Lack of planning on your part...or something like that

Its 5:30pm on a VERY busy day here at A. C. C. It's one of those days where we only have one doctor, Dr. Old. And when we only have one doctor, things can get a little hectic. (Who am I kidding, things get hectic no matter how many doctors we have.)

I feel as though I should give a bit of background on Dr. Kinda Old. Dr. Old has been at this for 40+ years. Before you cringe, you should know Dr. Old is one of those perfect "been at this since the dawn of time" vets. He's been at this long enough to have seen it all a least twice, and practiced back in the day  before diagnostic tests were the norm. As in, he will use a physical exam, history and his brain to make differentials unlike some new doctors who won't even hazzard a guess without a full blood panel, x-rays and an ultrasound. He strives to stay current, is an incredibly skilled surgeon but has the years to back it up. I'm so lucky to have this example as my mentor - and his following is pretty rabidly loyal. Clients who have been with him since the beginning, follow him no matter where he goes and, as such, sometimes place completely unreasonable expectations on his time.

Anyway, its 5:30pm, we close for business/appointments in an hour and Dr. Old is in a complicated surgery. Mrs. Entitled rings and our newest A. C. C. receptionist answers:

R-ACC: Awesome Critter Clinic, how can I help you?

Entitled: I need to speak with Kinda. Right away.

R-ACC: I'm sorry, he's unavailable. Can I please take a message.

Entitled: Oh, I see. You must be new. This is ENTITLED and I need to speak with Kinda RIGHT NOW!

R-ACC: I'm sorry, he's in the middle of a complicated surgery and I can't interrupt him. I'm happy to take a message.

Entitled: Listen Missy. My prized Cocka-Schnauza-Poo has been sick ALL DAY! I need Kinda to see him right away!! I'll hold while you go get him.

R-ACC looks up Mrs. Entitled's account and sees she owes us over $1700 in unpaid bills, and has been sent to collections. This, combined with her bad attitude, makes R-ACC more than reluctant to bother Dr. Old in surgery. However, she pops her head in. Dr. Old is, surprisingly, unwilling to leave surgery to talk on the phone. Nor is he willing to hang around an hour+ past closing to wait for this person to arrive.

R-ACC: Mrs Entitled, I'm sorry but Dr. Old is unable to leave his surgery, and he's unable to wait past closing for you to arrive. He has other obligations he must attend to.

Entitled: Well what am *I* supposed to do?!?!?!

R-ACC: I can give you numbers to local emergency clinics.

Entitled: I can't afford that!!!!

R-ACC: You could call around to clinics closer to you and see if they're open later.

Entitled: I can't afford those other places, they're way too expensive! I'm coming up there now. You'd better stay open and wait for me.

R-ACC: (in her head: apparently you can't afford us either, since you don't bother to pay your bills) Ma'am, I'm sorry, but we won't have a doctor here. Even if we received permission to stay open and wait for you, the best we could do is set your pet up in a kennel and monitor her overnight until the doctors arrive in the morning.

Entitled: WHAT DO YOU MEAN YOU DON'T HAVE A DOCTOR THERE OVERNIGHT? WHAT HAPPENS IF SOMETHING HAPPENS TO MY DOG?!?!?!?!?!?!?!

R-ACC: Ma'am, that's what I'm trying to tell you. We don't have 24 hour coverage here. That's why I recommended an emergency room.

Entitled: Well, I can see you're just not willing to work with me here at all. I'm not coming, and I'm not going to an emergency center, those people are crooks. I will be calling to speak to Kinda about you in the morning, you will be fired after he hears about this. And if my dog dies tonight, that guilt is on your hands. <click>

Poor R-ACC. The abuse the ladies who answer our phone take is unbelievable. The next day, R-ACC was agonizing over calling Mrs Entitled to see how her dog was doing. But she didn't want to know if the dog had passed in the night. Horrible feeling, trying to help people who won't let you help them. And berate you in the process.

*I feel the need to point out that A. C. C. does not have 24 hour doctor/staff coverage BUT we have a wonderful relationship with the local ER. When we have critical patients, like the one who was in surgery when Mrs. Entitled called, we are luckily enough to be able to transfer them for around the clock care to our local ER. Its a win-win.

Phone etiquette Part 1

If you call your veterinarian (or other health professional, for that matter), please leave a phone number where you can actually be reached for a call back.

Nothing upsets A. C. C.'s fabulous receptionists more than asking for a phone number and being told Its in my record or S/He knows my number. Is it really that hard to leave your phone number? Does it take less breathe to argue with my staff than to just leave a number? Since half the time the number in your account has changed, and you didn't bother to inform us, and 100% of the time, our doctors DO NOT know your number (no matter how special you think you are), failure to leave a number usually results in failure of a doctor to call you back.

But if you do leave a number, make sure it works. When I call someone and I get voicemail box is full or voicemail box is not set up, I can not (obviously) leave a message. And I will not try again multiple times throughout the day in an attempt to actually reach a person. I call once. So don't even think about calling my staff and yelling at them for not giving me the message. They did. I called. The malfunction is on YOUR end!

Hippo-crits abound...

Veterinary medicine is often divided into multiple categories. The most common being "big" and "little".  

There are separate divisions for zoo, wildlife, aquatics, public health, food safety - we are a multi and varied, talented bunch. But for today's discussion, we'll start with big and little.

In vet school we learn about the big and the little. In theory, you're able to treat anything when you graduate. Some people choose more training after school and will do an internship. Here you pick - big or little. And focus more on your area of interest. And then, if you're really ambitious and in complete denial how quickly interest is accruing on your loans - you do a residency. Here you're even more specific: big medicine, small surgery, hearts, eyes, blood. Then, after jumping through a series of hoops depending on the specific specialty, you get to call yourself a specialist and put extra letters after your name. Sounds great, right? Um - no.

I have some experiences in these areas and one of the things I want to do is share those experiences so that future vets might know what they're getting themselves in to. And, well, because when I tried to go through the proper channels for help, I got none. So, fine. I'll tell my story in another way. I have no illusions the people who behave poorly will ever read this, and if they do, they'll not recognize themselves. For those who have the ability to self reflect don't need to be told they're heinous. They can recognize it themselves. But I digress...

To read a truly awful, but all too common account of one DVM's internship experience, click here. 

And here is a fairly innocuous story from my own residency, as a stand alone incident seems harmless enough but highlights the inability to recognize a teachable moment, and general lack of respect for the well-being of the trainees under their care.

I took a bit of an unusual path, and my internship wasn't entirely focused on big. It was focused on big wildebeest, with aardvark, rhino and giraffe thrown in there. Now, I like wildebeest, rhinos, aardvark and giraffe, but I also like hippos. So when I did my residency, I looked for one with some hippos as well. When I applied I was very clear - I like hippos, I want to learn about hippos but I don't have a lot of experience with hippos. When I interviews, I verbally expressed that sentiment to all the faculty I met. Repeatedly, they said, "Oh, that's okay. We'll get you crackin' on the hippos in no time! Just excited to have an applicant with interest in, and experience in, more than just hippos!" Sweet!

Fast forward about 10 months, and things are already getting rocky. More on that later but this particular story involves a series of sick baby hippos, me being the only person on call over a holiday week-end and getting ZERO support from the faculty. See, these very valuable, and very fragile, hippo babies were getting sicker and sicker. The owners kept bringing in pair after pair after pair - clearly there was an outbreak! We worked around the clock to try to save them, and as new ones came in, I'd examine them, confirm my thoughts that it was the same disease and, based on previous treatments, make a plan. Which I then had to present to the senior clinician for approval.

One of the joys of an internship or residency is getting to know, and tailor your plan, to which senior clinician is on. Some like pink drugs, some like white drugs and woe betide ye who forgets who likes pink or white. Well, on Saturday and Sunday of the holiday week-end, Dr Wimpy was on. Dr Wimpy likes to treat sick baby hippos with 1 pound of pink powder twice a day. So all the hippos got 1 pound of pink powder twice a day.

Early Monday morning, yet another baby came in. But now, instead of Dr Wimpy, it was Dr Crabby on clinics. I formulated the plan that had previously been working, the one Dr Wimp approved of, and presented it to Dr Crabby. Dr Crabby approved the plan, and we proceeded to treat the baby hippos. 

I feel, at this point, it's worth mentioning that every single baby hippo got better and went home.

However, 6 months later (yes, 6 whole months) during one of my performance reviews, Dr Crabby told me that I was a substandard clinician. Why? Because treating baby hippos with 1 pound of pink powder is unacceptable. Dr Crabby likes to use 2 pounds of pink powder, and I should know this. The fact that I didn't know this means I was unfit to treat hippos.

What was never fully explained to me was why, why, why did Dr Crabby approve the treatment plan if she prefers 2 pounds? I don't know, I'll never know, and I did, in that moment, actually stand up for myself and point out the loss of a teachable moment. Which, in hindsight, probably did not endear me to them anymore than I already was. But I don't care. It was bull, they knew it, and I called them on it. Huh. Probably why I'm not in academia anymore.

Farm Acyst Part 1

Mrs. Kittymom: Well, Dr Awesome, we've been following the cardiologist's medication recommendations exactly, but it doesn't seem to be helping TinyKitty.

Me: Ok, we may need to increase the medication dose. To review, he's getting 1/2 of the 12.5mg pills every 12 hours?

Mrs. Kittymom: Well....not exactly...

Me: How "not exactly?"

Mrs. Kittymom: Dr. Kittyhearts sent us home with prescription for the 12.5mg tabs, but CostClub only carries the 20mg tabs. The Farm Acyst at CostClub said we could just give TinyKitty 1/4 of the 20mg tabs, because 5mg was close enough to the 6.25mg TinyKitty is supposed to be getting. But I think maybe they don't know what they're talking about because TinyKitty isn't getting better.

Review consult notes from Dr. Kittyhearts - nope. No mention of a dose change or a phone consult with the Farm Acyst from CostClub. During a follow up phone call with Dr. Kittyhearts, casually ask about medication changes - nope. Decide to quit beating around the bush and outright ask - nope. Neither of the veterinarians caring for TinyKitty authorized a modification of the prescription. 

Me: How about we get you the right sized pills so that its easier for you to properly medication TinyKitty? I have some in our pharmacy, I'll get them for you right now.

Mrs. Kittymom: Well...how much will they be from you? See, the reason we wanted to go to CostClub is because we can get 4 months worth for $20.

Me: Yes, I can appreciate wanting to save money. And now you've spent $20 on the wrong medication and would have been money ahead to have just gotten the correct stuff in the first place.

Mrs. Kittymom: Okay, I guess you're right.

After spending over $2500 in cardiology consults and follow ups for their beloved cat, this family was trying to cut corners and buy the medicine from the warehouse store to save a few bucks. And the pharmacist gave them the wrong medicine and suggested changing the dose without consulting either veterinarian.

Yes, I turned the pharmacist into the state pharmacy board. And I'd do it again in a heart beat.

No Intro, just go!

I've agonized over how to write an introduction. I'm not planning on outing myself, or my colleagues, so a semi-anonymous intro seems disingenuous. I have every intention of trying to remain a ghost author, if you will. Suffice to say I'm a vet, I've been a vet for a while. I've worked in academia, private practice, and research. And aspects of each really suck. But, in private practice, at least at my current gig, I have more control over my hours with better pay than I ever did previous. So here I sit, trying to save "Fluffy" and "Fido" despite their owners.
Huh, guess that was kind of an introduction. Well, strap in folks cuz here we go!

Welcome to our blog!

Welcome to our blog - Awesome Critter Clinic: Tails from the Trenches! We started this blog to tell the hilarious, heartbreaking and horrific stories of the things we encounter as veterinarians. Sometimes we'll tell on our clients, sometimes we'll tell on our colleagues, sometimes we'll tell on ourselves. But, other than altering details to ensure confidentiality, everything we tell will be 100% truth.