Measurement

One of the hardest things about leaving veterinary school (for me, anyway) is that there are no more concrete measures of success like grades. How do you tell if you are a good doctor? How do you measure improvement?

Is it the number of cases you see per day?
Financial measures like average client transaction amount or gross production?
The number of thank-you cards and gifts from clients?
The number of lives you save?
Getting corrected (or reprimanded) fewer (or zero) times?
The number of cases you can resolve with just one visit? Without referring?
Feeling satisfied at the end of the day, as though you made a difference?
The number of new procedures you learn?
The number of clients who ask for you specifically?
Having techs and support staff respect you? Like you?

I don't have a good answer right now - in all likelihood it is a combination of these factors and more. I *think* I'm doing a pretty good job, especially being out of school less than one year, but I can't prove it definitively. That's a difficult thing to deal with when you're a ridiculous goal-oriented Type A person.

Good at death?

It seems as though the best compliments and thanks I get from clients are my euthanasia cases. I'm not sure why that is - maybe it's the same reason why oncologists seem to have very grateful and nice clients?
Perhaps the clients have accepted what is going to happen. Maybe they appreciate that I explain what is going to happen, explain again as it happens, and ask them if they're ready for each step. Maybe there's something about having gone through it myself as a client multiple times that makes me more empathetic - I'm not really sure. All I know is that I've received positive Yelp reviews, really nice thank-you cards, or profuse verbal thanks from just about all of my euthanasia cases.
It's a running joke with my friends from veterinary school now - that I'm "good at death."

Mistakes

It seems like at least once every week or two I make a mistake and get talked to by the management about it. I get it - it's your money and reputation on the line, it's a new hospital, and I need to be made aware of my mistakes so that I can improve. Frankly I WANTED a place where I could get some feedback (both positive and negative) so that I can become a better doctor!

The latest one was where I didn't explicitly spell something out in the medical record - essentially the client did not agree to the recommended plan so we compromised. We discussed the consequences and risks of said compromise and I put it in the discharge instructions but wasn't explicit enough in the rest of the medical record. Long story short, the thing I warned the client about happened and the client didn't want to pay. Since it wasn't documented super-well in the record (note: my record was NOT finalized because I wanted one of the doctors to review it first, but the client came back before I could get that done) the management comped about $200 worth of services for that client. Oh, and as it turns out the client didn't want to see me or the other doctor on duty that first day but her preferred doctor was off and it was an urgent issue. I'm expecting some more meetings next week to discuss it - sigh. Lesson learned.

D says it takes about 1000 "atta boys" to make up for 1 "oh shit." I need a helluva lot more atta girls ...

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?

New goals

Here are my goals for the rest of 2013:

1. Get 3 pull-ups in a row (strict would be great, but kipping is okay too)
2. Get 3 toes-to-bar in a row
3. Take a vacation and go to a conference (I'm planning to go to IVECCS in San Diego in the fall, but AAFP in Dallas looks good too)

Inexperience

Sometimes It’s hard being the most recent graduate in the practice. There are clients who have followed some of the other doctors over the (10-20) years and who have a lot of history with them. I’m certainly not offended when they prefer to schedule their appointments with the doctor they know – particularly if their pet has a long and complex history.

I had one such client agree to see me a couple of days ago because I was the only one with appointments available and their pet was sick. Our practice has a policy of doing blood draws and injections in the exam room wherever possible, so I attempted to do so. If I had known (or picked up on?) the fact that the client was SUPER protective and nervous about their pet, I would have brought the pet to the back. Instead it took a couple of attempts to do the blood draw (my fault) and a couple of attempts to get the injection fully in (the tech’s fault).

The client emailed their “regular” doctor and asked them to take over the case as a result, which is hugely embarrassing. Now that doctor (who is my boss and an owner) wants to talk with me and the tech about how to improve.

I know that this is how you learn but it really bruises the ego. One of my mentors says that veterinary medicine is a constantly humbling endeavor – whenever you feel like you know what you’re doing you get knocked down a couple of pegs.

2013 goals met!

Remember when I said I had 2 goals for this year?

- I got the new job
- Today I managed an unassisted pull-up. It wasn't pretty at all, but I did it!!

Now I have to think of some new goals. I'll get back to you once I have.