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Dustin Bays

Dec 14 2022

Deteriorating Doctor

Uncharted Veterinary Podcast Episode 209 Cover Image

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and practice manager Stephanie Goss are working on a challenge question from the mailbag. A veterinarian wrote in because they have an associate who they thought was a great fit and the team was super excited about when they hired them. A year later and the sparkle seems to have worn off and this associate seems unhappy, anxious and angry a lot of the time. They are micromanaging the team, snapping and sniping at people constantly and this practice owner is worried about this associate. Can this situation be saved? How can the owner help the doctor and what support the team who is super frustrated are all the questions being asked? Let's get into this…

Uncharted Veterinary Podcast · UVP – 209 – Deteriorating Doctor

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Thank you to our sponsors! To learn more about this week's sponsor, GuardianVets, check out their website HERE.


Do you have something that you would love Andy and Stephanie to role-play on the podcast – a situation where you would love some examples of what someone else would say and how they would say it? If so, send us a message through the mailbag!

We want to hear about your challenges and would love to feature your scenario on the podcast.

Submit it here: unchartedvet.com/mailbag


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Episode Transcript

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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.

Andy Roark:
Hey, Stephanie Goss. Got you a second to talk about GuardianVets?

Stephanie Goss:
Yeah. What do you want to talk about?

Andy Roark:
Man, I hear from people all the time that are overwhelmed because their phones never stop ringing. I'm sure you hear from these people as well like, “Our caseload is blowing up and the doctors are busy and the phones just don't stop.”

Stephanie Goss:
They never stop. That is a true story.

Andy Roark:
I'm amazed by how few veterinarians know about GuardianVets. This is a service where you have registered technicians who can jump in virtually and help you on the phones. You can flip the switch and GuardianVets can jump in and take some of the load off the front desk and they can handle your clients and get them booked for your appointments and give them support and it really is a godsend.

Stephanie Goss:
Pre-pandemic, it was amazing to me how many people hadn't heard about it for after-hours call help. But at this point, I can't believe how many people don't realize that they are offering help during the daytime as well, which I would think right now is a huge benefit to practices because everybody is shorthanded. Everybody is drowning in phone calls. And so, we talk about it. We've talked about GuardianVets a lot on the podcast and every time we do, we always get somebody who says, “What is that?”

Andy Roark:
Guys, if you're not familiar with GuardianVets, if you think that you could use them help on the phones or up the front desk, check them out. It's guardianvets.com and if you mention our podcast, me and Stephanie Goss, you get a month free. Check it out, guardianvets.com.

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 dive into a letter from the mailbag from a doctor who has an associate vet who seems very unhappy, and as a result, they're making life very challenging for the team and they kind of seem to be deteriorating mood-wise, behavior-wise, all of the things. This doctor is looking for some advice on how to handle the situation. This was a fun one, so let's get into it.

Speaker 3:
And now, the Uncharted Podcast!

Andy Roark:
We are back. It's me, Dr. Andy Roark, and Stephanie, I am barely breathing Goss. (singing)

Stephanie Goss:
I mean, at the end of the year, it always feels that way. That is not an untrue name right now. I can appreciate that one very much. It is crazy.

Andy Roark:
That's a Thanksgiving song for me. I'm barely breathing and my pants are way too tight. It's like… I can't expand my chest because I ate so much. That's it.

Stephanie Goss:
So funny. How was Thanksgiving with your family?

Andy Roark:
It was good, I think. It was good. We did two Thanksgivings, which is great. Always recommend two Thanksgiving. If I can get in and do Canadian Thanksgiving a month or two ahead, I would do that too. I would do three Thanksgivings if I could. I'm not sure how to make that work, but I'm looking for it. Anyway, it was good. I did the thing with the family and we just rolled with it. And so, I wrote this article that I actually really like a lot and it was this article from this woman who writes cookbooks and she was talking about her Thanksgiving and she was like, “I have taught all of my children and my in-law children how to make these dishes. Everyone has assignments. We have spreadsheets. We review the spreadsheets. We have oven signup times.” They were like, “We do group grocery lists. We have organizational apps that we use to track ingredients for purchasing.” And she's like, “Then, it's total chaos every time.”
I thought that was so funny because she laid down so much work. Every Thanksgiving, her mother sits down and does a postmortem and reviews the dishes. She was like, “Oh, the time that my son's brand-new wife brought a pie that got a B minus was like… This is a tense family time.” And so, she goes through, she says all these things to emphasize how organized she is and then says, “And it's total chaos.” Then she says, “The chaos is the point. The point of this is to forge these memories of everyone crammed into the kitchen together, pushing each other out of the way and stepping on each other. That's what the holiday is and if it's not chaotic then it's not memorable. The chaos is what we remember of that almost forced togetherness and the challenge of trying to make this thing happen, so we have this sort of shared memorable experience.”
Man, I really love that because I think a lot of times people go into the holidays or in other aspects of their life with this idea that it's going to be just this well-oiled machine, and then it's not, and it never is. The sad thing is they feel like a failure. When I lecture a lot of times, I will put up a picture of the Disney princesses and say, “We talk about vet clinics as if this is what we're supposed to be. We're supposed to be these pictures of happy, lovable perfection and everybody's got all their stuff together and everyone's in a beautiful gown and this all looks great, but we're not Disney princesses.”
Then, I'll hit the next slide, and it's The Muppet Show, but we're the freaking Muppet Show. There's yelling. There's drum banging. Someone's riding a bull through the living room. That's what life really is. I think aspiring to be Disney princesses, I think you can aspire as long as you recognize that you are one of the Muppets trying to be a Disney princess and-

Stephanie Goss:
I love it.

Andy Roark:
… [inaudible 00:06:11]. Anyway, all of that to come around to say that's what I've been thinking a lot of was how was my Thanksgiving? It was chaos and I think that that's the point and I'm really happy with it.

Stephanie Goss:
I like it.

Andy Roark:
How about you?

Stephanie Goss:
It was good. It was mellow, it was quiet. The kids and I had some rowdy board games time and there was lots of laughing, which is the best. It was the stress of, it's always this challenge for me because we're getting ready to leave or I'm getting ready to leave to come to Greenville for a Practice Owner's Summit. I was weighing the do I get a tree now and avoid the stress of coming home and being like, “There's two weeks till Christmas, let's go get a tree,” and risk getting to Christmas and the tree is dry and dropping needles everywhere and my house is a wreck, or do I take the trade-off and wait until I come back and then have the last minute panic.
Ultimately, we chose just getting it now. It felt super early and there was nobody out looking for trees yet because it's right after Thanksgiving, but it was great. The house is decorated and we've hit that stage where the kids can do a lot of the work and it's amazing and I take full advantage of it as a parent. I'm like, “You guys go to town,” just going to sit right here.

Andy Roark:
I agree with that. That's the evolution of it along is that the kids, you can throw them into this and it's good for them. It's good for them to feel some ownership of what we do. At some point, I was putting up the Christmas tree, I look around and my daughters are just lounging on the couches and I was like, “What is this?” You are the ones who want this. That came to a screeching halt for them. They slammed head-first into what I call reality and they were put to work.

Stephanie Goss:
I'm like, “You want it? You have to help do the work. I'm not going to do all the work or it just doesn't happen.” We had one year where I was like, “No, if you guys aren't going to do it…” and our tree sat there for several days without anything on it because I was like, “I'm not going to do all this work by myself.”

Andy Roark:
Just a naked tree sitting there.

Stephanie Goss:
That was the one and only time, and ever since, they have been great and they're all about it. We had a great day decorating yesterday. It was good.

Andy Roark:
I imagine a really sad tree. Is it the Charlie Brown special where there's like this tiny little tree, it's got one ornament on it and it bends over.

Stephanie Goss:
I do. That is a good mental picture. No, it is. This year, they chose a big giant nine-foot tree. There was ladders involved this year. I was like, “Okay, all right. This is where we're at.”

Andy Roark:
When you're living in Washington, I expect an impressive evergreen from you.

Stephanie Goss:
Yes, I do. One of the things I love about being here is the availability of fresh ingredients to decorate. We always have the cedar garland and the whole nine yards. It is quite fun. I enjoy it but now it's back to reality because then you sit down at your desk Monday morning and there's just piles of work and hundreds of emails and the pain of taking a long weekend and having some break, but it's good, it's good. It's just the busy time of year.

Andy Roark:
I walked right into that of all the things that I said, “Oh look, we'll do that after the holiday.” They were all just standing and waiting for me, like walking into a circle of bullies who were waiting after school. That's what it felt like for me to come to work.

Stephanie Goss:
But it's all good. I'm excited to come to Greenville and I'm excited to get into some of the work that we've got some good stuff happening and it feels good to be creative. I'm excited about this week's episode. We got a good question from the mailbag and it's funny because there's a time in my career where I could have written this email. I thought it was a great one. It was kind of long, so I'm just going to give us the summary and the gist and then we can pick out pieces out of it because I think, again, I think this will be one of those episodes where lots of people are like, “Is this my clinic?”
We have an associate vet who has joined a practice and the associate seems really unhappy. She is making life very challenging for the team. She previously had been doing relief work and came and did relief work at this practice and the team really loved her. They all got along really well when she was doing relief and everything seemed good. And so, they offered her a position as an associate. And so, she's come on full time and since joining the practice, things have seemed to fall apart a bit. She's really overwhelmed, seems really anxious, is struggling when the team doesn't do things the way that she wants or what she thinks is the right way following… they're doing things that are differing from protocols.
A lot of it seemed to me like she is struggling in a world of gray because she is seeing things in black and white. And so, it seems like she's really unhappy and that's manifesting itself like what they're seeing in this practice is lots of snappy tone of voice, micromanaging, getting all over people when little mistakes are made. At the same time, she has lots of overwhelm in her own work. She's got stack of charts on her desk, things left undone for weeks at a time, messages that haven't been called back that are a week overdue, that kind of stuff.
And so, the doctor that sent in the message was like, okay, looking at it now, it seems like they're a very poor fit for us. And so, I'm wondering what do I here, because the market for vets is really, really slim. I feel like this person isn't a fit for us. In fact, the practice had someone in doing an internship in their practice and apparently that person made a comment, I would never treat my team that way after seeing the associate doctor go off on somebody for making a mistake.
And so, they're really struggling with what do I do with this situation? How do I manage it? For context, it doesn't seem like a whole lot of regular communication has happened, sounds like they've had some conversations about how can we support you, how can we make this better, but not a lot of regular visiting of that conversation. And so, they're like, “How do I get them in a better headspace? How do I solve this problem?”

Andy Roark:
This is unfortunately a fairly common presentation. When we get questions like this, the devil's in the details. We have an associate vet who's not getting along with the staff. Someone else goes, “I have that same problem.” It's true because you have wildly different problems, but they get lumped together as the we're not getting along. We're not getting along can mean a lot of different things. And so, we have to always start these things.
Let's start with headspace as we usually do. Assume good intent upfront. It's easy to get locked in on an idea of this person is messing up and so I'm going to get really fixated on them and I'm going to watch for them to mess up and just add a laundry list of things. I'm sure I'm not alone in seeing that with people where you go, “Oh, first of all, you are right. This person is struggling and you watching them like a hawk and documenting every misstep they make during the day and blowing it up because it's not a tiny mistake, it's further confirmation of this significant problem.” That doesn't help get past the problem. It doesn't set the person being watched like a hawk up for success, and it's miserable from the person who's hyper-attuned to this because they take every misstep as a huge failing. And so, that's not a good headspace to be in.
Now at the same time, we're not going to let this person go on and be awful to the staff. I am really bothered by the fact that someone was there and said, “I will never treat my staff that way.” I really don't like that, but we can balance those things. Try to start with the good headspace is always my first thing is go, “You know what? Let's try not to judge. Instead, let's try to diagnose.” I really think a lot of this comes down to what is going on. We had this person and they were doing relief work and they seemed to know what we were doing. Honestly, this is the ideal hiring scenario. They know your staff, you know them, you've seen them in battle conditions, and it seemed to work and it seemed good and they came on. How did we get to this toxic, bad, dark place when we had such a nice start of being open and transparent and everybody knows everybody?
And so, I would start off with that and say, “What is the diagnosis?” When I read this letter, it's like a number of the letters that we get where people will come forward and they have a laundry list of the things that are problems. Well, the person is a micromanager and they're mean to the staff and they get really huffy and they don't write up their records. I'm sort of pulling these out of the air, not that's what it was here, but we get a list of behaviors like that. I generally look at it and I go, “No, I don't know what to do with this when we're looking at people and managing people.”
My question is, is this 10 different problems or is this one problem that's manifesting 10 different ways? If it's 10 different problems, that's usually really bad. There's usually not much that we can do. You know what I mean? If you're like, “I have 10 problems with this person.” I go, “The answer is going to be for you and that person to part ways because 10 problems is too many problems.”
If you're like, “I have one problem with this person,” and it manifests all these different ways, then that's very doable. For example, if I have a doctor who refuses to take days off, who calls multiple times when she's off, she won't go home at night because she's writing up records, she rides the staff really hard because she says they're not doing it the right way. She won't let other doctors see “her cases.” That may sound like a laundry list to you. To me, I say, “Oh, this person does not trust the practice that she's in.”

Stephanie Goss:
Trust.

Andy Roark:
This is a tough problem. All of those behaviors are from one behavior which this person doesn't trust what is happening in the practice and other people taking care of what they're supposed to take care of. And so, that's not 10 problems, that's one problem. We can talk to this person about trust and it may be that we can meet their needs and get them to let go a little bit. We can come to a workable solution here as opposed to this person is doing 10 radically different things that are culturally incompatible with what we're doing. They go, “I probably can't help you there. This is probably just not a relationship that's going to work.” Anyway, that's the thing I put first from a headspace standpoint is we need to do some diagnostics here. Seek first to understand is this a lot of different problems or is this one problem? What are your thoughts from that when you look at this? Are you seeing a pattern here? Are you seeing one problem?

Stephanie Goss:
Well, it's interesting because I probably… No, there's not one clear-cut problem here when I read this, and I also am not sure that it's actually 10 different problems. When I was looking at this, I was trying to pick apart what is the root here? What is the real challenge? For me from a headspace perspective, I wondered if it was a little bit of what you were talking about earlier, which is when we see something as negative, so from a personal, I went through a period of time where I was struggling to get along with somebody that was on my team.

Andy Roark:
Was it me? It was me, wasn't it?

Stephanie Goss:
I was struggling to get along with somebody on my team. No, it was not you. Although this could apply to you, it could apply to anybody, because here's what happens. When we're frustrated and we're angry or any of those strong emotions, it is really, really easy to do exactly what you said, which is if I'm frustrated with you or I'm mad at you about something, it's really easy for me to look at you. Now, all of a sudden, instead of being able to see any of the good things, all I'm seeing are the things that are irritating me because I am irritated, I am in a state of upset, I am frustrated, I am angry, whatever that emotion is. Now, all of a sudden, it's really easy to start picking at all the little things that on a completely average ordinary day, I would give zero Fs about. I would not even notice care, think twice about, but because I'm frustrated because I'm angry because I'm irritated, all of those things seem huge.
And so, to me in reading this, it seems like there might be a little bit of that happening and I could totally be wrong. These could all be-

Andy Roark:
No, I agree.

Stephanie Goss:
… regularly occurring patterns of behavior that really are 10 different problems. At the same time, it's really easy to get into that negative headspace. I mean, I have done it with you. I've done it with some of my closest friends or with my family. When you get irritated, that's all you see. You really do have to work extra hard to force yourself to be in that good headspace and assume good intent and say, okay, let's start with the good, let's put together a good list, because one of the things that I would say from a headspace perspective here is that you need the ability to step back a second and do some weighing from a pro-con perspective because to your point, if it is really 10 things and you probably should part ways, one of the things that I want to do before I get to that step is to figure out is there something worth saving here? In order to do that, I have to look at the good as well.
And so, for me, some of it is, let's step back, let's assume good intent for a second and say, “What are the things that this person is doing well? What is the good in this relationship?” And really try to find those examples so that I can do a little balancing and a little perspective exercise for myself and say, “Am I just nitpicking the hell out of this because I'm irritated with this person and I just want to stab them in the eyeball with a fork?” Because that's a real place that we get to in our heads and it's really easy to be that negative or is there good?

Andy Roark:
I think you're totally right. I mean, I've seen this exact behavior in myself with my wife who I love dearly, deeply. I think anyone who's been married, and maybe I'm wrong, but I really believe probably anyone who has been married for any amount of time, you're like, “I got married last week but I haven't seen this.” I'm like, “Okay.” But other than that-

Stephanie Goss:
Come back to us in a year.

Andy Roark:
… if you've been married for any amount of time, you have come to a period where your spouse has just irked you and everything they do is seen through the lens that you're looking through as something else that further irks you. I think that happens with anybody, but I'm trying to think of examples that aren't going to get me in trouble when they get back to my wife.

Stephanie Goss:
When I get in that headspace, I get real mad and I'm like, “You're unloading the dishwasher incorrectly.” It's that little level, just like, “You're taking out the trash wrong. Can you do that quieter?”

Andy Roark:
Absolutely. I can give you an example, our story about this person who she believed her boss was out to get her and she was asked why she thought her boss was out to get her. She said, “Because the boss has moved all the birthday celebrations to Tuesday at lunch.” And the person said, “Why is that?” She's like, “Because he hates me.” He said, “Well how is this him hating you?” She was like, “He knows that on Tuesdays I have this thing and I never get done on time. And so, I always get to lunch a half an hour late. And so, he's put birthdays on Tuesdays to spite me so that I…” She was 100% serious that this was-

Stephanie Goss:
Out to get you.

Andy Roark:
Now, she could be right. Her boss could be next level… I mean that is Dr. Evil freaking… I mean honestly, there are petty, petty people who are playing the games at that level. I'm sure there are. But to me, I just sit and go, “Are you serious right now?” I have had those thoughts of, “You are unloading the dishwasher right now because I'm listening to a podcast I'm very excited about and you know how distracting it is when you do that.” It's just something ridiculous.
But we all have these thoughts and I say them jokingly, but once they happen, sometimes it's hard to get your head pulled out of your coat and say, “Wait a second, let's hold on now. Let's reset mentally here.” That's really hard. When it really gets hard is like, pardon me, but the old Middle Eastern conflict model where I don't even remember what you did that made me irked, but you did something and so I did something back and that made you irked, and now, this thing has built up over you did a thing, and so I in my resentment did a thing and now we've both spun up to the point you go, “What is this even about?” And nobody remembers, but here we are. I've seen those things happen as well.
Anyway, my point here in getting to the diagnosis, so part one was what is this really about? Is this multiple problems or is this one problem? If it's multiple problems, I do think you are right is can we reset here? I think that's going to be a big part of action steps. The first thing we're going to talk about is an intervention to try to hit a reset button. We've been able to pull these out when we get to that point, but what is going on here?
Then the other part of being fair to the other person is what is my role here? Let's start with our safe for the conversation. Can I sit next to this person, smile at him? And that goes into assuming good intent. Okay, they're doing this thing, this is not acceptable. If I can't smile at this person or just talk to them, I'm not in a headspace to have this. I'm triggered and this is going to go badly. A is assume good intent like okay, something is going on with this person. I really like the fact that they said the associate that she's overwhelmed and anxious. I think that's the words that she used at the beginning, but definitely overwhelmed and struggling. I say, “You know what? That's a good way to look at this as overwhelmed and struggling because we can all empathize with that feeling.” So, assuming good intent. She's not trying to be toxic, she's not trying to run you out of business. She's not trying to chase the staff away. She's struggling.
F is set up to fail. I think this is a big one. Has this person been set up to fail? Meaning, have expectations been communicated? Have we said anything at the very beginning of these behaviors or are these behaviors that have piled up without us having a real heart-to-heart conversation? Has she been misled about what her days were going to be like? Is she being supported by a staff that was fair given her experiences as a relief vet? If you're like, “It's the exact same staff that she's known as a relief vet.” I would say, “Well, that seems like she set out pretty clear expectations.” Has she been coached on these behaviors or is this something where we've just let this all bubble and boil and now we've got to deal with it?

Stephanie Goss:
I think that the F is a big one for me. This was one where I was like, “Oh.” This episode might be a little bit of Camp Tough Love because for me, a lot of this is think you got to own some of this as, and I'm going to speak to manager and it could be practice owner who's managing or the practice manager, but whoever is actually in charge of this situation, I think that there's some self-reflection here. That ultimately, when this was me in the practice, this was a bitter pill to swallow but is an important one in terms of leadership growth because relief is not the same as full-time. And so, you said, “Is this the team that she has been working with since the beginning?” I think that there's value in asking those questions. At the same time, I've never once worked with a relief doctor where the expectations for them and the nitty gritty nuance of how we work with them is exactly the same as it would be an associate doctor of practice. There is always flexibility and there's always difference there.
I ran a ship where I expected a lot out of my relief doctors and I communicated that upfront, “Here's what we want. We have a certain level of medicine that we're practicing and these are our standards of care. Do you agree with this?” There is a whole interview process to make sure that culturally, it was a good fit with a relief doctor so that our clients got the same level of experience and at the same time, there was lots of things that we let slip and that slid around when a relief vet was present because it's not the same. Those are two different things.
I say that because the expectations for you as a practice are radically different even if it's unspoken, and also the expectations as on the flip side as the doctor, those are two very different things. Practicing relief in a practice that you like the team and you get along with everybody is still radically different than being there every day or four days a week, whatever a full-time schedule is, as an associate vet. Those two things are radically different. I think that there's probably a lot of the unpacking of this conversation falls around expectations. I'm so glad you said that.

Andy Roark:
I think you're really spot on with that. The last part of safe is E, is what is the end result? I think people go, “Well, I want this person to immediately cease and desist all negative behaviors.” And I go, “Well, that's probably not going to happen right off the bat.” I think the end result for having this conversation is I want this person to feel heard and I want to feel heard and I want to have a path forward for how we're going to work through this.
What I don't want as an end result, what I'm not looking for is apology for past behavior, just owning things a person did before. I would like that, but really my focus here is not on adjudicating what happened before and did this person micromanage, were they mean, was what that intern said valid? I can't change the past. It was or it wasn't. It doesn't really matter. What does matter is that things have to change going forward. And so, just remember to keep that forward focus as you move into this conversation. I think that that's really important.
I think the last part for headspace for me is sometimes, especially we see changes in behavior like this, sometimes it's because people really are struggling and there's nuance here, but it helps me to be empathetic and I think to be a good leader if I can talk to someone and understand that this person is behaving the way they are because they are struggling. That just helps me to get into a good headspace.
This is important because there's nuance here. Someone can be struggling and still be held accountable to our core standards and our standards of behavior. That doesn't make me a monster for saying, “I understand that you're having a hard time and I want you to be successful and I want you to be here and I'm willing to invest in you to try to keep you here and to make these things happen, and, at the same time, I cannot have our staff members complaining about feeling unsafe. I can't have our staff members complaining that they feel tyrannized or yelled at. Those things cannot happen.” I really think that we're going to talk a little bit about that when we get into action steps about laying those things down.
We've had a couple episodes recently that have touched on this. There really is that balance and we're going into the Practice Owner Summit and that's the focus of my presentation at Practice Owner Summit is it's not about making everyone happy, it's about finding the balance between people. I want to meet the needs of this associate vet, but at the same time, it's my job to protect the staff and make sure their needs are being met. And so, part of balance is to say, I want to support you and I want to help you, and I can commit to giving you my time and energy or coaching or support or whatever else you need as long as these other needs that I have for my associate vets are being met. If they can't meet my needs, then this is not going to work.
It doesn't mean they're a bad person. It doesn't mean I'm mad about it. It doesn't mean that they aren't struggling or I think that they're not doing their best, it's just it doesn't work for me, it doesn't work for the team. And so, there is nuance in that where you can have someone, and I think a lot of people in vet medicine struggle with this. You can have someone who is struggling, and at the same time, they can't continue to work here because their behaviors are not changing.

Stephanie Goss:
I totally agree with that. I feel like this is a good spot to take a quick break and then we come back and talk about action steps.

Andy Roark:
Yeah, let's do it.

Stephanie Goss:
Hey friends, I just want to jump in here for a quick second and say that I am super, super pumped about all of the awesome things that we have coming down the pipeline in 2023. Now, we haven't announced all of the surprises that we have coming for all of you, but there are lots of great things coming to kick off the year. If you haven't signed up for some of the workshops and events that are happening in the first quarter of 2023, you want to head your little self over to unchartedvet.com/events and check out what we've got coming.
If you are a member, all of the workshops are listed there. You can log into your account and sign up for free. If you are not a member, you should check out what's coming and consider a membership for 2023 because you could pay $99 per workshop, but you also could pay $699 and sign up for a whole year of registration as a member and then you get access not only to all of the workshops that we do, but all of the amazing content that happens over in our workplace group and our community. It is so fun, it is lively, it is just jam-packed with conversation from the community about what's going on in their practices, how to solve challenges, how to support each other, and it is one of my favorite places to spend time. I would love to see you there. If you need that address one more time, it's unchartedvet.com/events. Now, back to the podcast.

Andy Roark:
All right, let's get in some action steps here. The first thing I just want to lay down is, and I said this in the first half, but this is why I took the microphone when we came back because I'm like, I'm going to say this before Stephanie says something else. Action steps are, it's time for an intervention. I call this an intervention because I don't like interventions, let me just say. Some people would be like, “This is the come to Jesus talk.” I'm like, nah, it kind of is. I don't want it to be, I really don't like this. The best way to handle this situation is to get in your time machine and go back six months or a year or two years. As soon as that behavior first started, you say, “Hey, that's not like you. Help me understand. What happened here?” I'm going to say, what are you thinking, but I'm going to try to say it in person. It's like, “Hey, you know we don't do that here. Tell me, what's going on?” That's the best thing.
If you got a time machine, you should use it and go back to the first time it happened and say something right then at the very beginning that brings this out in the open. Barring that, and given the fact that this has gotten to this place and all of these behaviors have been documented, we've had this experience with the intern coming and being like, “What is this?” It's our best hope is intervention with follow-up. I think a lot of people are like, “We're going to have the big talk and then I'm going to go right back to how things were before and this person's behavior is just going to be different and they're going to just be changed by themselves.”
I'm like, “No. We need to try to hit the reset button, which is a big thing.” It goes back to what we were talking about before about the spinning up and the resentment upon resentment or looking through this negative lens at other things and the list of grievances getting bigger and bigger. We need to hit that reset button to get a fresh start and then we need to have ongoing conversations or coaching conversations thereafter. And so, I think if your expectation is have the conversation and then be done, that's not where we are, that's unrealistic expectations. You're going to be unhappy with the results you get. Do you agree with that?

Stephanie Goss:
100%. I think that for me, a huge part of where we start actions stepwise, like I said, goes back to looking at the F because looking at the email, this person has done some great things in terms of trying to manage this. They were like, “We have had some conversations about the specific way that this associate is talking to the team and confronting them and the impact that it has on the team,” which is wonderful and amazing and they were like, “And then we get a couple of weeks where the behavior starts to shift and then we go back to the snapping and the criticizing and the way that it was.” And so, I think you're spot on with that, which is when we're asking for behavioral training, we have to follow the training model that we know works.
We've talked about this on the podcast before. We are simple animals and training requires doing the same things over and over and over again and rewarding the good. And so, I think that for me, there was a lot of things in the list of things that are frustrating this person where I'm like, “Okay, are you having a lot of the come to Jesus conversations or are you having ongoing conversations about how is this going? What went well here and what needs to change?” Because when we're talking about behavioral things, it needs to lean much more towards high frequency in terms of the touchpoints than low frequency. This needs to be a regular, “Hey, today was a great day. Thank you for the hard work today. I know that it was a challenging day, but you did a great job and you gave the team, you interacted with them really well and I really appreciate it.” It's that kind of ongoing.

Andy Roark:
Or are you having Andy Roark 2010 conversations that were conversations that only I know I'm having and the other person's oblivious to, where you're like, I'm so subtle, I'm not convinced the other person understood the conversation that happened. And so, there'll be people who, I'll be like, “Did you speak to them about them being mean to the staff?” They'll be like, “Yeah.” I'll be like, “What did you say?” They were like, “I asked them how was your day?” I was like, “Yeah?” And they said it was fine. I said, “Good, fine days are good.” I think they got the message.

Stephanie Goss:
I have tell you the best story that illustrates that point perfectly. I, once upon a time, had a manager and the expectation was that we would have regular one-on-ones when we had time scheduled where they were in the practice because they weren't in the practice all the time. The expectation for me for a one-on-one was we're going to actually sit down and have a conversation about how are things going, we're going to talk about specifics, we're going to talk about what's going well, what's not working, and get into the details.
We never talked about what the actual expectations would look like. I just was one-on-one. We're going to have time on the calendar, this means we'll sit down, we'll have a whole conversation. Probably, I don't know, the first three months went by and they came regularly. They showed up when they were supposed to, they brought coffee for everybody. They were like, “Hey, how's it going? How's everything going in the practice?” I'm like, “Things are going okay. We're just trucking along.” Then before I knew it, the day was done and they had left and we hadn't actually sat down to have a conversation, oh, they've got other stuff going on in their schedule like we'll sit down and have a conversation.
And so, it came time to do our reviews and one of the questions asked was how are one-on-ones going with your boss? I gave a really low score and my boss's boss was like, “Hey, I want to talk to you about this low score that you gave.” I was like, “Okay.” They were like, “Well, why was your score low?” I was like, “Well, because I haven't actually had a one-on-one with them.” I was like, “I guess that they'll get better. I know things have been really busy, assuming good intent. I know they've got a lot going on.” They were like, “Well, they said that you guys have been meeting every time that they have been at the practice.” I was like, “They did?” In the other person's head, the one-on-one for them was, how's it going? It was them asking the question, how's it going? My answer was the answer to a one-on-one in their head. My expectation and their expectation were at two opposite ends of the scale.

Andy Roark:
Oh no, that's funny.

Stephanie Goss:
Because I'm over here thinking we haven't had a single one-on-one yet.

Andy Roark:
And they're like, “She said she was fine. And so, I wrote that down.”

Stephanie Goss:
100%. 100%.

Andy Roark:
Bam! Nailing this management thing.

Stephanie Goss:
But it's like that, that's part of it from an expectations perspective. Also to your point, the communication perspective, are you actually having the conversation you think you are having? Super, super important. Part of that is you have to get it out of your head and you have to be able to communicate it to them and vice versa so that you know what are the actual expectations. For me, a lot of the F when I was looking at this, and again, we hyper-focus on the negative because when I was reading this, I was picking it apart and I'm like, “Oh, well as a manager, they should be doing this and they should be doing this and they should be doing this.” Then I was like, “You're picking them apart too,” which is also not fair.
At the same time, for me, some of it is, okay, look, if you're having a challenge with a thing, with the behavior, in order to change that behavior, there has to be regular follow-up and regular conversation. Not just a, “Hey, today was really bad, let's have a conversation about how bad it was because I'm going to ask you to fix it.” Those conversations are important, but equally important is the, “Hey, this was a really good day,” or, “Hey, this was kind of in between. Here's what you did great and here's what we still need to work on,” and it needs to be regularly occurring versus just those spot conversations when it's really not so great, which again, the devil's in the details and we're only getting part of the story in this email, but I suspect that there's maybe a little bit of that happening where, to your point, it's the come to Jesus conversations and not as much of that regular follow-up.

Andy Roark:
I agree. One of the things I think I want to try to do in the podcast, I'm looking at 2023 and I'm thinking about what we do here. I love our podcast and I love our conversations. I think I want to challenge myself in 2023 to try to do a little bit more role-play stuff on the podcast. I know a lot of people are like, “Man.”

Stephanie Goss:
We get asked for that a lot.

Andy Roark:
We do get asked for how do you say that? When we do it, people tend to really like it and we get really good feedback on it. I don't know, I think I'm just going to try to factor that in a little bit more. Let's role play a little bit right here. We're talking about action steps and we're talking about this intervention. And so, people say, “Well, what does that look like?”
The first thing that I want to do is say, “Okay, remember when we're going to go in, we need to speak in specifics,” because if we go in and say, “Hey, I don't think things are going well,” what does that mean, or, “The staff is unhappy,” that's hard to get people. I don't understand what that means. If you came to me and said, “Andy, the staff is unhappy, how do you think things are going?” I'm like, “Stephanie, I don't know what you mean. How are they unhappy and why? What did I do that made them, I don't understand.” But I do see a lot of that where people go, “The staff feel, they feel micromanaged, they feel unhappy,” and they'll drop that on the doctor and the doctor's like, that's the worst kind feedback because they're powerless. I don't know-

Stephanie Goss:
It's vague and it's subjective. It is so vague and it is so subjective. There's nothing concrete or specific. You couldn't say to me, “Stephanie, close your eyes. What does you micromanaging the team look like?” I couldn't give you a picture of what that looks like from what you just told me.

Andy Roark:
I agree. I hear that feedback given to people all the time. Guys, it's destructive because it makes the person feel terrible and does not give them anything actionable they can do to change their behavior. And so, a lot of it's when we're just speaking specifics because this person's going to need to know specifics. I'm assuming there's something that's going to bring this to a head or there's something that we're seeing a behavior, but we need to have some sort of a specific thing to have this behavior.
Remember, clear is kind. If you're struggling, you're like, “How? This is going to be a terrible conversation.” Remember, clear is kind because I need to fix this problem because what's happening, it's not okay to keep happening. And so, we're at that place where we're going to have this intervention conversation and clear is kind. What we're doing is it just doesn't work and I need to say that it doesn't work. If this person's like, “I hate it here. I hate these people here. I'm not going to change my behavior,” then they need to leave. That's where we are.
And so, it's time to put cards on the table. That doesn't mean I'm giving an ultimatum, but if that's how they feel, I need them to know that what's going on is not working for me and that's fine. A lot of times when I say we're going to do an intervention, people say, “Oh, you're going to bring them in the office and we're going to close the door.” I'm like, “No, no, no.” Just because it's an important conversation doesn't mean it needs to be a stressful conversation. I want to lower the stakes. I want to be empathetic. I want to have a real conversation with this person, not a performative flex on them, not a, I'm going to twist your arm, not a, it's two and a half strikes buddy. It's not that. Especially if you've got multiple problems or this person's acting out in these different ways, we need to really try to come together. Here it goes. And so, you can help coach me through this.
I guess what I'm going to try to do is we need to set a time, make sure we have time to talk with them. And so, “Hey, can you come in tomorrow morning? I want to do a touch base with you and talk through how things are going and where we are as we come into the end of the year. “I like to use landmarks like the end of the year to make it be like, “Yeah, we're going to the end of the year wrap-up.” And so, “Hey, can you come in? Let's find a time or can I take you to lunch tomorrow and we can talk through things and see how things are going, but I want to make sure I have time to do it.”
The big thing is I'm going to try to bring them in and lay out the problem and say, “Hey, I love having you here.” I tend to like to start in a positive conversation and try to frame the issue. I think a lot of times, we mess this up and we go too specific. I say, “Hey Stephanie Goss, welcome to my office. Yesterday you said this negative thing and it's a problem.” You know what I mean?

Stephanie Goss:
Yes.

Andy Roark:
That makes you feel like everything between you and me is bad. And so, I'm going to start out wide. I'm going to say, “Hey Stephanie, first of all, we're coming to the end of the year, I'm looking back at the year and I am glad you're here and I want you to know that. I want you to know that I think that you're a really good doctor. We've gotten a number of positive comments from clients about you over the last year. Here's looking over our online reviews and I see this positive feedback and I think you have great medical knowledge and I think that you are really popular with our clients and I know how hard you try to keep our clients happy. I can see that effort in you and I can see that care and compassion for the pets. I just want you to know that all those things are really obvious and I really personally appreciate them.”
And so, now, I'm trying to lay this down. It's not everything is bad and I'm not going to say it if it's not true. And so, I'm trying to say to them honestly what I wanted to do. If you can't come up with anything that's true and positive, this relationship is not worth having. I'm going to try to open up that and say, “Hey, this is where I am, this is how I feel.”
The other thing is I'm trying to lower the stakes. This is not do or die. There's lots of good things about our relationship. I laid down what's positive and what's going well, then I'm going to transition over to where we're going. I don't want to make this an accusatory thing and say, “Well, the staff says you were mean to them and so you were mean to them.” What I'm going to say is, “Hey, so these are the things that I love about… One of the points that I want you to focus on or that we need to talk about in development is interactions with the staff. There has been a perception that you can be really negative about the performance of the staff or how they're doing and I have some staff members who feel like they walk on eggshells because they're worried about making you unhappy. I'll give you some examples that don't divulge these people's identity, but for example, I've had people doing [inaudible 00:49:34].”

Stephanie Goss:
Or even if it does, if it's something that you see, that's a great place as a manager. Even if it puts the spotlight on another person on the team, if you have seen something yourself like in the email, they gave us a great example of where this doctor snapped really badly at an assistant who was stocking the room and put what the doctor thought was too many needles in the needle bin and they snapped at them.
That's a great concrete example of you see something like that, say, “I know it's a really small thing, but this felt like a really good example for me of what I'm talking about, because I know that you didn't mean to make her feel bad. I know that you didn't intend for your tone of voice to come off as mean. You want it done right and I appreciate that. At the same time, this is how it came across to me or this is how they perceived it and that's what we have to talk about because we can't have that. I don't want that to be that kind of interaction between you and somebody else on a regular basis,” or something like that.

Andy Roark:
I like that as well. The best thing is when we see that happen, that's the best time to intervene. And so, the best thing is if we can see something like that happen and this person snaps at one of the support staff because they put too many needles into the container and they raise their voice, the best thing is say, “Hey, can we talk real quick? Hey, listen, when you raise your voice to the staff like that, it rattles them to their core. They respect you and she's trying to do her best. That type of feedback, it damages the trust that they have in you. Also raising your voice like that, that's not what we do and that's not the behavior that I expect from you. Is everything okay?”
I really like that is everything or what happened, but if it happens and I see it, I'd say, “Hey man, that's not what we do here. Are you doing okay? Is everything all right? That's not how you tend to behave. I'm a little worried about you.” I use those phrases a lot of, what happened, is everything okay, I'm a little bit worried about you. Those are true and they're compassionate statements of not like, “How could you yell at her like a monster?” But instead, “Hey, that's not like you and that's not what we do here. Are you doing okay, man? I'm a little worried about your behavior, what's going on?” That's exactly where I want to get to. It's in that what's going on conversation. I really like that.
If I'm having a sit down with the person, again, catching them in the moment is always, and having this specific conversation is always the best. But if I'm doing an evaluation type thing, let's say this is something that's slowly, steadily building, I'm going to start with all the things that I like about them and then I'm going to say, “Hey, this is a developmental plan just so you know where we're at. We've gotten negative feedback from the staff about these behaviors. Their perception is that you are unhappy with the work that they do.” And that's important.
I'd say, “Their perception is, I didn't say you yell at them. I said their perception is that you are aggressive about mistakes that they make. Honestly, some of them seem to be fearful in their interactions with you, and that's a behavior we need to fix. Do you see those behaviors or do you remember interactions like that?” I'm trying to get them to say, “Yes, I see that behavior,” or, “No, I don't see that behavior.” We can open the conversation up from there.

Stephanie Goss:
I love that. I liked the idea of being able to use a landmark if that is appropriate. The other thing that I like to do is to just use the wide end of the net from the place of compassion. If I was going to have this conversation, it's probably going to feel a little bit like a come to Jesus, because it sounds like, and again, we only have part of the story, we only know what they sent us in the email, but it sounds like there's stuff that has maybe been building and hasn't been addressed really regularly. And so, I would probably start with, “Hey, I just want to touch base and check in with you because you don't seem okay. You seem really anxious. You seem really overwhelmed and I'm worried about you. I want to know where your head's at and how you're feeling so I can help figure out how I can support you and how we can support you.”

Andy Roark:
I like it.

Stephanie Goss:
Then we're coming from a place of compassion and I like them to direct the conversation. Ultimately, I don't like having conversations where I don't know how it's going to end because I'm a control freak, and at the same time, I'm okay with taking some detours. And so, I would rather open it up and have them tell me how do you think things are going? Even if ultimately, I want to get to the place of accountability and have the conversation about these are the changes I need to see from you, this is the behavior that I expect, I still want to know what's the backstory, because there are always at least two sides to every story and the truth is usually somewhere in the middle.
And so, I am looking at this from the perspective of the team is frustrated. I am frustrated. I have all of the stuff on one side of the story and I need the other side of it. I need to know what's going on for them, or is there stuff going on at home? Are they frustrated because maybe there was an incident I don't know about with the team member and now there are trust issues? Opening the door to that kind of dialogue is the only way that I'm going to get that information.
Now, they may sit across from me and be like, “Everything's fine.” And then this is where as a leader, it is a superpower to become comfortable with the uncomfortable and lean into the silence because that is where I will just sit and let them actually tell me, is it actually okay? Because one of two things happens, either they keep repeating it's okay, it's okay. You've said that three times now, that isn't actually reassuring me. In fact, it's making me feel like there is something wrong and you just don't want to talk about it. But if that is actually true, I'm cool with that. I would love to know what is going well. Give me some examples. Tell me what is going okay, and push back and drill down. Some of this is going to take work on your part to uncover where they're going.
But I have found to your point from the coaching conversation perspective, part of it is about getting them on your team, getting on the same page. I find it way easier to do that if it's coming from them because now, if they'll open up and they'll tell me about some of the things that are going on with the tech team or something's going on at home or whatever, now I have more of the story and now I can reevaluate. I'll tell you, I've gone into some of these conversations armed with a plan to, look, I've got to address this behavior and that is still true and I come out of it with a completely different plan than I had in my head going into it because they gave me information that I didn't have at the start of that conversation.

Andy Roark:
I agree with that. I think from a strategy standpoint, you put your finger right on it. I don't want this to be an adversarial conversation where I'm telling you that you are failing and you're telling me that you're not, or you're telling me I'm a jerk. I want this to be a conversation where we acknowledge that you are having some struggles with the staff and I'm supporting you. I'm going to help you figure out how to get through this, how to be successful, how to get you what you need and open doors for you with the staff so you can build those relationships. That's where I want to get to.
And so, asking them, and again, it's so much more powerful if I say to you, “Stephanie, how are things going?” And you say, “Andy, I don't think they're going very well.” And I go, “Okay, let's talk about what's going on.” That's so much better than me saying, “Stephanie, things are not going well. I'm going to need you to make some changes.” You feel how tight that is and it's the opportunities for us to work together for you as the associate vet to make your own decisions and own your own development. Those opportunities go away.
The other thing that I want to go back to is when you were like, they say, “It's fine,” or they say, “I don't know,” or “Everything is good,” I completely agree that you can't let things like that lie. And so, the phrasing that I'll use a lot in those things is, “I know you say that things are okay, but I'm seeing these issues from the staff and I need to work with you to figure out how to resolve them. I know that you keep saying it's fine, but I really don't feel like you feel it is based on our conversation,” or, “You keep saying it's fine, but the truth is we still need to deal with the outcomes and what the staff is saying and how they're feeling.”
It's a way of moving that conversation first, but I think we both agree, you can't let the person say I'm fine and then cross their arms. We can push in a number of times. A lot of these things are, you set yourself up for the best case scenario. The first thing is I want to lower the stakes here. I want to convince them that I see value in them and in our relationship. Then I want to ask them how they think it's going and I want the conversation to open up as they tell me where they're struggling. That's great.
If that's not going to happen, then we're going to fall back to, I'm going to present to them what I see going on and then ask them if they agree with that representation or if they have ideas about how we might move forward with it. If they say, “Nope, I don't agree with this, everything is fine,” and I can't draw them out, then ultimately, I'm going to fall back to the least favorite of mine, which is, “Hey, this is what I see and this is not acceptable for our culture. It's not okay. It's not how we run a practice. It's not the place that we want to come and work at. It's not okay for the staff to be worried about getting yelled at and I need you just to hear that that's not a thing that we're going to be able to do or that we're going to allow to go on in this clinic.”
I'd say, “I like you. I want you to be here, but I need you to hear from me that this is not acceptable and it cannot happen again and I want to support you. If there are things that frustrate you, I want you to communicate them to me so I can try to work on them, because I do want our practice to get better. I know our practice isn't perfect and no practice is perfect, but you got to work through these things with me and you cannot blow up at the staff and make them untrusting of you or scared to make decisions or to work independently. That's not okay. It's not in line with our values. It's not the workplace culture that we want to create. Can you help me with that? Can you make that happen?”
That's the type of wording that I'll use even if I have somebody whose arms are crossed and ultimately, I say clear is kind, it doesn't get much more clear than, “We cannot have doctors raising their voice to the technicians. That cannot happen. That's not in line with our culture. The damage to our team morale is huge and it undermines everything we're trying to build from a workplace standpoint. The optics for you are terrible. Really, it is what people will remember about you and it can't happen and it cannot happen again.”

Stephanie Goss:
I think that for me, that's the resolution note. Really at the end of the day, and you put your finger on this early on in the episode, which is like we've got to do some pre-work and some zooming out and some looking at this from a big picture perspective and really do some assessment pros and cons wise on does this feel saveable? Because if the answer's no, then as much as it's painful and as much as doctors are hard to find, and I think this person knows the answer because they were just like finding good people to work with us is also a challenge. And so, I don't want to lose a doctor, but I don't want them to run the team out of town. And so, you might know the answer already and it may just be doing the hard thing that you don't want to do and parting ways.
If you zoom out and you do the assessment and you're like, “There's some serious pros here and I would like to try and save this relationship,” then I think you have to look at this from the perspective of how can I start to have some of these conversations and you have to, for me, the last piece of advice on the action steps in gearing up to have this conversation is the trap, the giant gopher trap as manager that you can very easily fall into is now I've done this work and I've listed out all of these things that are going wrong or that this person is doing that are not okay or that I'm irritated by. The giant gopher trap is to fall down into that hole and say, “Here's the 30 things that are driving me crazy that you need to fix,” because all that is going to do is make them be like, “All I'm hearing is negative, all I'm being told is that I'm bad. I'm not doing things right. I might as well give up.” That is immediately going to set them up for failure.
And so, you have to resist the temptation to be like, “I need you to not raise your voice to the staff, and also, I notice that you have records that haven't been written up still sitting on your desk from two weeks ago, and I notice that you have client callbacks that you haven't made from last week. I need you to deal with all of those things.” It's such an easy temptation to give into as a manager to want to address all of those things. And this is where I think you have to pick your poison and you have to pick the place where you start and then recognize that this is if we are truly going to coach this person out of it, and I don't think that it's unsaveable.
I would look at this and say, “Well, I would want the opportunity to coach if there are enough redeeming things in the pros column. I would want the opportunity to do that. I also need to be realistic. Rome was not built in a day. I'm not going to change this situation overnight either. I have to pick a place that feels like the most middle ground.” For me, that's also part of why I'm going to do everything I possibly can to get them talking, because I want to know is there some middle ground? Is there a bone that they will throw out to me that I can pick up and gnaw on because it feels like a good starting place. Where can we meet in the middle? What can I help them work on? And then work my way forward, keeping my eye on all of those other things but also recognizing that things that have gone unspoken for months, you cannot dump it all in here. It'd be like, “Let me have this conversation.”

Andy Roark:
I think that's totally true. Well first of all, you don't know if this is salvageable, because you cannot change this person. It 100% depends on that person and whether or not they're going to change and you don't have any power of that. If you say, “Andy, is this going to work out?” No idea. Go have the conversation and the person sometimes they surprise you and they'll say, “Look, this is what I'm going through,” or, “This is what I'm dealing with,” or, “This is the thing that really bothers me.” I say, “You know what? I can support you through that or I can work with you through that.” Sometimes they'll say, “I understand what you're saying and I see that and I don't like it about myself and it's something I'm willing to work on.” Or sometimes they say, “Screw you. If you can't handle me on the bad days, you don't deserve me on the good days.” And you go-

Stephanie Goss:
Or sometimes they say, “I am really unhappy and I actually, I was going to give you my notice.” Sometimes it works out easy for you.

Andy Roark:
Exactly right. And so, you don't know what's going to happen. All you can do is tell this person what you need and go from there. The other thing to your point, sometimes we stage these conversations. We say these are the problems. When it's at the very beginning when a diagnosis and try to figure out, is this an underlying problem that's manifesting out? One of the reasons I want to do that is because when I bring them in, I don't want to talk to them about the 10 symptoms. I want to talk to them about the one problem. You don't seem to have a good relationship with staff from what I see, or the staff does not perceive you as being approachable and here's examples of things that they've given feedback on.
I'm trying to get to what is the big thing that manifests out multiple ways, so we can talk about one thing. If there's not one thing connected, then you need to pick one. You need to pick the most urgent one and you need to talk to them about that. A lot of times what happens is you can get that person to say, “Well, this is why I do that.” You go, “Oh, now I understand why you do the six other things that you also do.” A lot of times you can unlock that. But to your point, if you just back the dump truck of complaints up and just dump it on them, they're going to feel like it's pointless. No one wants to hear 87 things that are wrong with them because they go, “Well, you just don't like me and you're not going to like me and this is everything about me you don't like, what are we doing here?” And so, that kills it. But to your point, pick the things that matter and push for it.
The last thing is, you said pick your poison. That's always it. I think a lot of people ride in on their white stallion with their flaming raging sort of justice and say, “This person's a bad cultural fit and they're gone. You're better off without them.” I've always thought it's amazing how often we are better off without people when we think, “Oh, I can't hire anyone, I don't have an option.” A lot of times you are better off without the person.
At the same time to me, I'm pretty darn pragmatic. This is a math problem. You need to look at the discomfort of working with this person for the foreseeable future versus the discomfort of working without this person for the foreseeable future. Honestly, from this, it sounds like even if that person can't be replaced, the scales may still not balance it. You may have less discomfort without this person not being able to replace them than you do with this person. If you are able to replace them, then that's a bonus.

Stephanie Goss:
Oh man.

Andy Roark:
That's a lot.

Stephanie Goss:
This one was a lot, but also fun. I really like your idea about doing some more role-play because we get that a lot.

Andy Roark:
How was that? It's not as smooth as I hoped it would be probably.

Stephanie Goss:
That was on the fly.

Andy Roark:
Well, but here's the thing too. I think if we want to do more role play, and I should have said this from the very beginning is I don't plan to graph this out. I'm not interested in coming in because I think the real problem is when you have consultants and they do role play, they sit down with their spreadsheet or their laptop and their word processor and they wordsmith some BS that you would never actually say to someone. The truth is it's not perfect and it's never going to be perfect. We are not perfect when we have these conversations. I think we're pretty good at them.
I think what I would say is if we're going to do more role play type stuff, the way I would do it is to say, “How do I think I would do this? Let's talk about it. What might this look like?” Because the other thing is you don't know how the person's going to react, and so, I'm willing, I think that's what's held me back from doing more role play stuff is to say, “Well, there's not a perfect way to say this and I don't want to be critiqued on that.” And I say, “I'm willing to do some more role play stuff with everyone recognizing that you and I are just hammering through this and we're going to take our best shot.” Sometimes it works, sometimes it doesn't work and you never know what the person's going to say. Anyway, I'm interested in trying to do some more of that.

Stephanie Goss:
I love it. I love it. Our call to action to all of you is that if there is something that you would love to hear role-played or that you would love to talk through from a specific perspective, send us a shout-out in the mailbag because we would love to see it. Awesome.

Andy Roark:
I think that's fine. Let's try it out and see how it goes.

Stephanie Goss:
Take care everybody. Have a great week.

Andy Roark:
See you, everybody.

Stephanie Goss:
Well, that's a wrap on another episode of the podcast. This was so fun. Andy and I always enjoy spending part of our week with you all. We hope you enjoyed it. If you did and you have an issue going on in your practice or question that you would love to hear us answer, or if there is something that you would like to hear us role play, talk through the details of what to say and how to say it on the podcast, please send us a message. You can find the mailbag at unchartedvet.com/mailbag. Send us a message whether you want to be anonymous or have a secret code name or not. Send us your message and we would love to feature it on an upcoming podcast episode. Take care, everybody. Have a great week.

Written by Dustin Bays · Categorized: Blog, Podcast · Tagged: culture, management

Dec 07 2022

What Do We Do When Accidents Happen?

Uncharted Veterinary Podcast Episode 208 Cover Image

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and practice manager Stephanie Goss are tackling some serious questions that Stephanie lumped together from the mailbag. We've received some asks from veterinarians and managers facing the angry clients, online mobs, in-person harassment/bullying from people when the horrible, unexpected things happen. When a pet slips a leash and runs into the road in front of the clinic; when a patient dies with no warning during an exam; when a pet in boarding is gravely injured trying to escape their run during a thunderstorm. Things we all hope don't ever happen to us but are out of our control for the most part. These stories matter and the questions being asked by these brave leaders facing these situations matter, maybe even more than the story. Questions like “how do I emotionally support my doctor who is berating themselves for not knowing that pet was suddenly going to die with no warning?” or “how do I be there as a leader and support my team when we are getting death threats on our voicemail and people are being called out by name or their personal information shared online? How do I make sure we are all mentally okay at the end of the day?” These are wonderfully compassionate questions that Andy and Stephanie enjoyed looking at from multiple angles. Let's get into this…

Uncharted Veterinary Podcast · UVP – 208 – What Do We Do When Accidents Happen?

You can also listen to the episode on Apple Podcasts, Spotify, Google Podcasts, Amazon Music or wherever you get your podcasts.

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


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Thank you to our sponsors! To learn more about this week's sponsor, GuardianVets, check out their website HERE.


Upcoming Events

Dec 13 – Getting the Most Out of Your Relief Vet Relationships with Dr. Maggie Brown-Bury

Dr. Maggie Brown-Bury is a relief veterinarian in Canada and she is already booked for all of 2023. How does she do it? Who ends up at the top of her list of availability?

If you're struggling to find a consistent relief veterinarian or don't know where to start, this 1-hour workshop can help.

On December 13, she will be sharing her experiences (the good and the bad), what key things you should have in place if you hire a relief vet, how to set them up for success, and how to build the foundation for an ongoing relationship.

She will also give you a comprehensive list of the obvious and lesser known hiccups clinics encounter along the way when hiring relief veterinarians and how to avoid them so you're at the top of your favorite relief vet's list in 2023.

Join us on December 13, 2022 from 7pm ET/4pm PT – 8pm ET/5pm PT for this LIVE workshop!

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Episode Transcript

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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.

Andy Roark:
Hey, Stephanie Goss, you got a second to talk about GuardianVets?

Stephanie Goss:
Yeah, what do you want to talk about?

Andy Roark:
Man, I hear from people all the time that are overwhelmed because the phones never stop ringing, and I'm sure you hear from these people as well. Our caseload is blowing up and the doctors are busy and the phones just don't stop.

Stephanie Goss:
They never stop. That is a true story.

Andy Roark:
I'm amazed by how few veterinarians know about GuardianVets. This is a service where you have registered technicians who can jump in virtually and help you on the phones. You can flip the switch and Guardian Vets can jump in and take some of the load off the front desk, and they can handle your clients and get them booked for your appointments and give them support. And it really is a godsend.

Stephanie Goss:
Pre-pandemic, it was amazing to me how many people hadn't heard about it for after hours call help. But at this point, I can't believe how many people don't realize that they are offering help during the daytime, as well. Which I would think right now is a huge benefit to practices because everybody is shorthanded, everybody is drowning in phone calls. And so we talk about it, we've talked about GuardianVets a lot on the podcast, and every time we do, we always get somebody who says, “What is that?”

Andy Roark:
Guys, if you're not familiar with GuardianVets, if you think that you could use some help on the phones or up at the front desk, check them out. It's guardianvets.com, and if you mention our podcast, me and Stephanie Goss, you get a month free. So check it out, guardianvets.com.

Stephanie Goss:
Hey everybody, I am Stephanie Goss, and this is another episode of The Uncharted Podcast. So this week's episode is brought to you courtesy of a handful of letters that we've received over the months in the mailbag. And they are all the big picture questions that have to do with when we have a catastrophic event in the clinic, something that involves a patient or a client. A patient dies under anesthesia, a pet getting walked in from the parking lot escapes, slips their leash and escapes, a pet who is boarding during a thunderstorm escapes and gravely injures themselves, those kind of things. When it's catastrophic, what do we do to support ourselves as the medical professionals involved in the cases? What do we do to support our team when we're leaders?
Because we've gotten some letters from leaders who have gone through these situations and are really struggling with feeling like not only are they trying to keep it together and deal with the lawyers and deal with the liability and the weight of all of that sitting on their shoulders, but they're also trying to deal with the weight for the emotional toll that it has not only on themselves but on the team, particularly when clients go on the warpath and there is cyberbullying or people coming into the practice and harassing or berating the team, when there's death threats, nasty voicemails, all of those things that we've talked about in prior episodes that can happen when something goes sideways and people go on the warpath.
These questions all have to do with how do we support ourselves mentally and emotionally, and how do we support the team? How do we be good leaders in times of crisis? Andy and I leaned into some of our own experiences and really wanted to talk through what do we do and how do we do this. I hope that this helps. I hope that it is a really good episode. Andy and I really enjoyed this conversation. So let's get into this one.

Speaker 3:
And now, The Uncharted Podcast.

Andy Roark:
And we are back. It's me, Dr. Andy Roark, and Stephanie, she drives me crazy, Goss.

Stephanie Goss:
I was waiting for a good one. Are you going to sing me the song, please?

Andy Roark:
She drives me crazy. I was thinking, we're like 200 episodes and change, and it's getting progressively harder to find names for you.

Stephanie Goss:
Hey-

Andy Roark:
I do want to say something to you because I've got a website here.

Stephanie Goss:
You started this game.

Andy Roark:
The 1,001 awesome nicknames, is what it is. And I'm like, I need to pull from this. And so I'm looking at it, and how do you feel about, and we are back, it's me, Dr. Andy Roark, and Stephanie, the talent, Goss. They've got-

Stephanie Goss:
Awkward.

Andy Roark:
Stephanie Tomahawk Goss. They've got animal themed ones. Stephanie the Mastodon Goss, or just Wild Cat Goss.

Stephanie Goss:
It puts me back to grade school when dumb boys used just random things to make fun of you.

Andy Roark:
Stephanie, Lord Privy Seal, Goss.

Stephanie Goss:
I can't with you.

Andy Roark:
What if I just called you subwoofer? Okay, I don't know what to do with this list, but someone put a lot of time into this, and these are good. Cornflake. If I could go back to being a child, I would have a friend and his nickname would be Cornflake. And I don't care, it would get tagged on someone.

Stephanie Goss:
For me, it was Snuffleupagus.

Andy Roark:
No. Really?

Stephanie Goss:
Yeah, that was about the fifth-grade dumb boy teasing. Got pretty epic with Snuffleupagus for a long time.

Andy Roark:
Oh, man. I told you I gave myself a nickname, right? The camp story. My brother and I were going to that summer camp and my mom was like, “It says here, it asked if you have nicknames, do you have nicknames?” And I said, “Yeah.” I said, “I'm Hawk and he's Ace.” And my brother and I were Hawk and Ace when we went to camp that year.

Stephanie Goss:
Did anybody actually call you Hawk or Ace?

Andy Roark:
Oh, yeah. Oh, they went with it. They were like, “We're supposed to call him Hawk.” Yeah, they called me Hawk. I was embarrassed by it by 10 minutes after I was there. I was like, this was a bad idea. It was one of those things where like three months before summer camp when you're filling out the paperwork, it seemed like a good idea. When you were actually there and people did it, it was like, no, this was a mistake.

Stephanie Goss:
That's fantastic. I love it.

Andy Roark:
Oh man. How have you been?

Stephanie Goss:
It's busy. It is full-fledged fall. We had our first storm of the season out here yesterday, and it was crazy. I live in the boonies so we lose power. I went to try to go to the post office to mail actually something to you and something to Tyler, and there was no power. And I was like, I guess … I'd been carrying it around in my car for a week and I was so proud of myself. I'm like, I'm finally going to the post office. No power. He's like, “I can't help you. I can't print stamps.” I was like, “Gosh darn it.”

Andy Roark:
Yeah. Oh boy.

Stephanie Goss:
How have you been?

Andy Roark:
Oh man, living the dream. I was like how have I been? Just running as hard as we can, building out next year at Uncharted. It's going to be amazing.

Stephanie Goss:
I feel like it's the time of planning this, it was always this way for me in the clinic too. Fall hits and you've got all of the craziness of the end of the year, but then you're also excitedly thinking forward to the new year, of what are we going to do? What changes are we going to implement? What are we doing for marketing and social media and all of that kind of stuff? And I always enjoy this time of the year, but I feel like it adds a whole layer of chaos to the chaos that already exists in the fall.

Andy Roark:
Yeah, I do agree with that. I will tell you that part of growing a business is planning farther and farther forward. So when you have a small business, you don't have to plan all that far in advance. And then the more people you have to coordinate, the earlier you have to plan and start communicating what you're doing. And I'm not saying this as a joke, this is really what I've learned.
And so it used to be that December was the time of planning for the next year, and then it was November and now it's October, pushing into-

Stephanie Goss:
July. August.

Andy Roark:
Honestly, it was like by September we really need to be working on what we're doing next year, like really need to be working. And I'm like, it's just interesting that things change, and I think that everybody wants to believe that there is a plan that a quote unquote good business runs. And I'm like, it wholly depends on where you are in the lifespan of your business and the size of the business and the type that you have.
And just one of the big things that you and I talk a lot about is it's not one size fits all. It depends on your culture and your team and your location and your objectives and your challenges and the skillsets of your people. And all these things play into how you run your business. But that also means that as those things change, the way you run your business is going to continue to change.

Stephanie Goss:
Well, and I think it's funny because we get asked questions a lot where the answer is if you have a team of three, you have a doctor and a technician and a CSR, the answer's probably vastly different than if you have a team of 100 or 30 or 23. And we talk a lot about that scale, and it's funny because you think about it uniquely siloed to the perspective of the clinic, but when you zoom out, those same problems exist in a different way in every business as it grows and as it scales.
And it's funny, I've been reflecting a lot on how a lot of what we're going through as a team in Uncharted is very similar to a lot of the things, different specifics, but same rules apply to a lot of the questions and things that you struggle with in the clinic. So on one hand, it's nice to know that you're not alone because everybody has the same kind of challenges.

Andy Roark:
Yeah. I remember I was in vet school and there was an essay contest, and it was a business essay contest. And I was like, I'm going to crush this. I'm going to tee up on this essay contest. And it was about, I can't remember the specifics of it now, but it was something about you're having this sort of toxicity or whatever inside this practice, or they're trying to get the practice organized. I can't remember. There was a growth thing going on.
Anyway, but I distinctly remember it was a one vet practice is what it was. And I think based on the finalists of the essay among which I was not one, it became clear that they were looking for this organizational idea, and the winner was like, “Well, we need to have department meetings and a surgery department meeting and all these other things.” And I remember just sitting there and looking at it and saying-

Stephanie Goss:
They have one doctor.

Andy Roark:
It's a one vet practice. What are you talking about? In my thing, I was very much like, these are important conversations. I thought on an individual level, I would make sure this person is on board with this and talk to this other person about this and understand their feelings on that. And that was not what they were looking for. They were a hundred percent looking for an org chart of how these things are going to go. But I just remember being like, “A surgical team meeting in a one vet practice?” You know what I mean? And it was so overbuilt, and I just, I've never gotten past that.

Stephanie Goss:
That's funny.

Andy Roark:
Anyway, just the dissonance of what they said it was and then the organization that they celebrated, I was like, these things are not compatible. What are we doing? Anyway.

Stephanie Goss:
It's just funny.

Andy Roark:
I hold that up not because I'm still bitter about losing the contest in vet school.

Stephanie Goss:
Uh huh, sure. Nope, not at all.

Andy Roark:
But because it goes to my point of I think that a lot of people think that there is a way that a practice is supposed to run, and I'm like, that's not correct.

Stephanie Goss:
So all of this has nothing to do with what we're going to talk about today. Storytime.

Andy Roark:
We should note the recording time and just let people know you can just skip to the four-minute mark if you like.

Stephanie Goss:
Storytime with Andy and Stephanie. No, we have a good one today. And so this is going to be an episode. It's interesting we've gotten some, I've been kind of collecting a few asks from the mailbag and they're all very different, and I don't want to share specifics from any one of them because I think they're representative of a bigger concern. And they were situations where something catastrophic happened in the practice from a medicine perspective.
So a patient escaped, got off the leash and escaped, or they had a death under anesthesia, or a patient was not under anesthesia, was just in the care of the hospital, and died. Things that are really either accidents or out of our control where there actually wasn't anything wrong. When you zoom out, and bless you all for giving us specifics, when we zoom out and look at the questions we would ask to make sure that we did the right things along the way, all of those boxes were checked but something catastrophic happened and you have the reactions of the clients and the people immediately involved.
And in all of these situations, obviously there was upset and anger and hurt and emotions on the part of the clients. And that is then all getting directed at the doctors, at the team, at the hospital. And in several circumstances, we've done episodes on this before, it explodes into the online arena. And then there is bullying and cyberbullying and people who are not a part of the immediate family berating the clinic and the team. And in some instances, personal information is getting shared online, people are being called by name, they're getting attacked.
So unfortunately we've seen enough of these circumstances in veterinary medicine in the last few years, and I was holding onto these because I wanted to talk not so much about what do we necessarily do in the moment, although a little bit of that, but there was some questions that were asked in each of these that really stood out to me because they were not so much related to the how do I deal with this, right? Should I get an attorney? Who should I talk to? But they were about, when we think about the bigger picture, how do we keep the team safe? How do we lead the team through challenges like this? And there were several cases where people were like, I feel like I did the right, we got an attorney, or I work for a company that has an HR and a legal department, and they were there to help us with all of the paperwork pieces of it, but how do I support the people who are involved?
And my heart went out when I read some of these because these are good people who are trying to do the best for their teams and their patients, and they're just feeling really, really overwhelmed with how do I create the space, the emotional space, and how do I deal with it? And I thought this is really good for Andy and I because so much of it is headspace, which is what we spend a lot of time talking about on the podcast.
And then also, there are actionable things and what can we do to help the team in specific. So some of the questions that I really liked is when the worst case happens, when clients are angry about something, how do we keep the team safe? How do we lead them through the challenges, and really, how do we handle the extra sticky situations like this?

Andy Roark:
Yeah, no, I'm glad you brought this up. And I really like the fact that they broke this apart and said just the people part. And I go, great, because this is a big sticky wicket. And depending on the specifics of the case, I would give you different advice on handling the other things. I really like the way they set it up and they were like, “We got our lawyer, we got our liability insurance people involved. We are checking the boxes, we are covering our bases, we've got the social media part under control. We've locked down things, turned off comments, we've done stuff.” All right, so I really like this a lot.
So what do we say to the team? I think one of the big things is the way that we address this with the team is the way that we address trauma with any group of people, whether it's family or any group of people who are going through a hard time. I think the first thing we do is acknowledge the elephant in the room. And that may sound silly, but a lot of people miss that trick because they're like, “I don't want to bring it up because they might not know.” It's like, they know. They are acutely aware, and you not talking about it, it doesn't show leadership, it makes them feel isolated and cut off, or it makes them feel powerless. It makes them question what is being done? What should we expect? Are we just being left alone in this?
And so I think it starts there. I think the first thing is start with the elephant in the room, is having some clear conversation that just says, “We see that this is going on.” And I don't want to heighten it. I don't want to say, “Boy, really hope people's addresses don't start getting posted online.” Don't give them ideas, don't heighten this beyond where it is. Resist the urge to let this spiral into something else. And I think that's a big part of bringing it back.
So I'll talk about the spiral part in a second, but that's how I would open it up, is to say, “The first thing to know is the staff is aware of this.” I think your job in leadership is reassurance. You don't have to fix the problem, you don't have the power to fix the problem, but let them know that they're not alone and you see it and we're this together. I'm not going to let you sit up at the front desk and be abused while I stay back in my office and pretend this isn't happening.

Stephanie Goss:
And on the flip side of that, I think, you said that the team is aware that this is happening. And I think that that's true. And I think that our first inclination, my first inclination, I had a situation where we had a patient who was in a carrier, we were bringing it in from the parking lot. The client was walking beside the member of my team. And it was a large cat, and they got freaked out by a noise in the parking lot and shifted their weight, and the carrier dropped and it popped open and the cat exploded out of the box and took off and was gone for three days. And it was hugely scary.
And the team who was there at the time that day knew what was happening because the person ran inside and said, “Hey, I need a couple of people to come help me fan out. We're going to look for the pet.” But then the rest of the day goes on, we still have patients, other patients that are being seen. Not everybody knows. And I think my inclination at the time was to try and control the potential for the game of telephone. And so I was like, “I only want to tell them what they need to know.”
And I think there can be the inclination to lean into not telling people because it's like you just keep doing what you're doing, don't worry about what's happening over here. And so I think on the flip side of that, it is important to know that when something like this happens, particularly if you have a larger hospital where team members aren't present, it's really important I think from a headspace perspective to think about how do you make sure everybody is aware of what happened and not so much everybody needs to know all of the details.
Because I think that is an important piece of the action. They don't need to know all the details. And sometimes, especially if it's a case where it's a legal situation, you might not want to tell them all of the details. But I do think it's important to make sure that everybody does know what happened. So the next, if you're on shift and you have a death under anesthesia, man, that is freaking hard. Those are some of the hardest days in veterinary medicine, and I hate to say it, but when you come in the next day, maybe you've been able to tamp it down and you're trying not to think about it, but it usually doesn't mean you've shaken it off.
And if you're working with somebody who wasn't on shift the day before, they're not going to know what happened and they're also going to not know maybe why you're acting the way that you are or where your head is at. And so I think it is important to make sure that everybody knows, hey, this is what happened. And that there is a process to talk about those things when they do happen.

Andy Roark:
Yeah, I think that that's a really good point. I think one of the things that I, one of the first things I want to talk about with the team, and now we're shifting away from dealing with medical mistakes, which we have a podcast episode about that and communicating that with the team and things like that. I'm shifting a little bit away from how we communicate medical mistakes inside our team to the client component. Because that's specifically what we're talking about, is when the clients go on the warpath and they go on social media and there's this external nastiness coming in.
I think one of the things that I want to do, so we start with communication about the elephant in the room, and the next thing that I want to talk about is valid versus invalid anger. And it's about, I think part of the communication stuff with the team is hey, we empathize with people and we try to understand where they're coming from and how they're feeling.
And I feel like we have done that. We want to do that, we want to think about this from their perspective. And at some point, there is a limit to what is valid in people's behaviors. Can you be upset because your pet escaped for three days? Of course you can. Can you make death threats to the people who own the building? No, you cannot. That is not normal, rational behavior. And sometimes we just have to call it out, especially for the people who are dealing with the client, because people will say, “You are horrible, you are a terrible person. I hope your children are injured,” blah blah blah. And sometimes when people say that to us, a voice in our head says, “Do I deserve this? Did I mess up this bad? I know this went really badly, but do I deserve this?”
So I think bringing your people together and saying, “We are going to empathize with these people, and then also, we are going to be clear about what is acceptable and what is not acceptable and what is unreasonable and what is unwarranted.” Because I do think that a lot of people struggle, especially, I tell you, I can remember cases in my past where things have not gone well and the clients have blamed me for things to my face. And I have eaten myself alive, saying, “Why didn't I anticipate this? Why didn't I see this coming?”
And I needed another doctor, my friend, to come to me and say, “What are you talking about Andy? You're not omniscient. You didn't do anything wrong. You didn't imagine everything that a pet might do in that moment. That's not failure, that's being a human being.”
And I just think it's really important to have those types of conversations about what happened and then about what is a reasonable reaction that pet owners can have and what behaviors are over the line. And that gives people permission to put up some barriers. It gives people permission to feel sadness for this person, responsibility, upset, and also say, “And at the same time, you posting online in every forum you can find that I'm a terrible person, that's not okay and that's not warranted and that's not justified, given what actually happened.” And so sometimes it is those conversations to validate what is okay and what is not okay.

Stephanie Goss:
Yeah, I like that. I like that a lot. I also think it creates an opportunity, too, for the team to talk about some of the things that might actually have nothing to do with this situation that's currently going on, but that may have happened in the past, that kind of got set aside, like the emotional blackmail situations with clients. It opens up the doors and creates opportunity to talk about those things, particularly with your front desk team, who gets it really, really bad sometimes from clients, about what is invalid anger, what is invalid behavior? Not just in terms of they're in the lobby shouting, but the specifics of what they're shouting. Where do we draw those lines?
And I think the good part is that it opens the door to having those conversations because in the moment, I think a lot of the time we may not take the time to have that because we're trying to let the emotions process and dissipate, like let's calm down before we have this conversation. And then I think a lot of the times the chaos of every day, it comes into play, and we have the best of intentions, but I'll be honest, I didn't always circle back and have those conversations.
And so I think taking it as an opportunity to say, “Hey, let's talk about some things that we have experienced, and we don't need specifics. We're not going to rehash old situations, but what are the specific behaviors? What are the specific instances that you guys feel like would be invalid behavior, invalid anger from a client?”

Andy Roark:
Yeah, I think those types of conversations are important, because here's the thing, and this is why it's important to have the conversation too, is the question is how do I help support the staff? I can tell you, Stephanie Goss, that I think what you're dealing with is complete garbage and no one should talk to you that way or no one should say that to you. Me telling you that is never going to be as powerful as you coming to that conclusion for yourself. And so me asking you, well, what do you think is valid and what do you think is over the line in the interaction that you had with this person?
And if you can say, “Well, I understand them being mad, and I would be mad too.” I would say, “I agree.” And you say, “But I do not think that they should use homophobic, racist language, slurs, whatever, profanity, whatever they're doing. I don't think that they should do that.” And I would say, “I agree with you. I do not think that that's acceptable.” And now it's not me just saying, “Hey Stephanie, that's not acceptable,” and I'm telling it to you. You're coming to that conclusion on your own, and there's real power in hearing your colleagues say, “Well, this was not okay,” and just coming to that consensus.
And so I'm trying to build solidarity, and that's why we have these conversations about what do you guys think about this? Now, the important thing is I think it's good to go here and have this conversation about what do we think and what is over the line in how we're being treated, how do you guys feel about what's happening? I think that's good, but we want to bounce out of that area fairly quickly. I want people to be able to say and validate and reach a consensus about what is justified and what is not, and then we need to move on.
And so I want to evolve the conversation from that to, okay, what will we do or can we do to prevent things like this from happening again in the future? And the answer may be nothing. It may be this is a hundred percent out of our control. This was a lightning strike thing. The owner put the cat in the carrier, and the carrier was not put together well, and it didn't even make it across the parking lot to us. I don't know what we do. Maybe send people a text reminder to make sure if they have any questions about assembling their cat carrier, they can call us. I don't know.
So for example, we had a case years and years ago, I worked at a place and we had dog boarding, and a thunderstorm came up and this dog that we did not know was storm phobic just went bananas. And I can't remember how he got out of his run, but it was something that should not have happened, meaning he tore through chain link or something. Something you go, superhuman panic. It's heartbreaking, right?

Stephanie Goss:
Yes.

Andy Roark:
The panic. And then the dog sprints down the hallway, jumps up, hits the bar on the emergency door, and is gone into the night in the storm. And it's just like, oh my God. The question is, what can we do differently? Is it questions, direct questions about how does your pet respond to storms? Things like that. Maybe if we can't do anything to, we should lock the fire door. You can't do that. That's not going to go over. But are there questions we can ask? Are there other things? Maybe pets that have storm phobias, they go into different areas. Maybe there's a different monitoring, I don't know what's possible. We can get creative.
It's called credibility. And when I teach dealing with angry or complaining clients, I talk a lot about credibility. Credibility is figuring out what happened, why it happened, and what we're going to do to prevent it from happening in the future. And I like it for a couple of ways. Number one, it's one of the most powerful things you can say to the pet owner. You can say, “This is what happened, this is why it happened, and this is what we're doing to prevent this from ever happening again in the future.” And it's owning the mistake in an appropriate, productive way and talking about how this is going to be taken care of and it's not going to happen to anyone else again. And that is a very powerful thing that often doesn't happen.
So I like it because it is cathartic for the pet owners. It makes them feel like justice is being served and moving forward and this has been owned and it's being fixed, but also, it puts the power of the situation back to some degree into our hands as vet professionals and say, “All right guys, what in this situation do we have control of? We have control of what we do to prevent this in the future.” And so it's giving some power back to people who might otherwise feel powerless.
Finally, it also gives you clear talking points. So if you are being attacked from the outside, on social media, things like that, I don't want my people engaging on social media. However, if we're going to communicate, we can communicate what we are going to do or what policy changes we are making to make sure this does not ever happen again. It shows how much we care, it shows that we're working on it. It is a positive thing to put forward to say, “We are reviewing all of our policies and protocols. We plan to make some updates to things that will prevent accidents like this from occurring in the future.” Things like that. And again, without knowing specific, without talking about specific instances, I can't tell you exactly what the wording would be.

Stephanie Goss:
And I think one of the things too, and this certainly does not apply in every situation, but I think that there also creates opportunity there. And it's why I feel really thankful that I have the tool in my toolbox of knowing that I can always apologize for the impact to somebody. I can't apologize for something that was out of my control. Like your example, I can't apologize that a storm hit. I do not control that. But I can absolutely apologize for the impact that it had to them because I am sorry, I am so sorry that their pet was so scared and that it escaped and that whatever happened to it happened. And even in that worst case scenario, I can empathize with them, and that is a superpower here.
And I've been in the situation where empathizing with the owner, and to your point, Andy, having the conversation with them to say, “I can't change this for you. I wish that I could. I can't change it for you. I can't make them come back.” I remember being a very young practice manager and having a situation happen in our clinic where a pet that was supposed to have a private cremation was not tagged and they were group cremated. And I remember it was my first time handling something big like this, and I remember sitting in an exam room with the client and I remember just looking at her and saying, “I wish that I could fix this, but there's literally nothing that I can do to solve this for you. But I want you to know that I am hearing you, I am seeing you, and if I could make this different for you, I would. And I need you to understand that I'm going to do everything in my power to make sure that this doesn't happen to somebody else.”
And that may not bring them comfort in the moment, but being able to say that opened the door for that client, who actually called me a couple weeks later and said, “I've been thinking a lot about what you said, and I have some questions about what you do do.” And they were wonderful. Unfortunately, it was one of my all-time favorite clients, but she had this conversation with me and she asked me questions that I hadn't yet thought of, of what were our processes in the clinic.
And it actually helped me figure out how could we help prevent this from happening again. Because they weren't looking at it from the narrow inside perspective that I was, which is like, what are we doing? How can we fix this? She was asking different questions, and it enabled us to look at our protocols and processes in a way that was completely different and helped us solve some of the challenges. And I think we don't get to do that if we don't open ourselves up for that vulnerability. And it's not always right. There are absolutely circumstances where I would not touch that conversation with a 10-foot pole and without an attorney present, right?

Andy Roark:
Yeah, sure.

Stephanie Goss:
And at the same time, I think we can always apologize for the impact.

Andy Roark:
Yeah, I like that. I just start tying credibility and apology together. I think it's important.
I met this vet one time, and we were just talking and we were just telling stories. And I wasn't speaking, I was at a CE event, I was totally doing my own thing. And I met this guy and we were just talking and it was kind of, you sort of bump into somebody and you're just killing time and one thing kind of leads to another and you end up having this really weird, deep conversation. You know what I'm talking about?

Stephanie Goss:
Yep.

Andy Roark:
It was that. I was talking to this guy and he told me this story, and I don't remember if I asked him for a, I don't remember how in the world I got him to tell me the story, but he said, and I swear this is true. He said, “I've got a story for you.”
He said, “I was doing a dental cleaning on this cat, and the clients were wonderful clients. They had multiple cats who came to our practice.” And the cat had a mouth gag when it was intubated, and they extubated the cat and put it into one of the dens to recover, and nobody watched the cat. And it comes to the end of the day, the cat's dead in the den. And he goes and he looks and the mouth gag was still in. Nobody pulled the mouth gag.

Stephanie Goss:
Oh no.

Andy Roark:
And so the cat suffocated and died.

Stephanie Goss:
Oh no.

Andy Roark:
And he said to the pet owners that there was an unexpected complication during recovery and the cat died.

Stephanie Goss:
Oh no.

Andy Roark:
And the owners were just distraught and they went home. And he sat there and he just couldn't live with himself. And so he leaves the clinic and he goes and gets in his car and he drives to their house, because he has their address, and he knocks on their door and he tells them, “What I said was not true. This is what happened.”

Stephanie Goss:
Oh no.

Andy Roark:
And, “I am so, so sorry.” And he said, “I'm going to figure out how to make sure this never happens again.” And those clients were involved with him figuring out what the protocols were going to be in the future, and he kept them in the loop about what they would do. And he kept them as clients, and they continued to come back because they were like, “You came and you sat here in our house and you owned up and you told us what happened and then what you were doing about it.” And he kept them as clients.
I have never forgotten that story of just like, I get it. You know what I mean? It's the human experience on display where this is a terrible mistake and you can't fix it. And I understand panic and saying, well, just tell them there was a complication. Which is technically true. I get it. I get that impulse. I also get the impulse of being eaten alive by guilt and saying that's not true and that's not fair.
So anyway, but I've never forgotten that story of just owning it. This is what happened, this is why it happened, and I'm going to figure out how to make sure it never happens again. And I'm serious about that. And so I do think that those types of conversations about what can we own here, again, after setting aside what is, as far as anger, what is valid and what is invalid, then we can say what are we going to do about it? Because if you don't set aside valid and invalid, you make people feel like they deserve, we made a mistake and we deserve this. You have to pull those apart. I think that's really, really important.
I think that when we start talking about where do we go from here, one of the things that you're going to battle in yourself for very, very valid reasons, and in your team, is defensiveness, right?

Stephanie Goss:
Yeah.

Andy Roark:
I mean, when people are online attacking you, it feels awful. And you do get defensive and you feel like your reputation, which you have worked so hard for, is being destroyed. And I've got a news flash for people. Brace yourself, buckle up. You're not going to hear this coming. You're not always treated fairly in the court of public opinion.

Stephanie Goss:
Imagine that.

Andy Roark:
And I talk a lot about this too, and this is one of the things I'm really anti-social media, I'm really anti-social media in general these days in a lot of ways. But this is one thing I'm specifically, intentionally, very much over the top focused on, is the fact that veterinarians make great villains online. Everybody hates a hypocrite. It's why Ellen DeGeneres got torn down, like career ended when people found out she wasn't nice. If people found out Clint Eastwood isn't nice, they'd be like, yep, that tracks. You know what I mean? Like yep, he's a grumpy-

Stephanie Goss:
He's a grumpy man.

Andy Roark:
Being nice is not required for adoration unless you're Ellen DeGeneres, who has this reputation of being the queen of nice. James Corden is getting torched right now because of being crappy to a waiter. And I don't know whether he deserves that or not, but you can't convince me he's not getting torched entirely because his whole persona is Carpool Karaoke, happy, fun guy. And people go, “He's pretending to be happy and fun. In reality, he was nasty to a server.” And so they torch him for it. People hate a hypocrite.
And the problem that we as veterinarians have and vet professionals is, is that we have Ellen DeGeneres' reputation, we have James Corden's reputation of being the fun, wonderful, happy, loving people who would do anything for you. And then when things don't go right or when we're not able to do anything for you, we take the fall like Ellen and James Corden do. Because if your attorney, if someone's like, “My attorney screwed me over,” people are like, “Welcome to the club. Are we getting mad about that now?” It's kind of a thing that they're known for. And my brother's an attorney, I can say that. But no one gets their hackles up when people say, “My attorney is a crook.” They're like, “Of course he's a crook, he's an attorney.”
And that's not fair to attorneys. But I just use that to illustrate the difference between them and veterinarians. And in this social media world, being dubbed a loved profession, it has a downside. And it's that you make a great villain, you make a hypocrite, you make a horrible villain. And so I don't know that attorneys get mobbed the way that we do by strangers who don't have any idea what's going on. And maybe I'm wrong in that. But I do think that we are uniquely situated to get absolutely hammered on social media by faceless mobs.

Stephanie Goss:
Yeah, I think that makes sense. And we know that the keyboard warriors exist because there is the facelessness, right? People can say whatever they want and there's no consequences because there's a screen and a keyboard between them and the people. And I think that we've talked about this lots of times on the podcast, how social media has this ability for people to be able to be big and scream and rant and have it be this huge thing.
And I think it makes sense, what you said was a light bulb moment, because it totally makes sense. People think about veterinarians as the big hearts, the all creatures great and small. And it's at the heart of a lot of our challenges in veterinary medicine, particularly when it comes to things like money, but also when it comes to problems like this because then we make a really good, easy villain.

Andy Roark:
Yeah, that's my point. So I think that we get unfairly targeted or we draw passion from online mobs in a way that a lot of other professions don't. Nobody mobs the auto mechanic. Not that I can see, but maybe, again, maybe if you're in the auto mechanic Facebook group you're seeing a lot of things I'm not, I don't know. But it doesn't feel that way to me. It really is, everybody online hates a hypocrite. And when people say, “These people could have saved my pet and didn't. They charged me for money that I couldn't afford and they wouldn't take care of my pet,” we hit that-

Stephanie Goss:
It's an easy target.

Andy Roark:
… button in their mind. And we get torched in a way other people don't. And that's why I think I specifically look at social media as being bad for vet professionals. Now what I was saying was, resist the urge to get defensive. The reason is because it does not help. If you are wading into an irrational mob, it does not help. And again, I've had lots of debates with other people about responding to negativity online. And I will be up front, I own my position and I have had plenty of people who are very, very smart argue with me on it. My position remains unchanged, with very rare exception. It is better not to engage.
And people are like, “No, you should do it.” No. You should talk to the individual who's involved, you should communicate, you should do things like that. But wading into online drama does not tend to go well. It just doesn't. All it does is re-attract attention, stimulate people to post more, to write more, to call more. And it keeps the drama going, as opposed to laying low and letting it go.
And again, this is very much about the specifics of the case, but I think people feel too much of a pressure to respond to the masses. And I don't think those people deserve a response. They don't know what's going on. They don't have the information. And you are not going to change their mind because they don't want to have their mind changed.

Stephanie Goss:
Right, exactly. Yeah.

Andy Roark:
You can choose to be righteous or effective, and if you want to be righteous, you can wade into the crowd with your flaming, raging sort of justice, seeking to defend your honor. You can do that, or you can be effective and to say, “How do I make this go away as fast as possible?” And a lot of it is don't engage with it, and it's going to run its course in three days and it will be a distant bad memory in three weeks.

Stephanie Goss:
How do you feel about taking a break and then coming back and talking about some of the actual, like some of action steps in particular for how do we support a team?

Andy Roark:
Yeah.

Stephanie Goss:
Hey friends, it's Stephanie, and I'm jumping in here for one quick second because there's a workshop coming up and it is one of the last ones for this year of 2022. And I want to make sure that you don't miss it because it is coming to you from my dear friend Maggie Brown-Bury. Maggie is a former emergency veterinarian who lives in Newfoundland, Canada. And a few years ago, Maggie made the decision to make a change, and she moved out of ER medicine into being a relief veterinarian. And I remember Maggie telling us within weeks of opening up her schedule, her whole first year was booked.
And so we asked Maggie to come and do a workshop for how to get the most out of the relationships that you build as a practice with your relief veterinarians. Because more and more practices, as we face the veterinarian shortage, are struggling with needing to have relief doctors on their schedule, maybe more regularly than we would have previously. And Maggie's got some great ideas after working with a ton of different practices on how you can leverage that relationship and set yourself up for success, set your relief veterinarian up for success, and set your clients up for success. So if this sounds like something you'd be interested in, head on over to unchartedvet.com/events and find all of the information about the workshop and how to sign up. I hope to see you there. And now back to the podcast.

Andy Roark:
All right, let's start to transition a little bit. I've ranted about the internet and mobs and negativity.

Stephanie Goss:
You, Andy Roark, getting on a soapbox?

Andy Roark:
I know. All right, let's change this into some actual action steps. So number one, like I said, open communication with your team about what's going on within legal boundaries. Obviously we don't fill you in on the details on something that may be going to the state board. But they need to know what's going on, especially if they're getting hate from outside, the phones are ringing. They need to know what's going on. So part of it is they need to know that this is not being ignored. It is being worked on, that it's being addressed. That's number one.
Number two, we should have a conversation about what is valid here and what is not valid here. And so that we're all in agreement and we can have this conversation and support each other. We can start to shift the conversation from there into what are we going to do about this? Where do we go from here? How do we prevent these things from happening in the future? And part of that is making our people feel empowered. And it's also about coming up with what our talking points are going to be.
And that's the next part for me in this, and this is still equipping your people, but it's figuring out what are the talking points that they're going to have? What are they going to say when people call? What are their options? And they don't have to talk everyone into pieces. My favorite thing is called the broken record defense, is where you say, “This is what we can say, this is what we're working on, this is where it goes from here. And that's really all that I can tell you.”
And when people ask questions, basically you end up with-

Stephanie Goss:
Repeating.

Andy Roark:
Those little three pieces of information, and we give it, but we're not going to get drawn off track. We're not going to comment on other things. No, we're not going to connect you to the doctor. This is where we are. And it's helping people know what to say so they feel prepared and they feel supported.

Stephanie Goss:
Yeah. I think for me, when I think about the question of how do we support the team, it struck me because in one of the mail bag letters we got, they were like, “We had the legal side of this covered and that was great.” And I think it's important to say this is when the worst things happen, right? We're talking about the really unexpected and the things that are really catastrophic for an owner. Do not DIY this. Do not go it alone. This is where you pay professionals.
And my fellow private practice owners, this is where we have to say, we're going to dig into our pocketbook, because you should not, and [inaudible 00:50:31] is wonderful and they have attorneys on staff and obviously you should utilize all of the liability resources that you have. But this is also, especially, especially if people are sharing, calling people out by name on social media or in reviews and stuff, giving personal information about your team, you have to outsource this. You have to get a lawyer and get help because there's so many ways that they can help. And even if it's not something that they can provide, they can provide you additional resources that you should have at your disposal for those catastrophic situations. So don't go it alone.
And I think for me it's the same when it comes to supporting the team. This is where we need to lean into thinking about our responsibility as employers. And so I'm going to put on the HR hat for a second and step on that soapbox because at the end of the day, it is our responsibility to provide a safe workplace. And so if we have catastrophic situations which are inevitable, we can't control everything in veterinary medicine and accidents are going to happen, we have to still provide a safe workspace for our teams.
And so if there are situations like this and a perception is that we're not doing things to make it safer for our team, we can absolutely be sued as employers. And so I say that not to create fear and make you panic and go, “Oh God, that's another thing that's going to keep me up at night,” but it is something that we should think about.
And so for supporting the team, you and I, Andy, talk a lot for a variety of reasons of why, and employee assistance programs or EAPs are great, that is a really easy first step here in terms of supporting the team. So having a program in place where they can get assistance, including counseling, because when we have situations like this, where especially if a mistake was made, having access to counseling, having access to professionals who can help your team talk through those situations and deal with the emotions that they are going to feel, is really, really important. And if you don't have an EAP, or even if you do, depending on the circumstances, you may want to consider outsourcing additional help, like bringing in a grief counselor to talk to the team as a whole or individually, offering ongoing therapy for your doctors.
Generally, every time I had a doctor have a board complaint, part of it was that they needed to have access to talking to somebody. And if they declined, that was fine. But I wanted them to know that, hey, this is hard. You're going to have to defend yourself, and even if you did nothing wrong, that is a hard thing to go through as a human being, and I want to recognize that and provide you the opportunity to have someone who is professional. It's not my job as the manager, it's not my job as a practice owner, and I'm not qualified to do it, but you should have access to somebody. So providing them the support and resources that are professional I think is really important.

Andy Roark:
Yeah, I agree with that. So at Uncharted we have BetterHelp as an employee benefit, and it's not a plug for BetterHelp, but it's the one that we use and we have. So the way it's set up, I actually like the way it's set up. The way it's set up basically is you set it up as an employer and then if people want to schedule time with a counselor, they can. And I don't know those who use it and who doesn't. I get a breakdown on how much it was used and things like that. And that's it. It's not super cheap, it's not super expensive, but it is a thing that we've done as an employee benefit.
I don't see anything wrong with having it as a short term employee benefit if your staff is going through something like this, and what if you said we're going to offer this for three months and anyone who wants to have a counselor for three months can have it, and that's what we plan to do. It was not hard to set up. It has got some nice privacy controls on it as well, and it was just a thing that we were able to make available and our people can use it as they need to.
And so anyway, I like the EAP a lot. If your EAP has limitations in how much counseling there are or if you feel like your team needs something more than that, there are other ways that you can access professionals and get them some support as well.

Stephanie Goss:
I think the last thing in terms of resources and professionals that ties to this, and it's a little bit of the in the moment, but also a little bit of the abusive behavior, and so your team should know who to call for help. And I say that because I had a situation where we had a client who was being verbally abusive. It started pretty mildly in the lobby and escalated very quickly. And when I found out about it and then they went out, they finally left the building and they were hanging out in the parking lot. And when one of the team members went out to get another patient, they physically accosted the team member in the parking lot.
And when I was asking the team about what happened, because I wasn't there at the time, they were just like, “We were fine. We felt like we could handle it.” And I asked the question, I was like, “Did anybody call the police?” Literally the police station was across the street from the practice. They were like, “No.” I was like, “Why not?” And they're like, “Well, because it didn't feel serious enough.” And I was like, “You guys.” Then it opened up an opportunity for us to talk about it as a team because the person involved didn't think that it was a big deal. But when I looked at it, I was like, dude, if they're physically accosting us in the parking lot, you should have called the police because that's what they're there for. They're there to help protect us.
And I think it goes back to what we were talking about earlier, Andy, which is you want them to bring up the ideas, but also, we're all going to have different ideas on what the level of invalid is, righteous, or sorry, valid or invalid anger. And so for me, I was like, this is invalid behavior. This is a line in the sand. And it created an opportunity for the team to talk about it and for us to talk about those protocols of what do we do for personal safety, what does that look like, at what point? And we had a wonderful conversation, and it helped pave the way for me to create this rule with my team, which is no one should ever feel like they cannot pick up the phone and call 911.
If there is truly, they feel threatened or intimidated, that's what I want them to do before they do anything else. Get a professional there to help you. And I can think of a whole multitude of situations in veterinary medicine where that might be applicable, but your team won't necessarily use that if they don't feel like you're advocating for it.
And so I think part of it was having the conversation open the door to me in my mind, even as a manager, of like, hey, remember when you're in grade school and you do the safety drills and you know to get under the desk and duck and cover when we have an earthquake? I lived on the West coast as a kid, obviously. That's a thing for a reason and it kind of stops in adulthood, but it shouldn't. Like when we think about our practices, for me the last piece of this is we should be prepared for what we can be. And some of that is the safety drills. It is knowing who to call, when to call, and having those ongoing conversations, but also practicing it so that everybody knows this is what we do when those catastrophic things happen.

Andy Roark:
Yeah, I like that a lot. I think that that's really good. I think that those are some hard and fast resources for keep taking care of the team. There's one more sort of soft resource that I want to add to this, and I need to couch it just the right way because I don't want it to come off wrong. When people are going through cyberbullying or they're feeling this pressure from clients, they're feeling a lot of negativity, it's important to [inaudible 00:58:21] everything that we talked about, justify them, validate them, support them, all those sorts of things. I find that it's really important to try to point to the good things that are going on in the practice and what is going well and the good that we do in the world. And I'm not saying that in a way that invalidates the bad feelings that they have.
So there's two things that I point out. I picked my daughter up from high school yesterday and I was taking her out, she wanted to get a birthday gift for one of her friends, and so we had to drive. So I pick her up at 4:30 and we're going right into traffic. And Greenville is a growing city and we're going into the city part, and it sucked. The roads were packed, and there was this guy in this like BMW SUV and he was driving like a maniac. He came shooting down the road, he did that thing where he was in the left lane, he cut right behind me. He literally missed my back bumper by three feet, you know what I mean? As he cut all the way over in the other lane, and you just see him cutting people off and cutting back.
And he's doing that thing where he's driving wildly, aggressively, and he gets to the stoplight one car length ahead of where he would've been if he had just calmed the eff down, you know what I mean? And driven. And you see the guy and he's cutting through and just, he's driving like a maniac. So I get my daughter through all this stuff and we get back home and my wife goes, “Well, how was it?” And I was like, “Traffic is terrible. People are crazy.” And I thought about it later, I was like, you know what, I was probably next to 800 cars. There was one guy that was crazy, one guy. That's like a 0.01% of the population. But that guy wildly affected my interaction, my perception of this interaction I had with a thousand other drivers.
And I bring that up because it's negativity bias. We have this one thing that we, oh my God, and it deeply affects everything else. Well, the same thing is true when we have bad experiences like this, if something goes wrong or people really go over the edge in being negative or angry, and that same thing of, oh my gosh, traffic was horrible. The truth is, it's one guy. It's sort of the same thing with this.
And so getting people to realize and say, so I talk about, it's called negativity bias. It's our natural instinct to remember the negative things and give negative things more weight in our mind because it keeps us safe. That's why it's hardwired in, because it keeps us safe. And so putting those sorts of things out and just talking to the team and saying, “Hey, when we have a negative experience, we tend to see negativity everywhere. And I want you guys to remember that we do great work, and there's so many people that we help and so many people who are supportive of us, and don't forget those things.”
And then don't make it a big deal, but go the extra mile to call out the things that you see people doing well. And it's not about, hey, don't worry about this other thing because of blank. It's like, no, it's just, “Hey, I saw you doing this thing and it was really great. Thank you very much. You're really great at your job. Hey, those people were just completely smitten with you and how you treated them. That was really amazing to see. Thank you.” And lift people back up because they're getting beaten on, you know what I mean? You can make their day a little bit better just by recognizing them and appreciating them for the work that they do, to try to offset the crap that's falling from above.

Stephanie Goss:
Yeah, I like that. I think the other thing too, besides seeing the good things, and this is going to sound silly and it is a little bit silly, but it's also not meant to belittle it, is sometimes leaning into things that really make us happy in veterinary medicine. So find the puppies and kittens, man. Bring a petting zoo to your team. Do the things that are positive. And it's small and maybe it is silly, but I remember a period in my career where I was helping, I was working off the floor as a manager, but we had new people at the front desk and the area that they hadn't gone through in terms of training yet was euthanasia. And so I got called to come in and do the front desk piece for all of the end of life cases that came in.
And it sounds strange, but I enjoy that piece of work, but it also is not without a toll. And so I remember feeling really, really negative because I was like, dude, I get all the crappy sad all the time. That's all I'm focusing on. And I remember venting about it to one of my technician friends at the time, and I just needed to say something. I wasn't saying it and actually asking for help. And I remember, I don't know, half hour, 20 minutes later, she comes in my office and she's like, “Come with me right now.” And I was like, oh God, another case, I can't, I can't. And she brings me into an exam room and there's a literally a bucket of puppies in the room.

Andy Roark:
Oh man.

Stephanie Goss:
And it was so good. She's like, “You needed puppies.” And she's like, “You just need to sit in here for 15 minutes.” She's like, “We're not even ready to deal with them. Just sit in here and entertain them.” And it was so good and it was so simple and it was silly and it was what I needed to break out of that.
But I think thinking about those little things that we can do to think about what is really good about our jobs and get them to think about smiling, because we can't fix it. The reality is we can't make the behavior stop right away. We can't make the negative reviews stop coming in. I mean, we can kick a client out of the building, but we can't do anything to take away that feeling in the moment. And so I think your point about what is the positive, what can we control in this situation, and what are some of those things that we can do to just bring a little smile to somebody's face? Even if it doesn't take it away, for that moment it felt really good to sit there and cuddle puppies.

Andy Roark:
Yeah. You remind me of what we talked about not long ago. It's like sometimes you have to walk in the rain. You may not have done anything wrong, but it just, it's going to rain on you. And that's just life. We all have to walk in the rain. Yeah, I've been thinking about it a lot recently. It's like we go through hard times, and you can't make the rain stop. You know what I mean? It's out of your control.
But you can find little things to enjoy on your walk in the rain. You know what I mean? You can find little warm spots, maybe little dry spots along the way. You know what I mean? And I think a lot of times that's the best that we can do. I don't know. I think that's all that I got. I think we've kind of worked through.
I think sometimes it's really hard, and these things are a lot like a force of nature. It's about motivating your people to walk in the rain. It's about trying to make them find enjoyment in what we do. It's not invalidating the fact that we're walking in the rain. It's walking in the rain with them. And just being a part of it. Make sure you get them all the support that you can, but then just be there for them and know that sometimes we can't fix things, sometimes we just have to walk through them. But my experience in all of these things is that this too shall pass. It will pass.

Stephanie Goss:
Yeah.

Andy Roark:
Well, Stephanie High Octane Goss.

Stephanie Goss:
Was that from your website?

Andy Roark:
It was.

Stephanie Goss:
Ace. Ace was-

Andy Roark:
How about Stephanie Half Pipe Goss? Mustang. There's literally 1,001 of them here.

Stephanie Goss:
Okay, I think we're done for the day.

Andy Roark:
I think that's enough.

Stephanie Goss:
Take care, everybody.

Andy Roark:
See you, everybody.

Stephanie Goss:
Well everyone, that's a wrap on another episode of the podcast. Thanks for tuning in again this week, as always. We love spending time with you. And before we go, I just wanted to say I am getting so excited to head to Greenville in just a few short weeks. We will be there for our Practice Owner Summit, which is happening December 8th through 10th. This is a giant, giant thank you shout out to our sponsors for helping make this event happen. This is one of my favorite events of the whole year. It is so much fun.
If you are going to be there, I can't wait to see your face. I have all the hugs for everybody, including our sponsor friends. And so I just want to shout out and say thanks to Royal Canin, Hill's, Care Credit, IT Guru, and Chronos for making this event happen. Take care, everyone. Have a fantastic week. Be kind, and we'll talk to you again soon.

Written by Dustin Bays · Categorized: Blog, Podcast · Tagged: culture, management, public relations

Nov 30 2022

Playing Nice With Your Competition – What’s the Point?

Uncharted Veterinary Podcast Episode 207 Cover Image

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and practice manager Stephanie Goss are tackling a question Andy was asked about working together with our (local) competition. A manager in a rural/remote area is wanting to connect with other managers. It seems the veterinarians in the area don't all get along and see no reason to work together. These managers are looking at it from a different lens and wondering “Isn't there a point to us working together?” better yet, they are asking “how do we explain this to the vets who don't agree with us?” Let's get into this…

Uncharted Veterinary Podcast · UVP – 207 – Playing Nice With Your Competition – What's The Point?

You can also listen to the episode on Apple Podcasts, Spotify, Google Podcasts, Amazon Music or wherever you get your podcasts.

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Episode Transcript

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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.

Dr. Andy Roark:
Hey, Stephanie Goss. You got a second to talk about GuardianVets?

Stephanie Goss:
Yeah. What do you want to talk about?

Dr. Andy Roark:
Man, I hear from people all the time that are overwhelmed because the phones never stop ringing.

Stephanie Goss:
Yes.

Dr. Andy Roark:
I'm sure you hear from these people as well, like our caseload is blowing up and the doctors are busy and the phones just don't stop.

Stephanie Goss:
They never stop. That is a true story.

Dr. Andy Roark:
I'm amazed by how few veterinarians know about GuardianVets. This is a service where you have registered technicians who can jump in virtually and help you on the phones. You can flip the switch and GuardianVets can jump in and take some of the load off the front desk and they can handle your clients and get them booked for your appointments and give them support and it really is a godsend.

Stephanie Goss:
Pre-pandemic, it was amazing to me how many people hadn't heard about it for after-hours call help. But at this point, I can't believe how many people don't realize that they are offering help during the daytime as well which I would think right now is a huge benefit to practices because everybody is shorthanded, everybody is drowning in phone calls. And so, we talk about it. We've talked about GuardianVets a lot on the podcast and every time we do, we always get somebody who says, “What is that?”

Dr. Andy Roark:
Guys, if you're not familiar with GuardianVets, if you think that you could use some help on the phones or up at the front desk, check them out. It's guardianvets.com and if you mention our podcast, me and Stephanie Goss, you get a month free. So check it out, guardianvets.com.

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 answering a question that he got sent about playing nice with your competition. It is from a manager who lives in a small town, rural environment and is wondering what the benefits are of getting to know the other managers in the area. The doctors involved in their practice and the other practices don't seem to get along, don't seem to care, don't seem to want to get along, and they are looking at it from a different perspective and wondering, “Is there a point to playing nice with our competition? Are there benefits if I work together? because I like the manager at this other practice over here and I would like to get together and pick their brain about some things. How do I go about doing this?” I'm going to tell you, this is an episode where I get really excited because this is my jam and I can't wait to talk about this. So let's get into it.

Speaker 3:
And now, The Uncharted Podcast.

Dr. Andy Roark:
And we are back. It's me, Dr. Andy Roark and Stephanie Fight Like A Title Holder Goss. That's a song. It's punk. I've been listening to a lot of punk rock music recently. I have just been feeling like an anarchist recently and I listen to Rancid Radio on Amazon Music.

Stephanie Goss:
Stop it.

Dr. Andy Roark:
No, I'm serious. I missed a trick when I was young. I should have been into punk music. I love it. I love it.

Stephanie Goss:
The mental image I have in my head right now of Andy Roark as a punk is amazing. It is a job for Jen Galvin's photoshopping skills because it is an amazing mental picture. I need to just enjoy this for a second.

Dr. Andy Roark:
Blue mohawk and a thick nose ring, like a big ring.

Stephanie Goss:
Oh, I was imagining a nose ring. I was imagining some eyeliner, black, ripped clothes, safety pins. Oh, it is a good mental picture.

Dr. Andy Roark:
I could have… I'm serious like-

Stephanie Goss:
Stop it.

Dr. Andy Roark:
There is a pathway in my life… It was a door never opened to me. My parents never showed me that door and I didn't have punk rock friends. I think I was 10 years too late for punk rock. I hit high school in 1991 and I think if I had hit high school in 1981, I would've been counterculture, I think.

Stephanie Goss:
I can't.

Dr. Andy Roark:
The band 311 was just blowing up and I saw a show they did in this little community center and there was a mosh pit and it was so great. I was like, “I've never done this before but I really enjoy it.”

Stephanie Goss:
Oh my gosh.

Dr. Andy Roark:
I can see through the multiverse. There is a… Not this-

Stephanie Goss:
There is a punk Andy Roark.

Dr. Andy Roark:
I'm still punk rock veterinarian because I don't see that changing. So I've got a chihuahua that also has a mohawk. I would get a Chinese Crested with a Mohawk-

Stephanie Goss:
Oh stop. Oh my god.

Dr. Andy Roark:
Stick it to the man.

Stephanie Goss:
That's amazing. Okay. Add that to the pile of facts that I did not know about Andy Roark.

Dr. Andy Roark:
Yeah.

Stephanie Goss:
This is a mental picture. I'm quite enjoying this. Thank you for starting off the afternoon like that.

Dr. Andy Roark:
I discovered the band NOFX. I'm not sing you anything that they sing-

Stephanie Goss:
I actually know NOFX. Okay.

Dr. Andy Roark:
Yeah. That was a new discovery for me. I was like, “This is music I was unaware of.”

Stephanie Goss:
Okay. I kind of like it. I kind of like-

Dr. Andy Roark:
I think it's what I'm going to do with my 50s. I've got a couple years before I get there. I think when I turn 50, it's going to be like, “I'm starting over. Leather and chains.”

Stephanie Goss:
That's so funny. No. Okay. So now, I have to know, what was the musical choices of Andy Roark, the teenager, the actual high school? If you weren't listening to NOFX back then, what were you listening to in the '90s?

Dr. Andy Roark:
Oh man. Probably my favorite band in high school was Red Hot Chili Peppers. The album Blood Sugar Sex Magik came out, the best album ever. I love it which is why I could also say, I can 100% say punk rock Andy Roark given how much I enjoyed Red Hot Chili Peppers like there's-

Stephanie Goss:
Were you allowed to actually have the CD or did you have to get it in secret because your parents wouldn't-

Dr. Andy Roark:
Oh no. Well, I had an underground pipeline of music. I listened to a lot of gangster rap like I was N.W.A, Ice Cube. I had all of that stuff and… Exactly. I'm like, “Oh, punk rock.” Actually, punk rock might have been a better fit for me but we went with N.W.A and Ice Cube and I had a great time and enjoyed it.

Stephanie Goss:
Okay.

Dr. Andy Roark:
So anyway. Yeah, that was it.

Stephanie Goss:
I like it. I like it a lot.

Dr. Andy Roark:
Who knows? Maybe if I get to go around the world again, I'll go a different direction next time.

Stephanie Goss:
I like the multiverse punk Andy Roark. That is a mental picture that's not going to leave me anytime soon. I like it.

Dr. Andy Roark:
Oh. That's good.

Stephanie Goss:
All right.

Dr. Andy Roark:
All right. What do we-

Stephanie Goss:
Well, speaking of high school, we got a great message from someone who is a manager and they're a manager in a rural or more remote area and they've had a lot of practices in their area who have had transition. It was kind of all of the vets who were getting older and been in practice a long time and now, all of a sudden there's a lot of young whipper snapper vets buying the practices and/or corporate practices that have come into the area.
And so, the doctors have some animosity between clinics. There's not really a friendly vibe in the area that the clinics get along and there are managers in these clinics who have not been a part of any of that drama and who are looking at how can we connect with each other. How can we work together and have relationships, good healthy relationships with our competitors?
Gosh. Gasp, right?

Dr. Andy Roark:
Yeah.

Stephanie Goss:
How do we have relationships? Particularly, in a small town environment that are good. How do we play nice? But also, it asks a bigger question of like, “What's the point?” Because that was one of the questions that their owner doctor asked, “What's the point of playing nice with our competition?” and I just thought this was such a great fun question and I have some ideas having been come up as baby manager in a rural environment like that. So I have some thoughts but I thought you would have some thoughts on this as well.

Dr. Andy Roark:
Yeah. No, no. Definitely. Yeah, definitely. I think the questions of… So this is an old-school problem, right? I've been hearing about this for a long time about our competitors. I don't get the feeling that this is much of a thing with the new school owners and managers, right? I think it was much more, when there used to be single vet practices and I think when there were smaller towns or when there was overlapping call areas, I feel like there was a lot more competition.

Stephanie Goss:
Sure.

Dr. Andy Roark:
I feel like now… I mean, the truth is like, if you are the practice manager at Banfield, do you have animosity for the practice manager at NVA eight miles away? You shouldn't.

Stephanie Goss:
No.

Dr. Andy Roark:
That's ridiculous. The impact that person has on you is nothing but they have a lot of shared experiences with you and other people don't have those, right? Being a practice manager is a lonely job because there's no one else in the hospital, generally, that has the same experience you have.

Stephanie Goss:
Right.

Dr. Andy Roark:
And so, there's a lot of benefits to being able to say, “Hey, friend of mine who generally knows what I do for a living in my job, I really appreciate you to validate the scenery or possibly give some advice to me,” or, “We're out of an item that we need and it's going to be three days before we get it. Can you cover?”

Stephanie Goss:
Yes.

Dr. Andy Roark:
And so, for me… Anyway. I think a lot of new school owners, especially people in corporate practices, I don't know that animosity exists but it definitely does in the old-school crowd. I've always thought it was ridiculous. I think it was ridiculous in the old-school crowd. I'll tell you, just from a headspace standpoint, the first thing is like, “Who's your competition?” and people would say, “Oh, the guy down the road,” and I would say, “No. It's inactivity on the part of the pet owners. That's your competition.”
Your competition is not… It's not, “I'm not going to get to see this pet because they're going to go to someone else.” It's like, “No. You're not going to see that pet because that person's not going to get off the couch and bring their cat to the vet. That's why you don't see pets.” And so, when you look at it like that you say, “What I lose to another veterinary clinic is just so tiny compared to the pet owners not bringing their pets in, us not booking recheck appointments, us not scheduling follow ups, us not working up cases.” There's so many other factors that are holding you back from practicing the medicine that you want to practice. The guy down the road is such a tiny, tiny piece of any sort of obstacle you have.

Stephanie Goss:
But it's so funny because I think about it and I think about almost, really, every practice that I ever worked in, even the ones that ultimately had great relationships with our peers in the area, there has always been this mentality since I started in veterinary medicine to a degree and I agree with you. I think it was much more strongly expressed by the old-school crowd because I remember starting in veterinary medicine where it was all about everybody else is our competition and you are spot on. Even back then, if we zoomed out for a hot second and looked at it, they were not actually our competition. They had a different culture, a different clientele. It was not competition but that outwardly was definitely expressed by leadership in veterinary medicine much more prevalently than I think that it is now.
I would argue with you. I think even now there is… I talk about it with managers all the time where there is this single-sided view of other practices as our direct competitors. When you start asking questions as I do, I'm like, “Tell me what their practice is like.” It's like, “They're not actually competition.” I think if we zoom out, most of us could probably count on one finger the number of true competition that we have in our little practice radius, right? But most of us have other practices and even if they're completely, radically, polar opposites of us as a practice, there is still this prevalent thought in veterinary medicine that everybody else who is a colleague is competition.

Dr. Andy Roark:
Yeah, so I get it. I understand. I still don't get it. I thought I'd get it. I just don't. I understand. I think there's two things that traditionally have led us to have practices that see each other as competitors and we don't talk to them or we don't talk about them and we don't work with them, whatever. So there is-

Stephanie Goss:
Or we talk about them and it's all negative.

Dr. Andy Roark:
Exactly. There's scarcity mentality, right? So little behavioral psychology. It's the idea that winter is going to come and I'm not going to have stored up enough food and I'm going to die of famine. That is the caveman mindset. And so, it's scarcity mentality is you see someone else who's doing the thing that you are doing and you say, “Oh my gosh. What if I don't get enough to support myself and I starve to death?” and that's scarcity mentality which you can see from an evolutionary standpoint, having those thoughts is probably motivating for you to get out and work hard to harvest the fields. Do you know what I mean? So that you and your family can live on and make more babies and stay alive and do the evolutionary thing that you're trying to do. I get that. So that's scarcity mentality.
The other one is zero sum thinking and a lot of people look at the world as if you get something, that means that I lost something or the potential for something. If you get ahead, it means that I somehow got farther behind and that's even just all the way to keeping up with the Jones's. I knew some people who will be like, “Oh, you moved into a bigger house. Now, I feel offended because in order to keep up with you, I have to move into a bigger house,” and you go, “Golly. That's a weird construct that only exists in your mind but here we are.” And so, that's zero sum thinking. If the other veterinary practice down the road gets something, does something, succeeds in some way, then I'm falling behind and I'm saying, “You're falling behind in a game that only exists in your mind. It's not real.”

Stephanie Goss:
Yeah. Yeah. In-

Dr. Andy Roark:
So-

Stephanie Goss:
Oh, go ahead.

Dr. Andy Roark:
No. So those are, I think, are the traditional drivers of why this division has existed.

Stephanie Goss:
Yeah. I think for me in my own personal experiences in working with the practice owners that I have, both of those things, scarcity mentality and the abundance mentality, those two things put your finger right on why they were thinking the way that they were, right? It's like if this client doesn't come see us and they go see the team down the street, then we're not going to be able to make payroll, right?

Dr. Andy Roark:
Yeah.

Stephanie Goss:
The reality is that client better not be the only thing standing between us and not making payroll.

Dr. Andy Roark:
Yeah. Exactly right. Yeah.

Stephanie Goss:
That should not be how we're running our businesses but that's how we let ourselves think and I think the reason that I loved this question and for me, the question was, “What is the point of playing nice with our competition?” I think that for me, I'm super pumped because to me the point is, there are so many more benefits to having relationships and having a community in veterinary medicine than there are real potential losses when it comes to our clients or to our standard of care or who we are as a clinic.
Like your point, really, the scarcity mentality, most of the time doesn't happen. That's not how life actually works. Most of us are not running… Our business is on that razor edge where that one client or even ten clients that go see our competition make or break us as a practice. But the things that come from having a community and having collaboration, all of those benefits, those actually can make or break us as a practice. And so, I'm super excited to talk about it from a headspace perspective because the benefits, to me, far outweigh the risks here. I think that's what I would lean into in terms of trying to explain or get my boss who might not be onboard, onboard with what those would be, is to lean into the benefits.

Dr. Andy Roark:
Yeah. Yeah. I think that's really it. It's a cost benefit analysis, right? So you say, “Well, what is the cost of collaborating?” and we said, “Do you believe in zero sum thinking? Do you believe in a scarcity mentality? Do you think that you're being hurt by this person doing this work?” It's even more eye rolling to me right now is because… I know this is regional. So many practices, I was going to say most, but so many practices are as busy as they can be or as busy as they want to be-

Stephanie Goss:
They have clients coming out of their ears.

Dr. Andy Roark:
Exactly. I can 100% empathize with people who are wary of their “competitor” when there's not much work to do, when things are slim. As far as staying busy I would say, “Oh boy. Having a client or two every week go down the road, that does hurt when we are really trying to hang on and have enough to do.” I just don't see that as people's reality today.

Stephanie Goss:
Well, I think that goes back to the point you made earlier about the older school, the older generation and I think there is validity there. I think part of the reason of that is think back to when you and I started in veterinary medicine, the majority of our patients now are members of the family and they're getting care in ways that they never did when we started in veterinary… I mean, I remember starting in veterinary medicine, our family dogs, they didn't live in the house. We had a backyard, the dogs lived in the backyard. Now… I mean, my mom's dogs share the bed and sleep under the covers.
The shift in the last 20 years in veterinary medicine has been great. And so, I remember starting in veterinary medicine almost 20 years ago and there were plenty of days where the phone didn't ring and we didn't have clients coming in because we saw a lot of backyard pets and we saw a lot of farm animals. And so, we were seeing emergency cases and abscesses and we see all of that now but it was really, really different because the relationship that we had with our pets and with animals as a society was radically different even just 20 years ago.
And so, I think about why that might be prevalent in that older school generationally and I think that's part of it because we experienced those droughts from a business perspective and not having clients come in the door. And so, there were plenty of times where those clients leaving could have made the difference between being able to pay payroll or not. But I think, I said it and I didn't mean to say it in jest because I think the point is now for most, to your point, most practices are in a place where we're booked weeks out. We can't get the clients all in the door. And so, that environment doesn't exist now for most practices the way that it did back then.

Dr. Andy Roark:
I agree with that. I'll also say this and I can say it because I'm a vet and I love veterinarians and you guys know I love veterinarians. Veterinarians traditionally are some of the cheapest people that I've ever met in my life and I'm in it. Stephanie Goss is laughing because I also have a frugal streak and-

Stephanie Goss:
A mile wide.

Dr. Andy Roark:
A mile wide perhaps but I am a veterinarian to my bones and we are some cheap ass people and I get it, right? Because you come up and you're like, “We got to make it work.”

Stephanie Goss:
It's the only way you survive vet school, is being cheap.

Dr. Andy Roark:
Yeah. They're like, “Did you have an ultrasound machine?” “No, I just listened with my ear,” like, “I don't need an ultrasound machine.” I even have vets who are like, “You use a needle one time? Pansy,” like, “Back in my day, we shaved metal off the surgical table and used it for scalpel blades. We wore a barrel with straps, that was our surgical scrub that we wore.” It's like every veterinarian I know lived through the Great Depression in their mind but like, “Okay, I love it,” but that is our people. We are traditional people which means the idea of someone going somewhere else and us not getting that $32 for a physical exam from 1981, that's hard to bear.

Stephanie Goss:
Right. It matters. Yeah. No, I agree with that. Okay. So I want to move us a little bit from headspace to-

Dr. Andy Roark:
Do you want to talk more about… Let's talk about some other money-saving steps that we can take in the-

Stephanie Goss:
No. I don't but I want to talk about benefits. The benefits of collaboration is part of the headspace but it's also a part of the action here so how do we get to doing this? I want to talk about that because this is my heart, this is my jam. I love collaboration. It's part of what I love about Uncharted but I have loved it from the very beginning and I think…
So for me, the headspace piece of it and the advice for these managers is like, “Okay. You may not ever be able to get your practice owners onboard because they may be the veterinarians Andy was talking about who were like, “I wore a barrel for my surgical scrubs,” right? They may not get it but do they have to?” and the answer for me is a resounding no. I can still create a community and I can still drive those relationships independent of what they think and are doing and there is very much a benefit to doing that because I will tell you, my local community forging those relationships with the other practices in my area has saved my butt more times than I can count.

Dr. Andy Roark:
Okay. So let's take a break here and then when we come back, what I want to do is I want to talk about… Okay. Joking aside, how do we articulate the desire to work collaboratively with other practices to our higher-ups? And then, regardless of whether or not they go with it, what does that mean for us as individuals because we can do what we want with our lives when we're not clocked in and we can talk about that and what that looks like.

Stephanie Goss:
Okay. I love it.

Dr. Andy Roark:
What's inbounds and what's out of bounds? So let's take a break and we'll come back.

Stephanie Goss:
Okay.
Hey friends, it's Stephanie, and I'm jumping in here for one quick second because there's a workshop coming up and it is one of the last ones for this year of 2022 and I want to make sure that you don't miss it because it is coming to you from my dear friend Maggie Brown-Bury. Maggie is a former emergency veterinarian who lives in Newfoundland, Canada. A few years ago, Maggie made the decision to make a change and she moved out of ER medicine into being a relief veterinarian.
I remember Maggie telling us within weeks of opening up her schedule, her whole first year was booked. And so, we asked Maggie to come and do a workshop for how to get the most out of the relationships that you build as a practice with your relief veterinarians because more and more practices, as we face the veterinarian shortage, are struggling with needing to have relief doctors on their schedule maybe more regularly than we would have previously.
Maggie's got some great ideas after working with a ton of different practices on how you can leverage that relationship and set yourself up for success, set your relief veterinarian up for success, and set your clients up for success. So if this sounds like something you'd be interested in, head on over to unchartedvet.com/events and find all of the information about the workshop and how to sign up. I hope to see you there.
And now, back to the podcast.

Dr. Andy Roark:
All right. So let's talk about communicating this up the chain, right? So we're in a vet practice and we are interested in having a more collaborative relationship with the enemy, the competitor down the road. Basically, simple cost benefit analysis is generally a pretty solid way to go here. The question you're going to get is, “Why? Why would we collaborate with them?” and I think you should just honor that question for what it's worth and say, “Well, what are the benefits of us talking to these people?” I think the idea that there are drawbacks is pretty hard and I think that as we're so busy, I think there's even less room for people to be like, “Oh, but think about how we're going to get hurt.” I think you need to think about what is the benefits of having this open relationship?
I would tell you just as a general philosophy and then we'll get into some specifics. Guys, I look at the workload the vets have, I look at the labor shortage, and I don't see it going away. Now, pet owner spending habits might change and there's some interesting data about that and we can talk about that. But for the most part, there's no magical surplus of veterinarians that are going to get dumped out into the profession anytime soon or certified vet techs or honestly, there's no reason to think that hiring is going to get significantly easier in the short term.
And so, we've got our hands full and the work is not going to stop. And so, really, one way I look at it is us, as veterinary professionals all in this together, trying to meet the needs of our society for pet healthcare and that's how I look at the world. You know what, guys? I like that view. I like to believe that we're all in this together. I like to believe that everyone who listens to this podcast, we're on the same team and I care about you. I really do. I want you to be successful and I want us to be successful and I want us to come together and take care of the pets and the people that we see. I just tend to look at our profession as us doing good in the world and I like to minimize us sniping between each other and just say, “Hey, we're all in this together. Let's be in this together.” And so, philosophically, that's where I like to start.

Stephanie Goss:
I think I love that because the reality is we're not competitors. And so, if we let go of that scarcity mentality and we start from a place, “What are the benefits?” We start from that place. First thing, what happens when you do run out of rabies vaccine? Who do you call? There's just the pure benefit of being able to say, “Hey, help me out. I'm in this spot,” and that has saved me more times than I can count. Whatever it is from our… I have even gone to another practice and borrowed their digital dental x-ray probe because a patient bit down on ours and it was going to be six weeks before we get the new one, right? That is some serious mojo. Could you imagine not doing dentals for six weeks with our current caseload but that practice was like, “Well, we only do surgery two days a week, so the other three days a week, you guys are welcome to use it.”
Obviously, if anything happens, we would take care of it and pay for it but we kept being able to do dentals for six weeks while we waited for our new probe. So that, in and of itself, number one, is a huge, huge benefit. But the other piece from the competition perspective, which you brought up, Andy, I think is really important is that we're not going to be the right fit for all people. And so, let me tell you how awesome it is to be able to refer needs that clients have that I can't meet to other places and be able to give them a name and a number and say, “You should call over here and see what they can do for you.”
Whether they offer procedures that we don't, they have an ultrasound machine and we don't, or it's just a matter of, “I have a client who is particularly cash strapped and they're looking for a vaccine clinic environment.” If that's not something that I offer but it's something that another clinic in town offers, why would I not tell them that's the option for them and help them get care for their pet? If I can't provide it or if it doesn't meet our needs as a clinic and who we are, why are we thinking about it from a competition perspective and not thinking about it from the perspective of, “Let's help this client get what they need,” or, “Let's help this patient get what they need.”

Dr. Andy Roark:
Well, the future of vet medicine is fragmentation. That's what I believe. I believe that the days of us all doing basically the same thing in each of our practices, those days are over, friends. That means we are going to have high end, white glove, expensive practices. We're going to have specialty practices. We're going to have emergency practices. We're going to have middle of the road practices. We are going to have middle of the road, high communication practices and we're going to have middle of the road convenience-based practices that get people in and out and turned around and are super flexible. We're going to have low cost spay and neuter clinics. We're going to have just low cost clinics that focus on accessibility, access to care, things like that. We're going to have mobile vets. We're going to have house call vets. We're going to have hospice vets. We're going to have ultrasound. We're going to have acupuncture, holistic veterinarians.
Everybody's doing different things and I think that's going to continue. I think it's really interesting. I'm excited about it. But if you think that this fragmentation is true and that practices really are segregating out into different areas and moving into different niches, then it just opens up the idea of, “Hey, we should communicate because we're doing different things.” It opens up that more and further reduces that feeling that we're competing. And so, I really like what you're saying.
Oh, we had a practice down the road from ours and it was a one vet practice and they were very much focused on accessibility and affordability of care. Their doctor went on vacation one time and the relief vet fell through somehow. I don't know how that happened. It was never made clear to me how it happened. But hey, there was no relief vet. And so, that person went on vacation and told the front desk to send them down the road and they started sending their clients to us and we got more one-star reviews that week than we had gotten in 20 years and it's because those were not our people. It was not our clients. They were not looking for what we were doing. I'm not bashing them, they were bashing us. I'm not bashing them. We just did not provide the service that they wanted at the price that they wanted but our clients who come to us were very, very happy with what we do and how we do it.
That is the thing in my life where I really crystallized in my head, these people were very happy with their vet and these are not our clients and we don't want these clients. It's not bashing them, it's just they don't want what we are selling and they don't want what we're doing.

Stephanie Goss:
I think the honesty about that is really great. So my practice, when I first moved to Washington, a really small town and there's our practice which is a large multi-site practice and there's another one doctor practice in town and it's an older school veterinarian, small practice, like you said, they're focused on convenience and cost for the clients. So two radically different models but that doctor didn't do surgery. And so, their process was to refer their surgical patients to us. But unlike you, the conversation that they then had with their clients was, “I don't do surgery because there is a time and cost associated with all of this. And so, when you go over there, you are not going to pay my prices. You're going to pay because they have surgeons on staff and this is what they do.”
And so, the clients were still, sometimes you have that, very different models, and there were still clients that were displeased but by and large, the majority of the clients who came over were prepared for that and they were willing to do it because there was a collaboration between the two clinics and that's the kind of example… Their clients weren't our kind of clients and if they were like, “Hey, we really had a great experience here,” we would have some questions for them about whether it was a good fit to continue the relationship or not but it was really, really nice to be able to know that we could provide that service and not have a veterinarian who had clearly defined boundaries and was like, “I don't want to do surgery,” not have to feel like they have to be all things to all people because we could work together.
For me, that is a perfect example of why this can be a huge bit of it because it allows you to do the things that you want to do and also lean into not having to do the things that you don't necessarily want to do because there usually are people out there who want to do those things.

Dr. Andy Roark:
Yeah. Yeah, I completely agree. And so, if you buy into that, you start to see the benefits of having these connections, right? So the big things for me, there's too much work to do. I'm starting to push for referral to other GPs and people are like, “That's heresy,” and it is heresy. It is the sacred cow. We've talked about this before on this podcast a number of times but like, “Look, man. If you've got…” I've noticed I'm starting to say, “Look, man,” a lot. I'm like, “Look, man.” It's like-

Stephanie Goss:
Are you leaning into your '90s punk?

Dr. Andy Roark:
I guess so. Anyway, look, man, if you have more work than you can do and people are getting angry that they can't get in to see you, it makes sense to refer clients away. It does. Now, I would start by not taking new clients. If you haven't done that yet, that's the easy thing is try to retain and service your current clients but send new clients away. But referring to other practices, it's like, “We're not taking new clients. We're unable to get people in. If you need to get in sooner, here are two other practices that are nearby that we recommend,” and send them to practices that you would recommend. Again, it's that scarcity mentality of, “I can't send work away.” I was like, “You can't get all of your work done. You're going to burn yourself and your people out.”
At some point you say, “I've got all the business that I can do and I'm going to take good care of the people that I have coming in. And then, I'm going to send the other people away and I'm not going to lay awake at night. I'm not going to feel guilty or angry about it. I am going to take care of the people that I'm going to take care of.” People say, “But we're not as profitable as we need to be,” and I would say, “You cannot do any more work. If you're not as profitable as you need to be, you need to figure out how to cut your costs or increase your prices and those are the only two options or increase your efficiency,” but a lot of people who have pushed their efficiency as far as they can, at some point, just wanting to see more patients doesn't make it possible.

Stephanie Goss:
Yeah. I think for the other piece of this and I'll be honest, I was really lucky to have exposure to this collaborative environment in private practice from the very beginning of my career in veterinary medicine but I will also say that my belief in collaboration got even stronger when I worked in corporate practice because now, I had the benefit of a built-in community that private practices don't have. I have the ability to call my sister clinic eight miles down the road and be like, “Hey, we're really shorthanded today. Can you guys spare anybody? Can you send them over?” and that was a game changer. And so, for me, it made me think a lot about the relationships that I forged early on in private practice and how as we grow and as veterinary medicine changes and as we continue to have more clients than we can handle and not enough staff, that is not something that's going away anytime soon.
The ability to band together as small groups of practices, whether we're independent private practices or corporate practices, is really, really powerful to be able to say, “Hey, I need help here.” Whether it's borrowing equipment or borrowing team members or, we've talked about this, I think, and I've told this story on the podcast, but I had somebody that I interviewed and I really, really liked them. They were not a fit for my clinic and my team but I thought they were a great candidate. And so, you want to talk about heresy, I called up another manager and I said, “Hey, I interviewed this person today. They are not a fit for our team but I think they might be a really good fit for your practice. Can I send them over to you?”
It was another independent practice. There was no connection. It just was a manager that I knew from my local manager's group which is why I think this topic is so important. I called them up and I said, “Hey, would you like to interview them?” and they hired that person and they stayed. They are still at that practice years later and it felt so good. It felt good to help out a colleague but also, it was such a game-changing experience for me because I got to help another practice but it was the first time I felt in private practice where it didn't feel like every man for himself.

Dr. Andy Roark:
Yeah. The last point that I want to make on this as far as collaboration between practices, collaboration on high level is one of the critical takeaways that people need to remember is you have got to build the bridge before you can walk on it which means you cannot wait until your dental radiograph probe breaks to make a friend. That's not going to-

Stephanie Goss:
Right. It's not going to work out well for you.

Dr. Andy Roark:
Yeah. You need to have that relationship in place. And so, when the practice owner says, “Why should we talk to these people?” and you say, “Because one time Stephanie Goss's… Their dental radiograph probe broke,” and he's like, “But our radiograph probe is not broken.” You could say, “But-

Stephanie Goss:
But the day will come-

Dr. Andy Roark:
“If we don't have that relationship when it happens, we are going to be out of luck. And so, you have to build…” That's a phrase I've used for a long time is, “You have to build a bridge before you can walk on it,” which means you have to make relationships with people when you don't want anything. Because if you make relationships with people only when you want things, that's not a good look and it doesn't feel good. And so, that's a big part of it for me.

Stephanie Goss:
The last thing… I'm so glad you used the bridge analogy because I think you have to build it before you can walk on it and you also should not burn it to the ground. I'm going to say it for the person who asked this question, they were saying that it feels like there's animosity between some of the practice owners and I will say, the point, part of why it matters to build collaboration and play nice with our competition is because veterinary medicine is smaller than the smallest community.
We are closer than six degrees of Kevin Bacon, you guys. The reality is everybody is connected to somebody else, especially in small towns and that is important. When you burn those bridges, man, it is spectacularly flaming and you don't want to do it. And so, even if you don't like the person on a personal level or you don't like their medicine or the way that they run their practice, there is still benefit in being professionals and looking at it as, these are our colleagues and we should be able to have relationships. We should be able to come together and share things whether it's the vets getting together in having radiology rounds and talking about cases or doing case rounds together. Those are things that you get the automatic benefit when you're in corporate practice.
We had lots of… I went through a period where I had a bunch of new grads and I didn't have enough experienced doctors to help train them but collaboratively in our local area, there was plenty of mentorship available. The ability to send one of my new grads to participate in case rounds or radiology rounds with another clinic was a huge benefit. That doesn't have to only exist in corporate medicine.
My very first practice that I participated in veterinary medicine at was a small town. There was three vets in town. We literally were all on the same road, one at each end of town and one in the middle. They're all private practices and those vets got together once a month and did radiology rounds so that they could help pick each other's brains and pick apart the experience that comes… We had one vet who was older and who was very experienced and those younger vets got to take advantage of picking his brain and the medicine that he had seen in his career.
It wasn't that they weren't looking at each other like competition, they were looking at how can we help each other and how can we grow and get that without having to go call up a boarded radiologist or go to a CE that's two hours away? We leaned into the local community and I think that's something that a lot of people often think about it solely as a benefit of corporate practice and something that we can't do.
This is where I would be happy if somebody said, “But Stephanie Goss told me I can.” You do not just have to be in corporate practice to make this happen. You can make it happen in private practice and I think though, the why it matters and why I love this question is because you can do it on your own. This is where you can lead the charge from within the team.
Now, obviously, if your practice owner is not onboard, you might not get to go on the clock and meet with other practice managers for lunch once a month. That might be off the table but there's nothing stopping you from saying, “Hey, we're going to get together once a month in the evening and talk about what's going on in our practices and pick each other's brains about some things.” There is nothing stopping you from furthering yourself from a professional development perspective and I will tell you that the fact that veterinary medicine is so small and it is such a close-knit community, I can't tell you how many times that kind of networking and remembering the fact that I don't want to burn those bridges has really been helpful and impactful in terms of my career and growing myself.

Dr. Andy Roark:
Yeah. No, I completely agree with that. I think I've just benefited throughout my career from my connections more than anything. It's people who show me what's possible. It's people who talk about what they're doing and I go, “I didn't realize you could do that.” I've just had so many beneficial conversations and it's also people opening doors for me and people saying, “Hey, there's an opportunity for… I know this person who is unhappy where they are and they're looking for another place to go and your practice is a happy practice and has good culture and I thought maybe they might be happy. Would you like to talk to them?” Those things don't happen if you live in a silo and people don't know you. There's so many of those little benefits. The one thing that I want to say is, you can be connected and you can benefit from connections and you can talk to a lot of people and still maintain some level of confidentiality for your practice.

Stephanie Goss:
Oh yeah.

Dr. Andy Roark:
I think that's important because I can imagine business owners saying, “Andy and Stephanie are saying you can just go and tell them everything that's going on in your practice,” and I'm like, “That's not what we're saying.” There's some common sense to it about what you can share. But in general, you can avoid sharing details that would be damaging to other people's reputations or make them feel bad or would make your practice owners uncomfortable or things like that. That's not hard to do. Just speak in terms where you say, “I want to protect people's privacy and I still want to have these relationships.” Those things are totally manageable. You just have to think about it and then be intentional about the questions that you ask and how you engage.

Stephanie Goss:
Yeah. I think the last question that got asked by the person who reached out was, “Where do I start?” I think you can want the end goal to be I would love to have a local area manager's group. I think that's a fantastic goal and I'm a huge advocate for that and I ran our local one for years. It didn't start out that way. It started as a group of people who were like, “Let's get together for lunch,” and it was a one-time thing. And then, it was like, “Guys, this was so fun. Let's do it again,” and it very quickly became a once-a-month thing.
And then, we started having some structure and then we started talking about could we tie some CE to this and could we get some speakers to come and talk to us and it grew from there but it didn't start there. If you want to start there, if that's your end goal, that's great too but it doesn't have to be giant. You don't have to overbuild it. It can start with, “Let's go have a cup of coffee. Let's go have lunch. Let's have dinner,” right? Let's just pick each other's brain. It doesn't have to be a big thing. It can start small.

Dr. Andy Roark:
Yeah. I like it. All right. Cool. I think that's great. I think that's some good… Hopefully, that's good insight for people. Hopefully, it gets people some permission they need to make those connections and just start to grow their network.

Stephanie Goss:
Yeah. I like it. It was clearly my jam.

Dr. Andy Roark:
Yeah, definitely. Cool, guys. All right then.

Stephanie Goss:
All right. Have a great week, everybody.

Dr. Andy Roark:
Take care, everybody.

Stephanie Goss:
Well, everyone, that's a wrap on another episode of the podcast. Thanks for tuning in again this week. As always, we love spending time with you. Before we go, I just wanted to say I am getting so excited to head to Greenville. We will be there for our Practice Owner Summit which is happening December 8th through 10th. This is a giant, giant thank you. Shoutout to our sponsors for helping make this event happen. This is one of my favorite events of the whole year. It is so much fun.
If you are going to be there, I can't wait to see your face. I have all the hugs for everybody, including our sponsor friends. And so, I just want to shout out and say thanks to Royal Canin, Hills, CareCredit, IT Guru, and Chronos for making this event happen. Take care, everyone. Have a fantastic week. Be kind and we'll talk to you again soon.

Written by Dustin Bays · Categorized: Blog, Podcast · Tagged: competition, Practice ownership

Nov 23 2022

Managing a Neurodiverse Clinic Doctor

Uncharted Veterinary Podcast Episode 206 Cover Image

This week on the podcast…

Dr. Amanda Doran joins Dr. Andy Roark to discuss managing (and being) a neurodiverse doctor. Very little of the conversation is specific to veterinarians as opposed to other members of the vet healthcare team, and everyone in the clinic can benefit from this conversation. We cover common behaviors as well as resources and management strategies for supporting a diverse group of individuals across an organization. Let's get into this!

Uncharted Veterinary Podcast · UVP – 206 – Managing A Neurodiverse Clinic Doctor

You can also listen to the episode on Apple Podcasts, Spotify, Google Podcasts, Amazon Music or wherever you get your podcasts.

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


About Our Guest & Recommended Reading

Dr. Amanda Doran: @dr_amanda_doran

Love and Work: How to Find What You Love, Love What You Do, and Do It for the Rest of Your Life – https://amzn.to/3c7ZL5i


Upcoming Events

The Secret Sauce to Optimizing Workflow with Senani Ratnayake

Back by popular demand! It's time to take a look at the workflows that aren't working and come up with a plan to move forward with a strategy that makes sense.

Date: November 30

Time: 5:30pm ET/2:30pm PT – 7:30pm ET/4:30pm PT

Getting The Most Out of Relief Vet Relationships with Dr. Maggie Brown-Bury

Dr. Maggie Brown-Bury is a relief veterinarian in Canada and she is already booked for all of 2023. How does she do it? Who ends up at the top of her list of availability? If you're struggling to find a consistent relief veterinarian or don't know where to start, this 1-hour workshop can help.

Date: December 13

Time: 7pm ET/4pm PT – 8pm ET/5pm PT

All Uncharted Veterinary Community Workshops are LIVE! You will be able to ask the instructor questions that help you address your practice’s unique problems. This will not be 2 hours of silent screen time. Gear up for interactive, fun learning!

JOIN UNCHARTED! https://unchartedvet.com/uvc-membership/


Episode Transcript

Banfield Pet Hospital Logo

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.

Dr. Andy Roark:
Welcome, welcome, welcome, boys and girls to the Uncharted Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here with the one and only Dr. Amanda Doran. We are talking about managing the Neurodiverse Doctor. We start off talking about that, then we talk mostly about being a neurodiverse doctor and what that is like and what that experience is like. This is a fun episode, it is a make you think episode just about how people are different and about working with people who see the world differently in your practice. I think this is one of those things where we talk about neurodiverse doctors and really we're just talking about is people are people and people are different, and we all have different skills and strengths, and things that we're good at and things that exhaust us, and things that we're not good at.
And we're not cookie cutters. We're our own beautiful distinct human beings. And when you understand that, then a lot of ideas for how to support people become really clear. And so anyway, this is a fun conversation. It's a neat make you think sort of conversation. It's a good reminder about the humanity of our professionals, so whether you are a doctor, or a tech, or front desk, or manager, I think this is going to be just a good general episode to hear. Guys, without further ado, let's get into this episode.

Meg:
And now the Uncharted Podcast.

Dr. Andy Roark:
Welcome to the podcast, Dr. Amanda Doran. How are you?

Dr. Amanda Doran:
I'm great. How are you?

Dr. Andy Roark:
Man, I'm doing great. It is good to see you again. It has been a minute. How are things going?

Dr. Amanda Doran:
Oh, good. Living the dream. Northern Minnesota's very beautiful several months of the year. The rest of the time it is hot.

Dr. Andy Roark:
Yeah.

Dr. Amanda Doran:
But it's gorgeous right now.

Dr. Andy Roark:
That's awesome. Well it's good to see you in person. You actually came down and stayed with me and my family a couple of years ago pre-pandemic.

Dr. Amanda Doran:
Right before, yeah.

Dr. Andy Roark:
Yeah, it was right before working on some business projects and that was a awesome thing. And the family says, hi. What are we doing here? We are here, so those who don't know you are Dr. Amanda Doran, you are doing some speaking and writing, especially particularly kind of in the wellness space in vet medicine. You are an associate vet with Minnesota Pets, which is a home hospice veterinary company. And you do a lot of different things. You have a lot of different interests. I love it. I'm a big fan of people having what I call a third space, which is things you do that are like not normal home stuff and not work stuff. And so you have a booth at the farmer's market called Wicked Witch of the West End.
And you also have, you just told me, I was actually humbled. You have 35 cherry tomato plants. I have three tomato plants that I have fought all summer long just to have, and they have a high tomato failure rate. Let's just say that there is a lot fewer harvested than grow on that thing. But anyway, welcome to the podcast. I'm glad you're here. I asked you to be on because you did a workshop for Uncharted very recently that was extremely popular and well attended and it was on managing the neurodivergent doctor. And boy, we got a lot of positive feedback on that session. A lot of people who said they wanted to know more, they weren't able to come to the workshop. And so I just thought that would be a great opportunity to have you in to kind of run through this topic with you. And it's something I really honestly don't know a whole lot about. This is a weakness of my own and so I'm really excited just to start breaking this down, you ready?

Dr. Amanda Doran:
Yeah. Thanks. Good to be here. I feel like we only scratched the surface in the workshop, so definitely.

Dr. Andy Roark:
Oh, I know. Well that was the feedback that I got was there's a lot there. Well, let's just start out at a high level when we talk about managing the neurodivergent doctor, what are we talking about? Give me an idea going into this workshop, and again, neurodivergent can mean a million different things. Help me start to piece this together in my mind. I want to get my head around what am I talking about? I think a lot of us are probably managing neurodivergent doctors and we don't even know that we're doing that. Many of us may be neurodivergent doctors who have not yet realized or recognize that that is a part of who we are. And so talk to me a little bit about that. What does that look like as people come in? Paint me a picture in the clinic of the neurodivergent doctor, if you don't mind.

Dr. Amanda Doran:
Absolutely. Yeah, so I think definitely newer terminology that we're talking about. And so I think kind of neurodivergence as a term was really developed to help talk about and develop acceptance for people with autism. But the umbrella's gotten a little bit bigger and includes a lot of other different conditions in neurodivergence. And probably the most common one I think we do see anecdotally and I have personal experience with is people with ADHD. And so these might be people who are having a really hard time managing time, or managing different tasks, or they might have problems with memory, or organizing things, or starting projects and following through, they might have some challenges with emotional control, or paying attention, or focusing, they might get sucked into the vortex of time in the exam rooms, and might have a hard time consistently following goals, especially with something that they're not interested in. And we are neurodiverse as a population.

Dr. Andy Roark:
Yeah, so like goals that were set from someone else?

Dr. Amanda Doran:
Yeah, if it's something that people don't have a strong interest in, they might have a hard time working towards that goal.

Dr. Andy Roark:
Okay, so going back to those things, do me a favor, pick back up. And so you listed time management, task management, organizing, emotional control, paying attention, pick back up with neurodivergence. We're all sort of a diverse group and just kind of I think that's a laundry list of behaviors sort of help to put that into an organized framework, I guess. How do you start to look at these things?

Dr. Amanda Doran:
I guess essentially what neurodiversity means is that within our population of humans, we have a variation of cognitive function, right? Our population is neurodiverse, and in kind of thinking back to like back to basics of left brain versus right brain and kind of logic versus creativity and how we process things and how we engage in projects and how we perceive things and even how we solve problems. We all have all the things, but we do different things differently. And there's kind of this societal standard and then many people have traits that make it easier for them to adapt to those standards. And some people have traits that maybe are leaning a little bit more towards right side of the brain and make it more difficult to adapt to those expectations or those cultural standards that we have.

Dr. Andy Roark:
Sure.

Dr. Amanda Doran:
Does that kind of make sense?

Dr. Andy Roark:
Yeah. Yeah, no, it does. I will tell you sort of, okay, I like the way that you're starting to lay this things out, so I'll just sort tell you a position that I sort of have on the way that people's minds work and where it comes from.

Dr. Amanda Doran:
Yeah.

Dr. Andy Roark:
I was diagnosed with attention deficit disorder when I was in the second grade. And the doctors, the psychologist who did the child testing, told my parents not to expect too much from me. I probably wouldn't go to college, I probably wouldn't go on and do these other things. And my dad was a surgeon, so I think that that was the idea my parents maybe had. Now this was in 1982, which is the stone ages for child psychology, things like that. I am, listen, this is how I think about it, so I said something, I have a friend and her child was just diagnosed with attention deficit disorder and he is about seven years old now, I think.
He's probably second grade, something like that. And my friend had just gotten the diagnosis of her child had ADD, and she was obviously kind of worried about what does this mean and things like that. And what I said to her was, I'll tell you based on my life experience, we live our lives in a construct. I think that was made. We've got this crazy system, pardon the phrase, but we have this ridiculous system where kids are supposed to go and sit on their bottom for six to eight consecutive hours with a 15 minute recess break, which is what elementary school kids get now. And that's how their success is measured, is their ability to sit still and to take these tests that are put in front of them. And I say, this is ridiculous. Think back about how evolutionarily we came along.
The kid that never sat still, that was always exploring, that was always sort of investigating and doing new things, that loved to socialize with others, that kid's bound for success in the wild in a lot of ways. But that's not what success today looks like in the modern society that we have. And so when I think a lot about that, I will say that a lot of my career success comes from my inability to calm my mind in a lot of ways. I'm known as a pretty creative person. I like to think that I'm a fairly innovative person. Innovation and creativity come from smashing disparate ideas together, taking something and combining it with something else. And that's just kind of what my brain does. But if you are looking for somebody who can come and sit at a desk for eight consecutive hours and push paperwork, I'm not your guy, I'm never going to make it. And that's just the way that I am wired.
And so when you talk about neurodivergence and you talk about all the different types of behaviors that we see people who are not organized raising my hand, people who have problems paying attention, raising my hands, people who forget things, raising my hand. I check those boxes and that's sort of where I am. And so my big thing is I think that people have often thought that they is normal and abnormal and I reject that categorization. I would say what's what is beneficial is often context specific. And some of us may not thrive in the classic academic or classic work environments because that's not how we're wired. But that does not mean we are wildly successful in other ways or in other, I don't know, pathways. I know doctors who are forgetful and they can't stay focused and they're creative and funny and kind of, there's people who are sort of scattered and they bounce all over the place and the clients love them, the client, the techs are driven nuts by them, but the clients love them because they're fun and they're engaging.
Yeah, exactly right. Amanda is raising her hand. Exactly right. And I go, that's not a downside to me. And that's why I wanted to bring you on here was my position very much is I don't buy this normal/abnormal categorization in a lot of ways. I think that we all have strengths and we all have weaknesses and we're all very different. I think understanding what your strengths and weaknesses are is absolutely vital to your career success. I think having an understanding of the strengths and weaknesses of the people that you manage, I think that, that's vital to being a good manager. If you take someone who has a hard time organizing and push them into a position where they are going to organize come hell or high water, you're often going to burn that person out rather than have them figure it out. That's just my position. I'm curious how that sounds as I say it?

Dr. Amanda Doran:
Yeah, absolutely. Yeah, that's going to make some people miserable. This makes me think of this book that I read recently by Marcus Buckingham, it's called Love Plus Work. And he was one of the people that developed the Strengths Assessment and he talked about strengths and weaknesses in a way that I'd never heard before. And it changed a lot of perspective for me and not so much as strengths are things that you're good at and weaknesses are things that you're bad at, but strengths are actually as things that give you strength, give you energy. You don't have to be good at it, but do you like it? Do you want to do it? Do you want to get better at it?

Dr. Andy Roark:
Yeah.

Dr. Amanda Doran:
And weaknesses as things that you don't like, you can be really, really good at things that you hate doing. There is definitely some things in general practice that I had to adapt to and put masks on for and cope with that from the outside looks like strengths because I was really good at it, but I hated it. It left me completely drained at the end of the day. And so-

Dr. Andy Roark:
Oh interesting.

Dr. Amanda Doran:
I think as employee and manager kind of working together to help people find what are those strengths? And it's not, like you said, not necessarily giving people things. Like if you don't like organizing, you're going to have a hard time doing it. Are you in the right seat on the bus following your strengths, finding that love in your work and if you have that drive to want to do the thing that you like, even if you're bad at it, you can put in the hours to get better at it. And I think we don't always know what those things we are, we don't feel like we're allowed to follow those loves. I feel like that was one of my challenges in practice. I feel like I have to do this but I don't really want to do it, but I'm good at it and people keep telling me I should keep doing it but I kind of hate it.

Dr. Andy Roark:
Yeah.

Dr. Amanda Doran:
Yeah, finding those strengths and redefining, what does it mean. A lot to unpack there.

Dr. Andy Roark:
There's a lot to unpack there. I completely agree. Okay.

Stephanie Goss:
Hey friends. It's Stephanie and I'm jumping in here for one quick second because there's a workshop coming up and it is one of the last ones for this year of 2022. And I want to make sure that you don't miss it because it is coming to you from my dear friend Maggie Brown Bury. Maggie is a former emergency veterinarian who lives in Newfoundland, Canada. And a few years ago Maggie made the decision to make a change and she moved out of ER medicine into being a relief veterinarian. And I remember Maggie telling us within weeks of opening up her schedule, her whole first year was booked. And so we asked Maggie to come and do a workshop for how to get the most out of the relationships that you build as a practice with your relief veterinarians.
Because more and more practices as we face the veterinarian shortage, are struggling with needing to have relief doctors on their schedule maybe more regularly than we would have previously. And he's got some great ideas after working with a ton of different practices on how you can leverage that relationship and set yourself up for success, set your relief veterinarian up for success, and set your clients up for success, so if this sounds like something you'd be interested in, head on over to unchartedvet.com/events and find all of the information about the workshop and how to sign up. I hope to see you there. And now back to the podcast.

Dr. Andy Roark:
One of the things I always talk to people about when we talk about employee management is there's two different questions that I usually ask about employees, is when you're trying to delegate something away, you're like, Hey, would you do this thing for me? The question is, does the person get it? Meaning do they understand what you're asking for or what needs to happen? And the next question is, do they want it? And to your point, there are a lot of us that are good at things that we don't enjoy. This is an interesting idea of your strengths are things that give you strength and your weaknesses, you might be good at them, but they take strength from you, they take effort. There are things that I am good at that people ask me to do and they are exhausting and there are things that I am good at, people ask me to do that once you ask me to do them, I'm not going to stop.
I'm just going to get going and I am going to shake hands and kiss babies or kiss hands and shake babies, whatever, I'll just get going. And I'm not going to quit because I love doing it. But I think that's a really interesting way to think about it, so is this being good at something and wanting to do that thing I think are entirely different. I also really like your thoughts about when you are someone who has different skill sets, when you have these things that make you happier, that fill you up and things that don't. And you got to march to the beat of your own drum as a lot of us do. I think that there is a lot of weight in the veterinary culture on behaving in a certain way and following certain norms that have been laid down. And again, I'm just sort of talking off the cuff here, but you can't tell me that… We all took the same path, right.
We all went through undergraduate to become veterinarians and then we went through vet school and then there's some strong cultural norms in vet medicine and we all think that a veterinarian looks a certain way or acts a certain way and the technicians look a certain way or act a certain way or things like that. And I feel like there is this implied pressure to conform in a lot of ways. And I have found, and this is so stupid and simple, but for years people have asked when they ask for any career advice or anything, I always tell them the most valuable thing that I have ever found that I tell everybody is if you want to be successful, figure out what you like doing and figure out how to do more of it and figure out what you don't like doing and figure out how to do less of it.
And I think a lot of people don't think they have permission to do that. They're like, no, I have to do all of the vet things. And I go, no you don't. You're talking to a guy who literally works one day a week in the vet clinic and otherwise does what he wants to do. I was doing Facebook and people were telling me I was ridiculous and why are you spending your time doing Facebook? And I was like, it worked out for me in the long run. But those, I enjoyed it. I enjoyed expressing myself and this was before I didn't enjoy Facebook anymore, but at the time I enjoyed expressing myself and doing those things and other people, I mean I made these goofy, I don't know if back in the day I made these goofy videos that I, there's videos out there of me in a dog suit, a hundred percent running around.
And I remember well respected colleagues of mine being mortified on my behalf that I was making these things and I was like, I think it's funny. I am having a good time and I get that it's not your thing but I can do it. And it makes people laugh and I enjoy it. It makes me excited about that medicine so I'm going to do it. I really like that you said that it was like, I think some of us maybe need permission to say I'm not going to function the way that the other doctors do in the practice and I'm going, Hey buddy, as long as you can make that swing around and balance out with other people so their needs are being met and that you are not leaving other people hanging, go forth with confidence and do it.

Dr. Amanda Doran:
Yeah. Well, I think if anything it helps. It's helped me show up better every day when I do work, when I'm able to do those things. I think more so than balance or harmony, it's this idea of resonance. There's never going to be this perfect scale where it's like okay, my work and my life are balanced. It's kind of taking that it's like a dance that you have to do those other things. I remember hearing everybody say that in vet school. Oh yes, you must have these things outside of veterinary medicine that you do.

Dr. Andy Roark:
Yeah.

Dr. Amanda Doran:
But I feel like it's one of those lessons where you got to get burned. Some people know fire back because they've been told, well you got to figure out for yourself. Nobody knows what you love. And I think a lot of times we're conditioned to look for that external validation of people saying, yes, you're doing the thing. But it's a huge shift to shift that internally and follow what your weird little heart wants.

Dr. Andy Roark:
I completely agree with that, but I think when we're talking about managing people who are just different or who marched to the beat of their own drum.

Dr. Amanda Doran:
Yeah.

Dr. Andy Roark:
Or just have different skills, I think that not waiting for someone else to validate you is so important. And I think it's really hard. I think a lot of us who approach the world of differently, I think a lot of us live in shame, you know what I mean? Why can't I keep my calendar the way that other people do and why can't I just sit down and do these things that other people just sit down and grind through? And I say, look, we all have to figure out how to get those things done. We all have to figure out our own ways. But I completely agree with you as far as I think that we need to think about what makes us happy and making sure that we're doing the things we need to do.
But beyond that, the fact that the other doctors don't work one day a week, they work six days a week or four days a week, that doesn't affect me. That's not what I'm doing right now and that's not taking anything away from them. But I'm not doing it and I'm not feeling bad about not doing it. This is kind of where I am and what I'm doing. And so I think a lot of us need to hear that as, hey, this is fine.

Dr. Amanda Doran:
Yeah.

Dr. Andy Roark:
As far as the work life balance stuff, it's funny you bring that up. I had a conversation literally yesterday with a good friend of mine and we were talking about work life balance and I've never been able to categorize work life balance like a lot of other people can. I've never been able to be like this in my work self and this is my home self. And it is just, again, because of I think, the way that I see the world or whatever, that split has never worked for me, so I'm a big fan of Danny McVety calls it work life integration and it's just sort of like, I do a lot of different stuff.
I mean I write about that medicine when I'm at home and sometimes when I'm at the vet clinic on my lunch break, I'm doing other things and just I hang out with the technicians and we'll talk about our hobbies and just geek out about whatever the TV shows we're watching are, things like that. But I just mix those things together. But for me it's an outlet that works and keeping it separate just doesn't work for me.

Dr. Amanda Doran:
Yeah.

Dr. Andy Roark:
But it totally works for other people. And so I would never tell someone else, don't prioritize life balance. I would just say, well life balance for me looks very different than it does for other people. But I know after 15 years of doing it this way as a professional, this works for me and that's it. Well let's bring this back around to what this looks like professionally and working with others.

Dr. Amanda Doran:
Yeah.

Dr. Andy Roark:
And so we talked about managing sort of a neurodiverse doctor. We all have these different ways of approaching our job, of what we're good at. It's funny that when I said What does this look like? You listed a long string of problems, you know what I mean, of like oh they forget this. So this person, they don't get that done and they don't do this. What's funny is that when we ask about a neurodivergent doctor, people don't say, oh well these are typically creative people. These are people who bring diversity of perspective to the scene. These are people who often have ideas that others haven't thought about. They're think they're people who maybe have a different perspective when you ask what's going on that you just haven't rolled around and considered.
And I go, we always think about the things that we see where people don't match up in a positive way to the benchmarks that are set, but we don't really stop and say, well why do they exceed these other areas so strongly? I think that that's an important thing to consider when we talk about sort of neurodivergence and neurodivergent doctors is you cannot look at this as a detriment. What you have to do is look at the person as a specific package and start to identify what are their strengths and what are their weaknesses. And I love the idea of the strengths as what fills them up, what makes them stronger. Do you agree?

Dr. Amanda Doran:
Absolutely. And yeah, kind of what we talked about a little bit before in veterinary medicine, we kind of live by this kind of strict calendaring, very planned timeline and that makes some people very, very miserable. And you can very much struggle to manage time and to be productive when kind of the processes and practices that you're using don't match those natural tendencies that you have.

Dr. Andy Roark:
Yeah.

Dr. Amanda Doran:
And so I think when we think about neurodivergence, at least personally as I've started talking about it, people are coming and asking me all the time, how do I help this person who gets sucked into the Bermuda Triangle in an appointment? Whether that's in practice or an in-home euthanasia where they just completely lose track of time. And I think realizing that it's not an intentional disregard, like for some people it is actually a sensory issue and time doesn't exist if you're not looking at it. And so yeah, I was definitely that doctor who you'd send a search party because I was still in the exam room, well after the time it should be over, so I feel like that's where it comes up the most.

Dr. Andy Roark:
Yeah, I definitely see that. I think that to me, again, it depends on the individual a lot. I think classic organization and focus are often things that we see in doctors. What have you seen that can be helpful in setting, I know this is such a broad category of individual, it's hard to drill too deep into specifics, but in general terms, what are the steps that practices take to make these people successful and to bolster them up and to make them feel comfortable and happy in the workplace?

Dr. Amanda Doran:
I think the biggest thing is making sure that there's space to have those conversations. For people to be vulnerable and not blame them and see it as an intentional disregard for time. Helping them be able, you might have to help them a little bit in developing some of those skills, so consciously tracking time, like when are you going in, when are you coming out? What's happening in there? What appointments are these happening in? Are these appointments that give you strength and you're just so excited to talk to these people and help them? Or are these strengths that are weaknesses and it's sucking your energy to be in there and you feel like you can't get out?
Making sure everybody I think it's important for, but especially people who are neurodivergent, making sure you're taking breaks and eating food and going outside and getting exercise. Maybe having an afternoon coffee, because I think you do have a natural tendency to forget to do some of those things. I worked in the practice that didn't have clocks in the room and I found that really challenging. I felt rude always looking at my watch. But unless looking at the clock, I don't know times exists. And even when I was in general practice, kind of having buffer time in throughout the day to make sure I had a quiet place to go with no noise to catch up on my records so that I wasn't doing other things.
Because there's always 10,000 things going on in the treatment room and you want to help people. But unless I had a quiet place with no distractions, I couldn't get my records done before the end of the day. And I think another thing that would be helpful too is doing some role playing with language to help move visits along. I think sometimes we don't necessarily know the words to help people get back on track and be like, okay, what is our intention for this appointment? What is our desired income? What words can we give people to have light, moderate, or more heavy nudges to get us back on task? And I think those skills kind of develop over time, not the classes that they have in school always.

Dr. Andy Roark:
Yeah. Oh no, I love it. I just wrote down words to move appointments along. I'm like, oh, that's super great. Okay, so what I hear you saying, and this all makes total sense with me, I really love it. Assume good intent. We talk a lot uncharted about assuming good intent and just say, this person, they're not running late because they don't care, they're not failing to fill out paperwork because they're jerks and they're disrespecting you or blah blah, blah. Assume good intent. Everybody's trying their best. Some things come easier to some people than other people. I think that's just a great opening head space. I love the idea of just asking what happened. When this person is running late instead of saying, you are not going fast enough. It's going, Hey, I'm noticing that you're getting stuck in these rooms or you're spending a lot of time in certain rooms.
Why do you think that is? Is there something, and the rooms that you were in, why do you think that ended up being a trap? I also love flipping it around. I'm a big fan of positive inquiry, which is asking people about what worked well and then figuring out why it worked well, so you can know other places, so I can say, Hey, yesterday I felt like you were really moving efficiently through the exam rooms. I felt like you were doing a great job as far as staying on time. And that's what the tech said. What was good about yesterday? Why do you think you were you able to do that so well? And that can often give you some insight into, oh, this is how I support this person. And they go, oh well, yesterday I saw these types of appointments or I had this set up, or yesterday my technician was doing this thing that was helpful for me.
And I go, ah. And now it's not, Hey, tell me about why you're failing. Tell me about why you're running behind. Tell me about why people are frustrated.

Dr. Amanda Doran:
Great.

Dr. Andy Roark:
Yeah, it's tell me about why these appointments were particularly good. And I've just found that, that is a very soft, nice way to get, it's to help me to help you you know what I mean? Help me help you. I don't know what's going to be helpful for someone else, especially someone who sees the world differently or perceives it differently than I do or has different strengths than I have. I'm like I don't know how to help you because I don't have the skills that you have, I have different skills and I really like that. And then the big thing is, and the way I just phrased it is the way I would phrase it talking to the person, is not what can we do to get you to conform?
What can we do to fix you? No, it's what can I do to support you? How can I help you? How can I lift your workload? How can I make your time here more enjoyable? How can I help you meet the needs of the staff or any of those things? But how can I help you? How can I support you? What would you like me to do? What would make your time here easier? What would set you up for success? What does a great day of appointments look like for you? Those are all the types of questions that I try to get to get in there and develop specific action steps to support this person at an organizational level without making them feel like, oh, you are coming up short and so I need to give you a crutch. It's not that. And I don't want anybody to feel that way.
And that's not true. It really is more you kick butt in a different way than the rest of the doctors do. And so I need to make sure that you have support for your style and I need to understand what that would be, because I don't know your style as well as you do. And then I really like your point about enforcing breaks. I just, it's funny as you say that, I go, oh man, that makes so much sense of, hey, we've all had doctors that we have to stuff a sandwich into their hand and be like, you need to eat this. When was the last time you went to the bathroom? When was the last time you drank water, Amanda? We've all had those conversations, right?

Dr. Amanda Doran:
Have you seen the sun today?

Dr. Andy Roark:
It's so simple. Yeah, exactly. But that makes so much sense when you say that. And I go, oh, and it's an easy thing to do and it's a good thing to do, right? I mean, many of us work in states where breaks are enforced. A lot of us work in states where that's not necessarily true. We should still do it. And I just think that this is a good thing. It's one of those things where sometimes you slow down to go fast. And I find that that's really true in taking care of our staff and our doctors, especially with some people. I have to get them to slow down so that they can feel better, and so that they can focus, and so that they can then be productive and we can go fast. And so I think all of those are really, really great. Amanda, do you have resources that you really like? You mentioned one of the Love and Work book.

Dr. Amanda Doran:
Yes.

Dr. Andy Roark:
I'm going to check that out. It's not one I'm familiar with. Any other resources that pop to your mind that you think are particularly useful that you like?

Dr. Amanda Doran:
I do like reading books about time management, particularly related to neurodivergent people because I feel like a lot of the kind of more popular books, some of those things don't work. And so even people who may experience neurodiversity, even looking into like ADHD coaches or other people to help with non-traditional kind of executive functioning I found is really helpful.

Dr. Andy Roark:
Yeah.

Dr. Amanda Doran:
Part of that is I don't really remember names very well.

Dr. Andy Roark:
Sure, gotcha.

Dr. Amanda Doran:
Yeah.

Dr. Andy Roark:
What does somebody search for to find that, because you're talking about this thing, and I'm like that makes total sense to me. It's not a genre that I'm familiar with. What are some of the terms that when you look like you said executive functioning, coaches, ADHD coaches, things like that-

Dr. Amanda Doran:
ADHD Coaches.

Dr. Andy Roark:
Are there certain terms that you kind of look for?

Dr. Amanda Doran:
Yeah, I feel like ADHD coaching is a big thing that's becoming more popular. Or maybe just noticing it more and even kind of learning more about time and how different people relate to time and how it varies for everybody. We talked just briefly about those kind of languages for progressing with visits. I'm doing a talk at the hospice conference later in the fall kind of talking about how to do that with in-home euthanasia visits. And yeah, just kind of recognizing some of the more traditional approaches for kind of “neurotypical” people. If you feel like you're struggling with them as a neurodivergent person, it may be that there are other resources that can be helpful, so ADHD coaching is something that's really helped me and those people are full of resources.

Dr. Andy Roark:
That's awesome. That's really, really cool. Amanda, where can people find you online? Where can they follow you and keep up with your adventures?

Dr. Amanda Doran:
I do have a website @dramandadoran.com and the little social media on the Instagram @dramandadoran. And you can also find Wicked Witch West End on Instagram too. But most of my projects and other things that I've done on that Dr. Amanda Doran website, and if anybody has questions or wants to reach out, my email address is dramandadoran@gmail.com.

Dr. Andy Roark:
Awesome. That sounds great. Well thank you so much for that, guys. I'll put links to everything we talked about down in the show notes.

Dr. Amanda Doran:
Thank you.

Dr. Andy Roark:
Everybody have a wonderful week. Amanda, thanks again for being here.

Dr. Amanda Doran:
Thank you, Andy.

Dr. Andy Roark:
And that is our show. Guys, I hope you enjoyed it. I hope you got something out of it. Got to give us a special shout out to Banfield the Pet Hospital for making transcripts possible. Speaking of inclusion and accessibility in vet medicine, Banfield makes transcripts possible so that people can more easily access the information in this podcast. And they didn't have to do that and we could not do it without them, so I just got to stop and give a shout out to those guys. Guys, if you got any questions for us, shoot us a question in the mail bag. The email address is podcast@unchartedvet.com and Stephanie Goss and I are happy to tackle that. I'll be back with the goddess Stephanie Goss next week and we will see you then. Take care, everybody.

Written by Dustin Bays · Categorized: Blog, Podcast · Tagged: doctor, management, neurodiverse

Nov 16 2022

Overwhelmed and Won’t Give Up! Part 2

Uncharted Podcast Episode 205 Cover Image

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and practice manager Stephanie Goss are picking up where they left off last week! That's right, this is part 2 of our first cliffhanger episode (click here for Part 1). This week, we will dive into the action-step ideas for the challenge facing our repeat mailbag writer who was previously feeling squashed and stubborn. They are still at it and just as stubborn as ever, only this time, they are struggling with not letting client frustration over scheduling woes get them down. They are booked pretty far in advance and doing all the things they can to manage the schedule and clients are still really frustrated. They are voicing it to the team and it is starting to crop up in online reviews this doctor is asking for help in getting into a good headspace and not letting it get them or the team down. And also looking for help on how to communicate to clients that they have to wait and why it's okay to wait in some cases, without clients feeling brushed off. Let's get into the action…

Uncharted Veterinary Podcast · UVP – 205 – Overwhelmed And Won't Give Up – Part 2

You can also listen to the episode on Apple Podcasts, Spotify, Google Podcasts, Amazon Music or wherever you get your podcasts.

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


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Thank you to our sponsors! To learn more about this week's sponsor, GuardianVets, check out their website HERE.


Upcoming Events

Pay Scales And Wage Transparency with Stephanie Goss

Recent law changes in multiple states and more coming down the pipe January 1, 2023 make pay scales and wage transparency an urgent matter for all veterinary practices to consider. 

Date: November 20

Time: 4-6 PM ET – 1-3 PM PT

The Secret Sauce to Optimizing Workflow with Senani Ratnayake, RVT

Back by popular demand! It's time to take a look at the workflows that aren't working and come up with a plan to move forward with a strategy that makes sense.

Date: November 30

Time: 5:30pm ET/2:30pm PT – 7:30pm ET/4:30pm PT

All Uncharted Veterinary Community Workshops are LIVE! You will be able to ask the instructor questions that help you address your practice’s unique problems. This will not be 2 hours of silent screen time. Gear up for interactive, fun learning!


Episode Transcript

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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.

Dr. Andy Roark:
Hey, Stephanie Goss. You got a second to talk about Guardian Vets?

Stephanie Goss:
Yeah. What do you want to talk about?

Dr. Andy Roark:
Man, I hear from people all the time that are overwhelmed because the phones never stop ringing.

Stephanie Goss:
Yes.

Dr. Andy Roark:
And I'm sure you hear from these people as well, “Our caseload is blowing up and the doctors are busy and the phones just don't stop.”

Stephanie Goss:
They never stop. That is a true story.

Dr. Andy Roark:
I'm amazed by how few veterinarians know about Guardian Vets. This is a service where you have registered technicians who can jump in virtually and help you on the phones. You can flip the switch and Guardian Vets can jump in and take some of the load off the front desk and they can handle your clients and get them booked for your appointments and give them support. And it really is a godsend.

Stephanie Goss:
Pre-pandemic, it was amazing to me how many people hadn't heard about it for after-hours call help. But at this point, I can't believe how many people don't realize that they are offering help during the daytime as well, which I would think right now is a huge benefit to practices because everybody is shorthanded, everybody is drowning in phone calls and so we talk about it. We've talked about Guardian Vets a lot on the podcast and every time we do, we always get somebody who says, “What is that?”

Dr. Andy Roark:
Guys, if you're not familiar with Guardian Vets, if you think that you could use some help on the phones or up the front desk, check them out. It's guardianvets.com. And if you mention our podcast, me and Stephanie Goss, you get a month free. So check it out, guardiansvets.com.

Stephanie Goss:
Hey everybody, I am Stephanie Goss and this is another episode of the Uncharted podcast. In fact, this is Part 2. This is the second part of last week's episode where we started talking about feeling overwhelmed, but not wanting to give up. We tackled head space last week, so if you missed the episode, go back and listen to number 204, so you can hear what Andy and I had to say about how do we handle feeling overwhelmed about a certain issue in practice, but not wanting to give up on it.
This is a repeat writer from Squashed But Stubborn and we really appreciated their question about how do we manage it when our clients are frustrated that we can't get them in. And they're letting us know and we are doing everything we can to help them out, but it's still not fast enough for them. And now, maybe some of them are communicating it to the staff, but also leaving online reviews and it is hard to not let that get to you. So, Andy and I spent last week talking about head space and this week, we're going to dive into some of the action steps for how do we handle it when we feel overwhelmed. Let's get into this, shall we?

Speaker 3:
And now, the Uncharted podcast

Dr. Andy Roark:
And we are back. It's me, Dr. Andy Roark and Stephanie “Taking You to the Streets” Goss. That's right. We're taking it to the streets. That's right. It's taking it to the streets because this is an all-action episode.

Stephanie Goss:
Yeah.

Dr. Andy Roark:
If Arnold Schwarzenegger made a veterinary business podcast, it would be this podcast. It would be this podcast.

Stephanie Goss:
I can't. I can't.

Dr. Andy Roark:
We managed the practices in an aggressive way.

Stephanie Goss:
I can't.

Dr. Andy Roark:
You will set boundaries for yourself. Get ready, crash cart. All right. I could have ended this thing. This is the best thing that has happened to this podcast.

Stephanie Goss:
Oh, God.

Dr. Andy Roark:
I know. That's if Arnold was slightly German.

Stephanie Goss:
Right?

Dr. Andy Roark:
That was. And much, much smaller.

Stephanie Goss:
Much, much shorter.

Dr. Andy Roark:
Much shorter, yeah.

Stephanie Goss:
Much less muscles.

Dr. Andy Roark:
Less impressive, yeah. He's like Mr. Universe.

Stephanie Goss:
I mean, it is almost Halloween.

Dr. Andy Roark:
I'm like Mr. Corner.

Stephanie Goss:
That could be a good… that could be a Halloween costume for you.

Dr. Andy Roark:
Oh, and I would… I mean, what do I need to do? Take my shirt off. That's it. Done.

Stephanie Goss:
Andy Arnold.

Dr. Andy Roark:
Yeah. It's like-

Stephanie Goss:
Same thing.

Dr. Andy Roark:
Same thing. Oh, my God, I thought you were him. Yeah, I get that a lot.

Stephanie Goss:
Oh, my gosh. If you're tuning in, you're like, “What are these two going on about today?” We're back. This is going to be totally different for us. This is Part 2, our last week's episode. We got to the end of head space and said, “You know what? Rather than give you guys marathon episode, we are going to break this into two.” And we are going to tackle the action steps next week because there's some really good ones and we want to dive into that. Andy, do you want to give a recap of what we started off with last week in case anybody missed the episode?

Dr. Andy Roark:
Yeah. Yeah, I do. So, let's go ahead and talk about the… we got a letter from the mailbag. And we have a veterinary practice owner who is trying not to burn out. Yes, she is overwhelmed with cases. She has lost… I'm saying she. I don't know if it's a she. It's just a guess. She's lost half of her technician staff in the last year and two and a half doctors this year. Only, it's two and a half because one of the people retired and has come back.
She can't get her regular clients in and she's really bothered because she can't get clients in who need to get seen. And they're saying, “Hey, I don't want to go to the emergency clinic.” And she's really hanging on. Seeing negative reviews is starting to bother her, even though she's really trying not to be bothered by this negative feedback from the clients who are frustrated that they can't get in. It's taken a toll and she does not want to give up. She wants to do the thing that she came to do and serve the purpose and take care of the pets. And at the same time, this has taken a toll on her. And she's like, “I don't know what else to do to keep the wheels on.”
And so, Stephanie and I talked last week and we talked a lot about… I talked about walking in the rain and I talked about the death spiral, which are different ways that we can get into this predicament. I talked about how common this is in Vet Medicine right now, how nobody can hire. It's very, very difficult to hire. There's a labor shortage. And so, a lot of us are having problem. We have unfilled job positions, things like that. A lot of us are working this way.
We talked a lot about sunk cost fallacy and how we get used to seeing a certain caseload and then our capacity to do that caseload falls off and we are unwilling to make adjustments with our new capacity. Things like that. We talked about responsibility that we have as far as pet owners deciding whether or not to take their pets to the emergency clinic and spoiler alert, it's not our responsibility. We have to be honest with them. We have to be honest about what we can do and it's their pet and we can't make them do anything. We talked about how it feels to have pet owners go to other practices and how maybe it should feel a lot less like a big deal.

Stephanie Goss:
It was a really great episode and if you missed it for some bizarre reason because…

Dr. Andy Roark:
So good.

Stephanie Goss:
… who wouldn't listen to us every week? If you missed it, you should go back and listen to the last episode because it was great. And we are going to pick up where we left off, which was we talked about head space. We talked about all of the things that Andy just recapped and we are about to dive into, “What do we actually do about this?” Because this is not a single-person problem. This is an industry-wide challenge to the point that you just brought up, Andy.
There is a labor shortage. Everybody is struggling with this. Everybody is struggling with feeling like they're a bit overwhelmed for a variety of different reasons. And there is this rebel fighting spirit of like, “I am not going to go down without a fight, so how do I actually fix this?”

Dr. Andy Roark:
Yeah, so the first step in this, for me, is to step away. The first thing is strategy. We need to disconnect ourself from working in the business and step back and work on the business because this is not as it's put forward, this is not a problem that's going to change. We're talking about we're a couple of technicians down, we're a couple of doctors down and it is hard to hire. There is no scenario where six people are going walk in…

Stephanie Goss:
Magically, yep.

Dr. Andy Roark:
… and take jobs next week and be ready to go. It is not going to happen. This is your new reality. And so, acceptance is the first part. And then strategy. All right? Guys, let's be honest with ourselves about who we are, what our capacity is, what our purpose is and what we're able to do. And separate ourselves from the pet owners in the exam room looking us in the eye asking for our help. That's working in the business. We're working on the business.
And so, it's about stepping back and saying, “All right. What can we do?” And so, my advice to you is to step back and say, “How many doctors do we have and how well are we able to support them with technicians? If we were opening up a brand new clinic, but again, setting aside our history, if we were opening up a brand new clinic, how many exam rooms would we use? And how many appointments would we see in our new clinic to service these doctors and keep them busy, but not burn them out?” And that is a painful exercise.
And I'm not saying you have to do exactly this, but I challenge you to unemotionally sit back and figure this out. And then, when we have these numbers and we say, “This is how I would do it and this is how we would staff,” I would say, “Great. Are our prices in line to do those things and to keep the doors open and to retain the staff and to make payroll, and things like that?” Because that is another thing where our pricing model was often built on us having a much bigger team and a much higher capacity and that changes. And I go, “Yep, that is an unfortunate thing.”
I hear from a lot of practice owners out there who are chewing their teeth and saying, “We can't raise prices.” And I say to them, “I'm sorry.” You, guys, if you've listened to my other podcast, Cone of Shame, you know that accessibility of care is a big deal for me and I want people to be able to get in and I do not want that to be a luxury item. And I promise you that I fight with this and I wrestle with this. At the same time, support staff salaries are going up. Inflation is a real thing.
Prices are getting more expensive. I mean I don't know about you, guys. Let's take gas out of this. Man, my grocery bill has gone steadily up and I buy the same thing. I'm a creature of habit. I buy the same thing. I swear I pay twice as much for it as I did a couple of years ago. It is valiant for us to want to fight these prices. At some point, it does no good for you to undervalue yourself and your staff and your staff leaves and goes to work somewhere else because they're able to pay a better rate. This is part of acceptance is let's be honest about the amount of work that we can do and then let's set prices to support our team in what we're doing.
And the good news is when people complain and they might, when they complain for us to say, “Hey, there's inflationary pressure. We are taking care of our staff. These are changes unfortunately that we need to make to stay in business.” To me, that is a very, very defensible position. I'm not saying that people will go, “Okay, that sounds great.” But I think at some level, it should not be unexpected for people and guys, it really doesn't matter because it is what's required for you to do your job.

Stephanie Goss:
And here's one of the things, this is, I see a lot of my peers and colleagues struggle with maths and let's be real. Maths are really hard, maybe second only to time zones being hard in the universe. But it is really a simple math equation. And walk with me here for a second, everybody, because if you take a step back and you look at your people and you say, “Okay, if we have one doctor now and we had four and we have two technicians and we had four, what can we do now?” I think that's a wonderful exercise and you do.
I love that you have to consider your pricing, Andy because that is the next piece. You have to think about, “Okay, if I'm now changing this patient load, what is my output going to be? And is that going to be enough to cover our butts and keep the lights on?” Okay? And then most of us look at it and say, “Okay, well, the only choice I have here is to drive up prices.” That's the first lever that a lot of us reach for. It's like, “Well, if I have less people, I'm just going to drive up the prices.”
And that's I think where the panic you're talking about, Andy, comes from our practice owners who are like, “But I can't raise the price from $20 to $40 for a thing because that's double. And owners will flip out and they'll never come back.” Okay. The thing that I think a lot of us have to keep in mind is that math is an equation. There is an equal sign in the middle and there is room on both sides to help balance this out. And so, too many of us look at it and say, “Well this is my only option.” But I will tell you if you increase a little bit on one side and you increase a little bit on the other side, you can still get to the equal in the middle, you guys.
And this is where so many of us look at it and panic and think, “This is the only button that I can push. I can only push more cases through the door or I could only push more money.” And really what this is about, the exercise for each one of us, because it is individual and every one of our clinics is going to be different. And if you do the work that you're talking about, Andy, if you step back and really work on the business instead of in it, you have to look at what is right for you and your team. And maybe the answer is your pricing model wasn't set up great and you should increase prices maybe even by more than double. That may be the answer in your clinic.
And also, there are plenty of clinics where the answer may be that, “Could you figure out a sustainable way to do a little bit more volume? Not a ton, not twice the caseload with half the people, but could we do a little bit more volume and keep our prices where they're at?” Maybe, right? But the answer is that there is room on both sides of this equation to balance things out. And I think that's a step that a lot of us, myself included, have missed because we stand there and panic and think the only option we have is to jack up our prices.

Dr. Andy Roark:
Yep. Yeah, I completely agree with that. Okay. I want to get into that in a second. Let me start here with, I want to talk for a second about capacity. And so, I talked about this in our last episode, but it's important enough I need to bring it back here and put it at the top. Okay. You, as an individual and your practice, but we're just talking about you as an individual. You, as an individual, you have a capacity.
There is a certain amount of work that you can do at a day in a healthy way. There's stress and there's distress and a healthy amount of stress is good. That means we're pushing ourselves, we're working hard. At some point, there is a capacity above which you are not stressed, you are distressed. Meaning, this sucks. You feel crappy at the end of the day.

Stephanie Goss:
And you go home crying.

Dr. Andy Roark:
And you don't look forward to coming back tomorrow. That's it. That's the line. You switch from, “Boy, I worked hard today. I'm kind of proud of myself,” to “That was sucky. And I'm going to be right back in it tomorrow and I feel crappy about it.” And if you are having those thoughts as you leave practice, you, my friend have switched. You've pushed past stress into distress. That's capacity.
Now, you can push past healthy capacity into distress and you can do that for a day or you may be able to do that for a week. You may be able to do it for a month or even three months or six months or maybe a year, the bill comes due and you need to know that. The other thing is, it is, I have never seen a scenario where the doctor is pushed to distress, but the team is happy.

Stephanie Goss:
Right. I was going to say.

Dr. Andy Roark:
If you're feeling that, you better believe your team is feeling something very similar and you might be motivated and dedicated and you might own this practice or you might not. You might just be like, “But I don't break. I don't give up.” Other people, that's your own weirdness that you came up with that, yeah, you can take that on for yourself if you want, but you are also dragging other people into that. And they may not feel the same way because they're healthy. They have a healthy perspective. Maybe that's why, but-

Stephanie Goss:
They have boundaries. The other thing that I think is really important here to call out and I'm going to call this out because I have been this leader. No matter how much of a poker face you think you have, no matter how well you think you hide your distress, my team doesn't know how worried I am. They know.

Dr. Andy Roark:
Yes, they do.

Stephanie Goss:
They know. And to your point, Andy, you might be able to hide it for a day, but if you are a leader and you are operating in the place of distress for any sustained amount of time, no matter how good you think your poker face is, your team knows.

Dr. Andy Roark:
Well, everybody has a bad day. But if you have a bad day after a bad day, after a bad day, after a bad day, that radiates out, right?

Stephanie Goss:
Yes.

Dr. Andy Roark:
Culture comes from the top and stressed out, that's a type of culture. We have all seen a stressed out culture. It comes from the top. And so, if you're the medical director, if you're the practice manager, if you're the practice owner and you are just stressed every day then that's radiating out. And so, I say this because it's important. The goal for you in practice should be to do good in the world, the most good in the world.
And if you work past your capacity and your staff quits and now, you're shorthanded, you are doing less good in the world over the long term than you would have been had you rationed it down to a reasonable capacity and kept your staff intact. And if you want to do good in the world and you see all the pets and you burn out in four years and you leave the profession, you're going to see way less pets and do way less good than you would have had you done less and stayed in the profession for 20 years. And not by a little bit like a couple extra pets like…

Stephanie Goss:
A lot.

Dr. Andy Roark:
… by orders of magnitude. And so, if you say, “I'm here for the pets. I'm here for the community,” what I would say to you is, “Are you here for the community in the year 2022, 2023 and 2024? Is that what you're saying? Or are you saying that I'm here in the community for the next 15 or 20 years until I retire?” And you need to make that choice. You need to make it now because my friend are running this race like a sprint and you're in a marathon.
And so, anyway, but we have to put that forward. And if you don't buy into that, if you say, “Nope. I don't believe in this idea of a capacity. I can just work hard forever and not break,” I can't help you.

Stephanie Goss:
Good luck.

Dr. Andy Roark:
I'm sorry I can't help you. I would say you are kidding yourself and it's time to get realistic about you being a human being and your own mortality. But once you do that then we can settle into the real work of saying, “How do I maximize my benefit to society, to pets, to people, to my community?” And also, “How do I balance my own enjoyment of this one trip that I get on this spinning globe?” Because you only get to go through the ride one time and this is your life right now and you better enjoy it because it's all you get.

Stephanie Goss:
Okay, so if we accept the fact that we have capacity and we need to figure out what that capacity is, then where do we go?

Dr. Andy Roark:
All right. Great. So, we've got a couple of things that, and they're all interconnected, which is why it's a little bit of a tricky fish. All right, so access Step No. 1 is efficiency. Well, first of all, you might look at your capacity and how you're priced and you go, “Yeah, that's it. We're going to make some adjustments to our current schedule.” Guys, let's actually start with that.
So, I'm going to start with scheduling. Scheduling is one of the first easiest things to help people out and I'm amazed at how many people do not feel good about their schedule or how they do scheduling. If you need a little bit of extra help in scheduling, we do have a course inside. It's the Knowledge Library in Uncharted, it's run by Dr. Saye Clement. It's actually really, really good. It's a way that Uncharted teaches scheduling. She does a fantastic job with it, laying it out. But if you really want help with scheduling, there's an Uncharted course that we have in the knowledge library and we should probably run that again before long.
Anyway, big things for me. You need to have a plan, right?

Stephanie Goss:
Yeah.

Dr. Andy Roark:
You need to have a plan and if every day you're just getting overwhelmed, you have a bad plan. If you are not doing schedule blocks, meaning, when we look at our schedule, we need to be intentional about what we're doing. And as we always say on this podcast, if you're surprised by something again and again and again, at some point, it's not a surprise, it's your business model. And it's amazing to me how many practices still fill their appointment slots up with wellness appointments and then act surprised sick pets have the audacity to show up on of them.

Stephanie Goss:
Thank you for saying that. Oh, my goodness. Thank you, thank you, thank you, thank you, thank you.

Dr. Andy Roark:
So, if your doctors are continuously running behind and they're stressed out, and I'll push you on this and say, if your doctors are, as a group, all staying late at night to write up charts, I would say you are pushing them past capacity, right?

Stephanie Goss:
Yes.

Dr. Andy Roark:
They need to have time to write up their records as they go along. And there's a fall off the medical quality when people put off records to the end of the day, saying, “Oh, we are keeping up because we're not doing this essential part of practicing medicine.” That's not keeping up, friends and it's bullshit. Pardon me. It's bullshit to run the doctors as hard as you can and say, “You get out of here at 6:00,” and then they're here until 8:30 because they're doing this thing that is essential for their job. That's not okay.

Stephanie Goss:
I think we have to stop for a second because there are so many practices, my own practice included, where the model was, “Let's keep the clients on time. Let's get the clients out on time. Let's get the team out on time.” And then the expectation is that the doctors are calling back clients and writing on medical records for anywhere from one to four hours after the rest of the team has gone home. And I agree with you, Andy, that is total. And it is something culturally that we absolutely have in our control to change.

Dr. Andy Roark:
Yeah. Now, I did say as a group, and I have to throw this caveat in because I 100% have worked in a practice where I am out on time and there is one doctor that's staying there until 9:00. And I would say that is a personal problem and I think a lot of doctors really struggle with that. If you are insisting on writing up three pages of medical records for every appointment that you see and not being efficient in your records and not looking at what other doctors are doing and not figuring out how to get out on time. That my friend, that is a personal problem that I think is often tied to a perfectionist personality and things like that.
And that is something that some people have to really struggle with and work with. And so, that is why I said, we need to look at the doctors as a group. But if the culture is everybody stays and writes up their records at the end of the day, I think that's a problem. And so what do we do? We need to be honest about keeping up and the first thing is to put some catch-up blocks. If you have a walk-in practice or a walk-in practice that takes appointments and also walk-ins, boy, if your doctors are always 30 minutes behind, by 3:00 PM you need to have a block. You need to stop taking appointments at 3:00 PM and have a block and say, “This is catch-up time.” And so, that's one of the first easiest things is be honest about how your doctors are running. And at some point, you can't take an appointment because they need to catch up.
The other thing is, again, if you have walk-ins, same day appointments. I'm a big believer in if people are going to walk in and your doctors are getting swamped, you need to have some appointments that are blocked off that cannot be filled until the day of the appointment.

Stephanie Goss:
And I have to say this because I see it every single day in the communities that I am a part of, including in Uncharted, where somebody asks the question still, we are how many years into this pandemic and the changes that we've had with our schedule. And somebody says, “But we have three sick pet blocks on the schedule for the day. And everyday, it's just not enough and it's not been enough for three years.” That is the problem.
You have to step back and look at that. Like you said, Andy, if you're asking the same question over and over again. Good, if you're surprised, it's your business model. And the reality is no practice, not even a single doctor practice most of the time, I would argue, and this is one that I would… well, this is a hill I will die on, can have three sick pet appointments in a day and not fill them. We are in a place where we all have clients coming out our ears and what used to work for us having two or three sick pet appointments per doctor doesn't work anymore. When's the last time you only saw three sick pets in a day?

Dr. Andy Roark:
Yeah.

Stephanie Goss:
It's been years. Sometimes, we go through waves where there's not a lot of sick patients, but be honest with yourselves and your team. Sit back and ask yourself the question, “When's the last time we only saw three sick pets in a day?” And really, I think, I'm so glad that you brought it up because I think we need a radical overhaul of how a lot of us are approaching scheduling because we are doing it to ourselves.
We are letting ourselves be surprised over and over and over again and it has become our business model. And I see it and it drives me crazy because it goes back to what you said about in the head space piece, about we don't have to keep doing what we've always done and this is the prime example for me when it comes to scheduling. Well, but we are leaving two or three spaces. Ask your team that question. Ask your CSRs, “When's the last time we only had three call-ins in the morning for sick pets?”

Dr. Andy Roark:
Yeah, yeah. I completely agree. At some point, some of this probably starts with auditing. It's, “Take a moment and we're going to work on the business.” Look. Look objectively at what's actually coming in. Are you getting a ton of sick pets? Are you getting single sick pets that are really sick? Are you getting a ton of sick pets that are mildly sick? Are you getting sick pets that really could be, they could wait another day or two but they just they don't want to? Are you getting really sick pets that are getting turned away because mildly sick pets got those appointment slots first thing in the morning? All of those things can be adjusted.
I've come a long way on charging emergency fee as well and I still waffle back and forth. And what I'm going to say is it depends. It really depends on what you're looking at and how you're looking at it. There are downsides to charging an emergency fee to get in. Meaning, that some pet owners don't like it. If you are looking at a place where you have a certain number of sick pet slots a day and those are getting grabbed by people that could conceivably wait a little bit longer, they just don't want to, then it may be time to put an emergency fee on there that says, “Well, if you're going to come in as an emergency, you're going to pay more.”
And the idea of that, honestly, is not about making money, it's about making it a bit of a barrier so that people are incentivized to wait an extra day or two if appropriate, obviously. And we're going to have to teach our techs or our front desk on that.

Stephanie Goss:
And that's where you think about the human emergency room. That you go to the emergency room when it's truly emergency and there are lots of people who are like it's not “I don't want to wait.” Sometimes, it's “I don't feel like I could wait and I'm not sure.” And I think that that is medically acceptable. And there's also lots of people, and I hate to say this, but having kids, I've been that person where I'm like, “I can't wait another two weeks to get in. I will just pay the extra money to go.”
And I know full well I'm going to sit in the ER and so, I time it, so that I have the time to sit there with my kid. But when they've got an ear infection and I need to start meds now, not three days from now or four days from now, that's the price I'm willing to pay. And I think we have that model in human medicine. And let's be honest, it does not come without problems. It is part of why the emergency rooms are overwhelmed, both in human medicine and in animal medicine. And I recognize that and I'm not advocating for it because I don't think that is the only solution.
But I think your point, Andy, about there are always going to be clients, who are willing to pay no matter or do whatever, no matter the barriers you put up. And so, I think we have to acknowledge that and recognize that it's happening and also have a plan to help discourage the majority, so that we can help more people.

Dr. Andy Roark:
Yeah. And that's where the line in this. It's not about trying to punish people who have emergencies. It's really not. And so, I'm not like, “Charge more and more.” It needs to be enough ideally that it incentivizes people who we think that their pets can wait. It incentivizes them to just wait a couple of days and leave spots open for people who really need it. At some point, it's not about punishing people who have true emergencies.
The other thing is if you're at capacity and you say, “We cannot turn away sick pets. We just cannot do it and we're at capacity and these are coming in on top.” I would say, I think an emergency fee is absolutely warranted once you hit capacity. So, you might even have same day slots that can be filled, but once those same day slots are filled, if you still want to take emergency, you can. But that my friend is a bonafide emergency and is getting emergency fee. And I would figure out how to take that and give it back to the doctors or back to the staff because they're getting this extra stuff dumped on them. And while I'm trying my best to reduce that load, if I can't reduce it, I'm at least going to try to do something that is nice for those people.
And so, anyway, I'll give you a quick example. If you have doctors that are paid on production or pro-sal and you add an emergency fee, they're at least getting some extra compensation for taking that emergency over just another appointment that's being dropped on their plate. And that's just something to think about. In doing scheduling, we need to have a system for communicating from the back up to the front.
And so, if you're going to take walk-ins, one of the big things I see is the back is completely slammed. It is pandemonium and people are crying and the people up front are blissfully unaware. They know it's busy, but they don't see the chaos going on in the back. And so, they're taking walk-ins and sitting them down and things like that and the back gets super mad at the front. And the front is like, “What? We're doing our job. We have no idea.”
I really am a big fan, if this continues to be a problem where the back is getting angry at the front because the front keeps letting people come in, we need a communication system. And that can be, I've seen some light systems where people in the back can flip switches or hit a button. And there's a little green light that's front which means, “Hey, we're good if people walk in.” And there's yellow, which means, “Tell them that there's going to be a 30-plus minute wait.” And then there's red, which means, “We are not able to see anyone for the next three to five hours.”
And then at least the front desk knows if someone walks in, you can say, “We are not taking any more walk-ins. It's going to be at least a five-hour wait. We recommend you going somewhere else. We're not going to be able to see you today.” A lot of this stuff is clear communications and it's amazing how we suck it up and we don't tell pet owners. And again, if the pet owner is willing to pay the emergency fee and they're willing to wait five hours and it's not going to put us working past close, okay.
But it should at least be like a restaurant where you go into a restaurant and we've all walked into restaurants and the place is packed and they're like, “Oh, we might have open tables at 9:00 PM.” That's it. “We might be able to seat you at 9:00, but I can't even promise that.” And I go, “Well, I'm going somewhere else.” And then I leave, but at least I'm given that information. So, anyway, that's sort of back to front communication. Clear expectations, I think are the other part that I was just saying is we need to let clients know we are completely filled up. And if you want to be here, you're going to pay an emergency fee and you're probably going to wait four to five hours.

Stephanie Goss:
I love that and I think the other piece about communication, I was thinking while you were saying that, I think the other piece about communication is a lot of us are afraid. I have felt afraid to communicate outwardly to clients what is happening for fear that of I guess, of judgment of that they're going to think that things are falling apart. That we don't have our ish together. I've been there when you have gone from four doctors to one and it's like, “Do I tell them?” And the answer is yes.

Dr. Andy Roark:
Yes. The answer is yes.

Stephanie Goss:
If you are not communicating to them and you are not setting expectations, you are failing them. And a lot of times we make those decisions because we're afraid. Like, “Oh, but we're working on hiring other doctors. We're working on getting relief, so I'm just going to hold off on telling them.” It's all done with the best of intentions and I say that because I have been there. And at the same time, we are doing them a disservice when we are not communicating to them the expectation for reality.
And I have seen more and more clinics start to be open and honest about that and I think that there's ways that we can do that that are more successful than others. And I think a lot of us communicate from that place of panic and it can outwardly look a lot more chaotic or discombobulated, which is not what we want. So, I think it has to be strategic and smart. But look, if your reality is you were a four-doctor practice and you're now a one-doctor practice, you have to communicate that to your clients.
You are going to change your business model. You cannot go from seeing 50 patients in a day to seeing a one-doctor caseload and not have clients hacked off when you tell them, “It's three months from now before I can schedule you.” You have to take control of that situation and do some communicating. And so, I love your ideas, Andy, about communicating in the thick of it in the day between front versus back and also, with the clients as well.
And I've seen more of my peers start to have and share outwardly their local clinics and ERs have spreadsheets that they're using together to communicate, “Are they taking patients? Are they closed to patients? What's their wait time?” I've seen more of my GP colleagues share that kind of information outwardly on their Facebook pages, websites, whatever, for their clients to have access to it. Which helps them cut down on the volume because if clients can get that information themselves and see that there's a wait, it cuts down on the calls that the GP and the ER are both fielding, which is brilliant.
But also, being able to communicate that if within your own practice as well, but also the long-term piece of it. If this is not a short, if everybody is out with COVID, that's one thing. If you're closing temporarily because you've got a stomach bug going through a clinic, whatever, but when your reality is going to change for an extended period of time, it is your job to communicate that to your clients as well or we are failing them.

Dr. Andy Roark:
Yeah. You can be vulnerable, honest and a professional at the same time and you should. This falls right into our category of pick your poison. Do you want to not tell people what's going on or the realities of the situation because they might think less of you and deliver a crappy customer service performance because their expectation is that there's nothing going on and you should be functioning at full capacity? Or do you want to tell them this is our reality at the moment and thus, what you should expect in your visit and have them be disappointed that they're not going to get in, but also not be surprised?
Remember people don't get mad about what you give to them. They get mad about the difference in what they got and what they expected to get. And they're expecting to get what they've got in the past and they're going to be mad even though you do your absolute best. And I think that that is really important point.
I've got an article that just came out in today's Veterinary Business this month and I looked at it yesterday, I had completely forgotten what I have written. But I wrote about being in Charlottesville, Virginia with my wife and we were on vacation. We were just driving and hiking and stuff. And I went to this bougie little breakfast place with Allison and it was $8 for a cup of coffee.

Stephanie Goss:
Oh, my God.

Dr. Andy Roark:
$8 for a cup of coffee and it was very good coffee, still eight bucks for a cup of coffee. And then I ordered a breakfast thing and they brought a biscuit, but they didn't have any jelly for it or anything and it was not where I feel comfortable. That's not where I eat and especially, it made my wife extremely uncomfortable because I asked if I'd had to pay for refills of coffee. And I asked her if the water was free because I was looking into the menu and I'm like, “Is water free? Do I have to pay for more coffee?” And because I was like, “This is ridiculous.” So, anyway, so there I was-

Stephanie Goss:
I could just imagine Alli's face. Okay. Keep going.

Dr. Andy Roark:
I was like, “Is water free?” And she was like, “Ah.”

Stephanie Goss:
Again, “I can't with you.”

Dr. Andy Roark:
I see her jumping back 25 years and going, “Why did I agree to marry this man? This is the man that I married.” So, anyway, so there we are. And I'm drinking this $8 cup of coffee and it's great, but then it's gone. And so, I've got an empty cup of coffee and I've got this biscuit that does not have any jelly on it and this biscuit needs some jelly.
And there's one server and she is busting her hump. She has a smile on her face. She's seating people. She's running around. She's taking orders. Honestly, she's amazing. But there's one thing she's not doing and that's getting me more coffee or coming over, so I can ask for jelly for my biscuit. And minutes and minutes and minutes and minutes go by, and I'm sitting there. I'm turned around, trying to get her attention and she is working as hard as she can.
And so, at one point I get up and I go to the restroom and she's at the bar making this coffee drink for someone. And I said, “Boy, you're really working hard.” And she was like, “Yeah.” And I said, “Is it always this busy?” And she said, “Oh, yeah.” And I said, “Do you always work alone?” And she kind of pursed her lips and she made eye contact and she said, “No.” And I'm sure that someone…

Stephanie Goss:
Called out. Yeah.

Dr. Andy Roark:
… or called out or they have a new hire, anyway. Anyway, I tell this whole story because that person was busting her butt. She did not stop moving and the smile on her face never wavered and I didn't get a refill on my $8 coffee and I never got a jelly on my biscuit.

Stephanie Goss:
Right. You're still frustrated by this. Yeah.

Dr. Andy Roark:
And I'm still frustrated. And guys that's life sometimes, is that everyone can do the absolute best they can and it's still a frustrating experience. And so, I bring that up now because that is how a lot of us live. And so, tell them that you're working by yourself. Tell them how, we know what to expect and know it's not pleasant and know you'd rather not do it. But a lot of that, and a lot of it us start doing some weird Weekend at Bernie's thing where we're like, “No, he's fine.” We're acting like our corpse friend is alive. It's ridiculous. Everyone can tell. It's not exactly.

Stephanie Goss:
We've just dated ourselves because there's a ton of people listening to the podcast who have no idea what that movie is.

Dr. Andy Roark:
Yeah. Oh, yeah. If you want to see something weird and ridiculous and you don't know what Weekend at Bernie's is, go and YouTube, the trailer for Weekend at Bernie's and say, “Andy Roark says that's what we're doing.” A lot of us are pretending like we're fully staffed and we are not.
And so, anyway, pick your poison. Be honest. You can be vulnerable. You can be honest and you can be professional. You can set clear expectations and set them up front. And I tell you a lot of the stress goes away. Practice. Talk to your staff about how to communicate that and then let pet owners know what their expectation should be. And if they don't like what you're telling them and they decide to go somewhere else that is okay.

Stephanie Goss:
Be okay.

Dr. Andy Roark:
And it better be okay because you're burning out.

Stephanie Goss:
Yep, yep. Yeah.

Dr. Andy Roark:
And the last part is when we talk about training our staff, train them how to tell people that we're not taking any more walk-ins today. And set a time. If you close at 6:00, tell people you don't take walk-ins after 5:30 and mean it. Don't make it some, “We don't take walk-ins after 5:30 unless the doctor says that it's okay.” And they say, “Well go ask the doctor if it's okay.” And remind them of all the times I've come here and tell them how far I drove to be here and that I'm having terrible hardships in my life. And then they tell the doctor and the doctor folds like origami every time.

Stephanie Goss:
Every time. Every time. Bless their hearts. And I love my doctors for doing it.

Dr. Andy Roark:
Sure.

Stephanie Goss:
And at the same time, this is where it's really important. When you're in this overwhelmed mode, this is where as a leader, a lot of the head space pieces that we talked about in last week's episode, it has to start with you. And this is a piece, the communication piece, the training piece, the decision-making piece about what are we doing has to involve the team. And there's a lot of practice owners that are like, “But I have to decide what's best for the business.” And that is true.
And your people are going to leave if you don't take care of them. That is also true and so, this is where asking them for their input. It doesn't mean that you're going to go the way that they want you to, but they have to feel heard. And this is where you have to step back and say, “Okay. My doctors want to take care of all the patients.” And a lot of them are paid on ProSal. And so, a lot of them are motivated by taking care of all of the patients, so that they get paid. Those two things are true.
And it doesn't mean that the team having lives outside of the practice is not as important as paying your doctors. Those things have to exist together and this is where you have to have the conversation. And the team has to be able to agree on some of what your standards or your timelines or like you said, Andy, like if your cutoff is going to be 5:30 or 6:00, there has to be conversation. Because no one is set up for success if your hours are 8:00 to 6:00 and you see patients literally from the minute you're open until the minute 6:00 rolls around on the clock, your hours are 8:00 to 6:00, but your team is going to be there at least until 7:00.
And if you're staffing them to only be there at 6:00, you're setting yourself up for failure every time. And so many of us do it because we think we're going to say no at 5:00 and we think we're going to say no at 5:30. And we might have all of the best intentions in the world, but if the whole team isn't on board, if there hasn't been a discussion about it, if you don't have an actual plan like you were creating the business model that your team is there until 7:00.

Dr. Andy Roark:
Yep. And if you want to let people walk in and you're going to take these cases and you know that you're not going to turn people away, that's not wrong.

Stephanie Goss:
No.

Dr. Andy Roark:
It's not.

Stephanie Goss:
Nope.

Dr. Andy Roark:
But own it, and staff for it and budget for it. And have a fair system about determining, who's going to stay late so that the nice doctor and the nice tech don't get screwed over again and again and again. And the people and I say nice, but the people who go, “Nope, I'm not doing this,” they benefit every time.
And so, I just see that all the time of like I say, I'm like, “Hey, who stays late?” And they're like, “Oh, Carol. She's single.” I'm like, “That sucks. That's not fair. That's not remotely fair.”

Stephanie Goss:
What happens when Carol has something to do?

Dr. Andy Roark:
Yeah. You can do an on-call system, but for God's sake, schedule it, communicate it, talk to the team about it. The Uncharted approach that we teach a lot, there's nothing wrong with sitting down and talking to the team and saying, “Guys. This is the reality and people come in and they want our help. At the end of the day, what do we want to do? Do we want to say no and make it no? Do we want to take it on a case-by-case basis? Do we want to plan on this and make a system?”
And you don't have to commit to anything the team says, but man, you can go a long way in making them feel heard. You got to really listen to them. But if every one of them is like, “No, no, no,” then that's your policy. And you go, “Listen, we talked to them. They said, ‘No, no, no, no, no.'” They told you. And if you say to pet owners, “I'm sorry. We do not have the staff available to do this. We cannot see you. These people, their shift is over and they're going home.” And I wouldn't say exactly that, but you get my point.

Stephanie Goss:
Right.

Dr. Andy Roark:
Then that's what it is.

Stephanie Goss:
Yes. And I think goes back to your point about when you go into a restaurant and they tell you it's going to be two hours for a table, they are setting clear expectations for you. You can wait two hours for a table or you can leave. Those are your choices. And I think in Veterinary Medicine like so many of us reach for the, “We want them to understand.” We want them to not judge us. We want them to not look at us negatively and so we overshare.
And so, this is why a lot of us don't communicate when we've gone from a four-doctor practice to a one-doctor practice because we do it and we either overshare or we're afraid we're going to tell them too much and so, we just don't say anything at all. And the reality is this requires finesse and it requires education and your team has to know what to say and how to say it.
But you can absolutely educate them to channel that front desk host at a restaurant and be able to communicate to our clients, “This is what I can do for you. I can seat you in two hours. I can see Fluffy in two hours,” or “You're welcome to call and see if any of the other practices in town can see you sooner,” like that. There's nothing wrong with communicating those boundaries. And I think systemically in Veterinary Medicine, we want to help take care of everybody and so, we've been afraid of that and we have got to get over that.

Dr. Andy Roark:
Yep. That's like the hostess at Olive Garden is not going to run after you and be like, “Please, don't leave. Please, please, wait.” No. We need to move a bit more than that.

Stephanie Goss:
You're 100% right.

Dr. Andy Roark:
Yeah. We to move a bit more in that direction of putting our oxygen mask on ourselves. I want to move past scheduling here.

Stephanie Goss:
Okay.

Dr. Andy Roark:
I want to talk about sacred cows.

Stephanie Goss:
Okay.

Dr. Andy Roark:
Sacred cows are the core beliefs that you have that you believe cannot be touched in your practice and so, part of this is examining your sacred cows. What are the restraints that you have put on yourself and your practice because it just seems like this can't be changed and it's holding you back. And I'll give you an example of this. Well, first of all, the first example of sacred cows is referring to other practices and saying, “We can't get you in, but here's another practice that could see you,” or “Yeah, there's three other practices nearby who might have availability.” And you go, “That's heresy.” And I go. That's your sacred cow. I just poked your sacred cow.”
The other one is we have to be open every day. We have to be open on Saturdays. Surely, we have to be open on Saturdays. It's our busiest day of the week. And I'm like, “It's your busiest day of the week and you're burning out and drowning.” It is not heresy to not be open on Saturday if you can't staff for six days a week. I mean that's it. We have practices in Uncharted that are closed on Wednesdays and people are like, “That's not allowed.” I promise you it is. No one is going to show up and be like, “You have to be open on Wednesdays.” We have practices that are open Monday, Tuesday, Thursday, Friday and Saturday half day and that's their week. And they're like, “Yeah, everybody is off on Wednesday. Everyone gets Wednesday off.” That's great.
Or they'll have one front desk person there or they'll have one front desk person who works from home and like yeah, you're on the phones, but you can be in your pajamas and you can be home and that's what it is. You could do a million things. What are your sacred cows? If you are buried, you don't have to be open. We have lots and lots of practices, I see it especially on smaller practices or one vet practices, they're not open on Saturday.

Stephanie Goss:
Yeah. And I think that from a leadership perspective, I think, I'm going to speak for myself here, a lot when I was a younger manager, I was afraid to poke the sacred cows. But I was also afraid to change those kind of things because I didn't know how to smartly make the decision. I looked at it and I said, “Well, I can't staff Saturdays and everybody's burning out.” And so in my head I think, “Well, it seems like closing Saturdays is a good idea.”
And I think a lot of us struggle with like, “But is this just a gut feeling? Do I go with my gut here?” And a lot of us struggle with knowing, I did, with how do I crunch those numbers? How do I look at those things? How do I smartly measure? And this is where numbers need to be your friends, because to your point, Andy, you should be able to look at that. Is Saturday really your busiest day of the week? You should be able to audit that in your software and tell down to the minute what your busiest day is. And if you can't do that, you can grow in a lot of ways by learning how to do those things.
And don't like don't be afraid of what you don't know. Don't be ashamed that you don't know how to do any of that because there are plenty of us, myself included, who have sat there and gone, “I have no idea. How do I calculate that?” And that's where I love our community, the Uncharted community because…

Dr. Andy Roark:
I was just going to say.

Stephanie Goss:
… how many times have I gone, “Okay, I need to do this math in the clinic. How do I actually do this?” And phone a friend and just ask. There's no shame in saying, “I don't know how to do this,” because most of us didn't go to business school. That's why I went to vet school. There are some who also have MBAs, but lots of us didn't go to business school.
And so being able to say, “How do I make these decisions?” Because you shouldn't make it in a vacuum. You should listen to your team. You should weigh in and you should be able to poke those sacred cows. And also then, a lot of us sit in that place of fear and paralysis in terms of decision-making because we don't know how to make the decision.

Dr. Andy Roark:
Yeah. I feel like we're plugging Uncharted a lot and it's just, it's because we're talking about big action steps that we don't have time to unpack everything. Stephanie Goss teaches a course in Uncharted and it's in the Knowledge Library and we run it fairly regularly on key performance indicators and financial dashboards and things like that. So, if you're like, “I have no idea how to even figure these things out,” we got you buddy. Check out the Uncharted community.
But anyway, you don't have to be open on Saturdays. And I'm not saying, I don't want people to go, “Andy Roark says we shouldn't be open on Saturdays.” I didn't say that. I'm saying it's not a sacred idea. Here's the other thing. I'll really blow your mind. What if you're open one Saturday a month? What if you're open every other Saturday and say, yes, there's communication challenges there, but that's not out. It's not illegal.
The other thing is just because you're not open for Saturdays right now, it doesn't mean that you're not going to open back up for Saturdays in three months. What if you said, “Hey, we need to hire two doctors and when we do hire two doctors, we're going to open back up on Saturdays.” And doctors coming in will know that that's the plan and that's where we're going.
It doesn't have to be a scary thing. It can be, “Right now, we're not able to keep Saturdays open.” And that's where we are. And we hope to open back up on Saturdays, so when people say, “I wish you were open on Saturdays,” you could say, “Me, too, buddy. We are working toward towards it.”

Stephanie Goss:
We are working towards that.

Dr. Andy Roark:
Exactly.

Stephanie Goss:
Yeah. And it goes on both sides. You have to communicate that to your clients and you have to communicate that to the team. And I think that that's important. We have to set expectations, and that's where a lot of us struggle.

Dr. Andy Roark:
I agree. So, look at your sacred cows. There's a lot of people who just the idea being closed on Wednesday or every Wednesday afternoon, that seems terrifying and wrong to some people. And I go, “No, it's not wrong. We got a lot of practices that do it.” If that's what you need in order to serve your capacity, if you say, “We're closed on Wednesday and we are working at maximum capacity every day we're here,” I'd say, “You're doing it right.”
Are you priced appropriately, so the numbers make sense and your business is healthy? If the answer is yes, then go forth and carry the torch. That's awesome. And the last thing I'm going to talk about before we run out of time, and a lot of people think this is the first thing, it's not, it's the last thing. It's efficiency. And people are like, “Yes, tell me how to not change anything except get more work done, doing things exactly the way that I'm doing them now?” And I go, “That's not what this means.”
You might be able to increase efficiency. The problem, the honest to God tactical on the ground problem, is increasing efficiency often involves training. And if you're already overwhelmed and drowning, it can be extremely hard to do the training required to change your operation system while keeping your nose and mouth above water. And so, I'm not saying you can't do this.
Generally, like most things, a multimodal approach is going to be your saving grace. And so, you might close on Wednesdays and then use Wednesdays as training days to reevaluate your workflow, how you're moving people through the clinics. And guys, the biggest thing we talk about efficiency, the easiest go-to in most practices is, “Are you leveraging your support staff? Are your techs doing stuff that they could be doing or is everybody waiting?”
The quick thing I'm just going to say on efficiency and making it work is just like we started at the beginning and said, “You need to do some analytics. You need to look at your workflow.” You need to look at what's actually happening and gather some data. You need to do some data gathering on how pets are being seen in your practice and you need to look for bottlenecks. Where are the places where support staff are standing around waiting for a doctor? Where are the places where the doctor is standing around waiting for support staff? And we need to make adjustments.
And that honestly often runs into your sacred cows. People will say, “Well, our support staff get the histories.” And I'm like, “Is the doctor waiting in the treatment room for you to get this history.” I say, we need to look at that and have an audible that can be called where the doctor is free and we're going to have a modified-

Stephanie Goss:
They're just going to have to do it.

Dr. Andy Roark:
Yeah, we're going to have a modified doctor's ready to-go history that gets us into that room. And even say to people, “Guys, this is a way that we're going to run this while we're shorthanded and we're going to come back to it.” Are there things that the doctors are doing that the techs could do? And that's an easy one. It's like, “Hey, buddy. You got three technicians for every doctor, or you got one technician and an assistant for every doctor.
You need to get smart and look at how things are getting done and reallocate the workload there because a lot of times I can take some work off that doctor's plate and that is the rate limiting step. And so, anyway, and last of all, you look at efficiency, but know that you're probably going to have to poke some sacred cows. You're probably going to have to set some boundaries and change some scheduling stuff up. You're probably going to have to figure out how to do some training, communication training, maybe technical training to make this happen.
It is not simply, “Let's shift some things around. This is a bit of a process, but if you're committed to it, it's going to take some time. But week after week, walking in the rain, put one foot in front of the other and walk that training through your practice. Get people on board. Make small steps. Make small changes and keep making changes, you will be okay and you will come out the other side.

Stephanie Goss:
Yeah. I love it. Ooh, this is a good one.

Dr. Andy Roark:
Yeah. Boy, I'm really glad we decided to split this into two. Now, that we're in it, I'm like…

Stephanie Goss:
Could you imagine?

Dr. Andy Roark:
… I was rushed at the end. They are trying to get everything out and holy moly, yeah.

Stephanie Goss:
Oh, okay. Our first two-parter in the books. Have a fantastic week, everybody.

Dr. Andy Roark:
Yeah, everybody.

Stephanie Goss:
Take care.

Dr. Andy Roark:
You guys take care yourselves.

Stephanie Goss:
Well, gang, that's a wrap on another episode of the podcast. And as always, this was so fun to dive into the mailbag and answer this question. And I would really love to see more things like this come through the mailbag. If there is something that you would love to have us talk about on the podcast or a question that you are hoping that we might be able to help with, feel free to reach out and send us a message. You can always find the mailbag at the website. The address is unchartedvet.com/mailbag, or you can email us at podcast@unchartedvet.com. Take care everybody and have a great week. We'll see you again next time.

Written by Dustin Bays · Categorized: Blog, Podcast · Tagged: culture, fatigue

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