Working with your vet

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When we say, "Talk to your vet," what do we mean?

[00:01:04] Dr. Lancellotti: Welcome everyone to today’s episode of Your Vet Wants You To Know. Today’s episode is a little bit different than some of the other topics that we’ve covered on the show. Most of the other topics have been talking about specific diseases or disease processes and exactly what’s going on with your pet. Today, we’re going to be shifting our focus a little bit. We’ve talked a lot about the teamwork that’s required between pet owners and veterinarians, as far as managing their animal, figuring out what’s going on, and coming up with a plan together. But I wanted to dive a little bit deeper into how exactly to build that relationship- what you can do to talk to your veterinarian in a way that helps create a really successful team, so that you can get the best care for your pet possible. I’ve brought back a special guest with me, Dr. Curtis Plowgian. He’s been on several of our other episodes on steroids and scabies to talk a little bit about what that communication looks like. So welcome back to the show, Dr. Plowgian.

[00:02:05] Dr. Plowgian: Thanks. It’s great to be back. The topic of communication between the vet and the pet owner is a really important topic, in general. But this is a particularly important time, I think, to discuss it. The pandemic has really faced both veterinarians and pet owners with new challenges and new stresses when it comes to communication. Veterinarians and pet owners are under unprecedented levels of stress and many veterinarians feel that they are victims of client bullying and harassment, and that has led to widespread problems with burnout, mental health and even suicide within our industry. I don’t think most clients intend to be mean to veterinarians or their staff, but sometimes when they’re frustrated with their bill, or the results of their case, or just really stressed out because their pet or their family member isn’t feeling well, it’s easy for them to take it out on veterinary staff or veterinarians. I’ve seen a lot of Facebook posts talking about ‘Not One More Vet,’ which is a suicide prevention group on Facebook and people telling pet owners, “Please be kind to your vet. We’re under a lot of stress.” But without concrete steps about how to do that, I’m not sure that message really resonates with people or would really benefit them. So I wanted to lay out some specific steps that owners could take to better communicate with their vet, to better advocate for themselves and their pet, and see if we can overcome some of these common pitfalls that we see in the veterinary office and improve the relationships and interactions between vets and pet owners. 

A tough conversation

[00:03:48] Dr. Lancellotti: That’s great. I’m so happy that you were able to come on and want to talk about this, because I think that there are a lot of really good tools that we’re going to lay out today, and some really helpful ways that pet owners can communicate with their veterinarian. Tell me a little bit about an interaction that you had that kind of demonstrates why this communication is so important for us to have. 

[00:04:08] Dr. Plowgian: Yeah, sure. I had a client come in a few months ago and her dog had chronic ear disease. I had seen her once before, about 6 months prior to this visit, and she was supposed to come in for a 2-week recheck that she never showed up for. She had run out of medications and her dog’s ears were back to square one. They were a complete mess again. And so I asked her, “How are you doing today? How’s your dog doing today?” And the first thing she said to me was, “Well, Doctor, I just need you to find me an ear drop that actually works so I can stop wasting time on all these appointments with you.” And if you want a masterclass in how not to talk to your veterinarian, that’s about as concisive an example as you could get. I was actually fortunate that it was a curbside appointment, because if we had been in an exam room together, I probably wouldn’t have been able to hide how upset I was. I probably wasn’t even able to hide it over the phone. So the rest of the conversation with her, I was probably a little bit defensive, speaking a little faster, etc. Not all ears can be cured with drops. Some of them need more expensive procedures- videotoscopy under anesthesia or even surgery. She had really put me on the defensive. I was still giving her sound medical advice, but it changed the tone of the whole appointment. And when we got to the end of her appointment, I actually had to hear from the technician (when she brought the dog back out to the owner in her car) that the owner was crying in her car. She told the technician how upset she was because she couldn’t afford the more expensive procedures, beyond just the drops that we were trying. And it made me feel bad. It didn’t make it okay (how she was talking to me), but it made me understand where she was coming from at least. And those are the clients that I would really like to help, when you’re in a tough spot, how to not ruin your vet’s day.

What does good communication look like?

[00:06:04] Dr. Lancellotti: Sure. And how to get the most out of the relationship that you have with your veterinarian too. We want to be able to communicate with you and figure out how we can work together as a team. In an ideal world, how do we want a veterinarian or a pet owner to communicate with us?

[00:06:22]Dr. Plowgian: In general, there’s no ‘one-size-fits-all’ solution to everyone because there are different people from different cultures with different communication styles. But I think that some general things we can try to stick to, as rules of thumb, would be to keep our communication respectful (free of insults or attacks, etc). Anger and impatience are really easy to translate into disrespect when your vet’s overwhelmed and you’ve been waiting 20 or 30 minutes to get in for your appointment. It’s easy to get impatient and short with people, but we want to try to maintain respectful communication. Honesty is another big one. “The truth, the whole truth, and nothing but the truth,” is that old court standard. This is one where a client’s fear of judgment can get in the way. The classic example would be the dog who’s eaten marijuana. It’s a very tender subject and that can be a legal issue in some states, but veterinarians, if they’re doing their job, want to create a judgment free zone in the practice. They’re not going to judge you for what’s going on with your pet, but they need to know everything if they’re going to do their job the best they can. Similar to honesty is having open communication. This is more on the listener’s side than the talker’s side- being open to unexpected information, being open to different opinions or perspectives and withholding judgment. If you’re going to have a place where we can be completely honest about what’s going on with the pet, we need to be open about listening, and so this is something that vets can work on as well. Personally, I have a challenge with concise communication- getting to the point without too much information or words. I’m a talker. Part of why I’m in derm is that we have long appointments and we have complicated issues that we’ve got to explain. And I’m very happy to go over all the ins and outs of those with owners, but sometimes, when we have a pressing concern or there’s a vet with a compressed schedule, we really have to get to the point. So this is one I have to work on, but owners, when they’re talking to veterinarians, if you have distilled the problem down to something concise and you can tell the veterinarian exactly what’s going on as quickly and in as few words as possible, it’ll really help move the appointment along and help prevent any stumbling blocks that could come from going down a rabbit hole for something you didn’t even bring the pet in for.

[00:09:04]Dr. Lancellotti: So in an ideal world, we hope that everyone working together can be respectful, honest, open, and concise with the information that they’re giving.

Challenges to successful communication

Dr. Lancellotti: Because we live in the real world, there are challenges to this communication. What do you think are some of the stumbling blocks for successful communication when a pet owner is at a veterinarian’s office? 

[00:09:26] Dr. Plowgian: Oh, there are so many. One that everyone seems to know, as one of the challenges of being a vet, is that pets can’t talk to us. So, veterinarians can learn a lot from a physical exam, but we can’t ask the pet, “Where does it hurt?” or things like that. And if we need to know if a condition has progressed over time, if the pet looks different at home than they do in the clinic, or what medications or vitamins or supplements or even food/diet that the pet is on, all of that information has to come from the owner (or sometimes, the husband of the owner, who might not know as much as the caretaking owner would).  

[00:10:08] Dr. Lancellotti: Blaming it on the husbands. Huh? 

[00:10:09]Dr. Plowgian: I don’t mean to stereotype, but I would say that, typically, the husband is the one who knows less when they come into the vet’s office. And then from the owner’s side, having been a pet owner who’s taken my own pets to the vet, I know it can be difficult to remember every detail that a veterinarian might want to know (their vaccine history, the number of bowel movements they have per day, the names and doses of every medication that they’re on, etc). Normally, there’s also a time limit on the interaction that you’re allowed to have with your veterinarian in an exam room. A lot of vets only have 15 minutes per appointment, for example. So, that really puts the owner and the veterinarian on a time crunch to have their thoughts organized and keep the appointment moving and on time. Two of the biggest hurdles to effective communication that I’ve seen in veterinary medicine are when something is urgently wrong with the pet (life-threatening), or the pet has a chronic problem that has been addressed by multiple veterinarians, no one has found a solution to it, and the owner or the veterinarian are really frustrated about it. Personally, in dermatology, I don’t see very many emergencies anymore. But I see a lot of that second category- that chronic frustrating category. And it can be really frustrating and difficult, for both myself and for the owner, to stay positive in those cases. So those are the things that we need to try to overcome. 

[00:11:44] Dr. Lancellotti: Yeah, I absolutely agree that the frustration of chronic disease being a barrier to good communication is something that I feel in my practice as well. And in those cases where the animal doesn’t respond as well as I expect them to, I almost feel a sense of, “This client’s going to be upset with me because their pet’s not doing well.” And so having that open communication and honestly saying to the pet owner sometimes, “Hey, as a veterinarian, I’m frustrated as well,” is important in  sharing that experience because we are a team, right? When things aren’t going well for the team, the team should talk about it. But as veterinarians, we try and set the owner’s expectations as far as how we would like to manage the disease, but the animal and their body doesn’t always respond to treatments the way that we’d like them to. So having open communication, not hesitating to discuss any setbacks that you’re seeing, but we also want to share those successes with you. And that’s going to help the veterinarian adjust the plan to manage that ongoing chronic condition and help with your pet’s progress.

Challenges posed by the pandemic

Dr. Lancellotti: The pandemic (certainly for our practice, but for many other veterinary practices), hasn’t made any of these challenges easier. What are you seeing as far as the changes that the pandemic has brought to your clinic? 

[00:13:10] Dr. Plowgian: It has definitely increased many of the challenges that we face on a daily basis. On one side, I don’t want to complain, because veterinarians have been really fortunate during the pandemic to have been able to stay open. We’re deemed essential workers. Our businesses have stayed open. We’ve maintained an income, but we’ve had to completely change how we do everything, not just from a safety perspective, but from a logistics perspective. We don’t have the same face time with owners that we used to have. We don’t have the owner and the pet in the same room to say, “Hey, what’s this lesion right here?” It’s a whole new way of putting the pieces of the picture together. It can be difficult mentally and physically for veterinarians to adjust to the new schedule. I had to get a headset because I spend 20 minutes of each new appointment getting a history. And now that I do that on the phone, I’m on the phone all day, every day at work. And when I was cradling that against my shoulder, it was giving me neck and shoulder problems. There are physical challenges to it too, but it also has changed the flow of appointments, which especially early in the pandemic, has really made things slower. It has also made veterinarians get behind in their schedule, and that puts stress on the staff and the veterinarian, and also shortens the temper of clients who are there with their pets. We’ve been able to adjust and adapt. It’s been a year now, but there are still, even with that amount of time passed, owners that are still upset they can’t come in the building. They’re worried how their pet will be treated when they’re not there with them, that their pet will be stressed if they’re not there to pet them or hold on to them, or they even sometimes fear that the veterinarians or staff might be abusing their pet, if they’re not there to keep an eye on them.

[00:15:07] Dr. Lancellotti: Yeah, I can certainly understand pet owners’ frustration with not being with their pets during the exam. As a pet owner myself, I’m nervous about dropping my pets off with their primary care vet as well. I get it, but I know how much the staff and the vets there care for all of the animals that they see. Even Russell Sprout, the ‘Your Vet Wants You To Know’ mascot, who is not a happy-go-lucky golden retriever, who has to be handled a certain way before his anxiety level ramps up. Every hospital across the country has been completely inundated with a spike in visits from pet owners that are home with their pets and noticing more problems that they didn’t notice because they were out at work all day long. We’ve also had a huge increase in the number of new pet owners from people who are getting pandemic puppies and kittens. Then, people are having their own challenges throughout this time. There are staffing shortages because parents are trying to balance work and childcare, personnel have to stay home to quarantine after testing positive or being exposed, and some hospitals have even split their staff into teams to minimize exposure between as many people as possible. It’s difficult to have as much help and as many hands available to move things as quickly as we usually do (pre-pandemic). And really, we wish that there were more hours in the day to be able to take care of all the pets that need to be seen, and I know a lot of that burden has fallen on emergency rooms. Certainly, ER veterinarians and their staff are feeling a lot of the stress, because pet owners want to get their pet in and be seen when something’s going on, and maybe their family veterinarian isn’t able to do that as quickly as they’d like to. A big source of frustration for pet owners is the availability of exams. If you, as a pet owner, notice that something’s going on with your pet, don’t wait. Call to schedule a visit and understand that it will likely take a little while for your vet to be able to see your pet, and if your pet does improve before that scheduled visit, you can always call and cancel. Make sure that you’re giving adequate notice, so that they can get another pet in who may need to be seen urgently that day. If you have to wait longer to be seen than usual, or if your appointment is taking long, these are some of the reasons why. But trust me, your veterinarian’s doing the best that they can to try and care for as many pets as possible.

Communicating openly about finances

Dr. Lancellotti: I know money can be a difficult subject for people to talk about, so I want to address this as well. What do you think is the best way to discuss concerns about money and the cost of the bill with the veterinarian and their staff in an open and honest way? 

[00:17:51] Dr. Plowgian: I think, open and honest is so important. Money can be a taboo and a socially awkward subject in our country, and if you’re working within a budget and the treatment plan goes over that budget, that can be a really difficult subject to breach. Sometimes, there can be fear of judgment. Every client who sees me tells me that they want to do everything they can for their pet, but finances are a reality that we all face. For me, ideally, the more direct the communication, the better. If you have a budget for that day’s visit, and the plan that I’m proposing is going over that budget, letting me know directly and openly and honestly is great. If you say, “Doctor, we have a budget of $500 and that treatment plan is just not going to work,” then I can say, “Oh, okay. This is what I can tweak and change to get us into that $500 budget.” I know that can’t always be the case, because sometimes when you’re taking your pet to the veterinarian, you’re just trying to find out what’s wrong. You’re on a fact finding mission and you don’t know what the problem is or how much fixing it is going to cost. Sometimes, the cost is going to be way more than you expected, even if you didn’t have fixed expectations. Even if you didn’t have a budget, hearing that big number can be really upsetting. And when that happens, the most important thing to do is to try to take a step back, take a deep breath, and not lash out and take out your frustration of the situation on the person in front of you (or in this case, on the other end of the phone). There’s nothing wrong, for example, saying to a veterinarian, “Wow. That’s way more than I expected. I’m not going to be able to do that today.” But it is important not to go to a place such as, “Why is this so expensive? Do you even care about my pet or do you just care about the money?” When I was in school, the guidance counselors would teach us about “I” statements. “I feel when you… etc.” And as lame as those were, if you’re upset with something, and you can keep the focus on what is upsetting you and how you feel about it, rather than projecting the anger or blame onto the person that you’re interacting with, it’s a lot less likely to give offense and keep the communication respectful and open.

[00:20:19]Dr. Lancellotti: Yeah. Certainly, money can be a tough subject for anyone to discuss. And I know there’s a lot of heavy feelings that come along with not being able to afford veterinary care. Most veterinarians that you talk to are going to present the pet owner with what’s considered the gold standard (as far as testing and treatment), which is usually more expensive. But the gold standard often gives us a lot more information when it comes to testing, and as far as gold standard treatments, it usually carries less risks and less side effects. But if the gold standard is not something that your family can afford, then I think the thing to ask is, “What other options are available if this is out of my budget?” A lot of times, veterinarians may be able to offer other recommendations. They might not give you as much information, as far as what’s going on. Maybe the medication carries more risks or side effects associated with it, but there are other options. 

Advocating for your pet

Dr. Lancellotti: What would you say to pet owners who feel like their concerns aren’t being addressed? If the vet visit doesn’t go the way that they expect it to, what do you think the owner should do if they feel like they’re not being heard?

[00:21:33]Dr. Plowgian: It’s important to remember that, while veterinarians have a lot of training and a lot of and expertise, we’re still people and people still make mistakes. This can include communication mistakes. There’s a case that I will always remember. If you guys have heard me on this podcast before, you guys know scabies is my favorite disease. Well, I missed a case of scabies that was right in front of me and it haunts me to this day. There was a 10 year-old golden retriever that we saw and it had this swollen leg. It’s one front leg was 3-4 times the size of the other legs on the body, and that was all I could focus on. I was like, “There’s gotta be some sort of tumor or terrible infection cutting off the blood flow to this leg. It’s so swollen. Have you had this checked out?” And the owner was asking me, “Doctor, the dog’s itchy. I brought you here because the dog was itchy. Why are you so focused on the leg?” And I was like, “Itch is important, but if your dog has something life-threatening, I really need you to get this leg checked out.” And I was just so focused on the leg (because I thought that was an emergency), I wasn’t listening to what the owner was trying to tell me. He already had another veterinarian who was addressing the leg, and by the time he left my office, even though I had discounted his appointment, he was still really upset. He didn’t feel like he got what he wanted, and I didn’t even know that I could have solved his problem until I got a call from his referring veterinarian who said, “Hey, we have this dog under anesthesia to biopsy the leg and this dog is scratching itself under anesthesia.” I was like, “Oh my God, the dog has scabies. Nothing makes a dog that itchy. I totally missed this.” So for me, that was a big learning experience to say, “Even though I’m the doctor, sometimes I have to listen to the owner who brought the dog here for a reason,” and not have that tunnel vision. People have their own biases, their own foibles, and they’ll make mistakes. I think that owner did an okay job advocating for himself, but sometimes when you have a veterinarian like me, who’s stuck on one thing and you have to redirect their focus, it’s important to be an advocate for your pet. Even the best vets can make mistakes, and if you and your vet aren’t on the same page about what the top priority of your visit is, sometimes you have to be able to clearly communicate what you want and redirect the course of the visit. It can be difficult to be assertive about what you want without being aggressive, especially if you don’t feel like someone is listening to you (the way that I wasn’t). But the squeaky wheel gets the grease and speaking up to advocate for yourself and your pet is really important. And at that point, it’s a tight rope, walking the line of being assertive without getting angry or frustrated and keeping it respectful. But I certainly understand that it’s frustrating not to feel heard, so you just have to keep at it. 

[00:24:47]Dr. Lancellotti: Yeah. As much as we try to be, we’re not perfect. As you said, we can make mistakes. We can forget things, especially if an animal has a lot of stuff going on and it has a limited time during its appointment with us. Going back to what you said earlier in the episode about being concise and being prepared- if that owner can be prepared for the visit (have a list of questions or their top concerns), it really helps make it as productive as possible. That way, if I’m seeing an allergic dog for a recheck and I’m worried about the skin infection that they have, if the owner has written down a list of concerns for me, I’m not going to miss the new skin mass or the new bump that the pet owner has prioritized as something that they want to be addressed. It really just all goes back to communication. If the pet owner can make sure that they are communicating their top concerns to the veterinarian, then we can make sure that we are addressing those concerns and working together to find a solution. 

Managing the relationship with those who care

Dr. Lancellotti: What do you think are some of the big takeaway points that you’d like pet owners to remember from how to communicate with their veterinarian?  

[00:26:01] Dr. Plowgian: This is always going to be a work in progress, right? There’s no one who’s perfect at communication. Clear and concise communication can be difficult, even in the best of circumstances, and it’s even more difficult when a loved one’s or a pet’s health and wellbeing is at stake and on the line. The pandemic putting hurdles in the way of face time and human interaction, certainly hasn’t helped us at all either. But it’s still really important to try to communicate clearly, openly, and honestly, and that can be challenging. It takes persistence, as you’ve talked about. It can take some forethought and organization- having that written list, so that you can be concise and guide the vet where you want them to go. If you can be organized and respectful, I think it’s the best shot you have at being your pet’s best advocate, making sure that your vet can help them as best as they can. One of the things you mentioned before is that we’re on a team. In my ideal world, the veterinarian and the client are partners working together for the benefit of their pet. That’s not always the relationship we end up with, but I think that’s when it works best. When I think about times that my partnerships and relationships have really been strained, the most recent example I can think of is when I got COVID in November. My wife and I were moving into a new house, and in the middle of the move, I got COVID and I was bedridden and miserable. Even though my wife was the only person in the world trying to help me, I was nasty to her. I made her cry several times and it really put strain on our relationship. We got through it, and once I was in my right mind again (and no longer sick), I apologized to her for what I put her through. There are going to be times when you don’t have control of your circumstances and something really difficult happened to your pet, and when you’re going through that, some of the onus is on us, as veterinarians, to be understanding of that. But if your frustration got the best of you, and you weren’t your best self to your veterinarian or your staff, an apology after the fact can go a long way. I know I have had clients that have been really upset who, the next time we saw them, they apologized for how they acted. It’s really gone a long way to getting both on mine and the staff’s good graces. And that’s  relationship maintenance. We’re all going to make mistakes, we’re all going to stumble, but the big bullet point to try to drive home with this is that when we’re in a vet appointment, the pet is the primary focus. The vet is just trying to help. The staff is just trying to help. Sometimes, things are going to go wrong. When they go wrong and you’re upset, one of the most important things to remember is just to try not to take it out on the people who are there to help. 

[00:29:04]Dr. Lancellotti: I think that’s a beautiful message to end with. Thank you very much, Dr. Plowgian. This was a really good conversation.  Ultimately we are there to help the pet. We want to work together. The successes that we have, as veterinarians, are what keep us coming back to work every day, and what drives our passion for helping animals. So share those successes with your veterinarian because it really does a lot  towards minimizing the burnout that people may be feeling right now during these really tough times. We’re all together and we should be working together as a team. 

Taking action

Dr. Lancellotti: If you, as a pet owner, have a way that your veterinarian has gone above and beyond to communicate with you, or you found something to be particularly helpful during the pandemic (when communication is a lot tougher), I would love for you to join the Facebook group and tell other pet owners in the group about your particular veterinarian or something that’s worked for you. Share your stories with other people, and if you have a veterinarian that you have a great relationship with, make sure that they know. We need that positive feedback and reinforcement to keep us going. Send them a ‘thank you’ card. A box of donuts is always really helpful, too, for staff morale. But make sure that they understand that the job that they’re doing is one that is valuable to you as a pet owner and to your pet. Ultimately, that’s what we’re there for. We want to be valuable and we want to help in any way that we can. So join the Facebook group. Tell us about it. You can follow Your Vet Wants You To Know on Instagram or on Facebook. If you’ve gotten value from today’s episode, I would encourage you to please take a moment to rate the show, leave a quick review- and that really helps other pet owners towards finding the podcast and getting good information.   

[00:31:00]Dr. Plowgian: One thing that can be really helpful in the pandemic, even if you’re not coming in for an appointment, if you want to email an update of how well something is working or a success story, we will always be happy to receive those. Sometimes, even with update pictures. We like to share them on our clinic websites or Facebook pages, and that can be something that can bring us closer together as a team. 

[00:31:24] Dr. Lancellotti: Absolutely. I love when pet owners share success stories with me. It brings me so much joy. If things are going well and you’re really happy, don’t keep that to yourself. Share it. We want to feel the love too. Send your veterinarian and their staff a card, send them a picture, or send them a video of your pet doing something goofy. We love goofy pet videos as much as everybody else does too. Thank you very much, Dr. Plowgian. I really appreciate your time.  

[00:31:52] Dr. Plowgian: Yeah. It was great to be here. Thanks!  

[00:31:54]Dr. Lancellotti: I look forward to your next visit with Your Vet Wants You To Know.

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