“Can I just hit my head against the wall for an hour and bill him for the time?” I once asked my boss. “It’ll do just as much good.”
Our office manager had just booked me for a ranch call to a dairy where calves were dying from diarrhea. The dairy owner was...well, not a nice man, but once he got past his disgust at being sent the “girl vet” (it only took a few years), he and I had developed a mutual respect that had morphed from grudging to amiable. I’d even managed to convince him to scooch past “We’ve always done it this way” into the very edges of modern livestock husbandry. But I was pretty sure that the degree of diagnostics and management changes required to get a handle on the calf issue was going to push both of us into territory best covered by TV crime dramas.
Of course billing a client for self-induced cranial trauma is neither a viable business model (though there may be people who would pay to see me hit my head) nor in keeping with the better principles of veterinary medicine. But there are moments...
Even though it’s nice to think that the veterinarian could wave a magic wand and diagnose and cure an animal in one swoop, in reality medicine is a team sport. If one member of the team doesn’t engage, the game tends to fall apart.
Head vs. wall moments for veterinarians include episodes like this.
“He didn’t like the special food you recommended for his allergies, but he’ll eat it fine if we mix in a can of El-cheapo dog munchies. I don’t think that expensive food worked anyway; he’s still itching.”
“She was feeling better and getting hard to give the antibiotics to, so we figured she didn’t need them anymore. But now she’s acting sick again.”
“You didn’t do a very good job on that surgery; all her stitches came out. What? The e-collar? Oh she hated that, so we took it off as soon as we got home. Poor thing, she just looked so sad.”
A successfully managed case flows something like this:
- Owner notices X signs in animal and promptly calls veterinary clinic.
- Veterinarian asks owner about the animal’s history and signs and examines the animal.
- Veterinarian gives owner a list of suspected issues and recommendations for diagnostics to narrow down the list.
- Owner okays or declines the tests.
- Veterinarian revises plan depending on owner’s permission and proceeds with testing.
- Veterinarian makes diagnosis based on available information, and recommends ideal treatment.
- Owner chooses treatment plan based on family’s needs and capabilities.
- Veterinarian discharges animal with appropriate medications and recommendations for feeding, confinement, recheck, etc.
- Owner gives all of the medication exactly as directed, feeds the animal ONLY the recommended diet, confines or exercises the animal exactly as recommended, and watches for any of the signs the veterinarian may have warned about.
- Animal gets better and everyone throws a great party. With ice cream.
In order to follow the yellow brick trail to the party hats and sundaes, there are some steps everyone can take.
- Explain what each test or procedure is likely to accomplish and why it is important.
- Explain that a negative test result isn’t without value.
- Listen to the client’s concerns and questions.
- Ask questions regarding the client’s understanding of the plan and ability to implement.
- Provide clearly written discharge instructions.
- Call or email the client a day or two after the patient goes home to see if there are any questions and to check on the patient’s status.
- Listen to all of the recommendations.
- Ask questions.
- Listen to the answers.
- Ask more questions.
- Be up-front with the veterinarian about which tests and treatments fall within the family’s budget and capabilities.
- Give all of the medication.
- Follow all of the housing and feeding recommendations exactly.
- Contact the veterinarian immediately if anything seems off.
Save a wall. Follow the path to ice cream.