There’s no better example to prove veterinary medicine can be an art as well a science than that of the interchange between veterinarian and pet owner in the face of a crisis.
How a veterinarian handles these crucial moments can mean everything to how the patient is ultimately treated––or not. Typically, it all comes down to 1) how well these parties know each other, 2) the trust the pet owner places in their professional and 3) the veterinarian’s interpersonal skills.
This last point is affected by a complex mix of so many tiny variables that it’s no stretch to say that mundane issues like a veterinarian’s caffeine intake, time pressures, too-small breakfast and a million other small stresses can affect the outcome of an interaction.
But that wasn’t my problem during one of last week’s stressful client visits. It was more the fact of not having yet earned the trust of a brand new client––and realizing that I knew this client not so very well.
Here’s the story:
Though I’ve always urged Dolittler readers to seek second opinions from specialists, I see more than my fair share of second-go-round cases. In this case, however, no specialist was needed.
This was a geriatric male dog whose severe skin disease had led to a horrible gnawing injury of his tail. Exposed bone, ligaments and nerves at the middle of his long tail had been crudely (but effectively) bandaged by his owner.
Upon removing the bandage and revealing the injury, I thought his owner might hit the floor. She was so distraught over the situation I was somewhat at a loss to know how to effectively calm her.
- Perhaps I made more of the injury than I should have, intent as I was on explaining every detail of its lengthy and possibly ineffective treatment (tails heal poorly, especially in dogs whose underlying skin conditions might take weeks to resolve).
- Perhaps I was too quick to recommend amputation of the tail as a better solution than the slow, stressful, questionable recovery of a mangled tail.
- Perhaps I overwhelmed her with my explanation of the dog’s self-traumatizing condition as a potentially devastating behavior that might necessitate an e-collar for weeks or longer.
- Perhaps I frightened her with my explanation that we had yet to address the dog’s skin and any other physical concerns, especially his advanced orthopedic issues––not to mention the internal issues we might find, as this dog had never had comprehensive labwork done.
In any case, when the owner’s tears finally brimmed over at the end of this discussion, I knew I’d gone way too far. This sensitive owner had required more delicate handling than I had anticipated. Next thing I knew, she was talking euthanasia.
I was suddenly very confused, not having realized I’d hit her over the head so hard with all my cold, hard facts. I had advanced all my points carefully and optimistically, I’d thought. After all, this dog’s last veterinarian had left me with a clean slate, one I could do so much with that I was excited to get started on fixing this dog.
But instead, I’d left her feeling like all the work that would be required might be too much for her thirteen year-old dog. Somehow, my enthusiasm for healing her dog had fallen flat. I’d over-burdened her with my extreme honesty and lengthy discussion, something I guess her dog’s former vet had never done.
At first I thought it was the money. Yet after explaining that everything would come in at well under a thousand dollars she assured me that the monetary concerns were incidental. She was simply concerned that her dog would have to suffer...perhaps for nothing.
That’s when I changed my tack and backpedaled as hard as I could, assuring her that we didn’t have to make any snap decisions. Let’s clean up the wound, bandage it, go home on some Rimadyl and antibiotics and we’ll talk about it after the weekend. I even invited her to Dolittler so she could get to know the kinds of recommendations and discussions most vets now enter into.
And, yes, the story has a happy ending. Though still reluctant to amputate the tail, she’s an ace at bandaging it. She understands it may take months and that it may still need to come off, but she’s more comfortable with the concept.
So why the sudden change of heart? I’d like to think it comes down to Dolittler but I don’t think I can take the credit. A weekend on pain medication convinced this owner that her dog can still play at the park and enjoy life. Chalk it up to the life-saving power of very basic healthcare...despite the brutal honesty.
Sometimes it takes a powerful dose of this stuff...and sometimes we need to dial it down a few dozen decibels. Honesty may be the best medicine in some cases, but I’m now convinced it can also kill.
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That's always tricky. You're there to provide objective and informed opinion and expertise, and propose the most sound treatment, but you are not necessarily responsible for how people absorb that information, if they are even able to. One thing I've learned (hopefully) is to use a poker face in almost all situations, because some people are very good at reading expressions, because sometimes an immediate emotional response can trump more objective information and prognosis. And to give my most honest and informed answers, based on mine and others' experience. Listening to the client is part of that as well - and keeping the dialogue open. That's what you did, and it saved the day in the end. It's amazing what wound hygiene, antibiotics, antiinflammatories and hydrotherapy can do, given a bit of time. Hydrotherapy has saved the day for many of my patients with catastrophic wounds.
brebis noire March 4th, 2009 07:06:15 AM
From what you say, it sounds like, not an excess of honesty, but simply an excess of information delivered too quickly. Not exactly the same thing, even though related. "Let's clean and bandage this and give him some pain meds, and talk about more comprehensive treatment when we've got the immediate situation under control." You might want to be more artful about it than that, but that's the basic idea.
Also, she might be someone who can't really cope with blood and major wounds. She did it when she absolutely had to, for her dog's sake, but with the medical care in the hands of a vet, she was calmer and therefore, paradoxically, more unhinged by what she was seeing.
In general, I think there's a great tendency for experts in any particular field to imagine that non-experts will find the glorious detail of their field a lot more fascinating than they really do. Not just vets, not just medical doctors, not just physicicsts or chemists. I mean, seriously, you probably don't want to ask me what librarians are talking about when they say "cutter number"... And yes we CAN delude ourselves that it's actually interesting and useful information for the library patron who just wants to find a book.
Lis March 4th, 2009 07:08:42 AM
Lis: You're right, but it's tough to know which clients need more and which can't take it. Many of my clients want serious detail--pictures, possibilities, the whole nine... and then there are those who want me to do my job quickly with minimal explanations beyond what they actually need to do at home and what they need to pay. It usually takes me a while to get to know someone before I can slip easily into their mindset.
In this case, I think I simply mis-read the client. Yeah, too much info too fast. Comes from working too much ER, methinks.
A vet can't always be all things to all people...sigh...
Dr. Patty Khuly March 4th, 2009 07:22:27 AM
So easy to err in either direction! There are the practitioners -- some well intentioned and just presenting options, others more profit oriented -- who propose every available treatment under the sun and don't address the pet's prognosis and quality of life sufficiently. Many owners feel like if they don't do everything they are failing their beloved pet.
Years ago, when after weeks of treating my ailing cat I feared we were just torturing him, I asked his vets simply, "if this was your cat, would you keep going?" When they emphatically said yes, I went on, my cat recovered, and I was very happy with my decision.
In the end, it is just being human.
Susan R March 4th, 2009 07:34:12 AM
A mis-read occasionally is just a reminder to not slouch on the art of perfecting your "sensitivity" or lack of it if thats what a client wants you to be. You have to go "zen" during the process of getting to know your clients. Who they are, what their life philosophy is. Obviously a client who wants you to take charge and never asks questions is going to differ from a client who wants to have a 50/50 relationship and is into things such as natural "science" combined with medical science. Lastly if their are Spritual beliefs be it dogma or metaphysics thats another thing to have to deal with.
Evet March 4th, 2009 07:40:59 AM
Our clinic just hired a new vet who we really "clicked" with (we were asked to be part of this vet's job interview (like secret shoppers), so we feel good about having her treat our pets). She's the vet who was on call two weeks ago, when our two year old cat suffered sudden vision problems/blindness. We went in knowing the cat had fallen, and we hoped we were perhaps dealing with something like a concussion. The new vet skipped right past hypertension and hyperthyroidism as possible causes, and started suggesting things like brain tumors and seizure disorders and FIP and FeLV and ended by saying she felt the cat had a "poor prognosis". This is a healthy, active cat who we've had since she was one day old, and we knew she'd fallen, so to go from us thinking her injury could be a head bump to being told the outcome looked grim, well, we were in shock and emotional pain. I worried she'd die during the night at the clinic, and wondered if I'd have time to say goodbye to her. As it turned out, all bloodwork was normal, BP was normal, eyes were responsive to light and healthy, etc... within a few days she'd recovered her vision and was fine. We took her to an eye specialist who said yes, she could have suffered a concussion and now seemed fully recovered. Long story short, I guess the new vet prefers to present the worst-case scenario so things can only get better. Now that I know that, I'll be prepared, but I felt pretty bombarded by our initial consultation in this case. The vet who's been seeing us for the past 8 years is honest with us, but she has a softer delivery and gives us the sense that there will be a treatment option regardless of the diagnosis, i.e, she's never without hope. A balance between the glass being half-full and half-empty seems like the ideal situation, especially when the vet/client relationship is new.
Leigh-Ann March 4th, 2009 08:06:18 AM
Not even so much honesty, but the importance of knowing the client, which is difficult when faced with someone new. If the client is someone like me, I would want all the gritty details, but some can't handle it. We had an interesting conversation on a list recently where more techy list members were discussing one pet's labs and noticed the creatinine edging into IRIS Stage 2. That set the non-techy owner into a tailspin. I have two cats with IBD & pancreatitis, and another one with stable but slightly high creatinine. I am also a moderator on a feline IBD list, and do a ton of research. I keep a detailed diary of my cats meds, food, symptoms. When I'm discussing my pets health, I absolutely want the details, from the vet and not an assistant. I think your post drives home a different point - one I try to make on the lists I'm a member of. It is so important to establish a real relationship with a vet. The clinic I go to has three great vets, but there is always a difference when I'm dealing with one of the two backups to my normal vet. We have an established relationship where she trusts my judgement and respects my input as to how we should treat my cats. After a recent issue, I think one backup vet suspected my cat's IBD had possibly gone towards lymphoma (she didn't say that, but it was the vibe I was picking up on). But in reality, this bout of IBD/pancreatitis with it's acute vomiting was no different than his previous bouts and the key was to let things settle down, gradually reduce the nausea meds. I discussed the treatment with my vet and then as he began to improve, emailed her my proposed treatment plan to which she agreed. The relationship is so important as a vet that didn't know me as well, may not have respected my opinions and knowledge of what my cat can and can't tolerate.
Jenny March 4th, 2009 08:12:46 AM
Susan brings up a good point too. More than once my vet has said, "if this were my cat, I would..." Or has also told me what treatments she uses for her cat that has multiple illnesses.
Jenny March 4th, 2009 08:21:48 AM
I think that "if this were your pet, what would you do?" question is a great one. It lets the vet recommend euthanasia if they think that's appropriate, without risking being emotionally brutal to the client, but also lets them reassure the client in a convincing way, if they believe euthanasia is not the best next step. I've relied on it heavily in circumstances where I thought there was doubt. Or where there really wasn't any doubt, but I just needed the vet to say the word first.
Dr. K., if I'm right that the client got calmer because there was now a vet in charge, I can easily see that having a deceptive effect for you, given that you have clients who want a lot of detail. And it's rough on everyone when a crisis has to occur early in the relationship, and you don't know how to read each other yet.
Lis March 4th, 2009 08:35:14 AM
There's a patient side sensitivity, too; with a variety of critters, and having moved to a different state after acquiring most of them, I've seen a LOT of vets in the last decade or so. It's interesting to see; some of them want to present the worst case scenario and throw everything at it. Some want to only try one thing at a time, not even mention worst case scenario, not mention other types of treatment until the last one hasn't worked. (Some don't even want to bother with treating the problem and only give a rough bit of attention to treating the symptoms. Not thrilled with those.)
So with one vet, I feel like we're pretty well addressing everything that might come up, and we may only be taking things a step at a time, but we're prepared. With another vet, I may feel like I need to do more independent research just to be fully informed. Trying not to frighten/intimidate/bother the client can go too far.
Galadriel March 4th, 2009 08:47:50 AM
"if this were your pet, what would you do?"
Lis, Jenny and SusanR: I tend to like being asked the question because it personalizes the interaction and is almost always a sign of trust. But I think I would never come out and tell a pet owner 'what I would do if this were my pet' unless I was asked directly. Even with clients I know best, even family members, it would make me feel as if I'm telling what to do rather than inviting them to participate. But everyone's different...and many vets are far more diplomatic than I.
Dr. Patty Khuly March 4th, 2009 10:13:10 AM
I'm with you on that one Patty - I never tell people what I'd do unless they ask, or if I'm helping them come to terms with their (correct) decision to euthanise. It does sound too much like you're telling them what to do; and anyways, you quickly find out in practice that you have to deal with every possible attitude toward companion animals -extremes and everything in between. Not to mention a wide range of circumstances including no financial means, disabilities/illnessin owners, etc.
brebis noire March 4th, 2009 10:25:02 AM
I do not see many second opinions per se because of my isolated location. However I do see many pets on vacation. In more complicated situations, I found that by acknowledging the fact that they do not know me early in the discourse helps. I used to not volunteer what I would do if it were my pet, but now find it helpful to go ahead and bring it up in some situations, especially with an overwhelmed or confused owner. They are here for expertise tempered with opinion.
Hobson March 4th, 2009 10:53:35 AM
Advice tempered with opinion...
Yes, I guess it's inevitable, we're only human. No doubt my most objective, poker-faced approach is nothing more than a front for wanting to scream, "For the love of God, do X!"
Problem with all these scenarios is that if I don't offer every option and every possibility, tempered as it may be by my opinion, I'm running afoul of the ethical. How do you get past this with a client that isn't ready to hear it?
Dr. Patty Khuly March 4th, 2009 11:44:10 AM
I still offer plan A, B, or C with all the pros and cons in language I hope they can understand. You cannot skip that part, even if they won't hear it. Unless it involves inhumane sufferring, I never cut right to the case. After all this, there are many that have this blank, confused stare or lose it emotionally. It is then where I volunteer what I would do.....If you are completely honest and confident with that statement I don't see where it would hurt.
Hobson March 4th, 2009 12:10:44 PM
There's probably no way to know if the client is ready to hear it unless you ask them. It might seem a bit like "talking down to them," but I wouldn't have a problem with the vet telling me, "Here is what is going on with you pet. I can tell you all the treatment options right now, or we can go with the first one that I recommend, or..." and just ask the client how they want to proceed. Seems a bit like walking them through baby steps, but if you don't know the person well, it could circumvent hurt feelings or unnecessary anxiety. Just ask them what they want. You can't be expected to read their minds. And I LOVE asking my vet, "If Alfie were your scruffy mutt, what would you do?" I trust her answers when I ask her that specific question. Gets to the heart of the matter.
Shasta March 4th, 2009 12:11:23 PM
I agree with Shasta on saying "I can tell you all the treatment options" but I think it works better (for most people) if the vet says something like,"There are X number of things this could likely be" (if that's the case, or "It's this"for a definite diagnosis), and then saying "There are X number of ways to deal with/treat this" and explain what outcomes there could/would be with each. Yes, it takes time, but whether it's a long-time client or a new person, letting them know that you have tried to give them information and options is a good thing.
KateH March 4th, 2009 01:36:38 PM
I think Lis hit it succintly, it was too much at once for her. Never apologize or second guess honesty, no matter what the delivery!
Perhaps, she was already feeling overwhelmed, a bit sad seeing the shape of her elder dog, and contemplating euthanasia, herself. It is on a lot of owner's minds when they see the decline & not so pretty changes.
If it were me, I'd question the risk of surgery for an elderly pet, not too mention the healing process (not necessarily about a tail,but in general)
And the there could be the outside possibility that you would have "no way of knowing", that a family member or another person suggested that this was a horrible situation and perhaps "she should let her dog go".
I'll always remember the 2nd to last appointment with my last declining elderly dog. My head was spinning & stomach doing flipflops, because I knew "in my heart" that death was imminent for both my dog & my mother. I was scared silly that one of them was going to get short-changed for my undivided attention. Thankfully, Dottie's time preceeded my Mom's by 2 weeks.
We clients have our set of baggage too! Barbara A. Albright/NH
Pocket's Story from N March 4th, 2009 01:43:31 PM
I like Shasta's idea; make it clear there are lots of possibilities, but also that you have a fair idea of how YOU would proceed--all at once, as it were. Then if the person seems to want more detail, or to be unhappy with your suggested treatment, etc., you can offer more info and options.
For myself, when faced with something serious, I ALWAYS ask the vet, "I am crazy in love with this creature. If you loved this animal like I do, what would you do?" And I might also ask "why?," just to be sure I understand. I find I usually agree with their suggestions, and if I don't, then I may need more information. At this point, though, if the client doesn't agree with that course, they may need to be reassured that it's ok to go with their own preference (if it is...I think there are times a vet should be pretty firm, as when an animal really should be euthanized by any reasonable standard, or when something looks or seems drastically worse than it really is, and the animal really should be treated).
Maybe what it boils down to is, there is no substitute for an actual conversation. And that can be difficult if things are urgent and scary, or the parties are strangers. But absent an existing relationship, there's really no other way to figure out what is going to work for everyone.
Judy March 4th, 2009 02:26:46 PM
"Does a vet's absolute honesty save fewer pet lives?" Maybe but, unless you're advocating that vets become some kind of guardian ad litems or act essentially in parens patriae, how does withholding information allow a person to give informed consent? Doling out the information along the way? Well that sounds a little like stringing someone along and, again, are you really getting informed consent if you know the answer might be different if you fully disclosed? I always feel like my trust is betrayed when I find out information has been withheld.
What would my vet do if this were their pet? Hmm, let's see you (my vet) have a degree and can do the work yourself and you have access to supplies and equipment at cost (or less) and you have 24/7 access to a clinic (and can probably make due at home and/or bring your pet to work which happens to be exactly the appropriate environment) v. what I do while considering the cost of your services as well as all the logistics. Sorry, not really a fair comparison. Used to tell my legal clients the same thing. When I file my own lawsuit, I'm out the cost of some paper and ink and a wee bit of my time (since I already know all the facts, very expedited process). What I would do is virtually irrelevant to what the client should do.
PJBoosinger March 4th, 2009 02:43:40 PM
PJB: something happens to my neurons, when I read your comments, not a bad thing mind you, must have to do with your "education & training".
I had resisted the statement I've made before: "more HARM results in withheld information, than with full disclosure to make reasonably informed decisions"
And I hope that never happens to me again.
Barb A./NH
Pocket's Story from NH March 4th, 2009 03:16:05 PM
I can usually read a person on the first visit, and I've seen people come, and go.. The patients that have been part of the practice should already have a trust, or they wouldn't be repeat clients..
I favor getting the client involved in the desicion as.. and feeding them the info on what is available, and the pro's, and cons.. I think that holding back info causes more problems in the long run.. Clients now have access to the internet, and use it.. If I were the patient, I don't think I'd have it any other way..
barri March 4th, 2009 03:59:06 PM
Barb, Believe it or not, I'm trying hard to temper my crotchety old lawyerness tone.. Between being raised by a college Lit prof and trained by an ancient DA in legal drafting, it's tough. Pretty sure I no longer speak English. :)
PJBoosinger March 4th, 2009 04:28:50 PM
Well, PJB, I guess I'm assuming the vet is intellegent and insightful enough to understand the spirit of my question (which is, basically, "What would you be willing to put this animal through if you loved it as I do"), and not get completely tangled up in qualifying everything to the ultimate degree possible. The difference between our circumstances might well come into it at some point, but not without the welfare of the animal being duly considered. I've had to ask that question several times, including once of a vet I did not know at all, and it was fully understood and appropriately answered each time. No vet ever answered it as if they did not know why I asked it, or as if they didn't know I might have fewer animal-care skills or money than they did. But then, you are thinking like a lawyer, which I suppose is your job.
Thank goodness my vets (and the one I did not know, but had to go to with my very very sick Zoe) have always understood exactly what that question really meant, and answered accordingly. I ask the vet that question because they have the background to immediately and fully understand the many implications of the situation at hand with the animal; they can synthesize all of that in a way that is very useful to me. It should never be the beginning, middle and end of a conversation about caring for a very sick animal; but it is most appropriately the beginning, middle OR end, or some combination thereof.
I don't want any information withheld, but I can make much better use of it when it is offered if I've gotten the "Big Picture" first, so I've got some kind of framework to hang it on. In the case mentioned in the post, that might have been as simple as prefacing all the vivid, gory details of treatments and possible complications with something like "This may look really bad, and there are a lot of things to consider, but I'm really optimistic about the outcome." Or something like that. In any case, Dr. Khuly, I think you did a good save. Giving the client a chance to SEE that things weren't as bleak as they seemed just then was a very good choice.
Judy March 4th, 2009 04:47:12 PM
What would my vet do if this were their pet? Hmm, let's see you (my vet) have a degree and can do the work yourself and you have access to supplies and equipment at cost (or less) and you have 24/7 access to a clinic (and can probably make due at home and/or bring your pet to work which happens to be exactly the appropriate environment) v. what I do while considering the cost of your services as well as all the logistics. Sorry, not really a fair comparison. Used to tell my legal clients the same thing. When I file my own lawsuit, I'm out the cost of some paper and ink and a wee bit of my time (since I already know all the facts, very expedited process). What I would do is virtually irrelevant to what the client should do.
No, you're also out whatever your normal billable rate is for that time, because you can't use it for other billable work. And if you have a sensible accountant, you'll be counting it that way.
There's an old saying, PJB: A lawyer who represents himself has a fool for a client. The point being that for all his legal education and experience, he's at great risk of not being able to truly objectively evaluate the case in which he personally is deeply involved. It's the same with medical personnel; doctors should not generally treat themselves or their own immediate family members, and Dr. Khuly, while obviously willing and able to do more herself for her own pets before calling on someone else, has posted many times about seeking the services of other vets for her pets.
And most vets, like most lawyers, understand the point of the question: Is treating this animal a sensible course, with a reasonable likelihood of significantly improving the animal's quality of life, or is the sitaution so severe that it would be kinder to euthanize? Or, it the legal setting, "Is this a sensible case to pursue, with a reasonable likelihood of success? Or is it a case with little or no chance of success, and large expected costs associated with it?
Lis March 4th, 2009 07:02:47 PM
I have definitely done this to a client before. I know in my head it all makes sense and I know where I am going with things. Problem is the client is not on the same race track. Still I would rather give all the information and back up and clarify as needed, as opposed to limiting the information to the client and in some ways make their decision for them (simply by lack of all the options). You can ask me what I would do if it were my pet but I have to agree with PJB in that rarely do I feel like the situation between what I can do for my pets is the same situation as what my client is in............my favorite is when a puppy is diagnosed with Parvo and the owner is debating on whether or not to hosplitalize and they ask me the infamous question. Well fact is that I vaccinated my dog and so I would likely never be in the situation that you are in. Or another.....I don't wait until the mass is as big as softball to remove, I remove it when it is small.
Anyway I digress....my point is that my job is to present the client with all the options in the best way possible without overloading them, but it is what is necessary for them to make the best decision for them and their pets; and Dr. K in some instances (not necessarily this case) it maybe that euthansia is the best option. It is not your honesty that killed them, it is just the reality of the situation.
J.C. March 4th, 2009 07:22:23 PM
This is a part of Vet Medicine I'd never really considered. I think it is a very fine line you are asking us to understand about personality interaction. Humans have a very delicate balance to how they absorb information about their responsibilities (and our pets are our responsibilities). Some people take every comment as criticism, and others just can't absorb more than 'take two pills and call in the morning' advice. This would exhaust me. Perhaps, as you say, it's easier once you 'know' a client, but a new client with a serious situation sounds like a challenge. Personally, I think you did the right thing, you can't be all knowing. Better to offer up the fact than walk on eggshells and compromise your authority.
It's funny, I love ALL the gritty details. I love it when my vet gives me homework or reading materials... I can't get enough. Blood doesn't bother me, nor does poop or other bodily fluids. But if I thought for a second my dog was in pain or suffering - borderline hysteria would result. I wonder if my vet knows that? ;)
CreatureofHabit March 5th, 2009 04:15:33 AM
You can ask me what I would do if it were my pet but I have to agree with PJB in that rarely do I feel like the situation between what I can do for my pets is the same situation as what my client is in............my favorite is when a puppy is diagnosed with Parvo and the owner is debating on whether or not to hosplitalize and they ask me the infamous question. Well fact is that I vaccinated my dog and so I would likely never be in the situation that you are in. Or another.....I don't wait until the mass is as big as softball to remove, I remove it when it is small.
J.C., you do know that vaccination is not 100% effective, right? That with the best and most responsible care, your risk of having your puppy get parvo go waaaay down but never reach zero, right? You know that?
In any case, the issue is not "would brilliant vet J.C. screw up like his/her stupid irresponsible clients?" but rather "if J.C.'s pet were this sick, would J.C. feel it was kinder to treat, or kinder to euthanize?"
But as I said to PJB, most vets, like most lawyers, understand that.
Lis March 5th, 2009 06:39:16 AM
"A lawyer who represents himself has a fool for a client." By that reasoning, a doctor should not treat their own and human docs are actually prohibited from doing so in many jurisdictions. I doubt that standard is applied to vet's pets though. Nonetheless, IMO, the average professional out there in practice is nominally competent at best; hence the saying. Haven't actually encountered any problems representing myself in legal matters though. My son says I go into an icy cold analysis mode, more so on my own cases. When I find professionals in other fields that can do this, I'm far more competent and less emotional in working with them. A Vet who's capable of that is the one I would ask "what would you do?"
"No, you're also out whatever your normal billable rate is for that time, because you can't use it for other billable work. And if you have a sensible accountant, you'll be counting it that way." Only if I do my own legal work during hours I would have billed. Handling my own cases is my hobby; done on my time. Where did I put that Wells Fargo file...
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