Q: I’ve always believed in allowing veterinarians to exercise their judgment. Lately, however, I’ve discovered that two of our younger doctors are not practicing to the standard I expect. I’ve heard you refer to using written treatment protocols in your practices. Any advice about adding standardized protocols to help with efficiency and consistency?
A: You discovered one of my favorite topics: clinical guardrails. I’ve found them to reduce errors of omission, remind me of tests or treatments I might have forgotten, and serve as a gentle teaching tool for young associates. I began creating checklists and general treatment outlines early in my career as a solo practitioner.
But let me explain a critical concept: I use checklists and protocols as suggestions and reminders, not directives and mandates. In other words, I allow my veterinarians to drive their cars however they choose, and I build railings so they don’t go off a cliff.
Over the years, I’ve heard grumblings that such guides don’t allow for autonomy. I suppose that depends on enforcement and culture. My associates always seemed to appreciate the ability to reference a standard to see whether their medical rationale was sound. Likewise, my support staff and clients praised the consistency and reliability of our advice and services.
Even better, associate veterinarians can double-check themselves privately without risking embarrassment or discomfort by asking a senior clinician for help. If they disagree or question a step or suggestion, they could confidently ask for clarification, particularly after having a chance to research and process. In addition, written protocols make uncomfortable conversations less personal when you can reference a written standard. The focus shifts from “Don’t tread on me!” to “Explain why you deviated from our protocol, and should we change it?”
Every clinic should provide clinical guidelines and checklists. Start with presurgical lists outlining all necessary steps before the induction of anesthetics. Next, create actions and standards for simple tasks such as surgical pack preparation, lab machine calibration and immunization appointments. Be as general or specific as you want, although the more details you provide, the more consistent your service is. The guidelines serve as a foundation for staff training and enable you to quickly and efficiently onboard new team members.
For veterinarians, begin with guidelines for the 10 most common diagnoses your clinic sees. Pull the data in your practice management software to ensure it reflects the reality of your daily schedules, not your favorite conditions. Make sure the lists mirror how your team practices, and accommodate personal preferences as much as the scientific evidence allows. Start with outlines, checklists or a format you feel comfortable with. Just start.
The effort is worth the investment. As you learn how your team uses the protocols, adjust, adapt and add to them. Over time, referring to guidelines becomes second nature. And that’s my final point: They’re available when needed. While your veterinarians are busy whizzing along the highway of patients, the protocols stand ready to nudge your doctors back onto the road.
Q: A few months ago, I hired a veterinarian who had excellent references and 18 years of experience. The problem is she takes too long during appointments, goes into too much detail with clients — many ask not to see her again — and our support staff is frustrated. We’ve discussed the issues numerous times and put them in writing. She admits a problem and promises to change, but nothing happens. She’s a good veterinarian, and we need her, but she’s hurting clinic morale. Can she be fixed?
A: Allow me to adapt one of my favorite quotes to your question: You can’t fix people unless they want to be fixed. I’d further elaborate that you can’t fix people unless they know they’re broken, have a correction plan and want to change. And then comes the hard part: doing the work required to change. That’s a lot of elements that must align to help your veterinarian. Yet I remain hopeful.
If you’ve followed me over the past three decades, you’ve heard me extol the benefits of structured team training (including for veterinarians) and videotaping the staff in action. As a result, I’ve engaged in more than my fair share of debates on:
- Privacy. (We’re videoing team members, not clients.)
- Ability. (Be quiet and let the footage do the talking.)
- Acceptance. (Let’s be honest, no one likes watching themselves on camera.)
Perhaps part of your veterinarian’s issue is that she conceptually understands her time management and communication challenges but doesn’t really know the details. That’s where study, role-playing and videotaping can help.
Start by providing her with books, articles, seminars or videos on professional communications. Next, role-play the appointment scenarios she struggles to manage. Finally, discreetly record her seeing patients and allow her to review the footage independently. Schedule a meeting to discuss her thoughts and ways to improve. Offer suggestions as appropriate and repeat until you achieve your desired outcome.
This approach is a lot of work for everyone. However, if you put in the time to help and she’s ready to work on change, the effort can be your wisest investment. If any of the elements are questionable, carefully reconsider them before proceeding. If you’re wondering, I always bet on people.
Q: You’ve mentioned daily meditation to reduce stress. I struggle to stick with meditation. Am I doing something wrong?
A: I’m a fan of the Om. Meditation is proven to reduce stress, control anxiety, improve sleep, enhance self-awareness and potentially lead to a more positive outlook. It also can be practiced by anyone, anywhere and at any chosen time. Unfortunately, many folks struggle at first, wondering if they’re doing it correctly, if they have the time, whether it will help, or even if it might conflict with certain personal beliefs. I’ll never forget talking to my late father about my choice not to eat animals and to take up meditation and drink alkalized water. He thought I had joined a cult. I replied, “The cult of good health.” He later joined, too.
The biggest obstacle to meditation is our mind. While the essential element of meditation seems simple — focus on the breath — blocking out the endless parade of intrusive thoughts is challenging. Many colleagues report they can only think, “This isn’t working,” the entire time they meditate. It takes time and practice to still your mind.
Start by following a guided meditation. Several free apps offer excellent reflections lasting five to 30 minutes. (Begin short.)
Next, track your progress. Set a daily reminder, and use apps to monitor completion. Like most habits, accountability is a driver of action, and knowing you need to “check a box” can help establish personal practices. For example, I typically start and end my day with a period of stillness.
Finally, don’t beat yourself over your technique. Meditation is 99% you and 1% method. You’re doing everything right if you do something to improve your mental and physical health.
I wish you more shanti!