Dustin Bays

This Week on the Uncharted Podcast…

Could you imagine working in a practice that literally doesn't write more than the presenting problem and any treatments done during an exam in the medical chart? 😳 Gives me the cold sweats just thinking about it. This week on the podcast, Dr. Andy Roark and Stephanie Goss are tackling a letter from the mailbag from a CSR who has found herself in this situation. Our writer was previously a manager so she is well aware of the standards that are required legally for charts. The level of medicine seems quality and sound but the charts leave a lot to be desired. This CSR and the rest of their team feel like they are left holding the bag when clinics/insurance companies as for more info and they have to say “that is all we have.” Let’s get into this…

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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, Andy and I are tackling a letter that came in through the mail bag that, I have to be honest, completely caught me by surprise. They sent me an email and said, “Hey, I joined this practice and I am shocked that there's not soap notes for our charts.” And at first I read this and I thought, “Oh, well, what format are they using? Are they using chronological format? Are they just not using SOAP?”

Stephanie Goss:

Maybe the doctor went to a school where they learned something besides SOAP. I don't know. I thought, that's a little different, but. So, I sent an email back and I got a clarifying email back, who said, “No, no. It's not only that we're not using the SOAP format. We are using the soap format, but really, the charts aren't just getting written up. Patients come in and it says, “Here for an exam,” and then there's not a whole lot of notes or they come in for a surgery and there is more details, but it's not in the SOAP format. It might be written up on an anesthesia sheet or something like that. And it sounds like this practice is doing awesome, Medicine and yet the charts are a hotness.

Stephanie Goss:

And I have to tell you, there's not a lot of messages that I've gotten in the mail bag that have caught me off guard, but this one definitely did. And I couldn't wait to dive into this conversation with Andy. This is going to be a fun one. Let's get into it. Shall we?

Stephanie Goss:

And now, The Uncharted podcast.

Dr. Andy Roark:

And we are back. It's me, Dr. Andy Roark and Stephanie, write this down, Goss. Can I get stuff out of that? Yeah, and I don't want you to go write this down. Some Alan Jackson from the '90s.

Stephanie Goss:

I love it. It makes me so happy.

Dr. Andy Roark:

My wife is very cosmopolitan. She is a college professor. She loves some Alan Jackson. I mean, it just-

Stephanie Goss:

Hell, yeah.

Dr. Andy Roark:

It just comes out of her. And if I put on some…

Stephanie Goss:

Who doesn't?

Dr. Andy Roark:

… Alan Jackson-

Stephanie Goss:

Who doesn't like some Alan Jackson?

Dr. Andy Roark:

Oh, yeah. She dances around the kitchen to Alan Jackson. It's so silly and God, I love it so much.

Stephanie Goss:

I love that. That makes me like Allie even more.

Dr. Andy Roark:

Oh, yeah. It's funny. Anyway, it's those little things, you know what I mean, in life?

Stephanie Goss:

Yeah.

Dr. Andy Roark:

Where you know about people and you just, I swear. I think about that sometimes and I'm like when I die and people come together as for a funeral, I want people to talk about the quirky things that I do like dance to Alan Jackson, because I think that's how you really know people. You know what I mean?

Stephanie Goss:

Sure.

Dr. Andy Roark:

I think that's who people really are. And I think we talk a lot about these formalities. But I think a story that captures a little piece of who somebody is, I think that's just magic and I love those stories. But anyway, but yeah, I think about that sometimes of what stories or what little quirks really…

Stephanie Goss:

What is, yeah.

Dr. Andy Roark:

… encapsulate my wife or my kids. And anyway, it's just, it's fun stuff.

Stephanie Goss:

Alan Jackson, I love it.

Dr. Andy Roark:

It's so funny.

Stephanie Goss:

I love it.

Dr. Andy Roark:

It's because we listened to that when we were dating. And so, it's one of those things that always sticks around. It's so funny.

Stephanie Goss:

Oh, that's fantastic. How's it going?

Dr. Andy Roark:

It's crazy today. It's half day at school, so I've been running around. I took kids to school and then I turned around and I went back and got the kids again. And I was like, “Why do owe do this?” It's because legally, they have to be at school for three hours to get credit for a day. And so, they're like, the school board is phoning it in. They're like they got three hours and eight minutes they were at school killing it. I spent three hours and 12 minutes in the car line in dropping off and picking up, but whatever, anyway.

Stephanie Goss:

Oh, man. Yeah, that was me last week. I am glad school is done. Report cards have been had. Lockers have been cleaned out. It feels good to be on summer break.

Dr. Andy Roark:

Oh, man. Time marches on, it's just. And we are into the summer and the kids are like, “The swimming pool is open.” And it's just, there's funny things like that in life that are signs of the season. Just, we were cutting up watermelon for Memorial Day and eating it and I was like, “I guess it's summertime,” you know?

Stephanie Goss:

Yes, yes, yeah, no, I love it. I love it. Well, I love this topic that we're going to talk about today. I'm super pumped about this.

Dr. Andy Roark:

It's a good one.

Stephanie Goss:

Oh, we got a mailbag question. And this is funny because I actually had to go back to the Mailbag writer multiple times and ask clarifying questions. Because I was like, “I want to make sure that I actually have the whole story.”

Dr. Andy Roark:

Yep. Yeah. This one's hard to believe. This one's hard. Yeah, this one's hard to believe in its entirety. Okay.

Stephanie Goss:

I was shocked and I was just like, “I'm sorry, what?” So, we got a Mailbag question from somebody who's been in the field for a really, really long time. They had been a manager and wanted to cut back and so, they have been working reception. And so, they've been at the front desk and they joined a new practice. And since joining that practice, they found themselves very shocked because apparently the practice actually doesn't really write SOAP notes. And I thought, “Oh, well maybe, it's just learning a new practice management software.” Maybe they're putting it in a different place.

Stephanie Goss:

Because the comments were like, “Sometimes there's communication notes and sometimes there's info attached to the surgery.” But overall, a lot of the times it's missing information and we get calls from other vets in the area, the ER specialists, et cetera. And we get calls from insurance companies who are like, “Hey, we need more info.” And this manager was, or this writer said, “I find myself having to say, ‘I'm sorry, like that's all we have on this record.'” And so they were saying, “I feel like I know legally what's required, but I'm not sure do I even bring this up? Am I just not knowing where things live?”

Stephanie Goss:

And so, we went back and forth and I was asking some questions and I was like, “Well, every practice management software does it differently and has their SOAP format set up differently.” And so I said, “Is this really that? It's just maybe it's hidden?” But as it turned out, no. They actually just really aren't writing up charts. And really, the focus is on capturing some surgical notes, but the standards, or what we would assume to be standards, seem to be missing.

Stephanie Goss:

And so, they were like, “I don't want to step on anybody's toes because I'm just a part of the front desk team here. I'm not the manager, but I feel like this is really wrong. And it really bothers me.” And they said, “I feel like we're practicing a good level of Medicine and a quality level of Medicine, and at the same time it really concerns me that nothing is getting written down.” So, there were like, “How do I even approach this?”

Dr. Andy Roark:

Yeah. When I first saw this and they were like, “Oh, they don't write down SOAP notes.” And I was like, “What format do they use then?” No, no, no. It's not that they don't write down SOAP notes, it's that they don't write down notes.

Stephanie Goss:

That was the first response I had to them. I was like, “Are they using Problem-Oriented Medical Records?” Are they-

Dr. Andy Roark:

Yeah. I'm like interesting. Yeah, and yeah. Are they just writing paragraphs? No. Nope. And then also, examples of the type of records that are there. There are things like SPADE and the date.

Stephanie Goss:

Right. And that's it.

Dr. Andy Roark:

And that's the record, SPADE. And so, that's what we're talking about here, guys. So, anyway, there's-

Stephanie Goss:

So, let's just say for the record, both, Andy and I, were mind boggled.

Dr. Andy Roark:

That was, yeah. I had to sit with this for a little while.

Stephanie Goss:

And per day and age.

Dr. Andy Roark:

Yeah. It's like an ugly truth that you knew, but you didn't really want to believe was there. You know what I mean?

Stephanie Goss:

Yes.

Dr. Andy Roark:

It's, yeah. I don't know of a good analogy to give other than like [inaudible 00:08:20]. When I really think about it, am I surprised that their practice is out there? No. But I don't want to believe that there are, you know?

Stephanie Goss:

Right. Yeah, no, not at all. I think about it and I think about when I started in Veterinary Medicine. I haven't been in Veterinary Medicine as long as our Mailbag writer and so, it didn't surprise me because I think back to my first clinic and like that, we had paper charts and you were writing everything by hand, right?

Dr. Andy Roark:

Yeah.

Stephanie Goss:

And so, there was a lot of shorthand and a lot of shortcuts and it was like, “Here's the date? They're here to be SPADE. Our records have more info about anesthesia and suture and stuff like that. But compared to what technology makes happen easily now with hybrid records or with completely paperless records, it is amazing to me how little we did back then.

Stephanie Goss:

And so, when I read this, like you, I was like it feels like an ugly truth, but then my thought was, “Well, I could totally see some old practices where there's an older generation of veterinarians who when they went to school and learned like that was what they were doing. And I could totally see where… in veterinary medicine there, how many things do we do in our practices every day that we're doing them, because that's the way we've always done it. Right?

Dr. Andy Roark:

Mm-hmm.

Stephanie Goss:

So, I see this being one of those things where if we have an older generation veterinarian where that's how they've always done it. I could see that being the case and yet at the same time, I was really shocked because I was like, “They're not right.” Nothing? Not suture. Were there any problems? Not anesthesia note. Really nothing? Just the date and that they're here to be SPADE, like “Oops, that's what you get.” So, yeah, it was surprising.

Dr. Andy Roark:

Well, so I want to talk about this and then I want to add a little bit of nuance to it. And talk a little bit about the practice that writes up most things. But not all of the thing. There's way more unwritten charts than you would like, because I feel like this is an extreme case and it's going to let us really tee up in a couple of ways. But I don't think that most practices are at a, “Help me. We don't have medical records.” I think most are at, “I have a doctor that doesn't do medical records and all the other doctors do,” or you know?

Stephanie Goss:

Yes, yes.

Dr. Andy Roark:

Or “We were pretty lax about it and we miss a lot of charts that don't get written up.” And that bothers me. So, I'd like to address this problem, but also lean a little bit more towards those shades of gray, less extreme cases because I think that's where most of our listeners, who wrestle with these problems are going to live.

Stephanie Goss:

Okay, that sounds good.

Dr. Andy Roark:

All right.

Stephanie Goss:

So, where do we start?

Dr. Andy Roark:

I think we could start with Head space. I think we could start with Head space and you have to get your head around it. And so, let's just say when you're working at a practice where this is happening, to some degree. Whether it's every record or some records. I think the first thing is that you need to figure out how you feel about this because it is going to affect what you do from here.

Stephanie Goss:

Yes, yes.

Dr. Andy Roark:

So, when we talk about Head space and I would talk to this person, now this person is reaching out and they are a paraprofessional. They've been a manager and they are working as a paraprofessional. Not a credentialed vet tech, but another professional in the practice. I had some concern when we started out. It was like, “Oh, man.” I'm always a little weary that we make a podcast and people are like, “Oh, my gosh, that person is talking about our practice.” And they'll be right.

Dr. Andy Roark:

And then I thought about it. “These people don't listen to our podcast.” The people who write up zero records, they're not listening to this podcast. I'm pretty certain. But anyway-

Stephanie Goss:

For the five practices who are listening, just went, “Wait, are they talking about my practice?”

Dr. Andy Roark:

Yeah, I know, I know. So, anyway, let's get our heads straight about how do we feel about this. Now, it's an important differentiator because if you are a doctor at this practice, that's your license, my friend. Again, I'm not telling you what to do, but I'm saying you need to have eyes wide open and if there's no medical record and you get taken before the state board, your bum is grass, as my dad used to say. And that's it you're toast and that's not good. And honestly, I've talked to a number of people. I talked to them. Generally, I'm very interested in talking to people who sit on the state boards.

Dr. Andy Roark:

Just for the Cone of the Shame podcast. And I'm always just interested in what the experience is like of going to state board and what's really going on there because I think it's really important. And the number one piece of advice that I have gotten from a half dozen of these people at different states is, “For God's sakes, Andy, just write down what you do. You're doing good medicine. Just write everything down and you're going to be fine.” And that is the saving grace. And they say, “The people who get nailed are the people who don't write anything down. And then they got nothing. They got nothing to fall back on and they're torched.

Stephanie Goss:

Yes, yes.

Dr. Andy Roark:

And so I just go, “This is dumb.” It's just, it's dumb for you as a doctor. It's your license. And even if you're working in a practice and this is where we're going in the shades of gray a little bit. Let's say that you write up your records by other doctors in your practice, who don't write up your records. If there is a case that you are involved in and then it gets transferred over to them and then it comes back to you later on and the whole thing goes sideways and crashes and burns. And you end up in the state board, this is going to make your life significantly harder because there's big holes in the story.

Dr. Andy Roark:

And you might have written everything down, but other people did not. That's a stress that I don't want. And so, eyes wide open. And again, if you're a credential vet tech, you're going to feel some of this because you have a license to protect.

Stephanie Goss:

Right. Exactly.

Dr. Andy Roark:

And so, you need to be thinking about that. If you're a non-licensed professional, so like this person working up at the front, it really becomes a bit more of you don't have a license on the line or anything like that, but you need to think about how you feel about the work that you're doing. I have a problem working in a place where I'm really embarrassed about something that happens. And I just, that's a weird life thing for me is that I can't tell a lie. I'm a terrible liar. I am. Just, I'm not a secretive person. I just, I have a big mouth and I talk a lot.

Dr. Andy Roark:

And so, my life is just better if I work at a place where I'm proud of what we do and I don't have anything to hide or anything that I'm embarrassed by. And so, I just learn that along the way and I just go, “Yeah, I really like to work in a place where…” Every practice has got its flaws, but they're not flaws that bother me deeply. And that just makes my life a lot better. And so, start to have those thoughts about, “What are the repercussions here and do I feel good participating in a hospital where this is happening?”

Dr. Andy Roark:

And it would bother the heck out of me to send records to another practice and have them say things like, “Is that it? Is this all you have?” And you're like, “Yeah, that's all we have.” That would bother me every time I did it or even if they didn't call and I faxed it, I would still send the fax being like, “I'm feeling embarrassed about what I'm sending to you.” It would just nag at me.

Stephanie Goss:

Well, and I think that's why our writer wrote in. They are the ones answering the phone and talking to clients and talking to the insurance company when they call in the other vets clinics who are like, “What? That's it?” We can't do anything with this. We need more information. And they feel like they are the ones answering the phone, so they are the gatekeeper. And coming from the front desk, I want to do my job. And whenever I felt like I wanted to support my team and so for me, I would do everything possible to try and find the information myself before I had to ask somebody else on the team.

Stephanie Goss:

And it would have driven me absolutely bananas if I constantly had to go ask somebody else, “Hey, what'd you do on this case? Hey, what'd you do with this patient?” The fact that I can just look it up. Even if it was a paper chart, the fact that I couldn't look it up and say, “Oh yes, Mrs. Smith, I see that this was the medication that we gave Fluffy.” The fact that I couldn't answer simple questions like that would drive me absolutely nuts. There's no way that I would want to work in a practice like that.

Dr. Andy Roark:

Yeah, I agree. So, that's the big part of my head space is, “What is the risk to you and what are you willing to tolerate?” And then the step beyond that is to start to say, “Okay, what level of action am I deciding to take here?” And to me, there's a couple of different things you could do. You could say nothing. If you say, “Hey, I'm not a doctor and I'm part-time here. And they haven't asked me what my opinion is and I'm just going to do my job and go on.” I think that that's a choice that you can make and a lot of people would make that choice and just say, “Hey, I'm going to believe that they know something that I don't.” And they're the ones, “You have licenses on the line and so I'm going to go on.”

Dr. Andy Roark:

I think you could do that and I think a lot of people would do that. I think more people or probably most people would fall into the next two categories, which is, “I'm going to say something and then I'm going to sleep soundly because I said it.” And they may totally ignore me, but I am going to go on record saying, “I am bothered by this. I have concerns about this. And I just want to bring it to your attention.” Or making it some conversational point with the manager, with the owner. “But I am going to bring this up, so that I have the peace of mind and said that I saw this and I said something about it.”

Dr. Andy Roark:

And I think that for me is the easiest position as far as balancing what I feel is personal responsibility and feeling like I'm doing the good thing. And also, accepting that I'm not the boss here and I have very little power and no one asks me for input. But still, I'm going to bring this up. And I can't make them do anything with it, but I will at least have a clear conscience.

Dr. Andy Roark:

And then I will continue to say, “Am I comfortable here?” You know what I mean? If I bring it up and they don't do anything, maybe I go, “I don't like this. It still bothers me.” And if it continues to bother me or there was another instance and usually, what will happen is there's some instance, there's something that happens that really shines the spotlight right on it, you know what I mean?

Dr. Andy Roark:

And then you go, “I not doing this anymore.” And then the last level is to say, “I'm not messing around with this. That thing has already happened. And I'm really bothered and I'm going to go, and I'm going to tell them, I'm planning to leave because of this. And if you convince me that things are going to change in the next 30 days, I'll consider staying around. But unless there's a significant change coming, I'm going, and I want you to know why I'm going.”

Dr. Andy Roark:

And you can do that and that's not wrong either. So, all of those things and this all fits into the degrees. If you're working at the practice and one of the doctors occasionally forgets to write up their notes, I'm probably not going to go and give an ultimatum that I'm going to leave. You know what I mean? I will pick one of the top two, you know?

Stephanie Goss:

Right.

Dr. Andy Roark:

If you're at a place where it happens all the time you did that, that's going to influence us. So, there's degrees in nuance in which of these paths you take, but I really think that those are your three options.

Stephanie Goss:

I agree. I agree with that. I think the other thing from head space perspective for me, too, probably before I even start figuring out for myself where does my head land on it, is you got to assume good intent. Because if you're coming at this from the space of they're doing this intentionally for a bad reason, you're probably going to approach it more towards the latter, which is, “I don't like this and I'm just going to quit.”

Stephanie Goss:

And I've had people leave the practice because they felt strongly about something that they didn't ever ask any of the questions. And when I found that out after the fact, like I wish they would have asked the questions. But I think it, when we get into that head space of like, I assume that they're doing this for a reason and it's really easy to spiral yourself in a negative way, I think, if you don't assume good intent.,

Stephanie Goss:

And so, the second part for me is get curious and ask those questions. And so, before I started tackling it, I would want to make sure, and again, this is just me, but I would want to make sure. Could I be missing something here? Are we recording stuff? Are they doing a surgery sheet and maybe they're writing all their notes on there? And it's supposed to go in the chart, but it's not part of the chart. You know what I mean? I would start to ask those questions of like, “Am I missing anything? What are we doing and why are we doing it?”

Stephanie Goss:

And I would use being new to your advantage. This is where you say, “I just want to make sure that I really understand. Help me understand this. Can you tell me how this is supposed to look because I feel like based on my previous experience and other practices, this feels very different. I wouldn't say like I feel like there's lots of things missing. I would probably lean into the middle and I'll just like, I feel like it feels pretty different and I want to understand what we're doing and why we're doing it. And asking those questions to make sure that you have all of the answers.

Stephanie Goss:

When I went back to our Mailbag writer and I was like, “Is it possible that they just haven't shown you where this stuff lives? Is it really?” Because it really can't be that the charts are empty. And so, I think that's, for me. It's about assuming that good intent and getting curious and asking a lot of questions, because I think you're going to need to ask those questions and maybe not, maybe your mind is already made up and you could figure out which level of Andys you sort into. But it totally makes sense to me, Andy, that's your next step is what are you willing to tolerate? What are you willing to live with? And then, what level are you falling into?

Stephanie Goss:

Are you just going to put your head down and do your job because you decided you don't care about it or do you care and you're either going to say something, so you can sleep at night? Or you're going to say something and say this, “I feel really strongly about this. And if this doesn't change, here is how I need to move forward for my own personal satisfaction.”

Dr. Andy Roark:

To me, there's two things in what you said and I think you're spot on with both of them, but I separated these out. So, the first thing, the head space thing for me is in your mind, consider the idea that you are missing something. That there's something that, not you're making yourself leave, but genuinely, “This seems weird to me.” And rather than just assuming it's not getting done. Let me just assume that it's possible that something else is happening that I'm not aware of, especially being a new person.

Dr. Andy Roark:

And so, doing that and just going, “I could be wrong on this,” that is going to affect how you think about it and how you talk about it and you approach it. And that type of curiosity on yourself tends to make your conversations with other people go better. You know what I mean?

Stephanie Goss:

Mm-hmm.

Dr. Andy Roark:

Because you're genuinely just saying, “I just want to make sure I'm not missing anything here.” And it takes the danger or the fear or the stress out of it for you and go, “I don't know. I don't know. I could be missing something here.” So, in your own mind saying, “Maybe I've been set up to fail” Maybe I am just not aware of this.” I think that's a great healthy head space to be in. The why I say it's two things is one, is you do that to yourself in your own mind. And then, the first action step for me is asking the question.

Stephanie Goss:

Yeah. Got it.

Dr. Andy Roark:

And so when you go to engage, I would start with that curiosity and that's how I would engage.

Stephanie Goss:

Got it. Okay. I like it.

Dr. Andy Roark:

Well, that's what I got for head space.

Stephanie Goss:

Those are your notes for head space?

Dr. Andy Roark:

Yeah.

Stephanie Goss:

Should we take a break? And then come back and talk about how do we actually ask questions about this without knowing what the heck are you doing?

Dr. Andy Roark:

Yeah. Let's do it. And yeah, we'll start with the question and we'll wind up from there.

Stephanie Goss:

Okay. I love it.

Stephanie Goss:

Hey, everybody. This is Stephanie. And I'm going to jump in here for one quick second and make sure that you know about a few things that are coming up that I'm pretty sure you're not going to want to miss. But before I do that, I just have to say a thank you.

Stephanie Goss:

Thanks to a generous gift from our friends at Banfield Pet Hospital. We are now able to provide transcripts for all of our podcast episodes. And we have just to say thank you, thank you, thank you so much. Andy, and I have wanted to make the podcast more accessible. And when we're pondering the idea of how do we make transcripts a thing, our friends at Banfield stepped up in a big way and said, “Hey, we are striving to increase accessibility and inclusivity across the profession. This fits with that mission for us and we would love to sponsor it.” So, the 2022 podcast episodes are all now being transcribed and brought to you by our friends at Banfield Pet Hospital.

Stephanie Goss:

To check out the transcript and find out more about what Banfield is doing to increase accessibility and inclusivity across the vet profession, head over to unchartedvet.com/blog and you can find each one of the podcast episodes and a link to find out more about equity, inclusion, and diversity at Banfield.

Stephanie Goss:

And now, hey, party people. I am going to jump in here for one quick second and make sure that you know about a workshop that is coming up. It is called Navigating Neurodiversity: Your clients, coworkers, and self. And it is with the amazing Dr. Amanda Doran. Amanda is an Uncharted member. She is a wonderfully kind and funny person and she is going to be leading us through a conversation about learning how to navigate interactions with different individuals and creating a culture within our practices that is both supportive of and inclusive of neurodiversity. It is a really, really important topic.

Stephanie Goss:

It is one that I think needs to have a lot more discussion in Veterinary Medicine and we are really excited to be bringing this one to you. It is happening on July 27th. It is a 7:00 PM Eastern session, so it is two hours. It will be over at 9:00 PM Eastern, which means 4:00 PM Pacific, 4:00 to 6:00 PM Pacific Time. And it is $99 for members of the public. And it is free as always for our Uncharted members and this workshop is awesome.

Stephanie Goss:

We also have more coming up throughout the summer and the calendar at unchartedvet.com/events is constantly being updated. I encourage you, if you are not currently an uncharted member, to head on over to the website, check out what's coming up. And remember that all of our workshops like this are free for our Uncharted members. And now, back to the podcast.

Dr. Andy Roark:

So, let's go ahead and talk about taking action on this.

Stephanie Goss:

Okay.

Dr. Andy Roark:

All right. So, as I said before, the break, I think the first action step is to ask the question. It's to be curious. I think this is a really low stakes way and I'm all about lowering the stakes. It's having low stakes conversations that don't feel scary to people. But still introduce important ideas into their mind, hopefully, in a way that they will realize what is going on and parse through the possible implications and decide to make an idea and a plan and take action on it.

Dr. Andy Roark:

And so, going in and genuinely going with curiosity and going to the manager and saying, “Hey, I may be totally missing something. And I just want to understand and just make sure I'm not missing anything.” And I love that opening phrasing, “I just want to make sure I'm not missing anything. I just want to make sure I understand. That is a very disarming phrase.”

Dr. Andy Roark:

And so, then I would show the manager, one of the medical records and say, “I just got a call about this person's records. And when I look at them, these are the only things that I'm seeing. And I have sent some of these to practices before and they call and ask if there's more. And I tell them that there's not. But I just want to confirm is this really all that we have on these cases? Is there somewhere else I should look?”

Dr. Andy Roark:

And honestly, anyone with half a brain is going to read between the lines. What I'm saying is I've been doing this a long time. And is this really what we're doing here? And honestly, their reaction will tell you a lot. If they get really defensive really fast, you just learned a lot. And if they say, “Yeah, what else would be there?” Then I go, “Okay, this person needs some education on what good medical records look like. But what am I dealing with here? Am I dealing with somebody who's given up? Am I dealing with someone who just doesn't know any better?”

Dr. Andy Roark:

If I had to bet and again this is 100% just instinct, I was completely wrong on this. But if I had to bet, I wouldn't be surprised if they closed the office door and said to you, “Let me tell you a story about how we got here.” And then they tell you about the battles that they fought and lost spectacularly trying to get people to do what they're supposed to do. I would not be surprised by that.

Stephanie Goss:

Yeah, yeah. No, I think that is a good call. And I think part of it, too, is it's a little bit head space, but also for me a little bit action, which is like, “Look, we recognize that,” like you said, “not everybody loves to write records.” And there's always going to be people that write more and less. But at the end of the day, the written records, they are patients. They are patients in paper form. So, Fluffy can't get on the stand in front of a medical board or Fluffy can't get on the phone and talk to Mrs. Smith about why something was or wasn't done for her. Only our records can do that and our team accessing those records.

Stephanie Goss:

And so, from the head space perspective, I think thinking about it from very much for any member of your team, you should be able to pull the lever here about pet care and patient care and wanting to take care of our patients and make sure that we're doing right by them because this writer was like, “Look, they're practicing a level of Medicine that I agree with and I believe in.” And I just don't understand why there's no record of that. And so, I think this for me, when addressing it, like you said, whether you're asking the questions openly with that.

Stephanie Goss:

And they're answering them openly or whether you're having that closed door conversation, learning the background, the ability to be able to say, “I want to take care of Fluffy.” And I love your example of being able to say, “I just got a call about this record. Here's what I'm seeing. And this isn't the first time. And this is how I've answered it in the past, but I could be missing something. I really want to make sure that I'm not.” Because then if they tell you, “No, there's nothing else.” That is what it is. Like you said, you have now learned a whole lot. And I think it makes your moving in the head space about how you make decisions a whole heck of a lot easier.

Stephanie Goss:

And if you do get more information and more background, and maybe it's like we have fought these battles and this is the background on it. It's still thinking about it from the patient perspective, I would still be willing to go to and do that battle over again from the perspective of, “I want to help us really good care of our patients.” And being at the front desk like I really believe that this is our ability to speak for Fluffy. This is my way of being able to help her and so, I want to help us get in a better frame of mind or be in a better place to be able to answer questions that people are asking us, “How can I help with that?”

Stephanie Goss:

It helps bridge that gap between asking the questions and asking for change and coming at it from that place of patient care. And I can't imagine, even if you have a super old school veterinarian who didn't have to write massive records when they went back to school. And it's like, “It's my practice. This is the way we're doing it.” And I won't care what anybody else thinks.

Stephanie Goss:

I still think that I would feel good about having a conversation with that veterinarian and saying, “I know you care about your patients. And I care about our patients, too. And this is why I'm struggling because I view this as us taking care of the patients. And when it's missing, it makes it really hard for me to help support you.” And I don't think that you could say that to anyone even that veterinarian that I'm picturing in my head and not have them go, “Hmm, maybe that's something I should think about.”

Dr. Andy Roark:

Yeah. I agree with that. So, I 100% agree with where you're coming from. But I would counsel here a little bit of a little slide of hand and I agree with where you're coming from and your motivations. And I promise that we're going to get there, but it's not going to look like that's where we're going for a minute. So, just bear with me and say, trust me when I say that's where we're going.

Stephanie Goss:

Okay.

Dr. Andy Roark:

All right. And so, we go into the practice manager and I would start with the practice manager because it's their job to manage the practice. And so, especially if this seems routine, then I would say, “This is the way our practice functions.” If it's not routine, even then I would still go to the practice manager because if it's the practice manager's job, I assume the practice manager's job is to oversee medical record quality and medical record systems and unless, you've got some weird job descriptions that tends to fall into their purview. So, even if it's one doctor and I had concerns or questions, I would still probably go talk to the manager.

Dr. Andy Roark:

And here's the thing, okay? So, file this away, my friends. Doctors can take critiques of their medical records very personally in my experience. And the reason is they feel like a criticism of their records is a criticism of their medical competence. And again, it depends on the individual and that's not everybody. And I would not have a problem with someone critiquing my medical records and I'm happy to talk about it and listen. And I always try to get better. And I can also defend my position and why. I write what I write and things like that.

Dr. Andy Roark:

But I'm happy to have that conversation because I'm not super insecure about that stuff. But other people are not that way and there are some people, and we all know doctors, who can't take being criticized before it really hits them and they get real defensive real fast. What I want to avoid ending up in an old West style shootout with a doctor in the street. You know what I mean? Where they're standing at one end with their hands on the pistols and I'm standing out and they're like, “Draw.” I don't want that. I don't want to shoot out with them over this thing.

Dr. Andy Roark:

I want to be smart in how I introduce this. And I want to get heard and I want to understand what's going on. And so, I go to the practice manager and I ask the questions and say, “Help me understand, is this going on?” And guess what happens? They might close the door and say, “I cannot get these doctors on board.” And then they'll just tell you what the problem is or what the holdup is. They might just act like, “No, this is what we do and it's totally fine.”

Dr. Andy Roark:

If they don't tell me what the holdup is, I want to find out what the holdup is. This is called root cause analysis. Before I make any statement or a stand, I really need to know where this is coming from and why it's coming from, so I can know what I'm up against before I take a stand. I just need to know where is the pressure going to come from? And what's it going to look like?

Dr. Andy Roark:

And so, if they tell me, “Hey, this is has come down from the doctor, so I can't do anything about it.” I'm going to say, “Why? Why is this coming down? Why did they feel that way? What did they say when you talked to them about it? What is their concern? What seems to be the push back?” And I'm pumping the manager for information, because I want to understand, like, “Why is this happening? Help me understand.”

Dr. Andy Roark:

If I don't get that volunteered information from the manager and they start to say, “Well, this is just what we do or that's who the doctor is,” or it's just they indicate to me that they don't think it's worth the effort to try to correct this, I want them to understand my why in asking. And so, one way this conversation ends is I go and say, “Hey, is this right?” And they're like, “Yeah, that's what we do. Not a big deal. That's just how we handle it.” And then, the conversation stops. And so, I don't want that, so I needed to keep going.

Dr. Andy Roark:

Remember when we start to talk about things like medical records, honestly, a lot of these things, there are some people who will be motivated by data. And you can talk to them about aha standards and you can talk to them about state regulations, and you can pull that stuff out if it's important to you and say, “Well, I didn't know the State of South Carolina says this.” Or “I know that aha has these things in their guidelines. I suspect this is not an aha practice given the fact that they don't write any medical records.” And so, that's not super motivating.

Stephanie Goss:

I know that this is not an aha practice.

Dr. Andy Roark:

Yeah. That's not super motivating. I think I would probably go in and they said, “Well, that's just what we do.” And I'll say, “You know I worked at a practice one time and two doctors got called into the State Board.” And I remember the pet owner was really adamant that they had done something wrong and they had not done anything wrong. But I remember, there was a man and a woman and I remember the man lost 20 pounds in the four to six weeks before he got cleared. And they looked awful every day because they went through this stress. And they had good records, and I've heard that is the number one thing that saved them and saved other people.

Dr. Andy Roark:

And so, I would really reconsider this. I'm just, I'm really worried about what would happen to the doctors, given what I've seen before. And so, that's me trying to get them to engage in a conversation. If they still blow it off, then I'm going to say, “This person does not want to. They don't want to engage with me.” But ultimately, I'm trying to explain to the person I'm talking to, “Hey, this scares me.” Not bothers me, not makes me angry, not in a judgmental way. I'm not saying, “This is shotty medicine. This is inappropriate.”

Dr. Andy Roark:

Now it might be and we can come around to that. But at least in getting the conversation open, I want to use nonjudgmental language, which is, “I'm not saying these guys are bad. I'm not saying they're not doing good medicine. I am saying that I've had friends who went through this and they were saved because of their records. And I don't think it would have gone well at all for the doctors here because of this stuff. And it's really just about trying to keep the conversation as productive as possible and not trigger that defensiveness. And again, I'm using that to try to get this person engaged, so I can understand what is the hangout here? Is it that it takes too much time? Is it that the doctors don't like the medical record system or was there a plan that we were going to have scribes and we never got them? I don't know what's going on.

Stephanie Goss:

Right. Yeah, yeah. That makes total sense to me and I think trying to get on their side and being able to have that conversation about knowing what can happen as a result is a super impactful tool and a good one to pull out of your toolbox, because you do care about them. You're enjoying your job. You want to work here. You believe they're practicing a good quality of medicine. You just need to understand what is happening here, because you don't want them to not be able to defend themselves. Whether it's to an owner or to an insurance company or to the board, it doesn't matter. You don't want to feel powerless.

Stephanie Goss:

And so, for me, working at the front desk, every time I had to have a conversation with the doctor about their medical records, I usually approach it from the place that I want to help. I don't want you to have to get on the phone and have this conversation. I want to just have it for you and be able to give Mrs. Smith the answers that she needs. And so, I just want to make sure I understand where I get this information from. Because in your head, I'm thinking, “I'm not a mind reader. I can't go into Dr. Roark's head and know what he talked about in the exam room with Mrs. Jones because I wasn't in the exam room.”

Stephanie Goss:

But if I look at a chart and I could read back to her what you recommended, I can certainly have that conversation and save you that half hour on the phone, right? And so, I think your point about not everybody is that way, there definitely are people who will take any question of the medical records as a critique against their medicine is a super valid point. And I think it's definitely something that you have to frame really, really well.

Stephanie Goss:

And so, it's funny that you brought up the aha standards, because that's a feeling that was a part of it for me. And I would suspect, our writer as a previous manager would know what some of the resources are, but for any of our listeners out there who are just getting started or learning. The reality of how do we actually address this, is that everybody. I think everybody needs to know that every state is different. So, every state is going to have actual specific requirements.

Stephanie Goss:

And so, if you're getting curious and you're asking like you can look it up for yourself and find out what does your state practice act or medical act actually say about what your records have to include. And some of the states are super vague. There's not a whole lot there. They've got some basic stuff. And then you have other states, California was one of them, that really lays out. Tells you that you got to cross all these Ts and dot all of Is.

Stephanie Goss:

And so, I think for your own knowledge, like learning what is your state requiring? And then looking at what are the aha recommendations are wonderful because they do give a great outline. And also, respect the fact that there is going to be shades of gray because every state is very different. And so, when I think about learning or coming at it from a gentle perspective, when I think about what do we do here in our practice, because every practice is different. And every practice within every state is still going to be different.

Stephanie Goss:

And so, I would take being a new member of the team and use that as a tool and be able to say, “I want to know, where do we record? What medications of pet is on in our records? Where does that go?” Asking about something like, “Where do we put what diets a pet is on or medications or their vaccine history?” Coming at it from that place of curiosity and asking, “I want to understand how we are doing things here.” It goes back to what you were talking about earlier, asking the question in a very gentle way. Because I'm not accusing them of not putting it in there. I want to make sure I'm not missing something. And I want to make sure I know where this goes here in our records within this practice.”

Stephanie Goss:

Which feels very different than saying, “I know that our state requires that we record this information. I'm not seeing it in the record. What am I missing?” Those are two very, very different conversations. They're both, they're saying the exact same thing, but it feels very different to the person who is receiving…

Dr. Andy Roark:

Yeah. I agree.

Stephanie Goss:

… that question.

Dr. Andy Roark:

There's two types of presentations that we want to do. And so, the first one is the gentle presentation that's meant to not put them on the defensive. And the second presentation, which we'll have going on, especially this is a great conversation that if we're going to talk to that specific doctor is I might have strong feelings about patient care when I look at medical records and those are very, very valid. And I might mention those feelings, but to me, the most effective way to have conversations like this, we're talking about changing behavior is to talk about what the person who's doing the behavior cares about.

Dr. Andy Roark:

And so, for example, when we talk about medical records, things that motivate doctors would be, in some cases, patient care and not the patient care of the doctor. But I would make the case, “Hey, when we transfer patients, other doctors don't know what your plan was and they're not carrying out your plan.” And so, you can see that that's still, it's not a very critical approach. It is a benefits approach of, “Hey, we want other doctors to be able to follow suit with what you had planned.

Dr. Andy Roark:

Your reputation. “Hey, I want to make sure the client,” because the clients get copies of the records and they call for them and I want them to see that they're getting treated. And I want them to see the care that's being offered and what their patients or what their pets are getting when they come in here and I want to make sure that's clear to them. It's the standing in the vet community is, “Hey, the other vet practices see these.” And often ask us if there's more information.

Dr. Andy Roark:

And I don't want us to be perceived in negative light with the other clinics in the area. There's a simplicity in the life-balance argument, which is, “Hey, I want you to be able to go and be off and not have people calling you and asking you about what your plan was.” I want you just to be able to lay it down and then to leave and to know that the next person is going to know what the plan is. And also, when somebody else doesn't write up the chart or with somebody else as the case, I want you to be able to pick up their chart and have the information that you need to make this job easy and not have you going back and starting over again.

Dr. Andy Roark:

And then the client experience in the exam room. It's like, “Hey, I want our doctors to be on the same page,” so that when a client comes in and sees the vet, they haven't seen before that person stays up fumbling around. The client has confidence and that person that they know what's going on. And so, all of those are very soft ways to set this up. But it's all different ways to try to get at what that doctor cares about or what's going to motivate them. But those are the things that I bring up. And I'm very selective about what sorts of leverage I try to use to move the person in that direction.

Stephanie Goss:

Yeah. I think that makes total sense because who isn't going to want to hear that somebody else on their team cares enough about them, that they don't want them to get called on their day off. I just feel like there's no defense to that. Even if I'm a doctor and even if I'm the doctor who does have insecurity and feels worried about my medicine being questioned. If you came to me and you said, “I just want to make sure that you can take a day off and that we don't have to call you and ask questions.” I can't imagine that you could be bothered by that. It's just, it's feels very disarming in a good way.

Dr. Andy Roark:

Yeah. I really don't want to go the state board at all. And if I do, I really want to have great medical records, like I really want that. And so, I am highly motivated by that. And also, by not getting called on my days off. And again, I don't blame doctors who are like, “Hey, I'm looking at your case. I have no idea what you were thinking or where you were going. What do you have going on?” I don't blame them for that and I'm not getting mad.

Dr. Andy Roark:

I kick myself for not being like, “Hey, this is where I am. And this is what the idea is. And if you feel like this idea is not good or you want to try something else out, God speed. Go for it.” But at least you know what I was thinking and where I was going and that was two weeks ago. And so, you're looking at something totally different now. You have the benefit of hindsight that I didn't have. “Here's where I was going, but take it. Make the call and go on, but you don't need to call me. And I don't need to get involved back into this because I laid everything down and gave all the information that I had.”

Stephanie Goss:

Yeah, yeah, no, I like that. I think this is one where ultimately I think the final answer is you have to pick your poison, so I think this is one where if you're working in a practice, this goes back to your head space. You have to decide where you live. Are you okay with this? Are you not okay with it? Are you going to be able to say something and then sleep at night or do you need to say something and ask for a change. And what is that change going to be?

Stephanie Goss:

And so, I think ultimately, we talked about different ways that you can approach and the different levers that we can pull. But ultimately at the end of the day, I think this is once you go on your fact finding mission and you ask good questions and you're coming from that place of curiosity, and you're here asking, “Tell me more.” At the end of the day, you have to decide if the practice is willing to change or are they not, and if they are, great. What do you need the change to look like for you to feel good and sleep at night? And if they are not, what are you going to do about that?

Stephanie Goss:

What is going to make you be able to sleep at night because the answer may be that you can put your head down and go on from there. And the answer may be that you cannot. And you need to know that and be able to have a plan to move forward because ultimately, I think you're going to have to pick your poison here at the end.

Dr. Andy Roark:

Yeah. I think that's the advice for everybody, regardless of where they are on that spectrum from nothing is written up to once in a blue moon, a chart gets missed. The steps are still the same of you going through collecting information, figuring out why this is happening, figuring out what the pain points or resistance points are. Making a presentation about why you think this is important or what your concerns are. And then assessing what the response is and deciding how severe a problem this is or how strongly you feel.

Dr. Andy Roark:

I would say to the person writing, if you were a doctor or a licensed vet tech, I would tell you I'd cut and run, just because I would say this is too risky. This is too risky to my license, my license. I worked too hard for this license to worry about it getting tanked like this. And that stress would bother me enough then I would be like, “Hey, look, there's plenty of opportunities for me out there. I'll go somewhere else.” Those are generally my thoughts on that.

Dr. Andy Roark:

And again, as a paraprofessional, you have a little bit more leeway because no one's expecting you to make those medical calls you. But I still think you just want to think about what you need to feel good about the work that you're doing. And then there's nothing worse than going in and not feeling good about what you're doing with your time in interview.

Stephanie Goss:

Yeah. And I think that it's also not wrong that every member of the team contributes to the level of medicine that you practice collectively as a group within the practice. And there, I find nothing wrong with the front desk team wanting to be active, engaged part of that process. And so, I want to interview, especially when I interview people with experience, I want them to tell me what do they want to be a part of, medicine wise. Just because they don't have a license, just because they haven't gone to school doesn't mean that they don't have information to share that is important and valid.

Stephanie Goss:

And so, I think it's good and healthy for the front desk team to think about what level of Medicine do they want to be a part of. And that's when I interview as a CSR or looked for new clinics as I grew in my career, that absolutely was a piece of the interview process for me is, “Tell me about your Medicine. Tell me about what you're doing. What about your standards of care. I wanted to see, are they using paper charts? Are they using hybrid? Are they using completely paperless? What are they doing and how are they doing it?

Stephanie Goss:

Because at the end of the day, there were things that were important to me that I wanted to have in place to feel like I could go to sleep at night and feel good about what I was doing. And that, what that is for everybody is going to be very individual, but there's nothing wrong with asking those questions. And I would say you should be asking those questions.

Dr. Andy Roark:

Nope. I agree. I'm on board. All right. Yeah. I think that's good. I think that's the advice that I have.

Stephanie Goss:

I love it.

Dr. Andy Roark:

I think this is, to some degree, is a common pain point for a lot of people. Not to this degree, but to some degree, it definitely is. I hope that that's been helpful.

Stephanie Goss:

Listen, I think this is going to be one of those episodes where we're not going to have very many people who are like, “Are they talking about my practice?” But I do think that this is going to be one of those episodes where you step back and say, “Today, I'm going to be happy about the dumpster fire that is my practice.” Because there are practices out there that have bigger problems than I do. And sometimes that reminder is just as important, so you're welcome. You're welcome everybody.

Dr. Andy Roark:

Awesome. See you, everybody.

Stephanie Goss:

Well, gang, that's 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 bag. 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 Mailbag at the website. The address is unchartedvet.com/mailbag or you can email us at podcast@unchartedvet.com. Take care of everybody and have a great week. We'll see you again next time.

This Week on the Uncharted Podcast…

Imagine that you work in a practice as a new grad and form friendships with the people who are literally helping shape you into a veterinarian. You leave the practice to get some more experience and then you come back to the practice you started at – only this time, you are a part-owner and that means you are the boss! This week on the podcast, Dr. Andy Roark and Stephanie Goss are tackling a letter from the mailbag from a veterinarian who has been facing this situation and feels like its extra sticky because now the technician who helped mold/shape them is treating them like a new grad who knows nothing and definitely not treating them like the boss. Let’s get into this…

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Got a question for the mailbag? Submit it here: unchartedvet.com/mailbag

Related Episode – I'm The Boss Now…Can We Still Be Friends?

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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. Have you ever as a doctor felt like one of the technicians on your team was trying to tell you how to practice medicine? You're not alone. This happens, and in this case, we have an email in the mail bag that Andy and I are diving into on the podcast this week from a veterinarian who grew up in a practice, worked with a technician for a really long time, left the practice to get some additional experience, and has come back and is now part owner. They feel like one of the technicians in the practice who helped train them as a new grad is now trying to tell them how to practice medicine and treating them like they're the boss versus the other way around, which is a pretty sticky situation. Let's get into this one. There's a lot to talk about.

Speaker 1:

Now the Uncharted podcast.

Dr. Andy Roark:

We are back. It's me, Dr. Andy Roark, and the one and only practice management goddess, Stephanie, since you've been gone, Goss. Since you've been gone…

Stephanie Goss:

Oh, you guys make me feel so awkward…

Dr. Andy Roark:

Since you've been gone…

Stephanie Goss:

… when you use that moniker. How's it going?

Dr. Andy Roark:

Yeah, just singing some Kelly Clarkson at. That's that's what's up with it. Oh, yeah. I don't know. It's okay. My wife is enjoying life more than I am right now.

Stephanie Goss:

She's done with school?

Dr. Andy Roark:

Well, because she's done with school, yes, but also, I work a lot in the yard outside, you know?

Stephanie Goss:

Yes.

Dr. Andy Roark:

It's my happy place, and I have planted a lot of stuff since the pandemic started. It Looks really good. Recently, a herd of deer found my yard, and they have been coming and grazing on…

Stephanie Goss:

Eating all the things?

Dr. Andy Roark:

… the baby trees that I have planted and my beautiful hydrangeas, and it is driving me nuts, so I have gone to war with the herd of deer, but also I don't like to hurt animals. I'm not actually doing anything, but I need them to not. I get real upset when I come home and half my hydrangeas are eaten. I have a plan. First of all, I went and I bought the stuff. It's basically like bitter apple dog spray that you spray on furniture, but you spray it on plants.

Stephanie Goss:

For deer?

Dr. Andy Roark:

100%. Yeah. It's blood and eggs and coyote pee. Everything nasty they could think, they put it together to spray, and then you spray it on the leaves. I know that they love my hydrangeas, and so I have spent a ridiculous amount of time spraying hydrangeas with coyote pee and eggs. It's had mixed results.

Stephanie Goss:

How's that working out for you, Andy?

Dr. Andy Roark:

They keep finding new things, different things to eat…

Stephanie Goss:

Surprise.

Dr. Andy Roark:

… and I can't spray the whole forest.

Stephanie Goss:

Right.

Dr. Andy Roark:

They're just moving around different things, and I'm starting to freak out because what I read on the internet is that once they get in a habit of coming to an area, they just keep coming which makes them good if you're a hunter who wants to kill them, but not good if you don't want to kill them, you just want them to leave your plants alone.

Stephanie Goss:

Sure.

Dr. Andy Roark:

Right? Things went to the next level today. I spoke at Mississippi State University's College of Veterinary Medicine years ago for their students.

Stephanie Goss:

Can't wait to hear where this is going.

Dr. Andy Roark:

Asa gift, the students gave to me a cowbell, a Mississippi State cowbell.

Stephanie Goss:

Oh, dear lord.

Dr. Andy Roark:

It's a cowbell with a handle that is made to raise hell at a football game. You know what I mean?

Stephanie Goss:

Yes.

Dr. Andy Roark:

It's got an anchored… You just dong, dong. Oh, boy. It's real loud. We carry it gently through the house because it is real loud. My research has also told me that deer are skittish creatures, who don't like people, and if they become startled or associated in area with people or loud noises, they will avoid them.

Dr. Andy Roark:

Where we are right now is I and Skipper have taken to watching out the windows in the mornings and evenings to spot deer creeping into the yard. This morning, my wife saw one out the bathroom window and said, “There's a deer beside the house,” at which point I grabbed my cowbell, and ran out of the house, “Yes.” I'm screaming. I chased… This deer took off like a shot from a cannon, like you've never seen a deer. It just blurred into a brown streak with a white butt tuft disappearing into the… It launched like a rocket. I'm barefoot. I'm running with my cowbell. It took me a half an hour to get Allison calm back down to where she could go to work and be productive. Okay? I scared the heck out of that guy. I'm not convinced that he's smart enough to change his… I think this may become….

Stephanie Goss:

I was going to say, how's it working out for you?

Dr. Andy Roark:

Well, Stephanie Goss, if you were eating lettuce in my yard and I came running at you with a cowbell and screaming, would you come back?

Stephanie Goss:

The mental image.

Dr. Andy Roark:

I'm highly optimistic. I'm highly optimistic that it's check and mate Andy Roark over the deer.

Stephanie Goss:

I highly optimistic that the deer are just going to wait until it's dark, and then they're going to come back when you can't see them, and they're going to continue to eat everything that you haven't sprayed coyote pee and eggs on.

Dr. Andy Roark:

I don't appreciate your negativity. I'd like to table this until you have a proposed solution that you would like to put forward, because I don't want to hear why my plan's not going to work and no constructive feedback.

Stephanie Goss:

I started laughing six minutes ago when you started telling this story, because you have told us repeatedly on this podcast that you have multiple acres in the middle of the wood.

Dr. Andy Roark:

I'm defending a large territory.

Stephanie Goss:

I'm pretty sure that some of your research should probably involve really looking at farming techniques and resource material from way back when settlers lived in the middle of the woods and had farms in where they had large amounts of property in deer, because I'm pretty sure you're not going to be able to cover two whole acres with coyote pee and eggs.

Dr. Andy Roark:

No, no, no. I just need to defend the hostage. I will tell you, I have read all of the recent issues of Modern Golf Course magazine, because I'm not alone in this fight. There's a brotherhood of those of us united by a common enemy, trying to save expensive landscape plants

Stephanie Goss:

It's 100% true. That is how we got our dog, Bird. That was her job. She lived at the golf course for a majority of every day, and she chased off all of the deer and geese from eating and pooping on all of the plants and grass. Maybe you just need to teach Skipper how to go on patrol around your house without being a bad dog and taking off.

Dr. Andy Roark:

I was going to say, Skipper is wildly unreliable. This feels a lot like releasing a species to deal with another species and having more problems because of the second one.

Stephanie Goss:

This is why I don't think Skipper is the right dog for the job here.

Dr. Andy Roark:

There's not a problem that Skipper is the solution to.

Stephanie Goss:

Maybe the solution is to get another dog, don't know how would feel about that.

Dr. Andy Roark:

Yeah. Yeah. We have enough dogs.

Stephanie Goss:

Oh my God. We're almost 10 minutes, and it's to actually get to the point.

Dr. Andy Roark:

Okay. All right. If you want to talk about something else, we can do that.

Stephanie Goss:

Oh my God. Okay.

Dr. Andy Roark:

I don't know that I'll have any other solutions as streamlined and well thought out as my Mississippi State cowbell solution, but we can try.

Stephanie Goss:

I'm pretty sure any of the students who are listening are very proud of how you put their gift to good use.

Dr. Andy Roark:

My wife was like, “You've had that for years. Why do you still have a Mississippi State cowbell?” I was like, “One day, I'm going to need this,” and that day was this morning.

Stephanie Goss:

I can't wait to hear what your neighbors think of you.

Dr. Andy Roark:

I thought about that too. Is that the veterinarian screaming with a cow bill chasing the deer?

Stephanie Goss:

I can't. I can't.

Dr. Andy Roark:

Okay.

Stephanie Goss:

Oh my God. My face and my stomach hurt from laughing. Okay. We've got a good one today. I'm I'm really excited. I got to reign it in. Let's get it together. We've got a good one today. We got an email through the mail bag, which was wonderful, from a veterinarian who finds themself in a position that they're really struggling with.

Stephanie Goss:

They had a rough start to veterinarian practice life. Eventually, they found a practice that felt like it was a place that they could really get settled. They were there for a good amount of time. They had a great doctor team, excellent technicians. They had a technician who really leaned into training, and educating, and became a great resource for our writer veterinarian, and was a really good mentor who became a really good friend. The doctor who wrote in said, “I've grown and developed so much, and so much of it is in thanks in part to this technician who stepped up and helped be a mentor to me.”

Stephanie Goss:

They left their practice for a while, and then they had an opportunity to come back to the same practice. The same group of techs was still there. When they came back into the practice, they came back in as an owner in the practice, as a part owner. It's a group of us who own the practice together. This vet was like, “Obviously it's a learning curve. I've taken on partners. There's lots of growing pains. I'm coming back into a practice after having been gone for a while, and there's lots of change. Most of it is okay, and I'm managing most of it well, but I'm really struggling because in part, there's one relationship with one of the technicians that I'm really struggling with.”

Stephanie Goss:

It's the technician who really mentored this vet. To this veterinarian, it feels like this technician is really struggling with adjusting to the change in roles. Now, instead of being a mentee and an associate vet in this practice, this veterinarian has stepped in and is a leader in the practice and an owner. It seems like this technician is really struggling to accept that change of role. The doctor said, “There's lots of times where I feel like I'm still being treated like a new grad. I feel like I'm actually getting pressure from this technician to handle cases and do things differently with my medicine. Even when I don't agree, and we've had a conversation about why I don't agree. I feel like there's a lot of outwardly expressed disagreement and negativity towards the way that I'm managing my cases.”

Stephanie Goss:

Our writer was like, “I'm really struggling because I don't see the same behavior with the other veterinarians in the practice. I had never experienced this previously. I've only started to experience it since I've come back into the practice as a partner.” They said, “I thought I was handling everything fine, and I was looking at it from, I feel like, maybe this is just me perspective, but this technician has been on vacation.”

Stephanie Goss:

Our writer was like, “I felt like during that two weeks I went to work, and I felt unstressed, and I felt like everything was really good. I realized that a lot of the anxiety that I'm having around work has to do with my relationship now and where this is at. I'm struggling not only with the behaviors within the practice, but also feeling like I'm losing a really good friend, because this is somebody who I really treasured and valued the relationship. I feel like that relationship has shifted, and it's feeling really much a struggle for me right now.”

Stephanie Goss:

Our writer was like, “I feel like I'm on my own with this because there aren't problems with the other veterinarians, and so I don't know how to approach figuring out, is it me? Am I the problem? Also, how do I deal with feeling like, as a veterinarian, I have a technician on my team who is not only questioning my medicine, but who I feel like is actively pressuring me to do things their way, which feels uncomfortable to this vet.” It's a whole lot to unpack.

Dr. Andy Roark:

Yeah. Yeah, there's a lot here, but I think we can handle this. It's funny. The first thing that I thought about when I read this is my friend, Dr. Lance Roasa, who's a multi-practice owner, he has a phrase that he uses. He gives this piece of management advice sometimes. There'll be people who will be really struggling with an employee, or I'll be honest, a potentially toxic person. I'm not sure if they're toxic or whatever, but I keep butting heads with these people, and he calls it a garden vacation.

Dr. Andy Roark:

His advice is to send them home for two weeks and pay them. Send them home, and pay them for two weeks, and just let them have a garden vacation, and then see how you feel for those two weeks. If the whole tone of the clinic changes, and everybody's happy, and you have the best days you've had in months, you know what you should do then. This makes this clear. I'm not saying that this technician should go, especially if no one else is having a problem at all, but that was the first thing that popped into my head is the old garden vacation. It is an interesting and often effective diagnostic tool on, is this where the stress is coming from? Then you send them away, and you go, “Oh, yes, it was. It was.”

Stephanie Goss:

All I can think is that nobody wants to vacation in your garden because there's cowbells and deer.

Dr. Andy Roark:

And, deer!

Stephanie Goss:

It smells like coyote pee and eggs.

Dr. Andy Roark:

If anyone wants to come set up next to my height ranges, you can have a garden vacation. You can sweep with the cowbell, and when you hear the chomping of deer teeth on baby tree limbs, you can charge out.

Stephanie Goss:

Chase them off. No, I love that, and I think that it's true. I think the interesting part here is that is unintentionally, that's exactly what happened for this veterinarian, and yet they're like, “The garden vacation worked great for me because I feel like now I've recognized that this is a source of stress and anxiety for me, but it doesn't seem to be that way for everybody else on the team, so now what? When I've identified that part of it is just me, and it's not like the whole team was 10 times happier, or less stressed, or whatever emotions that they're feeling, but it was me then, then what do I do?,” which is what I thought was so interesting about this one.

Dr. Andy Roark:

Yeah. I think so. Anyway, let's walk it through. I think there's a lot of assumptions here, and I like to poke holes in assumptions. Let's go ahead and get started. We'll start with some head space. For our doctor here, who's stressing about this, and it sounds like he or she is questioning herself a lot about, “Am I wrong here? Are other people feeling this way?”

Dr. Andy Roark:

Let me start with a couple of things. I don't know what's going on with this technician, and I don't know how much of it is real and how much of it's perception. We all tell ourselves stories. I don't know how much is real here. There is a psychological principal called the anchor principal, and what it says is that people tend to remember us and think of us as the way we were when they met us. If you met someone as a college kid, 10 years later, when they're 27 years old, you still have a tendency to think of them as a college kid. I know people who still think of me as a vet student, because that's when they met me.

Stephanie Goss:

This is the reason that my kid recently told me, “Oh yeah, somebody was asking me how old my mom was, and I said that you were 32.”

Dr. Andy Roark:

That's how old you were when she met you.

Stephanie Goss:

I was like, “Kid, I love you so much. That's amazing. You can tell people I'm 32 forever.”

Dr. Andy Roark:

Yeah. 100%. Yeah. That's funny.

Stephanie Goss:

That makes sense, right? That was when he learned how old I was. That's stuck in his brain, and so that's what he tells people.

Dr. Andy Roark:

Yeah. That's exactly it. I see this a lot with young doctors and new doctors. I see it with pretty much every staff member is that when you start your career at a practice, and you're a baby, whether you're a baby vet, or a baby tech, or a baby front desk or whatever, the people who train you tend to remember you as a baby, and then three years go by, and you have three years of experience, plus the training that you had coming in, and there can still be a tendency for people to remember you as the new grad, the baby tech, things like that.

Dr. Andy Roark:

I think that's a reason why you see a lot of people change jobs after a year or two out of tech school or out of vet school, vet school especially. People come in, they take their lumps, they make their mistakes, they learn the things that they're going to learn to make them a competent doctor, and at some point, they are still getting treated like a baby vet. Other places are like, “Hey, you got three years experience. You're a fully functioning doctor. Come here.” I do think sometimes people just want to fresh start to get away from that.

Dr. Andy Roark:

I don't know how common that is versus other things, but it is a true psychological principle. It is a thing that happens. When I look at this, and I say, “Okay, we've got this technician who was here, who really mentored this doctor, and then later on the doctor's chafing, now that she's a partner, and she's still getting mentored in some ways, fact checked, and leaned on to practice in the way that the technician wants.” In fact, is that history thing? Is that because this technician remembers her just getting started? Is that what it is? Is this a power thing, because now you are a partner in the practice, and this person feels like you have jumped over them, and they're trying to take you down a peg, you know what I mean, or solidify their own place, and I don't know, try to convince others that you may be a partner, but that they're still, I don't know, the most senior voice? I don't know what that is, but all those things go through my mind as far as, what is the root cause of this?

Stephanie Goss:

Well, I think that's a super valid point. You and I did an episode. We'll drop it in the show notes. You and I did an episode, and I can't remember the title of the episode, but we talked about when you are friends with the team, and then you become the boss, right? I think that there probably is a measure of that attached to this, because to your point about the anchor principal, this is someone who knew you when you were recently out of school. You were very much in a developmental phase, and you were learning, and you were growing, and you were finding your footing, and you were figuring out how to be a veterinarian. This is someone who knew you then who became friends with you, and you built a relationship during that phase.

Stephanie Goss:

Now, you have jumped, and you have shifted. It's a big jump. In this case, to your point, Andy, you have jumped over them and into a role coming back into this practice where you are to some degree effectively their boss. You might not be their immediate supervisor, but as a part owner in the practice, you have a say, and you are their boss. You are their employer, and so I think that there probably is… I couldn't imagine not thinking about that, putting myself in the technician shoes. There would absolutely be a part of me that would think about, “Oh, this person is my employer now, and that shifts things.”

Stephanie Goss:

In that episode, we talked about, we have to have the conversation, and we have to ask questions. This, for me, part of the head space and part of the solution piece of this absolutely has to be about, did we miss having some conversations? You were saying, we need to poke holes in it. It sounds to me like this is one of the holes that I would poke is, have you talked to her about it, about how you're feeling, about how you valued the friendship? There was so much information given to us, and the first thing I thought of is like, “Have you talked about any of this?,” because those are big changes.

Dr. Andy Roark:

Yeah. You do that so well. That's something I really admire about you is that you have such a relationship focus, and you anticipate these things, and you're really good about having those conversations up front about what this means for our relationship. Let's talk about this. It completely makes sense that you would have that thought and want to go in that direction. I think that's really true. I think that you do that really well.

Dr. Andy Roark:

I think in the action steps, we should talk about maybe what that conversation looks like. I think the classic things that you and I always talk about, assuming good intent, let's try to lead with grace. It's easy to feel like this person is undermining me, they're working against me, they're destroying my credibility, insubordination. Insubordination is a code word for flaming raging sword of justice. That's exactly what comes to my mind, insubordination, and we pull the flaming raging sword of justice, and we take heads, because how dare you cross me and undermine my authority?

Stephanie Goss:

You and I are very much of one mind today because that was the mental image I had in my head. It's very easy to get into that negative head space of feeling like, “Okay,” especially because they have unintentionally had a garden vacation, and this writer has recognized that so much of their stress and anxiety ties to this person. I could totally hallucinate that if I put my myself in the veterinarian's shoes, that I would be feeling mad, and angry, and maybe not looking at things from a place of good intent because I'm just questioning my medicine, and I want to grab that flaming raging sword justice and just attack you with it. I agree with you 100%.

Stephanie Goss:

I had assume good intent at the top of my list. I think you have to be in a good head space to ask questions about why is it happening, and more importantly, what can we do to change it once we have that first conversation. I think the only way you get to that is to tell yourself that, “I don't think this person is doing this intentionally. I want to understand where they're coming from and why they're behaving the way that they are. How can I start there?”

Dr. Andy Roark:

I agree. I think that one thing you really don't want to screw up here that I think a lot of people screw up is they don't have the conversation until they're angry.

Stephanie Goss:

Right, and they're triggered.

Dr. Andy Roark:

They're triggered, and they've just felt mistreated in or in front of the group or undermined, and they get mad, and they say, “Let me tell you what I think of you.” That stuff is hard to take back. It muddies the water. It sounds like honestly, as this person has gone away for a garden vacation, and we've had some clarity and time to think, when they come back, it may be a very good time to try to have the conversation because we've had some space and some distance. They've had some time away. Yeah. I think that could be a distinct possibility.

Dr. Andy Roark:

That's the head space for me is don't allow yourself to get mad because it's not going to go well if you get angry. Try to assume good intention on his part. I really like your idea of focus more on where is this person coming from and trying to understand what their position is or why they're behaving this way. I think that's really good. Then I think that we should lean into the relationship and relationship power. I don't think that you want to lean into the idea of, “I'm your boss, and so we're going to have a boss to employee conversation.” I think we should lean into, “Hey, you and I have worked together for a long time, and I've always respected you, and you've really positively impacted my career, and I feel like we're not working well together right now. I want to talk about that because I want us to be friends, and I want us to enjoy each other and enjoy working together.” That's the head space I'm going for.

Stephanie Goss:

Yeah. I think that is really, really important. I think what you said about being in a good head space is so important because I think it would be really easy to, when you have the conversation, which is the action part, one of the things you're going to have to be able to do is give them some solid examples of the behavior or the specific behaviors that they are exhibiting, whether it's asking questions of you in front of the team. What is causing this veterinarian to feel like this technician is questioning their medicine, or second guessing the way that they're practicing medicine, or trying to, quote unquote, “tell them how to practice.” My question would be, what does that look like? I would bet you $100 that if you tried to answer that question when you're in the moment, your answer is going to be radically different than when you are not hacked off and feeling angry at this person.

Stephanie Goss:

I think the head space piece of it has to do with assuming good. Why assuming good intent is so important is because I think this veterinary needs to ask themselves to look objectively at the situation and say, “What is the behaviors? What are the things that are happening that make me feel that way? Is it possible that what I feel like is happening is not what is truly happening in the moment?” This is where I often… It's hard to tell that on your own because we don't look clearly at what we're too close to, right?

Stephanie Goss:

Part of it for me is sometimes stepping back and getting that perspective, whether it's asking a coworker who was present or another veterinarian who was in the treatment room when you guys had that interaction with each other, where you felt like they were questioning your medicine, to ask somebody else, “Hey, I'm really struggling with this. Can you give me your perspective of how that conversation went or how that interaction went?,” because it could just be me, right? I could be getting upset over something that feels emotional to me that maybe didn't come across that way to anybody else. I think part of it from a head space perspective is taking that step back and just telling yourself, asking yourself the question, “Is it possible that something else could have happened here, and I'm not seeing it clearly?,” because I think that really is helpful for narrowing down the behaviors specifically, to be able to use them as examples, and solving this, and having the conversation with the technician, but also from giving yourself some distance and self perspective from that emotion.

Dr. Andy Roark:

Yeah. This is where bravery comes in. The not brave answer is to approach this from a defensive position and to say, “Why is this happening? This is how I feel, and this is how you feel, and blah, blah, blah.” It's not putting yourself out there to be hurt or to accept a new responsibility. The brave position is vulnerability. It's to say, “I'm not sure if I'm the only one feeling this, or if this is not real. This could just be my own insecurity, but I'm looking at this, and I'm feeling like we're not connecting, and it's really bothering me. I don't know exactly what to make of it and what I'm contributing and what I'm not contributing, but I really want to talk to you about it and iron it out.”

Dr. Andy Roark:

That's how we get vulnerability in other people is generally, we have to go first. We have to be the first one to say, “I'm bothered by this, and I don't know if I'm doing something that's frustrating you. I don't want to. I want us to work well together. I'm wondering if you're having it feelings of frustration with me and where this stuff is coming from.” But, that is the scary place to lead from, is to say, “I don't know if this is just me, and I don't know if I'm doing something that's making you angry,” but it opens the conversation up for a really positive discussion. It's scary to do it. You have to be brave to put yourself out there.

Stephanie Goss:

It's a big first step.

Dr. Andy Roark:

Yeah.

Stephanie Goss:

I think that's part of why the head space part is so important. This lesson learned, it's funny because you and I always seem to do podcast episodes when sometimes it's just so timely. Thinking about my own life, I think one of the things that has been a golden rule for me, that has served me really well in terms of being brave, has been figuring out for my myself, how do I give myself enough space to process the emotions, so that I don't come at it from a place of being triggered and not too much time that I get so in my head that then I'm too chicken to have the conversation? I really do think that there is a fine line there when it comes to bravery, at least for myself.

Stephanie Goss:

I have found time and time again, that I have to have a timeline in the back of my head where I say, “Okay, it's time to address this.” Right? I've given myself enough time to process my emotions, but not enough time that I then chicken out on having the conversation with the person. For me, that timeline has to be pretty short, on a personal level, because what I have found is that if I let myself calm down, I very easily go into chicken mode. I have a 48 hour rule for myself. Depending on the level of the relationship and the situation, a three day rule is kind of my rule of thumb where I say, “Okay, I'm going to take some time to cool off,” and so 48 hours works for me. I give myself 24 hours to calm down, and process, and ask some better questions. Then I force myself to say, “Look, if this really bothers you, you either have to say something about it or make an active plan for saying something about it, or I'm going to let it go, and I'm going to move on.”

Stephanie Goss:

It's so funny because what I have found time and time again for myself is that the only time that I ever really truly get angry at myself or regret not being brave, happens when I break that rule and when I don't step up and say something to the person. I think that for me, that is something that has served me really well in terms of figuring out how to be brave is to figure out what that… to A, put a timeline on it for myself and really be true to that rule of look, if I say that I'm going to not talk about this, that I'm going to… I don't want to bring it up to the person. I'm just going to move on. Then, I really truly have to move on. If I find myself circling back to it, then I have to tell myself, “Okay, you've circled back to this. Clearly it bothered you. You have to do something about it.”

Stephanie Goss:

This is a lot of the shower conversations I have with myself or the conversations that I have in my own head, but it really truly has been the best tool for me in figuring out how to be brave because you and I talk about this a lot about being vulnerable and leading with vulnerability. I often have people tell me, “I thank you so much for what you guys talk about on the podcast, or you said this thing, and it really made a difference for me,” and anybody who knows me, knows that I immediately turn bright red, and get uncomfortable, and try and deflect that. At the same time, I will tell you all very vulnerably and candidly right now, the reason why I feel more comfortable with these conversations is because I have given myself rules.

Stephanie Goss:

I have said, “Look, if this is the case, if there is something like this that is emotional, that is really bothering you, this is the rule that you're going to live by.” It has really served me well for being able to step into that place of getting brave and saying, “This just really bothers me.” On a human level, I want to enjoy my job, and I want to be able to come to work and enjoy it. It doesn't just apply at work. It applies in my personal life as well, but I just think that is really, really important, and yet taking that step to be brave is hard.

Stephanie Goss:

It's hard for me. It is really hard for me, and I've had people tell me, “You make it look so easy,” even people that I'm just having the hard conversation with, “You make having this conversation look really easy.” It's not easy. My palms still sweat. I still get nervous, but that doesn't mean that I don't force myself to do it. I think that part of that force for me, has been making that agreement with myself and saying, “I'm going to step up and say something, or I'm going to move on.”

Dr. Andy Roark:

Yeah. I think that's really… It's a simple decision to make, but I think it's a really good intentional decision.

Stephanie Goss:

For sure. Should we take a break, and then talk about, okay, we've recognized that this is bothering this vet. What do we do about this?

Dr. Andy Roark:

Right. I think that's the place. Let's take a break here, and then we're going to come back, and let's talk about what actual action steps we're going to do.

Stephanie Goss:

Sounds good.

Dr. Andy Roark:

All right.

Stephanie Goss:

Hey, everybody. This is Stephanie, and I'm going to jump in here for one quick second, and make sure that you know about a few things that are coming up that I'm pretty sure you're not going to want to miss, but before I do that, I have to say, thank you. Thanks to a generous gift from our friends at Banfield Pet Hospital, we are now able to provide transcripts for all of our podcast episodes, and we have to just say, thank you, thank you, thank you so much. Andy and I have wanted to make the podcast more accessible, and when we were pondering the idea of how do we make transcripts a thing, our friends at Banfield stepped up in a big way and said, “Hey, we are striving to increase accessibility and inclusivity across the profession. This fits with that mission for us, and we would love to sponsor it.”

Stephanie Goss:

The 2022 podcast episodes are all now being transcribed and brought to you by our friends at Banfield Pet Hospital. To check out the transcript and find out more about what Banfield is doing to increase accessibility and inclusivity across the vet profession, head over to unchartedvet.com/blog, and you can find each one of the podcast episodes and a link to find out more about equity, inclusion, and diversity at Banfield.

Stephanie Goss:

Now my dear friend, Bret Canfield is absolutely awesome. He is coming back to work with our community and with you, if you want to register to attend this workshop to talk about how do we manage a negative team member? We all have them on our teams, right? These are people who are talented, whose skills are needed, but their attitudes might leave something to be desired. Bret is going to walk us through how to lead and how to coach while we explore the not so secret ways to repolarize our most cynical and cantankerous crew members. It is happening on July 13th. It is a 7:00 PM Eastern time. So 4:00 PM Pacific, and it is a two hour workshop, so it will be over at 9:00 PM Eastern, 6:00 PM Pacific. It is $99 if you are not a current uncharted member, and it is free, as always, to our uncharted members.

Stephanie Goss:

That is the thing that is coming up the soonest, and you are not going to want to miss it, but we also have more coming at you. The cool part about your uncharted membership is all of our workshops are included. If you head on over to the website at unchartedvet.com/events, and you take a look at what we've got upcoming, and you're looking at it, and you are not currently an uncharted member, and you're like, “Hey, a bunch of this sounds good,” remember that it's all included with your membership. It may be more cost effective to talk to your manager or talk to your practice owner about, “Hey, could we do this membership thing, because look at what I'm getting out of it?” Anyways, we will hopefully see you all soon, and now back to the podcast.

Dr. Andy Roark:

All right. Let's start to unpack how we actually approach this. I'm curious what you think about it. There's a fine line between gossiping and asking for advice.

Stephanie Goss:

True.

Dr. Andy Roark:

I think that in some of these situations, one of the things that has helped me is seeking validation of the scenery, meaning I am not looking for other people to tell me that I'm right, and this other person is being a jerk, but I want to know, am I the only one, because it very much seems in the letter that we got, that this doctor is saying, “I think I'm the only one, and everybody else is having a right experience.” Having a conversation with some of the other doctors and saying, “Hey,” not in a negative way, not in a critical way, say, “I don't feel like I'm connecting with this person, or I feel like there's some tension between us, and I'm having some anxiety about working with them and working around them. I'm just curious, have you experienced anything like that in the last couple of months or any interactions? Do you have any advice for me in working with this person or getting along with?”

Dr. Andy Roark:

That can be a really useful conversation because a lot of people have been like, “Oh, yeah. She and I went through this before, and this is how it went down and what we did, or what we decided, or what it took for us to feel comfortable working together,” or they might be like, “No, I've never had any problems with this person,” or they might say, “I have never had any problems, but they do seem to not be happy about working with you quite honestly.” I think a lot of that's, especially vets in a trusting relationship, we tell each other like, “Yeah. I think maybe you should deal with this issue because it looks like it might be sticking around.”

Stephanie Goss:

Well, and here's where you get to… For better or for worse, a partnership is to a degree like a marriage, and this is where you lean into the sanctity of your marriage.

Dr. Andy Roark:

The sanctity of partnership. Yep.

Stephanie Goss:

Yes, and you be able to say to your other partners, “Hey, this is something I'm really struggling with,” because at the end of the day, your struggles will impact them, whether it is already or not. If you were struggling at work, if you're second guessing yourself, if you're doubting yourself, ultimately that is going to affect them.

Stephanie Goss:

This is where you lean into the privacy rules that should apply to a good partnership and say, “Hey, I am struggling, and I want to address this. I'm not asking for anybody to solve this for me, but I need a sounding board, and I need to see if I'm the only one, to your point, or are other people having this, and in particular, if any of the other doctors have,” like we talked about earlier, “if any of the other doctors who are partners in the practice have been around when the specific behaviors have occurred and asking them for their perspective, without sharing necessarily first, how it made you feel asking for their perspective on the situation, can be really, really helpful. Ultimately you may talk about how it's making you feel, and you may have some discussion about how do you address it, but if you're coming to them from a problem solving perspective, I think that's the best thing you can possibly do because at the end of the day, it's going to impact them too.

Dr. Andy Roark:

Yeah. I agree with that. That was on my list as well is lower the stakes, meaning I would not want this to feel or look like a disciplinary conversation at all. I want this to look like, “Hey, I'm just talking to you. This is a relationship conversation.” I think that's a good approach to have. It's not overly formalizing or making this something organizational.

Stephanie Goss:

Yes. For me, where I start with action steps is where you just mentioned, true action steps in terms of talking to the technician about it. For me, it's about the relationship, and it's about addressing that first and foremost, because it sounds, from reading the letter we got, like the emotions and the hurt is the bigger problem or is certainly impacting the veterinarian feeling like their medicine is being questioned. For me, it's about having the conversation about the relationship. The pre-planning, the prep for me, would be maybe having a conversation with some of the veterinarians, my partners in the practice and saying, “Is this just me?,” especially if they've seen the behavior. “Hey, can I get your take on this because, I would really love to know your perspective on this interaction?”

Stephanie Goss:

Then I would approach it from having a conversation with the technician and really just leaning into starting with good intention. “I care about you. We've worked together for a long time. I really value our friendship, and I also really… I want you to know you have been a mentor to me, and I have learned so much from you, and I'm struggling because I feel like that has changed. I want to understand what's going on for you because we're both in this relationship, and we're also in this partnership working together as a veterinarian and technician. I want to understand where your head is at and what's going on with you.”

Stephanie Goss:

Maybe it's like you said. I'm the relationship person, so maybe it makes sense that's where my brain starts, but for me, it's about leaning into to that conversation first, because I feel like if we can't have that conversation, maybe it is a little bit about lowering the stakes and not coming at it from the disciplinary perspective. But, more than that, if we can't iron out how we each feel, if I was in this veterinarian shoes, I don't know that I could have a conversation about feeling like they're questioning my judgment as a veterinarian without getting fired up and strike out, right, because I feel like if I was them, it would be emotionally driven that conversation. If I don't address the emotions and where they're coming from first, I know on a personal level, I would struggle with having that conversation objectively at all.

Dr. Andy Roark:

Yeah. I agree with that as well. I really think the questioning, the judgment is probably a symptom, not an underlying problem. A lot of times, if we have the conversation about our relationship and how we're interacting, then the questioning of decisions will just go away. That may be something that we don't need to directly discuss because when I say to you, “Stephanie, I feel like you're questioning my decisions,” you're going to say, “No, I'm not. I'm just asking about the things that I see. Do you not want me to make any suggestions? Do you not want me to say anything if I notice something?” Well, of course, I don't want you to sit silently. I want you to be an interactive participant in what we're doing.

Dr. Andy Roark:

That's always been an unproductive conversation for me. We'll have that conversation directly if we have to, but to your point earlier, I think the only time to have that conversation is say, “Hey, when you said this specific thing in front of these specific people in this specific way, that felt like it was undermining my ability to do the job and to have the team trust me.” Hopefully, it won't come to that. A lot of times we can just have an overarching relationship conversation, and a lot of these specific instances will iron themselves out.

Stephanie Goss:

I think you brought up something earlier that I wasn't thinking about when we started, but I think is a super valid and important piece of the conversation which is, there is a fundamental shift that has happened in the power dynamic in this relationship. Whereas, you were colleagues before, you were an associate, he or she was a technician, you were on the same team at the same level. Now a power shift has happened where, like I said, even if you're not their direct supervisor, you're their employer. If you haven't had that conversation and asked about that, both for yourself like, “How do you feel about that, but also how do they feel about that?,” that would be a good place for me, whether it's where I start or where I end. I think I would want to unpack that a little and see how they're feeling about that.

Stephanie Goss:

I think that's where for me, it's really easy to get brave is to just say, “This is really new for both of us, and I just want to make sure that we're both okay with this and that if there's any worries or concerns, that we talk about it, because I really value your opinion, and I value you as a technician, and I value your skill set, and I want to be able to continue our relationship. At the same time, I'm acknowledging that a big shift has happened. That's okay to want to ask questions, or have concerns, or whatever, and I want both to be able to talk about it.”

Dr. Andy Roark:

Yeah. Yeah. I agree with that. Yeah. I like that. I think that's a good way to go forward. I think alternative approaches to take… I don't think there's any way to not have this conversation and try to be vulnerable and have it as open as possible. I think some objectives for me would be to try to recruit this person onto my team and to say, “Hey, I really want to do a good job here. I want to be successful. I want to be a good boss to work with. I want the team to like me. I want to help create a really good workplace, a positive culture for all of us. I'd like your help with that because we work well together, and I want you to be on my side and on my team so that we can do this together.”

Dr. Andy Roark:

That also allows me to pad this person's ego a little bit and hopefully make them feel like there's more opportunity and possibility in being my friend and working with me than there is in working against me. It'll be more fun to work with me, and they're going to be taken care of. They're going to benefit if things go well for me in the practice. I am genuinely going to try to make things better for everybody, and that's something that hopefully I can get them to support and also to feel like they are going to have… We talk a lot about when we do change management, trying to make sure that people can see themselves in the future. If I can recruit this person, I'm trying to get her to see herself in the future where she and I work well together, and it's a good thing, and everybody benefits from this collaboration.

Dr. Andy Roark:

That approach of, “Hey, I want you to be a part of this. I want us to work together. I want us to do good stuff,” not I want you to lead me alone so I can do my stuff. I don't want you to be neutral. I want you to be on my team. I want you to work with me.” A lot of times I can swing people and their perceptions because now they don't feel shut down. They feel included in something new.

Stephanie Goss:

I like that a lot. That makes sense. Do you have any other thoughts about things, sub pieces to this conversation?

Dr. Andy Roark:

No. I think we hit much of the big things, as far as we mentioned earlier about lowering the stakes. We talked about having an open, vulnerable conversation about the relationship, and what it looks like, and what it means, and taking as much ownership as I can of, “Hey, tell me what I'm doing, and tell me how you're perceiving this, and how we work together,” and try to recruit this person.

Dr. Andy Roark:

The last part after that is, what happens if it doesn't work? I think you do have a couple of options if this doesn't work, and hopefully it will, but let's say that this person is recalcitrant. Let's say that they're not going to tell you how they feel. They're going to do something passive aggressive. They're going to decide that they don't like your face, so that's all the reason that they need or whatever. My big thing would be… I try to balance the needs of everybody.

Dr. Andy Roark:

If the other doctors really like this person, to me, it does not feel like failure to minimize my time working one on one with this technician. I don't have to work with this person every day if the other doctors like her, and she does not seem to want to work with me. It really depends on how your practice is set up, but I do think that a lot of times that can be it, is to say, “Well, this person is not my favorite technician to work with, and you guys really like them.” I would be happy if we swung the schedule around a little bit, so maybe I wasn't seeing a lot of appointments with this person. That may be 100% possible.

Dr. Andy Roark:

There's the old fashioned feedback model where we have the conversation, and I try to recruit them, and then they won't get on board. I'm going to have some feedback conversations with the person using the specifics that we talked about. It's like, “Hey, this morning, you and I were talking in the treatment room, and I said this, and you said this thing, and you said it in front of a couple other people. When you did that, it made me feel self-conscious, it made me feel like you weren't supporting the decision that I had made. I wanted to point that out to you and say, ‘Hey, it's always fine for you to voice your concerns, but I ask that you do it in private in a way that doesn't call me out in front of the staff or make me look or feel self-conscious.” Just start that feedback process.

Dr. Andy Roark:

Again, we're working through it, and if the person continues to not want to change or interact at some point, you may have to decide, what does that mean? Does that mean that we're going to take this person away from working with you, and they're not going to work with you anymore? I don't like that as a practice rule. I think that there's a difference between saying, “Hey, I prefer to work with these technicians and not with those technicians, because in this one instance, we have this personal relationship that hasn't worked out very well.” That's different. That's different to me than, “I don't work with these people and they don't work with me, or these two people have to be separated.”

Stephanie Goss:

Yeah. Yeah. I agree with that. Then I think the last thing for me is to try and figure out, and this again, would be a conversation that I would lean into with your partners as a practice owner is, if it is just this one person, I think there definitely needs to be one on one discussions and feedback, like you mentioned. I think it important to give that person the feedback and coaching of how do you want them to give you input or ask you questions, because, like you said, most veterinarians are going to want, if a tech catches an error or sees something wrong, you're a team. You want somebody to have your back. You want them to catch that, and save your butt, and say, “Oh, did you mean to write that we're going to give that drug five times a day? Because, I don't think that's what you meant, right?” That's the whole point. You want a team that is going to look at that, and catch it, and have your back.

Stephanie Goss:

At the same time, I think it is important to know and be able to give that coaching to this person, if it is one person, of how do you want that delivered? What does that look like? What does it feel like, for all of the doctors, right? But, if this is really, truly happening with one person, you can take that level of feedback, and have that conversation with them, and give them that coaching and feedback. If it is more widespread than that, then I would have a conversation with my partners about, what does it look like for the technicians to give feedback in direct medicine? Because, every clinic is different, and there's really no wrong way of doing it. I've seen practices where the licensed technicians that are heavily leveraged, do direct a lot of medicine. I've worked with doctors who absolutely would not fit in well in those practices, because they want to work in an environment where they are not questioned when it comes to medicine, and they direct the course of medicine. Right?

Stephanie Goss:

That would be a conversation that I would want to have with my partners is, how do we approach it here in this practice, and how do I make sure that it's something that you can live with and be comfortable with? Because, everybody's going to have a different level, and there's really no wrong way to do it, unless it involves someone who's not a veterinarian practicing medicine. Right? I think that's where you need to have the conversation with your partners, if it is truly something that is impacting more than just this one technician and this one relationship.

Stephanie Goss:

But, if it truly comes down to you and this technician are really struggling, that's where I think you have to lean into addressing that, and giving feedback and coaching, and it is going to have to be active on the part of the veterinarian to be clear and say, “Hey, when this happened, I know you were trying to give me feedback about the patient, and I appreciate that. I want your feedback and what you specifically said, or how you specifically said it, or the words that you used.” You have to paint the picture for them, and tell them exactly what bothered you, and then tell them what about it bothered you.

Stephanie Goss:

Was it because it was in front of other people? Was it because you interpreted that and you translated that into your brain as, “Sarah doesn't think I'm a good doctor,” right? When you give that feedback and coaching to someone one on one, you have to be able to paint that picture for them. I think that has to be an active part for this veterinarian in the feedback and coaching relationship with this technician.

Dr. Andy Roark:

Yeah. I completely agree. Yeah. That's I think that's the best advice that I have. I think that covers all the bases.

Stephanie Goss:

I hope that this was helpful. This is a really good one. I had a lot of fun with this.

Dr. Andy Roark:

Yeah, definitely.

Stephanie Goss:

Take care, everybody. Have a fantastic rest of the week.

Dr. Andy Roark:

Yeah, guys. Take care of yourself. I'm going to go check the yard for deer.

Stephanie Goss:

I can't with you.

Stephanie Goss:

Well gang, that's a wrap on another episode of the podcast. As always, this was so fun to dive into the mailbag and answer this question. 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 of everybody and have a great week. We'll see you again next time.