Nervous/scared feeling about being bitten or injured on the job

[CalliopeDVM]

Yup - what LIS said. Not just the time, but the staff........specialists often have lots of dedicated staff who can monitor, but in the GP world, not so much. Because sedation and anesthesia are a risk in and of themselves (sedation probably more risky than anesthesia) and the patients should be monitored properly.

Sometimes I see GPs sedating what I would call too often -- it's important for aggressive and unmanageable animals, but I see it with nervous pets too that can be managed safely without drugs. But that take time and effort that their busy schedules don't allow. They do it because it's faster than approaching the pet slowly and calmly, working to relax the pet and convince them to cooperate.

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[deleted498041]

(Unless that's what people mean by "more hesitant".....)

Yeah, your post is pretty much exactly what I meant, in greater detail. I think a component of this too, at least in some places, is staffing. The place I'm at now has dedicated anesthesia techs, dedicated surgery techs, and then also surgery assistants. If a sedated animal has to be babysat for awhile, there are plenty of people to do it. Where I worked before vet school was GP and had as many techs as there were rooms, a surgery tech, and a triage. There weren't really any extra bodies to handle a sedated or recovering pet.

 

[deleted498041]

Yup - what LIS said. Not just the time, but the staff........specialists often have lots of dedicated staff who can monitor, but in the GP world, not so much. Because sedation and anesthesia are a risk in and of themselves (sedation probably more risky than anesthesia) and the patients should be monitored properly.

Sometimes I see GPs sedating what I would call too often -- it's important for aggressive and unmanageable animals, but I see it with nervous pets too that can be managed safely without drugs. But that take time and effort that their busy schedules don't allow. They do it because it's faster than approaching the pet slowly and calmly, working to relax the pet and convince them to cooperate.

Calliope beat me to it!

 

[DVMDream]

My adhd dvmd...

Yeah tl;dr lol.

I'm rather certain my adhd was in full swing while typing and I just went on rambling away. Meh, oh well.

 

[missdarjeeling]

I don't think it's really that GP doctors are "more hesitant" exactly. What some of you who are in school or pre-school aren't really grasping is that every single thing you do is a pro/con, risk/reward, time-value-money decision.

"Hesitant" was the wrong word to use, but I understand perfectly well that there are always multiple factors to weigh in any decision. My practice weighed "never say no to clients" very heavily in just about every aspect of the business, and the pressure trickled down to us support staff. Every once in a while, it put us at greater risk and made the experience even worse for the patient and sometimes even the client.

As far as sedation goes, I'm including oral meds that the owner gives at home. That was also very rare at my last practice, even for the very aggressive patients. Even if we had booked an appointment specifically for X-rays, which was an hour block-off instead of the standard 30 minutes, we would almost never sedate the fractious ones. I understand that there are always risks with sedation (and any intervention at all, period), but sometimes it didn't sit right with me to be pressured by the doctors to keep going in some situations. If, say, a nail trim is really THAT necessary that we're still pushing even though we're putting ourselves and the pet at risk and if the pet is healthy enough for chemical restraint, I don't see why chemical restraint should never be an option for the next visit, even if it's not an option in that precise moment.

Obviously, the equation changes if you absolutely need to get something done for a sick pet, but for healthy ones, I'm not so sure that it's beneficial to stress them out as much as we did sometimes for things that may not be all that important in the grand scheme of things. And, yes, I understand that giving up on an anal gland expression or nail trim or ear cleaning is a little bit of lost revenue and that you risk damaging your relationship with the client ("What do you mean you can't?!"), but from where I was sitting (or getting peed on) the cons of stressing the patient out to the extreme, taking extra hands away from their own appointments/tasks (and setting the other doctors behind, too, in the process), and risking injury tipped the balance towards "maybe not today."

In the GP world, there are appropriate times to say "maybe an exam isn't all THAT important today."

I agree. That's kind of my minor complaint about a few of the doctors I worked with. They didn't want to say that maybe XYZ isn't going to happen today. Some would adjust their plan as best as they could if we really couldn't get something done, but the owner especially would almost never say no to any request.

The only patient I've lost under anesthesia? It was a blocked cat with 100% normal bloodwork and no PE abnormalities. Even in blocked cats with 100% normal bloodwork I'm still pretty cautious with my protocol on these guys .... and he arrested within a minute of going under and didn't come back. Tough enough for me to go talk to that owner - would have really sucked had I sedated that cat for a wellness exam.

That is pretty terrifying.

And yes, I realize there are exceptions, so nobody needs to start saying "But, but, but... this one time at band camp in my GP clinic...." There are exceptions to everything. As a general statement it's still true that I've got more luxury to sedate things than most GP doctors do most of the time. So I don't think they are "more hesitant" - it's that it's often just not as feasible for them. (Unless that's what people mean by "more hesitant".....)

You're right that it's not as feasible. It's often simply impractical. I didn't mean to suggest otherwise. I just find it interesting when people point out that their professors strongly advocate chemical restraint or that their practices have refused to see patients when owners decline sedation. My practice never refused to see aggressive pets, and sedation was almost never considered, even for pets we had seen before and knew to be unmanageable. And the odd thing is that if someone booked a feline shave-down, the doctors had absolutely no problem writing a sedation protocol for the LVTs without question (and without bloodwork sometimes), but for everything else, it was just "get it done." Most of the time, that wasn't an issue, but when it was an issue, it often felt wrong and it was certainly frustrating. If sedation might have helped in some of those cases, it would've been nice to have.

 

[TerraVet]

GP doctors <tend> to operate on tighter time budgets - they see more patients per day than most specialists. Sedating a pet can be done quickly, but no matter how you cut it it adds time that, unless it was known in advance and planned, wasn't budgeted for. Dexmed and Antisedan? Still takes <some> time. Propofol? Now you have to place a catheter - takes time. A little Torb and Midazolam? Gotta let it cook for a bit. None of those things take huge amounts of time, but if you're on a 15-minute, 4 appts/hr schedule you just got backed up by an entire appointment or two dealing with that patient you want to sedate.

I think this is dead on, and with some of the places I worked at where DVMs were expected to do new patient exams in 30 minutes and regular appts in 20 it was really, really hard to find the time and have a dedicated tech to monitor the pet while sedated. At least one vet I worked with explicitly stated she'd rather be running late to her appointments and sedate an animal that needs sedation, or tell the owners they need to drop off, sedate it, let it cook, then do the x-rays later, but it's a really tough thing to balance. It's a shame that docs are so rushed that there is this feeling of "ok we HAVE to make this work, no matter how much the cat screams/dog struggles." I do wish there was more understanding from owners, especially about not trying to do EVERYTHING the first time a pet is seen. I get that they don't want to come back for another appointment but it just seems like such a vicious cycle where a new pet who is nervous but good for the exam then needs a nail trim and we end up wrestling with it, and then it's more sketchy the next time. I really just want to say to clients, "not today," but again, there's this duel need for medicine to be "customer service oriented" so clients are happy and come back and spend money, but also to look out for the patient's best interests, which are sometimes at odds with the first.

 

[CalliopeDVM]

DVMs were expected to do new patient exams in 30 minutes and regular appts in 20

And that's pretty generous. I see most places where all appointments are 20 minutes (new patient or not), and some where all appointments are 15 minutes (those are brutal). But even if they are 20 minutes, there are usually some blocked off slots to do procedures etc (so it isn't booked 3 or 4 appointments every hour - one or two appointment slots each morning or afternoon are left empty for overflow, procedures, or desk work).

 

[deleted498041]

And that's pretty generous. I see most places where all appointments are 20 minutes (new patient or not), and some where all appointments are 15 minutes (those are brutal). But even if they are 20 minutes, there are usually some blocked off slots to do procedures etc (so it isn't booked 3 or 4 appointments every hour - one or two appointment slots each morning or afternoon are left empty for overflow, procedures, or desk work).

Where I worked, it was kind of weird scheduling and only the receptionists could schedule but I remember it amounted to 6 appointments an hour. There was no balancing done if it was something like puppy vaccines versus vomiting for a week. One some days we'd get a HBC, three v/ds, and two lamenesses -- all things that required a substantial workup.

 

[CalliopeDVM]

6 appointments an hour.

Was it in the UK? I know vets there often work with 7-10 minute appointments.

 

[deleted498041]

Was it in the UK? I know vets there often work with 7-10 minute appointments.

Nope! In the US.

 

[dyachei]

And that's pretty generous. I see most places where all appointments are 20 minutes (new patient or not), and some where all appointments are 15 minutes (those are brutal). But even if they are 20 minutes, there are usually some blocked off slots to do procedures etc (so it isn't booked 3 or 4 appointments every hour - one or two appointment slots each morning or afternoon are left empty for overflow, procedures, or desk work).

I schedule all appointments for 30 minute slots, but I create my own schedule. So if I know something will be involved, I can book for longer.

Clients like the longer time slots.

 

[CalliopeDVM]

Clients like the longer time slots.

Yes they do. I don't, though.....not for most things. I'd rather spend 20 minutes on the appointment, and the other 10 at my desk doing all the other stuff that needs doing.

 

[pinkpuppy9]

"Hesitant" was the wrong word to use, but I understand perfectly well that there are always multiple factors to weigh in any decision. My practice weighed "never say no to clients" very heavily in just about every aspect of the business, and the pressure trickled down to us support staff. Every once in a while, it put us at greater risk and made the experience even worse for the patient and sometimes even the client.

As far as sedation goes, I'm including oral meds that the owner gives at home. That was also very rare at my last practice, even for the very aggressive patients. Even if we had booked an appointment specifically for X-rays, which was an hour block-off instead of the standard 30 minutes, we would almost never sedate the fractious ones. I understand that there are always risks with sedation (and any intervention at all, period), but sometimes it didn't sit right with me to be pressured by the doctors to keep going in some situations. If, say, a nail trim is really THAT necessary that we're still pushing even though we're putting ourselves and the pet at risk and if the pet is healthy enough for chemical restraint, I don't see why chemical restraint should never be an option for the next visit, even if it's not an option in that precise moment.

Obviously, the equation changes if you absolutely need to get something done for a sick pet, but for healthy ones, I'm not so sure that it's beneficial to stress them out as much as we did sometimes for things that may not be all that important in the grand scheme of things. And, yes, I understand that giving up on an anal gland expression or nail trim or ear cleaning is a little bit of lost revenue and that you risk damaging your relationship with the client ("What do you mean you can't?!"), but from where I was sitting (or getting peed on) the cons of stressing the patient out to the extreme, taking extra hands away from their own appointments/tasks (and setting the other doctors behind, too, in the process), and risking injury tipped the balance towards "maybe not today."



I agree. That's kind of my minor complaint about a few of the doctors I worked with. They didn't want to say that maybe XYZ isn't going to happen today. Some would adjust their plan as best as they could if we really couldn't get something done, but the owner especially would almost never say no to any request.



That is pretty terrifying.



You're right that it's not as feasible. It's often simply impractical. I didn't mean to suggest otherwise. I just find it interesting when people point out that their professors strongly advocate chemical restraint or that their practices have refused to see patients when owners decline sedation. My practice never refused to see aggressive pets, and sedation was almost never considered, even for pets we had seen before and knew to be unmanageable. And the odd thing is that if someone booked a feline shave-down, the doctors had absolutely no problem writing a sedation protocol for the LVTs without question (and without bloodwork sometimes), but for everything else, it was just "get it done." Most of the time, that wasn't an issue, but when it was an issue, it often felt wrong and it was certainly frustrating. If sedation might have helped in some of those cases, it would've been nice to have.

Just out of curiosity, how recent of a grad was the doctor(s) you worked with? My evidence is based off my experience of course, but it seems like the more recent grads are much more willing to consider sedation/safety. The two older doctors I've worked for...I can't recall a single time we used/considered any form of sedation with the patients that legitimately scared me. It almost came off to me as a sign of bad staff (aka the assistants) or some type of failure if the doctor had to resort to sedation. It could just be who I worked for, though.

I can't imagine sedation not being an option that's offered now, especially seeing it used in orthopedic patients needing radiographs. We used to have to hold down pets that were clearly in tons of pain due to the positioning at my last jobs. Most, if not all, patients I worked with were sedated for orthopedic radiographs at my school. I can see how it greatly lengthens the appointment time/time the dog is held at the clinic, but wow is it nice to not make a dog scream over and over for images and retakes. And less people exposed to radiation, too.

 

[dyachei]

Yes they do. I don't, though.....not for most things. I'd rather spend 20 minutes on the appointment, and the other 10 at my desk doing all the other stuff that needs doing.

If you slot it for 30 mins, I find I rarely use the full time with the client. But the techs will finish going over prevention and the like. So I start on notes then. Or look up history on my next patient. I think it's just the idea that we can spend time with them that is comforting.

Also separate note. We have a lot of down time occasionally as we're still fairly new. My associate will have loads of time between patients and won't start her notes before 4 pmish. We close at 6. And often have appts til then. Do she ends up doing them at home. Why would you do that to yourself?

 

[DVMDream]

If you slot it for 30 mins, I find I rarely use the full time with the client. But the techs will finish going over prevention and the like. So I start on notes then. Or look up history on my next patient. I think it's just the idea that we can spend time with them that is comforting.

Also separate note. We have a lot of down time occasionally as we're still fairly new. My associate will have loads of time between patients and won't start her notes before 4 pmish. We close at 6. And often have appts til then. Do she ends up doing them at home. Why would you do that to yourself?

Because you're crazy? I dunno only explanation I can come up with. I don't want to be taking work home with me, actually declined having remote access set up so I have no option but to get my notes done before I leave, yeah that means I've had to stay late (no more than 40 minutes) a couple times but better than bringing it home.

 

[missdarjeeling]

Just out of curiosity, how recent of a grad was the doctor(s) you worked with? My evidence is based off my experience of course, but it seems like the more recent grads are much more willing to consider sedation/safety. The two older doctors I've worked for...I can't recall a single time we used/considered any form of sedation with the patients that legitimately scared me. It almost came off to me as a sign of bad staff (aka the assistants) or some type of failure if the doctor had to resort to sedation. It could just be who I worked for, though.

The younger ones, in general, were a little more likely to discuss sedation with clients. Regardless of graduation date, the ones who had worked as support staff before were much more protective of us when it came to fractious patients, and by that I mean, if a client didn't want us to muzzle or take the pet into the back, the doctor would explain why it was necessary that we do those things instead of giving in and having us go forward with whatever we were doing.

Of the two most recent grads, one was often okay with us either giving the pet a break or telling the client that we absolutely couldn't get something done. It was rare that it ever happened in the first place, but when it did, the doctors were okay with adjusting their plan. The ones who graduated around 5-ish years ago generally didn't sedate anything other than lac repairs, but one of them was more likely to start recommending oral meds for the really terribly anxious ones. The owner was the one with the longest time since graduation, and she's the one who would push the hardest to just do it and give clients whatever they want. She's an excellent doctor, and there's a lot I admire about her, but sometimes I felt like she'd go a little too far in pleasing clients at the expense of other things. Overall, though, all of them were great at discussing behavior and giving out materials/referrals to trainers. Which helps with the dogs sometimes, but what about the cats?

I can't imagine sedation not being an option that's offered now, especially seeing it used in orthopedic patients needing radiographs. We used to have to hold down pets that were clearly in tons of pain due to the positioning at my last jobs. Most, if not all, patients I worked with were sedated for orthopedic radiographs at my school. I can see how it greatly lengthens the appointment time/time the dog is held at the clinic, but wow is it nice to not make a dog scream over and over for images and retakes. And less people exposed to radiation, too.

Yeah, we didn't give anything to orthopedic patients, though every so often they'd already be on a course of tramadol or Rimadyl. The doctors would just tell us to be careful because s/he's painful in X spot. For potential cruciate cases, our doctors would tell clients that if it is a cruciate injury and if they do go to a specialist, the specialist will want to take sedated X-rays. But we'd offer them X-rays with no sedation to rule out other things. The vast majority of orthopedic patients tolerated X-rays okay, though they showed obvious signs of pain, but some would be so painful that it was a bit upsetting to have to manipulate them like that.