When it’s time for your pet’s euthanasia most of you want a veterinarian who will show the right degree of compassion, know just what to say, give you a big hug or the room you need, and treat your pet with reverence and humanity—almost as if he were her own.
That’s hard to do. But most of us try hard to do it right—to the best of our abilities.
When you’re trying to make decisions on the ideal timing for a spay or neuter, which kind of microchip, diet choices for your puppy or aging kitty, whether to amputate and biopsy a toe or not…you want a veterinarian who can give you all your choices and help you arrive at the best decision possible.
Sometimes that means a lot of phone calls or emails back and forth as your research on any given subject is refined. It can be challenging for us—but how much time is reasonable for us to invest in your decision making process?
Should you have a hard time coming up with financial solutions for your dog’s oral surgery or your cat’s hyperthyroidism medications, how far should your veterinarian go to help you find affordable approaches?
***
You could view these veterinary service benefits as intrinsic to what you pay for. Or you could consider them going above and beyond the call of duty.
Some might argue that veterinarians did not go to veterinary school to help you save money on your prescription medication choices—nor to serve as grief counselor, confidante, financial advisor or any of the other non-medical hats we’re often expected to wear.
The latter point is one my [vet surgeon] boyfriend argued convincingly last night over dinner. He feels that too many veterinarians burn out as a result of taking on too much of the non-medical details traditional veterinary practice has always offered. He thinks we commit less of ourselves to the increasingly challenging medical aspects of care by trying to be all things to all clients.
***
The conversation came up as a result of my recent post on prescription medications when it was referenced in PetConnection maven, Gina Spadafori’s article on the same topic. When the Veterinary Information Network’s inclusion of Gina’s article on its Veterinary Partner home page raised a bit of a ruckus among some veterinarians (and was pulled from the page), I was compelled to defend it.
In doing so, the issue of “how far should vets go to help their clients get good deals on meds” was raised—at least in last night’s conversation.
Should vets work hard to help their clients out in these tough economic times? Is doing so by recommending ways to save money just shooting myself in the foot? Does it condemn my profession to the same? Is it even our place to worry about our clients’ finances? Is playing financial advisor placing an undue stress on me? On the practice I work for?
My answer? Our clients are going to find ways to save money whether we veterinarians like it or not. It’s only responsible that we show them how to do it right (by avoiding unethical outlets that might offer counterfeit prescriptions, etc.). As a practicing vet, however, it’s NOT my responsibility to help my clients save money. But it is one of the ways in which I go “above and beyond.”
But is going above and beyond on the topic of finances—holding my cients’ hands, if you will—any different than going above and beyond when it comes to providing the best euthanasia experience possible? When our clients find some decisions hard to make? I doubt that. Nonetheless, I’ll concede that wearing all these hats takes its toll...
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Well, yes, technically you didn't go to school to be a financial advisor, but then the client isn't asking for help with their investments, 401k, or college savings plan. What they're asking for is ideas and advice from someone they (hopefully rightly) percieve to have a bit of insider knowledge on prices of products as well as their actual cost/value ratio. I would consider it really sad if a vet couldn't tell me if product A is as effective as product B and if it's more or less expensive. It would be the same as asking the appliance store salesperson what the cost/benefit ratio is for this or that stove. Now, before someone says pets aren't appliances...I know that. The products (vital medicines to impulse buy treats) are what I'm talking about, and although the vet may not know every single detail about which cookies are better, they should know enough about the medicines to explain them to the client. That is part of a vet's job, IMHO.
As for how much time you invest helping clients with issues (from your 3rd paragraph), that probably depends on how much you like and value the client and the pet. I have no problem admitting that that will vary by client and pet. Yes, you 'should' treat them all equally, but in reality, some of the willingness to spend extra time will depend on how that client treats you and even a tiny bit on how you and the pet get along. I think you should make a reasonable effort to help every client, but yes, some will need more help, and that's where you must either do it happily, suck it up and do it with a pasted-on smile, or suggest another vet for the impossible person who is going to make you so unhappy or mad that your treament of others is effected. (I almost had to give up a lucrative and easy dogwalking gig because of the conditions the dogs were kept in, and I would have if the client hadn't changed some things, even though I knew the dogs needed and appreciated me. It bothered me so much it was effecting other aspects of my life. Sometimes you must save yourself to save others.)
Lastly, with euthanasia, effectively and compasionately explaining the whys, why nots, and hows is part of a vet's job. The 'extra' effort of helping a client make the decision or helping (or asking the staff to help) prevent unnecessary euthanasias depends on each vet and their personal philosophies (although I would have trouble respecting, let alone liking a vet who made no effort at all). Of course the extremely hard part of maintaining professionalism by not crying while you're doing it is so important (and why I would fail as a vet). But being able to show real sympathy and empathy is just as important, and that's where a vet shows their best side, as far as I'm concerned. It is the deal breaker for me, and I fully realize it's asking the world of a vet, so I applauded every vet who can do this balancing act with skill and grace, as I think you do, Dr.K., from the tone of your posts on the subject.
Just from a money-making standpoint, though, if making extra effort builds client loyalty, then I would suggest it should be worth it, if you want to stay in business. Even when things are tough, helping a client with a payment plan helps the animals, and although it's tough to wait for money, the good karma (hopefully) will give you a little satisfaction in a job well done, which can be better than having more money now but being unhappy in your work.
KateH December 10th, 2008 01:24:49 PM
I have to say I agree with your boyfriend, and I'd like to add that the staff feels it, too. Especially now, w/the holiday season and the recession and whatnot, I spend a lot more time talking to people about financial issues than I'd care to, especially when they distract from what the pet needs. The chief of staff at the clinic I work at has done such a great job of educating the nursing staff (tailored to his way of practicing, of course) that we end up doing a lot of his talking for him so he can focus on other things...and not go bonkers with the amount of hand-holding some of our clients require. I know most of these clients are truly trying to do right by their pets, and unfortunately finances almost always play a big part in veterinary medicine...but no, I'm not going to call six different pharmacies to price-check a drug the doctor has prescribed. I'm not going to call every clinic in a 20-mile radius to inquire about payment plans. I'm not going to call the feed store to see what they carry. Time spent trying to penny-pinch with clients is time spent away from pets who actually need me - for vaccinations, labwork, exams, post-surgical monitoring, monitoring of fluid rates, etc. One of our staff doctors prefers to do all the "hand-holding" herself...as a result, she tends to attract clients other doctors/staff deem difficult or time-consuming, and because she is constantly going above and beyond for each and every case, she gets terribly bogged down. She often stays late (as do the nurses assigned to her), and the rest of team kind of has to pick up the slack. She is, of course, an excellent clinician and a wonderful person...but she also only works two days a week as she is 50-ish and semi-retired. So, no burnout for her, but the nursing staff practically draws straws to see who is assigned to her each day!
anna December 10th, 2008 01:40:37 PM
Personally I think going "above and beyond" or basic compassion for your clients will build your business versus the standard model.
Granted, compassion fatigue is a real problem and people do burn out in the animal profession because of it.
However, ultimately I think those that do show they are human and take caring steps to help their clients (both furry and human) will benefit over their competitiors.
In the long run, I believe we are going to see a move toward the more humanized model which will mean that smaller practices instead of franchises will be the choice of many more pet owners.
Find me blogging at Ark Animals...
Diana December 10th, 2008 01:45:15 PM
I think it all boils down to a love for what you do, your patients and your clients. You truly care about them... and your bottom line.
My own veterinarian (and human physician) both do things that would be considered "above and beyond" their regular duties to make my visit and aftercare as easy and cost-effective as possible.
However, I do find it disturbing that the mere suggestion that this is something that should be encouraged, or even considered on a wide-spread basis as a detriment to the veterinary community upsetting... if the establishment finds this to be threatening, I find it to be another reason we should in fact have a seperation of pharmaceuticals and veterinarians much the same as we do in human medicine. Unfortunately, this will negatively affect those that don't abuse the system, but if there's no other way to keep those who do in check, well...
Kim December 10th, 2008 01:57:14 PM
I would expect a vet to discuss medication options with me if a medication was a budget buster. But I also quiz my Internist as to whether the new drug with the $50 copay is any better than the older, more established generic drug at a $10 copay. Human Dr's (and perhaps Vets) are bombarded by drug advertising - its bound to influence treatment. As for financial issues - I think this is largely the pet owner's issue. However, I think a little extra time is warrented if a long term client who always paid on time is now having financial trouble. For a new client - not so much. Finally, loosing a pet or putting down a pet is really traumatic. Any vet that doesn't show compassion and isn't supportive when these decisions are being made isn't going to get any more of my business.
2CatMom December 10th, 2008 02:03:04 PM
I agree with your thinking Dr. K, it is what seperates mediocre from best. To infer it is a disservice to the profession is indeed selfish and thoughtless. And I'm wondering how many of those voicing that opinion has ever "really" dealt with the human profession for any length or depth of time.
This isn't uncommon at all, weighing choices and expenses, even to those WITH health insurance. And as far as compassion, off topic discussions, many human doctors start off that way to make the patient and family comfortable and at ease, not to mention subtly find out if possibly something "external" is affecting the patient's well-being.
One of my Mom's last appointment conveniently included a P.A. that conversed with her in German and asked geographical and historical questions , which she thoroughly enjoyed, yet I'm sure was basis for forming an opinion as to brain damage. Her Oncologist always spoke about the Red Sox & trips to VT.
It doesn't take only but a few minutes, to express a kindness. I'm sure you aren't blasted with an hour of someone's life story--that would be rude from the client.
And lots of folks in the profession may want to consider that the economic tomes DEMAND some concessions...which should it be? An appointment or two, or none at all?
Another important difference, is your patient can not talk...it is the client put into the making the decisions, and there is most often NO health insurance involved either!
Is Dr. Wosar just a wee bit stodgy for a young guy ;) ?? B. Albright
Pocket's Story from NH December 10th, 2008 06:34:10 PM
I have to say that after this past year dealing with 4 board-certified specialists and my regular vet - I was quite surprised at how little the specialists did seem to care about my pet vs. my regular vet. I definitely detected a bit of a snob factor there AND they made mistakes!
Wendy December 10th, 2008 07:46:53 PM
Those incidentals are important to many different careers. The emergency animal hospital I use addresses some of these issues in pamphlets that are available in the waiting room, and the grief counselling by providing information about a pet loss/grief counseling hotline staffed by the local vet school students.
As a college-level teacher, I see the money issue a lot when it comes to textbooks, and while I'm not obliged to offer advice, I generally do point them towards cheaper sources online, and also point out that I keep the textbook on reserve at the library.
zandperl December 10th, 2008 08:40:58 PM
As an educator we are asked every day to go above and beyond what we were hired to do. Do you want someone dealing with your child that is only worried about ABC's and 123's or do you want someone that will do a little hand holding? I drive by two vets to get to my vet because of the compassion his whole practice shows to their clients. I am also a dog trainer that teaches dog obedience and am asked all the time to recommend a good vet. I have sent at least 100 people to my vet so I would say it helps their business to do a bit of hand holding. And most of those people drive by the same two vets to get to him. Yesterday my horse vet came out to float my miniature horse's teeth. He isn't the cheapest vet but is by far the most personable and we talked about a lot more than teeth. He gets my business every time. And when I had to put down my 22 year old horse, that I had her whole life, he was there to hold my hand. Sorry but I think your boyfriend is wrong.
Wendy aka goatgirl December 10th, 2008 09:33:34 PM
When our cat had cancer and we had done all the protocols and gotten to keep her for another 18 months (a long time for a cat with cancer) but the cancer came back (remission is just what the word describes) our dear Dr G did shed a tear when we brought her in to be euthanized. He was the first vet she'd ever seen 19 years earlier and even though she'd had appointments with the other vets in the practice he always stopped by to give her a treat and a pet...was this going above and beyond? Was giving me a prescription for a generic version of her pain meds so we could save $50 a year on it going above and beyond? Yes. And because of this I bring all my pets there. I also bring them a basket of homemade muffins early in the morning on Christmas Eve day. I depend on them to take care of my pets, family members whom I love. If they didn't show any concern for me, their guardian, I'd stop bringing them there. That would be a greater income loss for them than say giving me that prescription or taking an extra 10 minutes to figuratively hold my hand when giving my baby that final shot. By the way, all my cats have insurance but the money is still an issue. Do you keep going and spending to hold on for a few more months or stop now and get another week or two. My vet was very helpful in telling me how much it was going to cost and what sort of "time frame" we were looking at. This took extra time that he could have spent seeing another patient I'm sure, but, it was that little extra care that keeps me coming back.
Donna December 11th, 2008 02:12:09 AM
"He thinks we commit less of ourselves to the increasingly challenging medical aspects of care by trying to be all things to all clients."
I don't think the solution to this problem- and to compassion fatigue in general- is to pull back and not offer clients "above and beyond"-type services. I think part of the solution is surrounding yourself with good resources. It is impossible to be all things to all clients, but you can use people around you (techs, practice managers, etc) to help cover some of the services that clients need. You don't need to be a vet to stay up-to-date on where clients can get cheaper meds, or who the reputable dog trainers in the area are, or the like. Delegate delegate delegate.
I also think vets are lousy at remembering to take care of themselves. I got a note from an MD who specializes in talking to students and doctors about burnout. He said that, even though we constantly try to humanize the experience of being a doctor, the only sustainable solution is not to change the world, but to change oneself. Maybe you'll get a few extra points on the final because you got up two hours early, but you just set yourself up for failure on your next one because now you're exhausted. Getting enough sleep is really the only sustainable practice.
... or maybe that's just the finals talking. :-P More coffee!!
Megan December 11th, 2008 07:30:04 AM
Poor Dr. Wosar...sometimes I feel for his position given my public exposure of his opinions. But his position is inevitably going to be different than mine. Specialists may seem aloof but they're there for one primary reason: to achieve a higher level of care, care which requires a greater need to concentrate on their patients. Does that absolve them of the absence of compassion some may be guity of? No, but it does help explain how it happens.
And, for the record, Dr. Wosar has the BEST bedside manner of almost any clinician I know. My clients tell me so. In spite of his rational arguments, he's really a softie.
Dr. Patty Khuly December 11th, 2008 09:45:09 AM
I think your boyfriend's comments are reflective of the difference between a generalist and a specialist. The same is true for human medicine. You don't really care if your surgeon has a sparkling personality - you want him/her to have to best skills and outcomes possible. You don't generally have a long term relationship with a surgeon, so it isn't as important. But the person who takes care of you or your pets on a long-term basis should have an interest in you as a whole person (or cat or dog). I've had the same internist for 25+ years which is pretty unusual. Why? I have some complicated medical problems that need to be juggled around priority wise. While I only see my Doc 2-3 times a year - he spends at least one hour reviewing what's going on with each of these issues and how to best coordinate treatment. Now if he wants me to see a specialist, I know I'm only going to get 15-30 minutes - and that's fine, because my Doc reviews the specialists' recommendations and if he disagrees he gets involved. You probably already guessed that my Doc is not a kid. He's in his 70s and I'll really be at a loss when he retires. I feel the same way about my cats. Even though I go to a practice with 6 vets I do try to see the same one each time. My intention is that my cats will be going there and seeing that vet for their entire lifetime. But if that vet, over time, doesn't see the relationship as important (e.g won't return my very, very rare phone calls, won't spend a few extra minutes answering my questions), there are lots of other vets in the practice, hell, lots of other practices that I can take my cats to.
2CatMom December 11th, 2008 09:50:41 AM
Looks like Dr K and my comments overlapped. sorry about that! Ok, can someone explain how to put in paragraphs again? I obviously didn't get it the first time around.
2CatMom December 11th, 2008 09:52:35 AM
2CatMom,
As surprising as it was to me, apparently everyone (but you and me)(wink) is savvy enough to have just gone ahead and inserted html tags. I owned/operated a web design company for several years, so it's not as though I didn't know how to do it. I write all kinds of html code. It just seemed unlikely that would be necessary.
For paragraphs, for example, you use the < plus the letter 'p' and then the > to start a paragraph. You may or may not need the end tag, but if you do (I always put it in), you do the same, with just a / before the letter. That goes for 'i' (italics), 'b' (bold), 'u' (underline), etc.
In any event, just do an Internet search for html tags, and you will probably find what you're looking for.
:-)Marjorie December 11th, 2008 11:54:15 AM
Marjorie--thanks for that. I just sent my guy to fix it. hope it takes this time. Since I don't have Explorer I can't tell if it's working or not.
btw, your cutie clipped-in pup is fabu...!
Dr. Patty Khuly December 11th, 2008 01:36:24 PM
One more thing. Though I hate to do this here--are you using IE6 or IE7? You can reply directly to my technical questions contact in 'Contact Us' on the navigation bar beneath the Dolittler logo. Thanks!!
Dr. Patty Khuly December 11th, 2008 01:51:06 PM
"btw, your cutie clipped-in pup is fabu...!
Thanks, Dr. K! :-) I've made so many of those animated gif's, over the years...This is actually the one I meant to insert:
Marjorie December 11th, 2008 02:17:04 PM
HTML? Computers are like cars - show the me gas and the brake. I don't want to understand how it works. But I did get the paragraph thingy.
And while we're at it, Dr K - I still don't see the icon to insert pictures. I know, I'm hopeless.
2CatMom December 11th, 2008 02:39:01 PM
2CatMom,
That's html code, too. If you have an image already online, copy that URL (the "http://..." address of the actual image...not just the web page to which it may have been uploaded) and insert that into the html image code.
There are different ways of writing that code, but it'll be something like < then 'img' then a space, then 'src=' then the URL...which usually ends in jpg or gif, since you're inserting an image...in quotation marks on both sides (i.e. "http://www.sample.com/image/2catmom.jpg", then > to close out the tag.
You won't know 'til you try it! :-)
Marjorie December 11th, 2008 03:00:55 PM
Marjorie: Sorry to hijack this thread - but what if the picture isn't on line, just stored on your computer as a jpg?
2CatMom December 11th, 2008 05:34:30 PM
Sorry to continue the hijacking but I should tell you both that if you register on Dolittler your comments will reflect your websites so that those who converse here can converse one-on-one elsewhere. Not that I mind your conversing here, OK? I just prefer a cleaner thread, as you can imagine. I'm still working on the back end of the site to make all of this more transparent.
Dr. Patty Khuly December 12th, 2008 08:23:35 AM
A human doctor would hold the families hand for a moment, some would even give a hug. My dogs are my family too, yes give a hug or hold a hand. It is a death in the family the same as any other.
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