Did you expect practicing to be easier than vet school?

[chickenlittle]

Now this is a particularly interesting comment (IMHO) which points at something we've noticed regarding some of the vets we have had (or seen records from other practices) vs. the way we like to run the practice....You end up with the clients that matches the practice philosophy.

Our approach is that a client comes to us to fix a problem (if possible). We believe the client does not want to come back multiple times to figure it out (sometimes you only get one chance or they will go elsewhere - we have all seen the vet hopppers). So, we believe in appropriately working things up really well as close as you can get to boarded internal medicine level or university w/o being boarded. Of course, we do the medical treatment plans (estimates) and get approval and discuss with the client where they will like end up going down a treatment plan path. Beginning with the end in mind is entirely another topic....

We do the things we are really good at and refer as needed. E.g. all rads go out to be read by Board Certified Radiologists, we have ultrasound and us it, but all call in traveling boarded internal med people for ultrasound, use a very good boarded surgeon in addition to doing our own surgeries. Of course, we like medicine and think it is really interesting and keep learning and always want to be better.

Some vets we have employed and others whose clients bring their records to us, do not seem to want to practice at the level and would like to turf the hard stuff to someone else. It seems that it comes down to a philosophical view of how you want to practice and finding the place that matches you.

Is this a conscious individual choice, as in "I do not want to do all the complex stuff?
Or maybe it is hard to practice at a high level in a GP where no one else cares that much, so you just dumb it down to get along.
You get tired because thinking hard all day long is exhausting (it is we know)

Just saw this response. I'm late to the party.

In my previous situation, to which I was referring in that post, it was due to client finances. The clinic was located in a poor, rural area... clients tended to euthanize anything that was going to cost more than few hundred bucks. Hence the boredom. Giving rabies vaccines and euthasol all day gets incredibly boring.

In my current job, clients are more willing to pursue workups... but the referral hospital workup prices are very similar to ours, so there is no benefit to the pet or client to keep the workup at our location. Sure, it would benefit the hospital's bottom line, but my ethics require me to put the patient/client needs first in that situation - if the referral hospital can offer a higher level of care for the same price, I'd be remiss not to recommend that.

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[TXvet]

The one thing that does irk me a bit sometimes when I do get a true emergency case in and I've decided dicking around to even attempt to stabilize is costing the patient time and possibly their life, I'll call up the ER to give a head's up the patient is coming and I get judged for "not doing anything."

Sometimes you really can't win in this field. You'll be judged if you do something, if you don't do something, for not keeping the patient at your poorly staffed clinic, etc. No matter what you decide, it will be "wrong" in someone's mind.

I have certainly seen cases from RDVMs where something should have been done prior to referral. For example a severely dyspneic cat with horrible pleural effusion-you should AT LEAST tap the chest to make the patient feel more comfortable (BTW we did the chest tap in a matter of 5 minutes then the o's euthanized the cat because of the bad differentials-the RDVM could have done all of that at their hospital instead of making the poor cat suffer and endure another car ride). The GDV that is so tympanic and about to die-at least get an IV catheter in bolus some fluids, give some pain meds and trocharize the patient. Sometimes as an EC vet it is very frustrating as RDVMs like to dump things on us-and most of the time I get to be the bad guy. The most frustrating is when the RDVM sends a client they know has very limited finances with a very sick dog and they don't at least put an IV catheter in and send some fluids. AND along these lines don't have a realistic talk with them about how much it will costs even though they often call us and get at least a round about quote of the treatment-nope again I get to be the bad guy.

 

[DVMDream]

I have certainly seen cases from RDVMs where something should have been done prior to referral. For example a severely dyspneic cat with horrible pleural effusion-you should AT LEAST tap the chest to make the patient feel more comfortable (BTW we did the chest tap in a matter of 5 minutes then the o's euthanized the cat because of the bad differentials-the RDVM could have done all of that at their hospital instead of making the poor cat suffer and endure another car ride). The GDV that is so tympanic and about to die-at least get an IV catheter in bolus some fluids, give some pain meds and trocharize the patient. Sometimes as an EC vet it is very frustrating as RDVMs like to dump things on us-and most of the time I get to be the bad guy. The most frustrating is when the RDVM sends a client they know has very limited finances with a very sick dog and they don't at least put an IV catheter in and send some fluids. AND along these lines don't have a realistic talk with them about how much it will costs even though they often call us and get at least a round about quote of the treatment-nope again I get to be the bad guy.

You're kind of proving my point here, judging an rDVM without knowing their thought process, staffing situation, skill set, etc, etc. I've had many days where dealing with any of the above things would have meant me setting up every aspect because I was working with 100% brand spanking new off the street assistants. Basically go grab a random teenager off the street, plop him/her in your clinic and start practicing medicine, because that's the knowledge base my staff had. So I can dick around for 30-40 minutes doing everything myself and attempting to train people at the same time or I can send the client 10 minutes down the road to be addressed by a fully trained staff with much more diagnostic capability.

I always give people an estimate before sending them and have still ended up with upset clients/ER vets claiming I didn't tell them cost, when I did. People don't think/comprehend in ER situations, so when I discuss things it doesn't often stick. Heck I've had clients not give the bw we sent them with to the ER vet claiming we never gave it to them.

Stop judging the rDVM's choices and start communicating with them. The same goes for rDVM's judging the ER vets. I mean I had an ER vet send me a "stable" HBC that she'd been watching overnight, I tapped its pneumothorax when I got it, she didn't even offer rads per her notes. However, I don't know what her discussion was with that client, so I try to give the benefit of the doubt, maybe the pneumothorax became more obvious with time and was very apparent just by auscultation when I received the patient. Maybe the client told her they weren't paying for x, y, z right off the bat and were wanting to transfer for those things, if needed. I dunno.

But you've largely proven my point, judging without being present and without giving the benefit of communicating with that vet to really figure out what all was going on. This is a problem.

 

[DVMDream]

Oh and I've had ER's refuse to use my previously placed IV catheters and refuse to use the bag of fluids I've sent. So there's that too.

 

[Lupin21]

Oh and I've had ER's refuse to use my previously placed IV catheters and refuse to use the bag of fluids I've sent. So there's that too.

I have encountered this in the past, where the ER want their own and request for the veins not to be touched until the animal is in their care.

 

[WhtsThFrequency]

Oh and I've had ER's refuse to use my previously placed IV catheters and refuse to use the bag of fluids I've sent. So there's that too.

I have encountered this in the past, where the ER want their own and request for the veins not to be touched until the animal is in their care.

Yup. I've heard this from multiple colleagues of mine as well.

 

[Minnerbelle]

Dude... let's not play this ER vs GP game, cause we can all come up with just as many gripes with stories of the ERs that have "****ed up" our patients if you want to spin it that way. We can do this all day. It's not helpful.

At the end of the day after the mud's been slung every which way, the conclusion is going to be that there are isolated ****ty doctors in either camp, and that more often than not, issues start from misunderstandings/miscommunications that arise out of juggling patients/clients between hospitals and involving the layman owner in sorting this **** out. And records coming and going from either side are often not perfect, whether that be the doctor's fault or not.

Just as GPs have no business criticizing the ER without knowledge of what other things were going on that night in the ER (yeah, maybe the pancreatitis dog you specifically sent over for an ultrasound didn't get one for 24 hrs and was "neglected" simply wasn't priority when there were 10 simultaneous critical patients), the ER has no business criticizing GPS without knowing what is going on in their world. In the ER you have the luxury of triaging and seeing the stable patients as you can with staff and facilities equipped to do all the things. You don't have the pressures of every 20-30 min appts fully booked with a "come right down" walk in policy with hit or miss staff who sometimes can barely hold a nonfractious cat for vaccines. In that environment, you can really only see one unstable thing at a time amidst all the usual chaos, if that. If i have an add-on sedated/anesthetized patient for a walk in lac repair when I'm running 3 sick appts behind, I don't have the capacity to take on much more than that.

 

[Skindoc83]

I’m a human physician and this type of stuff happens routinely. And frankly from a medicoLegal standpoint it’s easier to just ignore the behavior then to kick them out.

I'm dismayed by some of the abuse this field allows towards its employees. To the vets but also to the support staff. Some of these techs and receptionists get screamed at, cursed at and outright bullied by people and then the client will be "nice" to the vet. And the clinic does nothing when the client treats the staff that way. It is quite disgraceful.


I knew practice would be hard. It is medicine, it doesn't always work out the way you expect. It is called "practicing" for a reason.

It is more the abuse by clients and also by other clinics, other vets, etc that I really am dismayed by.

You would never be able to walk into your doctor with an empty prescription vial and demand it be refilled "RIGHT NOW".

You would never be able to walk into your doctor with a week old wound and demand to not only be seen instantly but to also have surgery done that same day.

You would never be able to walk into your doctor 5 minutes before close and demand to be seen-- for anything. They are going to tell you to schedule an appointment or to go an urgent care/ER.

You would never be able to call your doctor the following day and demand lab results and actually get them.

You would never be able to call up your doctor and ask to "talk with them about something"... you would be told to make an appointment.

You would never be able to walk into your doctor with a surgical emergency and not only get seen but have the surgery performed and sent home that same day. It still baffles me that GP vets are able to fit in emergency surgeries like we do. That would never happen in human medicine, you are going to the emergency room and they are contacting a board-certified surgeon for your emergency surgery needs.

I could make this list go forever.

Just think about how much we expect the General Practice veterinarian to do and accomplish in a single day compared to that of the General Practice MD and you can really start to see how so many vets are burned out. We do so much more, take on so much more and so much more is demanded of us it is insane.