I readily admit I take longer than most veterinarians to complete client visits. That has been a factor in my professional life since I first set foot in Marina Animal Clinic in 2000 as a new graduate. In our fast-paced, volume-based, walk-in clinic, the emphasis was on seeing clients efficiently and crisply because the lobby was cram-packed and we wouldn’t turn anyone away.
However, with the passage of time and attrition of veterinary staff, we’ve adjusted the clinic hours. We now close for lunch, and we have check-in deadlines so staff members can hope to end the workday before 7 p.m.
I take too long during client visits because I make a point of looking pet owners in the eye, listening to them without interruption and trying not to make a snap judgment about my diagnosis. I pet their dog or cat and think of something positive to say. They aren’t as obsessive-compulsive as I am, so I don’t shame them about preventive veterinary care. Instead, I teach them about their pets’ problems by explaining the causes and effects and making extensive use of handouts. Sometimes, I Google subjects in front of them when I am unfamiliar with an issue so that we can learn together. A recent example was a young pit bulldog with sudden-onset muscle atrophy in his left cranial hemisphere. I figured out, and shared with my client, that he likely had a trigeminal nerve dysfunction.
Dr. Gruff
Is taking too long a professional asset or liability? Yet another personal experience inspired me to write about this subject.
After I moved to a new home last June, my right hip became increasingly painful, so I made an appointment with an orthopedic surgeon who worked at a hospital I discovered years ago after a carpal injury. The visit was brief, and the orthopedist didn’t ask many questions. He sat at a desk, examined my radiograph on a computer, and declared that I had arthritis and probably needed a hip replacement or regenerative medicine. He recommended a corticosteroid injection and subsequent scheduling of a hip replacement or stem cell treatment. Handing me a stem cell brochure, he left the room. I asked his staff members about the injection and was told, “That is usually done upstairs,” so I left and called back to reschedule it.
When I returned a couple of weeks later for my corticosteroid injection, I waited 90 minutes to be shown into an exam room, where I waited again. A staff member finally brought me into a treatment room, where my doctor was on his cellphone. He was agitated and swore at the other party while gesturing to me to get on the treatment table.
The injection was administered. As I left, I asked about the name of the drug because, as a veterinarian, I was interested. He said it was a corticosteroid. I asked again. Annoyed, he said, “That is the drug.” But I pressed him and finally got a precise answer.
Feeling disrespected, I left the clinic and vowed to write my next column about professional behavior. I thought about it for a while and recalled occasions in my veterinary practice when I felt impatient because a client asked in-depth questions based on internet research. To me, such conversations came across as laypeople questioning me about a subject for which I had hours of education and training.
I felt petty. The man who administered my injection is a nationally renowned orthopedic surgeon, I reasoned to myself, and maybe I needed to set my feelings aside and focus on his professional ability. I wrote instead about my life in the veterinary trenches.
Dr. K
Harboring mixed feelings, I made an appointment for a second opinion with another doctor. Amid much second-guessing and soul-searching, I asked myself whether I was placing personalities above principles. But I kept the appointment, and that’s where I learned yet again to trust my gut, and it reinforced the kind of doctor I want to be.
Doctor No. 2, Dr. K, showed me my radiograph and pointed out areas of concern. He told me I might have arthritis, bursitis or both. Prompted by my questions, he explained the difference. He spent time gathering information on the location and nature of my pain. Dr. K decided to start with another corticosteroid injection to see how the joint responded, and he wanted to recheck in three weeks. While surgery might be indicated, he said, physical therapy might be the first step, but he needed to make an informed diagnosis. Dr. K then told me he was always available by email. He gave me his card, and he moved me to a treatment room, where he administered a lidocaine-infused injection into the hip joint. He then asked me to move around to distribute the medication.
Who knows whether I will need surgery? I can tell you I feel better today, know what to look for in diagnosing my hip pain and have a follow-up appointment to reevaluate my case. A doctor looked me in the eye, asked me questions, showed me what he saw and made a game plan.
I have confidence in Dr. K because he took the time and didn’t make a snap judgment. He came across as a thoughtful, wise clinician. I believe that confident doctors have no need for arrogance or defensiveness about their work.
Better Bedside Manner
It’s been said that what you like or dislike in others is what you like or dislike in yourself. Dr. K is the kind of doctor I want to be, and I guess I am. Yes, I have a good education and 24 years of experience. I love animals and am interested in their owners. How I treat the owners will translate to the care they give my patients. In addition, the interest I show in my job could prompt an interest in my clients and inspire them to follow my instructions. The positive reinforcement and encouragement I give my clients could inspire them to take better care of their animals.
If I take extra time to help someone understand a problem, I consider it time well spent. I approach each case from scratch and work it up. For example, sometimes a simple ear cleaning and eardrops will do. Other times, it’s drainage of an aural hematoma and an estimate for surgical repair. Importantly, I allow myself to consider my client’s concerns and address the possibilities.
There’s an art to determining which cases need in-depth diagnostics and which can be handled more simply. Sometimes, I treat a problem symptomatically and caution my client that further investigation and treatment might be required. Even though my education might open my mind to a Pandora’s box of maladies, I remember the great pearl of wisdom that states, “Common things occur commonly.” In other words, “When you hear hoofbeats, think of horses, not zebras.” (Credit goes to Dr. Theodore Woodward, a professor at the University of Maryland School of Medicine, circa 1940.)
I still wrestle with the stressful challenge of professional efficiency while making a thorough investigation of my patient’s medical problems. It takes time and practice. My goal is not to sacrifice my professional instinct and responsibility for the sake of saving time or taking thoughtless shortcuts.
OPPORTUNITIES FOR IMPROVEMENT
A study of veterinarian-client communication published in the Journal of Veterinary Medical Education (bit.ly/3SN3PtY) found that “Nearly all respondents believed that communication skills were equal in importance to or more important than clinical knowledge.” However, “More than half were not willing to make additional communication skills training a priority.”