Fitting in the line up

Editors' note: We asked Dr. Philip VanVranken, a 33-year veteran of veterinary medicine and owner of Dickman Road Veterinary Clinic in Battle Creek, Mich., to act as a mentor to recent graduate Dr. Andrew Rollo, an associate at Gibraltar Veterinary Hospital, a five-doctor, small animal practice in Gibraltar, Mich. The two doctors exchanged regular e-mails over the course of a year. This is the second of four articles this year that share portions of their conversations, which we hope will stimulate discussion and help associates and owners understand each other better and learn to work together more effectively.

The first year in the game isn't a piece of cake—but it doesn't have to be moldy bread either. In the first few seasons, rookies learn where they fit in and decide how they'll relate to those up and down the bench.

The truth: For a rookie to succeed, he has to interact effectively with everyone from the bat boy to the pitching coach to the veteran—knowing what he has to offer and what he has to learn.

In the middle of their conversation, Drs. Rollo and VanVranken fielded some questions about how new doctors interact with their teams and coaches. Here are a few highlights.

The whole roster

Dr. Rollo: It became clear to me rather quickly that there were many people around me I could learn from other than the doctors. In fact, my first morning of work, at 8:02 a.m., a Chihuahua came in with dyspnea. The dog had congestive heart failure, but the only thing that went running through my head was, “I can't believe this is my first patient.” Luckily one of the technicians standing next to me broke me out of my trance and suggested we give the dog some oxygen and furosemide. As if I were Leonardo DiCaprio in “Catch Me if You Can,” I simply said, “I concur.” However, it wasn't long before I felt like I wasn't pretending to be a doctor and I was actually part of the medical team.

As a new graduate, there's certainly concern about how much you know. Since there's very little education in veterinary school about actual general practice, it crossed my mind that many of the support staff members could have considerably more knowledge on certain subjects than I do.

Clients really don't care if I can differentiate ALP from ALT; they want to know the difference between heartworm preventives. And it's the support staff members who know the answers to the basic questions clients have everyday. A team member at the front desk can be a client's hero by suggesting their dog be put on flea preventive to help take care of those gross white worms the client has seen coming out of their pet's backside.

Dr. VanVranken: In my early years as a practitioner, I kept a lot of my thoughts in the exam room to myself. Eventually I learned the “healthcare team” included me, and my team—but also the client. Between all of us, we figure out almost all of the answers. So make sure you keep clients on your team; they spend a lot of time with the pet, and they know what normal is for Fluffy.

Calling the shots—and then explaining

Dr. Rollo: There's a standard at my practice that the doctors have the final say. As the new doctor, I've brought some ideas to the practice that the staff has never seen before. Often I hear, “Dr. Rollo, what are you doing?” I like to educate. And I've found that if I take the time to explain why I'm doing something, the staff usually responds well. The technicians want to learn as well, so when I let them in on the trick, I usually find they're 100 percent behind me.

I've found that if everyone works together as a team, there's little opportunity for conflict. I know the strengths of my team members, and they know what I bring to the table. In terms of communication, two weeks out I tried to assess every interaction and ask myself, “How can I communicate with this person better?” But then I got busy—and we are very busy here—and I find myself falling into old habits. Right now, I guess I see the challenges of dealing with different personalities as a work in progress—and it will be for the next 30 years.

Dr. VanVranken: It's great that you like to educate. Sometimes I feel like the only thing I have to sell is information. Not drugs, not food, not surgeries—just information. Everything else is an ancillary service. Your clinic sounds ideal for this mindset, because you keep doctors in front of the client for a long time. The more clients know, the easier your job becomes.

Batting coaches and confident swings

Dr. Rollo: I told my boss, Dr. Patrick Mech, that he'd better be especially nice to me this week or it may come back to haunt him in print. Seriously, though, he's good to work for. And I've been surprised at the freedom he's afforded me. Every doctor in this hospital is incredibly easy to approach to discuss cases—yet at the same time, I don't feel like anyone's looking over my shoulder. This can certainly be a confidence booster as long as the infrastructure's there for support.

I wasn't sure at first how I'd do coming right out of veterinary school where there was always someone else who had the final word. Now, all of a sudden, “the buck stops here.” (President Truman actually never said those words. A friend gave him a sign for his Oval Office desk with that saying. He only had the plaque for about six months, but the press ate it up and the phrase stuck with him.)

The first time I do any procedure, there's nothing automatic about it; there's a considerable amount of thinking going on. I was told surgeons aren't supposed to be doing much of that. Yet my boss does a good job telling me that I'm capable of doing a particular procedure. For weeks he told me I was ready to perform a cystotomy. I finally had a patient with stones upon stones in the bladder, and as soon as I looked at the radiograph, I went back into the room and told the owner I would like to do the surgery. I never wondered whether I could do it, because Dr. Mech had convinced me that I could.

Dr. VanVranken: You're fortunate to have a boss who encourages you to “be all that you can be.” Too many doctors assign new grads the mundane chores of our profession (anal glands, infected ears, to name a few), while they perform heroic acts. Your boss, however, has allowed you to participate in the more exciting events in our profession—good for him!

Now your part is to be prepared and have a plan. Don't start on the cystotomy, get in the middle of the procedure, then look at the technician, and say, “Now what?” In many cases, reviewing the latest literature may give you a chance to improve your hospital's performance on certain procedures. It's a two-way street—make the most of the opportunity he gives you.

A word of caution: Baking three cakes doesn't qualify you to undertake a five-tiered wedding cake. To paraphrase Clint Eastwood, “A man's got to know his limitations.” Don't start something you don't understand, and remember to ask for help if you need it. The willingness to ask for help is a strength—not a weakness.

Opinions, please

Dr. Rollo: My boss is very interested in my opinion on tough cases. He knows that times have changed since he was in school and that I may have a different take on a procedure or treatment than what he's used to. I'm more than happy to give my two cents' worth—because usually I'm asking for at least a nickel's worth of information back.

In general, our work environment is very open. Many of my ideas have been put into place. However, a business isn't a democracy and the boss gets the final say. Every young gun comes into practice and thinks he knows the best way to do everything. Yet it isn't my huge investment that keeps the hospital running, and I don't have 20 years of making mistakes to learn from. I figure I have plenty of time to make my own mistakes.

Dr. VanVranken: We've all visited or been exposed to other practices and muttered to ourselves, “If this were my practice, I would ... ” My suggestion is to figure out what hill you want to die on. Pick just one or two things that you passionately feel should change, then share your thoughts during a quiet time. It very well could be your boss has been contemplating that change himself and your information will help.

Under no circumstances should you blurt out frustrations in the heat of battle or in front of clients, employees, or both. Case in point: Our doctors have been contemplating purchasing a new ultrasound machine. If you hand an ultrasound image to your boss and say, “I HATE THIS MACHINE,” that probably won't elicit the response you'd like.

A more pragmatic approach: Go to lunch with your boss and have a well-thought-out, unemotional discussion about enhancing your hospital's ultrasound capabilities. Discussing the benefits for both your patients and clients will be better received.

Of course, different bosses respond to different approaches, so you have to figure out the best approach for you. But remember, the client and patient should always be at the center of your plans to implement change.