I triage those, and then make the owner wait extra long sometimes just because they're being annoying.
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I triage those, and then make the owner wait extra long sometimes just because they're being annoying.
Don't tell anyone, but I'm sitting eating my dinner while an ear infection waits in the lobby. Darn pesky weekend ER emergency ear infections.
it became a tech appointment. Because the cat is fine.
I'm convinced that the tx for the cat is addressing the anxiety for the owner
Haha, yup. And everytime the front desk pages you about that owner who's pissed off who needs to wait for 'just an ear infection' I'd set the timer another 15 minutes while to do something else more important (or not). No need to reward poor behavior.
Haha, we had an owner who took that to mean the doctor would stay hours after closing to accommodate her schedule. Wtf!?
Yeah. It's amazing how much paperwork I can find to do when faced with a PITA whiny walk-in with an ear infection...
It's always an emergency. We had someone call recently to be seen for ears. For a change our morning was booked solid. So we offered them an afternoon appt or to walk in. They went to another clinic so they could be seen RIGHT NOW
To be fair, the acute ear infections and hot spots are quite distressing for the pet and the owner.
But it doesn't change the fact that the pet is stable and not going to die.
But it doesn't change the fact that the pet is stable and not going to die.
oh for sure. But it can usually wait an hour or so. And it's likely been going on longer than a day
My favorite was still the client that called up after closing and demanded an appointment for that night... she couldn't seem to understand what "we are closed and the vet has left for the day" meant.
Almost definitely. And in my admittedly short experience, 90% of those clients are of the "dog was in to be spayed at 6 months and now it's 7 years old and we haven't seen it since" variety. If you're a good client and you're polite to my staff, I will try to see you as soon as possible. If you haven't been in for 4 years and that was just to buy flea meds, and if you're harassing my front staff... Well, I'm gonna finish my coffee and maybe have a donut.
yup. this exactly.
I did have 3 really good clients today. it wasn't a bad day at all. but the crazy cat lady comes in and demands our time at least twice a week without an appointment. And never wants an office visit but wants time with the vet. So thats a huge issue for me. The associate lets her get away with it I think. Time to have another talk
Yup.
We had someone storm out once saying they were going to go elsewhere because it was five minutes past their appointment time. And it was a vaccine appointment. 🙄 The best is when clients get mad about having to wait when it's because they forgot what time their appointment was and showed up half an hour early.
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People who don't do any training with their dogs 
Which seemed to be the theme today. Every surgery patient was either aggressive or super high strung. There was a 12 week old puppy that tried to bite a tech's face. The best though, was a Great Pyrenees, who the owners have had since he was a young puppy, and they had never conditioned him to get used to having his ears and paws touched. So they never clean his ears (despite ear infections when he was younger and much smaller) and he plays in the mud/dirt all the time. Yay chronic ear infections...and of course they brought him in late in the afternoon so we couldn't sedate, they were unwilling to bring him back at an earlier time another day (though his current ear issue had been going on for A MONTH). I was the smallest of the crew, so I was designated ear cleaner and nail trimmer, but even I was sweating by the time we were done. And then they wanted to complain about being charged for extra restraint
Which seemed to be the theme today. Every surgery patient was either aggressive or super high strung. There was a 12 week old puppy that tried to bite a tech's face. The best though, was a Great Pyrenees, who the owners have had since he was a young puppy, and they had never conditioned him to get used to having his ears and paws touched. So they never clean his ears (despite ear infections when he was younger and much smaller) and he plays in the mud/dirt all the time. Yay chronic ear infections...and of course they brought him in late in the afternoon so we couldn't sedate, they were unwilling to bring him back at an earlier time another day (though his current ear issue had been going on for A MONTH). I was the smallest of the crew, so I was designated ear cleaner and nail trimmer, but even I was sweating by the time we were done. And then they wanted to complain about being charged for extra restraint
That's really interesting that you guys charge for extra restraint! One one hand I think that's kind of awesome, because it's frustrating to sometimes expend a ton of blood/sweat/manpower on a $10 nail trim. However, certain animals need extra restraint not because they're aggressive, but just scared and wriggly, and it would suck for those owners to have to pay extra. Also I would hate for the doctor to hesitate to pull in extra help because she would have to charge for it and the client's on a budget.People who don't do any training with their dogs
Which seemed to be the theme today. Every surgery patient was either aggressive or super high strung. There was a 12 week old puppy that tried to bite a tech's face. The best though, was a Great Pyrenees, who the owners have had since he was a young puppy, and they had never conditioned him to get used to having his ears and paws touched. So they never clean his ears (despite ear infections when he was younger and much smaller) and he plays in the mud/dirt all the time. Yay chronic ear infections...and of course they brought him in late in the afternoon so we couldn't sedate, they were unwilling to bring him back at an earlier time another day (though his current ear issue had been going on for A MONTH). I was the smallest of the crew, so I was designated ear cleaner and nail trimmer, but even I was sweating by the time we were done. And then they wanted to complain about being charged for extra restraint
Where I worked, we charged extra for "tech time". If the patient was extremely unruly and we had to put in a significant amount of time/effort dealing with them, we charge and extra $15. We really only used it for clients who's pets were known to be unnecessarily unruly, never for clients who were first timers or on a budget!
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It's doctor and hospital dependent. We had a similar patient at my main hospital a week ago (the doctor and practice manager were on the floor restraining while I dremeled the dog's nails) and we didn't charge extra. That time anyway. I believe we did let the owners know that they would likely be charged next time if his behavior hadn't improved. But at the busier hospital, when we have to take much more time than the appointment was scheduled for, and it puts us behind because it's crazy there (understaffed, overbooked), plus two extra techs are helping instead of doing other things...it makes a lot of sense to charge for the time and effort (and minor injuries). It's $15 or so. I've only ever seen it used for very large, unruly dogs. We pull in extra help all the time without charging for it if it's just a dog being wiggly.
Totally.
I think I am the only doctor in our practice (of 30+ docs) doing it, but I've started throwing lots of tech charges onto invoices if the patient requires abnormal amounts of tech time to get done what we want. Tech time may be "less costly" than doctor time, but it is worth something and tying up one of my techs for an hour should cost something.
We do "levels" for nail trims, anal glands, laser appointments - 1, 2, 3 and each is more expensive.
As for walk-ins, my boss wants us to accommodate these people as best necessary so I usually just end up going to get them as soon as I can so the rest of my appointments don't get backlogged
As for walk-ins, my boss wants us to accommodate these people as best necessary so I usually just end up going to get them as soon as I can so the rest of my appointments don't get backlogged
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We have the levels for ear cleaning but I think that's it.
One time we had someone walk in with "something stuck in the cat's foot." I was working up front that day so I took a look at it and what do you know...it was a piece of litter stuck to his fur
I personally do the ear cleaning in the room with the owner to show them how to properly clean, because it's an integral part of treatment. I find that 80% of clients who have seen other doctors for persistent otitis or had ear cleaning demos with techs don't do it right. And it's not uncommon to have treatment failures because of it. No cotton, no q-tips. Just flood the ear canal with appropriate cleaner, massage it in (this is where people do it wrong because it's not intuitive where the ear canal actually sits. You need to hear nasty squishing sounds from deep in the canal), let the patient shake out the now broken apart debris, and just wipe off the debris with Kleenex off the pinnae only. Clients who have had chronic otitis dogs are so amazed at how much crap comes out of the ear this way and realize why the infection hasn't cleared. It takes a good 5 minutes of doctor time, but I don't charge for it because it's a huge practice builder. It's exceedingly rare that I have treatment failures, even with the nasty stenotic resistant pseudomonas cases. And proper ear flushing is a huge part of that. The client needs to do it at home, and they need to know how to do it right.
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We do that for the patients that don't need extra restraint for the same reason (I've done many puppy ear cleaning demonstrations 😍). But if the dog is 80 pounds and flipping out when we come close to touching his ears...not happening. The demonstration in that case would have been useless anyway because the owners were unwilling to try to clean the ears at home. We did let one owner watch us through a window when we were cleaning/medicating her dog's ears so that he couldn't see her but she could see how we were doing it.
If the dogs are that bad (behaviorally) or because the ears hurt that badly, I don't bother with tech ear cleaning. One cleaning where the dog's flipping out isn't going to do anything anyway. That ends up being torture for the dog and staff. If the dog needs 'ear clean' for treatment, the owner needs to be able to do it.
For bad behavior. I sedate, do a serious saline flush, and then use longer acting ear meds. Or easy application type med that is short term.
For painful ears I put them on systemic steroids and/or liquid (not goopy) meds with steroids to make it much less painful, and then do the demo at the recheck. If the ear's totally stenotic, we're not going to be able to clean that out all that well anyway initially. It's just not worth it IMO. And it makes the dog very resentful of future visits. I just don't find it fruitful. It might work for other clinicians, but I just haven't had the need for it.
There are very rare cases where I do differently and have a tech ear cleaning. But I can't think of one in the past 3 months. I deal with several otitis cases daily. Only exception to that is the ear mite cat. I have techs clean those.
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I prefer your methods
we haven't done the crazy dog wrestling ear cleaning thing at my main hospital (only do that for nail trims apparently). The doc there requires sedation in those cases. It never really made sense to me to spend all that time and effort wrangling the dog, stressing them out, basically ensuring they hate their next visit even more. But I just do what I'm told.
Actually, it might.
There are newer products (like osurnia) where getting a base clean and putting in the medication once a week for 2 weeks is appropriate and the owners don't need to clean.
Other than that, I sometimes do a tech cleaning so I can get liquid stuff to absorb better (depends on the ear).
Otherwise I talk to owners about how to clean and usually show them on 1 ear (without solution) if they don't want to pay for a cleaning. I have had 1 client that had a dog with *really* bad ears and he was aggressive (had been for years). They came in faithfully every day to get his ears cleaned by us and we got a years long chronic otitis cleared. And wouldn't you know it? He was actually a pretty sweet dog after that.
That's what I was talking about. If I'm going to go with something like osurnia, unless sedation is contraindicated I'm personally going to give it the best shot for it to work by really flushing it out under sedation for the horrible patient. If the owner's just a twit and can't do it or the pet is just a twit for the owner, but the patient is fine with us, we'll do it without sedation.
There's always going to be exception cases. I've also had a couple patients who was fine for me, but horrible for owner that I've medically boarded for 5 days to treat with Easotic (patient was horrible to transport). I also find that post-steroids, many mean dogs are nice enough to actually handle. If it doesn't work, then we switch plans.
But in a vast majority of cases, the type of case management I do without tech cleanings work perfectly fine for me, and is less stress for everyone all around. I'm not saying it's how everyone should do it. Or that it's necessarily wrong. That's just how I do things, and my rationale behind it. My derm cases often are the source of a good chunk of "dr. Minnerbelle only" clientele, and I have pretty good outcomes, so I don't feel the need to unnecessarily torture my techs (they hate cleaning painful ears).
I haven't had many cases (that I know of) where I couldn't resolve the ear infection. And skin. I actually really like derm and thought about trying to specialize. But if the dog is a well behaved dog, I find that sometimes, even with bad infections, they don't need sedation (though I do give pain control). That was my point.
I prefer your methods
It never really made sense to me to spend all that time and effort wrangling the dog, stressing them out, basically ensuring they hate their next visit even more. But I just do what I'm told.
If I can't do nails with just the owner holding, the price doubles. If I can't do them with one assistant and a muzzle, they don't get done. At that point the owner can either go elsewhere (less ideal because brutacaine doesn't help these dogs) or we can set up a sedation nail trim and a desensitization plan. I have many people who come in every two weeks just to have me handle the dogs toes without clipping a single nail, and who will faithfully let me sedate every month. And I do see improvement in these dogs, sometimes to the point where I can do the nails on an awake patient with no restraint.
Want to come visit and give a second opinion on an otitis cat that I can't seem to resolve? I'm usually pretty good with ears, and am the second opinion on this case already, but this cat is a mess. Nicest cat and owner in the world and nothing keeps these ears comfortable for more than a week.
Yeah, I almost never sedate for the ear infection themselves.
The only dogs I sedate are the really mean dogs that you need to sedate for pretty much ANYTHING. Like the true behavioral dogs. The dogs where annual physical exam is a circus. Owner can't muzzle. Dog wise to the muzzle. Alligator roll, anal gland, pee, poop in muzzle big dog.
Not the I'm snapping because my ear is ulcerated and hurts like a bitch dog.
I've only had 2 dogs in the past 6 months that I've actually sedated for ears. It's not like a regular thing.
what's going on with it? Is it anatomy related? Are there any masses in the ear?
Sigh. I just got a call from someone with a goat with a temp of 106 who is due to, uh, kid (?) soon. Whatever you call it when goats give birth. Deliver.
Anyway. Politely explained I don't see goats. I asked who her regular veterinarian is and suggested they call them and noted that many veterinarians leave an after-hours emergency contact number on their voice mail. "Well, we don't normally have to use a vet." Promptly got a multi-minute rant about what kind of crappy veterinarian am I that I can't even refer her to someone who can come out there NOW to look at her goat, who is looking very weak and may die.
Gee. So it's <my> fault you don't have a regular veterinarian and have decided to not give your animals care until it's a crisis?
Yeah. Ok. Take a hike, lady. God I hate people like that.
That's what I get for answering the phone because my techs are all off doing things.
Anyway. Politely explained I don't see goats. I asked who her regular veterinarian is and suggested they call them and noted that many veterinarians leave an after-hours emergency contact number on their voice mail. "Well, we don't normally have to use a vet." Promptly got a multi-minute rant about what kind of crappy veterinarian am I that I can't even refer her to someone who can come out there NOW to look at her goat, who is looking very weak and may die.
Gee. So it's <my> fault you don't have a regular veterinarian and have decided to not give your animals care until it's a crisis?
Yeah. Ok. Take a hike, lady. God I hate people like that.
That's what I get for answering the phone because my techs are all off doing things.
someone in your friends/family?
Normal anatomy, no masses or polyps in ears or pharyngeal area. DVM1 tried various topicals, convenia and steroids. I did sedation for thorough cleaning to visualize tympanums (canals were packed with chunks of debris that would not come out with flushing- wax/yeast/cocci), then tried topicals but the canals were packed again two weeks later. No improvement on a 12 week food trial. minimal improvement on the antibiotic that cultures say should help (topically and systemic). Currently on systemic antifungals for the malassezia component but cat is still miserable. Normal lab work, young cat. Doing cytology every two weeks, have done two cultures on each ear. I'm considering an atopica trial next.
Oh, and no mites seen but we put the cat on revolution anyway.
I keep hoping that Osurnia/Claro/apoquel etc will magically get labelled for cats or at least have enough research saying it's safe to use off label.
Sorry to interrupt the crappy client ranting, I've just got something that's been driving me absolutely crazy. Between finals week and dealing with applying I'm going nuts! It's a long story that I'll try and condense, so sorry if it doesn't make total sense. I've interned/volunteered at this animal related non-profit for almost 2 years now. I've always gotten along really well with the staff and other volunteers and felt very welcomed. They've written me letters of rec and supported me through a lot of hard times. Since I am finishing classes this semester, I worked it out to come back and stay with another volunteer and be at the park from spring-whenever vet school starts, assuming I get in. In a complicated and long twist of events, this volunteer told me (after I prompted her and hadn't heard anything in a really long time) that I probably couldn't live with her for various reasons. I was really upset and angry, because I had been under the impression that living with her was a sure thing and she hadn't even contacted me to tell me it wasn't going to work out. So, I turned to some of the staff for other options. After weeks of not hearing anything, I called and got a text back saying they were working on something for me. That was in early November. I've tried to contact them a few times and haven't heard anything. Well, now deadlines are coming up for other internships/jobs so I really need to know where I'm going to be. I love this place but I'm really hurt that they have been so difficult to contact and it feels like they might be ignoring me. I know things are really busy there so I don't want to pester them too much but I also have no idea what's going on or if they even want me anymore. With how busy they are, they may just not have the time to talk to me right now but I wish I could just get some confirmation that they haven't forgotten me or something. It's really stressing me out. The last time I tried to contact someone there was via text less than a week ago. I was thinking of waiting until after finals are done and then calling them to ask them to at least confirm I can be there this spring/summer. Does that sound like a good idea?
yes
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Sorry it's been so stressful. I know what it like trying to get confirmation from people about that kind of thing when they're super busy. Usually the best option is to call.
Reading all your stories about the "emergency" clients made me think of the emergency anal glands that came in on one of my Saturdays. Yeah, emergency anal glands. I'm by myself on Saturdays, so she didn't get a choice of doctor. The dog wasn't scooting or anything, just doing some made-up thing, like the owner thought he was looking back at his rear end more often than he should be. He regularly comes in for this, so she decided it was a crisis and "time" for him to come in and get them done (asap). The AGs felt pretty empty to me, and while I was squeezing he made a little whimper. The owner immediately makes some comment like, "He's never done THAT before 😡" I think I suggested trying an antihistamine for allergies or something, and she was all "No, no, we just come in and have this done and it makes it better for a while." Then she went out to the front desk and complained about me, saying I hurt her dog, and now refuses to see me. When she makes an appointment, she'll see "anyone except the young one."
You should feel blessed you won't ever be graced with her presence again.
No. Just someone in the community. I'm going back to not answering phones. If my techs are busy it can roll to voicemail. If it's important, they'll call back. I don't need to get yelled at because (*gasp*) I don't see goats and (*double gasp*) I don't know any local goat veterinarians. Because it's totally all MY fault she didn't think "maybe being prepared would mean getting the phone numbers for some goat vets in the area just in case I need them down the road" when she started keeping goats. Jerk.
People just suck.
Why yes, yes they do. If I got a dollar for every time a client or non client was being a total jerk, I would probably have my student loans paid off.
Ah, I thought you meant personal phone. My bad!
I've had clients that don't want to see the new grad who looks like she's 12 (that would be me) and every time I am very thankful for their request 😉
This is a rant among the responsible goat owners too. There are very few goat vets and even fewer that are any good. We all recommend that anybody looking at starting into goats make sure there is a vet in their area first. Call her out to the farm just to look things over. Set up routine visits. Talk about kidding season. (Yes you got that right.) Talk about emergency care and who to call next if the vet is out of town. Talk more about distocia and kidding season.
If you canot be bothered to find the vet before you ever breed or buy a goat, you are going to lose the goat and it's your own damn fault. (It really is all over the ADGA, ABGA, and many other goat associated forums. It's not just you. The lady is an idiot. Without getting that call I'm pissed for her goat too.)
Some person once called while I was working emergency, and said they were on the way. My tech said, "can you tell me what's going on?"
And it was a horse with a forelimb lameness...
Glad my tech did what she was supposed to and asked. Cause otherwise it would have been pretty awful to have a trailer pull up an hour later.
Seriously... What is wrong with people?
And it was a horse with a forelimb lameness...
Glad my tech did what she was supposed to and asked. Cause otherwise it would have been pretty awful to have a trailer pull up an hour later.
Seriously... What is wrong with people?
Just got a message from an old coworker about her kitten that's had "diarrhea and stomach is gurgling. You've had some vet training, what should I do?"
Vet training eh? You mean when I restrained neuro dogs for three years? Didn't know that qualified as vet training.
Vet training eh? You mean when I restrained neuro dogs for three years? Didn't know that qualified as vet training.
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"You don't need 'vet training' to know you need to take your kitten to a damn vet."
