Q: I diagnosed a new client’s 18-year-old cat with hyperthyroidism and renal failure. The cat weighed only 6.4 pounds and was visibly weakened and minimally responsive. Due to the patient’s advanced state and poor quality of life, I recommended euthanasia. The owner said she hoped I had a suggestion other than “killing my cat” and that she’d seek help elsewhere. On the way out, she told us she’d done research on the internet and knew of several treatments to help old cats that were losing weight. I was offended by her tone and her rejection of my advice. I informed her that our clinic wouldn’t be able to help further. Surprisingly, the encounter divided my team members. Some said I was too harsh for firing her, and others blamed the owner for neglect. If clients won’t accept my recommendations, I feel I should be able to fire them. What do you think?
A: Recommending euthanasia on a first exam can be like predicting earthquakes: It’s only a tiny tremor until the ceiling caves in on you. The first bit of advice is, don’t take it personally. Ultimately, our job is to provide our best medical assessment and allow the pet owner to decide how to proceed. If the situation rises to abuse or neglect, you should notify the appropriate authorities, but this case doesn’t sound like you need to. But keep your head covered.
It’s essential that you don’t inadvertently escalate a situation by matching negative energy. Instead, remain compassionate, tempered and professional. Veterinary professionals need to develop communication skills and healthy emotional mechanisms to deal with refusals, dismissals and disapprovals. That’s part of the job — not a good part, but an inextricable element nonetheless.
One wise saying is that the strongest warriors are patience and time. Give clients time to process your recommendations, especially for something as serious as euthanasia. Eighteen years with a cat creates a lot of love and memories, and the owner might need a few days to accept that it’s time to let go. This suggestion applies to nearly any medical recommendation. So, be strong by offering clients the gift of time to decide things whenever possible.
Also, you must earn trust. Medical skepticism and doubt are pervasive in society and worsened by immense misinformation available at a simple click. New clients need to have confidence in you before accepting your medical advice. I approach clients with the mindset of “Why should they trust me?” My goal is to connect emotionally, be empathetic and share as much evidence-based medicine as possible. And then I allow them to choose.
Finally, I’m an ardent advocate for keeping the relationship door open unless a client is abusive, threatening or litigious. I do this because I still want to help the pet if clients change their minds (and they often do). I suggest not being so quick to fire clients who civilly question or disagree with your suggestions. Most of the time, they simply want or need to understand better, which allows you to articulate your message better. All in all, I rate this a mild shake, no more than a 3 on a seismometer.
Q: What’s the best way to train new hires?
A: The first thing to know is that there isn’t a “best way” to do nearly anything. You can, however, discover your own “best” by testing different tactics and analyzing the outcomes. Put another way, strategically implement a variety of actions and measure the results, learning as you go.
In my 30 years of owning practices and running businesses, I found that by starting with the most common challenges or tasks, I experienced accelerated progress. For example, determine the top 20 or 30 conditions your clinic sees each month. Then, write a simple one-pager describing the condition, symptomatology, etiology, diagnostics, treatments and prognosis. These training documents should allow anyone on the staff to understand the conditions and answer general client questions, such as “Why did this happen?” and “How is it diagnosed and treated?”
Next, use the synopses to create technical training tools that support clinical comprehension and procedural consensus and inspire assessment and the revision of protocols.
Finally, augment the training elements with role-playing to teach communication skills and boost your team’s productivity.
Q: I’m a new veterinarian working at my first job. I was performing a dental cleaning when the ultrasonic scaler broke. My boss said she’d never seen it happen and that I must have been negligent. She’s now asking me to pay for half of the replacement cost. However, the unit was several years old, and I was being careful. Should I pay up?
A: I’ve broken more medical equipment during my career than I’d like to admit. If you use tools, they will get dinged and wear out.
Regarding your scaler snafu: While it’s true an employer can respectfully ask you to pay, by law it can’t force you to recompense unless it has proof that you willfully damaged something. So unless you intentionally or with extreme neglect wrecked the unit, I don’t believe you should pay. These situations might be uncomfortable for everyone involved but are normal (and expected) business expenses.
The first couple of years as a veterinarian or veterinary technician can be stressful enough without getting blamed unfairly for equipment wear and tear.
Q: My boss is trying a new schedule I don’t like. Citing staffing issues, she’s giving the veterinarians three nonconsecutive days off each week. For example, I work Monday and Tuesday, off Wednesday, work Thursday, off Friday, work Saturday and off Sunday. I feel more tired than ever, and I miss my full weekend break. Am I being a crybaby, or does this schedule stink?
A: I detect the scent of a suboptimal schedule. I’ve worked in veterinary practice for over 40 years, and the erratic hours, scarcity of time off, increased client demands and workplace tensions continue to escalate, leading to burnout and poor job satisfaction. As a practice owner, I learned quickly that our team performed best with at least two consecutive days off unless someone chose otherwise for some reason. We collaborated with everyone to create a synergistic schedule.
That’s the first point I’d like to make: It’s essential to work with employees on their workweek. I’m generally not a fan of unilateral decision-making, especially on issues as important and impactful as when you work.
Next, you owe it to your boss to discuss your concerns directly. Chances are she’s unaware of the problem. Sometimes, change only requires bringing it to someone’s attention. You’ll be a crybaby only if you delay and don’t talk through it.
Finally, be prepared to offer a solution and negotiate. Explain how your work and well-being would benefit from consecutive days off. If you can’t achieve your goals every week due to staffing challenges, prepare a contingency proposal, such as three or four successive days off every other week. After that, you’ll be smelling like a rose.