The Wagging Tail

Self evaluation is important for veterinarians. We want to do the very best we can for our patients, clients, teammates and ourselves. You probably already evaluate yourself informally, as you go through your day, and perhaps on the drive home. Consider also periodically evaluating yourself formally, with a checklist of criteria important for success.

Feedback is always helpful when determining what is working and what needs work. For a well-rounded, accurate assessment of yourself, consider implementing a 360 degree evaluation in your practice, in which each person is evaluated by themselves, others on the team, and possibly even clients.

S: Subjective variables that relate to success include relationship quality, communication skills and attitude. How are your relationships with your boss, coworkers and clients? Do you communicate well? Do you work together as a team? How is your attitude towards your job, towards others? How are others’ attitudes towards you? Are there red flags of impending conflict?

O: Objective criteria are easier to measure, but are also easier to oversimplify or misinterpret. If the team is getting along well, and pets are well cared for but the number of patients you see a day is down from normal, have you succeeded or failed? I would contend you are succeeding with room for improvement. Fortunately, if subjective measures of success are positive, objective measures of success will usually reflect that. As my Dad always says, “Practice good medicine, and the money will follow.”

So what are good objective criteria to measure and track? A few to consider are number of patients per day and overall income for a day/week/month/year. Just remember that each statistic only tells part of the overall story.

A: Assessment of the data is the next step. Consider the subjective and objective data you have just gathered and determine what you are doing well and what needs improvement. Again, using the 360 degree evaluation concept, either formally, with standardized questions prepared ahead of time, or informally, by asking others for their feedback on your performance, will help you develop a more accurate assessment.

P: Plan how you are going to improve problem areas and maintain what you are doing well. With your assessment in front of you, this is the time for goal setting, for dreaming even. You are back where you started-envisioning success, but now it is even better, you are envisioning success with a personalized checklist of things to restore, develop and maintain.

Recheck: If you have found that things are going pretty well, you may want to revisit your self-evaluation quarterly. If you have problem areas that have been revealed, perhaps a weekly self-evaluation is in order until all is well. Write out your plan and jot a note on the calendar on the date that you plan to revisit your self evaluation.

Sound familiar? I thought it’d be easier to remember that way, Doctor.

Oral disease affects 68% of cats and 78% of dogs over the age of three years. Because it’s a common disease with a big potential impact on the Pet-family bond, the BARK team has spent a lot of time researching periodontal disease over the last year. We’ve examined the prevalence and risk factors for diagnosis as well as learned more about how often Pets are receiving dental prophylaxis and therapy in Banfield hospitals. Risk factors for periodontal disease include increasing age and small breed (Toy Poodle, Yorkshire Terrier, Maltese, Pomeranian, Shetland Sheepdog, Cavalier King Charles Spaniel, Papillion, Standard Poodle, Dachshund, and Havanese). Additionally, we’ve learned that canine periodontal disease is associated with certain cardiovascular diseases (cardiomyopathy and endocarditis).

Despite the fact that strategies for prevention of periodontal disease are fairly straightforward, Pets still suffer from the disease. The most effective strategy is multi-faceted and includes teeth brushing at home, feeding of dental diets or treats, and dental prophylaxis performed by the veterinarian. However, client compliance with brushing is low and we’ve found that there’s a big gap between the number of Pets diagnosed with periodontal disease and those that actually receive dental prophylaxis. That gap can be as large as about 2/3 of all cats or dogs diagnosed with periodontal disease.

Why, despite the prevalence and impact of periodontal disease, are preventive strategies not fully implemented for Pets? Why are the behaviors that people have adopted around their own twice yearly dental care not standard for our Pets? Do Pets (especially cats) hide the pain that they may experience from periodontal disease from us?

As veterinarians do we recommend dental therapy less often than we should? Are there factors like anesthetic risk or cost of therapy that affect your discussion of the diagnosis or treatment with clients? What factors influence your recommendations? What factors affect your clients’ compliance?

We’d love to hear what you think!

Further reading:

• BARK’s White Paper on periodontal disease

Walking into an emotionally charged, stressful situation, especially one you are not prepared for, is not something anyone would volunteer to do, even if your communication-style is up there with the likes of Dr. Phil. And yet, that is exactly what vets deal with when they close the exam room door and are face-to-face with an upset, sometimes, angry client. Being a vet means dealing with the pain of others who love their Pet; it goes with the territory. Day after day, clients enter your practice feeling distraught because their companion and friend is suffering, or dying, or both. Their worry and sadness causes pain, and unfortunately, when humans hurt, they don’t always handle their feelings in the most productive way. We tend to lash out, and it’s usually at the one who deserves it the least. In this case, you.

When someone is addressing you with an aggressive tone, it’s difficult to keep your emotions contained and not fire back in some way. In fact, after a full day of seeing patients and trying to fit it all in, it’s easy, almost understandable, to retort with a knee-jerk response that stings in return which we know is never a good idea. At best, a tête-à -tête with a valued client will leave you feeling bad and, at worst, cause you to lose business.

Veterinary schools offer helpful information on how to deal with worried, grieving clients, but once you’re out and running a practice of your own, you may find yourself focusing more and more on the physical needs of your patients and less and less on the emotional needs of your clients.

It’s natural to feel a bit angry when someone is hostile towards you, but what you do with your anger can make all the difference in the outcome of your interaction. Below are two simple, but effective strategies that can help you bridge the communication gap between you and your client.

Pause for the cause

It’s been my experience that by merely slowing down the speed of a verbal exchange, I can actually raise the odds of a more positive outcome. Just pausing momentarily before I allow myself to respond allows my brain to engage, evaluate and better diagnose the problem. Solving problems doesn’t happen when our emotions are in the driver’s seat. Allow yourself a moment to process. Create some space to regroup, rethink and redirect.

Sometimes, I find it helpful to actually remove myself, physically, from a high-stress situation. People are accustomed to medical practitioners coming in and out of examining rooms, so excuse yourself from the room, if need be, take a few deep breathes then go back in with your emotions contained and your head on straight. Creating a self-imposed “time out” is an effective tool to gaining composure. Increasing your awareness of your emotional thermostat during stressful times will allow you to adjust your internal temperature up or down accordingly and better prepare you to handle any situation.

Objects are larger then they appear

Before you walk into your next appointment, take a moment to remember that the people who come through your door (unless it’s for a routine exam) are there because they are concerned about a potential health problem with their family member. And, this may not be the only issue they are dealing with. Job loss, family problems and financial struggles might be swirling around in their head too.

When clients are agitated, try to look past what is being presented and respond back with a softer demeanor. When you take a bigger picture perspective and strive to understand your clients better, you inevitably neutralize the tone, and consequently, the outcome of the exchange.

(Print and post a copy of these concepts and use the information to discuss “How to Handle High-Stress Situations” at your next staff meeting.)

Few things annoy me more than the phrase, “That’s not my job.” Although I like for my team to have well-defined job descriptions, more than that, I like for them to see the big picture: that we’re all on the same team. We all have the same ultimate goal: to help pets. We all need to be willing to step up and help out whenever and wherever we’re needed in order to help the pets that are in our hospital.

Occasionally at hospitals a “war” between the “front” and the “back” will erupt where one group feels that the other isn’t carrying their weight. The first thing I do to try to avoid these “wars” is to ban all such language. There is no “front team” or “back team,” we’re all on the same team. The “back” is called the treatment room. Our “front” desk person is our Client Service Coordinator. I also try to have all team members as least partially cross-trained so that they understand the value and hard work that go into every position on the team. I doubt that it’s much more fun to make appointment reminder calls than it is to clean the fecal sink.

As a team, we all need to be mindful of the client flow so if there’s a back-up in one place we can step in to make things flow more smoothly. Oftentimes, the PetNurses will go from treatment to reception to help check someone in or out. We all, even the doctors, grab for the phone after three rings. Sometimes, I need my client service coordinator to come into the treatment area to hold a pet for me.

If we all realize that we’re on the same team, we’re all here to help pets, we’re all here to get through the day, then we’ll all have much higher job satisfaction. If we feel that the “other” team isn’t pulling their weight or that “they” don’t work as hard as “we” do, then we’re all going to be agitated by the end of the day.

When I hear someone say “that’s not my job,” I realize it’s time for me to remind everyone that their job description includes being part of a hospital team and that means doing whatever is necessary to help the pets that we see. I keep a list of topics that need to be readdressed periodically, and this is one of them. Periodically, I’ll schedule a team meeting where we can reset expectations and rebuild any lost sense of teamwork. I wish I could have this meeting once and never again, but with the addition of new team members, new duties, new products, etc., it’s a good idea to revisit this topic (and other basics) every three to four months.

Is there discord or perceived job inequality between your front and back office team members? How do you approach these type of conflicts? Feel free to share your stories and any suggestions you have for fostering team harmony.