Wednesday, August 15, 2012

In which I *obviously* don't know what I'm talking about.

(ring, ring)
Client: Hello?
Me: Hello, this is Dr. VBB calling, am I speaking with Mr or Ms Message-leaver?
Client: This is Dr. Message-leaver, who are you and why are you calling?
Me: This is Dr. VBB from VBB Animal Hospital, returning your call about Fluffy. What can I do for you?
Client: My wife must have called you. Hold on.
Me: (holds on)
Me: (plays a turn in Words with Friends)
Me: (signs a few faxes & puts them in the outbox)
Me: (plays another turn in Words with Friends)
Me: (changes my Facebook status)
Me: (puts line on hold, releases a barbaric yawp, picks up line again)
Me: (plays another turn in Words with Friends)
Client's wife: Hello? Who's calling please?
Me: Hi, this is Dr. VBB returning your call about Fluffy. What can I do for you?
Client's wife: Oh. I wanted you to talk with my husband, the doctor. He says you don't know what you're talking about.
Me: Excuse me?
Client's wife: He read the label on that medicine you prescribed and it says it is approved for use in dogs. Doctor, I don't know much about this but I know Fluffy is a cat and not a dog.
Me: Yes. Of course. As I explained in your take-home instruction sheet, we are using that medicine in an extra-label fashion. That means that it isn't approved for this particular use, but that's ok. I'm within my prescribing authority to use it, as long as I've explained to you the potential down-side, and why we are using it, and I believe it is appropriate and you agree the benefit outweighs the potential risk. You said you understood this.
Client's wife: well, my husband says you don't know what you're talking about. Here, talk to him.
Client: Hello? What's going on?
Me: (sigh) your wife says you have a concern about Fluffy's prescription.
Client: What are you talking about?
Me: Gosh, well - I guess that depends who you ask. Your wife tells me you think I don't know what I'm talking about. That's what I'm talking about. Did you have any questions or concerns about Fluffy's prescription?
Client: No.
Me: Well, ok then. If that's all, I'll let you go. Have a nice-
Client: wait a minute. Are you the one that sent home the dog medicine for our cat?
Me: yes.
Client: Why would you do that?
Me: I'm using it in an extralabel fashion because there is no approved cat medicine for Fluffy's condition. 
Client: Well I'd prefer you used cat medicine.
Me: Sir, there-
Client: I'm Dr, not Sir.
Me: Excuse me. Dr Message-Leaver, there is no medicine approved to treat Fluffy's condition in cats.
Client: I don't believe that for a minute.
Me: Well, it's true.
Client: why would that be true? Do cats even get this disease? if they did, there would be medicine for it. At least some kind of clinical trial.
Me: The thing is, most drug companies aren't interested in going to the expense of obtaining approval for drugs when the market is going to be really small, and the profit very low. In human medicine I believe they call them "orphan drugs," right? But I've read a lot of studies about the use of this drug in cats and talked to some experts and I think it's fine. It's not like there is anything approved for use in cats that would be helpful here.
Client: you think it's fine? why should that mean anything to me? Who the hell are you?
Me: I'm Dr. VBB and I'm Fluffy's doctor, unless you'd like me to send Fluffy's records elsewhere. Would you prefer to seek Fluffy's care elsewhere?
Client: (silent)
Me: (plays a turn in Words with Friends)
Me: Hello?
Me: Dr. Message-Leaver? 
Client: I still think you don't know what you're talking about. (hangs up)


  1. Have you not learned the lesson that MDs are more knowledgeable in all areas than anyone else, regardless of credentials? How have you not learned this? (sarcasm font) You should listen to him & not ask questions. He is a doctor, and no one else has the right to that title, regardless of credentials. Oh, and stay off the internet. Only doctors know what's real. How have you not learned this? (serious sarcasm font)

  2. I love messing with MDs. I've taught enough of them that I have little fear or respect for the majority of what I've encountered, especially since I have a chronic condition that is congenital and can't be fixed; just treated. They'll be damned if I'm not going into that MRI tube again, though!

  3. I can imagine this conversation occurring with a human pharmacist too. BTDT. sigh.

  4. MDs and RNs tend to be the worst culprits. They self-medicate and treat their animals like little humans without consulting us first. I almost had a dog die because his RN owner didn't want to come to her vet once and self-medicated his pain with a buttload of Naproxen. A couple thousand dollars in diuresis and supportive care later, he was OK, but geesh, I don't even try to understand everything about human medicine...

  5. Bet you he is actually a PhD in philosophy...

  6. You're a saint. I'd have ripped him a new one. And what CCL said. If you have to TELL me repeatedly that you're a doctor I'm gonna take that to mean that *you* are the one we always speak about graduating last in your class...

  7. Some folks have no concept of the quality creative malpractice we can supply when the legitimate drugs or techniques can't apply. Invent something! Solve the problem. It's called innovation, folks.

  8. "Dr." is generic. He could be a lawyer (technically a J.D., though few of them use it) Psychologist, orthodontist, Mycologist. etc.

    None of which changes the fact that he's an ass. This is the point in the conversation that I say "Well, since you feel so strongly about this, perhaps it would be best for you to seek care from another neurologist."

  9. I love it when jerky clients fire themselves. Even if it takes me helping them along a little.

  10. I had an emergency room MD once suture up a 12" long, heavily contaminated, abdominal laceration (skin only) on his AWAKE cat, b/c he didn't know that animal ERs existed in chicago....GRRRRRRRRRRRR!!!!!!