This week I find myself in a role that I am not entirely comfortable with - veterinary client. And not even a client at the hospital where I am employed but rather at the local veterinary school. My dog had total hip replacement surgery yesterday. Suffice to say it is expensive and will require a lengthy recovery time.
Yesterday I found myself sitting on pins and needles wiating to get the call from the surgeon affter the procedure was complete. Thankfully there was no "oh shit" moments; everything went as it should.
I arrived at the school last night to visit and sat in the waiting room until the ward technician came to get me to bring me to see my dog. Of course I want to explain to everyone that I'm a tech, so please everyone go about your business and allow me to sit here with my dog for hours and hours. On the other hand, I don't want to be that irritating client that lingers for too long while the techs try to go about the business of treating their patients. So I give my dog a pet, a kiss, thank everyone for taking care of her and head out the door. When I got home I sent flowers to the ward technicians from my dog. Cheesy - yes. But she may just get a little extra attention and TLC as a result.
So now I continue to wait for daily updates from the surgeon - or more likely from the veterinary student assigned to the surgical service this week. Luckily I do have some contacts at the school so I know someone will be looking in on my dog.
This experience certainly gives me renewed appreciation for our clients. I should take a little extra time with all of them to be patient and understanding. This is a good lesson for me - and for the low low price of $6000.00! Ug.
Thursday, March 31, 2011
Tuesday, March 29, 2011
The waiting room waits
I have worked in emergency veterinary medicine for a number of years and I am still amazed at what exactly constitutes an emergency in the yes of pet owners (and what does not). Every weekend there is a least one dog that presents to the ER with an ear infection. Now, it's not that we are above provding treatment for an ear infection by any means. I'm just surprised that pet owners will pay an emeregncy exam fee to have their pets seen for this condition. Often it is something that can wait until their vet opens on Monday. Still, even during the week we see these types of cases.
I have not worked in general practice for a long time but I can't imagine that their exam fee is nearly as high as ours. Still I think of it as a reflection of the pet owner's love for their animal that they will gladly spend the money to treat an ear infection on a Saturday night. Of course there is the possibility that the dog's frantic ear scratching has driven them nuts enought to pay whatever it takes to stop it from happening.
Another spin on this is the pet owner that presents to the ER for something like an ear infection - totally stable patient - and then creates a scene in the waiting room because an unstable hit by car dog that arrived after them is being seen before them. What do people not understand about being in the ER? If it bleeds, it leads - that's all there is to it.
Two weeks ago on a Sunday afternoon we had a waiting room full of patients waiting to be seen. All hands in the hospital were scrambling just to keep up with our inpatients while handling the outpatient load. The waiting room crowd was getting cranky - making frequent inquiries about how long the wait time was going to be. Just then a car pulled up with yet another emergency and I was called to the parking lot for a triage. In the back was a yellow lab that had just been hit by a car minutes before. He had degloving injuries to both his front paws (in other words, the skin had been torn from his body and his muscle and bones were exposed). There was a lot of blood, the dog was not at all stable - I carried him the building through the waiting room. We rushed him to the treatment area so that we could begin to stabilize him. After about 45 minues, the owners opted to euthanize this dog. It was unfortunate because we certianly could have fixed him up though it would have cost a significant amount of money. In the end the owners just couldn't afford treatment.
However, after seeing a dog, bloodied and in need of care being rushed through the waiting room, the rest of the clients calmed right down - realizing that all of our efforts had to be focused on this one dog.
Perhaps they realized how lucky they were to have very stable, practically healthy animals.
Perhaps it was the tears in the eyes of the teenagers that arrived with the dog and their mother.
Who knows?
I have not worked in general practice for a long time but I can't imagine that their exam fee is nearly as high as ours. Still I think of it as a reflection of the pet owner's love for their animal that they will gladly spend the money to treat an ear infection on a Saturday night. Of course there is the possibility that the dog's frantic ear scratching has driven them nuts enought to pay whatever it takes to stop it from happening.
Another spin on this is the pet owner that presents to the ER for something like an ear infection - totally stable patient - and then creates a scene in the waiting room because an unstable hit by car dog that arrived after them is being seen before them. What do people not understand about being in the ER? If it bleeds, it leads - that's all there is to it.
Two weeks ago on a Sunday afternoon we had a waiting room full of patients waiting to be seen. All hands in the hospital were scrambling just to keep up with our inpatients while handling the outpatient load. The waiting room crowd was getting cranky - making frequent inquiries about how long the wait time was going to be. Just then a car pulled up with yet another emergency and I was called to the parking lot for a triage. In the back was a yellow lab that had just been hit by a car minutes before. He had degloving injuries to both his front paws (in other words, the skin had been torn from his body and his muscle and bones were exposed). There was a lot of blood, the dog was not at all stable - I carried him the building through the waiting room. We rushed him to the treatment area so that we could begin to stabilize him. After about 45 minues, the owners opted to euthanize this dog. It was unfortunate because we certianly could have fixed him up though it would have cost a significant amount of money. In the end the owners just couldn't afford treatment.
However, after seeing a dog, bloodied and in need of care being rushed through the waiting room, the rest of the clients calmed right down - realizing that all of our efforts had to be focused on this one dog.
Perhaps they realized how lucky they were to have very stable, practically healthy animals.
Perhaps it was the tears in the eyes of the teenagers that arrived with the dog and their mother.
Who knows?
Friday, March 25, 2011
Triage is an art
The basic meaning of the word triage is "to sort". Sort through stable vs. unstable patients. Triage almost always takes place in the waiting room, though sometimes it takes place in the parking lot. When a patient arrives at the hospital, we are called to the waiting room to triage the patient. Because we operate as a human ER does, we do not see scheduled appoitnments (obviously the other specialty departments do not operate in this manner).
In emeregncy/referral practice, our primary clients are the referring veterinarians. When area animal clinics close for the day/weekend they refer their patients to us for emergencies. We do not want to do anything that will hurt our relationship with our referring vets, so we don't provide vaccinations (except for the middle of the night bite wound of unknown origin), routine spays/neuters, or dentals. Suffice to say a good number of the people that arrive with their pets through the ER have never been to our facility before. That in itself is challenging, particularly if the animal is not stable. When I arrive in the waiting room to triage an unstable pet, I have a very short amount of time to gain the pet owner's confidence. I explain in simple terms what I am noticing about this person's pet.
"It appears that Fluffy is working pretty hard to breathe. Would it be okay if I took him to the treatment area to be evaluated while you fill out the paperwork?"
"I'm concerned because Rover's pulses are so weak, his heart rate is elevated and his gums are pale. I'd like for the vet to have a look at him immediately. Why don't you fill out some paperwork while we have a closer look at him and Dr Smith will be out to explain what's going on to you in a few minutes?"
It is not the job of a veterinary technician to diagnose, prognose, prescribe medication or perform surgery. To that end it is crucial to not offer up any diagnosis at the time of triage. So even though I often have a pretty decent idea of what is going on with a patient at the time of presentation, I keep my mouth shut - no matter what the clients ask me.
When a dog presents after being hit by a car and has major injuries requiring a strecher to get from the car to the building the client generally has no problem being separated from their pet for little while. When the patient is a cat that has been gradually declining in health for 2-3 weeks and is just being seen by a vet now - and is not stable - the owner can be surprised when I tell them my concerns and my desire to take the cat from them for a little while to be evaluated. Couple that with an emergency consent form that, if signed, gives us permission to spend a few hundred dollars in diagnostic work on the pet right away- and it can be enough to send a client over the edge. However, I think that, in general, people are aware of the high cost of veterinary care, and the even higher cost of emergency veterinary care.
I do empathize with clients over the amount of money that is required to fix some animals. Sometimes the bills are astronomically high. I could never afford to pay some of the bills I have seen. So I really appreciate it when a client does whatever it takes to fix their pet (financially speaking). This is, of course, when the animal can be fixed. Clients that spend crazy amounts of money to extend the lives of pets with long term, chronic, end of life type diseases are more difficult to stomach. However, I am not the judge, just the technician. It's my job to do what I can for both the client and pet, make everyone as comfortable as possible, and hope for the best. Even when the best option is euthanasia for a 2 year old dog that has been hit by a car and will require multiple days of hospitalization and surgery to fix. Money is tight, jobs have been recently lost and a baby is on the way - we can't afford to fix our dog. I get frustrated and feel sad for the dog - but that's the way our business goes.
Back to the actual topic - triage. It is a skill to triage well. I have been doing it for a number of years and I still make mistakes. Two weeks ago I triaged a golden retriever that presented to us after having been to 3 other referral hospitals in the area. The dog's heart rate was normal, though the pulses were not that great. Because all of the dog's other vitals seemed okay (normal respiratory effort, sounds, pink gums), and because I knew it would not be a long wait to see the vet (about 5 minutes) AND because the owner did not really want to part with his dog, I let the dog wait with his owner. My gut was telling me to bring the dog to the "back" (I hate that term), but I didn't go with my gut. Fast forward 3 minutes - reception calls for a stat triage, and lo and behold, this dog has collapsed on the waiting room floor. Come to find out he had bad heart disease - and I should have followed by instinct.
This seems to be a lesson I have to learn over and over again.
In emeregncy/referral practice, our primary clients are the referring veterinarians. When area animal clinics close for the day/weekend they refer their patients to us for emergencies. We do not want to do anything that will hurt our relationship with our referring vets, so we don't provide vaccinations (except for the middle of the night bite wound of unknown origin), routine spays/neuters, or dentals. Suffice to say a good number of the people that arrive with their pets through the ER have never been to our facility before. That in itself is challenging, particularly if the animal is not stable. When I arrive in the waiting room to triage an unstable pet, I have a very short amount of time to gain the pet owner's confidence. I explain in simple terms what I am noticing about this person's pet.
"It appears that Fluffy is working pretty hard to breathe. Would it be okay if I took him to the treatment area to be evaluated while you fill out the paperwork?"
"I'm concerned because Rover's pulses are so weak, his heart rate is elevated and his gums are pale. I'd like for the vet to have a look at him immediately. Why don't you fill out some paperwork while we have a closer look at him and Dr Smith will be out to explain what's going on to you in a few minutes?"
It is not the job of a veterinary technician to diagnose, prognose, prescribe medication or perform surgery. To that end it is crucial to not offer up any diagnosis at the time of triage. So even though I often have a pretty decent idea of what is going on with a patient at the time of presentation, I keep my mouth shut - no matter what the clients ask me.
When a dog presents after being hit by a car and has major injuries requiring a strecher to get from the car to the building the client generally has no problem being separated from their pet for little while. When the patient is a cat that has been gradually declining in health for 2-3 weeks and is just being seen by a vet now - and is not stable - the owner can be surprised when I tell them my concerns and my desire to take the cat from them for a little while to be evaluated. Couple that with an emergency consent form that, if signed, gives us permission to spend a few hundred dollars in diagnostic work on the pet right away- and it can be enough to send a client over the edge. However, I think that, in general, people are aware of the high cost of veterinary care, and the even higher cost of emergency veterinary care.
I do empathize with clients over the amount of money that is required to fix some animals. Sometimes the bills are astronomically high. I could never afford to pay some of the bills I have seen. So I really appreciate it when a client does whatever it takes to fix their pet (financially speaking). This is, of course, when the animal can be fixed. Clients that spend crazy amounts of money to extend the lives of pets with long term, chronic, end of life type diseases are more difficult to stomach. However, I am not the judge, just the technician. It's my job to do what I can for both the client and pet, make everyone as comfortable as possible, and hope for the best. Even when the best option is euthanasia for a 2 year old dog that has been hit by a car and will require multiple days of hospitalization and surgery to fix. Money is tight, jobs have been recently lost and a baby is on the way - we can't afford to fix our dog. I get frustrated and feel sad for the dog - but that's the way our business goes.
Back to the actual topic - triage. It is a skill to triage well. I have been doing it for a number of years and I still make mistakes. Two weeks ago I triaged a golden retriever that presented to us after having been to 3 other referral hospitals in the area. The dog's heart rate was normal, though the pulses were not that great. Because all of the dog's other vitals seemed okay (normal respiratory effort, sounds, pink gums), and because I knew it would not be a long wait to see the vet (about 5 minutes) AND because the owner did not really want to part with his dog, I let the dog wait with his owner. My gut was telling me to bring the dog to the "back" (I hate that term), but I didn't go with my gut. Fast forward 3 minutes - reception calls for a stat triage, and lo and behold, this dog has collapsed on the waiting room floor. Come to find out he had bad heart disease - and I should have followed by instinct.
This seems to be a lesson I have to learn over and over again.
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