Communication resources in veterinary medicine outline the caveats of good communication and Dr. Nan Boss makes some great points in her reference.

My 3 big take-aways  from her book are:

1)     Excellent communication in the veterinary practice is a team sport – from the receptionist to the DVM to paraprofessionals

2)     Keep it simple – use plain language to describe health issues not medical jargon

3)     Provide concise written information in support of your diagnoses and treatment recommendations

We know from the 2011 State of Pet Health Report that the most common pet diseases are those that are entirely preventable.  Strong communication is vital to client compliance to veterinary recommendations for preventive care.  The Bayer Brakke study found that 59% of dog owners and 56% of cat owners would bring their pets in more often if they could prevent problems and extensive treatments later on.

For our 2012 resolutions, let’s make enhanced client communications skills a priority so that we can help even more pets get the preventive care that they deserve!

Along with being a lumpy bumpy arthritic girl, she is considered a geriatric large-breed dog and is at risk for dental tartar, ear infections, and nuclear sclerosis according to 2010 Banfield data.  These were the top three diagnoses in 2010 for this age group, and as a practicing veterinarian, I find it fascinating because my experience with my own dog is similar to what I see in practice.   But how does this information help veterinarians and why should we care?

It is important to continue oral health care in our geriatric patients.  I’ve seen more than one case in my practice that the owner perceived the dog as “too old to undergo anesthesia”.  And then once the dental procedure was done, often with multiple extractions, the owner called me later and told me how much better their pet was doing -eating, playing, and acting like a young dog again.  Full oral examinations must accompany every physical exam.  We, as veterinarians, need to look for broken teeth, worn teeth, oral masses, tooth abscesses, and general periodontal diseases.

Ear infections are another common health issue that can affect geriatric patients.  Bailey has had many in her lifetime and they have been extremely painful for her.  More than once I’ve seen her scratch her ear and then cry out in pain.  You’d think as a vet, I’d catch them sooner.  But as a busy mom, I miss things too.  This is just one of many examples of the benefits of bi-annual thorough examinations.

In addition to periodontal disease and ear infections, lenticular sclerosis commonly affects dogs over 10 years of age.  When educating clients of geriatric pets, it’s important to include discussions on ocular health. Along with detecting it during routine physical examinations, conversations can ensue on how to help their older dogs cope with declining vision.  Although it may be out of reach for many owners, surgery can be discussed, but I also recommend non-surgical, practical interventions such as not rearranging furniture on a regular basis.  My own Bailey can’t see the tennis ball sometimes and has tripped over things the kids have left on the floor, so my family has had to make adjustments to accommodate our aging dog

I was taught that age is not a disease and as veterinarians we can help our older pets maintain healthy lives during their “golden” years.  We need to help our clients prevent diseases, such as periodontal disease, that are common among aging pets, and detect problems early.  There will come a time when I have to say goodbye to Bailey, but I know that she has had the best life possible!

Despite the fact that I am already sleep deprived, I can tell that I am starting out this semester ahead of many other students.  We have a class called clinical competencies that focuses on small animal physical exams, restraint, blood draws, placing catheters, etc.  Because of my previous two years at Banfield, I have not only learned these techniques, but have become proficient in each of these.  Since my preparations have allowed me to excel in this class, it gave me the opportunity to pay it forward and help fellow classmates who have not been able to get previous experience with these techniques. 

In addition to being clinically prepared, I was also fortunate to scrub into many surgeries over the past two years.  This allowed me to not only become more familiarized with the process of scrubbing in, but also enabled me to become more confident with my surgery skills.  Since I will be starting surgeries within the next week, I feel much more prepared for the procedures to come.  While there is much preparation still required before each surgery, I at least feel confident that my acquired skills will aid me in my preparation.  Moreover, one of my surgery partners has not had experience with small animal surgery, so I am looking forward to being able to help her through our operative surgery course.  In return, I hope to learn how it differs from large animal surgical medicine. 

I am grateful for all of the experiences that I was able to get during my years at Banfield because it has made my semester slightly less stressful . . . slightly.  Amongst the numerous intense classes, Ophthalmology and Neurology, Metabolic and Endocrine Diseases, Theriogenology and Urinary Diseases, Hematology/Oncology/Dermatology Diseases, Digestive Diseases, Surgical Anatomy, and Applied Diagnostic Imaging, it is a very wonderful feeling at least to feel partially ahead in Operative Surgery and Clinical Competencies.  While the average person would look at that class list and would cringe, I feel very excited to getting my feet wet in areas that will be vital in every day practice. 

Good luck to those fellow students who are dangling between the wonderful world of clinics, and the dark hollows of the last semester.  With the right amount of coffee, it will be hello to clinics in January!

We have a reason to care. From 2006 through 2009, we saw a 57% increase in the number of new canine and feline patients seen at hospitals open for at least 5 years. Part of this increase, but not all, can be attributed to practice growth. Then something changed. In 2010, we saw a 21% decrease in new patients, and this downward trend is continuing. Although the decline could be blamed wholly on the economic crisis, other factors such as increased competition for services have also contributed.²

The implications of this decline for pet health are cause for concern. Fewer new visits means pets are not getting the care they need and deserve. Indeed, we have seen an increase in the prevalence of certain preventable diseases such as diabetes mellitus and roundworm in cats is increasing.³ In the current economic environment, the importance of routine preventive healthcare, something that pet owners already struggle to believe in, will surely take a perceptual hit, and the need to effectively communicate that importance is becoming direr.

But what about existing patients? Surely they are an important concern too.  Although Banfield data show an overall decrease in the total number of visits by new and existing patients from 2010 to the present, the number of visits by mature adult and geriatric cats and dogs seems to be increasing. Furthermore, the mean number of visits per month by all pets is also increasing by about 5%. This is indeed good news—it appears we’re getting better at keeping the patients we do have, and existing patients are getting more regular care.

So where should practices be placing their emphasis: on keeping existing patients or attracting new ones? I would argue that both are important in making a better world for pets. Repeat visits increase the opportunity for veterinary staff to develop trusting relationships with pets and their owners, which can be used to facilitate conversations about preventive health matters. I am much more likely to take my family doctor’s advice when I have a relationship with her than I am if I see a different physician each visit, particularly if she is familiar with my health history and my lifestyle. Initial visits open the door to ensuring all pets get consistent, compassionate life-long care. In the end, we all win.

1. Katie Burns. Reversing the decline in patient visits. JAVMA News. Sept 15, 2011. Available at: www.avma.org/onlnews/javma/sep11/110915o_pf.asp.
2. Bayer HealthCare LLC, Animal Health Division, Bayer Veterinary Care Usage Study. Available at: http://www.ncvei.org/articles/FINAL_BAYER_VETERINARY_CARE_USAGE_STUDY.pdf.
3. Banfield Pet Hospital. State of Pet Health 2011 Report, Vol. 1. Available at: http://www.banfield.com/Banfield/files/bd/bd826667-067d-41e4-994d-5ea0bd7db86d.pdf.

In a recent survey done by Banfield Pet Hospital and the National Association of Veterinary Technicians (NAVTA) in 2010, it was determined that recognition by their doctors and management team, along with maximum utilization of their skills, were just as important to veterinary technicians as their compensation and benefit packages and was one of the leading reasons why technicians left the practice.

Veterinary technicians are key to a successful and happy team.  If utilized correctly, client compliance, furry, feathered and scaly family members’ quality care and well being will sky rocket.  Team members overall will be happier in their positions, staying longer in the practice, and will also increase the bottom line in the practice/hospital.

Wouldn’t it be nice to surprise the veterinary technicians in your hospital and show them the recognition they need and deserve by celebrating with them?  Show them how much they are valued.  There are many ways others are doing this.  Some are taking them out for a special lunch, some introduce them to the clients as their credentialed technicians and let the client know that it is National Veterinary Technician Week, others post banners, posters (NAVTA’s has a poster you can request at no charge) or displays in their lobby/waiting area.  You can give them memberships to their state association and NAVTA or just give a simple thank you for the great things they do every day.

Happy Vet Tech week to all of you hard working techs out there!  This is your week!

For more ideas on what you can do to recognize your technicians, visit www.navta.net.

~ Betty Bender

The truth is, we spend much of our life at work, doing our job. The satisfaction we gain from that job determines in large part our level of satisfaction in life in general. Job satisfaction has many aspects, including the overall environment, the tasks we are required to perform, and the support of the team around us. Patricia Smith of the Compassion Fatigue Awareness Project has developed eight “laws” for creating a healthy workplace. Whether you are in management and can effect these changes directly, or are part of the floor staff that can help your team develop a healthy workplace together, these laws are important guiding lights for how we practice veterinary medicine. 

Eight Laws Governing A Healthy Workplace 

1. Provide a respite for the team.

Every team member needs to be given a break or “respite” from the work, both in small and large increments. This takes the form of a scheduled and actually taken lunch period and periodic short breaks, as well as a day off or extended vacation now and again. No matter the length, this respite needs to provide an actual detachment from the work. During short breaks, this does not mean sitting in the break room only to be called away by the intercom and back to work. Take lunch outside, or take a walk around the block after eating. Listen to music privately, or indulge in a good book. Actually escape from the workplace for at least a short time. For longer time away, release your worries and do not let thoughts of work interrupt or interfere with your escape. You will return much more refreshed!

2. Provide continuing education for team.

We usually focus on continuing education (CE) as a way to educate our team about information they need in able to perform their job, for the benefit of the practice. Yet an employee also gains personal satisfaction from the process of learning something new, and being able to implement positive changes in the practice. Ensure everyone on the team has a CE allotment, including the front office. If cost is an issue, work with the team to develop in-house talks performed by the employee who has an interest in a particular topic. Outside the workplace, be on the lookout for CE opportunities to pass along, both those recommended by management and those that the employee may be interested in personally attending. Especially if the practice offers financial support for CE, ensure that the employee is held accountable for bringing back information and sharing it with the rest of the team. 

3. Provide acceptable benefits to aid staff in practicing beneficial self care.

Typically this takes the shape of health insurance benefits, whether or not the practice pays a portion. Health insurance companies can also offer education regarding ergonomics, smoking cessation, and more. This law can also involve mental health services, including an employee assistance program (EAP). An EAP provides free counseling sessions to eligible employees who may self refer or be encouraged to seek help for a personal issue that is affecting job performance. There are other shapes this law can take, such as partnering with a nearby gym or fitness center for reduced rates or supplemented membership. Of course the old adage is true, you can lead a horse to water but you can’t make it drink. You can provide these resources, but it’s up to the employee to take advantage of them. But at least they have the option, and the practice shows their care and concern for employee well-being. 

4. Provide management and team with tools to accomplish their tasks.

This may sound like common sense, but it’s not uncommon to expect great results without providing the tools necessary. These tools may be equipment or supplies, which are obvious. Often more important and not as obvious is the allotment of time needed to do the task, or the authority with which the person needs to get it done. Perhaps training is the missing link standing in the way of success. “Tools” can be anything and indeed everything that an employee needs to get a job done, and this can take many shapes. The best plan is to ask the employee what they need to perform the task at hand. 

5. Provide direct management to monitor workloads.

Every person on the team is busy, and typically each one handles a large workload. Sometimes there is no one person in management that directly knows the workload of each person. This occurs when management gets more removed from the team, such as when the team size grows, the management tasks multiply, or the employees specialize in certain positions. This is where middle managers are so vital. These supervisors—lead techs, head receptionists, senior assistants, etc.—still maintain direct contact with the group of employees that perform a specific job, they understand the job itself, and they have a smaller number of people to monitor. Consistent and frequent review of each person’s workload is best. 

6. Provide positive, team-building activities to promote strong social relationships between colleagues.

Everyone groans when “team building activities” are mentioned at a staff meeting, but they can be fun, challenging, and insightful. When introduced as a “game”, many employees find themselves enjoying the activity despite themselves. Discover those exercises that would appeal most to your employees, and be sure to discuss the results and how they apply to the big picture of working together once the fun has ended. There are many resources online and in management books to offer suggestions as to appropriate team activities and how they should be introduced and performed. 

7. Encourage “open door” policies to promote good communication between team members.

“Open door” policies are all the rage right now, and for good reason. Management should not be hiding behind a closed door, but instead maintain an open and responsive presence in the practice. If employees fear going to management with an issue, the issue will only continue to grow and fester. However don’t always count on employees making the first move. Periodically check in with each employee, follow up any incidents that need further investigation, and provide a protocol for making suggestions in an open, or anonymous, manner. 

8. Have grief processes in place when traumatic events occur onsite.

This is perhaps the most vital piece that is missing in veterinary practice. In other care giving professions, for example human medicine, employees are debriefed after dealing with an emotional or traumatic scenario such as patient death. In truth, we are the only profession that must go from one room attending to the euthanasia of a dear family friend, to smiling at a new client in the exam room next door. This takes an emotional toll on us, particularly if there is no outlet for discussing how we feel about the situation. It is believed that it is important to debrief with someone who understands the job within the first 72 hours after the event. Waiting until the next staff meeting is not fast enough. Employees keeping it to quietf should not be encouraged. Instead we must learn to trust each other with our emotions and share the reality that is our job.

It’s easy enough to charge the practice owner and the management or leadership team with the responsibility for creating a healthy workplace. Indeed, some of these suggestions such as offering health insurance is a decision for the “higher” management. However the employees can suggest, initiate, and weigh in on all of these concepts. Express your ideas or feelings to management, and for those in management, take these suggestions seriously and do not shoot them down without further consideration. Only by working together can we truly create practices that are healthy for our patients, and also healthy for the employees inside!

Resources:

Compassion Fatigue Awareness Project at www.compassionfatigue.org, Patricia Smith

With all of the states not mandating licensure, registration or certification as credentials for veterinary technicians, how can we view ourselves as professionals? As I look at this, I would like to think that before I retire, all states will follow suit. There are 14 states now that have not taken this step with success. I come from one of those. It’s not that we have not tried and continue to try, but not everyone believes it is in the best interest in our state.

I truly believe that this plays a HUGE part in how we view ourselves as professionals.  There are many of us that won’t give up on our hopes to be included some day. I am challenging everyone. Stand up for your profession! Love the career you chose! Don’t listen to individuals that tell you otherwise. Believe in yourself as a professional. You will be amazed at how much better you feel about yourself and how much others will see that about you. You will feel confident and do better at the things you do in your position. You will see yourself in a career and not just a job. People around you will notice and trust and respect you more, empowering you to do more and to utilize your skills more. When this happens, patients will be getting even better care, clients will be much more satisfied and listen to what you have to say. There will be more client compliance, ultimately increasing visits and the profitability of the hospital, not to mention that everyone in the team will be less stressed and will be happier!

Veterinary Technology is a career and profession! I love the road I took! I was not going to pursue a career in veterinary medicine, because it was not the doctor’s position I was looking to do. I went to my counselor’s office before I knew there was such a career track for veterinary technology, and said I don’t want to be a veterinarian, I want to do the nursing, do the lab work, assist in surgery, take x-rays, comfort the client and patient, and educate people. This is the BEST profession ever!!!

In addition to being involved with non-routine cases, the program, along with the generous help and support of the staff at the hospital, allowed me to gain many technical skills that will help me when I enter clinics in January.  For instance, while I am on the emergency radiology staff at school, we do not get exposure to using film for radiology.  I was able to learn how to use film radiographs as well as how to process them, which will help me greatly upon graduation because I am now skilled at using both digital and film x-rays.  In addition, I had very little experience drawing blood prior to Banfield, and with the help of the staff I was able to master blood draws from both the cephalic and saphenous, and this summer I am working on my jugular draws to become proficient before clinics.  Finally, one of the most important skills that I was able to acquire through the externship was learning how to proficiently communicate with clients to gain all the information needed to treat the pet.  I feel very confident when talking with clients, whether it is gaining history on a patient or discharging pets at the end of the day.  I work in the ER at school during Christmas breaks while the clinic students go home, and I noticed a drastic increase in my ability to talk with clients when comparing the break before my Banfield program and then after it. 

Finally, the best part of my program at Okemos was working with Dr. Lynn and preparing for when I enter clinics.  Dr. Lynn allowed me to work through patients from start to finish, which helped me increase my diagnostic and treatment skills greatly.  She would first ask me for my rule outs, and then asked which diagnostic tests I would like to run and why.  After running the tests, she would ask my opinion first to see what I thought was the issue, and then she would ask me how I wanted to treat the problem.  Finally, once I looked up the drug or treatment option, she would act as a client and allow me to explain what the treatment is and why we are choosing it, as well as explain how long we are treating for and when we would like to recheck to ensure that the problem has resolved.  While the whole process was very challenging, I was so pleased with the results after finishing the program that summer.  I cannot thank Dr. Lynn enough for challenging me to step up and think for myself because it allowed me to build confidence in my knowledge and the choices that I make. 

I had an absolute amazing time working the program at the Okemos location, and I cannot thank the hospital staff or Dr. Lynn enough for the experiences they gave me.  I feel so much more confident in my skills that I do not feel nearly as anxious to enter clinics in January.  Because I had such a great experience, I decided to repeat the program at the same location.  This summer has allowed me to improve on all of my technical skills and client communication even more, as well as has given me the opportunity to work with a variety of doctors since Dr. Lynn was deployed to Africa for 6 months.  While I am just beginning my veterinary career, these experiences will follow with me throughout my lifetime.

Wearing my practitioner hat, the first thing I did was run a fecal float, giardia ELISA, and a direct smear.  As can occur, all results were normal, necessitating empirical treatment for “run of the mill” diarrhea.  But it got me thinking about some of the questions clients ask of me in the exam room.   What are the chances that my pet has parasites?  And, if so, can my family get them?

Recently, the Banfield BARK team published the State of Pet Health 2011 Report that shows trends and rates of many of the common findings of the 2.1 million dogs cared for in Banfield hospitals during 2010.  The full version is published on the Banfield website here.  What is the prevalence of parasites found on fecal tests?  In Oregon where I live, there were 134 cases of roundworm, and 22 cases of whipworm per 10,000 fecal tests run in 2010.  Considering how many fecal tests are performed as part of the strong routine wellness care program at Banfield hospitals, this is an important finding.  (I hesitate to say significant without a confidence interval to prove it!)  Not all of these pets are symptomatic, making it just as important to run fecal tests routinely as well as only when there is a problem.  Unless prompted, it is easy to focus on what is in front of you rather than prevention.

I know that I get busy, and more often than not I am putting out fires instead of preventing them, but Toby’s diarrhea got me thinking about what my kids may have been exposed to.  He’d had a recent fecal as part of a workup for an possible GDV event so I wasn’t as worried.  But what if he picked up something in the meantime or what if he wasn’t shedding at that time.  You really never know.  Giardia is a parasite we all associate with zoonotic potential, but according to the Companion Animal Parasite Council (CAPC) website, the jury is out as to whether or not there is a true zoonotic potential.  Tapeworm and whipworm infections have been documented rarely in humans, but hookworm and roundworm are considered serious risks to human health.  But they are all important if there is potential to infect my kids!

 Back to wearing all my hats, I’m still annoyed I had to clean up my carpet, but I’m glad Toby was free of parasites and his diarrhea resolved on its own.  Turns out he had eaten a Costco-size box of oatmeal packets that was most likely was the culprit.  The bottom line is that we should be running fecal tests at least annually on our pets, and definitely whenever a problem arises!  Better safe than sorry, no matter what hat you wear.

During a recent seminar on compassion fatigue and burnout, one attendee commented that the difference between the two is that you can’t do anything about burnout. Yet knowledge is power, so burnout needs to be understood better in order for us to counter the negative effects. Every occupation is subject to burnout, which can be defined as the result of frustration, powerlessness, and inability to achieve work goals. Six aspects of work life contribute the most to burnout: workload, control, reward, community, fairness, and values. Specifically, burnout can be caused by the following:

Conflict between individual values and organizational goals and demands

The issue here is that we don’t take enough time during the interviewing process to determine if our individual values are a good match for the organization we are considering for employment. Before you begin the interview process, take some time to define what your values are and where the boundary lies. What lines will you not cross over? Will you participate in “convenience euthanasia”? Dental cleanings without general anesthesia? Tail docks and declaws? Improper sterilization for surgery? Even pushing products that may not be necessary? When we join a practice and discover they are doing things that don’t mesh with our ethics, then a decision must be made to leave the job or suppress your own ethics to continue your employment. Either way, this is an uncomfortable decision.

An overload of responsibilities

We all know the feeling of being overloaded, and overwhelmed. There can be far too much work put on one person at any given time. There can also be too much responsibility or authority given to someone who either isn’t ready or isn’t willing to be in that type of lead role. This is most dangerous when an employee becomes the “lead” or supervisor for their position type. These middle managers are often promoted because they are excellent at their job, but are wholly unprepared for a management role. Once they become overwhelmed, it is very difficult for them to step back down into the team. We need to select people who show leadership potential, and ensure that they are willing and able to fill the role of responsibility we offer them.

A feeling of having no control over the quality of services provided

Many of us have worked in a practice or for a veterinarian when we questioned the quality of services provided, and this is an uncomfortable dilemma. You need the job, but once again your ethics are tested. You may be able to positively affect the quality of patient or client care through well thought out suggestions offered in the right way to the right person, at the right time, but often we cannot change people or protocols that have been in place for a long time. Being a part of an organization that doesn’t provide the best care for patients, clients, or even the team of employees does not allow you to reach your personal potential or professional goals.

Awareness of little emotional or financial reward

Typically those of us who grew up with a strong desire to help animals discovered the hidden truth along the way that this profession was not the place to get rich. We entered it regardless, determined to make a difference for those animals who needed our help. We were aware right from the start that there would be little financial reward, but we also knew that the emotional reward would tip the scales. This is not true for most jobs; typically you put up with little emotional reward to get a hefty paycheck. However when the emotional rewards start waning – such as when burnout or compassion fatigue creeps up – the veterinary professional starts wondering why he or she is working for peanuts. At that point in time, without the emotional satisfaction of being a caregiver, the team member finds themselves thinking “you can’t pay me ENOUGH to do this job!”

A sense of a loss of community with the work setting

Teamwork is not just the cliché of the decade, it is a palpable energy force that is created when people work toward the same goal. Without this sense of community, this team mentality, the practice becomes filled with many individuals all with their own private goals. There is no internal support to help the team get over obstacles such as busy days and short-staffed weekends. The “us vs. them” concept becomes part of the culture, where different positions or levels within the organization begin feeling superior and thinking others are inferior.

Inequity or lack of respect at the workplace

 While there is a medical hierarchy in veterinary practice, where the veterinarian has the final say regarding patient care, there should be no hierarchy when it comes to respect. The kennel person deserves the same amount of respect as the doctor, and everyone in between should feel this is true. If employees are not treated equally, the team loses respect for the management. It becomes impossible to lead the team if the boss plays favorites or let’s some get away with infractions, while others are disciplined or terminated. The hostility will grow, and management will have a difficult time reclaiming that respect and trust.

As we’ve mentioned, some of these burnout factors can be considered during the interview process. It benefits both parties to make sure there is a good fit. “The greater the mismatch between the person and the work environment, the greater is the likelihood of burnout.“ (Kearney et. al., 2009) We must use this awareness of burnout to create better matches for us and our practices in the future.

The bad news is that in any caregiving profession, burnout is not the only concern; the emotional aspect of our jobs, including the requirement to display or suppress emotions on the job or to show empathy, contribute above and beyond the job stressors of someone not in a caregiver profession.

The good news? It’s been shown that caregivers with more years of experience are less likely to report stress-related symptoms and burnout. So while time won’t heal all wounds, it helps to build perspective over the years as you meet the challenges of the veterinary profession.

Resources:

Compassion Fatigue in the Animal Care Community, book from the Humane Society

Self-care of Physicians Caring for Patients at the End of Life, Michael K. Kearney; Radhule B. Weininger; Mary L. S. Vachon; et. al., JAMA, 2009.