Yay! My Dog Doesn't Have Cancer! Now Give Me My Money Back.

There has been much talk on here about how clients could be better clients if only they... <fill in the blank>

Well, here's one.  How about if, when you bring your dog in for a wound that is necrotic and stinks so bad you can smell it from across the room, and we recommend debridement and closure and oh, I dunno...  maybe suggest a biopsy of the tissue because you aren't quite sure how long it's been there...  and we want to make sure it's not a cancerous lesion...

When we call you with the good news that it's not  cancer and the wound should heal with no complications...

How about if you  don't get all pissy with us, accuse us of stealing your money and making frivolous recommendations and instead...  just say thank you for making sure my dog doesn't have cancer.  I feel so much better now!

There's a novel idea.

In which we look like idiots for no good reason.

A friendly and collegial veterinarian from a local specialty/ER vet hospital left us a voicemail regarding our mutual patient who apparently "stopped by last night" and "was found to be in congestive heart failure, which was a big surprise to the owner. I'll be in first thing tomorrow so feel free to call me to discuss this, or I will try to call you before I head home," she said on our voicemail.

So I looked up our records on this pet....and found that at her last visit, she had come in as an emergency to our appointment-only day practice, and informed us she had been dry heaving earlier in the day, and subsequently developed difficulty breathing. She wasn't in any particular distress at that moment, but we worked her in and saw her. 

The physical exam findings were very concerning. The dog had a grade IV/V systolic murmur, focused over the mitral valve area, and bilateral crackles were noted during auscultation of the lungs. She was breathing rapidly but did not seem particularly distressed. She had lost about 15% of her body weight since her last visit three months previously, without having been placed on a reducing diet. 

Our chest radiographs revealed an enlarged heart with an alveolar pattern present in the perihilar area right dorsolateral lung fields.

The owner was informed that we strongly suspected this dog was in congestive heart failure and that we would like to arrange for a consult with a cardiologist, an echocardiogram, or if the owner would prefer not to seek specialty care, we could initiate treatment after just a few more tests done in our hospital (we wanted to get an ECG, and some basic bloodwork).

The owner elected to take the dog home without additional testing at that time, telling us she needed to think about it seriously and decide what to do and how to budget for it. We explained that it would be ok to at least start some treatment without additional testing if there was a big money concern, just to try to make the dog feel better, but she chose to go home and promised to call back on Monday (this happened on a Friday). We gave her the emergency clinic phone number handout we have on hand for this type of situation and wished her well.

When we didn't hear from her that Monday we left her a voicemail. We left another one several days later, too. When we didn't hear back we wondered if perhaps the pet had died suddenly, and were very concerned for the next week, wondering if we could have helped more.

Then, about three weeks after the appointment here - the voicemail came, the voicemail in which the specialist cheerfully describes how our client went over there completely "unaware" that her dog was in heart failure despite having "just been in to see the regular vet, who didn't know what was wrong."

It is this type of scenario that keeps the bourbon people in business, is all I can say. I know the specialist probably realizes that clients aren't always telling the whole truth, and not all referring vets are morons -- but it is hard to hear this kind of thing anyway, and I do worry about being perceived as an incompetent moron by the specialists in these situations.

Threats and shenanigans

It's been so bitterly cold across most of America lately - in an effort to stay warm, I have been thinking about summertime. When I think about summertime, I start off with images of sandy beaches and umbrella drinks - and usually end up with images of heatstroke and DIC. So, this story came to mind today. Enjoy!

A stray dog was brought to VBB Central once by a Good Samaritan. A real Good Samaritan - the kind who takes financial responsibility for the situation, not the kind who simply moves the problem from his lap to your lap. Anyway. He'd found this dog roaming his neighborhood and he thought it would be a good idea to bring it to us, because it had been outside for so long, he considered it a stray. He asked us to examine it and get it up to date on vaccines. He wanted to adopt it if possible. 

When we examine stray pets, we scan for a microchip, to see if possibly there is an owner somewhere looking for the animal. In this case, we found a chip, and were able to reach the owner - who told our receptionist that while he was unable to leave work at that time to pick up her pet, he would be happy to come get him in the morning. Okey-dokey. The Good Sam paid our bill for the care up to that point and went home, and the dog got put into the boarding kennel for the night. 

The next day, the owner came in to pick up the dog. When presented for the bill for the dog's overnight care (a whopping $23 boarding fee) he went ballistic. In the course of his ranting he expressed the belief that he had expected the care to be free, because it wasn't his choice to bring us the dog. Also, the dog should have been taken to the tax-funded shelter (there isn't one in his township, nor ours for that matter, but this fact was lost on him), and we were insane to expect him to pay. OK then.

So, Dr. VBB attempted to defuse the situation by telling Mr. Deadbeat to just take the dog and go home, and that instead of attempting to collect the boarding fee from him, VBB Central would report the stray dog situation to the township, and the township would handle it from there (historically this means that the township will assess a very large fine from the pet owner - and btw, this dog was not licensed, either, which is another fee). The man continued screaming. It got to the point where clients in the exam rooms with the other veterinarians were becoming fearful for their safety. One client asked "um, how well do you know that guy? are you sure he doesn't have a gun or anything?" At that point Dr. VBB, realizing that Mr. Deadbeat clearly has no intention of leaving, calmly said "if you'd rather stay here and yell instead of taking your dog and going home, I'm going to have to call the police and ask them to escort you off of our property. You are interfering with our business."

The man gets even MORE incensed. He is now asking Dr. VBB for her name, license number, social security number, all kinds of identifying information. He says he is going to "report [her] on the website" and she will lose her license, "why you say call police, you cabeza de mierda, you hate Hispanics, you want la migra send me home? you think I'm illegal? twenty years I'm American citizen! I'll take your license, pendeja!" But when Dr. VBB attempted to respond, the man just kept yelling and screaming over him. The man also refused to accept Dr. VBB's business card, which she offered to him so that he would spell her name correctly when he reported her to the board, of course...

This was going on for at least half an hour. Finally the man and dog went out to his car, and the staff at VBB Central watched warily from the window. That's when we saw the man put the dog into the trunk of his car! Bear in mind it was about 97 F at the time, too - and that car had been out there for at least an hour in the sun at this point. So against her best judgement as far as resolving this situation went, Dr. VBB went back outside and said "please do not do that, it is very dangerous for your dog." So of course he started in again "who do you think you are? you OBSERVE ME? you ain't allowed to observe ME! I'll have your license, pendeja!!" But luckily, while continuing to rant and rave, the man put the dog in the back seat, got in the car, and drove away.

It really kind of ruined that whole weekend at VBB Central though.

Happy New Year's Eve!

December 27, 2011. 

The day VBB was born!  Since then we've gone through many authors, many discussions, many fights and many tears.  Friendships formed and friendships failed.  Those of us in the VBB Core Group had no idea this would strike so many nerves and be so popular.  We feel we serve a very important function which is to give a voice to the profession unlike anyone else.  True, others try to copy (poorly) what we are doing, but at the end of the day what makes this blog a success are the READERS who keep the momentum moving forward.  There should be no sugar coating of what's really going on in the profession and we still feel at VBB that telling the truth from many different viewpoints is what sets this blog apart.

We are getting close to TWO MILLION VIEWS!  Please share our blog, send in your stories, and SHARE WITH US what your day is like, what your life is like, what makes you happy, what makes you sad...  we LOVE sharing the stories sent in to us and want this to be a blog with many participants.   Bring it on, readers! 

So here's a big fat HAPPY NEW YEAR to everyone who reads VBB, follows VBB, follows our tweets, argues with us, insults us, agrees with us.  Speaking your mind is what makes it all so great!

We hope everyone has hope on the horizon and happiness in their hearts and all of that bullsh*t we say to ourselves on New Year's Eve.  Except we mean it.  Sort of.   :)

HERE'S TO A NEW YEAR!!!

The Disconnect Has Been Duly Noted

    Greetings from the Midwest branch of the VBB Animal Hospital.  As the New Year approaches, we often take stock of our lives, our livelihoods, and we look for areas to change and improve. That is actually what I have been doing for the past year. Professionally, I have grown cagey and anxious. I am worried about the attacks on my profession, and I have had a growing dissatisfaction with the public. When you get right down to it, there are just more bad days than good ones.

    Because of this, I have started to explore what I can do with my hard earned veterinary degree, OTHER than seeing patients and clients all day. In order to begin to make a career change I have explored positions in both academia and the animal health industry. Surprisingly, what I have learned is that the institutions that produce veterinarians, and the industry that makes medications and products for our use actually have no idea what it is that we actually DO all day.

    After a couple of days of interviewing for a position at one of our nation’s veterinary colleges, I learned that they are extremely hopeful about the future of veterinary medicine and they see a positive, if not completely idyllic future for their graduates. I expressed concern that class sizes are increasing, student debt is rising, graduates cannot find jobs to pay off their loans, and the public is becoming more and more hesitant to spend their money on their pets’ health care needs. Not so according to the universities!!!! Class sizes are increasing because that is in their budget! The increase in tuition adds to hiring additional faculty. More papers are written, more specialists are produced and everyone is happy.  If they are not producing specialists, they can certainly produce general practitioners who will find wonderful, well paid, fulfilling jobs where the public will flock to them with all of their concerns for their well loved and well cared for pets. I was assured that “Things will turn around - You just wait!”  Now, these people with careers in academia are surely much smarter than me, yet I remain skeptical.

    I have also interviewed for a position with a large animal health company.  During a long day of interviews and meeting a variety of people, I was asked questions similar to the following:

Them: “Do you get stressed out having to meet deadlines?”
Me: “uh, no, not really. I have to meet 20-40 urgent deadlines every day”
Them: “Do you have a hard time making decisions?”
Me: “No. I can make decisions quickly. I rarely have owners who allow me to have enough information to make an informed decision, however. It would be like heaven to actually have a fairly full picture prior to having to made decisions regarding treatment plans, recommendations, and euthanasia.”
Them: “You have a very active job currently. How would you transition to sitting at a desk most of the day?
Me: “Are you kidding me?! That would be fabulous!!!! I’m so exhausted by the end of my day that I can barely lift the wine glass to my lips!!!” Well, ok, that wasn’t really my answer, but I think you get the point.

    These experiences have made me realize that there is HUGE disconnect in this profession. The institutions that produce us, and the companies that sell products to us actually have little idea what our day-to-day existence is like. I think they would like to believe that we play with healthy puppy and kittens all day, with appreciative owners who trust us and follow our advice. If this were true, I don’t think we would have the highest suicide rate of any profession. Currently, I feel like I exist in a very shaky house of cards, built on a pyramid scheme.

    So, I go back to doing what I do and try to find joy in it. I look for the things that make me happy, and help me to make a difference to someone. Because occasionally there is that ONE pet, with that ONE owner, who wants to work with me as a partner to ensure that their pet gets the best healthcare possible. And THAT? Well. THAT is nirvana.

Another Guest Post about a Unique Client

Wow there are so many great stories to tell!  You guys keep sending them in for sharing!

Another heartfelt guest post sent in to VBB about an unusual client:



He smells.   I don't think he ever takes a shower.  He's over six feet tall.  He comes in with his shirt halfway buttoned in clothes that never see a washer.  He's missing half of his teeth so when he talks, it's nearly impossible to understand what he's saying.  He spits on me when he talks.  

He's rude, loud, obnoxious and to be quite honest, pretty darned nasty and gross.  Definitely one of those "why I'm a veterinarian and not an MD" types of people.

He lives somewhere deep in the woods and has no running water and no electricity. He always just walks in without an appointment when I'm on my lunch break, making me miss lunch.   He has no way of calling ahead because he has no phone.  In order to get to our hospital, he borrows a ride from a neighbor because he has no car.

But boy does he love his dogs.

When I first met him, I immediately wanted to fire him as a client.  I didn't want to deal with this human.  He was rude to me, disrespectful, said fuck about a hundred times and he made the entire exam room stink. I had to change my labcoat when I left the room because just being in the same vicinity as him made ME stink as well.

But then one day something happened that stole my heart. He brought in one of his many little dogs (he probably has more than 25 dogs) and sat out on the grass, rolling around with that little dog, talking baby talk to it.   It was precious and heartbreaking and funny and sad all at the same time.  


It gave me a different perspective of him.  When that little dog needed surgery for its injured leg, he pulled out the biggest wad of cash I'd ever seen.  He didn't spend his money on frivolous things like electricity and running water.  He spent it on his dogs.

That day, after an especially frustrating conversation with him,  I was ready to walk out of the room. Right about that time he saw the picture I have of my own dog on the wall.   He immediately softened his voice and started talking baby talk again, saying, "Oh, is that your little doggy???" 

I have to say it did more to soften my mood that day than any other thing that happened. 

I reconsidered firing him as a client for no reason other than I was touched by how much he loves his animals. It's just a special thing to see another human express their love and emotion that way, when you know they have no ability to express it otherwise.

Then one day another thought occurred to me: if I didn't see him as a client, where else would he get any care for his pets? How does a person like that just walk into your average place of business and get service? People shun him; people avoid him; people are disgusted by him.  


He even told me that the people at the bank were mean to him and made fun of him.  He shared that with me.


But he loves his dogs.  And that's what mattered to me.

So we'll keep him as our client and try to understand and try not to judge and remember that we work hard so we don't walk in his shoes.  I'll keep doing whatever I can to help him.  I let him run a balance cause I know he'll pay me eventually, I send meds for dogs I haven't seen and I accommodate him whenever he shows up unexpectedly.  I take risks for him because he needs it.

Because the most important thing for me is that he loves his dogs.

What Now? A guest post....

One of our gentle readers, Dr. PN, has requested we share this entry with you. He loves his job, but hates the associated crap. He's wondering what to do now, so if you have any advice for him, let's hear it!

So what now?

I’m lost.  Not in a wandering around the forest kind of lost.  But lost in the sense that I’m not sure which direction to take next.  How can a guy with an Audi R8 be lost you ask?  Well it starts with many realizations I’ve had over the past year, a year that has been hard on me, but not for the reasons you might think.  Here’s some background…

Where to begin?  With that question most of you are probably closing this post right now, realizing that this could be a long post.  And it could be, because those who know me know I like to chat.  This year started quietly, which is what I wanted.  I had just sold my third veterinary hospital, sold my acreage I’d developed last year, and moved onto another property which I finished developing by Christmas.  Well that all sounds great, a new property, a bunch of money in the bank, a fancy car in the garage, and all the time off I could ever dream of.  Dream is the right word, because for most people that is the dream, and that was true for me as well.  I had busted my ass for the past 13 years, founding, designing/building and working at my three veterinary hospitals, running a veterinary equipment import business, developing five acreage properties, as well as some other side gigs to keep things interesting!  So why then was I not bouncing off the walls happy?  Purpose.  Or lack of it, that’s why.  

All my life I watched family and friends struggle to make ends meet because they didn’t have enough money, and that of course continues today all over North America.  I decided long ago that I wasn’t going to rely on anyone or any government to take care of me, that I would be successful and make it on my own.  And after 13 years of non-stop work I could’ve basically retired and lived a decent life, but suddenly I didn’t care about that.  Wow, talk about a kick in the teeth.  To set huge goals, accomplish them, then realize that wasn’t what made you tick, made you happy, made you want to get out of bed in the morning.  Fast forward ten months, where am I at now?  I’m frustrated, plain and simple.  You see the reason I sold my last vet practice is because I was burnt out.  My profession now has the highest rates of suicide and burnout of any profession.  Search veterinary burnout or compassion fatigue and you’ll understand.  Thing is, I’ve always been a ‘rock’, unbreakable, able to deal with anything.  Nothing stands in the way if I want to accomplish something.  But realizing I wasn’t doing myself or my practice any good, I sold it.  Somedays I regret selling it, other days I know it was the right choice.  I feel guilty for leaving the profession I used to love, and that gave me financial freedom.  Now I have an opportunity to build another practice but struggle to decide whether or not to do it.  It’s what has given me all the ‘material’ things like a nice house/car, it’s what gave me alot of pride and purpose in helping animals, and it’s what allows me to be respected in the community.  I went into veterinary medicine to help animals, plain and simple.  I never went into it for money, I knew there were many other professions where I could make much more money, but I’ve always loved animals, and medicine, so vet medicine was the clear choice.  What I didn’t expect was to be able to channel my entrepreneurial spirit into three veterinary hospitals that grew to be very successful.  That was a bonus!  Along with that success came incredibly long hours, no vacations, and s.t.r.e.s.s., lots of it.  So yes it’s no surprise I got burnt out.  

In the past year I’ve tried to think of what else I could do, not being burdened by financial worries allows one to contemplate doing anything they really want to do.  And yet I’m stuck.  I remember all the good days I had working in my clinics, and all the great animals and owners I had the pleasure of meeting and helping.  I think some people are lucky to find what are they are ‘supposed to do’, and I’m one of those people.  It’s just that our profession has changed so much over the past decade, it’s become very, very demanding.  And yes I’ve taken on alot of extra stress, and that is my own doing, lesson learned.  Can I start my 4th vet practice, but do it in a way that I can get back to enjoying my profession?  I think so.  At least I hope so.