I’m proud to see my undergraduate alma mater extolling the virtues of canine companionship! The University of Scranton sponsored a pet therapy day prior to final exams. It’s widely known interacting with domestic animals lowers stress and blood pressure. If only Fido took your finals for you….
You certainly don’t think of the veterinary profession as one where performance of duties risks loss of life. Police, fireman, and men and women in our armed forces certainly face the prospect of death daily, but veterinarians rarely need to worry. Sadly, a small animal veterinary colleague died this month after she was struck by a vehicle while attending to two dogs who laid in the road outside her home. The driver fled the scene but has since been arrested and jailed.
Dr. Kathryn Gilpatrick, 37, died assisting her neighbor’s dogs who strayed into the road near Knoxville, Tennessee. We animal lovers put ourselves in harm’s way treating these animals. I know the emotional trauma of seeing pets in the road struck repeatedly by traffic. As a teenager, I stopped in the middle of the night to carry a wayward snapping turtle across a darkened road to ensure its safety with disregard for my own. I’ve even pulled over on the side of the highway to help fearful dogs who’ve found themselves in the middle of traffic. I won’t say these traits are innate but they come pretty close. Veterinarians share the passion to preserve animal life and alleviate suffering. I am sure Dr. Gilpatrick died doing what she loved.
Like Dr. Gilpatrick, I find myself unable to sit idly by during times of crisis. It’s humbling to view the fragility of life and to know the call of duty, however great or small, comes with great implications.
How do you remove dried snot from painted walls without damaging the paint? You can’t. At least that’s my experience with my chronic snotting, snuffling, sneezing, snorking cat. Winston has successfully plastered my walls with copious amounts of mucous with a holding power rivaling the largest tube of gorilla glue. If you have one of these snorkers in your house, there is hope!
I recently attended a veterinary conference lecture that focused on these cats by Cynthia Stubbs, DVM, DACVIM. We all know snot-nosed cats can prove difficult to manage for both veterinarians and pet owners. Once the appropriate diagnostics are performed to rule out some of the more easy to treat issues, many pet owners are faced with the choice of advanced and often expensive diagnostics. While I still strongly recommend performing a vast array of diagnostics to get to the heart of the disease, many times cats suffer from difficult to diagnose rhinitis and sinusitis that can be exacerbated by respiratory infections. There is a probable association between chronic snorkers and chronic infections with herpes and calicivirus. Both herpes and calicivirus attack nasal and upper airway mucosa, causing chronic inflammation that can lead to nasal discharge and destruction of the delicate nasal bones that sit inside the nasal passages. This correlation has lead Dr. Stubbs to pursue both palliative and curative treatments.
Dr. Stubbs suggested one such treatment involves giving affected cats intranasal bivalent vaccinations against herpes and calicivirus. The intranasal delivery is purported to increase local mucosal immunity and therefore decrease the inflammation in the nose. Dr. Stubbs reported some cats needed only the vaccine on an every 3-6 month basis for near complete relief. The off-label use of the vaccine does not confer any immunity to panleukopenia, so Dr. Stubbs recommended also giving the traditional subcutaneous trivalent FVRCP vaccine. In addition, Dr. Stubbs bravely uses the anti-inflammatory antibiotic doxycycline along with the NSAID piroxicam to provide additional symptomatic support. Word to the wise: Non-liquid forms of doxycycline are known to cause esophageal stricture in cats and piroxicam should not be used in cats with kidney disease.
I am planning on trialing the intranasal vaccine in my own snorker. We’ve tried multiple antibiotics – no small feat given Winston is a perceptive, neurotic, inflammatory bowel disease cat. Nothing has alleviated his six years of nasal congestion. I will certainly follow-up in future postings.
Diagnostics Performed in Nasal Discharge in Cats
Common Diagnoses In Nasal Discharge in Cats
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:
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.
I began formal training today for the 10-mile Broad Street Run (Philadelphia) with my new found Team in Training friends at The Leukemia & Lymphoma Society. I ran 2 miles today in horizontal snow working up to my May 2nd 10-miler. I’m not going to lie, it was miserable to have snot dripping from my nose and my lungs scorched from the cold. And did I mention I hate running? But I did it. Let me tell you why.
Over a year ago I met a vibrant sassy 27 year old named Shanna when she began working at my hospital. She was diagnosed with uterine cancer at 16 and underwent chemotherapy. I learned she unexpectedly became pregnant at age 21. She went into preterm labor at six months gestation from complications from her cancer. Six months later, despite the NICU’s best efforts, he died. She then had a hysterectomy and partial ovariectomy. As if that was not enough grief for one person to bear, flash forward six years and she found herself afflicted with malignant tumors in her remaining ovary. Another surgery and series of body scans cleared her of cancer. She was doing well until about 4 months ago, when she found a painful lump in her breast. Multiple visits to doctors and multiple breast surgeries revealed severe mastitis secondary to Stage 3 Lymphoma in both axillas. This is a crushing blow to everyone who knows her as we anticipate more chemotherapy and surgeries.
Shanna brings join, humor, and life to people around her. In her 4th battle with cancer, she has remained positive and hopeful. She’s still working as she rapidly approaches her surgery date for a single mastectomy and lymph node removal. She’s the reason I committed to running and raising money for The Leukemia and Lymphoma Society. If Shanna can come to work every day with a smile on her face, I can certainly run 10 miles and raise money for this great foundation.
I need your help on multiple levels. First, I need fundraising ideas! If any of you have a practical idea for fundraising, please let me know! I have boxes of candy bars and sweet treats to sell at the office. I am thinking about selling homemade dog biscuits. What else?
More important is the focus on raising funds to benefit cancer patients, for research, and to provide a network of understanding and support for people with blood cancers. If any of you know of a blood cancer victim and feel compelled to donate to LLS, please visit My LLS Site to make a donation! My personal goal is $1000 by race day but I would be proud to surpass that!
Discussions on a colleague’s blog stoked my agitation about rude exam room etiquette. If you’re a cell phone user, screamer, or lousy parent, this blog post is for you. Most people understand how to behave in any professional appointment. When I go to the doctor’s office, I sit quietly in the waiting room and then in the exam room, stay courteous, and express my health concerns. I wouldn’t even think about wandering the hallways or yakking on my cell phone. Here are some examples of how not to behave at the vet’s office:
Don’t Arrive Late and Then Act Angry When You’re Bumped to the End of the Line
Most veterinary practices operate on 15, 20, or 30 minute appointment schedules. Your 10-15 minute tardiness can drastically affect the flow of appointments when the schedule is full. Try to arrive early. If you know you’re running late, call the hospital. If you arrive late, be prepared to wait. It’s not fair for clients who arrived on time to wait past their appointment time due to your tardiness.
Stay Off the Cell Phone
Cell phone etiquette is generally terrible every where we go. I enter a public arena and often hear a loud one-sided conversation. That doesn’t belong in an exam room. If you are caught on your cell as the veterinarian walks into the room, promptly end the call. If you don’t, your veterinarian may just walk out on you. I’ve done it.
Don’t Take Your Pet For a Walk During the Appointment
This seems like common sense. If you are in an exam room waiting for the vet, don’t leave. On numerous occasions I have walked into an empty room. I would rather have Fluffy urinate or defecate on my floor (what, you think that’s the first time it’s ever happened?) than walk into an empty exam room. See scheduling crunch listed above.
Your Appointment is Not the Time to Start Disciplining Your Pet
Most pets, when confronted with the unfamiliar and sometimes terrifying prospect of their veterinary visit, will act uncharacteristically anxious, fearful, or aggressive. Vets expect this. I dread owners, who I sense haven’t invested much time in training the pet, that resort to screaming and correcting the dog in a volume loud enough the dogs in the waiting room obey the commands. On the other hand, I also loathe the owner who finds the pet’s biting, scratching, and fearful behavior hilarious. Don’t laugh and think it’s cute when your pet bites at my staff. Bites and scratches are serious threats to well-being.
Your Appointment is the Time to Start Disciplining Your Children
Children should never handle instruments in the exam room. They are expensive and not designed for little hands to bang and drop on the floor. It’s happened to me. Don’t allow your children to pinch, poke, or otherwise agitate the veterinarian. That’s happened to me as well. And it’s always a good idea to keep your kids away from Fido’s face during the exam and vaccinations. You cannot always anticipate fearful behavior and bites may ensue.
I hate on-call. I loathe, detest, and lament on-call. Every time I have that ringing beast in my possession my stomach churns when it sings it melodic tune. Most small animal general practitioners would agree on-call just plain stinks. Calls during dinner, holidays, and the middle of the night coupled with the constant threat of changing plans and interruptions give on-call its much deserved bad reputation. No one likes a leash. Shifting trends in veterinary medicine are making on-call obsolete, though its archaic status is not uniform across the veterinary world yet.
Many new practitioners look for positions with limited or no on-call. It’s very difficult to balance home and work when works comes home and calls you in the middle of the night. The new generation of veterinary medicine recognizes the need to better balance work and life which has culminated in less hours, more vacation, and flexible schedules. Requirements to see patients on emergency add long and irregular hours to an already stressful, tiring job.
A majority of the push to eliminate or limit on-call is probably traceable to the changing demographic and ideals of the newly female-dominated workforce. Women must exercise caution when meeting a client alone in the middle of the night for an emergency. Ketamine, among other drugs, has increasing street value and veterinary hospital robberies are not uncommon. Additionally, phone calls and travel throughout the night do not provide a family friendly schedule and mothers of young children may find it impossible. Employers have noticed and many have begun advertising positions with no on-call in the banner.
On-call is more than an inconvenience for veterinarians forced to hastily jump from bed. If not executed properly, the on-call vet can find herself providing sub-par care overnight or on the weekend. On-call compensates for a closed office and closed offices rarely provide 24-hr care. While leaving an unsupervised but stable animal in the hospital overnight may be okay in some circumstances, sick and unstable animals typically require more extensive monitoring, medications, and treatments. I am in the camp of “If it’s sick enough for you to call me at 3am, it’s sick enough to warrant 24-hr care.”
If a veterinarian offers to see a pet at an owner’s regular hospital on an emergency basis, it’s important the owner know what types of services the vet can provide. Without support staff, usually simple tasks like drawing blood or taking an x-ray can prove challenging. Having owners help retrain their pets is dangerous and a potential legal nightmare. Will the vet or a technician stay at the hospital that night to observe the animal? Most times the answer is no. Many pet owners may find more comprehensive care at an emergency hospital, and given the rising cost of GP’s emergency fees, the price difference probably won’t amount to much.
Many stalwart veterinarians insist they are providing a service to their clients. In rural areas where the nearest emergency center is miles away, I can see that point. But the majority of people live in or around cities where overnight and 24-hr hospitals abound. Those hospitals are equipped with multiple technicians, multiple veterinarians, and the ability to care for a sick pet quickly and efficiently. I challenge those stalwarts to examine if they are looking out for the animal’s best interest or their bottom line.
I like to think I can separate my personal life from my professional life, but let’s admit it, we’re all guilty of letting emotions roll over from home to work and vice versa. When personal life drama spills into work everyone is affected. From patient care to interpersonal relationships, the entire practice feels the impact. Everyone has a personal struggle that affects work occasionally, but what do we do when that person’s problem becomes the practice’s problem?
Gossip Solutions: Veterinary hospital staff is predominantly made up of women. My various experiences with large groups of women leads me to believe that, no matter where you are or what the mix of personalities, conflict will arise. A wise businessman I know adopted a no gossip policy at work: first offense received a warning, second offense resulted in termination. The policy worked very well at stopping the behind-the-back sniping (at least in the office). Additionally, veterinarians and higher-ups must lead by example. It’s pretty difficult to correct a toxic environment if those in control are polluting it.
Relationship/Family Drama Solutions: Break-ups and divorce have no place at work. A person can talk with coworkers, however, personal relationship problems should be kept under wraps. In addition, parents with small children should be prepared for a child’s illness. They should have open communication with the employer regarding missed work days. Employers can and should allow use of sick days, vacation time, and/or unpaid time off for parents to care for sick children. However, at-will employees who repeatedly fail to show up at work are at risk for termination. Businesses require reliable help to operate properly.
Illness: Employees dealing with extended illness require us to explore our options. Nobody asks for cancer. Most reasonable small business owners will bend over backwards to accommodate ill employees as they seek treatment. There can come a time when an employer considers termination. Terminating an employee simply due to a diagnosis of cancer or disability is unethical but may not be illegal depending on employment agreements. At-will contracts allow employers to dismiss employees for any reason, extended illness and inability to perform duties included. Many employer contracts allow for legal termination if the employee cannot work for a period longer than two months.
The biggest problems arise when the illness prevents the employee from performing his/her normal duties. These employees can be reassigned different tasks in most cases. A bigger issue comes when the use of medications, fatigue, or lack of mental clarity directly affect performance. Small mistakes are forgivable. Bigger mistakes affecting client and patient care directly affect the quality of care and economics of the practice. These situations warrant medical leave and need delicate handling. Employers, though simply looking out for the best interest of the practice, can appear calloused and uncaring if they don’t make it apparent this is a professional issue and not a personal one.
Termination is a final option. Unfair? Probably. Legal? Most likely. Necessary? Maybe. Difficult? Absolutely.
Dr. Jennifer Koehl offers a unique perspective on all things veterinary medicine.
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