Here’s another entry born of an email response to Monday’s post on how to identify quality in veterinary care. This time, it’s related to my comment on the issue of compassion in veterinary medicine––particularly with respect to high-priced, technically savvy hospitals where concern for the owner’s pocketbook takes a back seat to what’s best for the pet.
The suggestion led one emailer to ask (and I paraphrase): “Is technical prowess inversely related to compassion?” In other words, she wanted to know why the more sophisticated hospitals filled with specialists, interns and millions of dollars of equipment always seemed so rough when it came down to these issues:
- Charging.
- Offering options.
- Taking pets away.
- Getting callbacks.
- Visiting hours.
And yeah, it’s generally true. A greater degree of impersonal interaction is to be expected at larger referral hospitals. These are not your regular veterinarians (and their staff) who know practically everyone who walks in their door. These are veterinarians who seldom get to see the same owner twice. And, as such, they don’t usually list "hand-holding" in their job descriptions.
Therefore, they won’t be calling you more than once a day. They won’t be allowing you to hold your animals or otherwise kowtow to your special requests. Visiting hours are limited. You will almost never be allowed to participate in even the least invasive procedures. That’s just how it goes.
Why?
Specialists and the staff of a specialty hospital are there for one good reason: You need more technically sophisticated care. And that means their organizational structure is geared towards better patient care...not better customer service.
Now, this is not always the case. There are plenty of secondary and tertiary facilities that pride themselves on their "compassionate care" towards its human customers. But that’s not the norm. And it’s absolutely secondary to their primary mission...as well it should be.
What is it they taught me in business school about “core competencies”? Stick to what you’re good at. Improve on the areas in which you offer the most value to your customers. And don’t sweat the other stuff as long as you’re really good at what your clients come to you for.
But not everyone agrees. This is especially true when it comes to the financial aspects of speciality medicine. If they can’t offer compassion in the form of a variety of financial options for advanced care, they can’t possibly achieve their mission when it comes to helping animals.
I see both sides––especially with respect to the finances. The other stuff? Phone calls, visits, bedside chatter? I can live without it. Not so much when it comes to a hospital that CAN help me find financial solutions for saving my animal’s life...but doesn’t have the bandwidth to do so. Sure, at some point the money’s just not there and euthanasia’s the only option. But when a middle ground is possible and hospitals require an all-or-none approach...that’s where I balk.
So yes, it’s true. Sometimes technical prowess does seem inversely related to compassion. But it doesn’t have to be that way. And now that the specter of competition looms larger in specialty care, we’ll see how that translates into homestyle animal hospital compassionate care. It’s another one of those things they taught me in business school: Competition is good for the soul...and for the customer, of course.
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The more a specialty practice toots its horn about "compassionate care" in its glossy brochure the less they provide it.
I'm just sayin' is all.
H. Houlahan November 18th, 2009 11:33:10 AM
The very first time a "specialist" treats me as though I just fell off the back of the turnip truck is the last time said specialist will see any of my hard earned dollars.
Ellie November 18th, 2009 11:35:54 AM
In most businesses, small businesses are in the business of accomplishing the objective while bigger, allegedly more capable businesses are in the business of making MONEY by accomplishing the said objective. So while one may spot you a few dollars on a test or work with your best financial interest as well as the pets, the bigger places are there to keep the lights on and pay for someone's yacht. It's like the large hospital/boarding clinic we boarded our dog once (and ONLY ONCE!!). They insisted that our dog required the bordetella shots twice a year when the manufacturer clearly states it's an annual. The boarding/doggie hospital said it was because it worked better if given twice a year. While my vet clinic stuck to the politically correct route and said that the manufacturer states "annual" but did not belittle the large clinic, they offered no argument when I stated the motivation for twice a year would be revenue related.
EAB November 18th, 2009 11:41:51 AM
I wanted to share my experience at Cornell University, where my dog had a lapropexy last year after an episode of simple bloat. Every animal there is assigned a vet student who feeds, walks, and otherwise cares for the animal. You are encouraged to call the student anytime up until 9 at night, as much as you want, and they call you regularly regardless with updates. They also take any postoperative calls too. My dog loved "his" student, and I felt like he had an advocate when I couldn't be there. I love this policy for a university hospital--it made for a much warmer experience.
Audrey November 18th, 2009 12:00:10 PM
From our experience i can concur with the inverse relation idea, and might add that technical prowess is directly related to an inability to say "I don't know."
Jerry's first vet insisted the limp was just arthritis, even after viewing x-rays, while prescribing the latest meds every couple weeks, and showing us his new laser surgery equipment. It was one of his techs who eventually suggested we get another opinion from UC Davis Vet Med Teaching Hospital who immediately discovered the tumor growing in Jerry's shoulder. Yes, they had even better digital x-ray capabilities, but they were also very understanding and compassionate.
tripawds.com November 18th, 2009 12:45:55 PM
I don't go along with the idea that more specialized care comes with less compassion for pets and owners. I have seen more compassion from Dr. Couto, and all the vet students he works with, and from the head internal medicine vet (whose name, I'm am so sorry to say, I can't remember) in 1999, who helped my paralysed dog, than from a number of GP vets in NEOhio. And I also received more compassion from (Akron's) Metropolitan Veterinary Hospital's specialty vets (Dr. Belknap, for one), than from some GP vets I actually worked for!
Yes, all the bells and whistles will cost more, and some people and their pets might not get all the warm fuzzies they think they get at their regular vets, but there are plenty of vets who don't have newer equipment or skills who are NOT compassionate. Yes, your bill will be smaller, but what you get is often not worth it anyway.
KateH November 18th, 2009 03:38:25 PM
Re: bordetella vaccination, it's actually the norm in my experience for boarding facilities to require a bordetella vaccination w/in the last six months prior to the boarding visit, regardless of the size of the hospital...at least in the are of the country I live in. I haven't seen a trend with this requirement that correlates to the size or degree of specialization of the facility. I did have a very small, local hospital deny my pets boarding unless I boostered their rabies and DAP vaccines (they were last vaccinated approx. 2 years ago with a product approved for 3-yr. DOI). Whatever their motivations, it mattered not to me...I simply took my business elsewhere.
I haven't had the need for a specialty hospital, but I don't imagine that I'd expect warm fuzzies or hand-holding or a loan counseling session. I'd want what I went there for - the best, most advanced care possible for my pet. I'm responsible for dealing with the rest.
anna November 18th, 2009 04:34:42 PM
I'll separate my comment into two parts: First the GOOD:
We were referred to a DVM, PhD, Dipl.ACVO for our now deceased elderly dog just shy of 14, with advancing mammary cancer, weakened heart, and the typical very senior maladies for sudden onset of glaucoma after lens luxation possibly due to advanced cataract & corneal ulcer in one eye.
This woman is on my forever hero list and if she had let me shine her sneakers and iron her lab coat, I would have done so gleefully.
Skill, compassion, respect from her & her staff lit the office. She gave up her lunch because of heavy booked appointments (we saw in the reception area) to treat Dottie's glaucoma & instantly relieve that pain. She walked out a new "old" dog and lived a happy 8 more months. The blindness in the eye never bothered her, we got to cuddle and spoil her silly & blessed every day.
Dr. R: Called her PC vet with full report, asked to be contacted for followup 1 week visit & her office was available for ANY and ALL questions or concerns.
No wonder she has patient/clients out the door. Despite her heavy workload, she was thorough , patient, and non-pressuring, answered all our worried questions & it was all about Dottie--not $$$, since the whole procedure was completely reasonable w/ meds.
Will I see her again? You bet, although I hope not to have another w/ glaucoma!
Barb A/NH November 18th, 2009 06:57:22 PM
I'm especially heartened to hear of these successes––especially after being treated to so many "horror stories."
I especially adore Audrey's story. I remember all my patients in vet school by name. Partly because I wrote them down. But also because they taught me so much. I always had the feeling that no one understood how much I cared for my charges. (Including my fellow students, to whom divulging this kind of information at the time might have seemed awkward, at best.)
Thanks, all, for the reminder that specialty veterinary care doesn't need to go the way of the compassionless.
Dr. Patty Khuly November 18th, 2009 07:22:10 PM
Is technical prowess inversely related to compassion in veterinary medicine? YES! (in many cases) (uummm, know many tender referral specialists)?
Robert November 18th, 2009 07:50:11 PM
In every profession, there are a few of the truly elite (as to skills) who are so focused they have tunnel vision and someone else has to do the "people skills" part. These elite are usually worth the big bucks so can easily afford to have those people-people on staff. The rest are asses by choice and perceived entitlement. They don't get a pass from me.
Most health care, animal and human, involves post care at home. It is in the best interests of the patient to have a grasp of the facts, medicine, and needed post care. Being an ass prevents proper communication with the primary caretaker, the owner. "Phone calls, visits, bedside chatter? I can live without it." YOU can, you're a vet! I need that "chatter" because it's how I'll feel out what questions I need to ask about post care, especially when I know I won't be able to get calls promptly returned once I walk out the door with my pet!
"need more technically sophisticated care. And that means their organizational structure is geared towards better patient care...not better customer service" I'm sorry but that's a fallacy. Better customer service, including communication, is integral to better patient care. The more sophisticated the care, the more needed is better communication which requires a decent level of customer service so the owner is actually hearing what is being said and what is being said is said in a manner that will be heard and understood.
"compassionate care towards its human customers... not the norm. And it's absolutely secondary to their primary mission...as well it should be" Hooey and mere excuse for being an arrogant ass towards other humans.
Core competencies include communication skills in nearly all professional fields. Core competencies include customer service when one is in a business that involves customers and clients. I'm beyond tired of doctors who want to shift these burdens to patients/paying clients. I'm not inherently a people person (can 'ya tell?) so I had to work on this constantly when dealing with clients but I never, ever, considered that obligation beneath me as so many professionals seem to.
PJB http://pjboosinger.viviti.com/ November 18th, 2009 09:12:14 PM
I have had 2 cats treated by the head of cardiology at Animal Medical Center, in NYC...all I will say is NEVER AGAIN.
LorriM November 18th, 2009 09:15:37 PM
Not that it matters, but Dottie was just shy of 15---typo above.
And the follow up appt. was with her PC that was instructed to report her condition & eye pressure back to the specialist.
Typed too fast---Dottie's picture is with her 15th yr. birthday cake, made especially for pets & smelled heavenly!
Barbara A./NH November 18th, 2009 11:12:05 PM
University of Tennessee Veterinary Teaching Hospital, THE BEST!! From students to professors, my dogs have received nothing but top-notch care. Their bed side manners are excellent. But most importantly, Tennessee is rated by ALDF "one of the top tiers in animal laws."
http://www.alabamavetboardwatch.110MB.com
Fotini November 19th, 2009 12:09:42 AM
Fotini: makes me laugh. You said you would never let me "practice" on your pets. I am a recent UT grad, and I take great pride in my alma mater, and the skills I learned there. You may not let me "'practice" on your pets -but many of the clients that I see have only myself as an option -for financial reasons.
Further, surgery is learned ONLY through practice. That's true for GPs, as well as specialists. Specialists don't wake up one morning with the ability to do surgery. They PRACTICE on client owned pets. Been there, seen it as a student. It's a fact of life. We all learn the same way.
Who knows - you might have seen me with one of your pets at UT before I graduated, and you never would have known it!
Catherine November 19th, 2009 01:25:56 AM
Fotini - something else to think about re: "practicing on dogs" - I am an ER doctor. Sometimes when these patients walk through the door - referral to the specialty hospital that is 30-45 minutes away is NOT even an option. The patient will die in that time period. The example would be the diaphragmatic hernia you sneered at - that dog was dying in front of me because his stomach, liver, and spleen were crushing his heart and lungs. If I had shipped him to the specialist, he would have died in transit, no doubt. I'm not going to stand there and act helpless when I have the ability to possibly save his life (which I did).
Catherine November 19th, 2009 02:02:02 AM
Catherine: "I am a recent UT grad" Meaning University of Tennessee? Where you practicing now? I'd like to know if I need to duck you in Texas 'cause it wouldn't be good for either of us :)
PJB November 19th, 2009 02:40:50 AM
PJB - UT (Texas) doesn't have a vet program, does it? I thought that was at A&M.
Posey November 19th, 2009 09:15:07 AM
I don't think UT does but the universities and grad schools in Texas have some odd programs and alliances. The private law school I attended is now somehow associated with A&M (but I stopped listening when they got to arguing about whose logo would be on the diplomas).
PJB November 19th, 2009 11:08:30 AM
The anonymity of the internet is a good thing. And no, Texas does not have a vet school. Texas A&M does.
Catherine November 19th, 2009 01:35:59 PM
PJB - you got my hopes up. I was about to start looking into the admissions requirements for UT (Texas) vet since it's not in a small town. ; )
And I am consistently confused by all the schools that are being swallowed up by the UTexas and A&M systems. Somehow, UTexas has a satellite MBA program up here (Dallas), but I could swear their local affiliates (UT Arlington & UT Dallas) have MBA programs, too.
Posey November 19th, 2009 02:27:43 PM
Catherine
"I am an ER doctor. Sometimes when these patients walk through the door - referral to the specialty hospital that is 30-45 minutes away is NOT even an option."
Oh, I am hip, and I would never argue your aggressiveness in such an emergency situation! When my dog had the Addisonian crisis, his surgeon told me to take him to his specialty hospital 1 1/2 hour-drive !!!! How pathetic and irresponsible. . .(by the way that was his answer to the board: he told me to take my dying dog back to him, and I didn't, although he knew I had taken my companion to the local emergency hospital--another BIG JOKE for Emergency Hospital!!!
I am taking my companion animals to Univ of Tenn JUST FOR DIAGNOSES/PROGNOSES, and SPECIAL TESTS--nothing else--no surgeries, no experiments, no invasive procedures any longer because my dog and I paid dearly invasive veterinary medicine.
PS Don't mind at all UT's fees which actually are lower than private specialty hospitals' fees for idential procedures. And I also don't mind the 4 1/2-hr drive in exchange for truly expert opinions and diagnoses.
http://www.alabamavetboardwatch.110MB.com
Fotini November 19th, 2009 03:44:22 PM
Fotini: I guess we could banter on what jokes of quality care we received, only we wouldn't be laughing!
A referralhospital that does not do an in-house urine? No CBC or slide reviews? Oh, no xrays either? Sends out a Lepto titer to Kansas and the urine to Antech---hmmm, what is that all about?
DVM, DACVIM in charge of patient is rarely on site? Owner DACVIM does not review cases?
Oh--I forgot, NO DRUGS to relieve suffering---NO means to HUMANELY euthanize--- but will anyways and the LIE about it!
Did Pocket and I really live that week, or is this all some utterly cruel joke & noghtmare?
I would like to thank Edgefield Veterinary Hospital, LLC for the wonderful and capable REFERRAL to compassionate, honest, well-educated Specialists, NOT!
Barbara A. Albright/NH November 19th, 2009 06:51:19 PM
Posey, Sorry about that :) On the other hand, I'm pretty sure the Texas colleges are shooting for having just ONE college with branches throughout the state! UT will probably have a vet program soon but it will still be located in College Station :) Don't be so sure about that "big town" thing. I spent the first half of my life trying to and getting out of small towns and the next 10 years trying to get back. Cities aren't always all they are cracked up to be!
PJB November 20th, 2009 01:04:20 AM
PJB - according to the "Star Telegram" it looks like UNT might open a med school (MD to go with their DO program) in Fort Worth, but still no suggestions for another vet program. :)
I lived in a small town for a while. It was nice not fighting traffic, and the town was charming. I just missed some of the conveniences of Dallas/ Fort Worth.
Posey November 20th, 2009 09:53:14 AM
Ms. Albright, How do you know that KCl was the agent used in the euthanasia process? That makes no sense to me. I have been a vet assistant for 7 years and have never seen anything used but Pentobarbital.
Amanda November 23rd, 2009 11:39:12 AM
Amanda, Please do call me Barbara. Yes for sure, Pentobarbital , commonly called Sleepaway, FatalPlus, and other names are the normal and ethical administration to perform euthanasia. Thankfully, you have not witnessed anything else!
This particular clinic did not fit in the norm, however. I was present and no form of pentobarbital or any narcotic was used.
It would make more sense to you, if you were an insider and knew the clinic was not licensed for any "controlled substances"
Barbara A./NH November 23rd, 2009 09:28:24 PM
Amanda: Scary things do happen in all professions. As Barbara says, be glad you have never witnessed the workings of a grade D animal hospital firsthand.
KCL, btw, is used as the last injection in the three-injection protocol employed by the criminal justice system in lethal injection scenarios. It's considered very painful and a very good reason to transition to a veterinarian-approved lethal injection protocol. So much more humane.
Dr. Patty Khuly November 24th, 2009 07:23:19 AM
Wow, Barbara, that is so terrible. I feel so bad for what you went through with Pocket, and I read your website. I am truely sickened by what they did to her. Compassion should ALWAYS be our number one priority, even in a specialty practice. Even if ones "bedside" manner with clients is brusque or what have you, the animals who do not understand why they are at the hospital/clinic should ALWAYS be treated with the best care and compassion possible.
I have been an assistant for 7 years and have been in technician school to be certified for the last year. I am devoted to my patients above all.
Amanda November 25th, 2009 01:16:23 PM
Amanda, Thank you for your empathy. I am glad that you found this hard to believe because it should be unbelievable.
An awful lot of people for way too many years kept quiet about this immoral behavior and let it continue. It is not only dispicable and unacceptable, but against the law in NH.
As an assistant soon to become a technician, I ask you to keep your high moral standards and compassion always; you will look back and be proud and always be able to look in the mirror and like what you see.
Barb A./NH November 25th, 2009 05:26:43 PM
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