The Longest Day

Last Wednesday was pretty rough. This was not a typical day for me. Here were my appointments:

- Puppy with vaginal discharge after her spay last week (no, I didn't perform it) whose owner was freaking out. Looked like puppy vaginitis.
- Newly adopted rescue dog, just preventive care. Fairly straightforward.
- Eye recheck for a dog with red irritated eyes, improved but not resolved.
- Rechecks for kittens who had upper respiratory infections, now resolved.
- Dog with recurring urinary tract infections, unable to get urine since she went just before her appointment.
- Dog with horrible skin issues (a breed who is notorious for severe allergies) whose owner repeatedly declines workup, changes the dog's diet frequently without consulting us, and sometimes forgets flea preventative then wonders why the dog's skin is always messed up. Repeat my speech on dog allergies for the 3rd? 4th? 100th? time with that client.
- Dog who needs vaccines but the owners have no idea what he needs or when he last had vaccines. They sat there with their arms folded across their chest as though I was supposed to use my magic psychic powers to figure that out.
- Ancient dog with 7-8 major problems and an owner with no money who wants to chat about everything that *could* be done for the dog but that they won't do for the dog. This appointment set me behind schedule by about 15-20 minutes.
- Dog ear infection recheck. I'm only allocated 20 minutes because it's a recheck appointment but hey doc, the dog is limping now too, could you check that out in less time than you usually have for a new problem?
- Itchy cat recheck. Owner just changed to limited ingredient diet and has been keeping all cats on monthly flea preventative. Say a silent thanks for this client because they are awesome.
- Recheck of cat being pet sitted by owner's EXTREMELY high-strung and rude daughter. Ugh.
- Wellness exam for a grumpy cat whose owner is pretty awesome.
- 30 minutes before closing emergency hit by car stray kitten who is 95% dead. Have to help it the rest of the way.

I came home, had a beer, and cried.

Speaking of emergency ...

I found this great blog entry today containing tips for dealing with veterinary emergencies (as an owner/client).

Emergency conference

A few days ago I returned from the IVECCS conference in San Diego. It was fantastic! There were 7 or 8 different learning tracks ranging from complex specialty center care (ventilators and the like) to things useful for a general practitioner like me. There was also a technician track with 2 different lectures to choose from at any given time.

Here are some examples of the lectures I went to:
Anaphylaxis
Lymph node cytology
Blood smears
Respiratory distress in cats
Anesthesia for patients with pre-existing disease (heart disease, diabetes, etc.)
What's new in the treatment of parvovirus infections

In addition to the excellent learning content, I got to catch up with many of my friends from my old hospital where I was a tech as well as friends from vet school. I also had time to visit the San Diego Zoo, Sea World, and to go to this crossfit box for a workout!

Here are some of my favorite pictures from the trip:

Turtles at Sea World

Flamingoes at the zoo

Manta ray at Sea World

Hilarious!

Next year the conference is in Indianapolis. I'd love to go again but may choose a different conference such as a feline-focused one.

Grump

Yesterday I went into work an hour early with the intention of catching up on phone calls. I had a lot of lab results and surgical estimates to discuss with clients.

OF COURSE then the phone rings - new client, dog got into a fight and sustained bite wounds, could we see them? Receptionist asks Dr. Bosses (one in surgery and one in appointments) and they say that we can probably have one of us work them in - perhaps me.

My heart sank. I told the receptionist that I could see the dog if no one else could but that I would really prefer to catch up on everything that I was behind on. You see, I don't have access to our computer system from home and so all my callbacks and records writing has to happen at work. I didn't want to stay late to do it or call people at 8:30 pm, so stupid me thought it would be a good idea to come in early.

Guess who saw the emergency. Guess who became 30 full minutes behind as a result and ended up apologizing to people the rest of the day for being behind.

To make things even more fun challenging, we had:
- A fully booked appointment schedule
- 2 dentals and 3 surgeries (dentals take up 2 techs and surgeries take 1, thus tying up about 50% of our techs all day)
- 2 other urgent care appointments earlier in the morning
- 2 ultrasounds (those took up the remaining 50% of the techs)
- 1 tech out with a sick kid

Net result: I had NO help with my first few appointments after that emergency.

I ended up being fairly grouchy and having to mentally check myself from biting people's heads off. I failed one time unfortunately and then felt horrible because that is how I felt and acted ALL THE TIME at the corporate practice.

There are certainly some efficiency things I can work on, such as completing more of the records in the exam room and maybe calling people back at night if necessary. However, I also think we had far too many procedures booked for the number of techs we had. When Dr. Boss is cleaning exam rooms and restraining animals we are definitely short on support staff.*

One of the challenges that I face with completing the records in the exam room is that the main tech I work with is slooooow on the computer and regularly makes errors, so I've lost trust in her being able to do any of my records or charges. How do you help coach someone to get better when you don't have the time to do so? Other techs are really good about entering charges and entering history and treatment plan into my records so I only have to complete the physical exam and assessment portions. With this other tech the history becomes a verbatim transcript of what the client said in run-on-sentence form (so it's unreadable) and it's a rare time when either a charge or a prescription direction or both are incorrect.



*Note: I am absolutely NOT saying that doctors are above doing tech work. It's just that when a doctor does tech work you are spending more money to get the same job done - AND you are taking away from time that could be spent making diagnoses and coming up with treatment plans.

Oh my.

Yesterday was a ridiculously crazy day. I had:

- A full appointment schedule
- 2 kitten spays
- 3 4 unanticipated emergencies (1 decompensating cancer patient, 1 vomiting and limping, 1 blowout vomiting and diarrhea with a VERY challenging owner, and one anesthetic emergency during one of the spays)

I ate my lunch at 6:30 pm. Oh, and I got my period too - fortunately I had the supplies on hand to deal with that.

The combination of all of these factors made me extraordinarily grumpy (however my mood improved quite a lot once I actually got to EAT). Looking at the bright side of things, though:

- I finished both spays in about 25 minutes each - so I'm getting more efficient, and both kittens did well post-operatively
- I generally DO have a full appointment schedule, which is pretty awesome considering the economy and that fact that I'm still a new grad
- I successfully channeled all of that stress into cleaning the house and kicking butt on a very challenging workout today
- With the exception of 1 appointment (the one with the challenging owner), I felt as though everything got handled very well and the clients were happy

Today was a nice chance to sleep in and relax. Tomorrow will likely be busy again!

Day 6/6

This week I worked an extra day at the hospital to cover for one of the other doctor's vacations. It was BUSY! Unfortunately I had several more euthanasias, but I got a lot of new and interesting cases such as a broken toe, a thromboembolism (unfortunately that turned into a euthanasia) and others.

Today was my 6th day working in a row - at the vaccine clinic. The tech and I both got bitten and scratched by a very ill-tempered cat which was no fun, especially since it was within the first 30 minutes of starting work. Cat bites really suck - even if you wash them out thoroughly they often get infected.

Fun quotes from this past week:
"Have you lost weight?" (- Crossfit coach and massage therapist both asked me this on Monday ... actually I've GAINED a little weight)
"You're doing REALLY well." (- Dr. Boss)

The emergency queen rides again

This week has been slightly crazy at work. We're a general practice open daytime-only and yet I've managed to have an emergency every day; the other doctors have had a few as well.
Here's what I saw:
Tuesday - foreign body ingestion
Wednesday - bee-sting allergic reaction
Thursday - urinary obstruction
Today - hit-by-car AND bit-by-dog

Good thing I renewed my membership to the emergency special interest group! I'm also planning to go to their conference this fall. If these things are literally going to walk in the door when I'm on duty I should keep learning how to best treat them, right?