Saturday, March 5, 2016

My Veterinary Rescue Shaming and The Frank-Starling Law.

Warning: This blog o' mine can become my sounding board. My vessel to vent. And, yes my therapy couch as I continue to try to keep my chin up and press on... I share my experiences, thoughts, and yes, even my stumbles along this journey as a way to grow, learn, and provide my burgeoning heart of emotional baggage a place to rest.

My Magpie. 
We live in a competitive consumer driven society. Subsequently there is intense contentious debate about pricing in veterinary medicine. I have added my own thoughts, and I do recognize that many people believe that the veterinary profession is pricing our clients out of their ability to care for their pets/our patients. I hear it all too often from an angry, frustrated, desperate finger pointed harsh protest about "excessive cost of care" and" how this is the reason for the current state of pet welfare."

None of us want to be humiliated or felt as if we have been taken advantage of. It is an emotion encountered when you allow yourself to be vulnerable and/or wear your emotions on your sleeve. It is a common characteristic for those of us who choose a profession in healthcare.

In medicine we call it "shaming."

After a decade in private practice, lots and lots of pro bono work (which I used to take great pride in and even boast about) for both clients, rescues, and rescue volunteers, and now I am feeling lost. The rescue people I hoped both appreciated and needed my skills are seeking care "at their regular vet" (what am I chopped liver?), or complaining about my excessive "regular costs." I now see why it is so common for other vets to just say "No" when asked for free/discounted care.

The trick to keeping yourself adequately armored from shame, guilt and humiliation is to be just far enough from the situation as to appear resistant to the emotional tactics employed when the dilemma presents.  I am seemingly unable to embrace or accept this concept.

Magpie relaxes after a hard day of relaxing.
The clinic I own has been or become the veterinary care provider to a few local rescues. We provide whatever care needed and provide our vet services for free and all goods at cost. It is the best deal I could even propose to provide.

As a practice owner it always appears that the need exceeds the ability to help everyone who asks. How do you manage this fact on a day to day basis? I think that most vets just start saying "No" because they feel they have to. If we cannot meet the need why even start? Rescues and shelters therefore believe vets have turned their backs on what the foundation of our profession stands for.

My current debacle is trying to remain interested in helping these rescues simply for my own peace of mind. The expectation of accolades or appreciation is being crushed by recent events.

My Joe and Wren
"Give me your clinic time and discounts but I'm taking my personal pets elsewhere."



Winter snow day 2016, Jekyll and Charleston. Both rescues..

Situation Number 1;
RV 1 (Rescue Volunteer 1);  "Hello, yes, I'm calling to get a refill of the xx medication for my dog."

Me; "OK, please hold, while we check your file." short pause on hold. "Umm, Ms. T, it seems we forwarded your pets records to another clinic? Is that correct?" (I swear I should know better by now than to answer my own phone lines..)

RV 1; "Yes, I don't come to your clinic anymore because the wait time to see the vet is too long. But I haven't been to the new vet yet and I don't want to pay them an office visit if I can get it from you guys now."

Me; "So you are telling me that you want to continue to bring rescue dogs here, but you don't want to wait while we take care of other rescue dogs? And now we are supposed to provide medications because it will save you money and from having to go to your new vet?"
Angry click and multiple Facebook berated comments about how we are all about the money follow. Along with an apology from the rescue founder when she caught wind of it.

Magpie proof reads
Situation Number 2;
How about answering to the rescue founders who bring their pets to other clinics who never help the rescue pets in need. That's a hard one to accept. Would it be so hurtful if their own vet participated in the spay/neuter clinics we do? Maybe not?

The reason I sleep in, Wren under the blankets, Oriole provides cover.

Situation Number 3;
Open letter from a personal friend and devoted long time rescue employee;
"Dear Veterinarians of the World,
I'd like to make a request. Until you work very faithfully and with utmost dedication at a rescue or a shelter, can you please not bad mouth ALL shelters and rescues ever? I find this very (very, very, very, very, EXPLICITLY...) frustrating.
We don't live in an ideal world. We're just trying to save lives.
heart emoticon,

PS. I absolutely LOVE all of the vets I know personally. It's the vets I hear about 2nd and 3rd hand who seem to criticize rescues and shelters the most. I'd love to have a conversation with anyone who thinks negatively of rescues or shelters...." XXXtech

Reply from another fellow RV (rescue volunteer);
"Really? How can you not think there is a problem with vet pricing, please 350.00-400.00 for a feline dental? I'm sorry if that isn't excessive , I don't know what is. Societal problem, no it's not a societal problem, not everyone has the means to put out that kind of money for routine care let alone if one of them gets sick. Most don't. You are doing a wonderful service to the community and the animals and don't ever forget how phenomenal you are, we need more people like you who dedicate their lives to the welfare of these animals and you should never let their ignorant comments affect the outstanding job rescues and shelters such as XXX does."

(personal note to self,, stop answering my clinics phones and reading posts on social media)

Me;
"We need to talk about this rant! If you can figure out a way to keep your cat quiet and still while I clean their teeth I would be happy to shave $150 off that price. It's not excessive. I promise. If you and the rest of the world would kindly start brushing your pets teeth twice a day society won't have an excessively expensive pet dental problem. I am sad to see this."

RV
"No rant, just my opinion, and I will never be convinced that that price is justified. Maybe $200, but 350-400, please. this was my opinion that 350-400 for a dental is overpriced. I'm not comparing them to XXX's care, I've worked too many spay/neuter clinics to compare; by all means the quality of care is far superior at the vet than what you get at the shelter, but sorry, this is my opinion and we can agree to disagree if you'd like."


Me;
"You are welcome at the clinic anytime. I would be happy to show you where the cost goes. In many cases the old adage "you get what you pay for" applies. If I could provide it cheaper I would. We can agree to disagree and I will do my very best to not give up on providing excellent care at affordable prices even to the wonderful rescue people who seem to sometimes not appreciate it. Perhaps some will not believe me when I say this, but, if done correctly by someone trained to do it, a dental needs to have anesthesia, should absolutely have iv fluids, nerve blocks, and dental X-rays. Extractions if needed, and most dentals (I would say 70% plus) need them have to be done by a trained vet. Then a cleaning and polishing. The fastest dental is about an hour. There is absolutely no way this can happen for less than $300. If you want it to be a profitable clinic it starts at $400. I am sure there are people who balk at the extra price of non GMO fair trade organic food. Do I understand why it costs more? Yes, because I care to invest the time and attention in understand how my actions impact the world I live in. If you can find a $200 dental I promise I can find numerous short cuts that are detrimental to your pets health and safety. Being an educated and compassionate consumer takes work and a kind heart.

I am trying to be a vet who helps everyone and supports rescue. I care deeply about the people of XXX and those in my community. I hate to see all of the nastiness and division between us. I wish you all well in your efforts to help animals."

XXXtech reply;
This conversation has definitely taken a turn from what I originally intended. I'm with Dr. Magnifico. The costs are justified at full service vet clinics. They have staff to pay, overhead to think about, and they offer quality service. While rescues need to think about these things, we're at least lucky to raise money for necessary expenses through generous supporters. Veterinarians do not have that luxury. Often times at a low-cost clinic, certain things aren't done to save time and money. This isn't ideal, but sometimes it's the only option the animal/caretaker has and, in those instances, it's better than having the animal euthanized because a full service vet can't be afforded.
I see both sides of the coin. We do the best we can for our rescue animals, and also people in the community who cannot afford higher prices. On a personal note, I prefer to take my own pets to vet clinics for exams and certain procedures because I know that there's often a higher level of quality care that is offered.
I am lucky though in that I can utilize certain services at the rescue like low-cost bloodwork or at cost medicines. That's why having so many animals is at least feasible. Many people don't have this nice perk, so vet care can be quite costly.

Me;
I'm sorry XXXtech I know this wasn't what you intended the post to become. But it is important that we all talk to each other openly and honestly. It would have been very easy to walk away from this conversation and silently swear to myself to never help the ungrateful critics who ask for it. Alienating myself from those I know are trying to help animals in need just feeds the problem. I don't want to be part of the angry other side. So I struggle remain a part of the solution and see the good in all people. In rescue, veterinary medicine, and life this is a huge challenge.

Jekyll reminds me to keep a healthy perspective on life.

I had to do what I often find myself doing more often, I had to walk away. Leave the battle that was only going to divide us. I have to pull up my passionate opinions, roots, let go of the connections that cause pain, try to reinforce my insulation in a healthy manner, and not carry a burden that will only prevent me from that next furry face who needs me as much as I need them.

In the end I still struggle. I don't propose to know what the right answer for everyone else is. I know that I have to focus on the furry faces I am here to provide for. I cannot ask, look, expect, or even hope to get anything from anyone else. Shame, I have it, we all do, it is why we became vets, I just can't chose my path based on it. My heart is still on my sleeve, it always has been, always will be, and in the end I think it is the best part of me.. broken, bruised, resilient, over burgeoning, over taxed, and over abundant. For those of you who are in this boat with me remember the Frank-Starling Law, our hearts can increase their volume when there is an increased load. (Personal note; all of my cats are named after bird species. Next cat; 'Starling').

There are lots of us struggling with this shame on every side. The immensely over burdening need, the responsibility of every rescue/person/vet trying to save every pet and asking each other everyday to extend our necks, our pockets, our hearts, and give away another piece of ourselves. There is an avalanche of need. A tsunami of shaming.

Worst for me the rescues, the people I most closely bear my soul to, work tirelessly for and try to help above and beyond every other request, berate and remind me that if I am fragile, sensitive, wear my heart on my sleeve, or let someone, they can humiliate, hurt, and castigate publicly. It feels as if this is going to drive me to either turning a blind eye, or succumbing to the compassion fatigue that hides like a shadow behind every corner.

How can the one group of people that are supposed to most closely understand the burden of my heavy heart turn on me? I don't know. But, there is probably enough blame to burn down every compassionate effort and then we will still have to remind each other why we do what we do.

Magpie.
Found as a kitten with a broken ankle and adopted by us from the rescue above.
She is one of the lights of my life and why anything else matters.

End footnote; Judgments, criticism and and cruelty can be kept to yourself, I have enough that I provide myself, and, am still trying to find a place to stow them.

Related articles on Vet Shaming; Coping With Vet Shaming, Andy Roark, DVM, MS

My related blogs;

Economic Euthanasia

Carry Each Others Burdens.

The Profitability of Drive-Thru Euthanasia Clinics.

Can Veterinary Care Evolve With Our Clients?

Compassion Fatigue.

There Has To Be Mercy Before Money.

Never Surrender Your Voice.

What Are You Building?

Making Vet Care More Accessible.

Make a new furry faced friend every day

Please join me on Pawbly.com. Pawbly is an open free community based pet information exchange network.

If you  would like to discuss your pets care in person I am available for appointments at Jarrettsville Veterinary Center in Jarrettsville Maryland. JVC is open 7 days a week. JVC publishes our prices every year. The 2016 Price Guide can be found here.

I am also on Twitter @FreePetAdvice.

10 comments:

  1. You're the best. I admire you more than anyone.

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    1. Thank you. You are my inspiration for always smiling through whatever life throws you. I love you to pieces and I miss you always.

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  2. Dr. Magnifico, Stay true to who you are and what you believe in. As long as you are pleased with yourself that's all that matters.

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    1. Thank you. I have learned this lesson but I still struggle with finding a place that I feel safe and secure in showing my vulnerabilities.

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  3. It's hard I know - but trust me you are making a difference in this world. God Bless you.

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    1. Thank you. I believe that you are too.. stay true to what your heart tells you, it is always right.

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  4. I find there is only one place I can find peace and strength with myself in what I do is right.....the mirror.

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  5. Thank you Dr. Magnifico for all the help you have given my feral cats over the years. You have continuously given me breaks and help when my cats have needed your services. They are much better off in this world with caring individuals like yourself and your practice taking care of them when in need. Keep up the great care and the remember all the innocent souls that you have helped through the years. Thank you.

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    1. hello!
      You inspire me everyday! Thank you for all you do to help animals. I am proud to know you and happy to help! Hugs to all from me.

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