My search for a seasoned associate veterinarian was unfruitful, so I started looking for a new graduate. After reading about mentorship programs and knowing myself and how clinic schedules blow up regularly, I realized I had to be intentional, creative and multidimensional when counseling a young colleague. As I reflected on concepts I knew and articles I read, I devised a detailed mentorship schedule. However, I scratched my head when I thought, “How do I share my experiences without sounding like, ‘Back in the olden days …’”?
Enter Leroy Jethro Gibbs, a character on the TV series “NCIS,” which my daughter talked me into watching a few years ago. The “Gibbs’ Rules” of investigation were quoted regularly and admiringly by his younger colleagues as they explained to a probie how a specific rule applied to a particular situation.
So, I thought, “I need the “Gibbs-Ramirez’s Rules of Veterinary Medicine.” Thus, they were born.
Words to Live By
In a helpful and relaxed way, I shared my experiences with my new associate. For example, on the medicine side:
- Rule 17: “Common diseases occur commonly.” Rule 17 ties into:
- Rule 18: “Uncommon manifestations of common diseases are more common than common manifestations of uncommon diseases.”
I reminded my associate that veterinary teaching hospitals are referral centers by default, so they see all the “uncommon diseases.”
Some rules are reminders for me, the mentor:
- Rule 28: “Make clear to clients who complain about other doctors in the practice that the veterinarians have my full confidence and support.” It’s like Gibbs’ Rule 15: “Always work as a team.”
In addition to medicine rules, my list covers the challenges of practice. For example:
- Rule 9: “He who gets the ear of the client first has the most authority.”
- Rule 39: “Underpromise and overdeliver.” That one is vital when setting client expectations.
Bring up this tenet early in the mentoring:
- Rule 44: “Most things worth doing are worth doing poorly until you get good at them.”
New doctors want to be liked by the staff and go out of their way to assist. However, newbies must remember:
- Rule 33: “When you haven’t finished your records, it does no one any good to help the staff put things away and clean the room. Entering your notes can be done only by you.”
Then there are those bedside manner and client relations rules that differ significantly from what new graduates saw in the university clinic.
- Rule 27: “If you do something for the pet or client and they don’t know you did it, then you actually did nothing.” Rule 27 ties into:
- Rule 38: “Paint a picture of what the client can expect.” Do it when the client is waiting in the lobby, with you in the exam room, or when your technician is taking the pet for tests. Failing to paint a picture fills the client’s mind with TV miracles and Google expectations.
The next rule is critical because we know cases don’t always go as we expected. Therefore we apply:
- Rule 36: “Animals don’t always read the book on how to respond to a treatment.” When a case doesn’t go as planned, a helpful way to speak with a client sounds like this: “Well, that wasn’t how Fluffy was supposed to respond, but we all know Fluffy is unique.” The client always chuckles and responds, “Yes, she is!” This leads to:
- Rule 49: “You don’t have to be serious to be taken seriously.” Introducing humor when speaking with a client is critical to your enjoyment of practice.
Decisions, Decisions
Another matter I raise in a mentor-mentee relationship is decision fatigue. Psychologists are conflicted over whether it’s real. Yet, any practice owner who made tough decisions through the early stages of the pandemic can attest that decision fatigue (or decision overload) is mentally draining.
Before COVID, I experimented with decision fatigue by counting the decisions I made in a day. During each adult pet exam, I counted two eyes, two ears, 30 to 42 teeth, one neck, four legs, one heart. Each evaluation included a decision (normal or abnormal, though we know there’s more to it), and each blood test parameter demanded a decision (normal or abnormal). And then there’s surgery, so let’s stop counting. I figured I ended up with 1,600 to 1,800 decisions a day.
As that was fresh in my mind, I devised a mentorship schedule for my new doctor, who did not know the computer software or our routine and had not created her own exam protocols or client interaction customs. I knew that to give her the best chance for success, I had to work into the mentorship schedule a way to spread out the decision fatigue.
The doctor started the first week by shadowing the reception team. We insisted on her wearing her lab coat and being called “Dr. (Last Name)” by all staff members. Also, knowing that she got into veterinary medicine to examine pets, we had her shadow me for the last hour of the morning and afternoon shifts. I introduced her to clients as “Dr. (Last Name), who is learning the computer systems and routine today. You know how weird the computer systems can be!” The clients were receptive and even laughed at that explanation.
Then, after each morning and afternoon session, she and I spent an hour in rounds. We talked about what she had learned and “Why did you treat the patient that way?”
During that first week, I made sure to explain how we implemented Rule 39 (underpromise and overdeliver) and Rule 38 (paint a picture for the client of how the problem should resolve). I talked about how we customized rules for individual clients and patients.
I made sure by the end of the first week that she knew how to do software things, such as:
- Look up a client.
- Find a pet’s last procedure and last prescribed medication.
- Check a patient’s vaccine and medical history.
- Schedule an appointment.
- Update the electronic medical record.
- Locate check-in sheets and client reminders.
Early on, we set up mutually agreed-upon parameters for when she would start seeing healthy and sick pets, how much time she would allot to each, and how often she would work on reducing the exam time. We also agreed on when she could be left alone for half a day and then for an entire day.
Understanding that many new veterinarians are nervous about doing something new, I would ask, “Do you want to see this patient?” She was always willing.
I made sure not to pose unreasonable questions. In other words, I didn’t ask her to see a client with a new puppy that first week before she knew the software and all the staff names. After learning the routine for three weeks and seeing me do things several times, I extended the invitation.
DVM HUMOR
Dr. Ray Ramirez is a naturally funny guy. Among his one-liners are:
- When using an ophthalmoscope: “We want to check the eyes to see if he needs glasses.”
- When he sees a dachshund or Corgi: “Maybe we can put you on the rack to get you longer legs like we did to create Great Danes.”
- When preparing an injection: “Everyone who is afraid of needles can turn the other way — except for you, assistant.”