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,

Sincerely, 
Krista"

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.

Sincerely,
Krista"

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 Pawbly.com, 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...

Smelly Poop? When Is It Abnormal?

I suppose there is a tiny hint of superstition in every one of us.

With that, I was asked the same question twice in as many days. So, I thought I would post the answer here to broadcast it to any others who might be waiting to make it a hat trick and ask tomorrow.

My kitty, Wren.

Tammy asked;

I have a cat that has issues with her poop being soft and not normal it is a very large amount and it smells bad I tried tape worm and ring worm change the diet from Iams to cat and paws did anyone have this problem.

My answer;

This is hard to answer without an examination of your cat. But there are a few things to mention.

A big cat is a cat who is eating too much and not burning enough calories. So the amount of food in will closely resemble the amount of food out. Talk to your vet about this.
A poor quality food is full of fillers, and or fiber, and this is not digestible, so the cat will produce more waste. Talk to your vet about this.

Cats can get medical conditions that affect their fecal output. Talk to the vet about this.

A fecal sample should be done before you ever give any kind of de-wormer. In almost every single case the de-wormer you are buying over the counter is inappropriate, unnecessary, and dangerous to your cat. It can significantly change the gastrointestinal tract and make the stool softer and the cats health is jeopardized. De-wormers should only be prescribed after a positive fecal sample. Think about someone giving you a pesticide that caused you to feel nauseous and then having chronic diarrhea afterward? Yuck! The longer a cat has diarrhea/soft stool the harder it is to fix in some cases.

My  best advice is to see your vet about your concerns. They can help rule out intestinal worms, poor diet, health concerns, and prescribe a tailored case specific treatment plan. No one else can help you with this except your vet.

Best of Luck,
Krista

AND,

Brittney asked;

I have 2 full blood Chihuahuas and when i first got them they didnt smell when they pooped but now it smells really crazy. What does that mean?

My answer;

The odor to feces is influenced by a few factors, like diet, age, intestinal health, intestinal parasites, etc.

The best place to start is with a fecal sample and a visit to your vets office to discuss all of these. Talk about how often the dogs defecate, what it looks like, and bring a sample to look at grossly and microscopically for intestinal parasites. I have had many pets come in for really terrible smelling feces and found tiny microscopic protozoa organisms that cause  really foul smelling poop. With a few days of a cheap widely available de-wormer most of these guys are back to normal. Some of these worms are treatable with monthly heartworm preventatives, and some are not. 

Also, some parasites are picked up by a pets feet in just a normal stroll through the grass, so everyone is susceptible to them. And, not seeing worms in the feces doesn't exclude your pet from having intestinal worms. We look for the eggs of the parasites in the feces, not the worms in the feces. 

In general, poop never smells good, but really foul smelling, watery, or abnormally colored feces should be examined at the vets.

I hope this helps,
Krista

My pups, Jekyll and Charleston.

All pet questions can be asked and answered for free at Pawbly.com. Pawbly is the place for all of us who love pets to meet, exchange information, and help each others pets live longer, happier, and healthier lives. Please consider joining us on our quest to help pets around the globe.

You can also find me on Twitter @FreePetAdvice, or at the veterinary clinic, Jarrettsville Vet.