Professionalism -- with thoughts from Bacon and Churchill

You make a living by what you get. You make a life by what you give.

-Winston Churchill

It seemed to be abnormally quiet in the clinic that day.

Inside the middle exam room, Penelope Smythe, the local librarian, watches as Janet Polk took "Jimmy's" temperature and pulse.

Jimmy wiggled a bit, but for the most part seemed just as proper as Mrs. Smythe. Jimmy was a small Silky Terrier with a lot of poise and dignity.

Just then sounds of levity could be heard bleeding through the tightly shut door to the back. Then a moment of silence. A few moments later the unique sound of Dr. Frasier's voice could be heard clearly as he guffawed loudly at the crescendoed end of what must have been a joke of some kind. The sounds of snickering and smattering of offensive language made their final bleed through of the hollow door. Then silence.

Janet flushed briefly and tried to finish her cursory exam of Jimmy. She had hoped that Mrs. Smythe hadn't noticed and tried desperately not to meet Mrs. Smythe's eyes. Unfortunately, Mrs. Smythe, with years of experience noting any deviation in auditory protocol, took note and filed it away for future reference.

Five minutes later, Dr. Frasier arrived and without introduction or hesitation started an examination of Jimmy. He was a charmer who worked with a focused frenzy that exuded "professional" care and warmth. Dr. Frazier gave a complete and accurate diagnosis of Jimmy's condition and gave a point-by-point analysis of his assessment. He then prescribed a plan of action that would have made any professor of internal medicine proud.

Doctor is in

Mrs. Smythe had not said a word. In fact, she didn't have the opportunity to do so. The picture that Dr. Frazier gave was in direct contrast to the awkward and profane intercourse that had leaked into the exam room just 10 minutes ago.

"I'll think about it, Dr. Frazier," she sniffed.

In the next room Sandra, a longtime assistant, walked up to Janet.

Grapevine in overdrive

"Did you see how fat Mrs. Smythe has gotten?"

"Yeah, her dog is just as fat and looks like an engorged tick." They both laughed loudly.

Dr. Frazier, walking in a nearby hallway, could easily hear the conversation. He walked over and gladly added his endorsement to the conversation. He added a few enhanced observations of his own and then sauntered away to the next exam room.

Judy had been checking Mrs. Smythe out and had briefly noticed her dim facial features. Just then the conversations currently occurring in the back wafted innocently to the front. You could have cut the chilly air with a knife. Jimmy and Mrs. Smythe left-never to return.

Meanwhile, across town, at Elsewhere Animal Hospital, Dr. Jones begins a conversation concerning his competitor, Dr. Frazier, to his recently graduated technician, Sarah.

Mud-slinging continues

Sarah had just asked an innocent question concerning the other veterinarians in the area. Dr. Jones' responded with an opening salvo castigating Dr. Frazier for a missed diagnosis that he had the opportunity to see as a "second opinion" just this morning.

He also was only too happy to denigrate the new equipment that he had heard was now available in his competitor's office. He finished up by taking an opportunity to mention the fact that another doctor across town had 'stolen' a technician from him last year. He added that she had been a terrible employee but that he had given her a good reference 'just for fun.' This was more information than Sarah was looking for-but she would soon learn to bottom feed like everyone else.

Annie, the new receptionist, arrived just as Dr. Jones finished his diatribe. She was alarmed and noted that there was a dog up front that just showed up vomiting and spewing blood from his rear end all over the newly waxed linoleum. It was just after 5 p.m. and Annie noticed that Dr. Jones was turning beet red and was obviously seething.

Shotgun decisions

"Put them in the feline only room, and I will see them immediately," he spat.

Once inside the room, it became apparent in his mind that this animal and the new client were from the less fortunate side of town. In the back the fire drill had begun-bleach, plastic bags and disposable paper towels and seldom used smocks were quickly assembled-the practice was in high alert for the universally dreaded disease-parvoviral enteritis.

Dr. Jones scowled at the client and the patient and went into a long and dominating discourse concerning the client's lack of patient care (unvaccinated for parvo) and lack of a veterinarian (she had just moved here five months ago). He also indicated that the patient was a disaster in every way possible for the clinic, the neighborhood and the patients in the hospital. He went on to imply that people like her always demand veterinary care at the end of the day and that if they want to save money on pet care they should start with prevention and seek only the advice of the veterinary profession. He went on to proclaim that the chances of this dog having parvo were 100 percent.

The totality of the information and the plight of her dog stunned the client. He recommended immediate euthanasia. She meekly added that she would be quite willing to pay for parvo testing if such a test existed. He obliged after giving her a point-by-point analysis of the expected costs. He proudly stated that he would throw a fecal in for free.

Ten minutes later Sarah stared at the test. It was negative. The fecal floatation and smear were loaded with hookworms.

Sarah asked Dr. Frazier, "What do I tell the owner?"

"Tell her that there are a lot of false negatives and that hookworms accompany parvo disease. Tell her we will treat the hookworms and see what happens."

The owner paid with Visa Platinum.

Lack of professionalism is a national disease that has infected the entire business world.

Professional ebb = cultural decline

This has gone hand-in-hand with this nation's deteriorating lack of civility and lack of personal responsibility.

It is likely one of the many reasons for our apparent downward spiral into cultural dysfunction.

Most people have been taught that they can have anything they want in life as long as they are willing to fight for it and that others along the way are either competitors or impediments to that end. Freedom in this country has come to mean personal license. In America, we seem to live in a culture of narcissism not seen since the Roman Empire-(that's right I said it, but so have others.)

To reverse this trend our culture must find better heroes than they currently have. Our culture in recent years has looked to Hollywood and the NBA for role models. Reports indicated a high percentage of NBA players have criminal records--no surprise. Unfortunately, when everyday Americans look to people who they can reasonably expect to interact with on daily basis and emulate-the business, religious and medical professionals-the current crop comes up short.

Why is this? Because professionalism, if promoted at all in our profession, seems to have been taught to us as an ideal that protects things and ideas such as:

Wrong perspective

• The integrity of the current database of veterinary information.

• The use of technical jargon instead of the transparency of everyday language.

• Rules or creeds devoted to technical expertise.

• Rules that exclude promotion (advertising).

• A reputation in the sense of an appearance.

• The use of cutting edge technical tools and methods as the prime measure of professional value to society.

Professionalism is really how you interact with people. People are everything-not a side issue. (See sidebar). And therefore, ethics and professionalism and how you treat other people go hand in hand.

People are everything

Do nothing from selfishness, or empty conceit, but with humility of mind let each of you regard one another as more important than himself.

-Phillipians 2:3

The suspension of self-interest: This is very hard at the end of the day after seeing many difficult cases.

Clinical professionalism

The last patient, even the one that comes in late, deserves our best efforts. This applies to veterinary technicians, staff and everyone else at your hospital.

Honesty and justice: The reputation of your hospital and the profession hinges on your integrity and fairness.

Technical competence: You theoretically graduated technically competent for the month and year you graduated and passed all the boards. Your professional reputation depends on a continually growing technical competence through continuing education. Our profession, unfortunately, has many who do not feel continuing education is a priority.

Authority and accountability: Authority and responsibility go hand in hand. What we provide is a service not just a market commodity. Although we are accountable to our vendors and employees, our major focus must be on our patients and clients.

Communication: Teaching and listening to our clients is vital. Busy practitioners should never be so engaged in the process so as to neglect to inform and be informed.

Humility: The degree of doctor of veterinary medicine, like all medical degrees, tends to promote arrogance in a select group of individuals. Our profession has a better reputation in this regard but is not immune. We must guard against pomposity and hubris.

(*Parts of the preceding were adapted for veterinary medicine from Professionalism and Ethics, Terri A. Schmidt MD, MS, Oregon Health Sciences University James G. Adams MD, Northwestern University.)

The information explosion in veterinary medicine along with the emerging complexity of the business world will make practicing in tomorrow's world very challenging.

Leadership and humility

It will take more than just learning the technical side of our profession to make it work. It will take leadership and a high degree of professionalism from all practitioners. It behooves us to understand what that really means.

When we do finally understand that it is not about us, but about everyone around us, then we can focus on our patients, our clients and our staff and a little less on ourselves. Then we will rekindle the joy.

I hold every man a debtor to his profession; from which as men of course do seek to receive countenance and profit, so ought they of duty to endeavour themselves by way of amends to be a help and ornament thereunto-Francis Bacon (1561-1626)