The NY Times recently published an article on how doctors get on the “Top Doctor” lists that got me thinking.
In medicine there’s this pernicious idea that you are either a good vet or a bad vet.
But what makes a good vet? Vet schools tell you it’s doing tests and treatments exactly by the book. Practice managers tell you it’s by being efficient. Pet owners tell you it’s by fixing their pet in the cheapest, fastest, most convenient way. If pets could talk they’d say it’s about keeping them happy and healthy as long as possible.
The problem is, those goals usually conflict. I am a thorough veterinarian whose great at explaining the “why” of what I’m recommending. I do a ton of follow-up. The clients who choose to see me love me, but if you want to be in and out the door of our veterinary hospital in 20 minutes and feel pestered by a reminder call to bring in your pet’s poop sample, I am not the doctor for you.
Sometimes I’ll be less efficient or more expensive than another doctor because I’m being more complete to make sure we don’t miss something. Sometimes what’s best for the pet isn’t convenient or affordable for a pet owner.
I use my heart and mind to their fullest every day just trying to juggle these demands. I usually put the patient’s needs first, start by trying to do things by the book and then work with pet owners to do as much as we can given their practical and financial limitations.
It’s messy and imperfect but ultimately it’s about being able to sleep at the end of the night knowing I gave the absolute best I had to give.
What do you think makes someone a top veterinarian?
We have dealt with many vets and I think I have a good idea of what makes a good one. When I simplify things, I usually say it’s the 3Cs: credentials, competence, compassion.
I want a vet competent enough to either be able to diagnose a problem properly or recognize they need an outside help whether from a colleague or a specialist etc.
I want a vet who is confident but not so full of themselves that they make up their mind with disregard to what I have to say about symptoms or medical history. Example? After her drug-induced hyperthermia, among other things, Jasmine had severe mobility problems. She ended up at our teaching hospital. She also had surgeries on both knees some time prior. The knees healed and she was walking, running and jumping just fine before the hyperthermia struck her down. Yet, every time I tried to discuss her mobility problem, I was dismissed with ‘she isn’t walking because of her knees’. I even her Jasmine’s primary vet call them to testify that her mobility was perfectly fine before. But they had their ears turned off. How could they address the whole problem while dismissing one of its major presentations? She was not nonambulatory because of her knees, she was non ambulatory because of something that happened during or after the hyperthermia event. It was very frustrating.
I had several similar encounters in the past. But when you’re already at the teaching hospital, who do you turn to? And I’m not even going to go to the experience at the emergency vet prior to he transfer to the teaching hospital. $700 worth of total misdiagnosis and they practically wrote her off.
She lived five more full years after that; active and PERFECTLY MOBILE.
I had more on my mind but getting into the details above I lost my train of thought.
And I could cite more examples.
I think, there are actually three categories of vets, not two:
1) top vet – able to diagnose and treat successfully no matter what the problem
2) average vet – able to efficiently deal with most common stuff
3) bad vet – an idiot who can botch about any ol’ thing
Another thing that makes a top vet is keeping up with what goes on in vet med; new and/or alternative treatments. Willingness to consider, research and discuss these. Having the guts to say ‘I don’t know’ and then go and find out. Having the guts to admins when they’re wrong.
I could keep going but I think my rant is long enough already.
What makes a top vet? Having some brains and putting the patient above all. And yes, vet, that includes thy ego.
You mentioned, obviously, working with some people who frustrated you. Can you share and describe an experience where you felt you were working with a top vet?
I don’t know that any vet can “diagnose and treat successfully no matter what the problem” but it sounds like from your description is that you’re looking for a vet who truly listens, leads you in a direction that makes sense, and when they find they are going down the wrong road is humble enough to admit it. Does that sound right?
Well, we had MANY frustrations with vets over the years. We finally found a great one when we were looking for Vet-Stem certified vets in our area and stuck with him until our move. We’re really happy with that one.
Because of our move we had to look for a new one which was very scary for me. But did a lot of homework, online interview and yesterday we went for an introductory visit and seems that this one will be great also.
I know there are some things that are hard to diagnose but I’ve seen many cases where the diagnosis wouldn’t be so difficult, as a second opinion vet diagnosed things easily. For example. And if you don’t know, ask somebody, right?
What kind of vet I consider a top vet?
Our last one and hopefully this new one too 🙂 What I need from a vet is the following:
– always putting the patient first (I mentioned ego before and I had a reason for that. Patient first, ego second. Period. Whether the vet’s or mine for that matter)
– keeping up with all that is happening in vet med
– looking for causes rather than getting tangled up with symptoms
– good diagnostician or a vet who will ask around, research or refer
– openness to alternative solution
– listening to what we have to say, particularly in terms of symptoms and concerns (I KNOW my dogs and I KNOW when something isn’t right, whether I might have a clue what or not)
– open to discussion, whether it is about treatment options, diet or anything else
Our last vet was all that and some. And even though he is quite skeptical about alternative treatments, I could discuss anything with him and he was open to research and try stuff and even happy to admit when some of those things worked.
And yes, sometimes we “argued” about things. And sometimes he’d win and sometimes I’d win. All part of the process. Only through discussion one can arrive to ideal (as perceived at the time) solution.
Our new vet seems to be just like that too. So that’s good. We’ll see whether she can survive working with me 🙂 Because I leave no stone unturned. But I believe that’s how it should be.
Ha! I love this < < We’ll see whether she can survive working with me :-) Because I leave no stone unturned. >>
Folks who say stuff like that are always my favorite clients because we always get the best outcomes for their pets! It’s awesome when we can be a team, when they bring the expertise on their individual pet to the table, and I can bring my medical expertise. We do discuss and debate a lot and I think that’s a good thing. What surprises me is that sometimes people apologize for being thorough, but no one should ever apologize for looking out for their pet.
I am curious about this – can you explain more what you meant by this? “looking for causes rather than getting tangled up with symptoms” – Since often we backtrack, matching symptoms to the most likely causes so we can figure out what tests to do first.
I definitely agree with being open to discussion, really listening, and being willing to ask around.
As a vet though, I’ll admit, second opinions often feel “easier” to solve. Sometimes just having a completely fresh perspective can really help. A human doctor does a good job describing this phenomenon in “How Doctors Think”. Also, when I can make the diagnosis look easier than if I had started with the pet just because I’m handed a lot of information already. I don’t often have to repeat the most commonsense tests.
You certainly sound like a top vet 🙂
I agree that second opinions are often ‘easier to solve’. I get a second opinion on most serious issues/treatments and our past vet often saught them on his own with other colleagues. For both of us it was getting another brain into a discussion.
Looking for causes rather than getting tangled up with symptoms example? How about ongoing stool problems? After parasites were ruled out nobody was liking any further and they just routinely prescribed antibiotics. We were at the vets all the time and that was all they ever did. Didn’t recommend further diagnostics or theories, just treated the symptom. We didn’t know any better than. That went on for 5 years! Only after that, while taking x-rays to asses for the stem cell treatment, our new vet (the last one we had until the move) discovered a mass on palpation.
Jasmine had IBD for a very long time which nobody considered never mind diagnosed.
Good enough example?
Btw, here are some of my more coherent thoughts on the subject
http://dawgbusiness.blogspot.ca/2011/06/veterinarians-are-people-first.html
There are many kinds of pet people and hence, many kinds of vets. Greatness is simply a measure of attainment of a goal. There a great people doing mediocre work everyday, and, conversely, lots of mediocre people doing great things. So, I think greatness resides in giving a tiny bit more than you think you have to, and consistently asking yourself if you are being a truly genuine person of admirable character to both yourself and to those you serve.
Love the thought provoking blogs, and the genuine transparency of your compassionate veterinary soul.
Many Thanks for being such an inspiring vet!
Krista
I love that, “I think greatness resides in giving a tiny bit more than you think you have to”. That’s absolutely beautiful. It means a lot to know that what I put out there is inspiring, sometimes being willing to be transparent can feel really scary, so knowing that it means something to others is what helps me keep doing it.