Veterinary Wisdom® Café

Eye Contact Or Computer Screens?

One of the newest rages in Vet Medicine are EVMR's (electronic veterinary medical records). Just as in human medicine, many veterinarians are using this technology in caring for patients. EVMR's offer the general practitioner a wealth of easy accessible information. There's no flipping through charts, or trying to read an illegible note or lab report. Digital images also allow for better and more precise x-rays.

The downside of all this? It's easy to get lost in the new technology and forget about the most important thing of all...the client and the patient. I've heard about many pet hospitals who struggle with keeping their services "personal" while implementing more advanced record keeping. For example, EVMR takes some of the doctor's eye contact away (to look at the laptop computer). In fact, a study done in human medicine found that 62% of respondents mentioned loss of eye contact as a concern and a barrier to use. (Banfield, Vol. 5, number 6).

For me, I embrace new technology and all the bells and whistles that accompany AS LONG AS the interpersonal communication remains the same! Making a connection with a client is critical for developing trust whether or not there is advanced technology. Things like open body language, eye contact, and interpersonal warmth must always exist in good working relationships.

Have any of you experienced some problems with your veterinarian after implementing new technology? I'm curious as to your thoughts and ideas.

--Dana

Doctors In Dangerous Waters

In October, I presented six lectures at the Wild West Veterinary Conference in Reno, Nevada (WWVC).   I was more than a bit tired after coming home but that conference has made me realize that the field of veterinary medicine faces a very real threat. As usual, I presented material to help veterinary professionals communicate more effectively with their clients in order to promotes client loyalty. The audiences were terrific and quite enthusiastic but I was stunned to see how many veterinary professionals wanted help with taking care of themselves as well as their clients.

My lecture covered the topic of compassion fatigue (a deep physical, emotional, and spiritual exhaustion accompanied by acute emotional pain). Compassion fatigue was originally thought to be a condition that afflicts disaster relief workers, fire fighters, paramedics, etc). In the past 10 years, more and more people are realizing that this type of professional burn-out can affect anyone who works in a "helping" profession. In the medical field, human doctors were the first ones identified as vulnerable but in the past few years, consultants, counselors and managers are addressing compassion fatigue in veterinary medicine as well.

The veterinary profession is a highly stressful. There's a a great deal of animal sickness, injuries, and heartbreaking stories. Workers in veterinary medicine witness death death five times more frequently that their counterparts in human medicine. That's a whole bunch of death and stress. Additionally, since euthanasia is acceptable and practiced routinely in vet medicine, these professionals are the ones who actually facilitate their own patients' deaths (obviously done to prevent needless suffering). Ultimately, no matter what the intent is behind it, it's still the purposeful act of taking a life. Doing this and also supporting grieving pet owners can take it's toll over time.

Ways to prevent and deal with compassion fatigue in medicine are still being developed so many professionals out there are in quite a bit of distress. I worry about these folks and hope that they can learn new self-care skills to make their stress a bit easier to bear. I'm curious as to what you all think (pet owners and veterinary professional alike). Do you see this problem in your own lives or in others in the "helping" professions? If so, what do you think should be done to help deal with it? (photo from Dreamstime.com)

--Dana

Close Encounters of The Cat Kind

This past week-end in Denver I lectured to a group of feline practitioners at their annual society meeting (AAFP). It was a fun time, a bit unusual, and a valuable learning experience. It was also the first time that I had ever lectured to veterinarians who work exclusively with cats.

The AAFP is committed to improving the lives of all domestic cats. They support cat advocacy programs and provide advanced medical continuing education for feline doctors. There are those in veterinary medicine who feel that cats are a bit under served when compared to dogs. While it's true that more people own dogs than cats, it's still very important for cat owners to have access to quality medical care.

As I spent time with this group, I started to realize that cat owners deal with some unique emotional issues. As we all know, cats and dogs are quite different as are some of their medical needs. Cats in general, tend to be more stoic than dogs. I've blogged about this stoicism before... but it bears repeating because many cat owners have a hard time knowing when their cat is in any pain. If owners  cannot know for sure, there's always the potential for them to miss a serious illness or problem. This can translate into an immense amount of guilt when their cat dies.

Cats also also tend to have longer life spans that dogs (some live well past 15-16 years and a select few can live into their 20's!)" These longer life spans can create tremendously strong bonds as a person can literally "grow-up" with their cat. When people have relationships with their cats dating all the way back to  childhood, their grief can feel quite overwhelming (they are not only grieving the cat's death, but they are grieving the end of an era as well).

What are some other emotions experienced by cat owners? Do you feel that any of these are quite different than for dog owners? I want to hear from all our cat lovers out there! (photo is of Tammy's cat Henry)

--Dana

A New Type Of Crash Cart?

An article in the October 2009 edition of Veterinary Practice News explores the problems associated with veterinary hospitals that are unprepared for medical emergencies. The thought is that developing and keeping a well-stocked and organized crash cart would create less chaos and make a difference in saving a life. To quote the article, "when emergency medicine isn't a daily routine readiness can lag. In the moment of need, technicians rush to find the appropriate drugs and equipment instead of reaching for it in it's designed space. This reduces the likelihood of a successful recovery."

It occurred to me that veterinary hospitals could also benefit from having an "emotional crash cart." These would be protocols, materials, and other procedures in place to help support the emotional needs of clients during these critical times. Obviously, medical intervention is paramount, but it is also important for the staff to know how to effectively support clients in these unexpected times

I would imagine that many emergency hospitals already have something like this since they see medical crises on a daily basis. How about your average general practitioner? It seems to be an excellent idea to me. I think I'll start developing a formal emotional crash cart for our hospital...what kinds of things should I include to help a pet owner in crisis? I welcome your ideas!

--Dana

Let's Hear It For The Nurse!

The September/October issue of Trends Magazine has an interesting article about veterinary as technicians (at our hospital we call them nurses) and how they are under-utilized. Overall, it seems that they are not doing many of the tasks that certified nurses are specifically trained to do. However, with the emergence of larger veterinary hospitals, things are changing. The nurses are no longer limited to just holding patients, drawing blood, and filling prescriptions. In fact, they are starting to take on similar roles much like nurses in human hospitals. This means that they can monitor a patient's condition, summarize intake findings, and carry out treatment protocols that the doctor prescribes.

When nurses take on more tasks and responsibilities, the hospital benefits by saving money (the nurses are doing tasks that are often done by higher-paid veterinarians and the doctors have more time to do things that only a doctor can do ( such as diagnosing a medical problem or performing surgery.) To quote certified nurse, Elise Atkinson at Alameda East Animal Hospital..."we want responsibility , and above all, we want doctors to have faith in us."

At our hospital, we try very hard to utilize our nurses effectively. We even have what we call "nurse-only appointments" (they involve things like vaccinations, wound checks, and removal of stitches). By utilizing our nurses more effectively, they also seems to have more job satisfaction because they are being challenged more. It's a win-win situation across the board.

As pet parents, what do you all think? How do you view the veterinary nurses who work with your veterinarian? What kind of experiences have you had and do you think they are under-utilized? All you nurses out there...please feel free to chime in! (photo from bigstockphoto.com)

--Dana

"Dr." Groomer

Let me start out right now telling you that groomers as a whole, are terrific people and work hard at what they do. They care about their clients and their pets. However, we occasionally have difficult days when a groomer has "diagnosed" a problem with a pet and the owner comes in telling us what treatment must be done.

Groomers, animal behaviorists, trainers, and animal care specialists certainly have experience working with animals and have knowledge that exceeds the average person. They can alert an owner about a change in their animal's coat or other problems. But...it is a bad situation when a client comes to us saying that the groomer has decided her dog has cardiac problems (this happened just last week). ???? How would the groomer come by that conclusion? That's a pretty bold statement and seems out of bounds to me. What's worse is that the client often believes the groomer even to the point where they argue with the veterinarian about the diagnosis. I'm sorry, but this makes about enough sense as it does for me to consult my hairstylist about my cancer treatment. It just seems weird but it happens more frequently than you think.

Because owners are loyal to their groomers, it can be very difficult to convince clients that their groomer is incorrect about advice they've given (especially with dermatological problems). It's also frustrating because the pet is the one who suffers the most. It would be so much easier and save a lot of time and heartache if groomers refrained from diagnosing medical problems all together.

Opinions everyone...what are your thoughts about this? If there are any professional groomers or animal care specialists out there to lend us your opinions? I welcome your ideas and feedback! (photo from bigstockphoto.com)

--Dana

"Soft Skills" Deluxe

Here at the café we often talk about the importance of effective communication in the veterinary profession. In the past 20 years, there's been an impressive "communication movement" that has allowed many more veterinary schools to improve their training and many veterinary organizations are offering more continuing education about these issues. While many veterinary schools and professional organizations are addressing this need, there is still much work to be done.

The September 8, 2009 on-line issue of Exceptional Veterinary Team magazine (myEVT) contains an article discussing this very problem. In the article: "Veterinary School: What They Don't Teach;" Dr. D. shares her frustration about having limited training in this area and how she felt unprepared to deal with her clients emotions in her first job out of school. The author states, "although I was confident in my medical skills, the way the client's tear-filled eyes locked onto mine as I explained the effects of snake bites made me more than a bit nervous...after all, veterinary school taught me how to treat an injury but not how to deal with distraught pet owners."

It's true that many more veterinary schools today are changing and adapting their curriculum to help students learn communication skills. It's also true, however, that there are some schools that still provide no training at all. The financial pressures Universities face in today's economy are just as intense as the pressures in many other institutions and businesses. It can be hard for them to find adequate resources to provide training with Dr. D. calls the "soft skills." When push comes to shove, they feel that the medical information has to take priority.

What do you all think about this issue? How do you go about ranking the importance of topics in veterinary curriculum? Should there be a formula, and what should be done when no money is available to teach communication skills? I'd like to hear your thoughts! (photo from istockphoto.com)

--Dana

Calming Canines

Yesterday, I heard about a growing problem that affects service dogs and their owners. It appears that the some of the public school districts in Chicago, California, and Pennsylvania are refusing to allow autistic children to bring their dogs to school with them (they worry about other children who may be afraid of dogs).  Like seeing-eye dogs for the blind or deaf, trained dogs are now used to help autistic children deal with their disabilities (such as repetitive movements, violent outbursts, and problems communicating). The dogs are trained to be a calming influence and provide the child with constancy between home, school, and other places.

While there's little research out there on how these dogs affect autistic kids,  many families with autistic children claim that the dogs are "amazingly helpful" in keeping their child calm and focused. Recently, two autistic elementary school students won court orders in Illinois to allow their dogs to accompany them to school. Similar lawsuits are being filed by other autistic children in California and Pennsylvania. It seems that these children and their families have absolutely no doubts about the importance of these special dogs.

What are your thoughts about this? Should assistance dogs be allowed in schools to help autistic children? Should it matter that there is little scientific proof of the benefits of these dogs? Let's hear your thoughts. (photo from bigstockphoto.com)

--Dana

Pink Roads And Floppy Ears

I must tell you that this past week-end my life had gone to the dogs. On Saturday afternoon, I participated in the "Pooches in Pink" walk (part of the Susan G. Komen foundation's Race For The Cure). The best part? I didn't have to walk alone! There were dogs-a-plenty in all shapes, sizes, and colors...and I must say, a LOT of smiles and tail wagging!

Last year, I was diagnosed with breast cancer myself and have been working through the treatments, the stress, the fatigue, and the fear. It can definitely bring you down sometimes. Saturday, I was able to turn this into a positive thing by forming a team from our veterinary hospital. So...The "Mountain Shadows Pet Hospital Tailwaggers" walked yesterday to honor and memorialize the thousands of women who have survived breast cancer or died from it. To be sure, there was lots of pink...pink collars, pink leashes, pink bandannas, and pink clothing (one woman even colored her standard poodle pink)!

I think that the best part of all this for me was seeing how much dogs enrich our lives. When walking with a dog, I feel more confident, happy, calm, and centered. I focus on the here and now and enjoy the day that I've been given instead of worrying about tomorrow. Those are the lessons and gifts that dogs bring to us every single day. As I saw survivors walking with their own dogs, I started remembering the long, difficult days after chemotherapy, and the profound fatigue I had from radiation. Yet, I also remembered how my dogs supported me and I just knew that these women didn't have to go through their struggles alone.  I'm confident that their dogs stayed beside them, supported them, encouraged them, and made them feel loved during a horrible time time in their lives.

For me, my three dogs (pictured at left) helped tremendously. After chemotherapy, I'd sleep on the couch in the living room, and they'd all form a little dog line on the floor beneath me with heads to tails all stacked up! Even though it often got really hot in this "dog clot", they all stayed with me and never left the couch until I got up. They never looked at me strangely when I lost my hair, and they accepted me no matter how I felt. I am so grateful for them and the ways in which they helped me. I'm also inspired to watch other women who have battled through this long road....a road that is turbulent and bumpy, but also filled with hope. It was uplifting to see all these women and their wonderful dogs. Dogs that are not only friends but also companions, confidantes, playmates, nurses, and even spiritual advisers.

How about you? Have any of you gone through cancer or have known someone diagnosed with this disease? How do you think pets can affect the cancer treatment process and how can we make it happen for all people with cancer? Please share your ideas and thank you for letting me share mine.

-Dana

P.S. I want to formally acknowledge and memorialize the thousands of beautiful souls who have died from cancer. Today, I honor them and the all the people in their lives who helped them through. I also want to honor all our dogs; our guardian angels in life.

Weight Watchers in Paws

Body weight...it's a national obsession. It's difficult to avoid the topic in today's media. We're too skinny, too fat, too lumpy, too tiny, too whatever. Having the perfect weight is highly valued and people spend lots of money trying to achieve it. Apparently, this is also becoming true for our pets. The recent issue of DVM Newsmagazine published the results of a study conducted by The American Pet Products Association (APPA). In this 2009 study, they found that veterinarians consider 13% of their dog patients and 21% of cat patients to be obese and have put them on some type of weight loss regimen. (I guess Kitty needs to hit the gym)!

This study further shows that at least 60% of pet owners are willing to spend more money for food if it can make their pet's weight healthy. That seems like a pretty impressive amount. I don't know the percentage of people who are willing to spend money for their own weight issues, but I would guess the percentages are pretty close to that of our pets. It makes sense when you consider that so many pets are considered family members

I find it ironic that some pet owners at our hospital are quite vigilant about their pet's healthy weight but don't seem to worry about their own weight in general. It's also interesting to look at a pet's weight in comparison to the owner's weight. Do you think these are related? Do owners who feed healthy food to their pets do the same for themselves? What's your opinion about this?

--Dana

Dual Obligations

The August 2009 issue of the Journal of the American Veterinary Medical Association (JAVMA) contains an ethical discussion about the use of non-human primates in biomedical research. In particular, the article quotes several veterinarians who specialize in caring for research animals. These veterinarians are stuck in the middle between dual obligations. Veterinarians have sworn an oath to protect animal health and relieve suffering in their patients. At the same time however, they are equally committed to promoting public health and advancing medical knowledge that could potentially save lives.

There's no escaping the fact that biomedical research data collected from primates (instead of mice) is significantly more accurate in determining a drug's potential for helping people. Non-human primates (especially chimpanzees) share almost 99% of the same genetic material as people. So, in some cases and with some human diseases, the question about using primates literally becomes a matter of life and death.

What would you do if you were a veterinarian charged to protect the animals used in research situations? How would you handle it and how would you see your role? Do you think veterinarians who oversee medical research on animals are "betraying" the very population they're sworn to protect? I'm interested in your thoughts.

--Dana

Internet Pharmacy Dilemmas: Part Two

I've written about this topic before...it's the problems associated with pet owners buying their pet's medication via the internet. As I stated then, drug companies won't sell pet medications to these companies. If something goes wrong, the drug company assumes no responsibility and the veterinarian who prescribed the drug is left dealing with the aftermath. Even when the owner signs a written document about the risks of using on-line pharmacies, it is the veterinary hospital who is still vulnerable to lawsuits.

A few weeks ago, this problem got kicked up a notch. One of our clients sent an internet pharmacy a prescription pain reliever (for her dog). What the client ended up receiving was a completely different drug than the one that was prescribed. In the package, there was a note assuring the pet owner that "this medication can be substituted for the prescribed medication."

Now I'm all for free enterprise, but this seems just wrong to me. We probably have good grounds for taking legal action against the pharmacy, but it would takes lots of time and lots of money (these pharmacies make a HUGE profit). It's only a matter of time before some unfortunate pet becomes sick or dies from this crazy behavior.  

What do you think is the best way to warn clients about these pharmacies? Since these companies can often sell the medication at a lower cost, many people buy from them. Yet...is the savings worth it? How should we warn and educate clients without scaring them? Please share your thoughts...we appreciate your help!

--Dana

Understanding Fluffy and Fido

It happens at least once a week. It's the client who needs help with his/her pet's behavior problems. We do the best that we can, but there are situations when the problem requires someone with specific expertise on this issue.

We are lucky at our hospital because we can refer our clients to Dr. Dan Estep, and Dr. Suzanne Hetts at Animal Behavior Associates. They are excellent animal behaviorists and have helped many of our clients with some very complex behavior problems. We also refer clients to Bark Busters (a service for dogs only).

I'm realizing that knowledge about animal behavior is instrumental in  helping pet owners and nurturing the human-animal bond. Some veterinary school teach behavior classes but some do not. What is your opinion about this?  Do you think that veterinarians should have more training in animal behavior? Should the state licensing boards require that veterinarians have advanced knowledge about common problems seen in dogs and cats? Is that placing too much of a burden on the veterinarian? Let's hear your thoughts!

--Dana

Hitting Close To Home

Last week, I gave a staff training about how to support grieving pet owners. We have recently hired some new staff and I routinely give these trainings to insure that our staff can respond sensitively to these issues.

When the training was over, one employee approached me in private. She was distressed and worried that supporting clients in their grief will trigger her own struggles with death and loss. This is a legitimate concern and it probably happens frequently to many veterinary professionals. I gave the employee ideas about setting good personal boundaries and ways to keep the focus of the conversation on the client. However, it is a difficult reality and can be very hard to work with.

What is your opinion about this? Would you be offended if someone at your veterinarinarian's office shared some of their personal struggles with you? When might this be appropriate and how far should the person go with the self-disclosure? I'm interested in your opinions!

--Dana

Elder Vet Wisdom

I was skimming through the June 15 issue of JAVMA this afternoon and an interesting connection caught my eye.  There were two separate articles in the journal about elder veterinarians--one who is 105 and the other who is 94!  When asked what young veterinarians, or anyone else for that matter, could learn from them, both men said very similar things.  Here are their quotes:

"It is important to work hard at things you love to do.  If you do this, you will be both successful and happy, and you will make a significant contribution to your profession and to society as a whole." --Nathan R. Brewer, DVM, 105 years old (p. 1508, JAVMA, June 15, 2009)

"Enjoy your life's work if possible, and happiness will flow from it."  Robert Ferber, DVM, 94 years old (p. 1520, JAVMA, June 15, 2009)

Here are two wise souls, looking back at their lives and work and both saying the same thing...enjoy what you do...

Dr. Ferber said he never wanted to work just to make money.  "My intent was to enjoy what I did," he told interviewers.  I think most veterinarians still feel this way and I think that's why we trust and respect them so much.

What about you?  Are you enjoying what you spend the majority of your time doing?  If not, what advice would your 94-year-old "future self" give you?  Hmmmmm.  This could be interesting!  (photo from istockphoto.com)

--Laurel