The power in being Present - When clients bring frustration

Let’s face it; people can be annoying and frustrating.  For those of us who work in the veterinary world, where people come attached to each patient, our frustration and stress can build throughout the day.  Each client’s idiosyncrasies piled one on one, combined with the eternal love and concern for their pets, can cause us to reach the end of our day totally drained. 

 I had one of these challenging client situations last week.  It is a perfect example of turning an annoying client experience into something wonderful if we can just remain present.   Amy Cuddy defines presence as “bringing your boldest self to your biggest challenges.”  Presence allows us to listen with an open mind and convey to people that we truly care about them.  It allows us to avoid giving up on a difficult client encounter and makes us work for the pet.

The short version of this story is that a client brought her adult terrier to me because the dog had been vomiting and having diarrhea for at least 3 days.  The terrier was sweet, but appeared to be depressed and somewhat dehydrated.  I proceeded to do my job as I normally would, getting vitals, asking questions and getting permission to do testing to try to diagnose the illness and choose the appropriate treatments. 

The annoyance started when the client kept referring to her cell phone to look up different diagnoses and asking me if I knew what the various diseases were.  She was also texting her friend who was apparently telling her about ways to save money in this situation and asking her to challenge me about the things that I was explaining. 

I attempted to remain kind and patient, but in my head I was getting annoyed. “Yes, I do know what gastroenteritis is.”  “ Yes I know about Parvo virus.”   (Me thinking - Yes I am a licensed veterinarian and I think that is why you are here.)

Well this appointment went on and on with the client declining my proposed plans and her reading about the things I should be doing on her phone.  After over an hour of this back and forth, she declined almost every test, asked me for a prescription for the medications, and almost denied treatment.  I say “almost” because that is when I decided to be more present and become my boldest self.

I used my most patient kind doctor voice to insist that she allow me to at least give the dog some fluids and an anti-vomiting injection to try to get her on the path to healing.  I would be happy to write her a prescription for the medications and bland diet to appease her frugal friend.  I knew that if I totally lost my cool the dog would be the one to suffer, so I accepted the reality of my situation and worked to make it the best that it could be.

Because I remained present I was able to convince her that her pet needed treatment and that I was the one competent enough to help her.  She left the office with a budget friendly bill and a dog that is on the road to recovery. 

So when you are faced with a challenging person, remember to not take it too personally.  Remain present and bring out the boldest, best version of yourself.  It will get you beyond the frustration and bring you through to a successful, albeit not perfect, outcome.

Dr. Julie Cappel

“Whatever the present moment contains, accept it as if you had chosen it.  Always work with it, not against it.”   Eckhard Tolle.

Am I good enough? Hello self-doubt.

Have you ever stood outside an exam room door and felt anxiety about what is waiting for you on the other side?  Do you wonder if you are up to the challenge or have the skills to get it right?   

If so, my veterinary friends, you are dealing with self-doubt.

What if the client does not like me?  What if I cannot make a quick diagnosis?  What if I make a mistake and the pet does not do well or even worse, dies?

Self-doubt is a struggle for us in the veterinary profession.  Every human can suffer from it, but we have many seemingly valid reasons for feeling it daily.  We are required to be brave and make decisions with little solid evidence, often guessing at where a pet feels pain, or about the source of their illness. Many times we do not have the benefit of proper diagnostic procedures due to a client’s financial situation.

To make matters even more difficult, most veterinarians have perfectionist tendencies.  The pursuit of perfection is tricky.  We want to adhere to high standards, but since perfection is impossible, our need to be perfect can hold us back causing us to avoid making efficient decisions.

How can we mitigate self-doubt, strive for perfection, deal with uncertainty and overcome our anxiety?  It takes some concentrated mental effort, but it is definitely possible.

Remember that you are a talented and unique individual.  You did not become a veterinarian by accident.  It took many years of incredibly hard work and dedication.  If it were easy, everyone would be doing it.  Remember that the clients appear in your exam room because they trust and respect you.  They are paying you for your education, discernment and expert opinion.

Realize that veterinarians, like all other humans, are not perfect.  You can strive for perfection, while knowing that the goal of perfection is impossible.  You can choose to accept imperfections or small failures as part of your learning process. Accepting that failure is part of the human experience may help to relieve you of some of the pressure that you place on yourself.

Recognize your successes and celebrate your accomplishments.  Keep a journal, or list of outcomes, of the cases of which you are particularly proud. Read it every time that little bit of self-doubt starts to surface.  Hold on to those thank you notes and cards that your clients send to you even after a pet dies.  Your clients know that you do everything in your power to help them and they acknowledge it.  Read a few of them the next time you feel anxiety or self-doubt creep in.

Daisy and Lambchop

Confide in a mentor, coach, or peer that understands where you are coming from.  Seek help when you feel that the self-doubt is keeping you from being the best veterinarian that you can be.  By understanding that everyone in this profession struggles with some feeling of self-doubt, you will recognize that you are not alone and will be able to quickly accept your feelings when they arise.   

Dr. Julie Cappel

Maybe later. Dealing with procrastination.

It is Sunday. I am working on my blog that I need to post tonight.  Ironically the blog is about procrastination and I have left it unfinished until today.  Anyway…

If you have been a veterinarian or veterinary technician for more than a day you know that clients procrastinate. They notice a problem with Fluffy on Wednesday morning and call for an appointment just before closing on Friday night.  You prescribe antibiotics for their dog’s ear infection to be given twice a day for two weeks, and they return with a more severe infection in four weeks, because they didn’t finish the prescribed course of medication.  They bring in their pet with a problem today, then refuse the diagnostics and medications choosing instead to watch and wait.  It makes our job so difficult, so why do they do it?

Procrastination is about fear of failure and every human being does it. Procrastination comes from our fear of making the wrong decision, so we avoid making decisions at all.  Our clients fear that if they bring the pet in “too soon” we may say that the pet is normal. They fear that wasting our time and their money will embarrass them, so they wait a few days to see if the pet gets better.  We procrastinate calling a client with bad news, talking to a problem employee or writing up a record on a long involved case.  When we procrastinate or avoid our problems they snowball into larger issues we could have avoided if we simply took action.

How can we avoid the fear of failure and make decisions without procrastination?  How can we help our clients do the same?

Never judge yourself or your client for the decisions that were made. It is difficult to avoid feeling judgmental when a client tells you that they didn’t give the dispensed medication, but beating them up over something that is in the past will help no one, including you. Increasing self-confidence will lead to better results, so encourage them in their small successes. Realizing that they have done their best is all you can do to move forward to correct the situation.  Don’t dwell on the past but stay in the present and be kind, so that they will feel comfortable coming to you the next time they need help.

Beating yourself up around procrastination is also an exercise that you need to avoid.   Encourage yourself by taking baby steps.  When you feel fear around a decision start with a small step in the direction of your goal.  Small steps can help you mitigate the fear and lead to leaps in the right direction. Realize that procrastination is just your brain feeling fearful.  If you see the fear as unnecessary, you will be more likely to take positive action.

“Whatever you want to do, do it now! There are only so many tomorrows.”– Michael Landon

Save the Drama - Feeling Overwhelmed and Dealing with Stress

Tomorrow is Monday.  At my veterinary hospital that means drama.

Because Monday is one of the busiest days of our week, it is the perfect day to experience drama, which leads to feeling overwhelmed and ultimately stressed.  I have to admit that I love a little drama, in fact I am sometimes the one that creates it, but I hate to see my veterinary team frustrated and stressed over something that is beyond our control.  Monday.

Last Monday we had three doctors on the schedule, plus me, working there doing my paperwork.  I don’t see clients on Monday as a general rule.  The schedule was packed as usual and several people called with sick birds.  Alas, I am the only bird vet.  When the receptionist politely asks me to see Mr. or Mrs. So and So with their birds, the first thing I do is loudly complain and create stress around the situation. “How will I ever get my paperwork done?” I declare, knowing that I will ultimately say “yes” and see the birds.  Why create the drama? 

I think that the drama feels necessary to us.  It feels warranted.  Our brain likes everything to feel structured, orderly and quiet.  Our brain does not like to be challenged or forced to make quick decisions.  That is why when we feel the need to make many decisions very quickly, our brain causes us to feel overwhelmed so we have a reason to just run and hide.   It is the way we are wired deep in our primitive thinking. 

Stress and feeling overwhelmed are simply emotions.  They have no purpose.  They pretend to be caused by the events going on around us, but are never caused by the events. They are in our mind and under our control.  The stress and frustration we feel is our brain avoiding decision making.  We don’t want to make a choice, so we create drama to avoid making that choice.   When too many choices are presented we have an emotional meltdown to avoid facing them.

How can we keep the drama away and prevent the feeling of being overwhelmed?  Start with managing your thoughts about the busyness of the day.  Why shouldn’t we be busy?  It is Monday.  Mondays are always swamped, because we have been closed for the weekend and people have been watching their sick pets just waiting for us to open.  Normal. Natural. Right?  Getting upset, complaining and stressing-out serves no purpose. 

This is something that we can control.  If our brain is avoiding making decisions we need to teach our brain to make quick decisions and give our brain limited options.  When a client with a sick bird wants to come in on my day of paperwork, I really only have 2 choices.  Say “yes”, or say “no”.  No complaining, no drama.  I know that I will always say "yes", so why not just go there first to avoid the stress?  Limit your brain’s options, make quick decisions and train your brain to avoid the drama.  This will ultimately save you time and energy and keep you from feeling stressed and overwhelmed.

The next time you say, “I feel so stressed” or “ I feel overwhelmed”, think about why you are creating these feelings.  Realize it is a choice that you are making to avoid managing your decisions. 

Dr. Julie Cappel

Please share a story about how you overcame your drama in the comment section below.

Find your Grit and become a Ninja.

“Grit is that 'extra something' that separates the most successful people from the rest. It's the passion, perseverance, and stamina that we must channel in order to stick with our dreams until they become a reality.”   Travis Bradberry

This weekend I was fortunate enough to participate in an event that reminded me about the concept of grit. 

What do I mean by grit?  The definition is, “courage and resolve; strength of character” and in the above quote “that extra something”.  It is the extra something that convinces us not to quit when our negative thoughts tell us that things are impossible in our work or home life.  Grit allows for success in the face of failure.

Have you ever watched American Ninja Warrior?   The contest is a true test of human perseverance and grit. The contestants prepare for the courses and come back to try again, even when they fall face first into the water surrounding the obstacles.  The Ninjas are doing things with their bodies that they thought was impossible until they actually hit the buzzer and finish.

What I did this weekend was nowhere near American Ninja Warrior caliber, but for me it was a test of grit.   It was a 50-mile bike ride, in 92-degree heat and I was a rookie.   My last 20 miles were along an asphalt road with heat radiating off the pavement up into my face,  sun beating down on my baking skin and sweat pouring into my eyes.  My legs were fatigued and it would have been super easy to just pull off the route and call Uber (with a bike rack) to take me home.  I had to reach down deep to pull out my grit to keep peddling to the finish.  I was hot, tired and a bit miserable, but when I saw the finish line, I was proud of myself for my accomplishment. 

Do we need grit in our veterinary practice?  Absolutely!  When an emergency walks in, just as you are just getting ready to leave for the evening.  Grit.  When you have two walk-in appointments in addition to your regular schedule.  You have to be gritty.  You have to put on your multitasking hat, boss your technicians around like a Ninja, and get the impossible done.  Your mind will tell you that it is crazy to take care of two emergencies at once, but in reality you can do it.  You just go into Ninja Warrior mode and get it done.  You don’t have time for worry or fear; you need to pull out your grit plow forward and trust your instincts and your team.  You will save 2 lives in the time it usually takes to save one.  What a great feeling!  Super Veterinary Ninja! 

The next time you feel your brain telling you that your life is too much, or you need to

do something that seems impossible, call on your grit and become a Ninja.   

Leave me a story about a time that you used your grit to overcome an obstacle in the comments below.

Make Time to Create Time

We had another rocking Saturday at our veterinary hospital today. It was loaded with patients ranging from the cutest little sheltie puppy in for his second vaccine appointment, to a difficult euthanasia, to the two vomiting cats that needed radiographs and blood work and still gave me no solid reason for their vomiting. The busy overloaded schedule and the stress that I felt radiating off of my veterinary team, made me wonder how can we better manage our brains around time?  How can we manage the way we think about our time at work and at home, and would it make a difference if we could think differently?

Over the years I have observed myself spending time and wasting time. Using time wisely and costing myself time with worry, indecision, regret and distraction.  I have the type of personality that always wants to know what is going on.  I have trouble sitting in an office alone when there are people and things to see and do outside my office door.  I find myself distracted by the activity in the rest of the hospital.  It is like a monkey controls a small part of my brain.  This results in me procrastinating the “boring” usually important tasks that I need to accomplish and wasting my time worrying about how my team members are spending their time.  Another big thing for me is helping other people get their tasks accomplished.  I find it more fun to help others get things done than to help myself.  

There are things that we can do to create time.

Make a plan:  In order to get more done, be very deliberate with your time.  You will need a detailed plan as to how your time will be spent each day.  The plan should have actual time blocks penciled in to accomplish each task.  If you give yourself a 30-minute slot at the end of the day to write up records, set the timer on your phone to 30 minutes.  Don’t look up from those records until your 30 minutes are up.   You will surprise yourself with your productivity.

I have a small journal that I carry with me.  I sit down in the morning and list all the things that I will get done in the day and schedule time for them.  When I write those tasks down, it looks like my perfect day.   But, we all know that perfect days are rare in a veterinary hospital.   Although I don’t always get it exactly right, by having the written plan I have a much higher chance of success.

Follow the plan:  Making the plan is vital, but following it is key. When you sit down to attend to your plan, your mind will tell you to check your phone, get a snack, get some water, catch up on some gossip and visit the bathroom. Your brain will try to foil your efforts, but stand strong and keep to your plan.  Realize that when your brain tells you to stray from your plan, you can control it.   Tell it to quiet down and get to work.  Later you can schedule in a snack break, but when you decide, not when the monkey in your brain wants it.

Make strong decisions and don’t look back: Many of us spend too much time agonizing over simple decisions instead of just making them and moving on.  Things as simple as, “What should I eat for lunch?” can take some of us over 20 minutes.  If you fear making decisions because you could fail and choose wrong, force yourself to make some quick decisions and don’t second-guess.  You can practice going with your gut and choosing the first thing that comes to you. If you make the “wrong” decision you can just chalk it up to a learning experience and make a better one the next time.  No big deal!

If we all pay attention to the way that we waste our time with distraction and become aware of reducing that waste, we can create more time in our day for the things that we want to accomplish.  Remember that you only have this moment.  The past is gone and the future is out there waiting for you to build the amazing life of your dreams.  

Dr. Julie Cappel

Dropped Pants!

I am always impressed and entertained at how intimate the relationship can become between a veterinarian and a client.  People just love us and often feel so close to us that they share things that they shouldn’t (or we wish they wouldn’t).  It can be a big responsibility and is stressful at times, but mostly it is an honor to be thought of as a trusted friend by people that pay us to help them with their pets.  

I see it as the human-animal-veterinary bond. 

Here is a story from my veterinary life as an example of this awesome phenomenon.

One of my favorite client pairs was a very sweet, happy, and proud Polish couple that brought their very fat Cocker Spaniel  “Taffy” into the office regularly.  They spoke English, but had very heavy accents that were sometimes difficult for me to follow.   In fact, I don’t know that the Mrs. understood much that was spoken to her in English, but she would always smile and nod her head vigorously in agreement with everything I said.  Mr. would explain Taffy’s symptoms in broken English with many details, most of which I got.  He would point and gesture with each word, then smile and shake his head in the affirmative if I repeated his words correctly.  Taffy was very loved as evidenced by his very obese physique.  He was always well groomed but would waddle into the exam room and wag his very stubby and plump tail, but promptly lay down because he was so fat.  He was the kind of fat that makes a dog look like a walking tabletop or ottoman.  Each time he came in I would gently suggest that they reduce his food and they would go on and on about how little he really ate.  “Doctor, he eats only a few bits of food, how can he get so heavy?”  I would ask, “Do you give him any treats or food from the table?” “Oh No!  He only gets a little toast with butter for breakfast,  a couple bites of chicken, a little of my sandwich, he likes pasta and once in awhile he likes a little ice cream and dog treats when he goes outside.”  But he really isn’t a very good eater.”

One day this poor eater arrived for an emergency visit.  It happened when Mr. was taking Taffy for his daily ride in the car.  When they returned home he jumped out of the car as he always had, except for this visit he jumped from the car seat as opposed to the floor.  When he landed on the cement driveway both of his front legs gave way, he screamed out in pain and was unable to walk.  Mr. and Mrs. rushed him right in to see me.  Taffy was in a lot of pain and you could see that the legs were already starting to swell.  I explained that we were going to need to give him some pain medicine and take some radiographs to assess the situation.  When the radiographs finished it was obvious that both of Taffy’s carpal (wrist) joints were completely dislocated.  All the ligaments were torn and Taffy would no longer walk on either front leg unless he had some major reconstructive surgery.  Which is not on my list of talents. 

 I talked to them and explained that I would get him comfortable and wrap the legs for stabilization, but they would have to visit a specialist with Taffy to get the legs repaired.  Once I explained the situation and contacted my favorite orthopedic specialist, we packed Taffy up for the transfer.  We all went out to the reception area to get paperwork together and take care of the charges.  As we were waiting there, Mrs. must have had a revelation of understanding because she called out to me “Doctor!” and as I leaned in readying myself to understand her, she dropped her pants clean to the floor and pointed to her knees.  She obviously understood what her little pet needed.  She was standing in the middle of my reception room, smiling broadly and nodding her head, with her pants at her ankles pointing to the scars on her knees where she had knee surgery.  I smiled back as I looked at her in her underwear now smiling and nodding my head so she would know that I understood, and thinking how much I really love my job.   Communication and trust at its best. 

If you are a veterinary professional, try to remember how much trust and love our clients have for us and treat yourself in the same loving way.  You are their veterinarian, the person that they trust enough to drop their pants.

Dr. Julie Cappel

Why we Love, Love, Love our veterinary technicians

Veterinarians would be lost: No,  we would be nothing, without veterinary technicians.  We would be sad, lonely, tired, overwhelmed, and totally broke. 

I thought about this as I was working today, a very busy Saturday.  I walked out of exam room after exam room to see my technicians scurrying by, handling a mega-pile of tasks.  Draw the blood, catch the urine, run the tests, radiograph the pet, give the fluids, trim the nails, present the treatment plan, count the pills, and call the client.  One crabby gentleman said some rude remarks and threw a stack of paperwork at one of my kindest, most gentle technicians as she was explaining a treatment plan.  She handled the assault with with grace and poise.

How can we honor these rock stars of the veterinary world?

Love and Respect their experience:

Some veterinarians take a superior attitude with their technicians. They do not respect their knowledge base and experience.  Most technician programs are 2-year programs, however much of the technician learning is done hands on.  They learn much of what they do by actually dealing with animals and clients.  Also, sometimes your veterinary technician has more years of experience than you do. Your technician has also worked with multiple veterinarians allowing them exposure to many different methods of  practice and new ideas.  They spend more time with the clients and patients too, allowing them to get to know what the individual needs possibly better than the veterinarian.  When a technician alerts you about  the status of your patient, it would be wise to listen to them with an open mind.  They will help you avoid missing something important.

Love and Respect their teaching ability:

Most of the technicians that I work with are vastly more patient than I am, and much more thorough when teaching a client patient care.  When they are properly trained in nutrition, training, puppy socialization, parasite prevention, and medication techniques they can pass that training on to my clients.   They are friendly, open, honest and able to talk to a client on the level that they need to understand many issues surrounding their pet’s care.  Not to say that we doctors are not great educators, but when we are in the middle of a packed schedule with many patients occupying our time, we are forced to rush through the client education “stuff”.  That is when we can call “super technician to the rescue!”  The client will get a much better education than they will get from the veterinarian (me).

Love and allow them to be who they are:

I work with 10 technicians on a daily basis and each one is unique and special.  I have one that loves inventory ordering and monitoring, one that loves to handle the schedules, one that is a top-notch repair and maintenance woman, one that loves working with the practice management software and one that is a master at social media.  One hates surgery, one hates running exam rooms, one loves exotic pets, one loves rabbits, one loves dog training.  They are all super talented in all areas, but are super productive in the areas that they like best.  The most productive thing that I can do as a veterinary leader is to assign them to the areas in which they excel.   Honoring their unique talents makes for a happier work environment and a more efficient hospital.

So cheers to Shelley, Carolyn, Deanna, Beth, Nicole, Sam, Dawn, Jessica, Jackie and Becky – my amazing technician team.  Thank you for saving me day after day. 

Please share your best veterinary technician story with me in the comments, to honor those who really run our veterinary hospitals.