Thursday, May 25, 2017

Lost In The Sea Of Need. When the Vet Needs the Advice.

Hello Everyone,

While my usual blog posts are about my veterinary life's stories and experiences in an effort to educate and inform the public about the pet needs I see as imperative to overall pet health and welfare this post is different.

In this post I am asking for YOUR advice. Hard as I have tried I don't seem to have figured out how to come to peace with how to not feel compelled to help those pets and their parents in need.

Weasely's Story

Here's the typical scenario...

The phone rings and someone on the other end of the line is desperately pleading for help for their pets condition that they cannot afford to treat elsewhere. We have gotten calls from across the country, the Big Apple (where everything is astronomically expensive), to around the globe (these are especially puzzling. How do I help you in South Africa?), to our own backyard.

Whenever possible we offer the following;

1. Come in for an exam and assessment. We will give you an honest opinion and reasonable prices. We are also full-service which implies we can do the work-up and surgery on premises. It is the whole reason we publish prices and cases.

2. We offer options. Options come in all sizes, shapes and scenarios. They can be life-saving and/or life changing.

3. A chance. Often we just offer a chance.

Some of these cases involve an ambiguous undefined disease process that after a quick exam are deemed "lost cause-leading to pro bono euthanasia". It may sound cold and cruel BUT life can be exactly that. We see cases that are so progressed and difficult the prognosis is grave and eminent. This is suffering without tangible hope to improve. These are the cases where mercy was overlooked at the last rest stop. These are the cases I feel compelled to intervene as the last option for empathy to provide peace. Even with these too-little-too-late cases; a client without resources, a pet dying in front of us, and no real way to provide even the most bare-boned plan for any chance at remission or cure, even then, SOME of these cases are not provided a consensual to euthanasia. If you think suffering is bad, dying without hope, or, hospice care, is worse. Despair is unavoidable, but, the crippling inability to relieve suffering is cruel and criminal. It is as unsettling as the suffering you know is occurring. It is where my words need to be concise, direct, and well-intentioned. For these cases clients have to step outside of their grief, their blame and their denial. These cases call for real-life intervention. They are not frequent but they do happen. I don't need advice for resolving these cases. I need advice for how to notify clients to avoid them in the first place.

One of the pets who needed us.

We, the whole lot of us in veterinary medicine, need help in providing guidance so that too late isn't when we are sought to begin. 

What is the most basic tidbit of advice I can give them?

Don't assume that you don't have any options, OR, wait so long that you don't have any left. 


I need help in spreading this message!

Tammy

Here is a real-life example.,,

We received an email asking to help a dog with a suspected pyometra who was living in the DC area. The dog belonged to an older woman who didn't realize how sick her dog was. Her daughter was visiting and on inquiry was told that the dog hadn't eaten or gotten up in days. She rushed the dog to the local vet to be told it was likely a pyo and the cost would be upwards of $2,000. They, like many of us, couldn't afford this. They went online looking for affordable help. They found me, via this blog, and called the clinic looking for help. This was on a Friday. We offered to see them but explained that we don't do surgeries on Saturday or Sunday and urged that they call every shelter, rescue, and vet they could asking for a quicker surgery and a way to afford it.

The next time we heard from them was Monday morning. We saw them on Monday night. By this time the dog was almost in a coma. She couldn't stand, walk, or lift her head. Her color was purple-blue knocking on deaths door. She was labored to just try to breathe. They had $300.

I made myself a promise many years ago to never walk away from a pyo or a parvo. Two savable conditions that never survive with a death syringe, but often surprise you with skill and time.

The conversation with the owners went like this...

"I'm sorry." Anything and everything that could be said after was irrelevant and shaded with unneeded character references.

The conversation with the staff and associate vet seeing them was that they couldn't afford even the most pared down treatment plan. Three hundred dollars wouldn't get us past anesthesia and antibiotics. They needed a $500 surgery on top of these to remove the rotting uterus festering inside of her. Even if we offered to use the Good Sam Fund (overlooking that fact that they aren't a client) this dog needed to go to the ER after and that was going to cost at least $500. The ER isn't going to admit a dog without a deposit. If I had to guess I gave her a less than 10% chance of making it through surgery even if they had enough money for the intensive care she needed to provide any real chance at survival. It is not about the money, it is about what is fair for everyone involved. I didn't even think she would survive surgery  and I felt that it wasn't right or fair to them to take the little money they did have for a patient who wouldn't survive.

When I explained this to the client she said she wanted to take her dog home.

While I had elected to withhold my previous chatter to spare the client from feeling any more sadness than they already did, it was time to be the advocate for the patient.

"What can you do for her at home? She needs medical and surgical help that you haven't been able to find elsewhere. I am afraid she will die on the way home, and even if she does make it home she will probably not make it through the night. How are you going to feel if that happens? What do you think you would want if you were in her position? She is dying and she is suffering."

After 30 minutes of deliberating they put her down. Everyone felt better after. It is something we don't often admit, but, peace can come after death.

Sweet Baby Rae.. mom needed in patient help Baby Rae needs a home.

I need help in figuring out how to not get cases at this point. 

The next scenario is the more common one...

The phone call goes like this...

"The shelter/the vet I go to/my friend told me to call you and that you could help my  pet...."

Nothing (yes, NOTHING!!) burns my butt like my neighboring vets referring cases to us that they can do, but don't want to do because the client lacks the money up front. These are YOUR clients and YOUR patients...  Shouldn't they be YOUR responsibility? Or, do you just help those who can pay upfront? Take a note from our play book. Use CareCredit! Offer third party billing! OR, ask for help from your compassionate clients who WILL HELP IF YOU ASK! Heck, you might even get more Facebook likes and more clients because you CARE.

Yes, these clients often have little to no available money, BUT, they all have desperate and dying pets. They all also have DEAD pets if someone who can help doesn't step in. 

When one of our patients is surrendered at a shelter we go and get them.
Beignette,, she needs a home too.
What might happen if you surrender your pet at a shelter.

So my friends,, 

WHAT SHOULD WE DO? How do we make an impactful, meaningful difference for these pets? 

For those of you who aren't familair with how we extend our help to our clients in need, here is a review of our policy;

1. We do not deny care to our patients when they are in need. Emergencies may need to be referred on a case by case basis, but, we will assist the pet if it is safe to do so. 

2. We do not offer "economic euthanasia" (euthanasia as a means of treating due to financial constraints).

3. We provide multiple ways to pay for needed care. 

4. We provide the option of signing over a pet to one of our affiliated rescues if the burden is more than the client can or will provide for.

5. The vet has the option of providing pro bono care IF they want to, IF the case has a reasonable chance of survival, and IF we believe the client can follow through with the after care needed to insure successful resolution.

6. We don't treat a good paying client's pet any differently than a struggling financially client. Their pets have exactly the same diseases, conditions, and needs. Financial profiling should be so distaseful and shameful that the profession should take a stand AND do something about it! WHAT ARE WE WAITING FOR? A MUTINY? A competitor to figure this out (P.S. It is my dream to have PAWBLY be that meaningful change for these animals).

Extension outreach foster family

Here's where I need help! 
  • What should we do so that we can provide meaningful timely help?
  • How do we extend that reach to people who aren't local?
  • Can we convince other animal care facilities to be both the business and the provider when the situation is complicated and resources are tight? If we haven't been able to do it on the human side can we do it on the veterinary side?
  • The rescues think the vets are the problem (we have priced ourselves out of accessibility AND we don't care), and the vets think it is the public's problem (after all if you cannot afford a pet you shouldn't have one). Meanwhile pet is sick and dying.. don't argue when the need is in front of your face.
  • What does your vet do? Have you ever asked "what would happen if your pet needed something that you couldn't afford?" Are you prepared for the answer?
Thanks everyone for reading and contemplating. I am all ears.. let the ideas fly!

One of our TNR friends.

Related Blogs;

Jarrettsville Veterinary Center For Clients With Financial Constraints blog.

Affordable Options Are Everyone's Right.

Rescue Economics. When The Expense Costs You Your Ability To Care.


If you want to help pets please reach out to me. Leave a comment here, join me on Pawbly.com, or find me at the clinic Jarrettsville Veterinary Center, Facebook at Jarrettsville Vet, Twitter @FreePetAdvice, or YouTube.


Together we can save lives! It is who we are and at the heart of every pet parent and animal lover.

Friday, April 21, 2017

Lock Down At The Veterinary Clinic.

Twice. This has happened twice in about 4 years. The vet clinic has gone into lock down over a client showing up enraged and threatening us..


There are safety and terrorist drills that every place of business, social meeting area, community gathering place and institution needs to practice. Sadly, this also includes the veterinary hospital.

Both cases of lock-down were eerily similar; an enraged client came in seeking immediate action after their phone calls to the clinic were not answered quickly enough. The phone calls were belligerent, accusatory, demanding, threatening and intimidating to the girls at the front desk. The front staff are not naive to difficult phone calls. They tried to explain that the messages had been delivered and that someone would get back to them. This wasn't an acceptable answer.

The phone calls start as short and frequent. They quickly (within hours) escalate to demanding and threatening. The avalanche has started and you should expect the rest of the catastrophic destruction to follow.

The next action was to show up at the clinic enraged. Their anger has turned into threats and demands in person and with immediate expectation of engagement.

There is nothing you can say or do at this point other than to call the police. You don't know what these people are capable of and you cannot diffuse this situation and concurrently take care of your business. From my perspective I am also responsible for the health and safety of the other clients, staff and patients in our care. I don't dare risk their emotional or physical safety, and my ego doesn't believe I am a superhero who can swoop in to save the day. I have learned to NOT ENGAGE.

There is a back story to the culmination of these lock downs, (of course), they all went a little like this;

New pet parents arrive with Amish puppy mill, OR, Craig's List, puppy a few weeks earlier. It is very apparent to everyone that they are unprepared and uninformed about the cost, care, and responsibility of owning a pet. All routine pet services are explained in detail, associated costs provided and many are dismissed as being "not needed" or "too expensive". It is not uncommon, nor unreasonable to space out vaccines, visits, services and instructions for new pet parents rather than try to overwhelm and scare them away. We take our time and break the whole process into little easily digestible pieces. These visits take a huge amount of time and energy. They are also vitally important for the safety, well fare and well-being of these clients and patients. As is customary for us we offered brochures on products (preventatives are often confusing and difficult to understand the value of with new parents), and vaccine schedules. Written personalized instructions go home with the owner along with pre-booked next appointments. In this particular case I also strongly encouraged enrolling in a puppy/new pet classes. Phone numbers and recommendations are also given for these. We go to great lengths to provide a safety net and support network to new parents.


There are vet visits where you feel like a pre-puppy/pet-selection process should be law. There should be a screening process, an application, a review of the home and a waiting period. This requires time and patience. You can buy an Amish/Craig's List puppy/pet cheap and get them quick.

The clients admit to their pet purchase because they had been turned down by all of the rescues. People may castigate the potential adoption process but it has its purpose and reason and is often correct in their assessment of adopters.


Not everyone should have a pet. They are not little neatly packaged ready to go inanimate creatures. They are the worst example of Ikea's "lots of assembly required" challenges. They have needs. Their needs have zero respect for yours. There is no ideal time for a broken bone, infection or acute diarrhea episode. When they happen (and they always do) the unprepared new parents with angst and disdain always behave the same.. Anger, yelling and excuses about a "defective pet." (I cannot even tell you how many times I have had this discussion).

What I have to politically say nicely is "All pets come with and will have medical and/or behavioral challenges." They are intelligent, intuitive, needful beings. They need help with the challenges of life like all of us do."

BUT,

What I want to say is; "What the hell were you expecting? A pre-programmed self sufficient robot? Of course they cry for attention. Of course they will poop and pee in your house if you haven't trained them. Of course they need love and exercise!"

The worst cases of new pet parent failures end in death. I have come to know this, fear this, and see this. If you don't put time and attention into your children they fail to adapt to society and are ill-equipped to live happily in it. The behavior issues turn from disappointment to cast away outside to surrendering at the shelter to euthanasia appointment. It is the awful reality of property that fails to serve its owners purpose. Or, it turns into an anxious pet who bites or lashes out, which turns into death by euthanasia, or, abandonment which in too many cases causes death by predation or designation of "unadoptable" which subsequently leads to euthanasia.

At some point in this timeline a frustrated owner starts providing clues that the relationship is not mutually reciprocating of adoration. The parent cannot understand and assist the pet and the pet is still desperate for love and attention but unable to articulate their needs and wants, IF the vet, or pet professional doesn't intercede at this point it will cause a shortened cheated life for the pet.

Here is where our lock down happened. The new pet parents told us on multiple occasions to multiple people that he didn't want this pet. It is not uncommon for vets, and vet staff, to hear clients disparage and complain about their pets care and cost of care in front of us. Perhaps they do it to try to complain indirectly about the bill? Perhaps it is poor coping skills? Regardless, I am not able to ignore it. I have been heartbroken too many times to not intervene.

After an odd peeing incident and a heated visit with the dreaded "defective" label being thrown out as a reason to not pay, and not wanting the pet. I called to offer help and try to explain that these things happen. I attempted to explain that "perhaps she needs more time, more training and help? We are here to help her, and them. We can't do one without the other." What I feared was that her "odd behaviors" were a direct result of the anger and angst they felt toward her?

The next day the client shows up unannounced to leave her. "She is too much work and too expensive." The client is in such a rush he doesn't want to wait to sign papers. (You cannot just drop off a dog at a vets office). To be honest we only take them to get them into a rescue to try to save their lives. At almost every shelter in the country a surrendered pet is a most often designated a "euthanizable" pet. These pets pay for their humans inadequacies and instabilities.

Three days later the phone is ringing, the messages are stacking up, and a few hours later a very angry guy is at the front desk making demands.

It was lunchtime and my sister (our hospital manager) and I were out to get a few minutes of much awaited spring time sunshine. What the client didn't know was that I, the practice owner, had just returned from hospice vigil and hadn't been at the clinic for a few days. It is not something I felt I needed to share, but, it is not outrageous for a phone call to take a day, or even two, to be answered when they do not include patient health care requests.

The client was so belligerent that my mom (cleaning the clinic that day) hid in an exam room and called my dad to come rescue her.

Texts to my sister and I quickly escalated to phone calls for help.

"Call the police NOW! And, lock all of the doors" imagining them fearing for their safety as they were unable to diffuse the demanding lunatic in the front office.

That's my advice for every out of control situation. You just call the police. Let them try to manage the person who is not willing to talk like a mature adult. Never escalate, never engage, and never allow anyone to make you feel threatened.

The police arrived as the client departed. There is now a record outside of yours to corroborate your concerns. If you are worried enough inquire about a restraining order. It is a the best way to protect your business, your self, and your staff while at work. You also will benefit from having a police officer present at the time of request.

"If they show up again call us. We are one mile away. We will send extra patrol cars to visit today and tomorrow. We can even post one to stay if you need us." It was the most consoling offer of protection and peace we could have gotten. It was the only thing that allowed us to stay open the rest of the day.

Where am I in all of this? I am back to being afraid of people who will harm you if they feel embarrassed and/or not in control and the collateral turmoil of not trying to save the pet in the middle. It is the world we live in. Where guns are prolific and temper tantrums happen in traffic, workplaces and even school yards.

A phone call from their lawyer followed. "They want their dog back. They have had a change of heart." Lawyers ALWAYS get involved. If you are lucky, they get involved early. Lawyers at least have boundaries and repercussions if the client is a psychopath. Any, and every, mediator should be welcomed. It is yet another barrier to becoming engaged with an unknown unpredictable person. It is a way to provide leverage and pressure. Every vet needs to have a lawyer on retainer, or at least PLIT insurance. Call your lawyer as quickly as the hairs on the back of your neck take notice. The point about "not engaging" also includes passing the buck when appropriate.

My reply; "My job is to take care of my patients. I am still here to take care of them. The pet is in a home with people who love her and they don't want to give her up. It was stated to us on multiple occasions to multiple staff members that your client did not want this pet. I also need to notify you that the police were called when your client threatened the staff would not leave after being asked to. The police were called to the clinic to remove him and are on alert to return if he does. The clinic went into lock down because the staff was so afraid."


Why am I posting this? Well, because we have been threatened before. Threatened with lawsuits, physical harm, and intense harassment. I have had to go so far as to get a restraining order, (it takes four visits to the police and courtroom to get), and I know what the consequences to my patients are if I don't offer to help. I also feel compelled to share this story with other vets and vet staff to try to encourage them to say something when a client states they don't want their pet, threatens abandonment, physical harm or personal injury. Do not ignore a threat, ever! Document and get backup corroboration to support the claim immediately. This case has multiple entries in the medical record to support the statements made in both our presence and in phone calls/email exchanges. I was granted a restraining order because I had emails and witnesses to support the threats made.

Do I think this is the end of this? NO, I don't. I think this man doesn't take "No" lightly. I think that in some cases standing up for your staff and protecting the people you care about makes you a target. I also think this blog allows me a place to post fears, concerns, and educate all of us about how behaviors influence outcomes.

How hard it is to stick your neck out with people who threaten and intimidate? How easy it is to turn a blind eye on your patients to spare your butt? Vets have to ask themselves this question every single day. It can break you. I have had to become comfortable with repercussions in order to stay true to my ethical code of my obligation to caring for my patients. It is not a code my profession shares publicly. I also think that veterinarians deal with the a ridiculously ambiguous fundamentally unfit status of pets being deemed "property". It denies us ability to intervene, advocate and make meaningful life saving pleas. At will on demand euthanasia is a viable option to every pet owner. If I push to hard every patient can be euthanized, and some clients will do so just to spite and hurt others. That is absurd and reality.



Here are my tips for preparing your staff for potential Lock Down scenarios;

1. Never engage. Ever. The minute you feel threatened or that the situation is out of control just pick up the phone and dial 911. You don't have to warn the client, you don't need to explain, and you should never apologize. Just pick up and dial. Every front desk employee has a phone at their fingertips.

2. Start recording the event. Any other staff member should discreetly pull their phone out and hit record. Evidence will save you time and money.

3. Have a protocol in place. Get people outside. Lock doors so others don't walk into the heated situation as it boils over. And, never call in more civilians. The police are your only call.

4. Get photos. I had to get a restraining order on a client under daily psychiatric care who was threatening to kill someone. Of course he didn't exist in any social media platforms and has never had a photo of himself taken (that I could find).. It is harder to alert the staff to call the cops if he shows up if only a few staff members know him by face. We were given make and model of the cars the owned to post for staff's attention.

5. Stay on the phone with the police dispatcher. They can help you to keep calm and be safe.



End note; I really never imagined that being a vet who cares so much about pets would leave me to having to decide whether to stand by protecting their lives would leave me sitting in the cross hairs of my own. We live in a dangerous and unpredictable world. It shouldn't be governed by so much pervasive fear and hate, that's not what our pets bring us, that's simply humans.

Where is JVC going to go to help deal with the ever increasingly hotheads who are making the job of an underpaid vet assistant question why they stay? We will be adding video surveillance to the hospital. They will be in every public space, including examination rooms, and parking areas. We are also recording telephone calls. Too often I have a receptionist find me frantically befuddled to notify me that a "very difficult, angry client" is on the phone. Many of these phone calls include threats, harassment, profanities and requests they cannot acquiesce to. I ALWAYS take these calls. Overwhelmingly the client is nice as pie to me. There is some unwritten excuse to being able to be rude to the staff and nice to the doctors. For every client who does so I ALWAYS ask the client if they were rude to the staff? I know that most clients are put off that I ask, but, I explain that we are never rude to clients and it is expected this is reciprocated in return. Every single client had provided a firm and disgusted "NO!" For the repeat offenders they are given a written letter of warning and at the third infraction; fired. Every practice owner needs to both protect their staff AND hold clients to a standard with consequences. No vet staff member is ever paid enough to allow or tolerate abuse.



Clues to Lock Down worthy clients; (Note; I am not a psychologist AND I am way out of my vet hat boundaries.,, But, these have been my experiences. I add them as personal reflections).

1. They are usually new clients. Never people you have seen and known for years.

2. They have seen multiple practices over multiple years.

3. They provide red flags at every single interaction. Pay attention to the little voice that tells you to be careful.

4. They do not provide small talk unless it is somewhat uncomfortable and moderately inappropriate. Like asking for your private information, or, disparaging others to find a common enemy.

5. They seem to exist on the ends of the spectrum. Either too nice, or, too angry. You never know which you are going to get?

6. The pet goes from happy and jubilant one visit, to afraid and shy the next. ALWAYS pay attention to the pets and the kids. They tell you what you need to know.

Here is a reference from Psychology Today on Dangerous Personality traits. The men of this blog possess many (or all of them). Please read this article if you are a woman, vet, vet staff, person, employee, anyone and everyone.


Footnote; None of the photos in this blog are of the pets involved in these cases. The situations and scenarios are collected experiences based on previous situations within the clinic. Names have been omitted and references to actual clients have been altered to protect the staff from further harassment and client instability and instigation.

About me;
I am a small animal veterinarian and the owner of Jarrettsville Veterinary Center in northern Harford County, Maryland. We are here to help you and your pet at every step of their lives. Please check out our amazing Facebook page JarrettsvilleVet. Or find our 2017 Jarrettsville Vet Price List here.

If you would like to learn more about pet care or ask a free pet related question please visit Pawbly.com. It is free to use and open to all of those who love pets.

If you want to help others and you have experience with pet care please join us on Pawbly.com. Pet care is about helping others and we are built on this alone. I also have educational videos on YouTube, or @FreePetAdvice.

And of course we hope that you will Please always Be Kind to every living creature.

Tuesday, April 11, 2017

Top 10 Mistakes New Pet Parents Make

If only we could learn from the mistakes of others...? How many of us would avoid painful life halting mistakes? There isn't a single one of us that hasn't sat shotgun watching a beloved family member, friend, or even marginal acquaintance make some tragic mistake that changes the trajectory of their lives indelibly for decades to follow.

Some of those mistakes even end up being fatal...
  • The text that had to be answered on the interstate while behind the wheel.
  • The late night celebratory ride home after a few too many that didn't include a taxi or Uber. 
  • The poorly socialized large breed dog who landed in the wrong house, with the wrong owner after being purchased on impulse because the photo online made them feel more "manly" about themselves, bites out of fear or anxiety,, and ends up getting a one way trip to the shelter.. This happens at least once a year at the clinic.
  • The cat who gets sentenced to solitary confinement because her pleas for help and/or peeing outside the box (which is after all always a plea for help) cause disdain to the already overburdened over stressed family who is hard pressed to find time to do anything other than add food to the bowl once a week. This happens weekly,, these poor misunderstood neglected cats! (Please, please call me,, or go to Pawbly.com, we can help)
The list is long, varied, and painful for every family member involved... but every single one could have?, might have? should have been able to be avoided.. with a little advice from your friends or the experts who want so desperately to never see another tragic mistake repeated.

For those of us in the exam room of the veterinary clinic for 8 hours of every day you learn that people are destined to repeat others mistakes. Perhaps it is the balance to keep nature from over populating? Some sick form of Darwin's Law maintaining a balance? It is still, however, frustrating to the point of feeling like you are caught in Groundhog Day meets Edge Of Tomorrow. It is a sickening cyclic chasm of repetition that causes you to either sit down and compile them into a list for the near futile desperate hope that someone will take pause, OR, you become blind, deaf, mute and indifferent. (God give me the strength to not become indifferent).

Madelaine,, one of my dearest friends
Here is my list of the Top Ten Mistakes That I See New Pet Parents Making,,, over and over again;

1. Not being prepared for your life to change. Your life is going to change. You have another life dependent on your ability to provide love, support, encouragement, training, and happiness. Adopting a pet requires time, patience, love, sharing of the care they need to thrive and financial resources. Your life is going to change for the better!! Be the parent your pet needs you to be.

Amanda, River and Rosie
2. Not understanding this is a living being who will need you, your wallet, and will have stumbles along the way. I am eternally perplexed by clients who happily spend many hundreds of dollars on that cute face in a window or internet ad then fly half a country away to pick up their 8 week old baby, and then tell me they don't have enough money left for preventatives, microchip, or spay/neuter? The adoption fee is often the cheapest part.

Ouch!
Not a quick or cheap fix here,, 

3. Not making a designated pet place and allocating enough time. Pets, especially puppies, need lots and lots of time. They need time before you leave for work, (I suggest at least an hour), time after you get home from work (I suggest at least two hours), and they need to get out of the house for training, socializing and general sticking their nose, face, feet and whole body in the dirt/grass (at least 6 hours on the weekends). They need to be a dog. Your cat needs emotional and intellectual stimuli outside of a couch and litter box. They need play, long naps on laps with constant petting, catnip toys, etc. AND both need a proportional allocation of your home to the amount of time they spend in it. For example; if you live in a 1,000 sq ft home with your dog/cat they should get at least 100 sq ft of dedicated space for what they want and need. For my home with two dogs and four felines this includes their own litter boxes in their own spaces. They each have their own room/area and their own stuff there (litter box, food, water, bed). Some like raised beds in windows, others like the bed in the flower boxes, and Jitterbug prefers the giant dog bed they are now unable to even get near. She has claimed it and the cats rule this roost (it is always safer for the cats to be in charge. The dogs are not allowed to challenge them). To all of the clients who tell me that they "don't want their cat on the tables or counter top, etc." I remind them that their cat is a little fierce predator under that purr. They want to be where we are. They want to perch from a vantage point and you NEVER, EVER, reprimand or discipline a cat. You can try to silently discourage by covering the area with things like tin foil or hard plastic (but, cats will pee on plastic, remember what the litter box is made of?), so you need to pick your battle carefully and provide a compromise. If you don't want them on the table/counter top you need to add cat shelves to these rooms. That's a compromise. Not banishing them to the areas you aren't in,, like a spare bedroom or scary gross basement.



Wren at the cat food bar
The long walk from food to heated bed

Arrival; heated bed

Magpie the sentinel

Coot gets the best seat in the house
4. Not knowing how to love on their terms. Having a companion is NOT ABOUT YOU! Don't get a pet to accessorize or complete your life. Too many "cute" pets are dressed, shoved into bags, smuggled as therapy pets to vacations far away, or asked to ride in a side car on a speeding motor cycle on the highway. They have their own needs and you have to understand, support and provide for this. Cats need to feel the world. They are compelled to give it a graffiti tag of ownership, and they need to be active. Most people don't get a cat and expect for them to be active.. Dogs need stuff that stinks of life.. dirt, sand, sticks, and to be the wolf of their forefathers,,, at least in their minds eye. That's loving a pet. Giving them (safely of course!) what they want and need, even if you don't want a dirty dog, a shredded chair and a life surrounded by organic materials.

Jitterbug gets what he wants,, Jekyll has to put up with him



5. Not being educated on your pets breed, needs, and behaviors. If you want to buy a car, shoes, house, or even vegetables based on how they look in the package that's fine. Don't buy, adopt, or steal a pet based on the way they "look". A German Shepherd, Border Collie, Cane Corso or Rottweiler (the list includes every single breed) can be a deadly weapon in the hands of the wrong (often well-intentioned) people. "Cute" and "designer" are not in your pets best interests. A brachycephalic dog or cat that can't breathe or maintain a healthy skin due to excessive folds, or is blind because we wanted a "cool, unique" color coat is not compatible with ideal health status IS irresponsible and a poor excuse to build your own self-esteem.
Attack!
6. Not seeing life from their vantage point or standing in their paws. Your cat is probably bored to tears (and perhaps subsequently peeing in inappropriate places) almost all of the time. Can you imagine sitting under the same roof day after day? The same food, the same expectations,, ugh.. bleck! spice up life. Add catnip, cat scratching mats, or start walking (have I expressed how much I love harness walking cats?). Your dog barks at strangers walking by because they live in their home and their job is to alert the family. (Never yell at them for doing their job). That's all they have; this little home to protect and serve. They dig, shred, play and get into stuff because they have excess energy (those dogs eating toys needing emergency foreign body surgery chew, and swallow, because they are bored) OR, you forgot to let others into their lives and now they cannot function without you. There is a happy medium between too much love and attention AND too much dependency on each other (separation anxiety starts here).
River keeps her eye on the treat




7. Not sharing the joy of being a parent. How do people who have never had a pet before learn about the joys of being a pet parent? Through friends and family. Share the joy that your pet brings. Where do I see the biggest obstacles? Men who are in relationships with cat women. (OK, I know not PC, but, you get honesty with this blog!) The number of relationships that come with "get rid of the cat" ultimatums is staggering. If your boyfriend makes you chose your family over them just dump them. Immediately. They aren't worth the sacrifice.. and what are you going to do if the list gets longer? What about when they dump you because their other girlfriend gave them an ultimatum to get rid of you? (Footnote; the only person who doesn't like a cat is the one who doesn't know AND understand a cat).


Happy snow day!

8. Not socializing early enough and thoroughly enough. Every puppy should be touched by at least a hundred people BEFORE 8 weeks of age. I have abandoned the old ideology that we don't encourage social interaction until your pet is fully vaccinated... we exchanged a protected pet for a happy well-balanced pet. Get out there and play with the world. (Please have your pet micro chipped at 8 weeks! and scrutinize the people you play with. No sick pets, no day care, and no dropping off at hospitals, shelters or rescues. Keep them in safe, clean, disease free places).



9. Not raising an independent responsible member of society. Those selfish paranoid doomsdayers who keep vicious guard dogs trained to display aggression, with beatings and harsh words have bred dogs who will be shot the moment they get loose, injure a human, or the junk yard closes. This might be an extreme example, but about 50% of the docile friendly 8 week old puppies that I see a year later have become cowering, fearful anxiety ridden beings. Now I realize that they haven't seen me in a while, (which I would love to change with more frequent "happy visits" just to get a treat and a snuggle), but it is much more difficult to retrain a fearful dog than to always keep them in your inside AND outside of the home life happily sharing all aspects of it. Take your pets everywhere you can (safely, NO LEAVING THEM IN CARS!). Your pet needs to exist within the confines of society. They have to be stable, confident and able to deal with life outside and away from you. That is your job; to raise a being able to move on and thrive without you. People die, things change, your pets life should never depend on these. They need constant exposure to help them understand the society we live in. Should you not be here to take care of them and they end up in a shelter the pets who love people are far more likely to get a second chance adoption. I love my pets more than almost anything in life. They have a back up plan for the time I can no longer care for them. I have a small army of people to take over (with written instructions ;-) about what they need and like). They will go on after I can no longer do so. They are a part of my life and legacy. To provide them the best chance of flourishing without me I have to expose them to life, other people and they need to know what love is so that they can provide it to their next family without fear, apprehension or contempt. Pets are far better at moving on than we give them credit for.

Rescue life
This idea of euthanizing them so that they can spend eternity with you is selfish. I have seen dozens of pets go on to new homes they love and are happy in. It happens all the time. I have never seen one be sad, upset or even unable to adapt to a new life. My family can go on without me.. I want them to with all of the life skills a good parent prepares us for.

Molly and her second chance

10 Not knowing who to get advice from and not getting help early enough. Feeding, vaccinating, and taking advice from the kid at the gourmet pet store, the tv commercials, the Facebook ads, the breeder, or the flyer from the feed store, all has enormous potential to be bad advice from a biased, partially knowledgeable person AND it can do more harm than good. All pet questions start at the vets office (OK I am biased), but, I get crazed by the gourmet dog food store owner giving medical advice for diet, ears, skin, and behavior.. etc, etc.. If they could be sued for practicing medicine without a license I would encourage my clients to do so.. Or at least submit their medical bills for reimbursement. A problem that sits, simmers, or grows and worsens is always harder to manage after months of bad and/or inappropriate advice. If your pet needs help you can find me, and a whole bunch of very credible pet experts for free at Pawbly.com. (Be prepared to be given advice about seeing your vet. They are your pets best advocate and adviser!).

Mack, minus the two foot long string toy I removed a few hours earlier.
As always JVC, and I, are here to help you and your pet. If you would like to meet the amazing staff and hear more about the ways that we can help you and your pet live longer happier and healthier lives we would be happy to show you how the face of veterinary medicine and the care we provide can ext end past the traditional options of hope and luck. Please also follow our amazing Facebook page JarrettsvilleVet. Or find our 2017 Jarrettsville Vet Price List here.

If you would like to learn more about pet care or ask a free pet related question please visit Pawbly.com. It is free to use and open to all of those who love pets.

If you want to help others and you have experience with pet care please join us on Pawbly.com. Pet care is about helping others and we are built on this alone. I also have educational videos on YouTube, or @FreePetAdvice.


And, of course, we hope that you will Please Always Be Kind.

Saturday, April 8, 2017

Veterinarian Rants. Our Failure To Take Responsibility or Compromise

Sweet Baby Rae, looking for a home now, come meet her at the clinic
 In general I get a bit miffed when I read many of the most popular current veterinary blogs these days. (I admit I have angst,, I'm working on it. Based on current affairs it is going to take a while).

Not to say that I am not equally guilty of self-sought pity parties, BUT, I am utterly sick of veterinarians claiming naive oversight to the huge pitfalls that plague our profession. My latest tirade is centered on Andy Roark's published article on "The Bad Economics Of Veterinary Medicine." Written by a surgical specialist (which is the absolute best way to make over $200,000 a year in vet med), it serves to explain that we are underpaid, in huge debt, and struggling "to practice the best quality medicine possible ... at the lowest possible cost."

Wylan,, lap dog
I went to vet school before the advent of outrageous school debts, (yes, these days did exist). They are the same days that students looking into colleges with published price tags made decisions based on what you could get into AND what you could afford.  I don't know if this rationale is still employed? Most of my friends with college age kids use the axiom "if they can get in I will find a way to pay for it" thinking. (HUH? Maybe that was the spawn of the economic dilemma? So much for "leading by example?"). Every single student knows what their school is going to cost. My parents were open and honest about this price tag. It was the single reason I attended a free and flipping hard painfully brutal school that began with the all caps "UNITED STATES",, and ended with .."ACADEMY". It was not fun, nor easy, but then neither was vet school. I had excellent pre-vet training. I also had no debt. While I agree with the premise that vet students get very little (or more aptly NO) business training, the field of medicine has not changed that much save for one BIG exception,, women (we are classes of primarily women) got empowered in the 80's. We were fed a steady diet of "you can do, and have, anything you want" and we believed it. This gender equality mantra remains strong and ingrained. We all wanted to be veterinarians with the same delusional dream-like perception of saving the fluffy critters we adored. That tiny simple equation led to personal quests that provided the market to supply and permit almost "anyone can get in" vet schools to feed the demand (at outrageous costs). These determined students didn't do their homework, didn't employ a better discipline than their equally over extended in debt parents (who not coincidentally also bought houses they and the mortgage companies knew they couldn't afford), got in to schools they couldn't afford, dismissed the price tag, and fed the off-shore pop-up vet school machine that doesn't have a conscious nor responsible soul.

Coot insists Loon make room.
When the motto is "vet school at any cost" the collateral damages include sensible debt loads, expected post graduation income, calculated debt to income ratios, a long term vision for a life to include other debt related items (house, car, kids, vacations), and, we also forgot to reflect on the pressures, realities and landscape we were stepping into once we got out of vet school.

We all trained with vets before we went to vet school (it is after all a pre-requisite). How many of those vets drove luxury cars? How many of them lived a lavish life? How many of them were arrogant outspoken advocates for anything? How many of them gently warned us about the pit falls of vet med? (OK, all of mine did, I just thought I would be different and knew better). They were, and remain, humble quiet hard working 'salt of the earth' people. They also rarely complained. Why was that? It wasn't that they worked less than we did. It also wasn't that they didn't have financial pressures, bad clients, or weren't ridiculously underpaid for their degree of expertise.

Quality control crew

Here's where we failed to stay in the firm footsteps of our veterinary forefathers. We forgot to think about our futures past our own graduation, OR, if we did we thought we would be different.

I have new vet school grads seeking employment with over $400,000 of school debt. I know they will never, (yes, never), pay them back. I also know I can't pay them enough to get out from under that rock. At some point their bad debt decision IS going to affect their professional decisions, my ability to provide a satisfactory workplace and something will give. Will it be theft? Or, adding diagnostics that aren't truly indicated? Or, self-medicating to avoid self-doubt/loathing/futility? The potential scenarios were all too bleak to warrant employment.

Dempsey
Too many vets want to blame the economic environment, plea for pity that they didn't know what they were getting into, didn't know how much they would make, AND THEN want to charge clients more to compensate for these, WHILE, arguing about how intelligent and skilled we are. It is an argument that sounds like it is based on a juvenile temper tantrum.

We are all consumers. Perhaps not all in the same market places, BUT, we vets balk about the cost of human healthcare, brag about how much more efficient and sensible we are, (where else can you get your exam, blood work, x-rays AND a diagnosis in the same building for less than a grand?), and then try to berate our customers for not understanding the value in our services. Why? Why do we show contempt for the exact things we disparage the MD's for?

Charlie

If my clients cannot afford, (yes, I do believe them because we have already shelved the pointing fingers and placing blame argument as fruitless, haven't we?), then we find affordable options. It is exactly what my mentor did all those decades ago. It is the cornerstone of the mercy AND accessibility we pride ourselves in being so much better at than our counterpart MD's. "Best medicine" is great IF your clients can afford it, and it is a death wish to your patients who cannot. Get off your soapbox pedestal and work with people to save your patients. How many of us don't offer options because there is not an incentive that is economically feasible for us to do so? And then why do we denigrate the vaccine/spay/neuter clinics? (Starting to look like a vicious avalanche on a merry-go-round yet?).

Lilly gets her ultrasound

Let's go back to the Bad Economic's article..  Let's discuss the only example cited; "The best example of this is the dilemma of overnight care in general practice". It isn't that over night care options have changed. What has changed is our perception of what makes us the most money, what our clients can manage, or want to do (many of mine do not want to go to the ER based on previous experiences there (shelter head from angry ER vets,, sorry,, truth)), what is considered "best medicine", and it is STILL (just like it was for the old timers) cost prohibitive to provide 24/7 care at my clinic. Nothing here has changed.

Except,, I follow the precedent set by the vet I learned from. I do not live in the vet clinic (the ultimate all access vet).. but I do provide help after hours to the best of my ability.

Pinkie
Here's my favorite example, I do orthopedic surgeries for the clients who cannot afford it elsewhere. I literally say this; "I only do the surgeries that you cannot afford to do where they should be done; at the referral center." My knee surgery is about $1500, referral is about $3500. They are the oranges, I am the apple. Go to the specialist, if at all possible. Your pet will stay and be provided with excellent 24/7 oversight for 3 days. Mine go home post-op 6 hours later for you to stay up all night next to them to monitor. We rarely keep pets overnight. Why? well, because there isn't any staff member who stays overnight and I don't want your pet here without supervision. I send my patients home with my email, phone number, and directions to the ER. How many post-op patients have gone to the ER overnight, NONE (knocking furiously on wood). That's best medicine based on the client economics... it is what we do with every patient in every situation.

My pup Jekyll


Where is the responsible ownership of acquiring bad debt?

My personal debt is not my clients problem. Nor is it my business to judge or scrutinize where they allocate their resources. My problem is their pets needs and figuring out a mutually agreeable compromise to getting to "better."

It is time to be fair, honest and transparent.. the finger pointing, self-pity and arguing for a landscape economic environment which has not changed save for our naive oversight and self-imposed debt.

Reference article; The Bad Economics Of Veterinary Medicine. by Sarah Boston, DVM, DVSC, Dipl ACVS.

My related blogs;

Ethical Fatigue. The Crossroads Of Vet Med and the Public Conscious Awakening.

Euthanasia. Why Do We Make It So Convenient?

Affordable Options Are Everyone's Right

The Jarrettsville Veterinary Center Policy For Clients With Financial Constraints

Rescue Economics, When The Expense Costs You Your Ability To Care.

We Don't See You. How Vet's Became Biased and Lost Our Clients in the Process.

Compassion Fatigue.

Rocky,, eye on the prize

As always JVC, and I, are here to help you and your pet. If you would like to meet the amazing staff and hear more about the ways that we can help you and your pet live longer happier and healthier lives we would be happy to show you how the face of veterinary medicine and the care we provide can ext end past the traditional options of hope and luck. Please also follow our amazing Facebook page JarrettsvilleVet. Or find our 2017 Jarrettsville Vet Price List here.

If you would like to learn more about pet care or ask a free pet related question please visit Pawbly.com. It is free to use and open to all of those who love pets.

If you want to help others and you have experience with pet care please join us on Pawbly.com. Pet care is about helping others and we are built on this alone. I also have educational videos on YouTube, or @FreePetAdvice.

And of course we hope that you will Please always Be Kind.

Monday, March 27, 2017

Ethical Fatigue. The Crossroads of Vet Med and The Public Conscious Awakening.

How did we get here? How did we get to this place where we can't help all of our patients, can't acquiesce to our clients requests and can't discern why we are still so unhappy? Seems it might help when staring into the abyss, contemplating embracing it, and feeling like there is only something to gain if you do, that understanding how we got to this place that, we might need to take a step back and start figuring out these gnawing questions.

Two of my favorite rescue babies of 2016.
Thor and Weasely.
Rescued, treated, saved and adopted to a client home.
Happy, happy ending!
"Ethical Fatigue" is the new catch phrase making the rounds in the vet med publications these days. It is the evolution (and in my opinion, more clarified definition of the veterinarian's experience) of "Compassion Fatigue". Compassion Fatigue is the term adopted from our friends on the more glamorous side of the scalpel; the MD's. Veterinarians have always been seen as the slow step-child to 'real medicine'. We copycat the physicians tools, tips, tricks, medicine, even their white coats and still we can't even come up with our own names for our own unique disorders? We are, however, the profession with the highest suicide rate. Our once humble beginnings have been met by high societal pressures and unrealistic expectations.

Veterinary medicine, the once heralded career path of every bright, science-loving moderately nerdy girl shadowed by her own introverted personality who too often sought refuge and acceptance in the non-judgmental arms of animals is now the place of veterinarians who are offing ourselves at sky rocketing proportions. A huge multitude of factors have caused this. They include; huge debt loads (because a determined nerd never gives up on a dream,,, even one we cannot afford), ridiculous expectations from everyone (most notably ourselves), lack of ability to dig ourselves out of a self imposed hole (did I mention introvert?), and loss of ability to know which way to go when we can no longer navigate bad from worse. The more we feel compelled to help and invest ourselves the more we get stuck in the trap. The boa constrictor only swallows the prey that struggles.. they don't eat carrion. Those of us who invest too much can find ourselves lost in the plight and forget to save ourselves in the process. I am one of these people. A decade ago we called this "Compassion Fatigue," defined as "a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper." Dr. Charles Figley. (More on Compassion Fatigue here). Today it's the "ethics" that are killing us.

Garfield, deemed 'feral' at the shelter he is so afraid he hisses at everyone.
If you challenge his bluff you get this; Love, affection and gratitude.
Misunderstood, misdiagnosed, and almost missed opportunity.
This is what vets do. We see past the misleading exterior.

Befittingly vets and medical doctors do not share the same exact burden with respect to patient care. We both deal with loss, long hours, stress of managing a balanced life and patient demands.... BUT, (there is a BIG BUT here), we veterinarians lack much of the team support and resources that human medicine provides. There is often no one else to lean on in vet med. We carry cases, often difficult, multidimensional, multi-specialty cases that one person with one lifetime of general medicine cannot manage. We also live in this conflicting dichotomy of purpose. Pets are in some cases the lifeline companion to our clients lives. The only thread holding them to life and happiness. This is an immense burden to shoulder, often made worse by the too often financial constraints these clients have. They need their pet desperately but they cannot afford what these pets need on a day to day basis, never mind the inevitable illness or disease. In other cases these companions are seen as annoying costly burdens that people all too easily unload as 'disposable'.

Ethical fatigue in veterinary medicine exists for reasons that human doctors rarely see or experience. (OK, I shouldn't speak for others). In veterinary medicine no one who needs insurance has it. Very few can afford the expensive tests, treatments and tlc needed to save the dire cases. The patients at the fringe live with families on the brink. They too often collide at the vets office. The vet was once the sanctuary for the meek, weak, and huddled masses. In the old days, before debt, McMansion's, fast food, and corporate take overs there was room for everyone to get help. I miss those days. I miss them desperately. I am left to decide whether I can always maintain "Standard of Care" as I try to offer assistance to everyone who needs it. I will not sacrifice that little girl I once was for a payment, an excuse about having 'overhead' and alienating yet one more person who used to believe I was in this for more than the money. If you have become 'one of those vets' your legacy will be shrouded in a gilded casket attended by your immediate family alone. These are not the vets we wanted to be. They are the vets society, drug companies, and the Jones' next door encourage us to become.

Sadie's first selfie
Half a century ago when veterinary medicine was simple, agrarian, and cheap these were less relevant. Now, based on student debt, some White Tower mandated governance of "Standard of Care" (most notably supported by billionaire drug companies reminding us that if we aren't with the times we either lose our clients, lose our patients, or lose our ass in state board reviews), the consequence of trying to be everything, worrying about everyone and somewhere reminding ourselves that we went to vet school because we cared got shoved out the door with the bath water. We have lost ourselves. We gave it up to a school we really couldn't afford. A profession that expects perfection and supplies only Kleenex, and clients who can no longer afford us, AND/OR no longer trust us. We even lost them. The last vestige of friendship in the cruel world of bottom lines and profitability.

I think it is bullshit. I do. I didn't go into vet med to make a million dollars (although I think this term is considered 'chump change' in any circle of any real business person acumen), I came to make a difference. I cared about the lives of animals and wanted to make them better. Not the few that could pay for my services, but every single one who came to me. I think, fear, and worry that the ethical dilemmas that we are facing is more aptly the subconscious yearning we are trying to suppress.

Mumford,, beaten, tarred and abandoned with
his adoptive mom who loves him more than anything.

I came understanding and accepting the ethics. (Maybe I am alone?) But the ethics don't scare me, and they damned sure am not walking away or giving up because of them. I am just not letting them decide my, or anyone else's fate. The ethics of vet med are the reason we have so much work left to do.

An AVMA study determined that the most common ethical dilemmas veterinarians face are;
  • Every pet in private practice is attached to a human being. Human beings come in all shades. Adoring; perhaps even to the point of hoarding to abusive, neglectful and cruel. How do you know which one you are about to meet? You don't. Those that reside at the barbaric end of the spectrum can take many visits to distinguish, and even then in many cases it is too awful to begin to imagine, and yet we have to. We don't want to be held culpable if we forget to look for the vile in our clients. Your ass is always on the line and often you don't see it coming. You need a team, at least for the benefit of different fresh perspectives. You also need emotional support when the judgement's are passed.
  • Pets are property. It is as non-sensible as it gets. Respect, cherish and provide for your patients as if they are family, but in the end they have almost no rights and they can be euthanized at any time. I saw a very sweet older found dog last week. She was as kind and endearing as they come. She was also too cachexic (sick) to be ignored. We started emergency treatments on her at arrival. All were done without owner consent and without security of reimbursement. I treated her because she needed me and she was so pitiful. She also captured the heart of my sister, our hospital administrator. When the owner came to claim her we pleaded that she stay with us for continued treatment. The owner declined. My sister pleaded that we intervene. "I can only offer help. I will follow up with Animal Control but remember if I push too hard he will just have her put down. I'm sorry." We found out she was euthanized after they claimed her.
  • Expectations. Veterinarians work incredibly long grueling hours, day after day. Vacations, complaining and shying away from areas of medicine that make us uneasy (like surgery for many) is both shunned upon and shamed. It is one of the trademarks of our predecessors we have to let go of. We are not the same people our veterinary ancestors are, (and I'm not even sure it made them happy either?). There has to be some acknowledgement in maintaining a healthy mind, body, soul and striving for balance. 
  • Euthanasia. The one place we receive the greatest amount of gratitude is also the one place that we are reminded (almost daily) that we are applauded and regaled for ending suffering. If every pat on the back was a genuine heart felt "thank you" for ending a life you learn to be comfortable and safe there. Think about that. Think about how reward based behaviors influence delicate hurting souls. 
  • Everything in this superficial material based world is about money. At least for the tv producers, malls, and magazines. If you don't have the biggest, the shiniest and the most exclusive designer whatever you haven't quite made the grade yet. I am also incredibly fed up with this side of medicine. The side that shames clients who cannot afford us, and berates them for "not thinking about and being prepared for the emergencies beforehand." There is no place for a cold unkind hand in veterinary medicine. There's enough of that out there in the world already. (For more on this see Why Your Vet Won’t Give You Credit blog.)
  • Toxic Workplace. You are either part of the solution OR part of the problem. Like every tragic case you try to save knowing that it might all be for naught you either try to ameliorate for the sake of your patient and your emotional stability, OR, you walk away damaging both. Be brave, as you already are (I mean who else whispers love songs and sweet nothings into pets ears as we are passing them into another place?). Be the gentle hand of compassion inwardly and outwardly. You can save every patient (at least from being worse off), you just can't convince every human.

Belle, spayed with the generosity of the Good Sam Fund
I have a busy, over extended vet hospital. We have a huge following and we do more than we have to. We do it all from a genuine place of dedication to the pets and families of our community. I know the practices around me also do more than they have to. I know some of them provide help that is very (almost crazy) affordable. They have there reasons and they make sacrifices to do so. I applaud them and I am grateful to them, (even if I have to have the too often uncomfortable conversation about the emergency consequences to not being encouraged or reminded to spay their dog. I do many emergency pyometra's because of this).

I also work around practices that charge up to $3500 for this emergency surgery. If you end up at one of these most of my clients can't afford it. The ethics of this are death due to economic euthanasia. The ethics of vet med are overwhelming.  We have overpriced ourselves out of accessibility and now we are blaming our unprepared clients for it.. even though we couldn't afford ourselves either (we don't admit this).


I have had to change both who I am in front of clients and how I practice medicine. I had to. I was going to want to swallow the abyss if I didn't. It was my ethical obligation to that little girl inside of me who finally got out of vet school.

Every client interaction starts with a deep breath. A moment of affirmation that "I am ok. I can do this and I have steps and plans in place if I need them." I start with an internal pep rally and knowing that I have a medic on the side line. I also have a team who supports me. I built this. It is as integral and important as having a firm understanding of veterinary medicine. I can manage a case on a shoe string. I don't back away from them and I never forget who I serve. I serve my own 14 year old rose colored glasses self AND my patients. My clients may have their own priorities in a different order, but all they have to do is care about their pet and we can make miracles happen out of thin air. By about now many of you might be wondering how I can possibly keep the lights on and the staff paid with this business plan? I make it work. We have a Good Samaritan Fund. We post like crazy on Facebook. I am honest, transparent and determined. I also never say no.. Well,,,, I never say no if I know that the client has no other options, I can help their pet, and that I will be ok with the outcome regardless of the roll of the dice. I go into every situation with a plan for a back up plan. I also remember where I came from. I grew up in a tiny town where the vet lived above the practice and routinely got calls at 1 am, often in the form of a hard knocking at the front door. He would get out of bed, help his clients and patients and never once complained, (he is a far better man than I). He worked 40 years like this. He retired with enough money to live the way he always had and he left a legacy behind more honorable than the fecals, rectals, and c-sections could have amassed by themselves.

Recipients of our Pet Food Pantry donations.
Every vet knows what the difference between right and wrong is. It is not that we don't understand NOR know which side of the ethical dilemma to stand on. In case you aren't sure here's where I start. What will ultimately help my patient most? I start here. I don't allow pessimism or the easiest answer to influence me. You have to be strong enough to live by these. You also have to be willing to lose clients because of them and be proud of who you are despite of all of this. You have to protect yourself from the abyss. You also need help to make things happen. Turn to your team. Lean on them. Build a community that reflects who you are. And most importantly never walk away from who you are. It is after all, ALL THAT YOU REALLY EVER HAVE.

Every client has my email address. The clients with critical cases also have my phone number. If I am asking them to invest more emotionally and financially in their pet, place more trust in our dedication to them AND their pet then I have to be ready to give it back equally. I am available as I would want my vet to be. I have never had a client abuse this (OK, one did he was a psychopath it wasn't my fault). I have had my share of abusive, demanding, neglectful clients, and I have fired them all. I cannot provide what they want, demand, or they were bullies who intimidated and I will not subject my team to them. There are boundaries. I provide ultimatums. But, we work very hard providing help and assistance and warnings. I am not going to ever let another person nudge me into wanting that abyss.. that is not going to happen,, there is enough of a fighter within the introvert to protect this. I had to learn that too.

Maybe we aren't alone if we collectively refuse to be shoved into the corner where only the abyss waits?


Proudly displayed at the front desk.
This little shoe box saves hundreds of pets every year.

So where do I see the debacle with Ethical Fatigue? I see that compassion is who we are. It is the BEST part of who we are. We do not surrender it and we do not run out of it. The ethics? well, I think we already know the answer to these questions.. we just don't have to comply. We all have a voice, a choice, and a skill set. Walk away. State who you are and embrace the differences between the person you grew into being. We all make mistakes, but we are not damned to repeat them.

Here's some of my crazy public displays of opinion and preference. Here are the ways I avoid making ethical mistakes;
  • A savable case is offered every option. CareCredit first, third party billing (yes, I assume some risk they may not pay, but almost everyone does), and then if all else fails the Good Sam Fund mounts a campaign to raise funds. 
  • We have a network of rescues and volunteers to help foster or adopt cases. Some cases are with us for months or years. They become a part of our clinic. Our mascot. Our cause. Our promotional pet of the month. They are a daily reminder of who we are, and are not. 
  • I ask for help, a lot and often. I now have a team on standby. They are my private reserve National Guard. They are also the support staff to my team. I have a team who helps our team. They are the most devoted amazing people and I am reminded that I am not alone, my quest is not in vain, and my community has faith in each other. 
It really is this simple. There are endings decided by fate. Medicine is like that. Immune to reason, fairness or pleas for mercy. But, there are happy endings more often than not anytime a client will let us try. How often have you labeled a case as that? They let us try. We all worked together. Not me, vs, for them, but for the we in together. That's where medicine came from. The humble place where value was exchanged in chickens, thank-you's, apple pie, and owing each other a favor simply because we are neighbors.

I cherish each Thank You letter as a badge of honor..
I have a keepsake box to remind me why I fight so hard
and how imperative it is that I never give up.

Where do we go from here? I think it starts by taking responsibility. Our debt and our over abundant life is not our clients responsibility. If you cannot afford yourself AND be a vet then you need to find a niche, think outside of the box, be creative. If you think you can pass it onto others you better have a back up plan.

Let's remember who we were and where the success in that lay. We owe it to ourselves and our patients to provide a vet for each member of our society. There is ample provision for the clients with unlimited bank accounts, why isn't there equal provision at all levels of the income chain? Let's remember what the other side of the exam table felt like? How many of us could afford $10,000 for an osteosarcoma treatment plan? How many of us would tolerate castigation when our provider told us we should have been prepared for this?

Lady Liberty

We need more dialogue, less criticism about "poor choices" and pet ownership being a "privilege". We need to remember where we came from and what we are here to do. No excuses and no abandonment of purpose and no sacrifice of ethics in the sticky spots. All of those belong to other professions who alarmingly have no suicide rates to speak of. There is always an abyss, and there is always a way around it. It is in these small decisions, these extensions of compassion and these building of trust that the greatest reward to a profession that will never pay enough resides.

We don't take pride in the 6 month old cat neuters, we take pride in the difficult grueling surgical cases, the multi-problematic medical cases, so, why not also in the helping those who need us the most regardless of personal financial gain? You won't go under and you won't go broke, and you might also never see the abyss again. Be smart, be proactive, be creative and ask for help. It will surprise you what you get back when you give away.

For ideas in how to make patient care more accessible please see my related blogs;

How Your Clinic Can Do It All. Being Kind and Being Genuine. Weasely's blog.

Affordable Options Are Everyone's Right.

Borrowing Battery Juice. How Recharging Keeps the Motor Happy and BUILDS Your Veterinary Practice.

It isn't just high school anymore. Veterinarian Bullying and Veterinarian Suicide. How the vet clinic is the new homeroom.

My Veterinary Rescue Shaming and The Frank-Starling Law.

We Don't See You. How Vet's Became Biased and Lost Our Clients in the Process.

Compassion Fatigue blog. When the candle you are burning at both ends consumes you.

What is veterinary ethics?
This girl worked at a local vet clinic,.She intervened when this 1 year old was brought in to be euthanized
for behavior issues. She protested, convinced her boss to let her try to rehome him and subsequently lost her job.
This dog has since found a loving accepting home and is playful, happy and adored.
He is getting the training he needs and she is in search of a better job.
References;
Moral stress the top trigger in veterinarians’ compassion fatigue, JAVMA, Jan 2015, Susan Kahler.

The myth of compassion fatigue in veterinary medicine, by Dani McVety, DVM, DVM360 Jan 2017.


For help in reminding yourself what kind of vet you wanted to be a dozen plus years ago see;
  • Any James Herriott book, or If Wishes Were Horses by Loretta Gage, or, When Breath Becomes Air by Paul Kalanithi, or, The Patron St of Lost Dogs by Nock Trout, or, either book by Dr. Coston Ask the Animals or The Gift Of Pets (whose writing is as intoxicatingly poignant as it is exquisite).

Remember what your "Why" is.. Why did you want to become a vet? Why aren't you living that now? And, Why is it not feasible to move your life in that direction now? I promise none of these answers included "ethics."

For more information on me, and my vet clinic please see;

Here is our complete Jarrettsville Veterinary Center Price Guide for 2017

If you would like to follow our Facebook page you can learn more about us. If you have a pet question you can ask it for free at Pawbly.com. You can also find interesting pet facts, cases and stories at my YouTube channel and @FreePetAdvice.