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.

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!

Friday, June 27, 2014

Book review - Lucky Dog

As you may have noticed, it's been kinda slow here lately, so let's try something new. We were recently contacted by the PR people for a new book called Lucky Dog, by Dr. Sarah Boston. The nice lady who contacted us asked if we might consider reading and reviewing this book, and sent along a PDF copy for review. I agreed to read and review it, and I am so, so, so glad that I did (not that there was ever any question. I am kind of a book slut, apparently).

This book has got it going on, as the kids say. Or maybe used to say. I’m a little bit behind with respect to pop culture, I’m told. Anyway. WOW! Dr. Boston’s book resonates with me on so many levels, I cannot count them. I have always enjoyed reading stories about animals, especially stories about veterinary medicine. I would venture to say that the James Herriot novels are my favorite books of all time. This book is definitely up on the top ten list.

So, what makes this book so great? Well - Dr. Boston talks about being a veterinarian, and shares stories about her patients, in classic James Herriot style. These dogs come to life, and I feel for them and their owners on a personal and professional level. Carney with osteosarcoma, North and his nose problem, Kelly's ironic fate. Their stories ring very true, but what really stands out is the strong relationship between Dr. Boston and these dogs and their owners. I hope I am able to build such strong relationships in my own practice.

But - it's not all cancer patient stories! There's plenty of non-cancer material here. I am sure there is no companion animal veterinarian out there anywhere who won’t be able to relate to her FAQ “taken from [her] real life,” on p. 69, in particular -
“can you trim his nails and express his anal sacs while he is here?”
“Yes, as a board-certified veterinary surgeon with fellowship training in surgical oncology, I would be more than happy to perform the same duties as your dog groomer. Expressing anal sacs is a particularly enjoyable task, and I would love to do it at no extra charge.” 

See? Don’t you love this woman already?

I was also charmed by her discussion of people who overshare with their veterinarians. As she explains, when a veterinarian has succeeded in building a strong relationship with a client, this sometimes leads to a level of intimacy that can be a tiny bit uncomfortable. Apparently a classmate of hers had a client tell her “that she wouldn’t neuter her dog because she liked to play with his testicles when they sat on the couch and watched TV together.” You may not believe this but I HAD A CLIENT TELL ME ALMOST THE EXACT SAME THING! Crazy, right? But it just proves that this book is full of win - this book is like a reality show, but written down (and with better production value, and a more sophisticated tone).

She draws parallels between her own health care and the care she provides to her patients, and the compassionate efficiency of her practice’s care serves as a sharp contrast to the sluggish and apparently unfeeling Canadian system which is providing her own care. I love her descriptions of the caregivers she meets, and how they treat her. Some of them are wonderful, and some of them need a swift kick in the rear. Note also that she is not ungrateful for the care she receives in the Canadian system - her critique is very well thought out, I think.  In the end, she also experiences the American system, and I enjoyed reading her perspective on that. She shares a lot of insight into the differences and similarities between veterinary and human cancer care, not least that dogs and cats do not suffer from anticipatory worry or fear of death like people do, which is something that I always tell my own clients. Of course she spares no detail in describing her own anticipatory anxiety - the severity of which led her to take matters into her own hands, which I can also relate to. Veterinarian readers who have turned the ultrasound probe on themselves, raise your hands…. yeah, I thought so. Of course, then there’s the matter of what you do once you’ve self-diagnosed but you have to convince the doctor or doctors that you are correct… Dr. Boston has the whole story covered.

Overall, Dr. Boston’s tone is witty and her material is relevant for animal lovers, cancer patients and those who love them, people interested in comparative medicine, or anyone who has a good sense of humor. I highly highly recommend this book. Read it now!

You can buy it on Amazon, of course.

Friday, June 20, 2014

Here, Pussy Pussy Pussy!

One of our esteemed colleagues shared a story with us that simply could not go unblogged.

I had an elderly client in today for a euthanasia......after the cat had passed away she said "he's in pussy heaven! A place with other cats, and lots of birds to chase. Dr Joe, what is your idea of pussy heaven?"
Her daughter looked at me as I stood there like a deer in the headlights and said "Mom, maybe you shouldn't ask Dr. Joe what he thinks pussy heaven is like. I mean, I know he's a vet, but he was a male first!"
So many levels of awesome right there....I love how it sounds like she's saying being a vet and being male are mutually exclusive, for one thing. For another thing - PUSSY HEAVEN! It's like Dog Heaven, but with more - oh, nevermind.

In the same discussion, another colleague mentioned his clients who used to come in with their elderly cat for frequent check-ups. While he examined their cat, the clients would chant "Dr. Jones LOVES Good Pussy, Dr. Jones LOVES Good Pussy." By the way, let this be a warning - most veterinarians have a very good poker face! We kind of have to.

And one for the VBB Gift Guide:

Sorry but I couldn't help myself. Meow!