Thursday, September 18, 2014

We Do The Best That We Can


People get angry at veterinarians all the time.  That procedure costs too much money!  All you're interested in is the contents of my wallet!  You obviously don't care about animals! 

Have you ever stopped to consider your veterinarian's job? We wear many hats, and we perform many jobs. And we do this with a good attitude and a heart for the patient's that we treat (and their owners). 

We must be grief counselors. We hold your hand, pat your back, offer tissues, and listen to your stories about Fluffy when it is time for Fluffy to go. Often, we hear stories about human tragedies as well - this pet belonged to your father who passed away, and Flffy is all you have left of him. This cat belonged to your son, who died tragically at 21 last week in a car accident. 

We shoulder the sorrow of watching the light in your beloved pet's eyes dim, and we shoulder the dimming of the light in your eyes as you watch it happen. We feel the tears drip our hands, holding the syringe of pink liquid. We feel helpless too, unable to stop death, and we grieve with you. And though we go onto other patients and other cases, a tiny bit of our soul went with your pet into that great dark night (and we must have very big souls, to let so many pieces go). 

We must be financial counselors. Guiding you through the myriad decisions involving a loved pet's care and the expense that it can incur. We tell you about CareCredit and about Humane Society funds that might help. We frequently discount or don't charge for services so we can help that "special" pet get well (and so many of them wind up being special). We trim down surgery times, even though it truly took us an hour to remove that sock from your dog's intestines, and we stay late after work, just to help keep finances manageable for you. 

We must be mediators and relationship counselors between couples warring over decisions on Flffy's pet care. We must delicately navigate the married (or ex-married) relationship shoals lest we be cast upon them and destroyed. Often, we field phone calls from each individual pet parent - sometimes within 5 minutes of one another - answering the same questions over and over. We do this with patience and a generally good attitude. We help soothe agitated couples and make our recommendations with aplomb. We try to make sure that both pet parents leave the hospital (or phone call) happy. 

On top of this, we ARE doctors. And not just 1 kind of doctor. Whereas if you visited your MD, he would look at your skin lesion and refer you to a dermatologist, we will skin scrape your pet, culture the lesion, and start your pet on an appropriate treatment course. If you visited your MD with a belly full of hemorrhage, he would send you to a surgeon post-haste. We will stabilize your pet with IV fuids, give a blood transfusion, and take your pet to surgery to address the cause of bleeding. We will talk you through options for chemotherapy if a tumor is found. We will provide palliative and hospice care as needed. If you request referral, we will help you find an oncologist. 

And we must do all this with a smile, a pleasant and cheery attitude. We must answer 10000 questions a day, from the mundane to the very serious. We must take care of the patients in our hospital, while seeing outpatients and doing surgery. We must make many phone calls in a day, relaying test results, 1 prognosis, discussing treatment plans and diets, nail trims and surgeries.  
Then we must go home and try to live a normal, well-rested and balanced life. Raising our children, enjoying our hobbies, cleaning our houses, fixing
dinners.

Is it any wonder that we suffer from compassion fatigue and complete burnout on a regular basis?


I am an emergency veterinarian. I am a mother of 2 young children

(and would like to have more). I love my job. It drives me to continually strive to be better, to do better by my patients and their owners. But it also drives me to illness, to lack of sleep, to dehydration, to emotional breakdowns, and nights with my patient husband. 

I wear many hats - both at work and at home. Remember that the next time that you see your veterinarian. Remember that your vet is a person too - with a family, hobbies, dreams, tragedies, and sadnesses - just the same as you. And much like you, they are working hard and doing the best that they can - every single day.

Wednesday, September 10, 2014

Rabies Testing & Quarantine

Today, VBB Central was closed down so our doctors could have a CE day. Continuing education is a valuable part of veterinary practice - it's how we keep up with what's going on in our profession medically, administratively, and so on. I usually enjoy my CE days a lot, although of course some lectures (and lecturers) are better than others!

Today, one of the talks was on the subject of rabies testing and quarantine, and rules applicable in various states and counties. The speaker was a veterinarian from her state's Department of Agriculture, and she was very dynamic and knowledgeable. Obviously the material she was working with was what it was - the nuts and bolts of vaccine, quarantine, and testing requirements are not very sexy - but nonetheless, she kept me interested the entire time. She even managed to gracefully handle the incessant "point of order" type questioning from the one guy in the back, who always has to ask a stream of arcane academic questions that are irrelevant to anyone living in the real world.

Here's the thing - dedicated readers of this site know that one thing most veterinarians have in common is that "nothing surprises us anymore." Except, you know, when the most stupid or ridiculous thing imaginable suddenly happens and it shocks the hell out of you, and you think "man, I THOUGHT I had seen it all, but I guess I was wrong." Then you think there's nothing left to surprise you - until it happens again.

Well.

This veterinarian was talking about how to properly submit samples for testing at the state diagnostic testing laboratories. Proper refrigeration is key, in case you are wondering, and she also recommends making sure everything is sealed well to avoid leakage and that identifying paperwork is enclosed, properly filled out, and in its own separate waterproof bag. There are various approved couriers, and instructions on how to deliver the samples without using a courier were also provided. She was very thorough. Then she got to the part about properly preparing the samples.

Well, ok, easy enough, right? You're either submitting a brain that has been removed from a head, or a head that has been removed from a body, or in the case of a very small patient (under 3 lbs) an entire body. She did take care to remind us that they only want mammalian samples. OK, I can see how someone might think it necessary to submit say a bird or something, if perhaps a pet chicken went batshit crazy and started attacking inanimate objects or whatever. So it makes sense she would remind us not to do that. Then she reminded us that they want only non-living samples. I am pleased to report that she did not provide us with an example of a living sample they had received in error.

So far so good, you're probably thinking. Where's the surprise? Well - apparently last year, she was going through the reports sent to her office from the state diagnostic testing laboratory, and was disconcerted to see that a particular sample had been "unable to be tested." She read the complete report and it said that the reason the sample could not be tested was because despite the fact that it had been labelled as a "bat," it was in fact not a bat but rather a banana peel.

I'll let that sink in for a minute.

It was not a bat, but rather a banana peel.

I am not sure how one makes that mistake, let alone how someone who mistakes a banana peel for a bat is then competent to package the banana peel up with the appropriate paperwork and submit it through the proper channels for delivery to the state rabies diagnostic testing laboratory. It kinda makes my head spin.

I did take the time this afternoon, after getting home from the CE, to put together this teaching slide for my own talks:






Feel free to use that yourself if you find it helpful. This is apparently something people need help with out there.

Tuesday, September 2, 2014

Our Chance to Be Heard

Many of us have been following the mess associated with the AVMA, the COE (Council on Education) ACCREDITATION baloney and blah blah blah.  (check out www.justvetdata.com)  All we really know is that it's not good for the profession, right?  I mean, another school just opened up and is going to be charging a cool $60,000 PER YEAR for their veterinary degree....   good freaking god.

If that's not enough to make you blow your morning coffee right outta your nose, then I can't help you.   :)

So now's our chance to make our intentions knowns and our voices heard.  PLEASE go to this link, read it, and submit your comments.    Let's come together and see if we can't make our profession better.


www.vetuscope.com

And please share the link with every vet you know - students also - and ask them to submit their comments if they agree.

It can't be any easier than this!

Let's come together, people, and do something to save this profession before it's too late.

Thursday, August 28, 2014

Chapters We'd Like to See in the Textbooks


A few of us at the VBB roundtable were wondering why we never see the following chapters in any of our veterinary textbooks: 


Chapter 1:   How to Accept That You Chose to Become an Emotional Sponge for the Public Without Killing Yourself.

Chapter 2:  How to Fake Diseases in your Patients Just So You Can Steal Money from Your Clients.

Chapter 3:  How Not to Giggle When Someone Tells You Their Name is Melena.

Chapter 4:  A Concise Surgery How-To Guide:  Cut that Shit Off...  It's Simple as Shit.

Chapter 5:  A Concise Surgery How-To Guide Part Two:   I Cut that Shit Off But It Wasn't Simple as Shit.
                      
Chapter 6:  A Concise Surgery How-To Guide Part Three:  I Cut that Shit Off, It Wasn't Simple as Shit and Now I Wish I'd Never Started This.

Chapter 7:  A Concise Surgery How-To Guide Part Four:  I've Been in Surgery for 3 Hours, I Cut that Shit Off, It Wasn't Simple as Shit and Now I Have to Just Close the Damned Wound and See What Happens.

Chapter 8:  Surgery:  The Ultimate Hack and Slash Experience.

Chapter 9:  Table Sugar:  Rub It on the Weenie and It Will Go Down.

Chapter 10:  Foxtails:  Not Just for the Gardener Anymore.

Chapter 11:   Canned Pumpkin:  So Many Uses, So Many Doses.

Chapter 12:  So You've Just Accidently Stabbed Yourself with Euthanasia Solution...  What's Next?

Chapter 13:   Using a Flea Circus and Homing Fleas to Increase Your Bottom Line. 

Chapter 14:  Controlling your Desire to Choke the Living Shit Out of Someone.

Chapter 15:  Post Grad Wal-Mart Budget:  Another Way of Looking at Student Loan Debt  (aka You Only Thought You Were Done Eating Ramen Noodles)

Chapter 16:  Vaccines Schedules:  Obviously Dr. Google Knows Best.

Chapter 17:  Keeping a Straight Face When a Client Wants to Keep the Toenails After You Trim Their Dog's Toenails.

Chapter 18:  Chocolate Vomit:  A Love Hate Relationship.




What chapter would YOU like to see in the textbooks?  





  

Friday, August 15, 2014

All About the AVMA and COE - Please Listen... and Share!

The battle against the AVMA and the Council on Education is heating up!  Some of you may not know exactly what I am talking about, but have no fear...  it's all explained on this webinar.  Please take the time to listen to it, educate yourself on what is happening within our wonderful profession, and commit to taking action soon.


https://www.youtube.com/watch?v=j9afQ06vfJ4&feature=youtu.be


If you have questions, please let us know.  Comment below or shoot us an email.



Come on folks, this is our chance to be heard.  Can we come together and make this happen?

Friday, July 25, 2014

Dear Pharmacists

It's no secret that we veterinarians are starting to interact with human pharmacies more and more.  We are MORE than willing to work with human pharmacists in order to find better pricing for our clients and patients to make sure that they get the proper care they need.

In fact, there is a sign on my wall telling my clients to please ask for a written Rx if they would like one.  I'm more than happy to oblige.

However, since Target and Wal-Mart and all those places now feel the need to "get in on the veterinary action" of selling drugs to our clients, allow me to put forth some suggestions for them to help... uh...  facilitate things.

1.)  Animals often require higher doses of many drugs than humans.  Please get used to this.  Because drugs have different pharmacokinetics in different species, and because you only learn about ONE species in pharmacy school, you're not aware of the doses used in our patients. Either go ahead and take a class in veterinary pharmacology, or get a formulary and use it EVERY TIME, but please for the love of all that is holy stop changing my drug doses while making snide remarks to the clients about how I don't know what I'm doing. If you're really concerned that I'm screwing up, go ahead and give me a call. I'll set you straight. But I'm not free to talk to pharmacists all day, so, you may be on hold for a while.

2.)  It is YOUR responsibility to learn the difference between the human world and the veterinary world, when it comes to sigs.  YOU must know that if I sign a DVM after my name and I put SID or whatthefuckever, YOU must know what that means.  Filling it wrong because you are ONLY trained in human medicine is unacceptable.  It is not my job to do your job for you. 

3.)  Please oh for the love of god teach yourself and your staff that 15 mg/5 ml is really the same as 3 mg/ml.   I do not have the time to sit there and explain this to you all every. single. time.

4.)  Please do not panic when I prescribe Alprazolam to my patients.  It really is effective for them.

5.)  Please also do not panic when I prescribe Trazadone to my patients, and especially do not tell my client "I can't give you that!  That vet doesn't know what she is talking about!  It's not USED for that!" until you've spoken to me and I've educated you on your own ignorance.

6.)  Please NEVER, EVER, substitute drugs.  EVER.  Yes I realize it can be done in the human world.  But remember, you are now in a world in which you were never trained, yet you are responsible!  So educate yourself about veterinary drugs OR DON'T SELL THEM OR FILL THE PRESCRIPTIONS IN ANY MANNER OTHER THAN HOW WE PRESCRIBE IT.  And, by the way, Tramadol is NOT a substitute for Trazodone. 

7.)  Stop questioning if I know what I am doing or not.  I do know what I am doing.  You do not know what I am doing.  See how this works?

8.)  Please stop asking for an NPI number.

9.)  No, not all insulin is the same.  No you may not send home a generic when I did not prescribe that.  See how this works?

10.)  The fact that I prescribed prednisolone to my feline patient means something.  It obviously means nothing to you because you keep sending home prednisone.  Please just follow directions.  It's really very easy.

11.)  Invest in a veterinary formulary.  PLEASE FOR THE LOVE OF GOD AGAIN, DO THIS.

12.)  Lastly, simply establish a relationship with us.  Respect us.  Treat us like doctors when we call and do not dismiss our questions for your pharmacy, such as how much something costs.  My clients will be paying you cash for those drugs, which is really really good for your business.  So stop busting my chops over it, realize we are colleagues and you better get used to having us around.

After all, it is your profession who asked for it.



An Interview with Dr. Sarah Boston


So after reviewing Lucky Dog written by Dr. Sarah Boston and really enjoying it, the VBB Collective decided to interview Dr. Boston and share it with our readers.  Let us know what you think! 




I have to tell you, among our group response to your book has been incredible. We love it! We love you! Thanks for writing it.

Thank you so much and thank you for the great review! I am so glad you liked the book. The support of the veterinary community for the book has been amazing!

We have some preliminary questions. I thought we could start with these and see where it goes.

1. Dr. Sarah, you seem to be someone who has maintained a positive outlook despite everything you've been through.  Have you ever experienced periods of compassion fatigue in your career?

I think that every veterinarian has experienced compassion fatigue. I do maintain a positive outlook and I tend to think that my baseline is happy, but I also think that being a veterinarian can be very challenging at times. I am hoping that Lucky Dog will shine some light on our profession and help people to understand what we do a little better and to take veterinary medicine more seriously. I am considering another book that will do this more deliberately and discuss some of the darker and harder aspects of this wonderful profession.

1.a. (If yes) how did you confront that? Or (if no) can you offer any suggestions to affected colleagues on how to handle that?

Even though I graduated in 1996, I think my strategies for dealing with compassion fatigue are still a work in progress. I actually had one of the most difficult cases of my career just a few months ago, and I definitely experienced compassion fatigue going through this. One of the benefits of being in academia is that we have breaks from clinical duty, which I think helps. I also think that setting boundaries with our clients is important. This would include boundaries with our time, availability, and also what we do for and with our clients.

2. Have you ever had a conversation with the author of Zoobiquity regarding human doctors learning from DVMs? That's assuming you have read the book. If not, you should! If you've read it but not spoken to the author - can you comment on your feelings about the "one medicine" concept?
I have not had a conversation with the author of Zoobiquity, but I am familiar with the book. One medicine is very important to me because I do clinical work and research in oncology. There is a lot to be gained on both sides through translational research and I am really happy to be a part of this. I am involved in a grant proposal right now that will fast track a promising treatment for liver cancer into dogs (through a clinical trial) and then hopefully back to people with this disease. When you work with a physician–scientist that really understands the benefits of collaborating with academic veterinarians, it is advantageous for all of our patients, not to mention exciting and fun. One thing we do need to be careful of as academic clinical veterinarians is that we do not turn into technicians for the physician-scientists. They need to understand that these are not lab animals, they are our patients and that they need to benefit from the work too. I personally have zero interest in doing research or testing treatments on healthy dogs. Where I get excited is when I can offer a novel therapy to a client and patient at a significantly decreased cost. In this scenario, everyone wins.

3.  Have you confronted any of your doctors who let you down?

I haven’t confronted any of my doctors. I was all geared up to do this when I met with my endocrinologist after I (finally) got my diagnosis. (I talk about this in the book.) He did let me down, but he was so genuinely shocked by the diagnosis, and such a nice person, that it was hard to confront him. Also, I think that in some ways it was the system that let me down, more than any individual doctor, so I guess in a way I am confronting the system through my writing.

4. Have these doctors read and/or discussed  the book with you?

I haven’t had this opportunity because I am not living in Canada right now. I did consider sending copies to my physicians, but I wasn’t sure how this would be received. (I still might, but the month since the release has been wonderfully frantic.) I am actually grateful to all of my doctors, despite how frustrated I was at the time. Ultimately, I did get good treatment and I am very likely cured of my thyroid cancer, so I feel a mixture of frustration and gratitude for the physicians that cared for me.


5. You talk about living with happiness, what formula have you found? Is it working for you? What would you advise other veterinarians regarding happiness?

I do try to check in with myself regularly and ask myself if I am happy. As a veterinarian, I try to do this every 6 months or so. That way, I am not reacting to the ups and downs of a particular day or week, but I can assess overall how things are going. I think that some jobs will take time to improve and maybe I have been to hasty to leave certain work situations in the past, but I also think you can’t wait forever for a job to make you happy. In the end, it is just a job and your health and happiness are more important than that. I allude to this in the book, but one of the reasons that I changed jobs and moved to UF is that I was experiencing bullying in the workplace. I tried several strategies to manage this, but ultimately, I decided that I needed to leave that work situation. As heartbroken as I was to leave Canada (still am) I think it was the right decision. My current work culture does not tolerate bullying or any aberrant work behavior and I feel protected there in a way I never did in my previous job.

6. Back to happiness--and managing anxiety--what is your best advice for managing anxiety? Would this have helped you through this time?

I have found a few strategies, but I think that the way to manage anxiety will be different for everyone. Some of the reason that I started writing (before I knew I was writing a book) was to help manage the anxiety. I was trying to channel the anxiety and frustation into humor. Humor has always been a big part of my life, not just to manage anxiety, but it is a way of being for me. I like laughing and making people laugh.

This will sound clichéd, but yoga was also a big part of my anxiety management during my treatment. It was a great way to turn everything off for an hour and to be physically active. I would recommend it to anyone, but you need to find what works for you as far as an outlet for anxiety.

I also think that as a profession, we need to find strategies for preventing our anxiety. We are all perfectionists and we are all very hard on ourselves as a profession. I think that setting boundaries with clients and not being so hard on ourselves helps. I also think that as a profession, we need to be supportive of each other. There is no one else who really understands what we do. I spent three years in general practice before my surgery residency and it has really helped me as a faculty member and as a specialist when I work with our veterinary students and referring veterinarians. I don’t think that there is a more difficult job in the world than being a small animal general practitioner.

6. Any word from Ellen DeGeneres??
Not yet, but if you talk to her can you let her know that Rumble and I would love to meet her! I realize this may sound insane and every author says this, but I really do believe she would love the book!