to quality of medicine practiced. This doesn’t mean the practice needs to have marble countertops and fireplaces. An old home that is well cared for can provide the physical foundation for an excellent practice. People make the practice, not the building.

Keep highly attuned to how you are treated from the second you walk in the door. Do the receptionists make eye contact or welcome you as you come in? Are they friendly? From a vet’s perspective, the receptionist’s are on the front line of the practice. Aside from the veterinarian, they are the face and personality clients will engage with most. Rude or inefficient receptionists can indicate a systemic problem.

Employee churn is a red flag. The constant turnover of employees, both support staff and veterinarians, can indicate a management issue. In my experience, churn happens for a few reasons. First, employees who feel undervalued or under respected are likely to leave. Next, employees making minimum wage need benefits because most cannot afford insurance or routine medical care. Practices that don’t provide benefits will lose employees as their life events dictate. Veterinarians tend to leave positions when the hours stink, the boss is inflexible, and promised changes never come to fruition. Personality conflicts are inevitable and expected. Most times, employees can work through them to get the job done.

For Pet Owners

Remember small mistakes will happen and cut the staff a little slack. If your medication isn’t refilled on time or a phone call isn’t returned in a timely manner, remember it isn’t personal. However, repeated errors, confusion, and inaccurate charges are a sign the practice is inefficient.

Basic observation skills and a little probbing can ensure both veterinarian and pet owner find a practice suited to their needs.