#1: Stress!
When clients add stress to our lives in quantities disproportionate to that of the average pet owner, we sometimes initiate divorce proceedings. It usually arrives in the guise of a nice letter explaining that it must be our fault:
“It’s clear to the doctors and staff of X Animal Hospital that we cannot render services at the level you deem acceptable. Enclosed are your medical records. You will doubtless be better served elsewhere.”
Translation: Buh-bye.
Stress is huge. Why else would any self-respecting vet with bills to pay choose to cut themselves off from a client, the lifeblood of any veterinary practice?
Here are some other reasons (incidentally, all arguably a subset of #1):
#2: Financial complaints
Because clients are not always willing to pay, or even if they are, because they’re unwilling to part with it ways we recommend. Sometimes it’s because they exhaust us with complaints on every single invoiced item every time they come in.
Recent example: The financially nitpicky client who outright refused to surrender his pet to the $40 X-ray which would easily have diagnosed the stones his cocker spaniel carried in her bladder. Instead, he berated me for trying to take advantage of him by forcing him to pay for “extras” when “antibiotics would have done the trick.”
Right. By the time I attended his pet in the correct manner she’d suffered months of recurrent urinary tract infections and the client ended up paying more for his chronic delays—not to mention what his pet suffered. Shame on him…and his $100K Porsche. We don’t need clients like this.
#3: Obsessiveness
We all know people like this. They mean well. But after six phone calls every day for a week the staff is ready to pull out their hair.
#4: Ridiculous demands
“The doctor MUST speak with me right now. No, it’s NOT an emergency and I don’t care if she’s in surgery. Just get her on the phone!”
If this is a client's M.O., it's a no-go.
#5: Freaky humanizing behavior
Clients who refuse to leave their pets without ensuring that the staff will change her diapers every hour and puree her food just so. “Oh, and here’s the silver spoon she must be fed with.”
Seriously?
#6: Lack of trust
Sure, we vets have to earn that trust but some clients never even give you the opportunity. I once fired a client for accusing me of taking her for a ride when I diagnosed (yet again) bladder stones:
“My boyfriend is a [human] radiologist. I just called him and he says you can’t see bladder stones on an X-ray. I know you’re cheating me so I’m not paying for that X-ray.” (Incredibly, this nastily delivered sermon came after I’d shown her the stones.)
Uncharacteristically, I fired this one on the spot. No letter. Just a simple statement explaining that if she wanted a vet who practiced canine medicine based on knowledge of human pathology she had better go elsewhere.
#7: Cheating
How to get your vet services for free: Just put them on an American Express and dispute the charges. AmEx always decides in favor of the client as long as the client says they didn’t authorize the services (despite being present while they were being rendered). Next time a merchant won’t accept your AmEx card you’ll know why.
#8: Unfair expectations
Sometimes owners expect their pet to be cured of all diseases instantly. They expect you to know exactly what’s wrong instantly. Then they get nasty about it, accusing us of committing all kinds of idiocy. This is when I explain (if they’re of a certain generation) that, “I’m sorry but I left my tricorder on the Enterprise.”
#9: Unethical behavior
Trying to get us to sign paperwork attesting to a pet’s age, weight, genetic abnormalities, pre-existing conditions—even a pet’s identity—to gain access to a flight, a boarding facility, a condo, an “excellent” grading on OFA hips, for puppy sales, etc. One client even forged my signature on a document once.
It’s fraud. It’s wrong. It puts MY license in jeopardy. These clients are summarily dismissed.
#10: Garden variety nastiness
This kind of behavior isn’t necessarily aimed at the veterinarians manning any given practice. In fact, it’s more likely confined to rude and inappropriate remarks leveled against staff members.
More than once I’ve had to fire a client after hearing them yell at a receptionist via telephone in tones loud enough to be heard by anyone in the same room. If a client isn’t contrite after being called out for verbally abusive behavior, or should it continue, they get fired.
It may sound from the tone of this that I enjoy firing clients and/or that I do so often. Truth be told I’m not often given cause. But when they do manage to raise our hospital’s collective stress levels to the breaking point, little gives me more satisfaction than knowing we don’t have to take it.
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I worked at an animal emergency clinic for 6 years. The stress level was beyond believable. The demanding clients, the know-it-all clients, the ones who told us to go above and beyond without a dime to their name, etc., we all wanted to strangle, but kept composure for the most part because of the innocent pet. There were only a handful of clients that we fired, and all fell within the guidelines you listed. I'm glad to see other clinics feel the same. There are just some clients that aren't worth the money, but I still feel very sorry for their pets.
Gail September 11th, 2008 02:52:00 PM
On the point about the innocents: the pets. That's the saddest part--especially if you fear they'll get no care at all if you fire the client. And you're right--some clients are just not worth the money. To make that point, more than once I've refused to take a horrible client's money at all: "No--you're just not worth it. I did it for the pet--not for you. And definitely not for you're money if you think that paying me means I have to put up with you." One of those times I even received an apology and a gift. People can be weird.
Dr. Patty Khuly September 11th, 2008 03:04:00 PM
i'm a vet in an emergency practice - and it just adds to the stress level. people think you're trying to rob them when all you want to do is the best you can do for their pet. they're already stressed and angry that they failed their pet by letting it get out, or eat raisins, or drink antifreeze...and then it all comes down on you.
i recently had a guy with a dog that had a history of eating buttons and needing an ex-lap. xrays showed a "possible" obstruction. the dog had been vomiting intractably all day. i recommended they let the dog stay overnight (it was 3:30 in the morning, at this point) for monitoring and possible xrays - but the owners refused. i gave the dog a shot of cerenia, famotidine, and SQ fluids with the admonishment that they should see their vet at 7:30am (a mere 4 hours away).
i got a call from him recently because he is disputing his charge. why? not because the dog died or anything like that. nope - dog is fine - just had gastroenteritis. the owner just thought he paid too much after going to his vet and paying less (we have digital xray PLUS we're an EMERGENCY CLINIC). he also pointed out that i didn't do anything for the dog (which went from our clinic to the rDVM in 3 hours...how many times has your doctor fixed a severe gastroenteritis in 3 hours with an anti-emetic and some poorly absorbed SQ fluids??). i discussed with him the fact that i authorized the charges with him BEFORE i did anything.
he also told me that giving cerenia to a possibly obstructed dog is wrong. i had to explain to him the difference between the a pro-motility agent like reglan and an anti-emetic like cerenia - while also pointing out that i knew he was taking the dog straight from our clinic to his vet. he didn't believe me - and further said he didn't leave the dog at our clinic because he was afraid i would cut it open without asking him first!!!
my head almost exploded, as i explained to him that the hospital administrator had looked at the chart and was comfortable with my treatment plan, recommendations, and notes...but she'd be happy to call him back. i had to restrain myself from slamming the phone down harder than i already did.
homeless parrot September 11th, 2008 03:11:00 PM
i meant stay the night for follow-up xrays to assess the "obstruction".
homeless parrot September 11th, 2008 03:13:00 PM
homeless parrot: It's amazing how often this kind of thing happens. And how ruinously it can affect your whole outlook on helping animals. I try to do the 1,2,3 trick I mentioned in a post last week on veterinary accidents. Step three, letting it go, is the hardest but most vital.
Dr. Patty Khuly September 11th, 2008 03:29:00 PM
People who behave badly should be fired. Anyone who doesn't understand that an emergency clinic has to charge more, is an idiot. Of course, they have to charge more... they're open 24/7! And, after hearing the AMEX story, I'd never accept another AMEX card again as long as I lived. People can be such jerks. I'm glad I'm a good client. My vets hug me when I come in with my pets. I realize that good veterinary care is not cheap and although I may sigh and worry about costs, I never put that on the doctor or their staff. People need to be prepared when their animals become ill, or are hurt, that it's sometimes going to cost a lot of money to get them fixed up. Those who are not prepared for this should not own animals. Period.
Vicki T September 11th, 2008 10:18:00 PM
I don't have a clinic story to contribute, but something along the same feelings. In 1992, I formed the first official rescue program affiliated with the Scottish Terrier Club of New England. It was a fairly new concept, pre-computer & web sites, and not received whole-heartedly or with much backup support, at first. Easily a 20 hour/wk. + volunteer position.
Without fail, despite my full-time USPS employment, EVERY holiday weekend, plus some, revolved around picking up a Scottie from individuals and shelters from ME. to RI & CT. One such individual asked me to meet her at White River Jct. VT to place her young Scot. I was tired, as usual, after my work week, but met as scheduled.
Her dog was barely recognizable as a Scottie, and as I went over the release paperwork, she suddenly "flipped out & became extremely rude" She insinuated that I was in the "resale-type biz", rehoming these unwanted Scots. I turned to walk away & simply leave without argument (not too mention, thinking how pleasant it would be to not have a foster to rehome, for a change) and she quickly apologized, handed me the dog and left.
Did I need that? Yikes, no. I would have relished a sleep-in Saturday, instead of 5 hours round trip.As any rescue or shelter person can vouch, there are some real beauts.
Barbara A. Albright/New Hampshire September 11th, 2008 11:26:00 PM
I have had to rarely fire a client. always did it in writing. On a couple of them, they showed up with the letter in thier hand and an apology. They were never really great clients afterwards but never caused us any more problems. I don;t think I was the first business that confronted them.
Hobson September 12th, 2008 09:33:00 AM
As I was reading through this list, it occurred to me that most of these (with the exception perhaps of #5 and #7) translate equally well into other "fire the client" situations. I used to work in consulting, and our primary reasons for firing a client were also tied most closely to stress. Stress can infect every part of your business, and it has to be controlled if possible. Unrealistic expectations is also a big one in consulting. Going above and beyond is one thing, but if clients are constantly expecting you to go beyond the "beyond," you're fighting a losing battle.
Jonathan September 12th, 2008 10:31:00 AM
The human ophthalmologist that I worked for had to fire a patient once. It was an older man who had all the technicians too terrified to go into his exam room for fear he would physically attack us. I felt bad for his poor wife - the man was obviously disturbed. He was verbally abusive to her in front of the whole office and she confided that she was having to travel farther and farther to find doctors willing to treat him, but as the last technician to go into his exam room before he was thrown out, I can honestly say I feared for my safety and that's just not right. He needed a facility that was equipped to deal with his situation.
Laura September 12th, 2008 11:42:00 AM
I'm glad you included #10. Too often vets and physicians only react if the client/patient mistreats the doctor. The office staff needs protected too and the physician is the one who should deliver the message that inappropriate behavior isn't going to be tolerated. Other clients shouldn't be exposed to that behavior either. The nice clients will benefit from the improved attitude of a safe, secure staff and polite behavior of others in the waiting room.
Shannon Watts September 12th, 2008 12:21:00 PM
thanks dr patty. as a new grad and intern, i take every little blip terribly hard. i've been told i have to "lighten up" or i'm going to burn myself out! i've found a great way to relieve my anxiety though. any time there is a blip with an angry client, i log onto VIN and read the message boards. the stories on there are absolutely hilarious and horrifying both. i usually get a good laugh, but i'm also reminded that i'm CERTAINLY not alone in all of this - it happens to all vets - and it can't affect how i feel about my job. i love what i do. i love most of the people i work with - most of the time. some are jerks. but then - there are jerks everywhere, in every field.
thank god for VIN - in a million different ways!
homeless parrot September 13th, 2008 12:39:00 AM
homeless parrot: I remember (in my early days) suffering through big, fat dog spays. I would cry. Really. I got on VIN once after a particularly horrible "big fat rottweiler in heat" and posted on VIN how broken down I felt after the experience. (You can probably go back in the archives and find this post.) I received so much support for my stress.Nothing anyone had said to me before that made any difference. VIN's community respected my fears and supported me so that I finally got over my extreme surgical fear. So I agree: Hooray for VIN!!
Dr. Patty Khuly September 13th, 2008 07:40:00 AM
Wow. I'm a slightly know-it-all overprotective worrywart of a pet owner, though I am quite sure I've
never been guilty of anything on this list to get me fired! (I hope) But this post has opened my eyes
a bit to where my vets and their staff stands. Earlier this year my old boy had broken teeth
that were in obvious pain and making him miserable - my vet offered me an option to
have them pulled and a cleaning done - I didnt ask for it. I took them up on it, and my dogs been
ever grateful for it since, I know!! They didnt even run a credit check on me, or insist on pre-authorized payments or record my Visa or MC number, or ask for minimum payments monthly. They just told me to pay whatever I can afford as I can afford it, and to make some kind of payment every month even if its a small one. I'd only been going to this vet's office for
2 years!
So now I think I really understand how lucky I am am to have these guys on my team! And to top it off, they are the best in town and offer pretty progressive care. My dogs and I are truly lucky, and I never want to get fired from this practice!!! Next week when I go to make a payment they are SO getting a thank you card and a note, at least.
Thanks, Dr Khuly
carmen September 13th, 2008 09:40:00 AM
on the bright side: i'm not timid at all, and when i know someone is acting poorly, i handle it well. i had a case recently - a dog came in on a holiday - which are madhouses at emergency clinics. the dog had a fever and a problem that was easily seen (don't want to give too much detail here) that was causing the fever. without going into too much detail, i triaged appropriately and moved on to the ventilator drowning case, the HBCs, and the snakebites - etc. the owners called me in the middle of (i kid you not) a CPR - demanding to know why further diagnostics hadn't been conducted yet on their very stable pet. i didn't have time to talk to them at the moment - so i continued my CPR. they showed up an hour later - demanding to know how i could shotgun treat their dog's infection (the owner was a human medical person) and questioning everything that i was doing. i was furious...because we were crazy - and everything was dying simultaneously (except their EXCEPTIONALLY STABLE pet). they demanded to speak to my superior, but i beat her to the room. by the time i was finished talking with them - they were so apologetic for their behavior that they bought lunch for the entire clinic:) of course, i spent 20 minutes of valuable time discussing everything we had previously discussed with them again - but in the end, they left so happy that they apologized and fed us all. they were really very nice people, just a bit on the high-strung side.
the ones that really suck are those that no matter how logical and polite you are, and how you try to explain to them that the dying dog with a traumatic diaphragmatic hernia comes before their small dog with very very mild back pain - they still pitch fits and demand immediate treatment...but oh well. that's emergency medicine, right??
homeless parrot September 13th, 2008 10:51:00 PM
(oh and the exceptionally stable dog recovered from her fever/infection excellently and continues to do well:)
homeless parrot September 13th, 2008 10:52:00 PM
ah homeless parrot, you reminded me of a story from when I worked in an ER....
We had a busy Saturday going and a couple come in with their bouncy Golden Retrievers, panicked out of their skulls because they found a tick on one of the dogs. They wanted to test both dogs for Lyme NOW (this was in an area with a lot of Lyme and other fun tick bourne diseases) They were advised they would be seen by a DVM, but they had to wait their turn, as the waiting room was alreayd full.
The grumpily acquiesce. 20 minutes later we get a HBC dog rolled in---this dog had to be raced through the waiting area from the parking lot on a gurney because it was trying to die enroute.
Golden Retriever couple become INFURITATED that this dog--who arrived 20 minutes after they did-is seen before their very healthy,happy and bouncy dogs. Why doesn't HE have to wait, they want to know. What strings do they need to pull to go to the front of the line. The receptionist tells them that dying gets you right to the front, and their dogs are not dying.
This couple left after making a GIGANTIC scene in the waiting room and making a huge production out of calling another clinic to see if they could get their dog in for that emergency Lyme test.
I have to wonder if these folks have ever been to a human ER with a stable emergency. I had acute gastroenteritis on vacation once and spent an hour waiting to be seen. I felt like I was dying, but my brain knew I wasn't...but the woman having the frightening sounding asthma attack might have been.
drsteggy September 14th, 2008 01:22:00 PM
emergency lyme test - that's a new one on me:) people never cease to amaze me. i had another owner recently throw a fit because we didn't see and take care of her dog with mild cervical pain as soon as she would have liked. she was unbelievably rude to me, my staff...i had to restrain myself from saying something that i would have regretted. it was a sunday (as per usual) - and from start to finish - she was only in our clinic for 2.5 hours. that's GREAT - in my opinion. i've never been seen in a human ER that fast - even when i had a kidney stone, and i was vomiting and crying and lying on the floor OF THE WAITING ROOM trying to find a comfortable position. they gave me a bedpan and escorted me to a dark room so that i could throw up and scream until the ER doc could see me. did i bitch about how long i had to wait before i got some morphine??? no - and i wasn't even in vet school then - i didn't even really understand triage...although it seems to be common sense to me now. and yet - i would never complain. i wasn't dying. and neither was this dog with MILD back pain that had persisted for weeks. when i came back in the room to explain the meds (which the pharmacist was frantically trying to fill along with the other 35 prescriptions) - the owner was packing up to leave. she said she didn't have time to wait for this "shit" - i asked her if she wanted the meds or not. guess what? she waited.
i hope this doesn't make me sound like a heinous witch - because i'm definitely not - and the good clients love me. but people like that - i just have no patience for them. they expect the world to revolve around them and ONLY them. ARGH!!!!
homeless parrot September 16th, 2008 10:04:00 PM
Emergency work is the toughest. But I think ALL us vets should spend some time doing it. It makes you appreciate the more stable, less stressed atmosphere of standard practice. Silly me, I also miss it. Love those do-or-die cases.
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