Thursday, August 14, 2014

Which Kind Of Vet Would You Be?

Madeline cuddle time.

We are all some kind of vet, just as we are all some kind of person, spouse, friend, and pet parent.

Some call it labels, which skews it as some sort of personally offensive connotation, but how else would we describe it?

I have been asking myself which kind of veterinarian I am? I realized when I first bought this clinic that my decisions from the very beginning were going to shape who we were. It is reflected in our color scheme, our motto, our hospital lay out, our pricing, and every word we speak or print. It is omnipresent. These in turn influence the kind of clients we see and serve. I would take this one step further and say that it even influenced what practice I bought, where I bought it, and who I bought it from.

This is what we call marketing and it is present in almost every facet or our personal and professional life.

From the very first baby steps of practicing medicine our words, our acts, and our ability to help both animals and humans is governed by our ability to sell who we are and what we believe to be warranted in the expression of our profession.

A client left us the other day because she felt that she would be better served at a clinic that was more in line with her personal perceptions of herself which she labeled as "old fashioned." At the heart of my veterinary soul I would have used this exact term to describe myself. I think that the disconnect between her definition and mine were not in how we treat people, but rather how we believe we should be practicing medicine.

Loverboy, up for adoption now at the clinic.
His name is 100% appropriate.
I am secretly scheming to add him to my herd.
He is the best therapy in the world. 

The example that she gave was that she felt pressured every time she came in to have procedures done. Here is an excerpt of her letter.

"Thank you for your note. I felt pressured every time I came there for the last couple of years to have procedures (e.g. stool samples at $30 a pop for dogs that are already protected against worms by their flea -- or maybe heartworm medication -- and who are very closely monitored by me) that were unnecessary, and as I am a widow who works as a church secretary, money is an issue. I am committed to my dogs health but must balance that against my budget. As I have  had dogs for about 40 years and keep a very close eye on them, brush their teeth and clean their eyes daily, look at and pick up every poop, I feel my position and choices should have been better respected. I felt as if some of it was pressure to add procedures that would raise the cost, though I certainly could have a misperception there. I have found a vet who is closer to my home and is I suppose more old fashioned in that he takes into consideration what I as the dog owner want to have done and does not argue with me and pressure me into having additional items done. Thanks so much."

My reply;

Hello Mrs. XXX,

I called yesterday and left a message on your phone about your departing email. I also wanted to clarify a few things that should have been explained to you at your visits so that you wouldn't be feeling as if we were doing any procedures unnecessarily or without your willing participation. I apologize for that failure on our part. If you would like to discuss why we recommend what we do I would be happy to clarify. For the record I do not believe we have ever made one single decision while I have owned JVC in an effort to make money or pad a bill. In the 9 years I have owned JVC we have never taken a profit (which is absurd when you own a business). Every decision and recommendation is done with the pet first, and the parents safety second. I also believe that we are incredibly understanding and absolutely committed to tailoring a treatment plan and wellness plan to the individual. Any item that the owner is uncomfortable with or unable to afford is discussed and compromised. But, we must adhere to a high standard of care and adjust down. It cannot and absolutely should not be the other way. This is never about the money, it is only and always about the health of the pet and their family.

I would consider myself an old fashioned vet. I grew up in the office of one and I remain committed to being one. Almost every one of my clients has my email, and or my cell phone and I am available 24/7 to them. Last week I did 3 emergency pro bono surgeries to clients whose pets would have died without our intervention. I did it for them for free (or at cost) because the were long time clients in a terrible desperate position. This does not happen at the majority of the larger clinics, or many clinics anywhere. 

Three weeks ago I helped a client who had been going to a small one dr clinic just south of us who was told to put her dog to sleep instead of removing the mass that was so large he could not walk. He received his life saving surgery here with us after his vet gave up on him. (His story can be found at my blog, Tucker's Story). She believed that he was old fashioned in that he saw her pet as replaceable and not worth the time or effort to treat.

I tell every single client that their decision about their vets care is a personal choice that should be based on trust. We have failed you in this regard and I certainly understand that you should be at a place that you feel comfortable in. But please do not confuse old fashioned with substandard. Fecals are part of the basic standard of care and should you or your family get one of the intestinal worms that dogs often carry, and become blind or disfigured you can sue your vet and you will win, IF they have not been recommending a yearly fecal. We live in a litigious society and doctors are liable and culpable.

Lastly, I write a veterinary blog and I would like your permission to use your letter as a way to publish how important it is that we talk to our clients so they understand what we are doing and why we are recommending it.

Thanks for your time, and I would appreciate your permission in using your letter. I can be reached here for any questions or concerns you might have,


Her reply;

"Well, obviously I have hurt your feelings. Not my intent, and I am sorry for that. I purposely said that it could have been my misperception that testing and procedures were pushed to increase income, because I believed it could in fact be my perception, not fact. It is fact, though, that I often felt pressured, and it was uncomfortable. My current vet does recommend fecals but when I decline I am not subjected to a long dissertation on why the medications they are already on are not always effective, etc. if I may be totally blunt with you, fecals for my two tiny dogs are more than I earn in a day, after taxes. TMI, I'm sure, but there you have it. As a 62year old widow, not much chance of moving upward financially. 

I have no doubt you are an outstanding vet. If you can meet XXX's standards, there's no question. I'm so sorry that I didn't just say that I'd moved and let it go. I so don't want to hurt you. I just was trying to be honest, not hurtful. 

You may use my letter. Perhaps the overarching problem was pride in that I  should have shared my financial limitations. The logical question after that, though, is why do you have pets you can't afford. I can afford them, I feed them well and care for them in every other way, but there are limitations. Not to harp, but this annual fecal thing is a relatively new vet care idea. As I mentioned, I've had dogs over 40 years. Dr. XXX (the previous owner of my clinic) commented one time about how closely I monitor my dogs when I picked up on one tiny thing (I forget what it was) that evidently he thought was usually missed. I'm proud of how I care for my girls and don't want to feel as if I'm giving them less than adequate care if I choose not to do something recommended by my vet. You all have the education but I know my girls intimately. 

Again, I am truly sorry to have hurt you. It was not my intent in any way."

My reply;

"Many thanks for the reply.. and I am sure that my personal involvement with my patients and my clients allows me to have my feelings hurt,, a price I pay for my stubborn resolve to not become indifferent no matter how long I stay in medicine..

I understand and empathize with your financial limitations, and I would never even hint at the idea that income is relevant or required to be a wonderful pet parent. The discussion should never come across as us badgering you to do anything, but I don't know where that fine line between concern and coercion exists. Fecals are not a new recommended basic standard of care, they are only new to us discussing them. In the near future veterinarians will be required to have you sign a waiver of liability if you decline them. The healthcare standards will become reality as the lawyers and medical boards provide us with tighter and tighter oversight. This is the world we live in. I never judge a persons commitment to their pet, and love for their pet by the amount  of money they have or spend on them.

I sincerely appreciate your honesty and I do appreciate that you were open about it. If we aren't open and honest we can't ever be true to who we are and what value other people have in our lives. So I am glad you didn't just say that you were moving on..those little white lies have a way of finding you again..

Being a vet is being a part of a team..and you have to be comfortable with your team, so I wish you well.


Mallard the chihuahua puppy.
So, what kind of vet are you? OR, What kind of vet would you want to be?

How would you describe yourself?

And, how do you think that your clients would describe you?

And, would you talk to an exiting client?

Are you leaving your fate to perception, and how do you insure that that perception is what you intend it to be? Or, are you the ostrich with your head in the sand?

Related articles:
Paw and Order, Limiting Legal Liability, by James Wilson, DVM, JD.

If you have questions or comments on this blog you can find me in the clinic, Jarrettsville Vet, on Twitter @FreePetAdvice, or on, where I am still fighting the battle between caring about other peoples pets in spite of the slow monotonous whittling down of my spirit steering me towards indifference, still talking to people, and still trying to save the world one wet nose at a time.

Thomas, the receptionists kitten.
A world class purring machine!
Who am I kidding? I couldn't go a day without my pets, and the best part of my job; everyone else's! If I am at the clinic you can bet that I am snuggling some pet somewhere. So be warned, if you arrive with a pet that will let me hug them I will be taking selfie's with them...


  1. Great post.

    I am not a vet and have no formal medical training of any kind.

    But I have lived with and cared for as many as 50 cats and a bunch of dogs at any one time. I was married to a veterinarian who brought many of those cats and dogs home for me to nurse. And we both worked at a no-kill shelter providing medical care for up to 100 or so cats at a time.

    While I have no medical training, I do know my way around the medical literature and the resources on VIN. I now have over 15 years of providing 24/7 care for cats and dogs with chronic diseases such as diabetes, epilepsy and chronic renal failure.

    I was among the pioneers in the use of calcitriol to manage feline CRF. I may well have pioneered the use of Keppra to manage both canine and feline epilepsy because at the time I first tried it and worked out the dosing, I couldn't find anyone who had tried it. I was one of the early pioneers in getting diabetic cats into remission and recently found a way to reliably accelerate that process which I tested first on a diabetic cat and then on a diabetic dog who is now also in full remission.

    I tried a treatment for biopsy-confirmed gastric lymphoma in a cat which resulted in full remission. This protocol has now been used in over 100 cats. Part of this same treatment has successfully resolved IBD in a number of cats.

    I spend a lot of time on the issue of veterinary non-steroidal anti-inflammatories, a whole lot of my time.

    My only point with this introduction is that while I am not a vet, or even a vet tech, the past 20 or so years of my life have largely been devoted to veterinary health care. My actual background is in economics and I have worked as a senior executive and founder of a number of companies in the computer networking and telecommunications business where my focus was on marketing and sales.

    When my wife was attending vet school here in the US as a foreign veterinary school graduate, the dean had ordered the faculty to end each class with a reminder to the students of the three "C's" of veterinary medicine: Charge, Charge, Charge.

    This mandate was not as cold as it sounds. It was simply a reminder that vets tend to overlook charging for things that they do and that to succeed, they needed to be sure to review all the procedures they performed.

    During that time, I thought often about the three C's, especially since at that time, we were providing health care for a no-kill shelter were there were no clients to pay for the care we provided.

    I came up with my own Three C's of veterinary care: Care, Compassion and Cost.

  2. Part 2

    I came up with my own Three C's of veterinary care: Care, Compassion and Cost.

    One of the things that frustrated me about many practices is the tendency to make assumptions in advance about client's willingness or ability to pay and further, a focus on the presenting complaint, ignoring other potential problems.

    Too many times a cat or dog would be brought in for treatment for something like prolonged diarrhea and then be brought back with a raging ear infection a few weeks later.

    This could have been avoided had the cat or dog been given a thorough exam at the time of the first visit. The owner may well have not been able to afford or be willing to pay for care beyond that which they brought the pet in for. But I think the veterinarian's first obligation is to the patient and that includes examining the patient for all common problems. Cost has to be secondary to what is medically right for the patient.

    I think taking this approach is not only the right thing to do for the pet, it probably has the effect of increasing practice income.

    My guess is that a practice which focuses first on what is medically best for the patient is one that will be sufficiently successful to be able to survive and possibly thrive financially.

    When you have no medical education, you tend to focus on a few things that you can do well. Much to the annoyance of the trained vets and vet techs, I insist that compassion can have as much influence on the outcome as medicine. This manifested itself in a focus on keeping the sick pet clean and comfortable and spending time with it to directly show the patient compassion.

    I realize that a certain amount of cold efficiency is needed, but I think it worth the effort for the effect on healing to spend time calming a frightened, sick or injured patient in a strange environment with strange people and a potentially frightening crowd of other sick and injured patients.

    I think it is better medically, to take a little time to allow a pet to trust you, let it smell your hand, pet it, and then cuddle it before doing vitals, meds or procedures. Certainly in the short run, this gets in the way of efficiency, but in terms of outcomes and the rate of recovery, I think it might be possible to prove scientifically that this little extra focus on compassion pays off by speeding the healing process. And even if that couldn't be proven, it just seems worth doing for its own sake.

    While my "veterinary" reputation tends to focus on the lengths I "needlessly" go to showing compassion for the sick and injured, my actual background is as a hard-nosed business executive.

    As I said above, the first step in veterinary care from my perspective is to focus completely on the needs, known and unknown, of the patient. Don't just check the presenting complaint. Do a complete examination to find out if there are other problems that should be treated.

    The second step is to look carefully at costs, especially in light of whether a procedure or treatment is going to make a difference medically. Sure, it would be nice to have a CBC, but if the results are not going to make any difference in the care of the patient, it shouldn't be done. The whole view should be attempting to figure out the lowest cost solution to the medical needs of the patient.

    Then, the vet is in a position to advocate for the patient and discuss costs with the caregiver. This probably means leaving a little money on the table for caregivers who can afford anything you suggest, but it goes the farthest to address the financial concerns.

    The vet is in a better position to advocate for the patient when they have already thought through the cost.

    It seems to me that too often vets make assumptions about what the client will and can afford and tailor recommendations for care around these assumptions, rather than around providing the best medical care at the lowest cost.

    1. Hello Edward,
      I think that I should use your thoughts in a blog! Although I suppose I should ask you if you already write on? This is excellent advice and I applaud you for your lifelong ambitious quest in improving pet heath care. It is quite impressive! I would love to invite you to join us on I created Pawbly as a place where passionate pet people can exchange information to help pets around the globe. We are free to join and use and our mission is simply to help pets based on the community exchange of information. It sounds like many of us have a thing or two to learn from you!
      I sincerely appreciate your comments, dedication to helping pets, and your words of wisdom!

      With appreciation,

  3. Hi Krista, I love the fact that you are so honest in your blog posts. Please never let 'the slow monotonous whittling down of your spirit steering you towards indifference' win. You know what's right in your heart - just keep listening to that and for the sake of every wet nose - keep fighting the good fight!

    1. Hello!
      I am probably a bit to "heart on my sleeve" it's true...and damned as I tell myself to stop fighting..I don't seem to learn that one either.. Thanks for the encouragement..
      Have a wonderful weekend!

  4. Hi Krista,
    Thank you again for sharing your point of view about the challenges of being a veterinarian. I always learn something new when I read your posts. I am not a vet, but I hope I would be as compassionate as you are if I was one.

    1. Hello,
      I would bet that you are just as compassionate, regardless of your profession!
      Thanks for visiting, and for taking the time to say hello!


  5. Dr Magnifico, I think you confused my post with someone else's since "wisdom" is not a term usually associated with my ramblings. :>)

    I will look into Pawbly. I'm pretty over extended by involvement in some human medicine issues as well as work on cat and dog chronic diseases and issues with veterinary NSAIDs.

    I really love your blog which another vet referred me to. You are definitely my kind of vet!


    1. LOL! I am certain that you are underestimating your skills, work, and contributions...Please thank the vet who referred you, I have this secret paranoia that my colleagues must think I am crazy, too much heart on my sleeve and trudging through the murky waters.
      I appreciate the kind words, and look forward to hearing from you again,