Friday, July 25, 2014

Dear Pharmacists

It's no secret that we veterinarians are starting to interact with human pharmacies more and more.  We are MORE than willing to work with human pharmacists in order to find better pricing for our clients and patients to make sure that they get the proper care they need.

In fact, there is a sign on my wall telling my clients to please ask for a written Rx if they would like one.  I'm more than happy to oblige.

However, since Target and Wal-Mart and all those places now feel the need to "get in on the veterinary action" of selling drugs to our clients, allow me to put forth some suggestions for them to help... uh...  facilitate things.

1.)  Animals often require higher doses of many drugs than humans.  Please get used to this.  Because drugs have different pharmacokinetics in different species, and because you only learn about ONE species in pharmacy school, you're not aware of the doses used in our patients. Either go ahead and take a class in veterinary pharmacology, or get a formulary and use it EVERY TIME, but please for the love of all that is holy stop changing my drug doses while making snide remarks to the clients about how I don't know what I'm doing. If you're really concerned that I'm screwing up, go ahead and give me a call. I'll set you straight. But I'm not free to talk to pharmacists all day, so, you may be on hold for a while.

2.)  It is YOUR responsibility to learn the difference between the human world and the veterinary world, when it comes to sigs.  YOU must know that if I sign a DVM after my name and I put SID or whatthefuckever, YOU must know what that means.  Filling it wrong because you are ONLY trained in human medicine is unacceptable.  It is not my job to do your job for you. 

3.)  Please oh for the love of god teach yourself and your staff that 15 mg/5 ml is really the same as 3 mg/ml.   I do not have the time to sit there and explain this to you all every. single. time.

4.)  Please do not panic when I prescribe Alprazolam to my patients.  It really is effective for them.

5.)  Please also do not panic when I prescribe Trazadone to my patients, and especially do not tell my client "I can't give you that!  That vet doesn't know what she is talking about!  It's not USED for that!" until you've spoken to me and I've educated you on your own ignorance.

6.)  Please NEVER, EVER, substitute drugs.  EVER.  Yes I realize it can be done in the human world.  But remember, you are now in a world in which you were never trained, yet you are responsible!  So educate yourself about veterinary drugs OR DON'T SELL THEM OR FILL THE PRESCRIPTIONS IN ANY MANNER OTHER THAN HOW WE PRESCRIBE IT.  And, by the way, Tramadol is NOT a substitute for Trazodone. 

7.)  Stop questioning if I know what I am doing or not.  I do know what I am doing.  You do not know what I am doing.  See how this works?

8.)  Please stop asking for an NPI number.

9.)  No, not all insulin is the same.  No you may not send home a generic when I did not prescribe that.  See how this works?

10.)  The fact that I prescribed prednisolone to my feline patient means something.  It obviously means nothing to you because you keep sending home prednisone.  Please just follow directions.  It's really very easy.

11.)  Invest in a veterinary formulary.  PLEASE FOR THE LOVE OF GOD AGAIN, DO THIS.

12.)  Lastly, simply establish a relationship with us.  Respect us.  Treat us like doctors when we call and do not dismiss our questions for your pharmacy, such as how much something costs.  My clients will be paying you cash for those drugs, which is really really good for your business.  So stop busting my chops over it, realize we are colleagues and you better get used to having us around.

After all, it is your profession who asked for it.

An Interview with Dr. Sarah Boston

So after reviewing Lucky Dog written by Dr. Sarah Boston and really enjoying it, the VBB Collective decided to interview Dr. Boston and share it with our readers.  Let us know what you think! 

I have to tell you, among our group response to your book has been incredible. We love it! We love you! Thanks for writing it.

Thank you so much and thank you for the great review! I am so glad you liked the book. The support of the veterinary community for the book has been amazing!

We have some preliminary questions. I thought we could start with these and see where it goes.

1. Dr. Sarah, you seem to be someone who has maintained a positive outlook despite everything you've been through.  Have you ever experienced periods of compassion fatigue in your career?

I think that every veterinarian has experienced compassion fatigue. I do maintain a positive outlook and I tend to think that my baseline is happy, but I also think that being a veterinarian can be very challenging at times. I am hoping that Lucky Dog will shine some light on our profession and help people to understand what we do a little better and to take veterinary medicine more seriously. I am considering another book that will do this more deliberately and discuss some of the darker and harder aspects of this wonderful profession.

1.a. (If yes) how did you confront that? Or (if no) can you offer any suggestions to affected colleagues on how to handle that?

Even though I graduated in 1996, I think my strategies for dealing with compassion fatigue are still a work in progress. I actually had one of the most difficult cases of my career just a few months ago, and I definitely experienced compassion fatigue going through this. One of the benefits of being in academia is that we have breaks from clinical duty, which I think helps. I also think that setting boundaries with our clients is important. This would include boundaries with our time, availability, and also what we do for and with our clients.

2. Have you ever had a conversation with the author of Zoobiquity regarding human doctors learning from DVMs? That's assuming you have read the book. If not, you should! If you've read it but not spoken to the author - can you comment on your feelings about the "one medicine" concept?
I have not had a conversation with the author of Zoobiquity, but I am familiar with the book. One medicine is very important to me because I do clinical work and research in oncology. There is a lot to be gained on both sides through translational research and I am really happy to be a part of this. I am involved in a grant proposal right now that will fast track a promising treatment for liver cancer into dogs (through a clinical trial) and then hopefully back to people with this disease. When you work with a physician–scientist that really understands the benefits of collaborating with academic veterinarians, it is advantageous for all of our patients, not to mention exciting and fun. One thing we do need to be careful of as academic clinical veterinarians is that we do not turn into technicians for the physician-scientists. They need to understand that these are not lab animals, they are our patients and that they need to benefit from the work too. I personally have zero interest in doing research or testing treatments on healthy dogs. Where I get excited is when I can offer a novel therapy to a client and patient at a significantly decreased cost. In this scenario, everyone wins.

3.  Have you confronted any of your doctors who let you down?

I haven’t confronted any of my doctors. I was all geared up to do this when I met with my endocrinologist after I (finally) got my diagnosis. (I talk about this in the book.) He did let me down, but he was so genuinely shocked by the diagnosis, and such a nice person, that it was hard to confront him. Also, I think that in some ways it was the system that let me down, more than any individual doctor, so I guess in a way I am confronting the system through my writing.

4. Have these doctors read and/or discussed  the book with you?

I haven’t had this opportunity because I am not living in Canada right now. I did consider sending copies to my physicians, but I wasn’t sure how this would be received. (I still might, but the month since the release has been wonderfully frantic.) I am actually grateful to all of my doctors, despite how frustrated I was at the time. Ultimately, I did get good treatment and I am very likely cured of my thyroid cancer, so I feel a mixture of frustration and gratitude for the physicians that cared for me.

5. You talk about living with happiness, what formula have you found? Is it working for you? What would you advise other veterinarians regarding happiness?

I do try to check in with myself regularly and ask myself if I am happy. As a veterinarian, I try to do this every 6 months or so. That way, I am not reacting to the ups and downs of a particular day or week, but I can assess overall how things are going. I think that some jobs will take time to improve and maybe I have been to hasty to leave certain work situations in the past, but I also think you can’t wait forever for a job to make you happy. In the end, it is just a job and your health and happiness are more important than that. I allude to this in the book, but one of the reasons that I changed jobs and moved to UF is that I was experiencing bullying in the workplace. I tried several strategies to manage this, but ultimately, I decided that I needed to leave that work situation. As heartbroken as I was to leave Canada (still am) I think it was the right decision. My current work culture does not tolerate bullying or any aberrant work behavior and I feel protected there in a way I never did in my previous job.

6. Back to happiness--and managing anxiety--what is your best advice for managing anxiety? Would this have helped you through this time?

I have found a few strategies, but I think that the way to manage anxiety will be different for everyone. Some of the reason that I started writing (before I knew I was writing a book) was to help manage the anxiety. I was trying to channel the anxiety and frustation into humor. Humor has always been a big part of my life, not just to manage anxiety, but it is a way of being for me. I like laughing and making people laugh.

This will sound clichéd, but yoga was also a big part of my anxiety management during my treatment. It was a great way to turn everything off for an hour and to be physically active. I would recommend it to anyone, but you need to find what works for you as far as an outlet for anxiety.

I also think that as a profession, we need to find strategies for preventing our anxiety. We are all perfectionists and we are all very hard on ourselves as a profession. I think that setting boundaries with clients and not being so hard on ourselves helps. I also think that as a profession, we need to be supportive of each other. There is no one else who really understands what we do. I spent three years in general practice before my surgery residency and it has really helped me as a faculty member and as a specialist when I work with our veterinary students and referring veterinarians. I don’t think that there is a more difficult job in the world than being a small animal general practitioner.

6. Any word from Ellen DeGeneres??
Not yet, but if you talk to her can you let her know that Rumble and I would love to meet her! I realize this may sound insane and every author says this, but I really do believe she would love the book!