The Art of Private Veterinary Practice L’art de la pratique vétérinaire privée When meanings get lost in translation Myrna Milani, DVM
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n Lewis Carroll’s Through the Looking Glass, Humpty Dumpty noted that when he used a word it meant just what he chose it to mean, neither more nor less. The veterinarians and her staff at Smithton Veterinary Hospital and their clients all like to think that they take this same approach too. As practice-owner Dr. Szabo noted, “Who wouldn’t want to use words that communicate their thoughts to others as clearly as possible?” However, she and her staff could not deny that this approach did not always result in quality communication. This column will consider four words routinely used in veterinary practice that may carry quite different meanings for veterinarians and their clients. What makes words like these so troublesome is that people may believe so strongly that their definition is the only right one that they cannot imagine that others do not agree with them. If and when it does become clear that, although they are using the same word they are not talking about the same thing, anger and frustration may result. When this occurs, the relationship between the veterinarian and the client as well as their ability to communicate effectively may suffer.
Responsible Decades ago when the veterinary and humane professions decided spay and neuter was the solution to pet over-population, the Heinos were among the first to have the surgery done on their dogs and cats. They read or listened to the information provided by their veterinarian and various humane organizations and agreed that doing so was the responsible thing for them to do. Their view was further reinforced by media campaigns that reminded them numerous times that responsible owners spayed and neutered their dogs and cats. Fast forward to when Dr. Szabo bought the Smithton practice several years ago. From the beginning, she considered the Heinos among the most irresponsible pet owners she knew. Dr. Milani is a behavior and bond practitioner, teacher, and author of several books on the interaction of animal behavior, health, and the human-animal relationship. Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. CVJ / VOL 57 / JUNE 2016
“I can’t believe that they allow and even encourage their dogs and cats to run loose. It seems like one of them is always getting into trouble,” she complains. “I simply cannot understand why these seemingly intelligent people would do something so irresponsible.” Meanwhile the Heinos have not missed the veterinarian’s dark looks or heavy sighs when one of their animals tears a footpad or gets an abscess from a bite wound. “I know we’ve used the Smithton practice for years and they’ve always taken good care of the livestock as well as the dogs and cats, but I’m wondering if we need to look for another veterinarian,” Ms. Heino raises the subject when the whole family gathers at the farm. “Dr. Szabo doesn’t seem to like us for some reason and I dread taking one of the dogs or cats to her.” In this situation, the veterinarian’s and clients’ different definitions arise from their different orientations toward dogs and cats. Dr. Szabo’s suburban upbringing and veterinary education primes her to perceive dogs and cats as cherished family members, whereas the Heinos consider their dogs and cats valued working members of the team that keeps their farm running smoothly. Their dogs are multi-functional farm dogs that herd, protect, control the larger vermin population, and are trustworthy with even the most fragile livestock; their cats keep the small rodent population under control in the barn and other outbuildings as well as the fields. Although they benefit from their animals’ skills, they also believe that being allowed to use those skills is necessary for the animals’ well-being. Along with spaying and neutering, it is the responsible thing for them to do.
Compliance and consistency Another aspect of practice that confounds Dr. Szabo is a lack of client compliance. She carefully explains exactly what she wants her clients to do, and how and how often to do it. She provides carefully written handouts that reiterate this same information. Additionally, she always encourages her clients to contact her if they have any questions about her recommendations. And finally, she mentions the hospital’s out-patient service for clients who cannot or do not want to treat their animals for some reason. But in spite of her efforts, there are still those clients whose animals do not respond to treatment because their owners are not compliant. 659
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“This bothers me the most when it happens with someone like Jack Stockton who I believed truly cared about his dog,” she explains. “He says he’s doing exactly what I told him but I know from the dog’s lack of response that he’s lying.” In this case, the veterinarian fails to recognize that compliance often hinges on a consistent response and definitions of “consistent” may be quite variable. Although she finds the idea of being mostly consistent an oxymoron on a par with being mostly pregnant, there are those like Jack Stockton to whom this seems perfectly reasonable. When Dr. Szabo asked him to describe his treatment schedule, he said he religiously soaks his dog’s infected foot twice daily for 20 minutes before going to work and again when he gets home. Unfortunately, she did not inquire about weekends or ask a sometimes overlooked question, “What do you do when you work from home?” Not all clients telecommute, but increasing numbers of them do. And unlike those days when they work in places of employment that involve a basic routine to which they more readily can link treating their animals, those at-home work days may have no schedule at all. Hence Jack’s contention that he’s mostly consistent because his dog never misses a treatment on those days he goes into work. It is that variable schedule of days he works from home as well as some weekends that create problems for him. In such cases, the best hope is to find something that the client reliably does do at home 7 days a week and link the animal’s treatment to that. However, practitioners must be prepared to accept that no such predictability may occur in some people’s lives. Additionally, some even may find the notion of any kind of consistent response offensive. In that case, asking the client “How may I help you ensure that Roxy gets her treatment every day for the next 2 weeks?” is the best approach to take.
Compassionate Just as practitioners and clients may attach highly specific (if not necessarily similar) definitions to “responsible,” “compliance,” and “consistency,” some may link the use of certain medications or procedures with the word “compassionate.” One common current example of this is the use of analgesic drugs for a growing range of conditions. Where practitioner-client breakdowns in communication may occur is when veterinarians perceive the use of these products as irrefutable evidence of their compassion-
660
ate natures, whereas clients may assign or withhold that adjective based on the way these products are used. For example, when Ms. Stengel drops her dog off for routine dental prophylaxis she specifically mentions that she does not want her pet injected with pain medication. The technician who admits the dog duly notes this on the animal’s record. When Dr. Szabo sees the notation later, she disregards it and medicates the dog anyhow. “But I also noted that there would be no charge for the medication if the client resisted,” she adds. “It would be inhumane not to alleviate the animal’s pain.” When Ms. Stengel picks up her dog later and discovers he has been medicated against her wishes, she asks to see Dr. Szabo immediately. The veterinarian quickly learns that any attempts to justify her behavior as compassionate only infuriates the woman more. “Do you think it’s compassionate to disregard information from someone who knows her animal better than you ever will? Do you think it’s compassionate to disregard a client’s wishes without contacting that person for more information?” Ms. Stengel asks the veterinarian. “Had you cared enough to do that, I would have told you that he doesn’t handle the medication well. It takes several days until he’s eating and acting normally again after a dental when he’s medicated compared to 24 hours, at most, when he isn’t.” Once again the practitioner finds herself in an awkward position because she assumed her definition of a word constituted the only valid one. While she may feel tempted to blame the client for not sharing this information with her sooner, this will only compound the problem. The examples presented demonstrate how definitions of certain words veterinarians may commonly use in practice are simply that: their definitions. Although some of their clients may share those definitions, others may not. When clients do not, those people may feel as strongly about their own definitions as clinicians do about theirs. To deny or become angry about this possibility, at best, will aggravate the breakdown in communication. At worst, it will cause the client to seek veterinary assistance elsewhere. Because of this, it is better to ask clients to provide more information to clarify their orientation than to judge them wrong according to one’s own beliefs.
CVJ / VOL 57 / JUNE 2016
I
n Lewis Carroll’s Through the Looking Glass, Humpty Dumpty noted that when he used a word it meant just what he chose it to mean, neither more nor less. The veterinarians and her staff at Smithton Veterinary Hospital and their clients all like to think that they take this same approach too. As practice-owner Dr. Szabo noted, “Who wouldn’t want to use words that communicate their thoughts to others as clearly as possible?” However, she and her staff could not deny that this approach did not always result in quality communication. This column will consider four words routinely used in veterinary practice that may carry quite different meanings for veterinarians and their clients. What makes words like these so troublesome is that people may believe so strongly that their definition is the only right one that they cannot imagine that others do not agree with them. If and when it does become clear that, although they are using the same word they are not talking about the same thing, anger and frustration may result. When this occurs, the relationship between the veterinarian and the client as well as their ability to communicate effectively may suffer.
Responsible Decades ago when the veterinary and humane professions decided spay and neuter was the solution to pet over-population, the Heinos were among the first to have the surgery done on their dogs and cats. They read or listened to the information provided by their veterinarian and various humane organizations and agreed that doing so was the responsible thing for them to do. Their view was further reinforced by media campaigns that reminded them numerous times that responsible owners spayed and neutered their dogs and cats. Fast forward to when Dr. Szabo bought the Smithton practice several years ago. From the beginning, she considered the Heinos among the most irresponsible pet owners she knew. Dr. Milani is a behavior and bond practitioner, teacher, and author of several books on the interaction of animal behavior, health, and the human-animal relationship. Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. CVJ / VOL 57 / JUNE 2016
“I can’t believe that they allow and even encourage their dogs and cats to run loose. It seems like one of them is always getting into trouble,” she complains. “I simply cannot understand why these seemingly intelligent people would do something so irresponsible.” Meanwhile the Heinos have not missed the veterinarian’s dark looks or heavy sighs when one of their animals tears a footpad or gets an abscess from a bite wound. “I know we’ve used the Smithton practice for years and they’ve always taken good care of the livestock as well as the dogs and cats, but I’m wondering if we need to look for another veterinarian,” Ms. Heino raises the subject when the whole family gathers at the farm. “Dr. Szabo doesn’t seem to like us for some reason and I dread taking one of the dogs or cats to her.” In this situation, the veterinarian’s and clients’ different definitions arise from their different orientations toward dogs and cats. Dr. Szabo’s suburban upbringing and veterinary education primes her to perceive dogs and cats as cherished family members, whereas the Heinos consider their dogs and cats valued working members of the team that keeps their farm running smoothly. Their dogs are multi-functional farm dogs that herd, protect, control the larger vermin population, and are trustworthy with even the most fragile livestock; their cats keep the small rodent population under control in the barn and other outbuildings as well as the fields. Although they benefit from their animals’ skills, they also believe that being allowed to use those skills is necessary for the animals’ well-being. Along with spaying and neutering, it is the responsible thing for them to do.
Compliance and consistency Another aspect of practice that confounds Dr. Szabo is a lack of client compliance. She carefully explains exactly what she wants her clients to do, and how and how often to do it. She provides carefully written handouts that reiterate this same information. Additionally, she always encourages her clients to contact her if they have any questions about her recommendations. And finally, she mentions the hospital’s out-patient service for clients who cannot or do not want to treat their animals for some reason. But in spite of her efforts, there are still those clients whose animals do not respond to treatment because their owners are not compliant. 659
L’A R T D E L A P R AT I Q U E V É T É R I N A I R E P R I V É E
“This bothers me the most when it happens with someone like Jack Stockton who I believed truly cared about his dog,” she explains. “He says he’s doing exactly what I told him but I know from the dog’s lack of response that he’s lying.” In this case, the veterinarian fails to recognize that compliance often hinges on a consistent response and definitions of “consistent” may be quite variable. Although she finds the idea of being mostly consistent an oxymoron on a par with being mostly pregnant, there are those like Jack Stockton to whom this seems perfectly reasonable. When Dr. Szabo asked him to describe his treatment schedule, he said he religiously soaks his dog’s infected foot twice daily for 20 minutes before going to work and again when he gets home. Unfortunately, she did not inquire about weekends or ask a sometimes overlooked question, “What do you do when you work from home?” Not all clients telecommute, but increasing numbers of them do. And unlike those days when they work in places of employment that involve a basic routine to which they more readily can link treating their animals, those at-home work days may have no schedule at all. Hence Jack’s contention that he’s mostly consistent because his dog never misses a treatment on those days he goes into work. It is that variable schedule of days he works from home as well as some weekends that create problems for him. In such cases, the best hope is to find something that the client reliably does do at home 7 days a week and link the animal’s treatment to that. However, practitioners must be prepared to accept that no such predictability may occur in some people’s lives. Additionally, some even may find the notion of any kind of consistent response offensive. In that case, asking the client “How may I help you ensure that Roxy gets her treatment every day for the next 2 weeks?” is the best approach to take.
Compassionate Just as practitioners and clients may attach highly specific (if not necessarily similar) definitions to “responsible,” “compliance,” and “consistency,” some may link the use of certain medications or procedures with the word “compassionate.” One common current example of this is the use of analgesic drugs for a growing range of conditions. Where practitioner-client breakdowns in communication may occur is when veterinarians perceive the use of these products as irrefutable evidence of their compassion-
660
ate natures, whereas clients may assign or withhold that adjective based on the way these products are used. For example, when Ms. Stengel drops her dog off for routine dental prophylaxis she specifically mentions that she does not want her pet injected with pain medication. The technician who admits the dog duly notes this on the animal’s record. When Dr. Szabo sees the notation later, she disregards it and medicates the dog anyhow. “But I also noted that there would be no charge for the medication if the client resisted,” she adds. “It would be inhumane not to alleviate the animal’s pain.” When Ms. Stengel picks up her dog later and discovers he has been medicated against her wishes, she asks to see Dr. Szabo immediately. The veterinarian quickly learns that any attempts to justify her behavior as compassionate only infuriates the woman more. “Do you think it’s compassionate to disregard information from someone who knows her animal better than you ever will? Do you think it’s compassionate to disregard a client’s wishes without contacting that person for more information?” Ms. Stengel asks the veterinarian. “Had you cared enough to do that, I would have told you that he doesn’t handle the medication well. It takes several days until he’s eating and acting normally again after a dental when he’s medicated compared to 24 hours, at most, when he isn’t.” Once again the practitioner finds herself in an awkward position because she assumed her definition of a word constituted the only valid one. While she may feel tempted to blame the client for not sharing this information with her sooner, this will only compound the problem. The examples presented demonstrate how definitions of certain words veterinarians may commonly use in practice are simply that: their definitions. Although some of their clients may share those definitions, others may not. When clients do not, those people may feel as strongly about their own definitions as clinicians do about theirs. To deny or become angry about this possibility, at best, will aggravate the breakdown in communication. At worst, it will cause the client to seek veterinary assistance elsewhere. Because of this, it is better to ask clients to provide more information to clarify their orientation than to judge them wrong according to one’s own beliefs.
CVJ / VOL 57 / JUNE 2016
