Growing Pains

Our practice is growing.  To be fair, for the first year or two it would have been hard to do anything else. When I took the reins of what used to be called Gladwyne Veterinary Clinic, Dr. Genser had been seeing about 4 patients on a busy day. Now we see 30 patients on an average day. I am grateful for every single client that walks in my door. I am equally grateful for every single employee that helps me to give the most amazing care to each and every client. It is really hard to do things the same way that we used to when we have grown from myself and three incredible employees to the amazing team that we have now. Those are the growing pains. 

Somebody called me to say that maybe I should go back to the way it was. That maybe I wasn't doing a great job anymore. I suppose that I needed to hear that. Don't worry though, I won't go backwards, because that really isn't an option. That would mean abandoning some of my work family, and well, that just cannot happen. I'm sure it would mean abandoning some of the clients and pets that we care deeply about also, I am not willing to do that either. 

I remember many times my daughters complaining about different things that were most likely growing pains, my 13 year old son complaining about them almost weekly now. I don't want them to stop growing. I cannot stifle their growth and continue to treat them like children. I cherish my memories of their baby, toddler, tween years and all that I learned from them during those years, but I look forward to every new day with them as they grow and evolve into something totally different and beautiful.  

That is what I think is happening to GAH. It is growing and evolving into something beautiful that I am proud of and stifling the growth so that we can remain the same isn't an option. We are figuring it out, from little things like adding another phone line and adding a few hours here and there to major things like talking to architects and the township about renovating our space so that it works better for everyone. Soon the growing pains will go away, and we won't be awkward anymore. But just like I'll still recognize and love my babies when they are all grown up, you'll still recognize and love GAH.

Treating Frustration

 

Yesterday I found out that somebody who I enjoy seeing very much was feeling disappointed with the care I was giving her pets. She felt like they were still having so many problems, and that maybe another veterinarian could do a better job.  Because I have enough years of experience under my belt, I wasn't even a little bit insulted; instead I was tremendously worried that my team and I didn't do a good job of treating frustration. I had already thought last night of a few ways that I might hope to regain her trust, but today I had a revelation about how I would prevent this from happening in the first place in the future with other clients.

  

So what happened today?  For about 7 weeks I have been going to physical therapy twice a week.  After a visit to a rheumatologist and a frustrating diagnostic session, she recommended physical therapy among other things.   While every time I saw Logan, the therapist, I felt better, it seemed really fleeting, like any exercises that I continued to do at home weren't helping and I was back to square one at every visit. Luckily, Logan is a great therapist and I trusted him and felt that I should keep going, but today I knew for sure that I should keep going.  Logan did something smart.  At my first visit, during my initial evaluation I filled out a long questionnaire about my symptoms and why I was there.  Then he asked me to do several things and wrote a bunch of stuff down.  Touch your toes, stand on one leg, turn your foot to the right, now the left....so on and so on.  Then, unexpectedly today, I filled out the same questionnaire.  I did all of the same tests.  Together we compared the results.  I had improved significantly.  Yay!   

I had gotten really frustrated, even depressed thinking that I was always going to struggle with this problem and that no matter what I did it wasn't better.  Without an objective way to measure it, I had not really known that I was getting better.  To be fair, this isn't a brand new idea for veterinary medicine, it's just one that I had forgotten about until Logan reminded me and I had my own experience.  

I feel really lucky that studying veterinary medicine gives me a great foundation to understand human medical problems.  It makes it possible for me to be a good advocate for myself and makes it easy on my doctors, I don't really expect them to hold my hand and explain things to me. Knowing that my dear client is frustrated reminded me that just because I know what she should expect with her pet's diagnosis, doesn't mean that she does and a 10 minute run down at every recheck wasn't enough to keep her from getting frustrated with less than 100% resolution of her pet's problems.  There is to be a new normal, and she doesn't know what that is.  

From now on, I am going to do a better job of giving people a way of knowing if their pets are making progress.  It will give me a better way of knowing if what I am doing is working anyway, and then both of us can do better.  It's going to start with a questionnaire and a checklist and a little more hand-holding.

  

Guess what GAH team, a few more checklists are coming your way!   

Work Hard, Play Hard

I had a great conversation with friends last weekend.  Both of the women that I was hanging out with are highly successful, and both have worked really hard to get there.  We were all talking about just that....hard work and how difficult it can be to find young people with our same work ethic. Luckily, I have found great people to work at Gladwyne Animal Hospital with me so far, and we are looking to hire more.  If any of the candidates coming to interview happen to read this beforehand, here is a piece of advice that will make me like you  more: do not say that you want "work-life balance".

I find the phrase "work-life balance" so annoying.  I feel like you could insert the phrase "do everything half-assed".  For example: "I would really like to find a career where I can have work-life balance."  You could also say: "I would really like to find a career where I can do everything half-assed."  I think that a much better phrase is "work hard, play hard".  That says to me, that you want to give 110% while you are working and do the absolute best that you can, then you want to focus 110% on whatever it is that you do while you are not at work the rest of the time.   Work-life balance is only achieved by working hard and playing hard.  If you are doing your best all of the time, whether it is at work or at play, then you have work-life balance. You create it, you don't ask for it in a job interview.

Could you imagine a working border collie herding sheep and then just thinking to himself, "Jeez, this is taking too long, I got most of them, I would really rather go chase a ball, I am going to stop now."  (Border collies are smart, they could possibly go through that thought process...)  No, he is going to work hard and play hard and be a happy dog.

Be where you are.  When you are at work, be at work, when you are at home, be at home. Don't think about what you need to do at work while you are at home and vice versa, then you have work-life balance.  Your boss cannot give it to you.

Now, a note to my husband: If you just read this and are thinking "What??? She just said all of that and she totally worries about work while she is at home!" You are right, but I am trying to work hard and play hard and not be half-assed.  I think that writing it down helps.

Inundated with Information

I love back to school time.  Even more than New Year's Day, I find the beginning of an academic year energizing.  I have loved it since I was a little girl, getting new shoes, a new lunch box, organizing all of my notebooks and folders....it always felt like I was prepared to accomplish great things.  I loved being a student myself, and I love watching my children as students.  As they cover and decorate their books, sharpen their pencils, and pack their book bags, I am reading through the numerous documents sent out by the school district about their plans for educating my family.  Luckily, I have time to do this because of my amazing and competent team at Gladwyne Animal Hospital taking care of everything expected and unexpected that happens there day to day. 

Last night, though, after a full day of kicking butt in surgery and appointments (a topic for a future blog post), I nearly threw the whole pile of back to school papers away.  Here is why, and next is how it relates to veterinary medicine:

I was struggling through the most poorly written document on the introduction of a type of computer called Google Chromebooks to the tools that students will have access to during the school year. I didn't even get to the end of the letter, but on the last page there was a consent form to sign that had, thankfully, a bottom line: my child will need a username and password to be assigned by the school district.  Fine. I am sure that Google Chromebooks are a good thing, but the document was so poorly written that I was not only bored before finishing the first paragraph, I was wondering who the district staff member responsible for writing it was.  That person needs to know that I trust the district to make decisions on implementing new tools, and if I wanted four pages of information on Google Chromebooks, I would have gone to the internet and read some clearly stated information about it.  (I did that this morning.)  What I wanted from the district was about four sentences: "We have decided after researching the evidence to use "x" in the classrooms.  In order for you child to take advantage of "x", you need to do "y".  Here is how to do "y".  Please contact us or go to "z" web page if you have questions about "x" or "y"."  That would have been ideal, but if they really felt the need to give a large amount of information, they should have proofread it.  The letter was awful.

How does this relate to dogs, cats or veterinary medicine?  I hope that I have earned the trust of my patient's owners and that they know we are always there to answer all of their questions any time.  With that, I think that most of those very busy people really just want to know clearly and  concisely what I think the problem is, and what action they need to take to solve the problem.  At that point, if they have questions, I have answers. 

Lower Merion School District has earned my trust.  The teachers and administrators have not let me down.  While I still love back to school season, I do not have time to read infinite pages (nor do I want to see that much paper wasted) about policies and procedures.  I trust that the policies and procedures are valid, and if I have a question, I'll ask.

Two ears and one mouth

I read a commentary article in a recent JAVMA (Journal of the American Veterinary Medical Association) issue that made me feel pretty good.  It was entitled "Reactive versus empathic listening: what is the difference?  Before I started reading, I was pretty sure that I knew the difference.  After reading, I felt grateful that I have been practicing empathic listening for most of my life.  I found the article both interesting and inspiring, and made me want to make sure that I do not forget just how important listening is.

It seemed funny to me, though, that an article needed to be written about listening as a way of coaching veterinarians who are practicing reactive rather than empathic listening. 

In a nutshell, here is the difference: Reactive listening is listening with the motive of formulating a reply.  Empathic listening is listening with the motive of understanding the concerns of the speaker.  Reactive listening will most often result in a response that is based on the listeners point of view, and usually involves interruptions and interpretations.  Empathic listening, if there is time, will usually be more rewarding, because the goals and problems presented by the speaker will be more fully understood and addressed. 

There were many times when I first started practicing that I felt like there wasn't enough time to really address the concerns presented in an appointment or I even failed completely addressing only what I thought the problem was.  When I opened Gladwyne Animal Hospital and could do things my way, I decided it was important to make my appointment intervals longer than the usual 15 minutes.  It is so important to me that people have enough time to get comfortable and remember everything that they wanted to say.  I am able to just listen without interrupting.  The funny thing is that I learned how to do that over thirty years ago!  I am the youngest of six kids, and my older brother Jeff has always given sage advice.  One of the things that he always used to say to me was that "You have two ears and one mouth for a reason. You are supposed to listen twice as much as you talk."  He is usually right. 

Interestingly, while I was thinking about writing this blog post, I was waiting for a Doctor appointment of my own.  I waited for 45 minutes with no interaction when I finally, politely, told the receptionist that I would have to reschedule.  She told me that she was sorry, but the doctor had 40 appointments scheduled for today, and was behind.  Of course he was behind!  How can you possibly see 40 appointments in one day!!!!  None of the patients could possibly be getting the chance to be empathically listened to.  I was glad that I had decided to leave.  I hope that nobody ever feels that way in my office, and it is my goal that they never do. 

I will admit, though, that sometimes after a full day of empathic listening in appointments at work my kids get the short end of the stick.  Sometimes they sound like the teacher from Peanuts, you know "wha wha wha whaaa, whaaa,whaaa...." and I may have said yes to some requests to which I should have said no!

 

This is me learning to sit quietly on my brother Jeff's lap.  Early lesson in listening skills....

Informative and reassuring, or overwhelming and off-putting...

I ask myself this after nearly every new puppy or kitten appointment.  There is just so much information to share with a new owner, especially if they have never had a pet before.  If the new puppy or kitten came from a shelter then I feel like I am overwhelming and off-putting.  If the person went to a breeder or pet store, then I feel like I am informative and reassuring.  That is a bummer, because I really love when people can rescue their new addition from a bad situation, but I feel like they never get enough information.  So as frustrating as breeders and pet stores can be sometimes, they do make that new kitten and puppy appointment easier somehow. 

Here is some support for how I am feeling.  Yesterday, I saw a friend in an appointment with her new kitten. The kitten is absolutely adorable and she and her 3rd grade daughter are in love with him after only one short week.  They made an appointment for a check up just so that they could be sure that they knew what they were supposed to be doing even though the foster family said "that everything has been done already" at the adoption event where they went to rescue him.  Well, if "everything" means neutering and a Rabies vaccination, then sure, everything was done. I cannot even be 100% sure that the Rabies vaccine was done, the paperwork just didn't jive in some instances.   For example, his birth date was October 20th, and the first vaccine was given on October 27th.  I doubt it.  That would be pretty strange.  So, after examining this sweet thing and reviewing all of the paperwork, and checking for the microchip that was supposed to be there and wasn't, we discussed all of the findings and the to-do list. 

The findings:  He is an adorable kitten with a lovely disposition.  He has the usual complement of shelter/rescue cat problems which are; ear mites, worms, a resolving cold, and very stinky gas.  I can fix all of that with relative ease most likely by asking his new owners to employ my to-do list, but is that overwhelming and off-putting?  Do I seem like I must have some vested interest in a pharmaceutical company (nobody is mentioning Pfizer in particular, here...). 

The to-do list:  First of all, consider a Leukemia and FIV test and consider a series of Feline Leukemia vaccinations and installing a Microchip since he didn't have one like he was supposed to have had.  However, with the remainder of the must do items on this to-do list, maybe we should spend the money elsewhere.  Treat the ear mites, send out a few serial stool samples to ensure that we eventually eliminate the scary zoonotic (transmissible to people, even 3rd graders!) parasites, deworm him right away before even waiting for a stool sample, begin applying topical applications of Revolution monthly to maintain a parasite free environment, start a special diet with prebiotics to help eliminate the stinky poops while we wait for the parasites to go away and for his little belly to straighten itself out, and go from there. When I say go from there, I hope that it doesn't mean test him for FeLV and FIV because he isn't getting better.

Can I really expect this person to now have a discussion about routine care and wellness after all of this has been thrown at them?  Would it be ridiculous to suggest that they come back for another appointment in two or three weeks just to discuss wellness since we had to gloss over wellness so quickly? 

Why do foster families and shelters mislead people by saying that everything is done, you just need to make a donation and you are good to go?  Most often, these pets are far from "good to go" and the people end up spending about as much as they would have if they had purchased their pet in the first few weeks.   I am not suggesting that people purchase rather than rescue their pets, I just wish that they were made aware of the potential problems and expenses that they may incur.  In this case, I am lucky, because my friend wants to do the right thing, and without even knowing there was a problem, made an appointment.  But what if she had just waited until the Rabies vaccine was due next year?  Well, chances are she would have never made it that far before the diarrhea began, but if she did, that poor little guy would have suffered with ear mites for a whole year!  I am willing to bet that his ears would never recover to a completely normal state if it had gone untreated.

I hope that I was informative and reassuring, but I am afraid that I was overwhelming and off-putting. 

I can finally get some sleep

Cats and dogs eat crazy things, and those crazy things can occasionally get stuck somewhere in the middle.  When this happens, we call it a Foreign Body Obstruction (FBO) and they can be pretty simple to remove or a total disaster.  If the foreign object hasn't been in there for very long and it is visible on an xray, that usually results in a good outcome, but if Fluffy isn't telling her owner just how sick she really is, and the item is not visible on an xray (metal, bone or some other dense object), then things can start running downhill quickly. 

This is Cookie, he looks like a good boy, right?



This is Cookie's story. What Cookie swallowed wasn't that big, but he isn't much of a complainer and didn't start to act like he was sick until about a week after eating a large bead from a child's jewelry making kit.  I have to imagine that most of the time, these things are swallowed by accident, I can just picture him playing with it, carrying it around in his mouth and then, GULP, down it went.  At first his owner wasn't worried,  she hadn't seen him swallow the bead. Eventually she brought him in and we were able to figure it out pretty quickly.  I didn't know what he had swallowed, but I knew that we were going to find something.  Well, that bead managed to get out of the stomach, but got stuck in the duodenum, right next to the pancreas.  Ugh, the pancreas is so sensitive, I don't even like to look at it.  Well, with it having been there for a week or so, that piece of duodenum was pretty grumpy.  If it is questionable whether or not a piece of intestine is going to survive, we just take out the whole section and put the good, healthy ends back together.  But in this case, I really wasn't willing to take out that section of duodenum because of its proximity to the pancreas unless it had already fallen apart, so I made an incision into the duodenum, took out the bead and closed it back up. I put in my usual "sleeper stitch", which is that last stitch that you put in when you are asking yourself or your assistant, "do these look like they are close enough together?" so that you can sleep knowing that the sutures were definitely not too far apart.  That didn't really work for getting sleep though, like its name suggests. 

I have a friend who is an amazing human cardio-thoracic surgeon, so as usual, I told him about the case and asked, as if he had a crystal ball, did he think that the duodenum would live.  His answer, of course, was that he didn't know, but he would have made the same decision and in fact used to go running from any procedure involving the duodenum and pancreas as a general surgery resident.  That made me feel better, but not better enough to sleep well for about 10 days.

It was finally at that 12th day when Cookie came in to have his sutures removed that I had a good night sleep.  Any problems from here on out couldn't be a direct result of my surgery.  I also let my kids off the hook during bedtime prayers, they could pray for whoever they wanted instead of saying "God, please let Cookie get better". 

This is the bead that Cookie swallowed.

Cookie is back to his playful self, as lovable as ever.  Now his owners are probably the ones losing sleep trying to keep their house Cookie proofed.  That is not going to be an easy job!