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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


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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

Nov 09 2022

Overwhelmed and Won’t Give Up! Part 1

Uncharted veterinary podcast episode 204 cover image

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and practice manager Stephanie Goss jump back into the mailbag to make history. That's right, we got a topic we loved so much this week that we are splitting this episode into two! This week, we will dive into the headspace of 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 and 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. This was a super fun challenge of an episode – don't forget to stay tuned next week for part two – the action steps! Let's get into this…

Uncharted Veterinary Podcast · UVP – 204 – Overwhelmed And Won't Give Up! (Pt. 1)

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

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

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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!

All Links: linktr.ee/UnchartedVet

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


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, 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 knew 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. So check it out, guardianvets.com.

Stephanie Goss:
Hey everybody, I am Stephanie Goss and this is another episode of the Uncharted Podcast. And this week on the podcast, Andy and I are making history. That's right, we had a fantastic email from the mailbag and I'm going to set it up in just a second. But it was so good that we decided to split this episode into two parts. That's right, we're tackling headspace and we're tackling action steps, but we had so much great conversation about this specific topic that we decided to make the headspace part one and the action part two. So if you love this week's episode, stay tuned because next week will be part two. We're going to cover all the action steps and we hope it's worth it for this little bit of a lengthier than normal episode because this is a fantastic topic that came to us from Squashed but Stubborn.
I just want to take a quick second and give a big shout shoutout to our friends at Banfield Pet Hospital for making the transcriptions of this podcast possible. The podcast transcripts are brought to you, thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity all across the veterinary profession. If you would love to find out more about the DEI initiatives for Banfield, you can head on over to the link in the show notes. And now let's get into this, shall we?

Announcer:
And now the Uncharted Podcast.

Andy Roark:
And we are back. It's me, Dr. Andy Roark and the one and only Stephanie, I'm a hard working Goss.

Stephanie Goss:
I do. I feel that this week. It is a hard working time of year. How's it going Andy Roark?

Andy Roark:
It's insane. It's insane and it is a very hard working time of year. Holy cripes, we got a lot going on.

Stephanie Goss:
Hell yeah.

Andy Roark:
We got two new uncharted team members last week. Last week we got two new and they are both bad A, bad mamajamas. People aren't going to even recognize Uncharted in about three years. We've got Batman's secret lair and we've got a lot of people down there building a bat mobile or two or three. It's going to be freaking nuts. So anyway, we've got awesome stuff going on here. How are you doing?

Stephanie Goss:
I'm good. It is busy. We have a lot on our plate. And it is that time when we're recording this, it's right before we do Get Sh*t Done. And I'm super, super excited about that. And then you and I and one of our other team members have an event the week after and it's just busy, busy, busy. And it's busy with the kids. So it's that time of year the weather is changing and it is crazy, but it is good. I'm here for it. I'm along for the ride.

Andy Roark:
Well, you write the book you need to read. It's like we put on the conference, we need to have… I'm like, “Boy, we really need a Get Sh*t Done conference.”

Stephanie Goss:
When you're overwhelmed.

Andy Roark:
Yeah, exactly right. When you're overwhelmed. That's exactly… Like, let's get some smarter people than us in here. Yeah, no it's funny. Boy, it's a stressful time here. Two stressful things. Tomorrow we go to the hospital. Allison's going to get the nasty little lump in the breast tissue under her left arm removed. And so that's a big time for us and our family and so a little bit stressed about that. And then the other stressful thing, I would say equally stressful, is on the advice of behaviorists that I interview on the other podcast I do, Cone of Shame-

Stephanie Goss:
Oh, no.

Andy Roark:
I moved my bad dog, Skipper, to food puzzles for his meals because he needs intellectual stimulation and he-

Stephanie Goss:
How's that working out for you?

Andy Roark:
He does not agree that food in a food puzzle is one of his two meals. That's it. He has chewed up the measuring cup and all the other things. He is still convinced that he is supposed to get food in a bowl twice a day and a certain amount of food in a bowl. What is being introduced in the food puzzle, he does not see that as a substitute for it.

Stephanie Goss:
Sure.

Andy Roark:
Which I kind of get because if you gave me a lasagna in a lockbox and I got into it and you were like, “Well that was your dinner,” I'd be like, “Oh no. Dinner comes on the table.”

Stephanie Goss:
Right.

Andy Roark:
“Dinner's on a plate. This was just lockbox lasagna. This is extra.

Stephanie Goss:
Lockbox lasagna. I love it.

Andy Roark:
Yeah. So I get it. But he'd chewed up the measuring cup this morning.

Stephanie Goss:
Oh gosh.

Andy Roark:
Yeah, that's where we are.

Stephanie Goss:
He's one of a kind. That's going to work.

Andy Roark:
Yeah. Oh wow.

Stephanie Goss:
Oh man. Well, I am-

Andy Roark:
Well, that's how things are going here.

Stephanie Goss:
I am super excited. We have got a letter from a practice owner, and this excites me because I think it falls in line with a lot of the kind of questions that our community members have been asking and we're getting ready to Get Sh*t Done in a week, but then we're already thinking ahead to December for our Practice Owner Summit. And I'm super excited to tackle questions like this because I think so many practice leaders and practice owners in particular are feeling overwhelmed but also feeling this fighting spirit of like, “I'm going to figure this out.” So I love seeing questions like this.
It came to us from our previous writer in the mailbag who said, “This is how you know me. And I'm still stubborn, but I am in a new place and I am feeling a little bit apathetic, which is not me.” Their clinic is scheduled weeks out and have gotten to the place where they're not taking new clients. They lost half of their licensed technician team in the last year and they lost two and half doctors to it sounds like retirement and life. So nothing that anybody can control. Just had some changes. “I say two and a half because one of the doctors that retired this year has already come back part-time to help us out because we're so overwhelmed.”
They said, “I can't get my regular clients in. I'm struggling with what to say and how to say it when it comes to us not having an appointment for their first time issues for things like never been itchy before and now has flaming allergies or has crazy diarrhea.” These are things that they know that they need to be seen for and they want to get them in and they just don't have a space to do with them and to put them.
This practice owner was like, “Look, I know what to do with the immediate, urgent fire things that we can't handle, but what do I do with those things that I know need to be seen but won't go to the emergency room and I can't see them for days or weeks and I'm struggling to explain it myself. And also my team is struggling to explain it to clients in a way that isn't then opening up the doors to negativity and criticism.”
And so this doctor was like, “Look, I've been the anti negative review person for a long time, but really the client's reviews matter to me. Don't tell anybody. Don't tell, but it does. I take it to heart. It matters. And they're struggling. What do I say? Like, ‘I can't help you because my client or my doctors are about to go get other jobs because they're too overwhelmed and they're too overworked'? I feel like I'm running out of ideas and I need a strategy.”
They are just in that rut where they are overwhelmed, they have too small of a staff to handle their patient load. Everybody's constantly in training and they just don't know how to direct that energy at clients in a way that doesn't feel negative when it feels like clients are just like, “Help me, help me, help me.” And so he said, “I need help. Sighed. I can't give up. I won't.” And I just loved this question because they are not alone. We get this question a lot. I think it's just such a good one for us to tackle as we head into what's another usually crazy part of the year for most clinics.

Andy Roark:
Yeah. This is the defining question of vet medicine right now, in my experience. This is the question that people ask me all the time. There is no beautiful, “Hey, I have the solution you haven't thought of answer.” But there are absolutely best practices, and I think that's really important. I was really glad to see this question come through the mailbag because we got a lot of experience answering it at this point. There are best practices, there is really good headspace that I personally think is really, really important. And I want to try to lay it down eloquently today if I can. But headspace, it really matters.
And then the other thing is what can you actually do and what can you actually control? I think that there are things that you can do and that you can control.

Stephanie Goss:
Yeah, totally.

Andy Roark:
I'm excited to get into this and start to lay this stuff down. You ready?

Stephanie Goss:
Yeah, let's do it.

Andy Roark:
All right. So let's start with some head space.

Stephanie Goss:
Okay.

Andy Roark:
Okay. All right. I don't know what happened with their doctors, things like that. There's two contributing factors. One of them is what I call walking the rain and one of them is called the death spiral. So I'm going to talk about both of them in kind of how I see this, but I know that I don't have any more information than what you guys just heard from this mailbag. So anyway, that's it.
All right. I mentioned starting this podcast that tomorrow my wife and I are going to the hospital to deal with this breast cancer. And it sucks, my friends. I do not recommend… If anyone's like, “Hey, you want to try breast cancer?” You should say no. You should say no. If you are given the option, hard pass. Hard pass. My wife is… She wouldn't mind me saying this. She's 43 years old. Why does someone who's 43 have breast cancer? Why does that happen? And the answer is, I don't know. I don't know what happens. I don't know why sometimes we end up with a bunch of patients and we can't hire people. You know what I mean? I don't know why sometimes really great staff members move away and go to somewhere else. I don't think we did anything wrong. You can't convince me that we did anything wrong.
Sometimes through no fault of our own, we have to walk in the rain. And that's kind of how I put it, is because I don't have any control. You guys have probably heard me talk in the podcast before. I think that I say we're all backpackers. And that's really what I believe. I believe that we're all out exploring this profession in this world and we're all walking. And hopefully we find good partners to walk with. Sometimes we walk with a team. And that's great, but at some point we're all walking. And we all walk and sometimes we get beautiful views and sometimes we get eaten by mosquitoes and sometimes it pours rain on us.
There's really not a lot of options that we have other than be smart in how we pick our paths. And if we find ourselves circling back to the same spot again and again and again, we need to pick a different path. We need to change that. But there is truth at some point you're just going to walk and sometimes you're going to climb big hills and there is no path that does not have hills on it and there is no path that doesn't have mosquitoes on it and there is no path that doesn't get rained on.
And so sometimes guys, we just get rained on and we have to walk in the rain. We can be angry about it or we can be sad about it or we can sing a song while we get rained on. That is generally the power that we have. But we have the power to choose our path. But you should still know that every path gets rained on. And so I put that forward first when I say sometimes staff leave. So many of us are shorthanded. And guys, it's really, really hard to hire people right now. And I'm talking about across the US and Canada. Boy, it is very, very difficult to get people. We have a labor shortage. And so if you're looking around and you're like, “Gosh, I can't hire people and we've got a ton of work,” I want to put forward the idea that you're probably not doing anything wrong. You're probably just walking in the rain like the rest of us are. And so I want to remove those feelings of guilt first of all.

Stephanie Goss:
Yeah, I think the other thing that's really important about the metaphor, because I think it's such a good one and it's certainly more positive than thinking life sucks sometimes, right?

Andy Roark:
Yeah.

Stephanie Goss:
That's how I looked at things for a really long time. But I love the idea that yeah, it does, but you just have a choice. I think the danger is that there are people in the world who are eternal optimists and who always try and look at things on the sunny side and who will look at this and say, “You can choose to sing while you're walking in the rain.” There are certainly times where that is the tool that I want to reach for. And I also just think that it's important to say like, “Sometimes you need to just sit in the rain and cry,” right? And that's okay too. Sometimes somebody joins you and then you have a friend. Sometimes you run to try and outrun the mosquitoes.
The reality is the choices that you're making are not wrong. I think this is one of those places where it's really easy to beat ourselves up because we are perfectionists in veterinary medicine and it's really easy to focus on, “Well, I feel really, really crappy about this and I'm sad and I'm mad and I don't know what to do to help my team and I feel lost.” And it's really easy to add more emotions to that by letting yourself sink into the guilt by feeling like, “Well, I should figure out how to sing in the rain and be happy about this.” I think it's really important to acknowledge all of the emotions are valid and you're going to go through all of them. That's the whole point. It should always be this cycle.
And at some point, if you sit there in the rain too long, you're going to get pruny and you're going to have side effects from it. And so yes, you shouldn't sit there forever. There should be then the place where you pick yourself up and you figure out how you start walking again, right? But in the moment, don't let yourself feel bad for wherever you are on that journey. And if you need to stop, you need to stop. That's why I loved how they started with, “Okay, well I thought a stopping point would be not taking new clients. And so I did that thing,” right?

Andy Roark:
Yeah, totally.

Stephanie Goss:
So I think it's really important to acknowledge that there are places along the way that all of us are going to stop and there's nothing wrong with that.

Andy Roark:
Right. I agree. Well, that's another part that I put to this backpacking metaphor, is if anyone who goes out in backpacks, you better take breaks. There's no scenario where you get up and you put your pack on your back in the morning and you walk all day and you never stop and drink some water. Breaks are required to enjoy backpacking. If you're walking and walking and you never stop to rest for a minute or have a snack or have a drink of water, I think you're doing it wrong.
There are some people who sit down and take a break and just never get back up and get going again, and that's not good either. But again, and I'll move on past this metaphor in a second, I really like the idea of just imagine that you're walking in a crappy place. There is a desire to hustle to get through that place. And I think that that's good. However, there's also a thing where you say, “This is a big stretch of bad place. I'm going to have to take some breaks here. I cannot sprint five miles down this trail. I can't. I'm going to have to walk. I'm going to take care of myself. I'm going to take breaks. Even though it's not where I want to be, but I'm going to rest because I can't push myself and I can't push my team hard without stopping to get through this to come to the other side.”
And again, if it's raining, you can push yourself as hard as you want. It's still going to rain. So anyway, that's it. But I want to put that forward because I feel like when we start talking about this, I think a lot of people are wrestling with a lot of guilt. And I just want to put forward that, “Hey, this is probably not about you. This is a hard time for a lot of practices.” And there's not a magic answer. Sometimes we walk in the rain.
And so I think to our writer I would say, “Hey buddy, you're walking in the rain, and that's all right.” I don't expect most of us to sing in the rain. I'm not pushing those sorts of things. But I would say the most enlightened of us can still enjoy the views even when it's raining when we come to them. And I really think that's the key. If you are miserable in the rain and you can't enjoy the views and you can't enjoy anything at all because all you can focus on is it's raining, I think that's a really hard, really dark place to be. I think enlightenment is being aware that it's raining and still saying, “You know what? I'm going to appreciate where I am and I'm going to appreciate what I have. I'm going to stop and I'm going to celebrate the beauty that I find even though it's in the rain.”
So anyway, that's the first thing I talk about. So I want to put that head space out and say, “Hey, sometimes we walk in the rain and we need to put the guilt aside.”

Stephanie Goss:
Sure.

Andy Roark:
The other part of that I see in a lot of practices that are in this place is what I call the death spiral. The death spiral is this, it's where we say, “I am super overwhelmed and we have so much to work to do. There's nothing we can do but put our head down and work, work, work really hard to get through it.” And what happens is, and we have the best of intentions, it is 100%. It's not about, “I want to make all the money. It's not that.” It's, “People need my help and I need to go and there's no other alternative but to put our head down and just work, work, work.” And what happens is you burn out your people.

Stephanie Goss:
Sure.

Andy Roark:
And they quit because they don't own the practice. And so they say, “I'm miserable. I'm stressed. I'm burned out. I come home and I cry at night. My spouse is telling me that this is not acceptable.”

Stephanie Goss:
[inaudible 00:20:12]. Yeah.

Andy Roark:
“This is affecting me. I have to take care of myself and I'm going to leave.” And basically going back to our backpacking metaphor, this is someone that we forced marched to the point that they say, “I'm not hiking with you anymore. I'm getting off this trail.” And they leave. And now you're in a worse place because you have fewer team members. You know what I mean?

Stephanie Goss:
Yeah.

Andy Roark:
And I saw that. I saw this during the pandemic it was a big one because I saw people put their head down and work because they thought that was the answer. And then they burn their people out and their people quit. And now they have just as much demand for their services with a smaller team. And so that goes back. And all that stuff ties together and it's really important. Like I said, a lot of times people leave because their spouse gets another job or they get another offer.
I had one of my favorite doctors in the world say to me that he had just lost one of his licensed technicians and he said, “I can't blame her. She got a job 30 minutes closer to home and at $6 an hour more than I can pay. I can't blame her for taking that.” And I was like, “Good. You shouldn't blame her for taking that. And you also shouldn't feel guilty if you can't magically make her be 30 minutes closer to…” I mean the 30 minutes is a big deal and then $6 an hour. If you can't pay that, then you can't pay that and you shouldn't beat yourself up about it. But you should also not hold it against her or feel bad that she went to this other place.
So I think a lot of it is that accepting where other people are and knowing, “Okay, I cannot drive these people. If I drive these people until they quit, then now I'm making this worse. I can't control the rain, but I can control whether or not we let people rest and how we take care of them and how we respond. And so anyway, the death spiral is the other part of this that I see where people say there is no answer but through as hard as we can go. And you end up burning your people out and then you lose them. The patient number doesn't go down, it stays the same but you're more shorthanded.

Stephanie Goss:
Hey friends, there is a workshop coming up that some of you are not going to want to miss. This last weekend was Uncharted Get Shit Done. There was a lot of conversation about workflow challenges in our practice and how a lot of us are struggling with things not working very well. Things feel pretty inefficient. We're all struggling to do more with less, less time, less people, less resources. There was a lot of conversation about how do we get more efficient and effective in our workflows.
And so while a lot of you were there with us this weekend, not all of you were. And so I want to give you all an opportunity to join us coming up in November, November 30th at 5:30 Eastern, 2:30 Pacific, we are offering a two-hour workshop with my dear friend, Senani Ratnayake. Senani is an RVT. So she is a licensed technician, she is a general badass, she is a practice management consultant and she loves talking about workflow. And so Senani has agreed to come back and lead a workshop that was voted one of our most popular in all of 2021 in Uncharted, and that is the Secret Sauce to Optimizing Workflow. This two-hour workshop is here to help you and your team dissect your workflow so that you can get out of the place where everything feels inefficient and ineffective. So if you are struggling with efficiency and effectiveness in your practice, head on over to unchartedvet.com/events and sign up for the workshop. We would love to see you there. And now back to the podcast.

Stephanie Goss:
I think this is one that is really hard for a lot of leaders to wrap their heads around because they care so much about their patients and they care about their teams too. They care about their clients, they want to make everybody happy, right? We're a field full of perfectionist people pleasers. Let's be honest about what we are. And so there are a lot of leaders who look at it and say,” Well I just want to take care of the patients. Everybody let's huddle together and let's support each other, but also let's lean in and just do the thing.” I think that it's done with the best of intentions.
The thing that I always struggled with, and I had several partners in practice, whether it's medical director or a co-owner, where we butted heads about this because it is not a single option here because the other side of this coin is that there are people to take care of and there are people to consider as well. We want to do right by our patients and at the same time we also need to do right by our clients and our team. It's really easy to reach for the pet lever and pull it because we all have empathy. And even the people who are here because they people care about the patients and care about the animals. And so when we say like, “Let's just put our heads down. Let's take care of all of our patients. We want to be there for them,” that's a really easy one. And I think it's one to remind ourselves like, before you pull that lever is really important to take the step back and look at it from the people perspective as well.
I say this for two reasons. One, to the point you brought up, Andy, which is that if you put your heads down and just work and work and work, and I saw this with lots of my colleagues during the pandemic, people will leave. They will 100% leave. They'll get overwhelmed, they will burn out and they will leave. And then you are worse off.
And also we are superheroes, all of us. We do amazing things for our patients every single day. And at the same time, what level of medicine can we practice when we're down three or four people? Can we be our best team of superheroes when we are not rested, when we worked a 16 hour day, we went home and slept for five or six hours and then we come back and do it again? The reality is you can do that for a short period of time, but that's not sustainable long term. And that's where I think it's important to think about the people side of it.
The other piece that I encourage a lot of us to think about that I think we don't, we should think about it more than we do is the client piece of it. Because just as much as we are there for our patients, we also need to be there for our clients. And are we serving our clients if we are driving our teams to take care of our patients and we are overwhelmed and we are running behind. And now we shift the business model so that clients are constantly on hold, they're waiting hours because we've taken in more patients than we can see, they're not getting calls back. And we are doing our best. Don't get me wrong. We are trying to take care of those clients. But are we serving them in the best way possible when we just put our head down into, your point, go into that death spiral and focus solely on, “Let's just take care of the patients. We have to be there to take care of the patients”?
And so I think it's really, really important to consider that you cannot pull one of these levers, either of them, pets or people, without it becoming a lopsided equation. And so I think it's really, really important from a head space perspective to consider the fact that we have to consider both sides of it and really try and figure out how do we strike that balance. And it's hard. Don't get me wrong. I have done this. I have done this wrong. I have had it go well, but I've also done it really wrong. And so I think it's important piece of head space to keep in mind because so many of us immediately, myself included, can lean into the patient piece of it because that's what we're here for, and forget about the people piece of it, and it is equally important to the balance.

Andy Roark:
Well, that is the leadership challenge, isn't it? I mean, it's the classic challenge of getting the most out of your people so that you can pursue your goal, your mission, your purpose, the reason that we do this. We need people to work hard and we want to get the most out of them. But you can push that too far until they break and people say, “Well, where is that line?” And I go, “Boy, that line is a moving target, isn't it?”

Stephanie Goss:
Yes.

Andy Roark:
And sometimes your people… I mean, I've had it with our team. With our team, there was a time everybody on our team was sick. It was funny. We had COVID go through our office, which is funny because we're virtual and we lived hundreds of miles apart from each other, yet we all got COVID. Like within two weeks, I got it.

Stephanie Goss:
It is true.

Andy Roark:
Yeah. We had that happen at one point and you go, “Boy, cracking the whip and really pushing people.” Not “We crack the whip,” but you get the point. We're really trying to push people hard.

Stephanie Goss:
We had a ton of deadlines. Yeah, It was crazy busy.

Andy Roark:
I was like we were busy but also our people were just down and sick and you go, “Look, we're not going to get the work done that we would get done when people are healthy. And trying to get that same amount of work done right now is a bad idea because all we're going to do is really break people.” So it's always that balance of as the leader, you have challenge that every sports coach has, which is “How do I motivate? How do I inspire? How do I get the most out of my people without pushing them to the point that they get injured or that they don't enjoy playing this game anymore and they don't come back?” That's the real challenge that we all have here. And so we need to keep that.
When I talk about getting the most out of people and sort of building this thing and the mission and the purpose in where we're going, the last part I want to bring up in headspace is the sunk cost fallacy because I see this really messing with a lot of people's heads right now.
What happens in the sunk cost fallacy, the sunk cost fallacy is the idea that I have invested so much to get here. Stepping back or changing what I'm doing now feels like I wasted that energy to get here. And so what that looks like right now in a lot of places is we built our clientele up to a certain level. We built, we have 10 exam rooms now and we have been seeing X number of clients a day and not using some of those exam rooms feels like failure. Significantly, reducing the number of clients we see a day, that feels like mega failure.

Stephanie Goss:
Sure.

Andy Roark:
Like, “I worked 10 years to get to this place where we did this amount of cases and everything and now going back down feels like all the energy we spent to get here was wasted.” And that's the sunk cost fallacy. And so the last thing I'm going to call out head space wise before we go into this is to say, “Hey, I see you there. I see you overwhelmed. I see you struggling. You need to not think about what you've done in the past. You need to do the mental exercise of thinking, if you were starting your practice right now today with the team that you have, how many exam rooms would you run and how many patients would you see? And the number of patients that you saw two years ago, that doesn't matter because it's not two years ago, it's today.”
Realistic expectations about if we were starting right now today, what would we service? And the fact that we serviced more last year when we had two and a half more technicians and two more doctors than we have today, that doesn't matter because that ain't where we're living right now.

Stephanie Goss:
Nope. And listen, this is one of the things that I struggled with the most in practice, particularly in my journey as a corporate practice manager, and I'm going to talk to my fellow colleagues here for a second, because when we run our practices from a leadership perspective, it is our job as business people to be concerned about the numbers. I'm not going to lie, that is part of your job. As the business side of the leadership, your job is to think about the numbers. And to your point Andy, our practices should be built on what can we do when we are efficient and effective, right?

Andy Roark:
Yeah.

Stephanie Goss:
How can we maximize seeing and doing the best work for the best number of patients? And we know that when we practice good medicine like that, the revenue follows. And that is good thing, right? And at the same time, it's really, really easy to get caught up in micromanaging or being micromanaged to the numbers. And so a lot of us, particularly those of us who have managed in corporate medicine, say, “Well, we have to see certain number of cases because our whole structure is built on that.”
The thing that I will tell you, and don't get me wrong, it got me in trouble more than once, but I will say I stand by it. The reality is, if your practice, any practice, private corporate does not matter, if your practice can't stand to say, “This month we are going to change things and it's not permanent, but right this second this is what's best for the people. Whether it's the clients, your team, a combination of all of the above, we're going to step back and we are going to see 10 patients a day instead of 25,” or whatever it is that you need to do-

Andy Roark:
That's quite a step.

Stephanie Goss:
But here's the thing, if you go from four doctors to one, going from 25 patients a day to 10, maybe your only option, right?

Andy Roark:
Yeah.

Stephanie Goss:
So even if you can't, you have to be able to take even a radical step like that for a short period of time. If your practice can't sustain that, you weren't running a good business in the first place. You should be able to sustain that for a short period of time, right? You should be able to pivot and do what you need to do for a short period of time. And that short period of time is going to be different for all of us. We are all in different places in our business. We all have different levels of buffer. We all have different levels of reserves in the bank. I recognize that all of those things matter. But if we're running it so close to the line that we have to live forever in the place of sunk cost fallacy and we can't look at things and say, “I am going to make these changes temporarily to take care of my people, to take care of my clients,” whatever the reason is, then we have to change the business model because it's not going to work for anyone long term.

Andy Roark:
Boy, leadership in modern vet medicine is more about advocating up the chain than it's ever been before. Don't you agree?

Stephanie Goss:
100%.

Andy Roark:
Boy, wouldn't it be great if there was a place like a community that you could go and you could work with other people who have the same struggles and advocate up the chain for their people and that would provide ongoing support and guidance and lessons learned and hard fought battle experience? Wouldn't that be amazing?

Stephanie Goss:
Uh-huh. That would be so amazing.

Andy Roark:
God, I can't think of a place like that.

Stephanie Goss:
Neither… I wonder where one might exist.

Andy Roark:
Oh, there's a place, it's called Unchartered Veterinary Community and that is what we do. We have literally hundreds of leaders who are in corporate practice that are also leading teams on the ground. We work with them because that's what we do. And yeah, we 100% help people advocate up and down the chain. And you're like, “No one's ever told me how to communicate up the chain to take care of my people.” I was like, “Well, that's the thing that we definitely do at Unchartered.” So if you're interested in that, then check us out.
Wait, there's one more thing. I said that was my last thing to say and now I'm like, “Oh, there's one more thing I have to say because, and I hadn't planned on talking about this, but then when you were going through what this person said in their letter, there's one thing that popped out and it hit me like a thorn. It was like a splinter and I'm like, “That's going to hang with me and it's going to bother the heck out of me.”

Stephanie Goss:
Okay.

Andy Roark:
This person said their clients won't go to the emergency room, right?

Stephanie Goss:
Uh-huh.

Andy Roark:
And what they were saying was like, it's like an allergy flare up.

Stephanie Goss:
Sure.

Andy Roark:
And they won't go to the emergency room. And it's like, I get it. I can 100% understand the person saying, “I don't want to pay that money to go to that emergency room and I don't want to go there and wait for hours to get seen.” I totally get it for sure. But this is a thing, and this is going to sound maybe a bit harsh, but I need everybody to hear it, right? It is not your responsibility to solve the problem of a pet owner that won't go to the emergency room or they won't go somewhere else. That doesn't mean I'm heartless, it doesn't mean don't care. I totally do care. But in order for you to keep your sanity, you need to know that that's not your pet, and all you can do is advocate and be honest and compassionate and do the best that you can do without burning yourself out, right?

Stephanie Goss:
Yes.

Andy Roark:
Because you giving everything you can today and leaving this profession in three years, that is not the best outcome. And I say this because I can see it in the writing of the person who wrote in. I see all the time guys, the trap in vet medicine is people jump in, they say, “I'm here for the pets and the people and I'm going to take care of them.” And they do everything they can for five years and they burn out and they leave the profession. And I say, “You know what? If you had made some hard calls and set some boundaries that made you unpopular at the time, you would still be here 10 years from now and the net number of people and pets you would've helped is much greater.”
And so the greatest outcome over your life is not seeing everything that you can see and taking responsibility for everything. It is being honest about what you can do and taking care of yourself, working hard of course, but still setting those boundaries. And so it sounds awful when I say it's not my responsibility to handle problems when the pet owner says, “Well, I'm not going somewhere else.” And I would say, your job is to present them honestly with their options and to set clear expectations and let them know what you can do and what you can't do. And that is what they have to decide. So maybe they're not going to take their allergy dog to the emergency clinic.
And here's another thing that's really, really hard for vets to hear. If I can't see your pet because I am swamped and overwhelmed, I'm going to recommend you go to a different vet practice. And people go, “That is harassing. Oh my god.” There's some competitiveness to it. There is some scarcity mentality. There is the fear that one day I'm not going to have enough clients and I'm going to go out of business and we're all going to live in a box by the street.

Stephanie Goss:
Under the tree. Uh-huh.

Andy Roark:
Under the trees. All of those things are scarcity mentality that kick in. But I'm saying is in order to feel whole, is to look around and say, “I can't see you. You're not willing to go to the emergency clinic and pay emergency prices. I don't see this changing in the near future and your pet is having an allergy flare up. My recommendation is that you need to go find another veterinary clinic and I'll send your records over. I hate it, but I'm just being honest with you. I can't get you in and I don't want your pet to suffer and this is what I'm doing.”

Stephanie Goss:
Yeah. I think that is such a struggle for us in veterinary medicine for so-

Andy Roark:
People hate it.

Stephanie Goss:
… Oh my god, for so many reasons. But I'll also tell you it feels like this boring concept, and it shouldn't. Because at the end of the day, we are in the customer service business. And let me tell you, when I was really young, when I was at university, I was a manager for a book chains. It's not around anymore, but I worked for Borders and was the manager for the children's department. I was covering at the customer service desk one day and we had a customer come up to the desk and they were looking for a particular book and we didn't have it in stock and I wasn't going to be able to get it for two and a half or three weeks. And they were just like, “Thanks, but I really wanted to get it.” And I said, “Well, hang on. Do you have just a moment?” I said, “Let me see if anywhere else locally has it.”
The next closest Borders to us was like 45 minutes away. So it was like this poor customer is looking for this thing. And they had told me why and it was for school and it was really important. So I picked up the phone and I called Barnes & Nobles, which was 10 minutes down the street, and I said, “Hey, do you happen to have a copy of this? I'm calling from Borders.” And they put me on hold and then they said yes. And I said, “Great, I have a customer here.” I gave them her name and I said, “I'm going to send her over. Can you set it aside for her at the front desk?” And they were like, “Yeah.”
And that client was like, “Oh my gosh, I can't believe. Did you say Barnes & Nobles? Are you sure?” And I said, “Yeah, it's right down the street. Go ahead. They have it waiting at the front desk for you.” She went. And it was so funny because it was on and she went on her day and I didn't think about it. Later that night I got a page to come to the customer service desk and I go up to the customer service desk and the woman is standing there and she has a bag in her hand and a coffee and she's just like, “I had no idea what you liked, but I just wanted to say thank you. You saved my day for school.” She's like, “I picked it up.” And she's like, “But I just want you to know I'm going to come back here.”

Andy Roark:
Wow.

Stephanie Goss:
“It made a huge difference in my day. And the fact that you would send me to your competitor, that means something to me.” And then I saw her over and over because she would come in once a week to do school stuff. It stuck with me because I just didn't think twice about it. I had a conversation with my manager about it. And they were just like, “Well, but you sent her to a competitor.” And I was like, “Yeah, but she's a loyal client now. She's a loyal customer. She's coming back. So what? So we lost the $10 on that book sale, but look at what we've gained in the long term in that relationship.”
I think it's really important and it stuck with me and I have used that for myself and with my team, especially my client service team. Because at the end of the day, we are here to take care of our patients and our clients. And if there's something that we can do that is better for that pet than the care we can provide, or different care that we can't provide for that pet, we should have no doubt in our mind to send them to someone even just down the street, right?
And so if that client is telling you, “I can't go to the emergency hospital for whatever reason,” but their pet is miserable, then I love that you said that because sometimes the answer should be, “Okay, I really feel strongly that this shouldn't wait. And so if you're not willing to do this, here's my suggestion.” Because you know what the alternative is? The alternative is they're going to go home and they're going to do what that customer would done, which is look it up herself, see that the Barnes & Noble down the street has it and go there anyways. So they're going to go home, they're going to Dr. Google and they're going to either find somebody else's care or they're going to try and treat things themselves. So it really matters to me that we keep in mind that we are in the customer service business at the end of the day.
And so I will tell you, there have been times where I've spent sent really good clients to our competition. Because here's the thing that I know, I know that if I take care of those clients, if I help them, they will on an overwhelming average comeback, even really good clients. And people are like, “Oh my God, but what if they have a better experience at that hospital? And what if we lose them as a client?”, then we weren't doing our jobs. If they could go for a one and done appointment and be so impressed by somebody else, that's okay. That teaches us some lessons about where we have opportunities as a practice. And if you're not willing to take those risks as a leader, I think you're selling yourself and your team short.

Andy Roark:
Yeah. Well, we create this inescapable trap for ourselves where it's like we are overwhelmed and we can't see all the pets. And also the idea of referring them to someone else is-

Stephanie Goss:
Yes, but nobody else can [inaudible 00:43:48].

Andy Roark:
… absolutely unacceptable. And they go, “Wait a second, you have 100% created this soul sucking trap that's burning you and your people out.” And I go, “This isn't worth it.' The other thing too is I would say let your purpose guide you. I have just found in life that if you have a purpose and that's what you follow, everything else seems to work itself out. You know what I mean? If you believe, I say, “I'm going to do what's best for pets,” and you set your prices appropriately, you will have a healthy business because you will take care of pets and make sure that the money makes sense and it works. But you can 100% focus not on the money, but on taking care of the pets and the money will take care of itself.
The same thing is true with this, is if you want to take care of the pets, at some point, that might mean I can't get these pets in and I'm sending them away, then you're going to sleep well at night knowing that you did what was best for pets and you're not going to burn out and quit and you'll be here years from now.
And so anyway, the idea that you would send people away because you're overwhelmed and then all of a sudden you can't get enough people to come in and support your business, I don't buy that. I don't believe that. I think that's a scarcity mentality and it's a recipe for disaster.

Stephanie Goss:
Yeah.

Andy Roark:
Hey, we are about 40 some minutes into this episode and I feel like this has all been really good head space, and I know a lot of people are really struggling with this. I don't want to sprint through the action steps. Are you okay Stephanie, what if we split this episode and then next week we'll come back and we'll just do action steps?

Stephanie Goss:
Yeah, let's do it. We're going to try something different, everybody. I love this because we've got some good action steps and I don't want to rush into these, Andy. Let's take our time and let's do it. So let's do our first two parter.

Andy Roark:
Our first two parter. Yeah, I think that's it. I'm looking at the action steps and stuff I have kind of laid out here that I want to unpack them. I think they're really helpful. So let's not rush. Let's just do head space right here. We're going to call this an episode.

Stephanie Goss:
Part one.

Andy Roark:
And then we'll see guys back next week and we will run through the rest of our action steps.

Stephanie Goss:
Stay tuned overwhelmed and won't give up because we'll be back.
Well, again, that's a wrap on another episode of the podcast. And as always, this was so fun to dive into the mail bag and answer this question. I would really love to see more things like this come through the mail bag. If there is something that you would love to have us talk about on the podcast or a question that you are hoping that we might be able to help with, feel free to reach out and send us a message. You can always find the mail bag at the website. The address is unchartedvet.com/mailbag, or you can email us at podcast@unchartedvet.com. Take care everybody and have a great week. We'll see you again next time.

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

Nov 02 2022

Unforgiving Doctor is Ticking Off the Staff

This week on the podcast…

Bret Canfield joins Dr. Andy Roark to take a MEATY question from the mailbag. When you have a doctor who came from a toxic clinic and now has serious trust issues with staff, how do you coach him or her through that behavior? Are you at risk of driving this doctor away? Let's get into it!

Uncharted Veterinary Podcast · UVP – 203 – Unforgiving Doctor Is Ticking Off The Staff

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


Upcoming Events

JOIN UNCHARTED! https://unchartedvet.com/registration/

Uncharted Practice Owner Summit: https://unchartedvet.com/upcoming-events/

More Resources From The Episode

Belbin Team Roles: https://belbinnorthamerica.com/?gclid=CjwKCAjw0dKXBhBPEiwA2bmObTTWlmfL57KtkwfIdV74o5ksSzg_Usn4bbdKrQGgztenwwRDgCTa_hoCCRcQAvD_BwE

Radical Candor TED Talk: https://www.youtube.com/watch?v=4yODalLQ2lM&ab_channel=FreshBooksUniversity

Crucial Conversations (Amazon): https://www.amazon.com/Crucial-Conversations-Tools-Talking-Stakes-ebook/dp/B093Y3N433/ref=sr_1_1?keywords=crucial+conversations&qid=1660245538&sprefix=crucial+%2Caps%2C88&sr=8-1


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 everybody to The Uncharted Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here today with the one and only, Bret Canfield. Guys, I'm going to introduce Bret in just a minute. He has been working with Uncharted for a couple years now. I like to have him on lectures and conferences. He's a fantastic lecturer. He and I are going to be breaking down questions from the mail bag. It's all about we have a project owner who is a golden retriever and we have an associate vet that's the opposite of a golden retriever and they get along well, but the staff doesn't handle this mixture of the two doctors.
Also, our non-golden retriever tends to be a bit critical when people make mistakes and it's off putting, especially to new staff members. It's a coaching conversation, guys. It is a really good one. I hope that you guys will enjoy it. Also, at the end of this episode, I mention that Bret is going to be joining me and Stephanie Goss at our Uncharted Practice Owner Summit. I'm not sure with the dates, but I'm going to tell you right now that the Practice Owner Summit is in person in December. It's the 8th through the 10th, confirming that. Yup, it is December 8th through the 10th in Greenville, South Carolina, my hometown at the Westin Poinsett. We are going to be getting together. It's only open to practice owners. It's only open to practice owners who are Uncharted members.
So, if you are one of those people, if you're both of those, go ahead and get registered. You can't get registered yet. Registration is coming. Click on your calendar. Mark yourself out of the clinic, December 8th through the 10th. If you are not an Uncharted member, but a practice owner and you're like, “I want to hang out with other practice owners,” go ahead and get your Uncharted membership. Guys, let's get on to this.

Meg:
Now The Uncharted Podcast.

Dr. Andy Roark:
Welcome to the podcast. Welcome to the podcast, Bret Canfield. How are you?

Bret Canfield:
Fabulous. How are you doing?

Dr. Andy Roark:
I'm doing really well, man. I really appreciate you coming here and making time to work through this with me. How have you been?

Bret Canfield:
Life has been good. I mean, it's veterinary medicine so it's chaotic and it's busy and hectic and we wouldn't have it any other way, right?

Dr. Andy Roark:
Yeah. Oh, yeah. Maybe short breaks. Maybe short breaks for me if we could. Turn down the volume a little bit sometimes, but for the most part, no, I agree. It's pretty good. For those who don't know you, you do a lot of things. You've been working with us at Uncharted for a couple years now, coming in, doing sessions, lectures. I have pulled you in. I pulled you in for a number of different jobs that we do because you are an outstanding facilitator and thinker. You do a great job of getting people talking, of making conversations go to good places. It's just a skill of yours that I've always admired.
I aspire to be as good a facilitator one day as you are, but you were also the director of organizational development for Summit, which is probably a side thing that you do when you're not hanging out with Uncharted and doing stuff with us. But anyway, you are a person who has really good insight. I have a question that I think you have a very specific set of skills for this question and I was hoping you'd unpack it with me. You up for it?

Bret Canfield:
I'd love to. I think you may have oversold me just a skosh, but let's give it a whirl anyway. I like it.

Dr. Andy Roark:
Here we go. Great. We got a question in the mail bag. It's from a longtime listener, first time caller. She's a practice manager. She's got a privately owned, two-veterinarian, small animal clinic. The practice owner and the associate vet have wildly different personalities. So, while they get along, we have had difficulties with new staff. So, I really like the way she sets this up. So, she describes the practice owner, I'm assuming that our writer is she, she describes the practice owner as being basically a golden retriever of a person, which I love, because that's one of my favorite breeds. She loves everyone, is always on the move, is pretty laid back, has no attention span. The staff love her and she loves to teach newbies.
When someone makes a harmless mistake and is accountable, she always tells them, “Hey, I f-ed up more than anyone. It's how you handle it that matters.” I would just put a pin right here and say, I love this person. I'm ready for it. I'm ready to go work with this vet right now. The associate is the opposite. She has a great relationship with the practice owner and with me. After a rocky six months, she now has one technician that she trusts and another that she at least likes. She came to us from a toxic clinic and she knew she had some neurosis from that. We hope that our laid back, respectful, and positive culture might help relax her some. In a lot of ways, it has.
The one thing that hasn't improved is a biggie though, she is consistently off-putting with how she treats new people. I've had multiple new people come to me frustrated and upset about not knowing how to communicate with her. The practice owner and I have both tried to talk with her about it. “If an employee makes the smallest of mistakes, she immediately doesn't trust them with anything. She will frequently complain about something little that an employee did after the fact.”
So, let's go ahead and just start with that. Things seem to be getting worse, instead of better. We 110% want everyone who works here to treat each other with respect. How do we address this? What actions can the PO and I take? That's the question that we got. I want to just go ahead and start to open that up. Bret, do you have initial ideas on this question? Have you seen anything like this before?

Bret Canfield:
Yeah, it's a great question. It's a doozy, because it involves a whole lot of different factors as a lot of our questions do. I do feel like I've seen this before. I mean, one of the things that I love and that I'm very passionate about are elements like team dynamics and communication and culture and things like that. This particular question seems to touch on a lot of those. Right off the cuff, here are my first reactions. The first thing I'm going to say is this is actually a really good thing. It just doesn't feel like a really good thing yet. The reason it's a really good thing is because you've got the two veterinarians in this practice, they communicate very, very differently.
The reason that's such a good thing is because when I've been into practices that have a really, really, really fundamentally hard time changing their culture and really struggle, it tends to be because there's several people in the clinic that all communicate the same way. Once that happens, unfortunately, it's a very narrow communication scope. So, God forbid you have a client come in that communicates differently than the way that you all communicate, you might have absolutely no capacity to deal with that person. The fact that you've got some variety of team dynamics, some diversity of team dynamics could actually be a really good thing. We'll see if you and I can unpack that in a little bit and figure out how to make it a good thing, make it feel like a good thing.

Dr. Andy Roark:
That's a very positive way to look at this. I definitely like it, right? Yeah. So, let's start to unpack this. So, I like what you're saying about diversity of team dynamics. I think that's really interesting. Let's get into headspace. So, the way we break these cases down, first thing we do is talk about headspace. The second thing we do is talk about specific action steps. What do we say? How do we say it? So, let's get into headspace. I really like your idea. I think you've already framed this in a really, really positive way of this is just a different team dynamic. I think that that's really great. I think if you identify the associate that as a problem, then anytime you label a person as a problem, you've got issues.

Bret Canfield:
Absolutely.

Dr. Andy Roark:
People don't change all that much. Behaviors can change. People don't change. I don't get that necessarily from the writer, but there's some degree of that. So, I really do like that a lot. I have a fantasy that lives in my mind is that if you set a perfect culture and you've got a really positive place, you can overcome almost any challenge with good positive team culture.

Bret Canfield:
Agreed.

Dr. Andy Roark:
I appreciate that the writer said, “She's come a long way and things have gotten a lot better in a lot of regards.” I say good. That jives with what I've seen. At the end, a positive culture does not undo past traumatic experiences or a hard-ingrained patterns of behavior. So, this all tracks with about what I see as far as the impact we can expect to make. So, I guess in headspace, what I would say is again, I think this person who's writing has already done a lot of really good things of saying, “Hey, this is something that our doctor picked up at a previous practice. That was a really bad experience and a lot of these are coping mechanisms.”

Bret Canfield:
Yeah, she's been hurt before.

Dr. Andy Roark:
Exactly right.

Bret Canfield:
It happens. Yeah.

Dr. Andy Roark:
Exactly right. She's had trust violated probably in a formative time. Especially if you're a young vet and you get burned a couple of times, those lessons tend to stick with you. So, I think that just all of this is a really healthy headspace to start coming from. So, I really like that a lot.

Bret Canfield:
Agreed. Yeah, agreed. I think you nailed it. I mean, I think whenever we look at people as problems, then we're setting ourselves up for failure. There's some great literature written about the difference between a problem and a paradox and they're not the same thing. I always look at a problem as a surgical experiment. There's an issue, you find the issue, you remove the issue. Sew the culture back up, you're good to go. Most of this stuff, it doesn't work that way. This is derm. This is internal med. It's muddy, it's messy, it's diagnosis by exclusion. It's management, not necessarily just surgery. I think this is a similar situation. I don't think that this is a problem.
I think this is a paradox. I think that you've got two different people that communicate very, very differently. Both of them probably think that their style of communication is the right style of communication. So, from the headspace perspective, I think that's a big part of it. Like anything else, I think that some of what we're talking about probably relates back to expectations and agreements. I think part of what we're talking about absolutely relates to communication and team dynamics. I think part of what we're talking about always bubbles up to culture. It always bubbles up to culture. So, there's a few different ways to look at this from a few different lenses.

Dr. Andy Roark:
Talk to me a bit about expectations and agreements. So, you put that out and say some of this comes from expectations and agreements. Get me into the headspace where I'm thinking about expectations and agreements. Help me understand where you're coming from when you say that.

Bret Canfield:
For sure. I mean, whenever I look at a problem like this, when I'm trying to work with somebody who communicates differently than I am, I have a lot of expectations in my head and I might not be aware of those expectations. But if I'd like to communicate a certain way, I often don't understand or don't appreciate why somebody might communicate differently than I do, because to me, there's a right way to communicate. It's the way that I communicate and I don't understand why somebody would do it differently. We do that a lot.
So, in this case, the practice manager may have already done a bang-up job of communicating with this associate vet and saying, “Fabulous associate vet, there's 99 things that you do right. That being said, I am going to challenge you on this one. I do think sometimes you can come across as distrustful. I think that you can come across as inaccessible and I want to challenge you and work with you on that. I want you to understand that this is really important. So, as we have our conversations moving forward, I want us to agree instead of it being an expectation that only lives in my stupid little noodle, I want us to agree that this is something that is happening, that it's something that we can work on together and it's important.”

Dr. Andy Roark:
Yeah, I like that a lot. I would talk about how to do that when we get into action steps. I think that that's really true. It's taking this thing that's going on inside my mind as the manager and bring it out and externalizing in a place where we can all look at it in a really productive way. The other thing that I see when I read through this question and some of these little examples that came along with it, one of the things that I say and I don't know if this is the right term for it, but I think of it as a justice mindset.
So, there are people who are like, “There is one way to do it. If that person didn't do it, it's because they lack integrity. They're supposed to follow what's in their handbook and they did not and that shows a failing of their moral character. They have let our patients down.” That may sound extreme, but I see that mentality sometimes. It's about fairness and acting in a way that lets me trust you and things like that. So, what really is a minor human mistake in this person's mind becomes this person can't be trusted and more so this person has hurt me. I think a lot of us maybe go into that mindset sometimes.
I've seen people who are struggling with depression or burnout definitely go into that mindset, but I think some people live probably from past experiences, they can live in that mindset where if they feel let down, it's a one-strike and you're out policy. Now we're really into some people's psychology, but what I'll say is if you're a person who has that mindset or you find yourself going innately to that behavior, that's really career-limiting for you because everybody makes mistakes. If they get written off as a person when they make a minor mistake, then you're going to be real lonely for a long time. So, I do see that. So, we have to figure out how to work with those people.
So, that brings me around to a piece of it for me really is I may have this problem figured out about what we need to do and where we need to go, but I need to make sure that this associate vet feels very heard and that they feel understood in their behavior and they feel seen for the way that they approach these things. Because if I try to say, “Look, you are jumping to this conclusion and you're mistreating this person and that's not healthy and that's not reasonable,” I'm really dismissing this what this person's concerns are.
I'm not saying I agree with them, but I need them to at least feel heard and feel that they have a valid concern about yeah, it's true. Sometimes if you don't hold people accountable or if we don't enforce standards, then medical quality can slip down to an unacceptable level.

Bret Canfield:
That's right.

Dr. Andy Roark:
That does happen. That is something that we're very aware of and you're not wrong to be thinking about that. I think just having that conversation, getting that part out into the open, that oftentimes can set that person at ease. So, I think between the two of us, I think we've really come up with a nice little combination of acknowledging this associate vet's concerns and where they're coming from, setting expectations about what they're doing and what the impact that it's having and how we want them to behave, and then also just going on and challenging them to make some improvements while also still keeping a good focus on the things that they're good at, not letting this become the focal defining point of them as a doctor.

Bret Canfield:
In fact, I'll jump into that. In my experience with team dynamics, one of the most interesting points I keep coming back to is that we often have a mentality where people have strengths and people have weaknesses. I think it's not necessarily more complex than that, but I think it's different than that. I think the truth is that oftentimes our biggest challenges don't come from our “weaknesses,” he says with air quotes. I think that our greatest challenges actually come from our strengths, either unfocused or in excess. So, I would even also look at this associate vet and say, “This person doesn't have a problem with trust. This isn't a weakness.” This person is probably and I'm totally guessing, I know very little about this person, but they're pretty good at medicine, right?

Dr. Andy Roark:
Yeah, I'd make that guess too.

Bret Canfield:
Part of the reason that they're distrustful sometimes of staff is because they probably do have very high and very exacting standards of success. It probably makes them a very good clinician. So, part of the challenge here is that making sure that this person's strengths don't become their dragon. It's like you said, Dr. Andy, I think that the other challenge is that we'll sometimes look at the team and say, “Okay, I like the way this person communicates. They communicate the way I want people to communicate, but this person communicates badly or poorly or I don't like the way this person communicates.”
I think one of the mindsets we have to have in looking at this is that I think we need to honor the uniqueness, even celebrate the uniqueness of this associate vet and her approach, but I think that we have to help her become the best version of herself. So, let me put it this way. I look at this associate vet like a little bit of a cat. They're not going to trust somebody right away. They're skeptical. You got to earn everything. You got to earn their trust, earn their affection, earn their loyalty, earn their respect. And then you got the owner who's a golden retriever who seems like-

Dr. Andy Roark:
Yeah, a golden retriever.

Bret Canfield:
I don't know you but I love you. Yeah.

Dr. Andy Roark:
The cat's not broken. The cat's not wrong.

Bret Canfield:
That's right. That's right. You're never going to turn a calico cat into a golden retriever and you're never going to turn a golden retriever into a calico cat. If we try to do that, there's going to be a lot of suffering.

Dr. Andy Roark:
I like that a lot.

Bret Canfield:
I think we're allowed to say is, “You be a cat but you be the best version of that.”

Dr. Andy Roark:
The best cat. Be the best cat. She's like, “You're trying to be a golden retriever. Oh, yeah, sorry. Sorry.” Yeah.

Bret Canfield:
Right.

Dr. Andy Roark:
No, that's perfect. It's great. Basically, I talk a lot about most of our strengths are double-edged swords. Most of them are. Being charismatic has strengths and it has drawbacks. This vet can make friends with anybody. Yeah. They're also always 30 minutes late because they can't get out of the exam room because they're being friendly.

Bret Canfield:
Exactly.

Dr. Andy Roark:
Everybody's got strengths that at some point become a weakness. You have people who are great at spotting potential problems. The downside is they have a habit of coming off as the Negative Nelly who craps on everything. Well, they're very good at avoiding catastrophe by seeing potential problems, but there's that downside to that same skill. So, yeah, I like that lot. One of my favorite sayings for this is don't ask a fish to climb a tree. I think that that is true too. I'll give the example that I see from this all the time is so we have a profession full of perfectionists and our perfectionists are really in a bind right now, because they got too much work to do and not enough time to do it.
This, Brett, is the perfectionist crucible, because it needs to be done and it needs to be imperfectly and there's more work than I can possibly do. If I give this to someone else, they won't do it as well as I'll do it or they won't do it the way that I do it. So, now, I as a perfectionist am really in a vice grip and there's no way out of this. It is how it feels and that perfectionism makes them a wonderful clinician but it really hinders their ability to delegate and rely on other people and to adapt to a high workload beyond how many hours they have in a day. So, anyway, but that's what I see a lot and it almost feels like that when we talk about this vet. Okay.

Bret Canfield:
Yeah, agreed.

Dr. Andy Roark:
I think that's what I got for headspace. I feel like I'm in a pretty good place to start putting together an action plan. Philosophically, anything else we need to be thinking about?

Bret Canfield:
I think we nailed it honestly. I'm going to declare victory and we can start polishing our laurels.

Dr. Andy Roark:
Exactly. I think we can just break right here and have a beer.

Bret Canfield:
We crushed it.

Dr. Andy Roark:
This is done. It's done. All right. Okay. So, let's take a break for a second and then we'll come back and do action steps.

Bret Canfield:
I'd love it. Let's do it.

Stephanie Goss:
[inaudible 00:20:13]. Hopefully, this is a big, hairy, audacious goal, hopefully, we'd be able to make you feel better and feel like you have some tools in your toolbox to help make hardships and conflict in your practice a little bit easier to deal with. So, if you would love to come and join us, head on over to the website, unchartedvet.com/events. You can see the registration for this and all the rest of the things that we have coming up, because we got really more good stuff coming now. Back to the podcast.

Dr. Andy Roark:
All right. [inaudible 00:21:53]. As veterinarians, you may love having two golden retrievers, but in our metaphor, a practice with two golden retrievers is exhausting because they run everywhere and they love on everybody. At some point, you need a cat to be like, “Hey, look, let's bring this down.”

Bret Canfield:
That's right. They're not going to be in the OR until 2:30 in the afternoon every day and you're not going to run an hour and a half late on every exam.

Dr. Andy Roark:
Exactly.

Bret Canfield:
Look, having two golden retrievers is great as long as every single client you see only wants golden retriever energy, but I doubt that that's the case.

Dr. Andy Roark:
I can tell you as a fellow golden retriever, it's not the case. There are clients that are like, “That guy's too much. We need to turn him down.” All right. Yeah. All right, cool. Let's go ahead. Let's go and make some action steps. So, you're the practice manager. You've got this doctor. What I would say, this is going to be a coaching conversation is how I see it. I don't know if you see it that way, but you've got this coaching conversation. How do you set the table, Bret? So let's get into the nuts and bolts. What does this look like?

Bret Canfield:
Yeah, great question. I would absolutely have a coaching conversation with this vet. Honestly, I would also probably have a second component, which is I would probably adopt some stuff from a holistic team perspective as well, but let's talk about the coaching conversation first. Because I think that absolutely has to happen.

Dr. Andy Roark:
All right.

Bret Canfield:
This calico cat is extremely conflict-averse based on what I'm hearing. So, one of the things that I would want to do is make sure that this person felt very, very safe. I would make sure this didn't feel like an attack. I would make sure this didn't feel like an intervention. Because I think once you get somebody into that place, they're going to hit threshold, they're going to shut down. Their fight, flight, freeze, fidget is going to kick in and they're probably not going to be receptive to the coaching.
So, from my perspective, I would probably just lay some groundwork and probably say the quick version is what we touched on earlier, which is like you do so much stuff that is going well and I hope that I've done a good job acknowledging those things. If I haven't, I'm going to work hard, because I really value you and I really value what you bring to the team, so much so that I think there is actually an area that we can do better.

Dr. Andy Roark:
Yeah, let me jump in here for a second and just say I love that you show vulnerability first. I think that that's a really important part of this conversation. I think it's a really good skill is to say, “Hey, if I haven't communicated that, it's something I'm working on is to make sure that I communicate these things ahead of time.” I love it. I think going into a coaching conversation with the ability to own anything that you can own and I don't want to say criticism, but essentially lay some criticism on yourself and say, “Hey, look. This is the thing that I'm working on. We're all trying to get better and I'm going to keep working on it.”
I think that is a great way of going first by saying I'm going to accept some negative feedback from myself and commit to working on that. That really hopefully says, “I'm going to do this. I'm going to go first. It's not me calling you in here and criticizing you. We're talking about this, but I'm going to own as much as I can and say look, I have things to work on as well.” So I just want to jump in and praise that specific point before we get too far and say, I really like the way you set that up.

Bret Canfield:
I've learned from some really good folks that if you approach any coaching conversation from an authoritarian standpoint, a command and control standpoint, it's not going to usually be well-received. I think the truth is none of us are perfect. If you can go into the conversation with that in mind, there have been even times I've sat down with somebody and I've said, “I've been thinking a little bit about this conversation and I'll be honest, I'm a little bit nervous because I don't want this to happen.
I don't want you to walk away from this being offended. I don't you want you walking away from this thinking that you're not exceptional at your job. I'm going to try really hard to do a good job and to try to prevent those things from happening. But if I screw up, I'm just going to ask for your forgiveness in advance because I don't want those things to happen. You're really important.”

Dr. Andy Roark:
I love it. Yeah, that's great. Well, man, that's gold.

Bret Canfield:
I think once you've done that, I think you just lay out the challenge and say, “Here's the behavior that I've observed.” I think again, as much as you can own it yourself, it's important, because if this person's automatically distrusting and you say, “Hey, I've gotten some feedback from the team,” their mind is immediately going to go to, “Who talked? Who squealed? Who told you what? I want to know. I have the right to face my accusers.” You do not want to open that particular barrel of monkeys.
So, I would say here's what I've observed. I've observed that you have very high standard in terms of what you expect the staff to meet, what you expect from yourself. I think that's a really good thing. I think the way that high standard comes across sometimes is I think it comes across as you being distrustful of the team. I think it also comes across sometimes as you being somewhat unforgiving of the team. Our practice manager who submitted this did an outstanding job of submitting a couple specific examples to us. I do the same thing in that conversation, because that way, it's not some nebulous thing. I would say, “Hey, for example, last Thursday, here's an encounter that I observed.”
And then I think at that point, you have to do the hardest thing for me personally, which is to shut up for five seconds and say, “Quick pause. That's where I think we are. Give me some feedback.” One of the ways I'd really like to ask that and there's a very tactical reason is I'll say, “Now, is this something that you're aware of? Is this something that you also see as a challenge for you, or is this more of an optics problem?” What I mean by that is this isn't what's in my heart. I don't feel like I'm distrusting, but the team is perceiving that I am, because it gives them an out.

Dr. Andy Roark:
Yeah, I love that. Yeah, I really love that. I want to validate a couple things you said and then-

Bret Canfield:
Sure.

Dr. Andy Roark:
… explain a few places that I think are important. One, I think you're right about the authoritarian approach to feedback, but God, Bret, so many of us think this is supposed to be authoritarian. I coach vets, especially vets in larger corporate groups, where they have an established evaluation process, which totally makes sense, but it is an evaluation process and it happens once a year or twice a year and people come in and they get evaluated. I'm like, “Well, then I'm the evaluator and I will evaluate you.” The whole thing feels like it's supposed to be authoritarian or militaristic, where you come in and I will tell you, soldier, what you did and what you didn't do. I think that that whole vibe sets people up for failure from the very beginning.

Bret Canfield:
Agreed.

Dr. Andy Roark:
It really needs to be conversational. So, I like that you just called that out, but I really think that that is a wild misperception in evaluating giving feedback is it's supposed to have this power inequality between the person giving the feedback and the person receiving. It's really not. The best coaching feels peer to peer even if it's not.

Bret Canfield:
That's true.

Dr. Andy Roark:
So, I really like that you said that. Again, we go back to I love you give a couple examples of how to be vulnerable of opening up and saying, “Hey, if I make a mistake with this, please forgive me and know that you're really great in your job.” I really also like very much that you pause and say, “Is this surprising? Does this feel valid in any way, or is this off base?” It's funny the way I talk about the perception problem versus the reality problem, I really like that you set it up that way. I tell a story sometimes of I was busting my butt and my wife was teaching abroad. So, she went for a couple of weeks to Ecuador and she was teaching. She's a college professor, so she went and she was teaching.
It's a really hard job, where she has to go to Ecuador and teach about biology to college students. So, she's working up for the team and she did it, but she was gone. The kids were much younger. So, I had young kids. I had a bunch of work coming down the pipes and I was working really hard. So, I just decided what I would do is I take my kids up to my parents' house for the weekend. I would take them up there and they would get great grandkid time and I would tuck away and just do work. So, I went up there and I didn't set that expectation with my parents. I just showed up with the kids and they said, “Hey, we're going to come.” They were excited.
And then I disappeared into a room and just worked up my laptop for two days. And then when I was leaving, my dad was like, “Son, I'm worried about the relationship you have with your kids.” Man, that hit me like a hammer. You know what I mean? I was like, “Oh, my God. My dad said that he's worried about the relationship that I have with my kids.” I was really appalled by it. So, I called my brother because he knows me and he knows my dad and he is my best friend. So, I said, “Hey, well, dad said this to me. Man, I'm really wrestling with it.” He said, “Andy, I've known you for 40 years, you have a great relationship with your kids. You have a perception problem. All that he saw was you showing up, dumping your kids, and going into a bedroom.”

Bret Canfield:
That's right.

Dr. Andy Roark:
He thinks this is the norm and how you live your life. You and I know that this was 100% not the norm. This is an exceptional circumstance where you changed your behavior radically because you thought that that was something you needed to do. So, he said, “You have a perception problem.” That was the best example in my life of going, “Oh, he's right. I do have a great relationship with my kids. I know I do, but my father's perception of my relationship was not accurate.”
So, I really like that you called that out and said, “Do you think this is a perception problem?” That can 100% percent be true. People will say, “But Andy, if the whole team thinks that she's curt or she's mean, then surely that's not a perception problem because everyone thinks it.” What I would say is part of culture is collaborative creation of narratives.

Bret Canfield:
That's right.

Dr. Andy Roark:
Once people start to talk to each other, it is possible the team has decided that she's angry, unforgiving. The truth is she's like, “Well, I just don't know how to tell them that they didn't do it right and they're taking it really personally.”

Bret Canfield:
I think you're allowing that possibility. I mean if you say to somebody, “Look, I know what's in your heart. You're obviously a distrusting person. You obviously don't care about your team,” again, that's not going to be a good coaching conversation.

Dr. Andy Roark:
Nope.

Bret Canfield:
Dr. Andy, you got two choices, right? Let me put it this way. The choice of “Hey, this isn't actually a challenge,” that's not a choice. You do have a choice though. Is this a challenge that you acknowledge is happening in reality and that you're aware of, or is this a challenge where you're like, “That's what's in my heart. I'm not a distrusting person. I like our team so you guys are wrong”? No, there's still a challenge to be addressed. The challenge to be addressed is you are coming across as being distrusting or curt or whatever word you want to use, right?
The good news is in this particular scenario, the solution to both of those challenges happens to be the same, right? If somebody says, “Yes, I'm distrusting in my heart,” okay, let's talk about the solution. If they say, “I'm not distrusting in my heart, but I'm coming across that way,” it happens to be the same solution, which is now let's have a conversation about how to change the how, how to change how you're being perceived, how you're coming across.

Dr. Andy Roark:
That can be very collaborative too.

Bret Canfield:
That's right.

Dr. Andy Roark:
We can say, “Well, this is the perception that we're getting. What do you think?” Quite honestly, if it is a perception problem, the person who was there saying the things and doing the things probably has more insight than I do about what they might do differently. Of course, there's ways that I can smooth this over. I can be a messenger and a peacemaker and go to the staff and say, “Hey, guys, this is something that I've heard and I want you guys to hear the other side of it and let's give grace that we wish that we would receive from other people.”

Bret Canfield:
Exactly.

Dr. Andy Roark:
Again, I wouldn't say to the technicians, “How dare you miscast our beloved doctor?” I would say, “Hey, we're all doing our best. Nobody wants to feel preached at or judged. I get it. At the same time, no one communicates perfectly all the time. So, we want to make sure that we're assuming good intentions in our colleagues and the people that we work with and start with that.”

Bret Canfield:
Well, and that's why I said the second component to this I think has to be more of a holistic conversation as a team about our culture, right?

Dr. Andy Roark:
Yeah, I like that you put that out there.

Bret Canfield:
There's a couple quick things to dip into. Thing number one is you have the coaching conversation with your calico vet, but then you have conversation with your team and say, “Folks, we've had a coaching conversation. Now I'm not going to get into the nitty gritty because I don't air out other people's dirty laundry any more than I would air out yours, but we've had a conversation. This is something that we're working on together. Now I need you all to hit that reset button. I need to hit that reset button, because otherwise, what you're going to get is a lot of confirmation bias.”
Once the team has decided that this person's curt, any slight example of this person being curt, they're going to have out their little clipboards and they're going to be like, “Oh, she did it again. She did it again. Oh, she was curt.” It's like time out. I love your word, Dr. Andy. We're going to give this person some grace. We're going to assume the good. We're going to recognize that this is challenging and we're going to allow this person the opportunity to be better.
The other thing I would probably do is I'd probably take the team through a workshop or maybe even a couple workshops on things like courageous conversations. You and I talk about resources so I can geek out about that all day, but there's a few established tools for, “How do we as a team get better at showing each other that we do care about each other and that we're willing to challenge each other?”

Dr. Andy Roark:
Yeah, lay it on me. What are your favorites?

Bret Canfield:
I mean first one right off the cuff is Kim Scott's Radical Candor. It's a great book. It's an even better TED Talk in my opinion. It's 14 minutes of your time well spent.

Dr. Andy Roark:
Right. I'm going to link that in the notes.

Bret Canfield:
I love it. That's a good one. I love the book Crucial Conversations. I think it's very powerful. The only thing that I'm worried about with that is that there's a lot of steps and there's a lot of meat on that bone. Sometimes when teams go through that, they start to overcomplicate these things. In my opinion, the number one most important thing about having what I call courageous conversations, the number one most important thing is to have them. Yes, there are rules. Yes, there are strategies. Yes, there are tactics, but the number one communication problem in our industry and in fact in the world, it's not miscommunication, it's not rude communication, it's not curt communication. It's the absence of communication.

Dr. Andy Roark:
Yeah, no, I like that a lot. We're in the business of fixing problems that are established, but I think sometimes if you can use the way back machine and jump back a little bit and start to lay down some different patterns of behaviors, you can make a lot of things much more easier and much easier on yourself. So, for example, one of the things that I feel like is an unfair advantage that places with good culture have is that they give a lot of feedback. The great thing is if you give a lot of feedback, then giving feedback and coaching when you get to this point is really easy because it's not a hard thing. What's really weird is when you give no feedback and now you have to have a conversation with this person. I look at you and I say, “Well, just make it casual. Try to make it not a big deal.”

Bret Canfield:
They can't.

Dr. Andy Roark:
Oh, it's a big deal.

Bret Canfield:
They got a whole laundry list of stuff that they haven't talked about for a year and it's like, “You did this.”

Dr. Andy Roark:
Exactly.

Bret Canfield:
You did this, you did this. Wait, there's more. This, this, this. It's like, “Now, I feel like I'm on a trial,” right?

Dr. Andy Roark:
Yeah, exactly. Well, even some of the advice that I see people giving, I've given for giving conversations, like lower the stakes, go off-site, go out to dinner. You think that's going to lower the stakes? If you have never ever had coffee with this person offsite before, you think inviting them to go to coffee with you is not going to send up warning flares-

Bret Canfield:
To the whole clinic, right?

Dr. Andy Roark:
… and danger bells.

Bret Canfield:
All of a sudden, people are going to be like, “Hey, whatever you do, don't go out to coffee with Dr. Andy.”

Dr. Andy Roark:
That's exactly it. Yeah, totally. So, a lot of it is just if you can get in the habit of giving feedback all the time, this is super easy.

Bret Canfield:
Exactly.

Dr. Andy Roark:
People go, “That sounds awful.” Positive feedback is feedback. Again, it goes back to that militaristic command and control ideas. No, tell them what's great. Praise them for what they do. Praise them for wins. Ask them how things are going.

Bret Canfield:
That's right.

Dr. Andy Roark:
Ask them how they thought the day went yesterday. What did you guys think? Hey, how did this go? Just ask them so that you can ultimately be like, “Hey, how did you think things went yesterday? What's good? Hey, what are you working on developmentally? What do you think your goals are for the next year as far as a doctor? I can make that roll off my tongue because I say crazy stuff like that all the time.

Bret Canfield:
Exactly.

Dr. Andy Roark:
Hey, what do you think about that?

Bret Canfield:
It changes the culture. What we're really talking about is microdosing communication, microdosing feedback. Instead of me waiting until I review every year to get you a giant huge honk and bolus full of feedback, how about we just say stuff every day like, “Hey, Dr. Andy, nice job”? You're like, “And, but.” It's like, “No and, no bud, nice job, hard stop, mic drop,” or vice versa. Hey, I love you. I think you could have done this one thing just a little bit better. They're like, “Tell me what.” It's like, “No, that's it. You just could have done this one thing a little bit better. You're okay. I'm okay. Everybody's okay.”

Dr. Andy Roark:
I'm going to push you on this a little bit in that when I do feedback stuff, you say, “Hey, great job,” I think the real magic is give them an example. Speak in one level more specific than that. Hey, great job doing this thing. Hey, I saw you talking with the vet student who came to visit today and you were showing them around. You've had their full attention and I just wanted to say, hey, I know you're busy. I really appreciate you doing that. That was great and you put on such a good face for our practice. I just want to tell you that.

Bret Canfield:
Agreed.

Dr. Andy Roark:
It's that one click better than hey, good job or love working with you. It's trying to hit that a little bit more specifically.

Bret Canfield:
Yeah. Well, I'm on the field a lot. I mean I'm on the floor a lot. So, one of the things I'd love to try to do is give feedback in real-time. So, even then when I say, “Great job,” I'm standing there for a minute, I'm in surgery, I'm watching a new technician or whatever, do something, do a difficult task. They do it and I'm just like, “Hey, we need to do a quick time out. That was awesome. Am I the only one who just saw that?”

Dr. Andy Roark:
Yeah, that's right. Yeah.

Bret Canfield:
And then you don't even need to double click on it because you're there. It's happening. You were there at that exact time. If you give somebody applause in the moment, they know what it's for. If you give them applause two days later, they're like, “What did I do again? I don't remember.”

Dr. Andy Roark:
Yeah. Well and the other thing too is you do that five times and you can say something like, “Hey, could you work on this for me?” They go, “Okay.” It's because they feel safe.

Bret Canfield:
That's right.

Dr. Andy Roark:
Because you've told them that they're great five times before you told them this.

Bret Canfield:
That's right.

Dr. Andy Roark:
The other thing that I want to say, so you had mentioned before if we get the specific feedback or say, “Hey, this is the complaint that I've gotten,” so sometimes there's coaching, meaning this is generally where we need to go. Sometimes there's feedback in response to a specific thing that happened a couple of days ago. So, let's just say this person got into an argument with the vet tech on the floor. Let's just say. Well, I need to address that. So, I'm going to have to talk to them about this specific thing that happened. My big go-to and this helps me, because I'm like you, I have to twist my own arm to shut up and let other people talk. But I know how important it is. My favorite thing is the two most powerful words in management are, “What happened?”
So I just really like to say, “Hey, I heard that there was a bit of drama on the treatment room floor yesterday and that you were involved. What happened? What happened?” I coach improv comedy and I have a team that I coach. I really love this team. I went out of town. You would love this. I went hiking with my wife for a week and we just went up to the Appalachians. My cell phone didn't work most of the time and it was great. I got back and I had asked someone to coach the improv team for me while I was gone.
While I was gone, there had been an altercation at improv practice and someone's feelings got hurt. It was 100% had to do with some feedback and someone's feelings got hurt. They felt defensive or they felt it was act. They got really upset. So, I came back and I'm walking to this group of people. They've all saw what happened but I did not see it. I really have to say something about it because some people's feelings are really hurt. So, I walked in and I said, “Guys, I heard about practice last week. What happened?” That was all I said. Someone goes, “I'll go first. I think I made a faux pas.” They were like, “I think I made a faux pas when I did this.” It was great.

Bret Canfield:
That's so powerful.

Dr. Andy Roark:
It worked so well. So, again, you got to have good people who were willing to say, “I made a horrible misstatement yesterday last time, and I tried to be helpful. The way I did it, I could understand why that would make someone feel like they were being attacked, but I never meant it that way.”

Bret Canfield:
Totally.

Dr. Andy Roark:
And then we start off and it just ironed itself out beautifully in about five minutes. Everyone felt good and felt heard. I say, “Okay, let's do some improv.” That was it and that was the end of it. People talked and it was great. But that was just an example from last week of, “I wasn't there. I don't know what happened. This could be really tense. What happened, guys?” They told me and they sorted out in a meaningful way. So, I thought it was really good.

Bret Canfield:
It's a great way to guide things if you're a talker, like you and I both are. The team and I were joking around just having some lighthearted fun, because things have been so intense. One of the things we were doing is pointing out each other's verbal quirks. What are the words that you always say that maybe you don't know you say? I asked the same feedback. When it came to me, I was like, “Okay, hit me. What are some of mine?” They said, “Tell me more.” I said, “That's my version of what happened.”
So, I'll be in a conversation with them and they'll start to talk to me. It's my way of shutting myself the hell up for a second because what I want to do is I want to jump in with solutions. When I say, “Tell me more,” it's my way of saying, “I want you to work through this for a minute. Frankly, I don't have all the information I need.” I think stuff like that can work. I've one more thing burning desperately in my heart. Can I share one more thought with you on this scenario?

Dr. Andy Roark:
Yeah, of course.

Bret Canfield:
My one other thought and this has taken this whole idea up to 11, but my one other cultural thought is that I absolutely love team dynamic tools. I absolutely love psychometric instruments. So, for a practice manager, if you haven't taken the team through something like DISC or Myers-Briggs or Insights or True Colors or Canine Colors, I can't recommend those things enough. In fact, there's one that I especially love that most people in our industry don't know about, and it's called Belbin, B-E-L-B-I-N, Belbin team roles, developed by Dr. Meredith Belbin in the UK many years ago.
The reason I like these tools so much is that once you have the team go through and it helps them identify their communication styles, et cetera, it's a very non-aggressive way to call out certain behaviors without coming across like you're criticizing somebody's soul. So, instead of saying, “Yeah, Dr. Andy, I think you're a very distrustful person,” if I can say whatever you're doing, “Hey, you're a bright red,” or “Hey, remember when we went through that thing and remember when your communication style was very heavily weighted towards this, I think that's what's happening here. I think you're zigging and they're zagging.”
It makes the whole thing much more call it scientific rather than having it be, “Hey, I'm openly criticizing your personality.” So if it's something I'm a huge believer in, if anybody ever has any geeky questions about any of that stuff, I'll talk about that stuff all day long.

Dr. Andy Roark:
Yeah, I'll put a link in the show notes to Belbin as well. We teach DISC in Uncharted just for that same reason as that.

Bret Canfield:
I love DISC.

Dr. Andy Roark:
You get people out and there talking about their communication style. I love it, because again, everybody's got their favorite, but we teach DISC in Uncharted. Stephanie is a great implementer and teacher in DISC, but we use it a lot just because it's quick. You can recognize yourself and you can recognize other people really quickly in their style and what style they're using. And then again, I think probably the most powerful part of any of these is what you said, which is it shifts us to talking about the communication or the behavior and shifts us off of from talking about person. That just makes genuinely more productive conversations.
One last thing I want to jump back to that you brought up before we go, I love the holistic team perspective. I love going to the team after we've talked to this person and saying, “Hey, guys, we're going to have to reset button,” because you're right. Otherwise, it's confirmation bias. We've all worked really hard with someone and then sent them out and then the team immediately reacts to them based on their previous history. We just see it going right back into the old spiral, where it's like, “Okay, I've got reset button hit on this person,” but if we don't hit the reset button on the rest of the group, this pattern is going to pick right back up. I need both sides of this equation to stop pushing into the pattern and let's try to establish a new pattern.
So, I love that. I was just going to say, when we talk about a team approach, that does not necessarily mean a team meeting or a staff meeting. It might, but I think it's super awkward to bring the team together and be like, “All right, I've talked to Dave. This is what we talked about.” So I just want to be clear and say, hey, a lot of times these are private conversations, just saying, “Hey, I can't really get into details, but I want to let you know, I'm working with this person and they are really committed to trying to break out of this habit and I want to ask you to help with that. So, press the reset button, let you know and try to be supportive and open to the idea that they're trying to do better. Let's see how it goes.”

Bret Canfield:
Exactly.

Dr. Andy Roark:
Give some grace, but that can definitely be a private conversation. Usually, when we talk about things like this, there are certain people who have personality conflicts specifically and those are the people I really want to make sure I talk to, because they are going to be the ones that they're most likely to have a negative interaction with. So, for example, let's say that I have a technician on the floor who tends to take things very personally. That may be the person who's going to be who tends to be most affected by this or maybe the most vocal person who has these interactions and then goes and tells the rest of the staff or they vent about it or whatever.

Bret Canfield:
Or the most influential person. Absolutely.

Dr. Andy Roark:
Exactly right. Recruiting those people onto your side as you try to make this coaching adjustment, I think that that's a good use of time and energy.

Bret Canfield:
Agreed. Well, the truth is if we're really going to be a team, this is not clockwork, right? Like I said, it's not surgery. You can't just take the clock, pull out the part that's bad, fix it, put it back in, and not touch anything else. This is biology. This is an ecosystem. If you change one thing, you change everything. I do think it's important. As you said, Dr. Andy, to also close the loop, because one thing that happens to us a lot as leaders in veterinary medicine is someone will approach us with a problem.
We'll often go work on that problem, but as far as that original person knows, I don't know what the hell's going on. Sometimes just sitting down with somebody and saying, “I appreciate you telling me. I have had a conversation with this person. I'm not going to share the details of that conversation, but here's what I need from you moving forward,” now, we're doing a good job and we're taking a holistic approach, which I think is important.

Dr. Andy Roark:
Yeah, that's awesome. Bret, thank you so much for being here. Where can people find you online?

Bret Canfield:
Good question. I don't have the social media presence that I would like. I keep promising I'm going to do it and I keep not doing it. But between now and then, everyone can always just reach me on my email. I live for this stuff. Best email to reach me on is just bret.canfield@cast.net. Dr. Andy, please feel free to put it in the notes.

Dr. Andy Roark:
Sure.

Bret Canfield:
If I can ever be of service, I love this industry, so I'm happy to geek out over it. The challenge, of course, is getting me off the phone.

Dr. Andy Roark:
Yeah. Definitely. Well, anyway, guys, thanks for being here. Bret, thank you so much for being here. Guys, take care of yourselves, right? Talk to you later on.

Bret Canfield:
Always a pleasure.

Dr. Andy Roark:
That is our episode, guys. That's what we got for you. I hope you like it. Hope you got something out of it. Bret is fantastic. That's why we have him work for us in a variety of different ways. He's really a joy and a pleasure to be there. Let's see, anything else I want to tell you before you go? Banfield Pet Hospital, I got to remember that always in the Uncharted Veterinary Podcast. [inaudible 00:51:03] inclusivity in our profession. So, we couldn't do it without them. Always trying to thank those guys. Gang, take care of yourself. Be well. We'll cheer you on.

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

Oct 26 2022

Consequences When A Client Behaves Badly

Uncharted Veterinary Podcast Cover Image Episode 202

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and practice manager Stephanie Goss jump back into the mailbag to discuss a letter from a veterinarian who is fed up with naughty client behavior. This vet is even more fed up with feeling like their hospital management does not have their back or the backs of the team when it comes to holding clients accountable for things. Clients are being mean, they are wasting a ton of time and no one seems to care. This vet is asking how to help their team draw some lines in the sand and when to reach into their toolbox so that they can manage up and let their management team know “Hey, we need your help here!”. This was a fun topic to discuss so… let's get into this.

Uncharted Veterinary Podcast · UVP – 202 – Consequences When A Client Behaves Badly

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Got a question for the mailbag? 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.

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 they 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 knew 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 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. So check it out, guardiansvets.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 tackling a letter from a mail bag who comes from a veterinarian who is very frustrated with some naughty client behavior and most importantly, and the [inaudible 00:01:51] of this episode that they're frustrated with feeling that they're not getting backed by management from their hospital to address naughty clients. Feels like [inaudible 00:02:01] fatigue and often occurrences of bad behavior are going unpunished or without accountability. And they are wondering, “Hey, how should I, as a doctor, expect my hospital management to deal with situations like this?” And we've got a great example in the episode. They're wondering, is it wildly unacceptable to expect the client be [inaudible 00:02:19] to discuss behaviors like this? At what point do we hold them accountable? How should they be held accountable?
All of this coming from a doctor who's being made to feel like these problems are trivial. That is not the case, it is not unreasonable and Andy and I hold have thoughts and feeling about how do we [inaudible 00:02:41] when a client [inaudible 00:02:39]? Let's get into this.

Speaker 3:
And now, to the Uncharted podcast.

Dr. Andy Roark:
And we are back as me, Dr. Andy Roark and Stephanie ‘Dirt Off Your Shoulder' Goss.

Stephanie Goss:
How's it going, Andy Roark?

Dr. Andy Roark:
Go and brush your shoulders off. It's good. It's good. Yeah. You know what I mean? Making it, making it. I had a immediate failure this morning. We were podcasting first thing in the morning and I got up and I've been inspired to try to give Skipper work a better place to live. I don't know why, I feel like, I just feel like I need to make Skipper work's life better. And so I got a new food puzzle for him and this morning I was like… You know how you jump out of bed and you're excited about a stupid little thing in your day? If you're not, you should be. You should get out of bed and look forward to something.

Stephanie Goss:
Goals in life.

Dr. Andy Roark:
It can be a tiny little thing. Anyway, I got Skipper a new food puzzle. And I'm like, “Today's the day.” And so, I took his food and I put it in his big puzzle and I put it on the floor and Stephanie, he looked at me, “Why did you lock my food away?” And he just looked at it and he looked at me like, “Dude, why did you do that?” And I've been trying to coax him into getting the food out and he just looks at me, “Don't understand why you're doing this to me?”

Stephanie Goss:
“Why are you torturing me, Dad?”

Dr. Andy Roark:
I know. Yeah. It'd be like it much of me to Outback Steakhouse and put my Alice Springs chicken in a lock box and just sat there to watch me look at this lock box. That's the experience Skipper had this morning.

Stephanie Goss:
Oh, poor Skipper.

Dr. Andy Roark:
Oh I know.

Stephanie Goss:
He has such a rough life.

Dr. Andy Roark:
It's like, you try to help somebody out and they're like, “Why did you just make my world harder, darker?”

Stephanie Goss:
I love how you're like, “I'm trying to make Skipper's life better.” But let's be real. That dog has a very, very good life.

Dr. Andy Roark:
He does have a good life. He does have a good life.

Stephanie Goss:
Oh, man.

Dr. Andy Roark:
That was the worst thing that happened to him. And as long as he can remember, that was the worst [inaudible 00:04:59].

Stephanie Goss:
Someone put his food in a box and told him, “Do some work for it.”

Dr. Andy Roark:
That's how good his life is. All right. What's up with you? How have you been?

Stephanie Goss:
It is busy over here man. It is. I am protesting the fact that it is starting to show signs that fall is here. Fall is my favorite season and I love it, but I am not ready to let go of the sunshine in Washington. We have just had gorgeous, gorgeous weather and rain is coming, which makes me sad. But then we're predicted to have some more sunshine. So I am happy and I'm just trying to hold on to every bit of it until it gets rainy and overcast and everything. It is beautiful. It is my favorite time of year, but man, this year. It's funny, when we moved here everybody was talking about seasonal affective disorder and how overcast it is in the Pacific Northwest. And I love the rain, I hate the heat. A tropical beach is my worst vacation nightmare because I really turn scarlet red in two seconds of sunlight.
I have to wear long sleeves and long pants. I am that kid and I hate the heat and the humidity is awful. And so I was like, “Yes, let's let's go to where it rains more than anywhere else in the continental Pacific or the continental United States.” And so, I was really excited to move here. And the first few years was great. And I will say this last year was really, I really noticed how much the weather impacted my emotions and the mood and so I started trying all of the holistic things and after this last year was just really, really rough. And I decided that I'm okay with the fact that I might need some better living through chemistry this year because, winter is hard here. It is gray and it is dark and the rain is beautiful and there's nothing I love more than coming over the bridge and seeing the mountains that are snow capped in the distance, in the midst, wandering through the trees. It's gorgeous. But days after day, after day of that is tiring. And so I'm holding on to every bit of the sunlight.

Dr. Andy Roark:
Yeah, lets soak it up. Yeah, definitely. It's funny how we come across things like that. I always struggled in the summer times of just getting down and really just kind of feeling crappy and stuff in the summertime. And for a long time I'd say something to my general practice doctor, something I'd be like, “Hey, I generally feel pretty depressed in the summer.” That stuff would happen. And she was like, “That's not how-

Stephanie Goss:
That's not how that works.

Dr. Andy Roark:
… That's not how seasonal affective works. I was like, “I'm pretty sure it's seasonal and it's in the summertime.” And she's like, “No one… That's not a thing, Andy.” And so, anyway, come after a couple years what I came to find out was that for me, I think I definitely struggle sometimes with feeling good about what I'm doing and where I'm going and things like that. In the summers, I'm convinced it's because of a lack of structure. You know what I mean?

Stephanie Goss:
Sure.

Dr. Andy Roark:
For me, in the summers because the kids are out of school and everybody's traveling and vacationing and stuff and conferences are shutting down and I'm not hustling like I usually do. And it's funny, as I've committed myself to adding more structure into my summers, that has fallen by the wayside and into the rear view. But I just say that as, man, it's just seasons are real for a variety of different reasons. And I think that not taking a moment to just be honest with yourself about, “Hey, this is a thing that I deal with.” That's a mistake. If you're surprised by something again and again at some point it's not a surprise. It's kind the same thing with you. If every winter you roll in to this time and you go, “Man, I really feel crappy for X amount of time.” At some point it's not a surprise. That's a choice that you make, to continue doing that.

Stephanie Goss:
Yes. Yeah, absolutely. And that was me. I was like, “I'm going to just see if this is in my head or if this is a real thing.” And so last year was my year of trying it and it was a really hard winter for me and I said, “You know what? I am I okay with better living through chemistry this year.” So we'll see how that goes. But yeah, the seasons are changing. I heard fall is maybe coming to Greenville. I heard you guys are starting to cool off, all of a sudden.

Dr. Andy Roark:
Yeah. The leaves are just starting to change right now.

Stephanie Goss:
That's awesome.

Dr. Andy Roark:
It's pretty darn beautiful here and I got up this morning and it was 62 degrees when I walked Skipper and just being beautiful and cool. I got my sweatshirt on for the first time in months.

Stephanie Goss:
Nice.

Dr. Andy Roark:
It's good. Let's get into this.

Stephanie Goss:
Yeah, I'm excited. So we have a question from the mail bag. Y'all have been blowing that up and I have a nice backlog for us to work through. So, if you are listening and you're like, “Gosh, are they ever going to get to my episode,” we are working our way through.

Dr. Andy Roark:
Going as fast as we can.

Stephanie Goss:
Big list. But we got a great letter from a veterinarian today and I love this one. It is about consequences for clients, especially when clients are being very naughty. It is a vet who has been out of school for a while and is working in a companion animal practice and they're a corporate practice and they feel like they are hitting a wall with how to meet the needs of the teams when it comes to client behavior correction. And so, they are feeling like there is not a lot of structure and there's not accountability with clients. And so, they gave us some examples of things that are happening. They had a client who ran out of a med for their pet and it happens to be a controlled substance.
And so, they called in. When the doctor who had seen that pet wasn't there and the client wanted the team to call in a script and the team was like, “We can't do that. We actually need a written script and we don't have a patient… Or, we don't have a doctor here who has seen your pet. So one of the other doctors will have to verify the chart and make sure that we can prescribe it, because it requires them putting their DEA license on a handwritten script and then you're going to have to come get it and take it to the pharmacy because we legally not allowed to call it in.” And the client lost their mind on the CSRs and was yelling at them and then they went ahead and filled the script for the client anyways. And then the client never showed up to pick the script after yelling at the front desk and screaming at people on the phone.
And this doctor was like, “Look, how am I supposed to deal with this as an associate vet who isn't even this patient's doctor? Am I unrealistic for expecting that somebody should deal with this bad client behavior? Is it crazy to think that a client should be called to discuss it? Especially because they not only made the front desk cry but then they never even showed up and so they wasted our time, really the whole team's time.” And so, this is a doctor who said from a doctor who's being made to feel like these problems are trivial and they are just wondering, “What expectations should I have? What should be the next steps when we have clients who act like this? Should there be some consequences? At what point is the management team of the hospital held accountable for dealing with and communicating with clients when it comes to their bad behavior?”

Dr. Andy Roark:
Yeah, I think this is a great question.

Stephanie Goss:
Me too.

Dr. Andy Roark:
Yeah, I think a lot of us really wrestle with this. Let's start with some head space.

Stephanie Goss:
Okay.

Dr. Andy Roark:
This is a shades of gray question and I just want to say that upfront. If you came to this podcast expecting us to pull out the flaming, raging justice and be like, “No, does pet owners do to just deal with it?” Or, “How dare you not do what the pet owner wants?” Neither of those two things is going to happen. And I think that it's important. I think that, that's the frustration is people want to know, pet owners, they need to be held accountable for making me feel bad or I just need to suck it up and the client's always right and neither of those things are remotely correct. Yeah. Let's start with some validation on the medical side because gosh, we've all been there.

Stephanie Goss:
Oh, yeah.

Dr. Andy Roark:
We work really hard and having people jerk us around and be mean to us or say nasty things or make us do a bunch of crap and then not even show up and pick it up. Man, that's wildly frustrating. You know what I mean? I am super busy and now I'm on the phone and I'm pulling the records and I'm reviewing some other doctor's-

Stephanie Goss:
Notes.

Dr. Andy Roark:
… Work and what they did and trying to decide am I going to write this script and there's the quality of life or this pet and I don't want this pet to suffer and at the same time, I do not have time to see another pet today. And going through this emotional work and this mental work and taking this time to do this and then have them not even show up to pick the thing up and they made the person at the front desk cry. That doesn't seem right and that doesn't seem fair and that I fully understand being angry about that and I also understand being angry about that and then saying something to management and they don't do anything and feeling like my needs and my thoughts are being trivialized. And so, I just want to really validate those feelings and say, I think we all have those feelings and that is not remotely unjustified, I guess, to feel that way. Do you agree?

Stephanie Goss:
Yeah, no I totally agree with that. It is something that whether it's this specific… This happens a lot so that I think a lot of us can recognize our own clinics in the prescription issue because this is a challenge for every clinic. But there's a bunch of different scenarios where it feels like, “Oh, I totally get this,” and it is wildly frustrating and it is definitely a case where you just want to go postal sometimes because you're frustrated, you're frustrated, your team is frustrated. And it is one of those circumstances where I think validating the frustration is really, really important. And then I think for me, having come from the front desk and come from the client service world, the next piece of head space for me in situations this is, I always ask myself to step back for a second and put myself in the client's shoes, because the reality is especially in a case like this, if it's a controlled substance, there's probably something going on with the pet or there could be something going on with the client.
And let's be real, that often, when we're dealing with controlled substance requests in particular, there are always questions that we're asking ourselves about, “Is this a situation where the pet actually needs this medication and the client is upset because maybe they're end of life and they're just trying to make them comfortable?”
I try and ask myself all of those questions and I try and ask myself the questions of, “Is there something going on in this client's life? Are they trying to leave to go out of town and they just want to leave the pet sitter with the meds that the pet needs?” There's a million different reasons, if I really ask myself to step back, that I could hallucinate why a client is acting, maybe, not their best behavior wise. And so for me, the second piece of head space, it really comes to, “Can I put myself in the client's shoes?” Because that leads us always to where we want to be when we have hard conversations, which we will get to when we get to action steps. But it is in that safe head space where we can stand next to them or I can pick up the phone without my hand shaking because I'm not so angry.

Dr. Andy Roark:
Yeah.

Stephanie Goss:
I've been that manager where I look at the charts and I read the interactions with the team and I'm just pissed. I'm like, “Why are you screaming at my front desk team?” And I pick up the phone and call that client and recognize that my hands are shaking because I'm so angry and I just make myself put the phone down and take it because you have to be in a good head space to have those kind of conversations.

Dr. Andy Roark:
Yeah, I agree. The other side of it for me is empathy. And so I got a story I want to tell on this just because it happened recently. You know this, Stephanie, but a month ago my wife found a little lump in her armpit. It was this tiny little BB size lump and jump ahead 10 days from that. And we had worked it up and gotten CT and biopsies and stuff and wanted to know what this thing was. And so, Stephanie had flown into town and Ron Sosa was there and we were doing strategic planning stuff for Uncharted and we were at the west end in the board room and we were working on strategic planning and my wife had just gotten results I wish we didn't know were coming. And so she had pulled over, she'd been driving so she just came on to the west where we were working and she came and she got me and she told me that the results had come back and she has invasive carcinoma, which is not good.

Stephanie Goss:
Right.

Dr. Andy Roark:
In the grand scheme of good and bad, not good. Not the worst of the sucky things, it's a pretty good sucky thing. Of the sucky things it's a pretty good sucky thing.

Stephanie Goss:
Yes.

Dr. Andy Roark:
Man, but she came and got me and told me out in the hallway and we talked for a while and after a while it was time to go on with our lives. It's kind of a funny thing about cancers, not a whole lot you can do. It's waiting and making decisions and then waiting and the uncertainty is really pretty terrible. Anyway, I came back to the room and I said, “Guys, I need to take break.” And I went for a walk and so my wife went back to work and I went for a walk and so I'm walking through downtown Greenville and I go to this coffee shop because it was there and I was sort of looking for something that made me feel better.
And so, I walk up to the desk and the guy behind the counter looks at me and he says, “Hey buddy, how's your day going?”

Stephanie Goss:
Yeah.

Dr. Andy Roark:
Like that? My thought was, “I just learned that my wife has cancer and I'm not sure how I'm going to tell my kids. How was your day?” That was what I thought. And of course I didn't say that. I think I just flat out said, “I'm good,” which was not true. “I'm good.” And then he went ahead and he was like, “Oh yeah, we're just making coffee right now, it's going to be a couple minutes.” And I said, “Okay.” And I waited and I got my coffee. But I thought about that and all seriousness, I thought about that of how surreal that moment was, of this guy saying, “How's your day?” And me going, “10 minutes ago I got news that absolutely rocked my world. How are you?”
I thought about that a lot since that time because I wasn't mean to that guy.

Stephanie Goss:
No.

Dr. Andy Roark:
But I was… Boy. He and he had no idea, no idea. And I just asked myself how many times have I talked to someone who's just had their world rocked and I had no idea. I said, “How're you doing?” And they said, “Fine.” And that was all. And I just obliviously went on not knowing this person was dealing with something that was enormous for them. Right?

Stephanie Goss:
Right.

Dr. Andy Roark:
But I think about that and it was just this massive wake up call for me it's like, “Man, you have no idea what people are dealing with.” And it's just for me that's just a reminder of empathy. And I think that you can hold two thoughts in your head at the same time. You can be frustrated that you got jerked around and you had to spend your time and this person was mean and nasty and they shouldn't have been mean and nasty. That's not okay, that's not acceptable.
And at the same time, perhaps they're really, really struggling with things that have nothing to do with us and that doesn't make it okay, but it does at least make it understandable. And a lot of people say, “But Andy, how many people are having this terrible thing?” And I go, “I don't know. How many people do you talk to in a day?” Seriously? I think that's a lot of it, is we talk to a lot of people who are fine and the ones who are not fine really stand out. And so I go, “We'll play the odds. There is a chance that we talk to people who are having bad stuff in their lives, like real bad stuff.” And those numbers might even match up. The other thing I was thinking about is this. If somebody comes to you and they say, “Oh man, I got this terrible news. My mom is really sick and I'm struggling, I'm sorry.” You would say, “Hey I understand. No problem, I get it. I understand that.”
But what if the person comes to you and says, “I have 15 different things that are all a bit stressful and they've compounded and now I'm really struggling.” I don't think that we think as much about that. You know what I mean? I don't know that we see that the same way as having one big scary thing. But I think a lot of us would say, “Boy if you have…” A lot of us have had 15 kind of small things that are all-

Stephanie Goss:
Right, and then you just blow up.

Dr. Andy Roark:
… [inaudible 00:21:13] up and we struggle. And so there's that empathy part to it on the other side, which is to go, “We don't always get to deal with people in their best days and no, they should be strong enough to not take it out on people who aren't responsible for what they're dealing with, have nothing to do with it.” But at the same time, most of us struggle.
The day after I went to the coffee shop, I went out to dinner with Ron Sosa and we went to this restaurant, one of my favorite restaurants and it's kind of had a black mark on it for years for me because before the pandemic, I was struggling with a couple things at work and stuff like that. And we went to dinner at this place and I am not mean to servers and I am not mean to people, in general, that's not who I am. But on this particular day I was hangry and I think I was tired and I had some other stuff going on and I went to dinner and my family was there and this server was there and he was running way behind.

Stephanie Goss:
Sure.

Dr. Andy Roark:
And finally he shows up and he is like, “I'm sorry I'm late.” And I said something kind of crappy, “Well, it's about time, man.” And the table got really quiet and part of it was because it was a crappy thing to say. Other part is because I don't say those things, I am not the guy that gives the waiter a hard time. And I think my family was like, “Whoa, what is this?” And I will tell you I felt bad about that for years. For years. I was like, I remember when I said that. And I remember the table got quiet and I remember feeling crappy afterwards, “Why did I say that?” So anyway, the day after I had gone to the coffee shop, we go back to this restaurant and that waiter is waiting on our table. I recognized him immediately. I was like, “That's the guy.” And then as the meal went on at one point I got up and I caught him off by the kitchen and I said, “Hey, have you been working here a long time?”
And he said, “Oh man, four years.” And I said, “Listen, you don't remember me but a couple years ago you waited on table and I said something really shitty to you and I just wanted to tell you, man, it had nothing to do with you. I felt really bad about it ever since then I think back.” And I'm like, “I regret that I did that.” And he laughed and he said, “Oh man.” He said, “You don't have to say that.” He said, “Everybody has their moments,” and that's what he said. And I just thought about that, everybody has their moments.
So anyway, so I put that down again as saying, I cannot say that I'm someone who has never been an ass. You know what I mean? Or said something me and that's not who I am. And that's so rare that I remembered it and it bothered me to the point that I remembered the guy. It was post-pandemic when I saw him. So it's been two to three years since this thing happened. And I still remember that guy and that's how rare it was for me to act that way. But, man, it really bothered me and he just said, “Man, everybody has their moments.”
So anyway, I know it's a long way to go but I think this is important. It's just an important concept I think a lot about as I sort deal with my wife having cancer and stuff [inaudible 00:24:05]. Everybody's said for a long time everybody fights something we don't know anything about. And I go, “Nah. Yeah that's true,” and I just want to make it clear. So anyway, I don't mean to overplay that or anything, but it is just something I've been thinking a lot about recently and I go, “Yeah, I get it.” And I've been on both sides of this and is frustrating. But I think that best head space is to say you two things can be true at the same time. You can be wildly frustrated that your time is wasted or that someone's not treating you well or that they're behaving in a way that they should not behave. Objectively, they are being a jerk.
And you can also hold in your mind the idea that, “I don't know this person and I don't know what it's going on and it costs me really nothing to assume the best intent that I can possibly assume and try to give grace.” And I know that that can be hard to do, but I really think space for me, you got to try to hold those two things in your hands at the same time.

Stephanie Goss:
Now there are people who are listening to this and who are just want the flaming, raging sort of justice and are like, “There should be two camps. There should be, this is our job and we just deal with it.” And there should be the other opposite, polar opposite side, which is, “Clients are not allowed to behave badly, they're always consequences. Screw that.” And I think, hold your horses because when we get to action steps, I think we're going to talk about the fact that you can have empathy. I think about this a lot when I think about the team and this conversation I have most often in the context of team behavior because there you can have empathy and you can ask yourself to put yourself in somebody else's shoes and you can do the head space work. And it is important because you could do that and still have accountability.
And I think your point of you can have two opposite thoughts in your head at the same time, this is a case where that is a hundred percent true because you can absolutely have accountability and when you have accountability solely in the absence of ever having grace for anybody else, it doesn't usually work out so well. So the hard and fast line in the sands, it is, as a manager, I am an advocate for having some of those. And I would ask all of you as we talk about the head space and we start to talk about action steps, this is one where you have to think about, is this a hard line in the sand or is this one where there should be some shades of gray? And I think that this is true because to your point, you never know what somebody else is dealing with.
And so, there are some hard and fast lines in the sands of things that I do not tolerate under any circumstances when it comes to client behavior in my practice. And I will fire a client, no questions asked. And there are a lot of things that fall into that shade of gray. And so I think the head space piece is really important because when you're in the moment, when you are that person on the other side of the coffee shop counter, Andy, or when you are the server on the other side of the table or when you're the CSR sitting at the front desk, it is really hard if you are in that seat sometimes to have the objectivity to look at this and say, “Should I be asking more questions? Is this a shade of gray? Does this person deserve a second chance?”
And I think what that waiter said to you is so important because everybody does have their moments, we all have bad days. And so I think it is important to have those lines in the sand and if it falls into the shades of gray, I think we have to have a process for dealing with that. And we going to get into that with action steps. But I love that you said that because I think it's really, really important here to help find that the shades of gray.

Dr. Andy Roark:
Yeah. Well and I'm really glad you said it too because that is a key, key point we really have to make here before you go into the break is, you can have a good positive head space and also make changes to protect yourself. And you can also say, “You know what? I hear you, I'm assuming the best intent possible and I'm not going to continue to be treated this way.” Again, so I don't want anyone to think that Andy's saying, “Oh, we have to suck it up because the client might have gotten bad news today.” No, I'm not saying that. I'm just saying it helps me to look at this in a more positive way and to not feel so bad that I was taken advantage of and my time was wasted. If I can give some grace to the other person and just assume that we don't know what battles other people are fighting, that is true.
And, at the same time let's make some changes, let's set some things up to minimize a number of times these things happen because just saying, “Oh we're going to give grace and allow people to beat on us and make us feel bad and be nasty again and again and again,” that ain't what I am talking about. And we're going to make some changes to make sure that doesn't happen. So how do you feel about taking a break and then coming back and we're talking about what we're going to do to release this pressure.

Stephanie Goss:
Yeah, I think that's great.
Hey friend, there is a workshop coming up that some of you are not going to want to miss. This last weekend was I [inaudible 00:29:17] you done. There's a lot of conversation about challenge in our practice and how a lot of us are struggling with things not working very well, things feel pretty inefficient. We're all struggling to help you more with less, less time, less people, less resources. And there was a lot of conversation about how do we get more efficient and effective in our workflows? And so, while a lot of you were there with us this weekend, not all of you were. And so I want to give you all an opportunity to join us coming up in November 30th at 5:30 Eastern, 2:30 Pacific, we are offering a two hour workshop with my dear friend, Sinani [inaudible 00:29:55].
Sinani Is an RVT, so she is a licensed technician, she is a general badass, she is a practice management consultant and she loves talking about workflow. And so Sinani has agreed to come back and lead a workshop that was voted one of our most popular in all of 2020 in Uncharted, and that is super [inaudible 00:30:12] optimizing workflow.
This two hour workshop is here to help you and your team to [inaudible 00:30:19] your workflow so that you can get out of the place where everything feels inefficient and ineffective. So if you are struggling with efficiency and effectiveness in your practice, head on over to unchartedvet.com/events and sign up for the workshop. We would love to see you there. And now back to the podcast.

Dr. Andy Roark:
Okay, let's get into some acting steps here. So we've talked about this, we're talking about giving grace and talking about balancing our needs to be treated with respect. We feel like our time is valuable with the fact that we're dealing with human beings, we have no idea what's going on in their life and we want to give grace. What can we actually do here besides suck it up? Which is not the answer that anyone's looking for.

Stephanie Goss:
Yeah. I want to look at the questions that our frustrated doctor asked because I think they're really good ones and to walk ourselves through the action steps. And I think we'll get to all of the main things that I think you and I both would be thinking about, how do we solve this? So the first question they asked us, how should a DVM expect management to deal with this client? And for me, the action part is [inaudible 00:31:28] is a dangerous word, but where I want us to start here is that you can use transformational vocabulary here. So ‘should' is very dangerous because you ‘should' think a lot of things should happen. But that isn't always reality. Is it unrealistic to expect that management would deal with a client who is acting X, Y and Z? That's a great question. Would they deal with this because it asks them to think about it.
Not that you're implying that you think that they need to be doing something different than, what they are doing, but you're asking them a question of would we deal with this client behavior? And so from an action step perspective, it's a great question to ask from a team perspective, what would we tolerate? What would we not tolerate? And that's a great place to start figuring out some of those, how do we treat each other and how do we expect our clients to treat us? Because I think that there are some things when you start to talk about it as a team. And where I'm going with this is, a huge part of this for me is you have to have the discussion so that you can clearly explain your expectations to your team and to your clients and have some policies. Andy knows that I love policies and protocols and structure because it allows your team to deal with these kind of things and know what the expectation should be.
It resolves that four letter word piece of the should because it is outlined, the team knows how you expect, as a manager, that they would handle it. So I would start by asking some of those questions about what would we tolerate well, would we not tolerate? Can a client scream at a member of our team? Well, that's kind of on my high danger red list. If a client is literally screaming at my team, that is not something that I really tolerate. However, I also want to have empathy and so I want to be able to put myself in the client's shoes. And if I had a client who just found out that their husband or wife or partner had cancer and they walked in and they started screaming at my team, I could hallucinate a world where I might give them one more chance.
I might say to them, “It is absolutely unacceptable that you scream at my team. Full stop. That is not something that I'm going to tolerate in the future. I completely understand that you are having a really hard day because now you've told me all these things and I get it and I have empathy for you. I need you to understand that in the future, under no circumstances can I tolerate this behavior.”

Dr. Andy Roark:
Yeah.

Stephanie Goss:
That is giving them that chance, giving them that grace. And so I think for me it starts with where are those lines in the sand for us? What are the things that we're willing to tolerate, because that then helps us figure out what are those shades of gray.

Dr. Andy Roark:
Yeah, I completely agree with that. All right, so I want to expand on this because you and I look at these things a little bit different way, which is always really healthy, which is why we're a good team, is that you look at it from a policy standpoint and I think you're completely right. Again, we go back to this all the time. If there's a surprise that it happens again and again, at some point is not a surprise, is your business model. But people getting angry is not a surprise for any of us. And I wonder if there's shifting social norms going on. We see people at restaurants are worse than you've ever been.

Stephanie Goss:
Yes.

Dr. Andy Roark:
The videos of people on airplanes, for god's sakes-

Stephanie Goss:
Yes, are awful.

Dr. Andy Roark:
… what in the world is going on with people. But this seems to be a thing that is happening.
And so, you can't act like, “Oh this never happens.” And so what I would say is when people get angry, what are we doing? So I have a angry client course which is made for teams to take together and talk about getting on the same page when they're dealing with angry clients. And it's over at the Drandywork.com site. And the reason I made it as a team training, it's because there's not a right answer. It's let's all get on the same page and understand what the expectations are at clinic are and how we do these things. And so I really want to make this a discussion-based team thing that we would do during staff training and stuff. So I make that, but one of the big things that we talk about is angry clients. You never know why they're going to be angry and you know what they're going to say and you can't really prepare for that.
But the one thing you can prepare is, what are your systems for receiving angry people and dealing with them. And a lot of us just don't have that. We're like, “We're just going to wing it.” And I go, “Okay.” I think to your point, it's time for some protocols, which is just, “What happens. How do we set expectations? Who does this person get to talk to? How do we escalate concerns? What is the front desk in power to deal with? What goes to the doctor versus what goes to the manager? How does that work? And there's not a right answer. It really is who is your personnel and what is your culture and how does your practice work it and just figure that stuff out? But if you don't have that stuff, I think you just figure it out. The other part of the protocols where I would say this is really where I tend to immediately go to, because it's where my head is, is the expectations extended to the pet owners.
And so I am all about sign posting and signaling and setting expectations to pet owners. I really like patient bills or client bills of rights and responsibilities and responsibilities, meaning this is how you'll be treated and this is how you're going to treat us and this is how we work together. And if you can't abide by this, then you're not going to be able to be seen here. And I think that that's really important. I see more and more of those things going into the hospital. That stuff is up in the waiting rooms. If we expect to be treated with respect and raising your voice is not acceptable and there is clear communication about what is acceptable and what is not. We had a hospital in Uncharted of talking recently because they're a walk-in practice and they just do walk-ins, but now they're splitting and they're doing a wellness section and a emergency urgent care section and they're both walk-ins but they're two different doctors.
And so, they were already having this problem of people coming in and seeing other people who came in after them getting seen before them and getting mad. So imagine someone comes in with urgent care and someone else comes in after them for wellness. Well the wellness doctor is moving faster or has less going on and the wellness thing goes straight back. You can imagine the urgent care person getting angry and that's what was happening. And so in the hospital I had seen in the waiting room these signs that said, “This waiting room serves multiple services. People may not be seen in the order that they are brought into the waiting room,” but that sign exists for a reason. It exists because there was stress or frustration over that at some point, in some way. And so that type of sign posting at least literal sign posting, but that type of sign posting, this is what we expect, this is how we want to be treated with.
I think setting those expectations is really important and saying, “This is what we expect from you and what you can expect from us.” And I think that you can hold clients accountable to those standards when those standards are communicated.

Stephanie Goss:
Yes.

Dr. Andy Roark:
I think it's much harder to say, “Hey, you were really mad at my front desk,” and I would say, “I wasn't mad.” And they would say, “Well, you made my front desk person cry.” And I would say, “Well your front desk person is overly sensitive,” and you see exactly how this would go. And you go, “Okay, this is useless. What are the standards that we can set and we can communicate to set ourselves up for success so we can have productive conversations? So we can talk about policies, not just how you made me feel and how I interpreted what you said?” I think that that is absolute groundwork, basics for being able to handle these types of situations.

Stephanie Goss:
And I'm going to step on a soapbox here for a second-

Dr. Andy Roark:
Yeah, do it.

Stephanie Goss:
… From a manager perspective, and this is where I'm going in addition to policies and protocols, I'm going to step on the documentation soapbox for a second because this is where the reality is we want to think the best and we want to assume good intent. And as a manager, my point goes to what you just demonstrated, Andy, which is that I can't argue with a client about what happened if I wasn't there. I can rely on my team's documentation and for years as a manager, that was the only thing I had to go on. If it wasn't in the chart, it didn't happen. “So you guys, for the love of Pete, please write it down so that I can help you and I can back you up.”
We live in an age of technology. If your clinic does not have cameras and if you are not recording your phone calls, you are doing a disservice to your clients and you're doing a disservice to your team because you can't do your job as a manager and help on either side if there's not documentation. And so there are rules and regulations and it is your responsibility as a manager to know what the requirements are in your state. But in this day and age, especially if you have a clinic where you have late night hours or you run skeleton crews, you need to have cameras and you need to have recording on your phone calls because then it becomes a no brainer to be able to document along with the client and make them a part of the conversation.
“Well, I listened to the phone call and I would love to share it with you so that we can figure out how we're going to resolve this because what you said happened and what I'm hearing on this tape feels like those are two different things and I want to figure out where the disconnect is.”
Right? You can make them an active partner in that conversation in a way that you absolutely cannot do if you are not present. And let's be real, I don't know about you all, but as a manager, I cannot be everywhere all the time. But despite the fact that my kids think I have back eyes and I can see everything that is happening, whether I'm looking at them or not, I can't be in 10 places at once. And that is something that I have talked to a lot of managers and a lot of practice owners who are like, “I don't want my team to think I'm spying on them. I don't want my clients to feel like they are being watched.” The reality is you are doing it to help protect them as much as you're doing it to help protect yourselves.

Dr. Andy Roark:
Yeah, I would say the world is changing, like we said before, and this is a wildly litigious society.

Stephanie Goss:
Yes.

Dr. Andy Roark:
You better film it and you better record it. And if your staff goes, “You're spying on us.” I would say, “Look around, we are in healthcare and people do bad things and this is for our protection is to be able to say this.” And I see if you explain it to teams that way, they get it because they've been yelled at or had people say wildly inappropriate things to them in the exam rooms. I hate it. That's part of our job to some degree is it does happen and you want to protect yourself against that. You want to minimize that. We want to make that not happen. And so for me, that type of stuff. Yeah, that's not about spying on the team, that's about us just taking care of ourself and our team.
I will tell you. God, it's been years, we had an incident in the treatment room one time. A pet got away from restraint and ended up really hurting itself in the treatment room. Again, this has been years and years and years and years and not in my current job or anything. And boy, having film of the treatment room of what happened, it saved our butts because the person was like, “What did you do to my pet?” And we're like, “This is exactly what happened and we can tell you and we can show you what happened. We can show it.” It was the most freak accident thing that ever could have happened and you never would've believed it if we didn't have the film to say just happened. The other thing about this too, as far as prep work, Im going to throw this back in.
I know you and I have touched all around it, but we just want to say it really, really clearly. You should have an idea… Not idea, you should have a policy about what constitutes abuse versus bad behavior. And I think we said that. I think we've said that. But I just want to make real clear that we say it. When I talk about dealing with this, I am not talking about abuse, I am talking about bad behavior. And so I am not talking about how to empathize with people who threaten violence, make death threats, make racial slurs or homophobic, transphobic, whatever. Whatever your things are, whatever your lines are, that's not a, let's see how it goes. Let's talk to the person. It is totally fine to say no, this constitutes abuse and it is immediate termination. You should know what those things are and everybody should know what those things are.
But anyway, I just want to be real clear about that. It's like when we're talking about shades of gray, don't think that we're talking about worst case behaviors. That's not shades of gray, that's abuse and that's not acceptable.

Stephanie Goss:
Yes. And the last piece on my technology soapbox was I heard… This is not something I have done in my clinic, but when I heard this I thought this was totally genius. So if you are monitoring and recording your client calls, there is something that I have seen more and more clinics start to do, which I just think is brilliant, which is have a voicemail box set up to support what your abuse policies are. So as a CSR, I've been there where I've had the client who is acting crazy and is crossing the lines where I have still had to try and maintain professionalism and say, “Sir, I need you to calm down. I can't talk to you if you're speaking to me like that.” And try, in the moment, navigate those waters.
And there are clinics that have a voice mailbox set up so that when a client crosses that line if somebody's swearing at you, if they're shouting racial slurs, whatever, where the CSRs can hit the button and send the client to the voicemail that then picks up and says that you've reached our zero tolerance line and for the safety and wellbeing of our team, our animal hospital has a zero tolerance policy for these things. This phone call will be reviewed by a member of our management team before we can continue services.
The CSR has a way to navigate out of that and then the client knows this is what the follow-up is going to be, because in that moment the adrenaline rush gets going. I've been the CSR that feels really empowered to have those conversations and still I'm shaking and I'm just trying not to cry. And I'm like, “I need you to calm down.” And I just thought that that was so brilliant and I was like, as a manager, how great would I feel?
I would have no problem taking those voicemails and being able to look at the caller ID and reviewing the call and breaching out to that client and saying, “I've reviewed the tape and this crossed star zero tolerance line. Where would you your records forwarded?” That is an easy conversation for me to have if I have the ability to review that with my team. So I'm going to step off the soapbox for a second because we have a bunch more, I think, solutions to talk about. But man, if you are not taking care of your team and your clients by having some surveillance in your practice, you are missing a giant trick.

Dr. Andy Roark:
I think that, that's a great, great point. I also want to bring this back around to the shades of gray conversation. I think that people's… I can give grace to people having a bad day and having a bad moment. At some point a pattern is a pattern and that's not a bad day. That's your behavior pattern.

Stephanie Goss:
Correct.

Dr. Andy Roark:
And so, I really think that documenting these types of interactions is really important. Yes. I have a sort of a multi-strike process where you say, “If you're unhappy, I get it. If you're unhappy three times this year about different things, I don't think that we are meeting your needs and I'm going to recommend that you seek services somewhere else.”

Stephanie Goss:
Yes.

Dr. Andy Roark:
And so I do think that there should be some patterns in policies for documenting these interactions and just to let people know what they're walking into, but also just to have a track record so that later on I can say to this person, “Hey listen, I have documentation here that you had an interaction with the front desk back in January and then in March. There was also notes here about you being very angry when you called about these things. And now here we are in October and this is a third issue that is really not being resolved very well and that you were very upset about and we are not agreeing on. I really do think that we've reached a place where you may be better served somewhere else.”

Stephanie Goss:
Yeah, I love that. And I am the same. And you're speaking my nerd love language, Andy, because I can't tell you how many times I've had conversations with clinics where they're like, “But client communication, documentation doesn't belong in the medical record.” And I look at them and go, “Are you crazy? I don't know how you're running your business. But in this day and age, if you are not doing something to document your interactions and things that happen with your clients, I feel sorry for the board lawsuit that's waiting to happen someday because that's just the society that we live in.” And so, have a system. Have a way, a process, and it to cannot be something you make up on the fly. It cannot be something that you telephone out to the members of your team. This is a huge part of your staff training.
Every member of your team has to understand what are your policies, what are your protocols when it comes to client behavior. How does it get documented? How do you flag it? Because I'll tell you, being the manager, looking at a 30 page chart and trying to look back at 10 years of client communication notes and hope that I might pick out instances in the past where they behaved badly. Because the CSR was telling me, “Oh yeah, every time Mr. Smith is here, he yells at the front desk.” And then I'm like, “Okay.” And they're like, “Oh yeah, we've documented it in the chart,” but documented it in the chart means bearing in 10 pages of chart notes. I'm hoping that I can pick that out of the chart.” So there has to be policies and protocols that support documenting these things so that it is really easy, like you said, Andy, to figure out what is the pattern.
Because if Mr. Smith was here five years ago and had a bad day and now he's here today, that might be two strikes.

Dr. Andy Roark:
Yeah.

Stephanie Goss:
Am I going to fire him? Because five years apart, he had two bad days?

Dr. Andy Roark:
Yeah. Exactly.

Stephanie Goss:
I don't know, maybe. Depends on what's happening today, but probably not. And this is where the front desk and in particular because they bear the brunt of the bad client behavior, where they struggle because they're like, “Man, it says in his chart that he had this incident five years ago and here he is yelling at the front desk again and you're not going to do anything about it.” I can't have the conversation with them to try and teach them the empathy skills that I'm using, but also the judgment skills that I'm using to weigh this conversation. And if you are not having kind of a postmortem or a rounds process for your team to teach them why you're making the calls that you're making when it comes to client behavior, you're missing a trick.
Yeah. Because I will tell you that I learned so much from my team about what upset them as much as they learned from me about why I was making the calls I was making when we sat down and reviewed when a client has been fired, what they have been fired for, and how I reach that conclusion. Right. Or if I chose not to fire them, why did I do it? Because I want them all to understand this was the exception that was made and how did I document it in the chart so that everybody knows this was the final line in the sand. This is exactly what I said to the client. They know what the consequences are going to be moving forward and I am not afraid to let it rip moving forward if they cross that line because there should be some sort of, this is again, is a dangerous word, but in my world, I don't think it's crazy.
And our doctor who wrote in asked, is it wildly unacceptable to expect that a client be called to discuss their threatening behavior? No. For me the answer is no. I think that they should be expected to be called to discuss their behavior, but that may not be the reality in your practice at this moment in time. And so that for me is like it should it be done for me? Yeah. Heck yeah. Is that the reality in your practice? I don't know. And so this is where we have to step back and the action steps have to start with where those lines in the sand, how are we documenting it? To your point, what is our multis strike system? Because if it's always one and done, somebody's always going to be unhappy. Either your team is going to be unhappy, your clients are going to be unhappy or both.

Dr. Andy Roark:
Yeah. Well, so let me expand this a little bit further too and say the benefit of the documentation, the way that we're talking about and things like that and having a system for handling these sorts of things. Listen, it's about making your team feel heard. Now if you are management and you have that doctor that is putting these things forward and this doctor says, “Am I wrong to put this stuff forward?” The answer is absolutely not. No. Let me tell you what this doctor is probably really worried about. In my experience, this is what I see again and again. So there's three parts that suck here. The first part is dealing with an angry person and that sucks. The second part is not feeling heard. When you turn to your staff and ask for support or ask for them to look at it or you just want to vent, you just want someone on your side to say, “You didn't do anything wrong. You should not have had to deal with this. I'm sorry.”
Just feeling heard is a big thing. And then the third thing is that people generally have a fear in my experience that this is going to go on forever. Meaning, if you let this person be mean to me and I say something to you and you ignore me, that means that you're going to let people be mean to me forever. And so now I'm standing here and I'm looking down the road and people being mean to me without repercussions looks like my destiny until the day that I die. I'm 98 years old at the front desk, people are going to be mean to me. And from a management thing, you better make people not feel that way. They need to know, one, now every case is going to be different and you might not call this person, I don't know. It depends on the specifics and blah blah blah and what your capacity is and things like. You might not call them, but you better make this doctor feel heard and feel that their concerns are valid and important.
And two, you better make them know that this is not going to be their life and it's not going to be acceptable going forward. And if you don't do those two things, you're going to lose your doctor.

Stephanie Goss:
Yes.

Dr. Andy Roark:
And I'm not convinced that, that's undeserved.

Stephanie Goss:
And I'm so glad that you landed there because that was really the last thing for me is that our doctor said… They signed it from a doctor being made to feel that these problems are trivial. And then their post script was, if this is the case, do I need to just stop fighting these battles and accept that my time isn't valuable to my clients? Is this the nature of the beast for VetMed or is it time to leave a non-supportive clinic? And so I'm so glad that you stopped there because I can tell you I have, a as manager, it is very, very painful lesson to learn. You talked about the waiter that you felt like you were mean to, Andy, and how that stuck out to you. I vividly to this day where call a situation early in my management career where I had a team member at the front desk who had interacted with some difficult and very naughty behaving clients, said something about it.
And because I struggled at that point and I didn't have the conflict management skills that I have now, I didn't know how to deal with angry people in the way that I feel confident doing it now I didn't do anything about it. And I will tell you that I wound up losing that CSR and they are one of the best CSRs that I ever worked with. And that has lived with me from that day. And I still think about it because, for me, that was a failure for myself as a manager, was that I had somebody who was brave enough to stand up and tell me that this hurt them and here's why it hurt them. And I did nothing about it. And so I think for me, this doctor was asking the question, “Is it time to leave the practice?” And that's only a question that you can answer that does very personal question.
And it's funny because this doctor asked in the context of working for a corporate practice, we have these rules and protocols and this is how they kind of handle things. And I think this is for me a very personal thing, but I would challenge this doctor to ask yourself how do you feel about it? And if you feel like you would, if it was your practice, if you could hallucinate it being your practice, would you have different policies and protocols than the ones that are in place now? If your answer to that is yes, then I think you have two choices. You can either just quit and move on, which is totally acceptable choice. Or you can say, “Hey, I feel really strongly about this. I would like some of these things to change and here's why I feel this way. I would like us to have stronger policies or I am concerned about this and here's why?
You could step up and you could advocate for yourself and then change may happen or it may not. But I think ultimately at the end of the day, each one of us should decide how we feel about that. And if we set those boundaries for ourselves, there's nothing wrong with moving on if it's not what you need.

Dr. Andy Roark:
Yeah.

Stephanie Goss:
Just like we want to set policies and protocols to say to our clients, this is how, these are our lines in the sand. This is what is unacceptable behavior for you towards us and what you can expect from us towards you. We should have those kind of boundaries for ourselves and our jobs.

Dr. Andy Roark:
Yeah. Yeah. I agree. I think the last part of this for me is some level of acceptance. Meaning at some level we all have to accept a certain amount of this and I think that, that's important.

Stephanie Goss:
Absolutely. We're in a customer service job whether we like it or not.

Dr. Andy Roark:
That's exactly right. That exactly it. I hate to say it and I'm going to be saying this the wrong way, but this is a customer service job and we are going to deal with people. And I just came to accept a long time ago, and I had a mentor who kind of helped me realize this. It was like, “At some point you're going to help people and not get paid.”

Stephanie Goss:
Yes.

Dr. Andy Roark:
Because it's the morally right thing to do when you want to help them. And there are going to be people who are going to stiff you on the bill.

Stephanie Goss:
Yes.

Dr. Andy Roark:
They are going to have a payment plan and just not do it. They are going to just tell you after you've done the work that, “Oh, I don't have the money for this.” And yes, and you can boil inside over that or you can set policies and protocols to minimize the number of times that that happens.
And then you can just accept that what is left is the cost of doing business, which means you need to structure your day to allow people to waste a little bit of your time because they're going to. And if you don't set yourself up to allow some of your time to be wasted during the day, if you're, “Every moment of my day has to be used in a productive way, I would say you have made a schedule that is going to fail you and burn you out.” There's a quote from Charlie Munger who's Warren Buffet's investment partner. He said something like, “A business that can't stand a little mismanagement is no business at all.” And I always like that. And I would say a veterinarian that can't stand to have a little bit of their time wasted is a burned out veterinarian. I think that, that's true.
That's not a criticism, this vet just honestly, this is just what it means to be in our profession. And so set your protocols bill appropriately for your time knowing that people are going to call you. And that if your protocol is our doctors take phone calls and answer questions, you better set your prices so that you can keep the lights on while your doctors are answering phones and not working in exam rooms. And I would say, that's just part of accepting what the business is and setting yourself up so that everything keeps going while people behave like people because they're not going to stop doing that. And so-

Stephanie Goss:
I love it.

Dr. Andy Roark:
Set your expectations that way. I would say at some point we have got to, as a profession, and this is something I think we really needs to be injected into the wellness conversation. And a lot of people don't like to hear it this way, but we got to stop taking things so personally.
And again, I am a sinner preaching the sermon in that when people get mad at me as a doctor, I can take that as a reflection on my self worth. I, because I identify that way, I tell you I was a real pain for me in my thirties and in my forties. I said, It's just a job and I love it. Don't get me wrong, I love being a vet. I love working in vet medicine. It is not who I am. It is my job. And when people come in and they get angry, it's my job to deal with them. And that mental distinction for me, it has helped a lot of not tying myself up so much with the work that gets done and also recognizing that I'm not going to make people happy and some people are just going to choose to be unhappy.
That have nothing to do with me. I've gotten a lot better later in my life of saying I can't make everybody happy and some people are not going to be happy. Yeah, I'm going to deal with them, but I am not going to internalize this and I'm not going to take it personally. I am going to find pleasure in just doing the work and going on. I am going to enjoy looking at the patients. I am making the plans, watching patients get better, talking to people about their animals and what they need to do and making recommendations and puzzling out diagnoses.
And I am going to enjoy that work and that's where I'm going to find my pleasure. Not in people being happy when they leave because that's outside of my power. And so I guess that's the last part for me, is some level of acceptance of this is a customer service business and it's my job. And so I'm going to know that some people are going to waste my time. And that's just the thing. And I'm going to try not to get too upset about it because I don't think there's a way around it, dealing with other human beings.

Stephanie Goss:
Yes. I love it.

Dr. Andy Roark:
Cool.

Stephanie Goss:
This feels like a good place to end.

Dr. Andy Roark:
Yeah, no, I think I'm good with that. I hope that was helpful. Yeah, that was helpful. we're definitely in shades of gray. Those are the, I think it's a good mixture of some action steps and then also some philosophy. And that's where I like to leave an episode that makes me feel really good.

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

Dr. Andy Roark:
See you everybody.

Stephanie Goss:
Well everybody, that's a wrap on another episode of the podcast. Thanks so much for spending your time with us. We truly enjoy spending part of our week with you. As always, Andy and I enjoyed getting into this topic. I have a tiny little favor to ask, actually two of them. One is if you can go to wherever you source your podcasts from and hit the review button and leave us a review. We love hearing your feedback in knowing what you think of the podcast. And number two, if you haven't already, hit the subscribe button. Thanks so much for listening, guys. We'll see you soon.

Written by Dustin Bays · Categorized: Blog, Podcast · Tagged: behavior, client

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