...Pants on Fire...

As a long time practicing veterinarian I have learned that some clients lie. Maybe a kinder way of saying it is, they stretch the truth.

Untruth after untruth will be reveled if you ask enough questions.  They tell the receptionist one story on the phone then tell the doctor a different story in the exam room. It is so fascinating.  Why do they do it?  How can we understand their motivations and get the real story so we can help their pets?

It happens almost every week in some small form, but it happened to me a few weeks ago in a big way.  

The story goes like this.

I had a couple come in with a beautiful, but quite ill parrot named Cass.  Cass was not feeling up to par and the couple was worried about him.  They told my technician that he was on a great diet and had never been ill before.  They also said that he was not on any medications.  They repeated the same story to me when I was examining Cass.  The owners seemed to love him very much and wanted what was best for him, so we drew some blood for testing and took some radiographs. When the results showed that Cass had severe liver disease we discussed a course of medications and diet modifications.  The couple was grateful and promised to adhere to my recommendations and bring him back for a recheck in a week to see if we were making any progress. 

The second time I saw Cass he was acting a bit better, however after more testing we realized that he still had a severe liver problem.  As I talked to the couple about next steps, they asked me to speak to another family member on their cell phone to explain the results.  I happily took the phone.  As I was explaining the tests results and my recommendations for an ultrasound of the liver, the person on the other end of the phone said, “He already had an ultrasound a few weeks ago.”  Flabbergasted I asked for more details.  He said that the bird had been seen by another veterinarian and had the same tests that I was recommending.  I could not believe my ears.  Why would the owners bring me a bird with a known problem and not tell me the complete history?  What kind of game were we playing here?  I asked which veterinary hospital and promptly called them.  When I asked the receptionist if they had any records on Cass she said, “Oh yes, we have a huge history on him.”   The other veterinarian told me that Cass had been visiting their veterinary hospital for 15 years and the bird was diagnosed with liver disease over SIX MONTHS ago and was on multiple medications for the problem. He also had radiographs, and ultrasound exam and was treated multiple times over the years for similar problems.

Once I had the entire history, I went back to speak to the couple to see if I could figure out why they chose to lie to me about his history.  I asked them about the medications that he was supposed to be getting from the other hospital and they magically produced a bag of at least 10 medications that they had but were not giving.  When I asked them why, they just looked at me and said, we didn’t think they were working.  I pointed out that when he was getting the medication they reported to the other hospital that he was doing better, but now he was ill after not getting the medication.

Oh, My!!  Why did they lie?

As a veterinarian I think it is our duty to be patient with “liars” and see the lies for what they really are, FEAR.  Fear of the unknown and fear that we may judge them for seeking a second opinion or not following our recommendations.   We need to be able to reassure people that we are all on the same team.  We need to be open to sharing information with other veterinary hospitals so clients will not feel that they have to hide information. We need the whole story before we can do our best work.

Gently ask probing questions in different ways and ask multiple times.  It seems that when I ask the same questions in different ways, I often get closer to the truth.  Also, be open to suggestion.  Most clients know their pets’ needs best, and want us to think as they do.  If they make a suggestion about their pet’s care, be open to it as well as being open to their opinions on treatment options.  

If you are a veterinarian or veterinary technician, be patient with the “little white lies” that people tell.  Understand that they are not doing this to harm us, but are just trying to navigate the fear they have of our profession.  Show them how much you care about the truth and the patient’s care to put them at ease.

If you are a pet owner, please do not hide important information from us, we really do love animals and want to help you and your pet.  We will be better able to help if you do not keep important information from us.   

We are all on the same caring veterinary-client-patient team.

The truth will set us all free.  :)

Dr. Julie Cappel

How to love people you don't like.

Yesterday I heard someone complain about one of their colleagues.  I listened to them grumble about the other person’s personality, work ethic, intelligence and leadership skills.  They had an idea in their head about how the person should behave and it was not happening for them, so they felt frustration, which lead to complaining and gossip.

Complaining about a co-worker, family member or friend is not a useful or productive exercise.  Wouldn’t life be easier if we could accept and love everyone?  What would your day be like if other people did not bother you, but in fact pleased you? 

Beautiful right?

It is totally up to you.

Your relationship with other people is about how you THINK about them.  It really has nothing to do with them.   It is your thoughts about them and their behavior that determines your relationship. 

The first step towards accepting others is to learn about and understand you.  We are all wired in different ways and in fact we all think differently.  There are many tools to help you understand personality and behavior styles.   I like Myers-Briggs, DISC, and Enneagram but there are many others that you can use.  Through these tools I have come to understand that I am an extrovert that enjoys harmony and getting things done.  I enjoy a fast paced work environment and quick solutions.  I do not enjoy tedious tasks that require reading detailed directions or sitting for long periods of time alone in my office.  I have the capacity for detail work, but it is not my preference.

Once you understand some things about yourself, you will have more capacity to look at others and understand their personality preferences.  You will be better able to appreciate their usefulness in your world and in your relationship.

The second step towards acceptance is to let go of your script.  We all have these scripts in our head that we write for others.  How we think they should behave.  How we think they should do their job.  How we think they should treat others.  The scripts keep us from allowing others to just be.  The truth is that adult people get to behave in any way that they want to behave.  Nothing in our script can prevent them from doing as they wish.  Once you accept that, you can let go of your preconceived notions towards their behavior and appreciate the things that they do well.  They have their own agenda, which has nothing to do with your script.  

Adults get to behave as they wish.

The third step is unconditional love.  Once you accept yourself just the way you are, you can move on to any self-improvement project without boundaries and the trappings of past failure.  You are free to explore anything that your heart desires.  When you accept and love others unconditionally, your relationship with them is free.  You no longer have to try to control their behavior because you realize that they are perfectly perfect the way they are.  This does not mean that you have to put up with abusive behaviors or poor performing employees.  You can love someone and still set boundaries around yourself or the job.  If the other person chooses to violate those boundaries, you can let them go without guilt or anger.  You can set them free and complete the relationship with love.

How you feel about another person is totally dependent on how you think of yourself and think of them.

“As you think so shall you be!  Your relationships are all in how you think about other people in your life.”  Wayne Dyer

Dr. Julie Cappel

Photo credit - Quattrozampe.online

Seek First to Understand

It occurred to me yesterday, as I was telling my family a very funny story from my workday that being a good listener is a huge part of my job.  Veterinarians must be good listeners and very often, good actors too. Some of the stories we are told are not to be believed and would cause a normal person to either laugh hysterically or drop open their jaw in disbelief. 

Listening is one of the most important skills that we as veterinarians must perfect, and is one of Stephen Covey’s seven habits from the book “7 Habits of Highly Effective People”.  Steven said, “Most people do not listen to understand; they listen with the intent to reply.” 

John Maxwell, leadership guru, calls listening our most important skill.  He recommends that we spend 80% of our time listening and 20% talking.

In veterinary medicine we not only have to listen to the clients to get an idea about why their pet needs help.  We also spend much of our time “listening” to the body language of our patients as we attempt to figure out what they are telling us about their illnesses.

There are multiple ways that we can work to develop skill as a good listener to benefit our clients our teams and ourselves.  These are the some proven steps for success when it comes to listening carefully and responding appropriately:

Identify the speaker’s problem.  You can get to the identification of the problem by asking yourself a few questions.  What is the issue that brings this person to me?  What is their goal?  Once you have the answer to these questions you can start to try to understand the facts that will help you solve the problem and offer the speaker a solution that they are after.

Determine the person's mindset and formulate your plan to cater to them.  Are they approaching from a scarcity mindset or an abundant mindset?   Are they more concerned about the financial cost for treatments, or are they willing to align your goals with theirs in order to get to the bottom of the problem?

Respond in a way that meets the other persons wants and needs.  To respond in the correct way you need to approach the problem with empathy and the speaker’s personality in mind. Use the words that you believe that the speaker wants to hear as you present the solution to their problem.  If you have really paid attention and listened well you will have no problem getting their problem solved to everyone's satisfaction. 

Remember that listening is a skill that requires practice and the ability to be generous to the other persons' needs and wants.  If you listen with the goal to understand as your first priority  it will open up your skill as a listener and grow your relationship with your clients and your team.

And also practice your "straight face" for those times when the clients say or do things that cause a shocked response.  Then later you can use those stories to entertain your family and friends.  

Dr. Cappel

Lessons from "Reality" Vets

There seems to be an ever-growing obsession with veterinary reality shows on television.  In my mind it all started with "Emergency Vets" back in the 90s, which was a show that focused on Alameda East Veterinary Hospital where the medicine was cutting edge.  Now, there are so many shows with veterinarians working everywhere from Alaska to Hawaii to Houston, with varying levels of veterinary medical care. There are even some wacky veterinary characters that have become admired in spite of their less than conventional medical practises.  I am a fan of some of these shows because they allow the pet loving public to get a glimpse --albeit not always an accurate glimpse -- into the “reality” that is our veterinary world.

As I watch the variety of veterinarians showcased on these shows I am reminded of the huge job that we do each day and the challenge of treating a wide variety of patients and conditions.  I see the tremendous capacity that veterinarians have to persevere when the going gets tough.  It is one of our most admirable qualities.  It is the thing that keeps us from running out the door on any given day after we face a treatment failure or nasty case.

Perseverance is “steadfastness in doing something despite difficulty or delay in achieving success”. 

Perseverance is something that we needed to get through our difficult schooling and something that we possess each day in order to do the best job for our patients, clients and families. So how do we continue to develop this skill in and out of our work environment?  How do we further develop our capacity to persevere?

Formulate strong goals.  In order to push through to a conclusion of success, you have to have a clear goal in mind.  It may be something as simple as cleaning off your desk or as complex as getting through a successful surgery. You have to start with an end in mind. 

Make up your mind. Have a strong will or intention to achieve your stated goal. You cannot persevere if your mind is weak, so decide up front that you will not fail or if you do hit a bump in the road, you will continue to try.

Hold on to optimism.  If your brain thinks the goal is too lofty or wants to think negatively about it, you are less likely to follow through.  Think optimistic thoughts and you will be more likely to push through when things look grim.

Stay focused on the present.  It will not help you to dwell on your past problems or your future fears.  If you stay focused on each step you will be less likely to give up if things look down.   You will have a higher capacity to get each thing done and will feel less overwhelmed.  With each step, acknowledge your accomplishments or small successes then focus on the next step in the process.

All of us can learn to develop our tenacity and increase our ability to push through when the going gets tough.   When obstacles get in your way and discouragement threatens your optimism, think of the grit and strength that brought you where you are today and carry on. Learn a lesson from those “reality show vets” and get the job done before the "hour" is over.

“Perseverance is the hard work you do after you get tired of doing the hard work you already did.” Newt Gingrich

Dr. Julie Cappel

Time always wins.

Today I want to talk about time. Time is something everyone wants and something that everyone wastes.  We have a tremendous capacity to waste our time.  We worry about how to change our circumstances, change our past, change our co-workers, and wish away some situation that we find ourselves in.  These are all things that we really cannot change.  

Wasted time.

Time is basically math.  We all have the same 24 hours in a day and we get to choose what we do with that time.  Will you write the next best selling novel or will you binge watch Netflix?   Will you spend time alone or with friends and family?  Will you work or play?

Last week I adopted a new puppy.  I already have one excellent dog named Trent but I guess I felt the need for another challenge.  The new puppy is Parker and so far he has monopolized a good portion of my time.  House breaking, feeding, cleaning and training all take up time.  I must set aside some other important things to invest in developing another good dog like Trent. It is a choice.

How is it that we can enjoy our time and also be the most productive?

Before you do anything, take time to plan.   Spend a moment choosing the activity that will have the most positive effect on your day.  What is it specifically that will most positively affect your family, clients and your team?  Resist the temptation to distract yourself with less important tasks. 

In order to organize your mind, ask yourself some questions. What does my team/family need from me now?  What will cause the most problems if I do not get it done?  Which task, if completed, will bring the most value to my day?

Minimize interruptions.  Identify the activities that tend to disrupt your day and find a way around them.  It could be something as simple as closing the door to your office.  Your team will still interrupt you (as mine often do), but they may do it a little less often.  Avoid checking email or social media when you are in the middle of something important.  Keep your flow going and work on one task at a time to completion.  If you get the most important things done first you will feel a sense of accomplishment and build momentum.

Learn to delegate wisely.  There is no rule that says you must do everything yourself.  Team leaders often feel that they need to do everything themselves to be sure that it is done correctly.  They have an attitude or fear that others will get it wrong.  I have seen many veterinarians and managers doing things that their team is perfectly capable of doing all in the name of misplaced perfectionism.  If you let go of a little control and ask your team for help, you will not only get more done, but it will free you up to be even better at the things that only you can do.

Learn to say “No”.  If you just weed a few things out of your day, you will have so much more time to spend working on things that are important to you.  People pleasers like myself have a difficult time with this concept.  We will often say yes to things that we really don’t want to do in the name of not disappointing our team.  We will spend our precious time working for others instead of ourselves.  Take a few moments before saying yes to someone and really think about how the “yes” will impact your day and your time.  If in your heart you know that a “no” will serve you better, be brave enough to say so.  There is always another way to complete the task if you think outside the box.

Be bold enough to guard your time.  It is your most important asset.

As my favorite movie character Rocky so eloquently said,

“Time takes everybody out.  Time is undefeated.”  - Rocky Balboa

Dr. Julie Cappel

Burning Out? Fire Up!

I had a perfectly delightful day Saturday running a wing and nail trim clinic at our local bird show.  I say delightful, because we had a great time people and bird watching, and it was a change from our daily routine.  My wonderful technicians and I were not as busy as we are used to, however it was good to do something positive for our community and see so many people enjoying the company of birds.

Why does a change in routine feel more energizing than a typical day?  How can we have this same energy every day in work and life?

Many veterinarians and veterinary technicians struggle with feelings of exhaustion often voicing that they are “burned out”.  Exhausted from the physical challenges of the job and burned out from the emotional challenges that we face every day.  It is the routine that usually gets to us. We say things like, “I am so exhausted.”, “what a long day”  and “I am overwhelmed.”  

Are we exhausted because of our job or because of the way we think about our job?  Is it the clients or the team members, or is it you?  The way we think about our day has a strong correlation with our ability to keep a positive outlook and overcome the tendency to lump all of the daily activities into the category of over work and feeling tired.

The exhaustion comes from our brain telling us that we are incompetent, unappreciated and unqualified. 

So, if our thinking is the problem, how can we change it and fire up? Here are a few great things that you can do. 

Finish what you start.  Multitasking seems fun, but it really adds to daily stress and leads to overwhelming feelings.  If you can focus on one thing at a time and really finish it, you will feel much calmer and in control of your day.  Make a short list of the most important things that you want to finish today and get it done before you do anything else.  That will allow you to feel more in control and less exhausted at the end of the day.

Make yourself the priority.  Take some time and actually schedule the break into your day.  Learn to say “no” to things that do not serve you. (This is a big one for me).  I know that you can’t always say no to clients and patients during your workday, but if you control your schedule before and after work, you will feel better and less exhausted. 

Compliment and appreciate your fellow team members.  When you are on the look out for positive things in your workplace, you will procure a better attitude towards it.  Feelings of gratitude for your team and work environment are the polar opposite of stress and burn out.  Look for reasons to be grateful and your mind will turn from noticing the negatives to appreciating the positives.  Fire up your gratitude and challenge your attitude to drive it in a positive direction.

If you have to think each day anyway, you might as well think like a positive, self-confident, grateful, competent, bad ass veterinarian.    

Managing your thinking  will have your feelings of burnout and stress turning into excitement and joy that you get to work as a veterinarian.  

 Dr. Julie Cappel

There is no correct way to grieve.

As a long time veterinarian I have to deal with grief.  Grief when a pet gets a bad diagnosis and grief when that pet’s life comes to an end.   In a blog that I wrote two weeks ago, I wrote about how grief and love go hand in hand and how we should embrace grief as being a part of love.  I do believe that, but it got me to thinking about how we navigate that grief.

My amazing husband reminded me about the work of Elisabeth Kübler-Ross and David Kessler in the books “On Death and Dying” and “On Grief and Grieving”.  In the books they talk about the stages of grief.  David Kessler writes, “The stages…are responses to loss that many people have, but there is not a typical response to loss as there is no typical loss.”  Grief is as unique as the person that is experiencing it.

I find that to be true in my experience with my clients and their pets.  Each situation is unique and there is not a proper way to express grief.

The five stages are denial, anger, bargaining, depression and acceptance.  David writes that not everyone goes through all of the stages, and not everyone experiences them in the same order. 

Denial is usually the first stage of grief.  Denial involves confusion and shock and is our brain’s way of guarding us from the emotions that will follow.  We are blocking reality, so we don’t have to feel the terrible emotions that are to come.  Denial is what causes us to avoid the reality of the situation until we have the capacity to really feel.  I remember feeling this when I lost my first dog as a young adult.  I could not face the fact that I was going to have to make a decision to let her go.  

Anger is the second stage.  Anger is what gives our grief structure and makes us feel stronger.  When we feel anger towards another person, the current situation, or even God, it makes us feel more in control than the denial that feels so chaotic.  Anger is the manifestation of the underlying pain.  Lashing out makes us feel more in control of something that we cannot really control.  I have experienced my personal anger when losing a family member or pet.  I also have been on the receiving end of anger as a veterinarian when delivering bad news.  I do not take it personally as I know that it is just grief talking and is a necessary part of the natural grieving process.

Bargaining is often the third stage but I have seen it mixed in with denial and anger.  Bargaining is the thinking that “if only” I had done something different this would not be happening.  We say, “I wish” or “I should have”, brought the pet in earlier, paid closer attention, or been there when the pet died.  Veterinarians do some bargaining of their own when a severely ill pet is presented to us.  We think, “Why didn’t this pet get to me sooner?” or “Why did they wait so long?”   We think that we may have been able to do more if we had seen a pet sooner.  Bargaining allows us to remain in the past and avoid the reality that we are facing.  Bargaining seems to crop up over and over again as we navigate grief and is the thing that makes us question our euthanasia decisions.  We wonder if we chose the correct time or waited too long.

The fourth stage is depression.  Once we have let go of the bargaining we feel the true weight of the situation.  This is not just feeling sad but really feeling lost.  The realization that your loved one is gone and is not coming back causes profound sadness and is an appropriate response.  It is one of the steps that we need to go through to get to the other side and move on to acceptance.  There is no proper way to deal with this stage, except to say that getting help from others is very important.  Talking through your grief with a family member, friend, support group or therapist is often needed to navigate this stage.  Remembering that pets are a significant part of our lives and not being ashamed to talk about it to others, will help us to progress beyond the depression and move into acceptance.

The fifth stage is acceptance.  Acceptance is not being “ok” with the loss or “feeling good” about it and moving on.   It is about accepting the reality of your pet being gone but not forgotten.  Accepting that life has changed and will be forever different going forward.  I see acceptance in one way, as a veterinarian, when people adopt a new pet after a loss.  They are not replacing the love that they had for the deceased pet, they have accepted the loss and have chosen to love again.  The new pet is not a replacement but an addition to a their life.  I personally spent a year without a dog after I lost both of my previous dogs within four months of each other.  When I got to the point of acceptance and my house felt empty I adopted Trent my current Sheltie.  I will never forget my other two dogs, but I chose to open my heart to another. 

I write about this subject not to make you feel sad but to help us all to feel supported and understood.  There are people that judge us on grief surrounding pets.  They may be unkind or lack empathy when it comes to the choices surrounding pet care, illness and euthanasia.  I want everyone to be assured that most veterinarians and veterinary technicians will treat you and your pet with compassion, love and support in all situations. 

Guilt, judgment and regret have no place in this discussion. 

There is no correct way to lose a pet and no correct way to grieve. 

Dr. Julie Cappel

If you would like to comment on this story or any other, please leave a comment here or visit my Facebook group “Veterinary Life with Dr. Julie Cappel”

Learn to love a little conflict

It may sound very strange, but I really do enjoy a good conflict.  I just experienced one yesterday with a group of my most trusted colleagues, and even though it was passionate and uncomfortable at times, I think we are all better for it. 

In veterinary practice, upset clients are the main source for confrontation and conflict.  Even the kindest, most efficient and most experienced practice will face client dissatisfaction, because no veterinary hospital is perfect.  I have faced my fair share of upset clients and although they are not always pleasant, I do enjoy the challenge of confronting their problem and repairing the relationship with our practice.

How do we look at an upset client as an opportunity to improve and grow instead of a problem to avoid?  

Let’s remember that all clients are unique individuals and have different preferences and needs. One client will be happy to sit and wait in the reception area for 40 minutes on a busy Saturday, and the next will storm out after waiting for 15.  One client will happily wait for your phone call back after business hours, and the next will call back in thirty minutes and wonder if the doctor forgot about the message that they left “hours” ago.  Because everyone’s expectations are different, we are bound to disappoint someone in spite of working diligently to please everyone. 

When faced with a client issue, the best thing that we can do is address the problem as soon as possible and do so face to face.  Bring them into an exam room and sit in a chair facing them.   Take a deep breath and relax.  Your body language will make all the difference, so stay relaxed and do not get defensive.  Allow your client to speak freely and actively listen.  It will be tempting to interrupt, but don’t do it.  Let them get it all out.  Everything that they are feeling needs to be expressed before you try to resolve anything.  Once you feel that they have told you the entire story, ask a few questions to clarify that you really do understand the problem.  Most people just want to be heard.   You cannot change their experience or change the past, but you can allow them to express their frustrations and work towards resolution. 

Also remember that sometimes clients complain for good reason.  Your practice may have a very valid issue that you would not have realized, if it were not for their complaint. Thank them for bringing the problem to your attention and give them a sincere apology for the inconvenience.  Once you have listened, thanked them, and given them a sincere apology, ask if there is anything that you can do to repair the relationship.  Assure them that you will address their concerns with the entire veterinary team.  If they feel that they were truly heard and something is going to change, they will feel validated and less likely to leave the office upset and retaliate on social media. 

If they do retaliate on social media, be sure to again address their concern, but never argue with their review.  It will only fuel their fire and make you look bad to boot.  Thank them for speaking to you personally to try to resolve the issue and assure them that you are working on a solution.  Ask them to call you again so they know that you are open to further discussion.  Many times when you follow up with a kind response after you have also been kind in person they will remove their Internet rant. 

My practice is fabulous and I can confidently say that we have the best veterinary team anywhere.  We rarely have conflict with our clients, but when something does go wrong I can jump right in and enjoy the challenge of conflict.  I consider it an opportunity to improve my communication skills and for our practice to grow; making things better for our clients, patients and veterinary team.  

Conflict is a part of life, so why not learn to enjoy it?

Dr. Julie Cappel