Philosophical battles can compromise care

It was definitely not a beautiful day in the neighborhood.

Like the long lost honeymoon couple locked into an impossible marriage for the sake of the children, the two veterinarian's were at it again, and the entire staff had to put up with their bickering for yet another day. The more than 20-year difference in each doctor's experience was painful for the entire staff to bear.

Let's just call them Ol'Doc and Newdoc. Ol'Doc has been practicing for 2½ decades, while NewDoc is a relative newcomer with just 2½ years in practice.

These two just didn't see eye to eye on philosophy of practice according to their office manager's e-mail plea to me.

The owner feels that:

• Comprehensive examinations are a waste of time, and you can't derive a lot of information from them.

• It is better to over-vaccinate than under vaccinate because vaccines never harmed his patients, except a couple of cats out of 10,000.

• We are wasting client's money frivolously with geriatric or pre-anesthetic profiles for all patients.

• Once you've graduated, continuing education is just a waste of time and money because they just tell you about diseases you will never encounter in the real world of private practice.

The associate feels that:

• Comprehensive examinations are not a waste of time because a significant number of pets do have disease entities that would otherwise be missed, and the wellness examination procedure shows concern for the pet's overall health and bonds the client to the practice.

• Pre-anesthetic exams help point out organ function deficits that might lead to anesthetic complications.

Who is correct here? Tough question, huh?

But who has the power? Ah, the plot sickens.

Imagine for a moment that you are a professor of medicine at your own veterinary college alma mater. As a realist, you know full well that the moment 98 percent of the students graduate, they are the most astute diagnosticians that they will ever be, and the road to mediocrity starts with their first step over the practice threshold. How frustrating that must be. Oh sure, 2 percent will stay in academia and rise above their mentors, but is that 49-1 ratio good enough?

Here we have the classic graduate practicing 1980s medicine into the new millennium alongside the new graduate with the a prior superior education who takes a vow on all she holds dear that she will never allow herself to decline into another Ol'Doc.

Well, the pressures of life are constant. There is struggling to start your own practice while keeping a roof over your head. Then there is the instinctual urge to pass your genetic material into the future, resulting in strange ill-smelling creatures, crawling and spitting up everywhere, consuming bottom line profits as your disposable income shrinks directly proportional to your genetic urges.

Then there is the eternal tug of war between family time and the needs of our furry, feathery, finny charges. For too many, that war is finally and depressingly won in the divorce courts.

Yet, every Ol'Doc was a NewDoc once. I make it a point in my seminars to ask my listeners ... How many here once took an oath to themselves that, "They were never going to let themselves get like the Ol'Doc they hired on to work with?"

At least half the older attendees laugh, and yet they raise their hands.

Then I ask ... How many did not keep their oaths? And ... surprisingly, most raise their hands again!

Why not? Honesty is not an uncommon trait in our profession. Admit to yourself that keeping up with the world of veterinary medicine is just about impossible today. There is more information in our journals and Internet pages than any one human can possibly absorb, even those who graduated from your vastly superior alma mater.

Knowing this, the question is: "What can we do to practice with integrity in accordance with the license we are afforded by our state of residence to practice in accordance with the best interests of our clients and patients in mind?

Every hour we practice is an hour closer to death, and if the purpose of that hour was just to get through another 60 minutes, then we should be pitied.

The worst sin we Ol'Docs can commit is to try and hasten "Ol'Doc syndrome" in the new and enthusiastic NewDocs of this world. Why rain on their parade just because we are too professionally crippled to march proudly.

The only question practitioners have to ask is: Will the New Doc's procedures prevent, cure or delay disease for the pets we are asked to care for? If so, we are morally and legally required to commend that course of action to the client that loves that pet.

Nowhere in the veterinary oath or creed is it stated that we practitioners are to decide questions of treatment economics "in loco parentis." Maybe it is early Alzheimer's syndrome, but I can't remember a class in client/patient economic valuation.

A very wise client once said: "She's an expensive veterinarian but worth every penny."

If all the Ol'Docs of the world are so concerned about their client's pocketbooks, they should set up a booth in their reception areas with a full-time employee sitting there selling pet health insurance policies. That way, the client has economic protection yet avail themselves of the modern, comprehensive miracles of veterinary medicine.

The most frustrating problem for the NewDocs of the world is having to examine the pet that just received a clean bill of health from Ol'Doc last week only to find lesions that appear to be months old. She wants to protect the reputation of her colleague, but the lesions are not going to go way by themselves. We're not talking Addison's syndrome here, folks; we're talking about the Malar abscess that "just happens to appear" in the mouth that should have been exhumed two years ago.

The staff turnover of a practice like the one described is usually double or triple what it could be. No one likes to work in a hostile environment. NewDoc is leaving to open up down the road anyway, so I guess the problem is temporary.

What bothers me is how many pets are going to be cheated out of the practice of "good medicine" in the interim. What bothers me is that Ol'Doc is never going to retain any NewDoc long enough get the bottom line up to where the practice can be sold for enough to fund a retirement.

What bothers me is the number of "practical" but poor medicine procedures that NewDoc is going to subconsciously adopt in the interest of practice harmony to his/her detriment as a practitioner.

Practices like this one are more common than you could imagine. To one degree or another, the practitioners, staying together too long, start to compromise toward a central level of mediocrity.

What would you advise the practice manager on this battlefield?

Dr. Snyder, a well-known consultant, publishes Veterinary Productivity, a newsletter for practice productivity and is available for in-practice consultation. He can be reached at PO Box 189, Hebron, KY 41048-0189; (800) 292-7995; vethelp@insightbb.net, or Fax (859) 689-0564.