Everyone Is NOT Welcome Here. When Do I Close The Door To Bad Clients?

While I recognize that this is prejudice, I also recognize my own limitations. 

I mean isn't that fair? Didn't the Supreme Court decide who could, or, didn't have to, bake cakes? Why not have my cake, and eat it too? (The degree to which cake defines acceptable social tolerance is alarming, isn't it?).

Seraphina. She is adamant that you will hold her.

I would like to believe that I am the person who accepts all; lovingly, unconditionally, and without the harsh judgement that divides, alienates, and perpetuates. BUT, it turns out I am after all the person who yields death, AND, therefore, I feel I deserve reprieve and definition to my latitudes.

No one enters my realm unless they love their pet. in itself this offers a huge range of persons. those that love so much they cannot bear goodbye. those that love so blindly that cannot see the path of despair they reap. those that love so much they will not permit one ounce of struggle...the list goes on.

My Charleston. Second chemo session.
passed away 10/21/21

If you aren't sure what I am referring too, let me explain the polar end of loving so much..

The woman with the elderly cat with the facial mass. She found me after visiting a dozen other vets. Two of them specialty clinics with all of the options available for every disease and ailment imaginable. These are the pinnacles of exceptional care and treatment options. She had been told by every single person before meeting me. They all told her that the mass on the face of her cat was so advanced that it was no longer curable. There were no surgeries, no medications, and unfortunately this cat was so debilitated that not even oncology had any suggestions. Cancer is often like this. It can cause such devastation that at some point we should seek merciful end of days, versus, fighting for an ending that leaves no hope for any quality of life. What was best for this cat? Simply helping this woman understand what lay ahead for both of them. She refused to see what all of the rest of us were telling her. She refused so vehemently she became angry. Argumentative, accusatory, and nasty. I kept repeating to her that I was on her side. Her cats side. They are not, or at least did not, have to be separate sides. She couldn't see it. She did not believe us. Any of us. None of us should have to suffer. This cat was comatose and suffering. Now for all of you who are as incensed by this as I was, there were measures in play to help. Animal Control was on her case before she came to me. Another vet before me had reported her. It is incredibly difficult to force euthanasia on anyone seeking care for their pet. Hospice is an option for all of us. But, just like all of us it requires acceptance of dying. My mom couldn't see her own cancer killing her. I get it.

The woman with the mass that took the life of the patient. What about the client who brings in the happy, active dog with the softball sized mass that is bleeding, necrotic and seriously problematic for both his quality of life and his family. Bandages cannot contain masses of this size and severity. They only go away when taken off. Nothing (alright, to be honest, almost, nothing hurts my heart like euthanizing a mass because I don't have a chance to save the patient from it. (Veterinary pearl of advice; don't wait to do surgery on a mass that will never go away without surgical intervention. Take it off  asap!) Ask me how many old dogs with yucky masses I have taken off and had them live years, yes, years, after. See Spencer's story).

The hoarder who loves kittens so much she cannot spay. Ugh. This one drives you to question humanity at its core. The most egregious hoarders that I have tried to help have been compassionate enough to see the respiratory infections, the lethargy, the signs of illness, but, they are resistant to spaying and neutering the whole colony. Why? Well, they don't want to admit it, but, the core of the hoarding is the feeling of purpose and feeling needed. (Every veterinary professional can identify. It is why we are all here.) If there are kittens you are needed. If the cats are sick you are needed. It is an impossible cycle to stop. They will go adopt new kittens if the colony is sterilized. It makes you crazy to see the cycle of dying, disease and suffering be promulgated due to mental illness. Cats need to have kennel licenses required by law. It is the only way to curb the tide for this situation.

The old man with the lifeless chihuahua who cannot put him down,, even as he is agonal. The times when an elderly, (it has happened twice, and always been very elderly), man cradling his dying dog and refusing to let go. There is obvious suffering, and still, they cannot let go. Who do I advocate for? Who do I work/serve? There are times I do not know.

....at least there is some salvation with them,, some bedrock of a foundation that helps me justify the end,, at least they were loved..

The people who give up at the first sign of hardship to spare suffering.. . There are cases that wag, wiggle, and delight into the clinic. Most are here for routine examinations. Every blue (black?) moon these patients are attached to clients who perceive something I do not. They feel their pet is unhappy. Struggling in some unidentifiable fashion, and, therefore needs to be put down. I reel on these cases. I offer free everything: diagnostics, exams, drugs, every pain medication in the arsenal, even taking custody of him. These, yes, absolutely these cases are what ruin me. I have had two clients, both men mid 40's, yell at me. Threaten me, and yes, even charge my via the State Board, that "I work for them." Get so angry and unhinged you fear for your safety. They, (my perception) seem more about the control of it all. The embarrassment of being challenged. Called out. Questioned. That they resort to anger, outrage and threats. One I will never forget is Chuck the dachshund. When Chuck walked into the clinic he bounded toward the treat jar at the front desk. He sat, waited patiently with the drool running down the sides of his mouth, and gulped up three treats the receptionists gleefully delivered. He was euthanized because they were going to have it so even if it meant dropping off at the shelter to have it done by someone who primarily euthanizes via a cardiac stick and doesn't know him. He would be afraid there. He was loved here. I hugged him, cuddled him in my arms, and cried. I made it as full of love as I ever did for my own pets. He was mine in that moment. He was the most beloved dog who ever lived. They weren't going to watch. They told me so as a weapon to remind me that they were so hurt by the loss they couldn't watch. I can't put into words the hate that burned inside of me at that moment. I whispered in his ear as he fell asleep that I loved him, and I hope he returns to pee on them every day of the rest of their lives. Let Chuck be the karma I couldn't deliver in person. 

Did I have to do this? Put Chuck down? No, of course I could have declined. I have done so only to have the Sheriff be called out to witness the dog being shot in the backyard tied to a tree. 

(Middle finger salute to that idiot who ever said "what ever doesn't kill you makes you stronger.")

Like it or not, the minute you threaten me is the same second my claws come out. Yesterday I screamed back into the phone to a woman who was insistent to tell me that "she has friends who do not like me!" It was a dagger she thought would hurt me. She wanted to hurt me because I was forcing her to wear a mask in the clinic. I very loudly told her that "I truly didn't care what anyone thought of me." I am over that manipulative crap. These two guys, gone for good. Hip-hip.. I definitely don't work for them.

Jitterbug. My beloved cat. Passed away September 2021

The wise old veterinarians before me would tell me that it is not my place to judge. While at the macroscopic this might be best for mankind, it is not the reality of the world I am trying to stay alive within. 

Diedra, always a smile.
Me, claws at the ready, yet still looking for the next adventure/challenge

Can you love too much? No, I don't think so, but, you can love so much that you are blind to the other person/soul/being/dependent in the relationship. You can love so much that it is destructive to the others around you. You can love so much that there is no other perspective to influence decisions. If that includes your health care provider they cannot do their job with the best interests of the patient first. I also cannot survive with a compassionate spirit to guide me. 

End Note;

This blog is about the lives I meet and the struggles I face as a veterinarian. It's about the endless questions that I grapple with everyday as I try to find my way. I can say that I am trying to stay true to who I am, and why I chose this profession. But in reality I am just trying to keep that little girl who always dreamed she would grow up be a veterinarian, in the face of the harsh realities the adult me has to manage, alive.

The 20% that Suck Up The 80%. What to do with your "BAD" clients.

There is some archaic hidden law somewhere buried in the first veterinary business text book written that states that "20% of your clients comprise 80% of your ____ ."
This blank can be filled in with a multitude of phrases. These include;

• business
• heartache
• stress
• revenue stream,
• etc..

Jekyll reminds Joe who is in charge.

It is not a concept that is unique to our industry. I am sure  that you could ask every other service industry and the same would apply.

My hairdresser, dermatologist, and salon friends would all agree. 80% of your clients walked into your life long ago as a customer, but you now consider them a friend. And then you have the 20% who cause you to walk on eggshells fearful at every interaction that the tongue will lash and the feelings will be hurt,,, again.

I suppose that some business savvy individuals have taken this fact and settled upon accepting it. No hard feelings, IF, there are no feelings involved. Some people cut whomever's hair is sitting in the seat and should they never see them again, well, that's OK. No gain, no loss. In veterinary medicine many a 'relief' vet has been born because of this. 

Every vet must decide where they fall on the business spectrum. The entire P&L sheet of every business has to have some loose guidelines to assist you when it comes to managing time, resources, and turnover. In many fields a one time client is perfectly acceptable. You may not be able to build a solid legacy on burning people, but if they are one trick ponies and your audience reach is large enough you can survive and pay your mortgage. If, however, your goal is a bit loftier you begin to scrutinize the relationships and draw some lines.

Dunkin. The Jarrettsville Vet 2015  rescue.
He never has the chips in his favor and he never lets it stop  his smile.

When I bought my practice 10 years ago we served a vast population of pet people across both geographical and ethical landscapes. It was a nice even pie shaped chart of family pets, breeders, rescue work, and clients who defaulted on paying their bill and were forgiven 12 months later to repeat the same year after year. The former practice owner was loved far and wide as a good friend to all. He also ran a business with minimal overhead and minimal stress. He chose to ignore a problem and most of the time they went away without his attention. He was tired, financially secure and had long ago determined that very little was worth his worry.

Ten years later I am still paying him back for buying his practice and I still have to clean house to be able to afford those checks I write to both him and the banks. I also lack the DNA sequence that allows me to tolerate the 20% "bad" clients.

Labels, oh, how we try to avoid them, and oh, how they are unavoidable. "Bad" clients are the source of their own veterinary doctorate discussion. The label I prescribe is never the exact label as another vet would prescribe. But, if you don't pay attention to your business your business will pay for them a thousand times over.

Not too many vets will allow a non paying client return visits. How can you pay your employees, or the bank if you do? We had to work very hard to avoid the secret walk-outs on the bill  that had been "dismissed and forgiven" in the past. I also had to have some tough conversations with some self described "long term clients" who never paid in the past and couldn't believe we were not running them a tab any longer.

Not too many vets will allow a client who can't pay sign over their treatable pet to us? Could I send that anemic kitten to the bank as payment for my note? She is after all "healthy and adorable!"

How about the guy who threatens, screams, and demands unrealistic exam walk-ins at his convenience, and then is a no show about 50% of the time? He is a jerk, he knows he is a jerk, he seems somewhat proud about being a jerk, and he will leave a trail of dismay, disgust and destruction a mile wide for the rest of the day. He is also a pet parent who obsesses over his dogs and cannot see his behavior costs his dogs the care they need and deserve. He is part of my left over 20%. He is one of my remaining "bad" clients. These people cost you, your time, your staff's ability to want to come back to work the next day and they need to be addressed or your business will pay for them.

The first 19% were fairly easy to eradicate;

• Non-paying or cash only clients are marked with a special folder. In the past the only person who knew who wasn't paying was the bookkeeper who worked about three hours once a week. These clients would come in for an examination authorize all the care the pet needed and walk-out never to be heard from again,,, until the next time their pet was sick.  Putting your staff in the middle of payment debates is not fair, so we devised a plan to notify the staff, without embarrassing the client in advance. Special folder clients are provided an examination and a written estimate which requires a down payment for anything further. I can accept paying a vet for their time and expertise, but I am not going to be as silly as my predecessor and write off a shyster year after year when we allowed them to dig a debt they couldn't see out of. We either go into each case knowing we are doing it pro bono, or get some form of payment in advance. Expecting these clients to change their modus operandi is naive and leaves us feeling as the jaded ex-girlfriend every time.

• Breeders/Hoarders/Abusers. (I know, I will pay for this bit of confession). Most of the breeders my clinic served before I bought it were hoarders and neglectful abusers. Their dogs were sick, diseased, parasite ridden, unvaccinated, puppy mill dogs. The Teacup pups were emaciated, bony, barely able to stand, matted and petrified. They never left their metal cages and therefore being in the clinic was tantamount to landing on Mars. The German Shepherds fetched a fine price on Craig's List but all had awful hips which were passed on to their offspring. I would cringe every time a GS pup from our breeder showed up at 6-9 months old with a "limp." We euthanized more adolescent dogs simply due to poor breeding than I care to ever recall. The breeders ran a business on a shoe string and their dogs bore the brunt of that business plan.

• Fellow healthcare providers. What is the saying? "A little knowledge is a dangerous thing." Human healthcare professionals tend to guesstimate their pets ailments, downplay the repercussions, or they avoid the whole unnecessary vet visit all together until the at home plan results in a full blown disaster. For these clients I tried very hard to convert "self-reliant" into "healthcare partners". I provide accessibility and we walk through treatment plans (many of them started at home) together. It has created some strong friendships and excellent referrals from their friends.

• Abusive, caustic, abrasive, soul-sucking jerks. Ugh, these people will drive you to the pink juice, and not the one that I prefer dry and dirty with extra olives. How do you work around people who destroy your ability to serve your clients with compassion, respect, and integrity? I promise that if you cannot separate yourself from the people who hurt and destroy you you won't be able to walk away from any service industry feeling as if you made a positive mark on the world we share with each other.

The last 1%

• The last one percent are the people I have the hardest time parting ways with. They yank at the heart with their undeniable love for their pet(s), but they cannot care for them adequately. Some due to financial hardship, others due to mental duress. I am unable to turn away a client with a pet in need. I cannot make a solid business decision when I know I can help and they only lack the resources to provide payment. I have devised multiple options to help  with these cases. We have a wonderful rescue who will take ownership if we ask, or a third party billing agency when the credit cards are declined. 

• I have other clients who are so emotionally bound to their pets that they are unable to face the reality of mortality. The gradual decline of a pet can lead to the decline of a client. There are clients who ask for services I do not, and cannot, provide. These include mass euthanasia's should the client die before their pets do, and fears about how the pet(s) will survive without them? Emotional attachments built on a foundation of unrealistic expectations are sticky difficult relationships to navigate. They can become toxic, dangerously intertwined and ultimately lead to someone asking you for services you cannot ethically, morally, or logistically manage. You can find yourself stuck in the rabbit hole trying to care for both the passionate and incapacitated. And, sometimes the lives you advocate for change from domestic to human. And, sometimes you don't know who your license serves?

There are a few "Dear John" letters waiting for me to write. Break-ups are always hard. They are especially painful when there are kids involved. I will miss the kids. A lot.

I am available (if you are nice and a good pet parent) at Jarrettsville Vet, in bucolic Jarrettsville Maryland.

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