This week on the podcast…
Dr. Andy Roark and practice manager Stephanie Goss relish in living in the shades of gray. We received a mailbag letter from someone who asked “Is it just us or do any other hospitals have the struggle of whether or not support staff should be taking a detailed history from clients before the doctors get in the exam room?… Should full medical history be the doctor's responsibility?” Andy and Stephanie get lively when it comes to should – it's a four-letter word in veterinary medicine, friends. They jump into a great debate about medical records and have a blast doing it so… let's get into this.
You can also listen to the episode on Apple Podcasts, Spotify, Google Podcasts, Amazon Music or wherever you get your podcasts.
Got a question for the mailbag? Submit it here: unchartedvet.com/mailbag
Thank you to our sponsors! To learn more about this week's sponsor, GuardianVets, check out their website HERE.
Upcoming Events
Upcoming events: unchartedvet.com/upcoming-events/
Join us for LEVERAGING TECHNICIANS – MAKING PRACTICE LESS STRESSFUL FOR YOU, THEM AND YOUR PATIENTS! We discuss ways to balance leveraging technicians while creating a positive culture of respect for all team members! We all recognize that every member of the veterinary team is valuable. In this workshop, we will:
- Explore how to create trust among your team so that veterinarians will fully utilize technicians and technicians will fully utilize veterinary assistants
- Discuss how to cultivate a well-balanced team resulting in less stress for everyone to create positive client and patient experiences.
Join us on Wednesday, October 19 from 7-9 PM ET/ 4-6 PM PT for $99 (FREE for Uncharted Members!) Register here
Episode Transcript
This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.
Stephanie Goss:
Hey, everybody. I am Stephanie Goss and this is another episode of the Uncharted Podcast. This week on the podcast, Annie and I are diving into the mail bag. And tackling another question from a listener who is asking a “should” question. And I love this so much because it lets me talk about one of my favorite answers as a manager which is, “It depends.” If you are one of those people in veterinary medicine who struggles with living in the shades of gray, this episode might make you a little bit uncomfortable, because we're going to dive in and we are going to relish in the shades of gray here and talk about who should take the medical history in a practice and we're going to have a lot of fun with it. And let it be noted for the record that I hopefully have not actually been fired through the course of making this episode, but I'm not entirely sure. Will I be back next week? You'll have to tune in again and find out. Let's get into this one.
Meg:
And now the Uncharted Podcast.
Dr. Andy Roark:
And we are back. It's me, Dr. Andy Roark and Stephanie More is Better Goss.
Stephanie Goss:
I like it, how's it going, Andy Roark?
Dr. Andy Roark:
Oh, it's so good. It's so good.
Stephanie Goss:
Good?
Dr. Andy Roark:
It's so good that I'm going to break one of my cardinal rules of social media and podcasting right now at the very beginning.
Stephanie Goss:
Uh-oh.
Dr. Andy Roark:
Yeah.
Stephanie Goss:
Uh-oh.
Dr. Andy Roark:
So, I have a rule where… I really don't like how social media is so performative, right? And everybody shows their front stage but they don't show their backstage and it makes people feel crappy about themselves. And you see people like Instagram influencers and they're on the beach and you're like, “I never go to the beach and wear a thong,” and you feel bad about yourself.
Stephanie Goss:
Oh God, is this …
Dr. Andy Roark:
And so anyway, that's why-
Stephanie Goss:
This is a 1-800 HR moment because I did not need to think about my boss in a thong in the same thought process there. Thank you so much, Andy Roark.
Dr. Andy Roark:
I am confident that the social media team pushes back on this post because of the fact that they're damaging to people's self-esteem, not because they have concerns about my thong pictures.
Stephanie Goss:
Right. Okay. Fair.
Dr. Andy Roark:
Okay? Anyway. Anyway, I am not one to share things that make other people feel less than, but I'm going to right now so buckle up, peasants. I'm going to tell you about the thing that I have that is amazing.
Stephanie Goss:
I think this might be a record for us. We're not even a minute and 30 seconds in and we've gone off the rails.
Dr. Andy Roark:
Oh no, I had something to talk about when I sat down.
Stephanie Goss:
All right. Let's do it.
Dr. Andy Roark:
So I have a yard which I talk about and it's in the woods and the front of the yard is up by the road as fronts of yards are. And I want to have plants up at the front of the yard where people … What are you laughing at, Goss? I haven't even …
Stephanie Goss:
Keep going, because I know where this story is going.
Dr. Andy Roark:
Oh, you know where it's going? Of course, you do.
Stephanie Goss:
I know where the story is going.
Dr. Andy Roark:
So I want to have plants up at the front of the yard and I got empowered and inspired, and I called the plumber and I said, “I want a faucet in the yard up near the front.” And he looked at me and he came out to look at the [inaudible 00:03:28]. And he looked at me and I said, “I want a faucet.” And he looked at me and he said, “You mean a yard hydrant?” And I was like, “Yes, I do. That's exactly what I mean.” And he said, “What kind of yard hydrant would you like? Do you want a yard hydrant that stands up like a old school water spout or do you want a yard hydrant where it's buried under the ground under a trap door?” And I was like, “I want a trap door yard hydrant.” And he came out yesterday and I just want you guys to feast your eyes on a man who owns a yard hydrant.
Stephanie Goss:
I can't.
Dr. Andy Roark:
I watered. I watered so many things today at the front of the property and it is, God, it was everything I thought it would be.
Stephanie Goss:
When you talk about trap door yard hydrant, all I can think about is bugs and spiders that will be living in there before you know it, because you live in the middle of the woods.
Dr. Andy Roark:
Right now it's pristine. I had not considered the fact that's going to be a nest of spiders in no time. I just want to thank you for sucking the joy out of my … Stephanie's like, “Oh, you like that thing? Let me stamp on it. Crunch. Oh, did I break your thing, Andy? Oh, I'm sorry.” Thank you very much. Every month you're like, “Why am I not employee of the month at Uncharted?” And I'm always like, “Let's go to the tape.”
Stephanie Goss:
This is a moment. Case anybody's wondering, this is reason probably 200 why Andy has fired me and it's only September 2nd or two days into the month. This is probably reason 200.
Dr. Andy Roark:
That's fine.
Stephanie Goss:
No, I'm really excited for you and your yard hydrant. The first thing, the first thing-
Dr. Andy Roark:
I'm not questioning my decision to get the underground yard hydrant. Thank. Now that.
Stephanie Goss:
The first thing I thought of when you were telling it was like, I'm just imagining the average run of the mill spigot just sitting in the middle of your front yard.
Dr. Andy Roark:
It's in a hole under a trap door in the middle of my front yard.
Stephanie Goss:
Which is fantastic.
Dr. Andy Roark:
You're picturing like the Indiana Jones tomb when they unearth it, and you can see the floor is just snakes. It's not going to be that. It's not going to be that. It's not going to be that. I'm going to have a yard Swiffer to Swiffer out all the spiderwebs with.
Stephanie Goss:
So just so you know, I am never going to reach my hand in your yard hydrant.
Dr. Andy Roark:
Oh. It was going to totally happen 'cause I was going to be like, “Stephanie Goss, turn on my yard hydrant.” And that was going to happen.
Stephanie Goss:
That's a hundred percent a thing that will never occur in our relationship.
Dr. Andy Roark:
All right. That's fine.
Stephanie Goss:
You have bears. You have spiders. You have snakes.
Dr. Andy Roark:
See. This is why I don't flex on people online, because I always get knocked down like six pegs and I just suck the fun out of my thing.
Stephanie Goss:
But you've now given Kelsey and Tyler 10 million ideas for doing fun things with swim swimwear on social media. The memes are going to be epic coming out of this podcast episode, just so you know.
Dr. Andy Roark:
It's fine. It's fine. Let's move on. I don't want to talk about my yard hydrant anymore.
Stephanie Goss:
I'm very excited for you. So what are you going to do with all the extra hoses?
Dr. Andy Roark:
No, I don't want to talk about this anymore. I think, are you trying to point out that there's no place to keep a hose in the yard hydrant in the front yard?
Stephanie Goss:
No, I imagine that there's lots of extra room but you don't need nine of them because now you have a yard hydrant. Right? That was the point?
Dr. Andy Roark:
That was the point. I just. Let's just move on. Let's just move on. We're here.
Stephanie Goss:
I've crushed.
Dr. Andy Roark:
We're here to answer mailbag questions.
Stephanie Goss:
The soul out of Andy today.
Dr. Andy Roark:
No, it's fine.
Stephanie Goss:
Well, we have a great mailbag question if you want to know what's happening today. So we got an email from someone who loves the podcast and loves the flaming, raging sort of justice. And I feel like Andy's about to smack me down with that sword today, probably more than once. So they were asking is it just us or do any other hospitals struggle with whether or not the support team should be taking detailed history from clients before the doctors get in the exam room?
Stephanie Goss:
One doctor in particular on their team keeps adding questions that they want the team to ask when they're already have a whole list of things that have to be done before the doctors can get in. And they were saying half the time doctors are walking into the exam room before the history taking's complete. And then they start asking either questions that have already been asked or different questions. And clients, or we've all been in the exam room when somebody takes a history that's not the doctor and you get one and then the doctor comes in and then you get a second history from the client that's completely different.
Stephanie Goss:
And so they're like, okay, we all know that all of these things are happening. So my question is, should taking a full medical history be the doctor's responsibility or is it the support team's responsibility, and or how do we find a balance between those two things?
Dr. Andy Roark:
Yeah, I've gotten this question a number of times. First of all, this is one of the many, many, many consulting questions that they ask you. And the only answer is it depends. There is not a right way to do this. It depends. And so I always just like to put that out at the very beginning. So head space, let, let's start. I always like to look at problems like this and say why is this happening?
Stephanie Goss:
Sure.
Dr. Andy Roark:
I really do feel like that is the first diagnostic step in problems like this is why is this happening? I think, and I've gotten this question many times in my travels. The first thing is it's always pointed out that pet owners will tell the doctors things that they don't tell the staff. And so they'll say, “Well, I do it because…” Sometimes they'll tell me things and we have all been in the exam room and had the pet owner tell the nurse one thing and then tell the doctor I completely different thing.
Dr. Andy Roark:
I had a video. I think it's with Kelsey. I think Kelsey was in the video. No, it was Meg Pearson when she was doing videos with us. So I had a video of Meg sitting down with this pet owner and she was like, “So why is Boudreau having diarrhea?” And the guy's like, “I have no idea.” And then I walk in and sit down and go, “Why is he having diarrhea?” And the guy goes, “Oh, he ate a whole meatloaf,” and that's the whole video. It's like 30 seconds long and makes me chuckle every time I see it.
Stephanie Goss:
Cause it's true.
Dr. Andy Roark:
Totally true. So that is totally true. There's also, there's a list of reasons why we do this. Number one is there is a mentality that more is better. More history is better history. We should ask all the questions. And we have a lot of type A perfectionists who are like, they got trained in vet school and graded on the robustness of their medical records, which is, this is a trigger for me.
Dr. Andy Roark:
I hate it. I hate that in vet schools we positively reinforced volume of medical record creation. Like a medical record that's 10 pages long is clearly better than a medical record that is a page and a half long. And that is because if you're a completionist and you are like, “I want all the differentials and all the things it could possibly be,” then you want the 10 page record. That is wildly inefficient and ineffective in practice. Writing a 10 page medical record is no better to me. Hardly than writing no medical record at all because I'm not going to read it. ‘Cause it's 10 pages and I have 20 minutes for this whole appointment. And so anyway, I'm on a bit of a soapbox here and I know I'm speaking in some extreme terms, but it is true.
Dr. Andy Roark:
And I think that a lot of us are like, “Oh no, we need to have a medical record that is large and has all the details captured in it. And I don't have time to get that. And so I'm going to send my poor assistant technician CSR into that room and make them invest the amount of time it's going to take to generate chapters one through six of this visit. And so that's part of it. There is pressure I think, and again this is not, I've not seen this published anywhere. There is some pressure on GPs from specialists to ask all the questions. So for example, and my other podcast, which if you don't listen do you should listen to, it's called Cone of Shame Veterinary Podcast. And I bring specialists on and I ask them how to treat cases and they come on and this is all the different specialists and they all are like, “Make sure you ask every pet owner this thing.” And every different specialist has got.
Stephanie Goss:
There's like, 19 different questions.
Dr. Andy Roark:
They're like, “Oh, well, clearly you want to do this.” And the nutritionists have 18 questions that you should ask every pet owner and the ophthalmologists want, they want their questions about eye health answered and I get it. And when that's your jam, you're like, of course you're going to spend your time talking about this thing. And so for a while I kept a list of the questions I was supposed to ask and when it broke into the second page, I was like, this is ridiculousness. As a pet owner, I would never fill this out. And so I think that that's a part of it.
Dr. Andy Roark:
There's a lack of awareness about what the techs have on their plates.
Stephanie Goss:
Yes.
Dr. Andy Roark:
And I say this as someone who has that lack of awareness. I think a lot, as a doctor I can be like, “Hey, look, why don't you just talk to them about this thing and then I don't have to talk to them about the thing,” or, “You talk to them and then I'll come back over and I'll ask the relevant questions that I need to ask on top of it.”
Dr. Andy Roark:
And again, everybody is, everybody's looking at the world through their own lens. Everybody's looking at the world through what they have to get done and what's on their to-do list. And again, I'm not bashing on doctors at all and I am a hundred percent guilty of this. I know I am, but I really don't know what the techs have to get done this afternoon. I know what I have to get done this afternoon, but I really don't know. So I can have a tendency to be like, “Hey, why don't you just take care of this thing?” And really I'm piling extra work on a people who are already super busy just because I don't understand the other things that they're trying to do.
Dr. Andy Roark:
And then the last thing that I will say as I sort of laundry list out the reasons why this happens, I do believe that there's a phenomenon where, and I've probably been guilty of this before too, if I'm running behind, I really hate the idea of the pet owners sitting in the exam room.
Stephanie Goss:
Sure.
Dr. Andy Roark:
Alone. And so I'll be like, “What? Get in there. Get in there and entertain. Get in there and make them feel important by taking a significant medical, expand this history into basically a Late Night with Conan O'Brien style interview to keep this person entertained until I get there, so they won't be mad at me because I'm a half an hour late. They will feel like something positive is happening.” And again, I can't remember last time I did that, but I have a hundred percent felt that pressure of please go in there and make this person feel like their time is not being wasted while I dig myself out of the lateness hole that I put myself into or that someone dumped on top of me when an emergency came to the door.
Stephanie Goss:
Well, and I can tell you that as a technician a lot of the time that is completely unintentionally. I think that's how I approached. I am one of the, shocking, this is going to come as a shock to you, Andy Roark, or I am one of those people that the details are important and I will write more than probably a lot of other people. And unintentionally, I think that's how I approached it as the technician. If I was working with a doctor and I knew that they were running behind, I would totally go into the room and be that person to ask them the questions. And I would find myself taking way more of a thorough history because I was trying to come at it from a customer service perspective of I still want their appointment to start on time. I still want them to feel like they're getting value out of this visit.
Stephanie Goss:
And so I look at it as a technician from two perspectives. One, can I keep the client happy but also can I do a better job for you as the doctor? Maybe I can save you some time on the background by on the back end by asking all of these other questions. And at the same time, nothing would frustrate me further than when I felt like I had gone to that effort because I wanted to help you as I want to help you, Dr. Roark, and I wanted to take care of the client. And then you come into the room and ask the same questions, it would just make my head want to explode.
Dr. Andy Roark:
Yeah, I think that's so valid. I said all the reasons like, oh, this is why the doctors do this and this and this. At the same time, it's not hard, I don't think for any of us to empathize with the person who just went in there and spent their time asking these questions, listening to these rambling stories about like, oh, what does she eat? Well, my sister Mabel comes over on Tuesdays and Mabel always says, and you're like, why are you telling me this? And you have to set through it, because at the end what happens is that she gets a dog treat on Tuesday from Aunt Mabel, and that's where this is going. But you have to listen to seven minutes of people talking about and Mabel coming and their stupid yard hydrants and things like that before you get to the thing you actually care about.
Dr. Andy Roark:
I know how it is. I get it. And so it's not hard to empathize with the person who goes in there, does all this stuff, and then just gets ignored because the doctor comes and goes, “Ah, just tell me what's going on.” I'm like, I get it. So I think that's true. So now sort of head space, right? Yeah. The good news in head space is this is one of those beautiful problems where sorting this out is good for everybody, right?
Stephanie Goss:
Yes. Yes.
Dr. Andy Roark:
Sorting it out saves the pet owner's time. It makes for better medicine. It can take work off of the techs' plate. It gets the doctors what they need in efficient way. By freeing up the techs, they can end up being involved in other parts of getting these cases out the door. Getting efficient in how we do this is good for the pet owner, the doctor, and the team that are in the room, the team.
Dr. Andy Roark:
And so to me, the nice thing as I get into head space is this should not be conflict. There shouldn't be conflict here. This is a mutually beneficial problem solving exercise. And to me, I really like problems like that because I go, okay, I have to frame this the right way and I have to present it. But really we all want the same thing, which is for my time to be maximally valuable and for you to get what you need to do this appointment and for the client to feel heard. Let's just figure out what that is because I don't think that we're doing that now.
Stephanie Goss:
Right. Yes. And I would say the last thing for me from a head space perspective is just remember as we dive into action steps, should is a dangerous word.
Dr. Andy Roark:
Yes.
Stephanie Goss:
It's a four letter word, friends. Because what should happen in one practice, not necessarily the same thing that should happen in another practice, right? And should is full of the best intentions. And so I think for me from a head space perspective, what you just said, Andy, about we want it to be good for the doctors. We want it to be good for the clients, and it is also important that it be good for the team. And so I think it's great that the question is being asked and I think this is a good, this is for me an example of where this can be excellently healthy conflicts, talking about this as a team and bringing up each bit of the team's perspective and their insight. You guys, it may be uncomfortable. The text may be like, “Dude, I don't want. I want to be respected. And when you go in and ask the same, I've had this conversation with my doctors, when you go in and ask the same questions, Dr. Roark, that I just asked, I feel devalued as a technician.”
Dr. Andy Roark:
Yep. I've had this conversation.
Stephanie Goss:
Right. And we think about it and we think about, oh, this is super negative. But you guys, this is good conflict. This is healthy. Being able to talk about it as a team and figure out what works best for us and for our clients, I think that's diving into the action items. But just remember getting out of the head space, think about should very much with a grain of salt because should what works in one practice is not necessarily going to work in another. And I think you can't compare yourself to other practices here. And I think that's why you said, Andy, it's all relative and it's not necessarily going to be the same answer for everybody.
Dr. Andy Roark:
No. It's not remotely going to be the same answer. I think that that's the first part of diving into this question. So there's really two things there. One of it was I really like how you put when I ask these questions and then you ask the same ones, it makes me feel devalued. I think feeling valued and feeling that our time is well spent. I do think that that's a big part of this. So like you said that. But the other thing too is I like this question because how you do history taking, it really fits in an important way with the identity of your clinic and your practice. And so, of course the technician who works for the veterinary nutritionist or the veterinary neurologist is going to ask a detailed history about those specific subjects because they are really digging into this.
Dr. Andy Roark:
The clinic that charges $42 for a physical exam and vaccines, I don't think that you expect to have that technician in there doing a 22 minute history for what's essentially a low cost visit. And again, nothing wrong with that model, but if you're lower, low cost or lower cost, and I'm not saying 42 is low or lower. It depends entirely on where you are and your area. But if you are a low cost practice or a lower cost, you're probably not going to be able to afford to have your technicians in there taking huge histories, right? Because you need to move efficiently through the rooms.
Dr. Andy Roark:
On the other hand, if you charge $89 for a physical exam and that seems, I think people will expect that your technicians would go in and spend some time and get a good history and talk to them about their pet to prepare the doctor and to flesh out the medical records so that they are going to get the white glove service that they're paying for and they expect. And again, it's not right or wrong, it's just about what is your practice and what are your cultural values? I do see a lot of times when there's a mismatch between how we get the history and who we are as a practice. And I always think that that's really interesting.
Stephanie Goss:
Yes. And now I will tell you, I love that you said that and I think a lot of it has to do with how your exams are structured and timing and everything like that. And I can tell you, I was trained in a practice that had longer appointments and I will tell you, I will say straight up to my team, “I am not the technician to send into a room if I'm helping out at a clinic that is high volume, fast appointments. If you're 15 minutes double booked, I am not your tech, I not your technician.” And I'll tell you straight up because my process is one where at our appointments ranged anywhere from 30 to 75 minutes depending on what they were there for. And so I struggle, and I am not the one. And at the same time, if you are the kind of person who needs someone to build the relationship with the client and ask the probing questions, that's my jam.That's where I feel comfortable.
Stephanie Goss:
And so I think your point is spot on Indy. You have to look at who are you serving, what kind of clients are you serving, what is your culture as a team? And also who are the people that make up that team? And what do all the doctors need? And so for me, I think you're right, head space perspective, this is a good thing. Sorting this out is, no matter what, is a good thing for everybody, and I think the head space where I end head space and move into action for me is it's about balance and it's about figuring out that balance as a group.
Dr. Andy Roark:
Oh, I love that example. I think that's fantastic. You are such a relationship building person that you in a role where you're supposed to get in and out in four minutes.
Stephanie Goss:
I can't.
Dr. Andy Roark:
First of all, it would be hard on you. But here's the thing too is it's such a missed opportunity for you to shine in this role. And we hear from so many people who think that they're bad at their job or they're a failure. And I'm like, no, you are in the wrong system.
Stephanie Goss:
Yes.
Dr. Andy Roark:
You are struggling here, but boy, you'd be an all star down the road at the hospital that runs in a different way or runs in a way that matches your priorities. I'll tell you from personal experience, I had a technician who was amazingly skilled technical technician, not a people person. And she did not want to be a people person. And ultimately she did not work out at the practice that we were where, because it was a white glove, high touch, high communication practice.
Dr. Andy Roark:
And she went to another practice and was very happy there and it was a lower cost, higher volume practice. And she rolled in, she did a short history, went to work, and she was on it. Good for her. It's not about good or bad. It was about she did not match the system. But boy, when we get her into the right system, she absolutely blossoms. And I think a lot of us are there in that way. And so that's why I really like this question is there's not a right or wrong way. It's really, and I think you summed up so well, it's about the culture of the practice and also who are your people. And I will tell you another thing is it's my belief that those things change over time. And so you might end up shortening up your history taking. So for example, right now a lot of people are real shorthanded and they're really overwhelmed.
Dr. Andy Roark:
And I would say you can tighten the nuts and bolts on your history taking and it might not be the history that you would love to have.
Stephanie Goss:
Yes.
Dr. Andy Roark:
Or that you plan to have for the long term. But right now you say we need to be efficient in our history taking. We're going to take a stripped down version of what we had before because we need to be moving quickly between the rooms, and this is not how we plan to do it in the long term, but it is what we're going to do now. And so that history may get shorter and then it may link them back out later on.
Stephanie Goss:
And I love that you said that and that part of why I love this question and go ahead, you can make fun of me, but I love this because ultimately if you are a practice that is thinking about this and having these conversations, at the end of the day you are working towards systems and processes and that is going to help your team overall. And so I will tell you I love that. And ultimately the best system for me as a technician, as a team member, is a system where I know, okay, our ideal is this and our minimum accepted standard is this. And I get to make a judgment call. My doctors get to make a judgment call. We change it as we need, whether it's because of the patient's needs that day or the client's needs or the team's needs. But I feel like I have a guardrail on either side and I know what is expected of me and that's what I mean about this is a good kind of conflict.And we shouldn't be afraid to have these conversations as a team.
Stephanie Goss:
But a lot of us are because they're not easy conversations and they're hard conversations. And especially if you're a technician writing this question, it can be hard to feel like you are potentially challenging your doctors by saying, “Hey, when you ask these questions that I've already asked, I feel like you're just walking all over me.” That's a hard thing to stand up and say. Likewise, as a doctor sometimes I've had doctors be like, “I need the questions asked in this way and I know you're trying to help, but this doesn't get me everything that I need.” Those can be things where we take it personal and it's not meant to be personal.
Stephanie Goss:
And so this is where from a head space perspective, I think it's super, super important to say we are going to talk about this and we are going to look at this as a team, and we are going to look at it from a systems and structures perspective. And everybody has got to take a deep breath because there might be some hurting feelings here, but we're going to work through it because we're doing it for the needs of the patients, the needs of the clients, and the needs of the team.
Dr. Andy Roark:
Yeah, I completely agree with that. I like that a lot. Now the other thing I would say too is if you are someone who's listening to this and you're like, “Oh man, that's really interesting,” and “What kind of practice are we? And what's our culture and should we be doing these longer things, then how does that work?” If you're interested in that and you just go, “Oh I see how the differences are between the practices,” you might be an uncharted practice, 'cause that's kind of how we roll. And it's beyond I think us sitting down here talking about history taking to figure out what kind of practice you are, but that's what we do in our community. It's getting in there and talking about how different people do it differently and why they do it that way and what works for them. And really digging into the culture of who your people are and who your practice is and how they communicate so that you can answer questions like this in a way that is going to work really, really well for your people.
Dr. Andy Roark:
So that's just sort of the last thing I was going to say. That's why I really enjoy this question I think is really great. Let's take a break and then we'll come back and then we'll get the action steps of like, oh great, we've talked about the philosophy. We've talked about the head space. Let's get into actually making this conversation happen and what we're going to try to accomplish.
Stephanie Goss:
I love it.
Stephanie Goss:
Hey everyone. I just want to make sure that you know about some upcoming events from Uncharted that you are not going to want to miss. We have a workshop that is happening in October and it is the wonderful, the amazing Melissa Entrekin LVT. For those of you who don't know Melissa, she is an amazing technician and she helps out our team on the Dr. Andy Roark side of things, on the medicine side of things, and she is doing her very first Uncharted thing. And I am so excited about this. Melissa is going to be leading a workshop for us in October. It is happening October 19th and it is called Leveraging Technicians: Making Practice Less Stressful for You, Them, and Your Patients. I cannot wait for this one. It is going to be happening at 7:00 PM Eastern. So that's 4:00 PM Pacific on the 19th and it will be a two hour workshop, which means it'll be over at 9:00 PM Eastern, 6:00 PM Pacific.
Stephanie Goss:
It is, as always, free to our members. So if you are an uncharted member, head on over to the website at unchartedvet.com forward slash events. You can click the register button and register for free. And if you're not a member of Uncharted, you can join us. It's $99 for the workshop. Or you can look at all of the awesome upcoming events that we have. And it may make sense very quickly for you to say, “Hey, I'd like to get an Uncharted membership because you get all of this stuff for free.” So come join us for Melissa's workshop. You don't want to miss it. And hopefully we'll see you in the community soon. And now back to the podcast.
Stephanie Goss:
Okay, so now we've talked about how do we get into a good head space.
Dr. Andy Roark:
Yeah.
Stephanie Goss:
Let's talk about what do we actually do with this? So we asked the big should question.
Dr. Andy Roark:
Yeah.
Stephanie Goss:
We both agree that should is a dangerous word, but we still have to talk about solutions here. So what do you with this challenge?
Dr. Andy Roark:
Well, a lot of it depends on who you are. And so I'm going to take this. Let's eat the meatballs off the top. That's a metaphor I just made up. I like it. I'm going to stick with it. Let's the meatballs off the top. That's when you take the good stuff and just handle it before you have to get into a bunch of noodles and sauce. If you are another doctor or if you are the practice manager or the medical director, just a little bit of coaching and feedback is really easy. Because the medical, the doctor that's like, “Hey, I'm going to add some questions,” or “Hey, make sure you add some of these things.” Stuff like that. They probably don't have any idea what the impact is.
Stephanie Goss:
Sure.
Dr. Andy Roark:
You know what I mean? They probably don't understand of hey, you just don't think about, hey, these questions are getting long answers and they're asking them in every exam room and so they're in 15 exam rooms a day and it's adding an extra two minutes to the history and that's a half an hour a day that they have lost in productivity beyond asking these questions, which are just two quick little questions you wanted to answer or to ask.
Dr. Andy Roark:
And so if you are the medical director, the manager, something like that, just a quick little coaching thing of “Hey, I need to talk to you real quick about the histories going into the exam rooms.” And then just say when we add extra questions to the techs, they ask in every room across every doctor, and it really backs everything up really fast. And so if there's questions you want to add to the history, just let me know and we'll talk it through or we'll run it through or we're compare it to other questions or things like that. But it's just, it's important for us to have consistency across the doctors as far as what's getting asked. And small questions, when all the doctors just add them, they add up really, really fast.
Stephanie Goss:
Yeah. Yeah. And I think you don't think about it and as a technician, your brain having to switch back and forth between, “Okay, what questions does Andy want me to ask? What questions does Dr. Sarah want me to ask?” When you make those switches a million times a day, it is exhausting. And also from the doctor perspective, having been the practice manager who strong armed, I'm going to say strong armed or forced my doctors to sit down at a table and have some of these conversations, the perspective afterwards from them was there are times where they get frustrated with each other because another doctor is not asking the questions that they would necessarily want to have asked. And so on a peer level, the benefits of being able to have some of these conversations and think about why are we asking what we're asking and are we more alike than we are different is super, super helpful process.
Stephanie Goss:
And so I would say if you've never, and particularly if you're a bigger hospital that has multiple doctors, if you've never taken the time to just run a poll and ask the doctors, say, “Hey, what questions are you asking? What questions do you want to have asked?” And as colleagues go back and forth and pick each other's brains about why are you asking that way, what are you asking? It was enlightening to me as a manager to sit in on that and hear the commonality amongst my doctors and also be able to pick out where are the differences, but in a really good way of, “Hey, I learned this time, this technique in school and here's why I do it.” And have other doctors be like, “Oh, I had no, that makes total sense to me, but I've never done it that way. Can we do it that way?” It doesn't have to be negative.
Stephanie Goss:
But to your point, starting with the coaching in the moment and just getting them to think about how it affects everybody and not just them, but then also being able to talk about it as colleagues I think is a unintended bonus side effect that for me in my experience has turned out to be really positive.
Dr. Andy Roark:
Yeah, I completely agree with that. It really depends on the relationship. So now I'm switching over to the technician side here. So you're the technician. You're doing this, you're taking this long history. The doctor's coming in and asking the same questions that you've already asked and you're kind of feeling like your time is not valued. The way I would approach this from the technician standpoint, the first thing I got to say is what's your relationship and how much trust do you have? And I would tell you that as a doctor, I aspire to be a doctor that my technicians can look at me and say, “Hey, Dr. Roark, I'm struggling because I feel like I ask these questions and then you come in and you ask the same questions and I feel like I could be using my time better somewhere else or I kind of feel like I wrote all this stuff down and then it gets ignored.”
Dr. Andy Roark:
I want you to say that to me that is great. I think I understand that a lot of technicians would say, “I don't have that relationship with my doctor.” I want to be the person who's big enough to take that feedback in a stride and say, “I don't want you to feel that way when you work with me. And so let's, let me either explain why we do it this way,” and we're probably going to talk a little bit about how you might get things, different things than what I get and whether or not that's worth the time to suss that out. We might talk about why we do our medical records the way that we do, however it interfaces, but we can always talk about why. But I would like to hear that and I have heard that from technicians in the past. You can imagine. You know me well enough, Steph. You know that there's a protocol for what gets asked. And I walk in and I'm going to improvise. And I did that until one of my technicians said to me, “I write all this stuff down.”
Stephanie Goss:
And you're stressing me out.
Dr. Andy Roark:
And then you come in and put on the Muppet Show and I'm just like, why did I do this? If you want to do your Andy thing, just do it, but don't make me do a 20 minute interview before you ignore it. And I'm like, unfortunately that's a very fair criticism at the time. But hey, this is the thing where it's like, one of my dad's favorite sayings was always, “Good judgment comes from experience and experience from bad judgment.” It's like I think that's how you become a good doctor. I think it's how you become a good anything is, you know, you make mistakes and hopefully when someone points them out to you or how they're affected by what you're doing, you adjust course and you get better.
Dr. Andy Roark:
So again, I'm very forgiving of doctors in this regard. So ideally, you have the relationship and you can say, “I'm just going to tell you how you made me feel because I trust you. Because I trust you and I believe you care about me.” And I think we should all aspire to that. That is the place that I want to work. That is the doctor that I want to be.
Stephanie Goss:
Yeah, yeah. No, I think that's great. And really I think for me, a lot of the answer to the should lies, the actionable answer, lies in the fact that we're a team and this is a relationship on all sides with the client, with each other as a technician team helping the doctors, as a doctor team working together to see patients across the board, and as a doctor tech team. And so I think for me a lot of the should falls in looking at that and trying to figure out what are our superpowers? And I'll tell you as a technician who, shockingly I know, likes to talk. You guys, I like to talk and I like to talk to people. I have worked with doctors who struggle building relationships in the exam room with clients and they have said to me, “I want you to take all of my histories because you get way more information out of them than I get, and that is helpful to me as a doctor 'cause I feel like I can do my job better.”
Stephanie Goss:
And I've also worked with doctors who are like, I want to do this piece and this is how you can best support me. And it's give and take. And so I think for me a lot of the action in the should is what are we trying to accomplish here and how can we best do it together collaboratively as a team? And it is a team of at least three, right? It's me as a technician, it's the doctor, or it's me as the history taker, however that looks in your clinic, and the client. And you got to be able to work together or else, let's be real, all of us will be in the exam room for two hours if we don't figure it out.
Dr. Andy Roark:
Yeah, absolutely. Yeah, I completely agree. So yeah, it's a cultural thing and there's a big culture that I see. It's a cultural shift, and I feel like we're on the downhill side of it, which is good. But there for a while, it is different. Vet medicine is a team game and I try to hammer that into doctors' heads and I think the support staff have known that for a long time. I think the doctors kind of want to hold onto the old way, which is a James Harriet way, which worked a lot better when was one vet practices and you held, hung your shingle out.
Dr. Andy Roark:
And now though, as the demand for our services that have gotten higher and higher, we can't be a one person operation. We have to function as a team to, one, to meet the needs of pet owners, but two, in order to be able to have some downtime and to unplug and to not be on call. It is just a requirement that we have got to play this as a team game. And if you play it as a team game, then coming together to figure out what the history is and what it includes, it just makes sense. It's just a smart part of running our business and everybody should benefit from it.
Stephanie Goss:
Yeah, I love it. So if we agree that it's going to be cultural and each practice is going to have a different approach based on who makes up their team and who their clients are, then how do we figure out whether we do or don't take history before the doctors walk in the room? Because really at the end of the day, that's part of the question here. How do we figure this out for ourselves as a team, right?
Dr. Andy Roark:
Yes. Right. Perfect. So here's how we do it. So these are the action steps. So we got in a good head space. We've talked about where we're going, what we're doing. I'd love to have that trust in a relationship where I could just say this, I feel of us don't. So here's how I'd do it. So number one, I'm going to go as the tech and I'm going to ask to discuss this and I'll ask the practice manager, probably, especially there's multiple doctors. But remember when you're the tech and you go and you talk to the doctors, you talk to the practice manager, it's always smart and it's always safe to make it about the pets, the people, or the practice. And so those are big things for me, the pets, the people, or practice. And so you can absolutely go to the practice manager and say, “I feel like I'm being ignored and my time is being wasted.”
Dr. Andy Roark:
And you could be a hundred percent right. That doesn't hit the eardrum in a way that stimulates warm fuzzy feelings for other people, even though it should. If you want to get heard, remember communication happens at the ear, not the mouth. And I was like, how do I say this in a way they're going to hear me? Make it about the pets, the people, or the practice. The pets, meaning how does reconsidering this end up in better medicine? How do we get better patient care from talking about how we're doing our history and talk about patient care. People, what is the client's experience with this? Do they find it confusing when they're doing all these things and they have to do them again? Are they frustrated when they have to answer these questions twice and they feel like this is a huge process that doesn't need to be there?
Dr. Andy Roark:
And the last thing is the practice and that's the team game. How does this affect the practice and our ability to get cases done? To be available? And again, I always phrase it, try to frame it into a positive way for the person I'm talking to is, how does taking history make me available to support you, doctor so and so?
Stephanie Goss:
Right.
Dr. Andy Roark:
Let's talk about the best way that I can support you and I just want to make sure that the way we're doing histories is the best way I can support you as opposed to other things I could be doing to move things along and be a benefit to the practice.
Dr. Andy Roark:
And the other thing is you can even practice it, depending on who you're talking to. If you're talking to the managers, it could be a revenue thing where you say, Hey, I want our practice to be financially viable. Can we talk? I'm spending a lot of time doing this, and then the doctor's just asking these questions anyway. And so I don't know if this is a good investment in time and really which one you use of that, it depends on who you're talking to and what they care about. And so anyway, pets, people, the practice. And I would couch my request in that way, saying these are the things that I'm seeing and I wonder if we could do that. I would also start to sort of say, I want to understand what's important about the history. And I say it that way. I would say it to a doctor that way. I would say it to the manager, I would just sort of say, I think we should talk about what's really important about taking a history so that we can decide if we're doing it in the best way.
Dr. Andy Roark:
And that's me getting into the culture. And so when I talk to the doctor, then I say, “What is the most important thing for you about the history?” What I would say if you ask me is I tend to get hyper focused on the problem I'm presented with.
Stephanie Goss:
Sure.
Dr. Andy Roark:
And the most important thing for me is to make sure that someone is checking the major boxes to make sure this pet is getting the other things they need. And I'm not zeroing quickly on the focal point and missing other things. And so if it's my practice and they say to me, “What do you want?” I say, “I want us to come together and figure out what should we ask every pet owner when they come in to get any hidden information or information I'm going to miss.”
Stephanie Goss:
Yes.
Dr. Andy Roark:
And then I would say, “I don't want you to spend a ton of time flushing out the specifics of the condition because I'm going to do that.”
Stephanie Goss:
Right.
Dr. Andy Roark:
And that's redundancy. And that's what I want. Other people may absolutely want different things or there's different things that are important to them about the history. What's important to you about this history? What's important to our practice about this history? What's important to our team about this history? Those are good, open, nonjudgmental, non-pointed help me understand questions that start to generate that conversation of this is what I like and this is what's important to me. And I guarantee you'll have one doctor who says, “Well, I want to know all of the things.” And the other doctors who see the world differently like myself will push back and say, “Well, I want to have technicians who are available to help me when I'm-
Stephanie Goss:
And not stuck in an exam room.
Dr. Andy Roark:
And so I don't want my technician to wrestle that doctor. I am perfectly willing to wrestle that doctor on behalf of the technicians, for selfish reasons as I go. I understand that they want a million questions. I don't want the techs tied up doing history when I need them back in the treatment room, or I need them helping me with communications, or the other things that a well licensed, well leveraged team uses technicians for.
Stephanie Goss:
Yeah.
Dr. Andy Roark:
Anyway, that's kind of how I would do it. But as the technician, I would set the table for the doctors to, I'm looking for a metaphor, so the table. I'm actually, my metaphor, I almost said I would set the table for the doctors to dance and then I'm like, why do the doctors need the table set to dance? How are you going to bring this home, Andy? And I'm like, I'm sorry. I'm still reeling from the realization that my yard hydrant is going to be a spider pit. I'm going to lose a finger in there. It's just a dirt hole with a wooden flap on top and I feel like an idiot.
Stephanie Goss:
Oh God, it's fine. I'm getting fired. I think the flip side of that, also for me, is as a team member, whether you're a doctor who's questioning this or you're a technician or a CSR, it doesn't matter who you are in the practice. A great, this, you guys, this is a great topic for a team meeting. And it's a great thing for me to think about asking why are we doing it the way that we're doing it? And really everybody on the team understanding because again, every practice's makeup is totally different. And so if you're working in a practice where doctors are double booked, and what I mean by that is you're dancing. You have one doctor who's dancing between two appointments at a time and you have a fully leveraged tech team. It may be, the why may be that it's important for the techs to, in room A, to ask this set of questions because the doctor is in room B doing this portion of the appointment. And that may be part of your dance as a team.
Stephanie Goss:
And that why is very powerful and it's very important because to your point, it speaks to the client experience, it speaks to the practice experience, it speaks to the team's experience. It's okay to ask and it feels very non-threatening to ask why. I want to understand the why here, because you should want every member of your team to understand what that why is. And if by asking the why question, you unearth, “Well, Dr. Roark does it this way and it's just because that's the way he likes it. And Dr. Sarah does it this way and she doesn't really care one way or the other. And Dr. Smith on Thursdays does it this way because that's the way they do it at the other practice that they work at.” It may unearth some of those answers that allow you as a team to say, if this isn't working for us, we can ask the questions that help us change it in a way that is healthy and has that healthy dialogue and creates the space to ask those questions. And so I think that the starting with the why is a very powerful tool here.
Dr. Andy Roark:
Yeah, no, I completely agree. So anyway, I think that's how I would put it forward. I think this is a good, healthy conversation. I think every team should probably talk about this every couple of years.
Stephanie Goss:
Yes.
Dr. Andy Roark:
I just think that what we're asking for or what we need or where we are, it just changes over time.
Stephanie Goss:
Yes.
Dr. Andy Roark:
I think that this is a cool problem because it gets into culture and what's important and why do we do this job?
Stephanie Goss:
Yes.
Dr. Andy Roark:
And how do we move appointments efficiently and effectively through our practice? And it's all fairly low stakes way to really talk about what matters to us. No one's like, “Ah, I went out of business because I asked the wrong medical history questions.” It's not that. It's just, it's good for the doctors to even talk to each other about what's important and why do we do this history and what's important to you? What's important to me? It is a very good team building discussion that I have found brings groups together pretty well.
Stephanie Goss:
Yeah, I love it. I think this is a great topic to have, ask at a team meeting.
Dr. Andy Roark:
Yeah.
Stephanie Goss:
It's going to be fun, I think. And so I think we end up here with who should take the medical history? It depends.
Dr. Andy Roark:
Yeah, it depends. Yeah, absolutely.
Stephanie Goss:
This is my favorite answer of vet med. ‘Cause 99% of the time the answer is, it depends.
Dr. Andy Roark:
Yeah. I hope that's helpful to our writer. I hope they're not like, they're listening to the end and they're like, “Ah. Sat through an hour for that.”
Stephanie Goss:
They're like, “That's the last time I send something in through the mailbag.”
Dr. Andy Roark:
I sent them a question. I heard about this doofus's lawn hydrant. And the answer was basically, it depends. But I hope you don't feel that way. It depends on the practice, but you can reach a consensus in your practice.
Stephanie Goss:
Yes.
Dr. Andy Roark:
Following our simple, simple system. All right. That's it. I'm done. I'm going to go water some plants.
Stephanie Goss:
Water your lawn.
Dr. Andy Roark:
Yeah. I'll see you guys later.
Stephanie Goss:
Take care everybody.
Stephanie Goss:
Well, gang, that's a wrap on another episode of the podcast. And as always, this was so fun to dive into the mailbag and answer this question. And I would really love to see more things like this come through the mailbag. If there is something that you would love to have us talk about on the podcast or a question that you are hoping that we might be able to help with, feel free to reach out and send us a message. You can always find the mail bag at the website. The address is unchartedvet.com/mailbag, or you can email us at podcast@unchartedvet.com. Take care everybody, and have a great week. We'll see you again next time.
