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This week on the podcast…

Dr. Michael Miller joins the podcast to talk about the downside of leaders eating last. He and Dr. Andy Roark discuss what happens when servant leadership turns to martyrdom, signs that practice leaders are “giving” in an unhealthy way, and what to do about it. This episode is perfect for anyone who is pouring their heart and soul into practice and feels burned out and used up at the end of the day.

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Episode Transcript

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Welcome, everybody, to the Uncharted Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here with my friend, Dr. Michael Miller. This is a fantastic episode. Boy, I could have talked to Michael for another hour.

Dr. Andy Roark:
Listen, should leaders really eat last? I mean, I hear that there was a book, that it's popular, and leaders eat last and servant leadership is the way to go. And I have said these things myself, but let's be honest, I think a lot of us are out there struggling with the idea that we pour our heart and souls into serving clients, into serving our team, into serving our practice, into serving our community, and we eat last. And at the end of the day, we go home and we're starving, because we haven't gotten to eat ourselves, and we are empty, because we have poured everything out of ourselves to give to everybody else, and we're not happy. And we're thinking, “Oh, well, I'm lifting everybody else up, but I only get to live this life one time and I am burning out and I am not happy and this is not working for me.” If you've ever had thoughts like that, this episode is for you. I hope you'll enjoy it.

Dr. Andy Roark:
Man, I got a ton of ideas out of this. I have been sitting and thinking since we recorded it. This is a really good one, guys. I hope you're going to really enjoy it. Let's get into this episode.

Meg:
And now the Uncharted Podcast.

Dr. Andy Roark:
Welcome to the podcast. Dr. Michael Miller, thanks for being here.

Dr. Michael Miller:
It's great to be back.

Dr. Andy Roark:
He says that because I forgot to hit the record button and we talked for 10 minutes and I was like, “Oh, no.” And so now I'm going to reintroduce Michael Miller in a much more streamlined way because I know where this is going now, and so we're going to kick this thing right off.

Dr. Andy Roark:
For those of you who don't know him, Dr. Michael Miller is a practice owner. He has written many things in a variety of outlets, including drandyroark.com, that did very, very well. He writes under the moniker the Harry Potter Vet, which I think is a wonderful way to approach this. He makes a lot of analogies between the wizarding world and the vet world, and I think that's a refreshing way to look at what we do, and it's also a neat way to kind of visualize problems, and it makes for great metaphors. So Michael has championed that. This is his third time being on this podcast and/or the Cone of Shame Podcast. He has done a number of lectures and he's got some stuff that we're working on with him in the future. It's kind of in the incubator for him to do some more workshops and things with us. But Michael has got a fantastic perspective on something that I really want to talk about. So Michael, first of all, thanks for being here.

Dr. Michael Miller:
It's great to be here. We're going to hit the time turner and go back and relive.

Dr. Andy Roark:
We're going to relive.

Dr. Michael Miller:
And just like in Harry Potter, it's not always the same thing when you do it the second time, but it's meant to be and it's going to happen.

Dr. Andy Roark:
Oh yeah, totally.

Dr. Michael Miller:
It's also not the first podcast I've been on that this has happened. Not with you, I was on a different one, so I'm good to go. We're rolling with the imperfection and we're going to be fine.

Dr. Andy Roark:
Yeah, all right. It's the second time. And I've done like 500 podcasts, this is the second time I forgot to hit record. And so the other time, I had multiple guests and we recorded, we went for an hour, and then I was like, “Oh, no.” This was like 10 minutes in, I feel much better about it than the last one. But hey, we all make mistakes as human beings.

Dr. Andy Roark:
All right, let me lay this back down again, and I just want to talk about the reason that I was really excited to have you on. And it comes from a story… Honestly, it's a story from yesterday. And so I talked yesterday with a veterinarian who I really like. I think the world of her. She is a practice owner, she runs a large vet hospital. And I just talking to her and I was like, “How are you doing?” And she was like, “I'm holding on.” And I was like, “Well, what does that mean?” And she told me this story.

Dr. Andy Roark:
So here she is, she's a practice owner. They can't hire help in the kennel right now, they just can't find people. And so she's seeing appointments and doing surgeries, and then running back to clean kennels and feed pets and do these things that need to get done in the kennel when people no-show her or if people call out sick or stuff like that. So she's working her full vet job, plus she's the practice owner, plus she's doing everything that she can to keep up the kennel. And she's got little kids at home. School is about to start, and so she and her spouse are running around and they're doing all of these things. And she had just gotten chewed out on the phone by an angry pet owner who's really mad because her pet was vaccinated for canine influenza while boarding.

Dr. Andy Roark:
Now let's be clear, the pet owner had signed a document saying, “These are the vaccines that are required. I understand that these vaccines will be given,” blah, blah, blah. We have a canine influenza outbreak right now in the southeast that we are going through so this is not pie in the sky. This is like, “Hey, we have canine influenza in our area, cases being reported. This is what we're requiring. You were told this before you dropped off.” And of course the pet owner is screaming, using profanity, telling her that she's over vaccinating and blah, blah, blah.

Dr. Andy Roark:
And I'm looking at my friend and she just looks tired and sad. And she's giving everything to the practice, to the clients. And I'm going, “This…” I'm struggling kind of with how to talk to her and of say, “I don't think this is how it's supposed to go. I don't think this is healthy.” And so let me just leave that story with you for a second and say, how does that sound when you hear it? Does that sound familiar? Do you see this in other people?

Dr. Michael Miller:
Oh, I definitely felt that during the last two years of the pandemic. But even before that, this is a thing that happens to practice owners in vet meds. So people who are listening that maybe have not experienced that, I feel like that happens all the time. And to take one of your sayings, when it happens all the time, well, then that becomes your business model. And so how do we get out of this loop? How do we escape from this situation that we keep putting ourselves in? So it's not uncommon, and it is something that we need to think about as a profession.

Dr. Andy Roark:
Well, yeah, I think the position I found myself in was interesting was I was talking with her and I was thinking about what she was going through, and I ended up feeling like the crotchety old vet who was like, “This is not working. Somebody else can call that client back.” And when I heard myself say, “I don't think you need to be the one to call the client back to deal with this angry person,” then I had this internal conflict of, “Wait a second, Andy, if you're practice owner, shouldn't you be the one to call the angry client? Shouldn't you be the one to handle these sorts of things and deal with the one-star reviews where you are the one who needs to respond?” And blah, blah, blah.

Dr. Andy Roark:
And I think in my idealistic mind, yes, that's what it means to be the practice owner, that's what it means to be the servant leader, to lift up the other people. At the same time, I'm looking at this pragmatically and saying, “My friend takes this a hell of a lot harder than the practice manager would,” who is a great practice manager and very caring, but it's not her baby. She's not feeling emotionally punched when people say, “How dare you do this?” The manager is like, “These are our policies, and you signed the form saying that you agreed to them, and that's all there is to it.” And my friend is hearing this as someone's calling her baby ugly is kind of how it is; she's feeling this.

Dr. Andy Roark:
So I felt that conflict of I feel like I'm supposed to say, “It's important for us as the practice owner or the leaders to be the ones who have the hard conversations. And you lead by example, by jumping in and doing this, and being the first one to jump in and clean the kennels because that shows that we're the servant that people want us to be.” And at the same time as I'm looking at my friend who's overwhelmed, and I know other people are overwhelmed and shorthanded, I go, “Michael, this is not sustainable,” and so help me with that. I mean, how do I get out? How do I resolve this internal conflict? I mean, where does this go?

Dr. Michael Miller:
Yeah, I think that is the key point. And that was something when I started talking about servant leadership that somebody after the lecture came up and said, “The part that resonated with me the most was when you made me realize that I am being a leader for my team in a way that demonstrates that nobody else would ever want this job. Nobody else would want to serve the way that I'm serving right now.”

Dr. Michael Miller:
And I think that's something as a profession we need to look at because there's a shortage of doctors, there's a generation of people that don't want to be practice owners. Well, if your example are people that are only working for three or four years and then burning out and moving on to something else, then I don't want to do that.

Dr. Andy Roark:
Right.

Dr. Michael Miller:
So are we setting this example where the next generation is seeing us create something that's unsustainable and they don't want to do it? And to be honest, that was me. I remember very clearly as a pre-vet student being so excited when I got into vet school and one of the doctors that I worked with said, “Well, get ready for your life to be over.” And I was like, “What?”

Dr. Andy Roark:
Oh, that's terrible.

Dr. Michael Miller:
I mean, I still, to this day, think about that moment and think about, that's my goal is to prove that doctor wrong, that I can be a veterinarian and also feel like I have not given up everything else that makes me a person. And I think that's the part of servant leadership that I felt like I was failing. I've got two little kids at home, and I would come home from work and was wiped out. And suddenly, the two kids want to play and I have no energy. I'm like, “That's not the way that it's supposed to be. There's got to be something wrong here.”

Dr. Michael Miller:
And so I started, as I do, as a person who drank the Uncharted Kool-Aid, that I went to Uncharted for advice. And right there in the Uncharted core values is servant leadership, and so I thought I knew what that was, but what I was doing was not working. And so I had to start to look into more of, what is this servant leadership and am I doing this wrong?

Dr. Andy Roark:
Yeah. Okay, so tell me about that. So you start to look into it, where does that go? Because everything you've said so far feels very normal and in alignment to me. Like I said, I would definitely not criticize the heart of my friend. And at the same time, you kind of blew my mind when you're like, “No one's going to want that job.” And I was like, “Man, this is a big, financially very successful practice,” and I was like, “she couldn't have given it to me yesterday.” I was like, “No, I don't want that job.” Yeah, that's exactly right.

Dr. Andy Roark:
Okay, cool. So talk to me about this epiphany. You say, “I'm tired. I'm burned out. I'm serving everyone to the point that I'm not happy and I don't have anything left to take care of my family and do the things that matter to me.” I think that is a very relatable head space, and I think a lot of people are feeling that way right now. What'd you do about it? How do you make peace with this and how do you figure out how to get out of this hole?

Dr. Michael Miller:
So as somebody who identifies with Hermione, there's my Harry Potter reference for this episode, I ran to the library, or this online store, and ordered a book.

Dr. Andy Roark:
Right. Okay. Right, right. Made a Kindle appear, yeah.

Dr. Michael Miller:
Yeah. So one of the things that was recommended to me was Leaders Eat Last by Simon Sinek. And right off the bat I'm like, “I hate this title. I hate this title of this book.” And I realized that when I was single parenting for my two little kids, the days that I was in charge of them, I would spend all this time trying to make a meal for them, and then put it in front of them and they would refuse it. And then I would end up eating some leftover fast food or something unhealthy just to shove food in my mouth and move on to the next thing, and felt like, “This is not working.”

Dr. Andy Roark:
And you feel demoralized too. I mean, hey, I'm right there with you. I cooked a lot of meals for little people, who they would say, “It's spicy.” I'm like, “It is not spicy.” But yeah, I feel that. And then you feel demoralized. I'm totally with you.

Dr. Michael Miller:
So then I decided, okay, I'm changing this. I am cooking food that I want to eat as well, and I'm going to sit down and eat with them. And anybody who knows sort of child psychology and behavior, that's one of the recommendations is eat with the kids so they can have a family meal and that will help them to eat, and they started eating. And oh, by the way, I was also eating and wasn't starving through the whole time.

Dr. Michael Miller:
And so maybe it isn't that leaders eat last, maybe the leaders need to eat with. And so I thought, “Well, wait a second, if this is working at home, maybe that's the type of thing I need to rethink what I'm doing at work. And instead of being the one who is making the staff happy and making the clients happy and making the pets happy and then ending the day unhappy, maybe I need to rethink that and figure out, how do I find that balance?”

Dr. Andy Roark:
I'm really loving this metaphor because I think a lot of us see ourselves as the cook. We are working our butts off in the kitchen trying to serve clients and our staff, and we feel good in a way, and it can be deeply rewarding. And we all know people who show love through cooking, meaning they jump in and they serve, and other people enjoying what they do makes them happy until it doesn't. And when you're the one and you're like, “I'm working so hard on serving these other people that I, myself, am not eating, I, myself, am unhappy, and I'm feeling rejection when people don't want to eat what I'm serving them,” I think that that's common. But I think that that's a great metaphor.

Dr. Andy Roark:
Stephanie and I talk a lot about balance, and I think that's kind of what you're getting to a lot. I think one of the big mistakes that a lot of people make, especially in business leadership, is this idea that, “I'm going to make the clients happy, I'm going to make the staff happy, I'm going to make the practice profitable. And then if there's anything left, I'll be happy, or those things will innately make me happy,” and I have not found that to be true. I have not found making clients happy… Actually, I saw a study, I can't remember off the top of my head where it came from. It was an interesting study, but, shoot, I'll have to find it.

Dr. Andy Roark:
Anyway, there was a study I saw that actually looked at the correlation between customer satisfaction and veterinarian happiness. And it's not linear, boys and girls. It is not like, “Hey, the happier you make clients, the happier you are.” In fact, what they found is that veterinarians who consistently score the highest in customer satisfaction are not happy. And yeah, this inverted bell curve of like, “Oh yeah, there's a problem with that. And it does not mean that the happier you make other people, the happier you're going to be.” That does not work. And it was just really interesting way to see there's a lot of vets who don't have any personal boundaries, who give everything they have to the clients, that do everything the clients want, they make the clients happy at any end, at any length, and they're deeply unhappy. And I go, “Man, I see that all the time.”

Dr. Andy Roark:
One of my favorite sayings is you can't pour from an empty cup and you can't feed from an empty cupboard. And how many people do we know in this profession who came in and did everything they could and served from the bottom of their heart for five years and then burned out and went to industry, or decided to stay home with their family, or, honestly, went into equipment sales, or just said, “I'm going to go”? I mean, I have a friend that I went to vet school with and she does equipment sales for human medicine. And she's a veterinarian and she sells equipment to physicians in a completely different field. And she's like, “[inaudible 00:16:43], I love it. I did vet medicine for a couple years, I worked as hard as I could, and this is actually great. I make just as much money and I don't have to deal with these constant calls for support at an emotional level.”

Dr. Andy Roark:
So anyway, I really like this metaphor. So that makes sense to me. I like where your head's at. I like the fact that you're like, “Hey, I'm the practice owner. I'm going to cook dinner that I'm going to eat and everybody wants to eat with me. And I care what you guys want to eat and I will factor your preferences into the meal choice, but at some point I'm going to make this thing so that we all sit down together as a team and eat and I get to eat as well.” How does that look when you start to implement that idea into your actual life?

Dr. Michael Miller:
It's a good question, and I think part of it is the pivot of, it's not just serving the clients, it's serving your employees. As the team leader, now it's not just cooking the meal for the pet owners, I bet you would have that same bell curve, or inverse bell curve, if you looked at the practice owners and the happiness of their teams. So I tell a story about how we got an ice cream truck one year as a staff appreciation thing. And the first year it went great, everybody loved it, it was one of my golden snitch moments of the year highlights. And then the next year, we did the same thing. And at the end of the day, I felt horrible and I couldn't figure out, “Wait a second, I did the same thing last year. Why am I feeling so bad on ice cream truck day? I should be happy on ice cream truck day.”

Dr. Andy Roark:
Yeah, I was going to say, ice cream truck day makes me deeply happy. I don't understand this. What's going on?

Dr. Michael Miller:
And so I realized that it reminded me of Thanksgiving dinner with my grandma where, in the farmhouse, we had the buffet set out, she did all of the cooking or oversaw all the cooking, and then stood there until every single family member went through the line. And then by the time she got food and sat down, most of the people were done and out of the dining room and onto the next thing. And I always felt like, “That's so horrible that grandma didn't get to enjoy the meal with us.” And then I realized, the ice cream truck day, they got me ice cream, I had ice cream, but I missed seeing them get ice cream.

Dr. Andy Roark:
Oh, yeah.

Dr. Michael Miller:
And I suddenly understood my grandma.

Dr. Andy Roark:
Yeah.

Dr. Michael Miller:
So it was this sort of moment of, the ice cream wasn't what filled my cup, it was watching them get the ice cream that filled my cup. And we went long on surgery that day, so I was stuck in surgery and I sent all of my team outside while I was recovering the patient thinking that, “I'm serving my team, it's ice cream truck day, I'm doing this for them,” and I didn't take care of myself.

Dr. Andy Roark:
Yeah. Oh man, that hits hard. Oh, buddy. Yeah, I have to process this sort of story. This makes so much sense. Oh man, that makes a ton of sense when you say it that way. We can do great things and take care of the staff, but we got to feed ourselves. Creating a meaningful, purposeful place for other people to work sounds awesome, but it's got to be meaningful and purposeful for you as well. And creating a happy workplace, where everyone around you is happy because you have sacrificed so much, but you're unhappy, that's not the goal.

Dr. Andy Roark:
And so I really like this a lot, and so let me say this back and see if you agree. So pushing back against leaders eat last, I'd say this is really leading from the middle is what we're talking about, meaning I'm going to be in the crowd. I'm going to go through the buffet line with everybody. We're going to figure out, first of all, how to move the buffet line along so that everybody gets to sit down and eat together, that's what we're going to do. But I'm going through and I'm going to sit down with everybody else and eat as well. And I don't think that that's selfish. I think a lot of us may feel like, “Oh, that's something wrong.” Here you are, as a veterinarian, and you're the owner, you've signed on to be the one to lift others up. And I go, “Boy, this analogy feels weird.”

Dr. Andy Roark:
But I do think, honestly, Michael, as you're saying this, I'm going, “That's the answer to wellness in vet medicine and longevity in vet medicine is that we need to be sitting down and making sure that everybody feels like they're a part of this thing we're trying to create, as opposed to being the practice owner who nobody wants that job.” I'm really kind of enjoying sitting with this a bit. I'm going to have to keep working on it.

Dr. Andy Roark:
Okay, so I love that. So you did that. Did you talk to the team about it? Did you go back and say, “Hey, guys, we're going to do this differently”? Did you set up something different the next time you did the ice cream truck? Where did you go with this? What adjustments did you make?

Dr. Michael Miller:
So the next year, I made sure that we had a staff meeting scheduled so we did not schedule surgery that day. And we had it that it was very clearly that everybody will be done and everybody will be having it. And actually, this last year, I had my wife bring my kids, so they came to the ice cream truck.

Dr. Andy Roark:
Oh man, that's awesome. That's really fantastic. Again, this is a simple thing. We're talking about the ice cream truck. It's not the ice cream truck that matters, right? Although I think more of us should be doing ice cream trucks things; I'm very excited about the ice cream truck. But it's a-

Dr. Michael Miller:
It was not as expensive as I thought it was going to be. Compared to just a regular lunch, it was not that much more expensive. So just throwing that out there.

Dr. Andy Roark:
Hey, I'm feeling this. This makes some sense to me, so hey.

Dr. Michael Miller:
Although I will say we also learned, though, that you don't have the ice cream truck come at the very beginning of lunch. You let them eat lunch first and then you have the ice cream truck come.

Dr. Andy Roark:
Right.

Dr. Michael Miller:
Because we made that mistake the first year.

Dr. Andy Roark:
Sure. Because then they eat sweets and they don't want to eat their lunch and then, oh, it's that whole thing again. No, but it's not about the ice cream, right? It's about the idea. It's the metaphor of making this thing happen so that we can all come together and enjoy this. And I think you take that, I'm not talking about team building things, I'm not talking about celebrations, I'm talking about practice itself of saying, “Hey, I need to get what I need out of this.” And I'm not talking about the fun stuff, I'm talking about the work stuff, “I need to feel like I'm doing work that I'm proud of. I need to feel like my bucket is getting filled up and that I am doing the things I got into this profession to do.”

Dr. Andy Roark:
And there's always balances, right? This does not mean I'm putting myself first and I'm going to be happy and the rest of you peons are not, because that's like grandma cooking Thanksgiving dinner then eating it by herself and being like, “All right,” and then leaving. Grandma gets in, drives away, and she's like, “That was the best meal I ever had,” and everyone else eats cold food. It's not that. It's 100% about saying, “I want to be a part of this positive work experience that we are creating.” And if I'm creating a positive work experience that is not positive for me, that I am resentful of, that I don't like, that's burning me out, then that's not success. And I don't care what Simon Sinek says. I feel this really deeply. I really like the way that you're putting this together.

Dr. Andy Roark:
Hey, everybody, I'm just jumping in with two lightning fast updates. Number one, if you have not gotten signed up for the Get Shit Done Shorthanded virtual conference in October, it's October 6th through the 8th, you need to do that. If you are feeling overwhelmed in your practice, that you want things to go smoother and faster, if you do not want to watch webinars, you want to actually talk about your practice. You want to do some discussion groups. You want to do some workshops where you actually make things and work on things and ask questions as we go along, and have round table discussions, and things like that that's really going to energize you and help you figure out actionable solutions that you can immediately put into practice to make your life simpler and more relaxed, I got you covered buddy.

Dr. Andy Roark:
But you don't want to miss it; go ahead and get registered. Mark yourself off at the clinic for the time so that you can be here and be present and really take advantage of this. I don't want it to sneak up on you. I know October seems like a long way away; it's not. But go ahead, I'm going to put a link down below, and then when registration opens, we'll let you know it's open and you can grab your spot. But you do not want to let this sneak up on you. Check out our Get Shit Done Shorthanded conference. It's going to be a great one.

Dr. Andy Roark:
The second thing I'm going to tell you about is Banfield. Thank you to Banfield, the pet hospital, for making transcripts of this podcast available. You can find them at drandyroark.com. They are totally free and open to the public and Banfield supports this to increase accessibility and inclusion in our profession. It's a wonderful thing that they do. Guys, that's all I got. Let's get back into this episode.

Dr. Andy Roark:
So does the team notice when you're doing things like this? Do they understand why? Is there a reaction from them when you make these sorts of changes? What does that look like?

Dr. Michael Miller:
It's a good question and I'll be completely honest right now, I do not have it figured out. I am constantly figuring this out. You like an analogy about a spiral staircase, like reach for the landing. And the next year, the ice cream truck comes and there's a whole new thing I didn't think about that we have to deal with. And that's part of the freedom of it is realizing that I'm probably never going to get it exactly perfect. And by the time I do, things are going to change.

Dr. Andy Roark:
No.

Dr. Michael Miller:
And I keep evolving with that because that's the veterinarian pressure.

Dr. Andy Roark:
Absolutely.

Dr. Michael Miller:
Did I get 100% on that test? I know it in that moment of time. You give people that same test five years later and half of those answers are wrong now. And so trying to apply that to leadership… So when I went into my sort of evaluation of servant leadership, I was looking back at servant leadership over time. And the one that was the most impactful for me was something from 1970, which was the original work. And when I looked at that compared to then there was one that was 10 Characteristics in the '90s, and then in the 2000s there was something about Seven Pillars of Servant Leadership, and there were things from the initial work that started to drop away. And one of them was self care.

Dr. Michael Miller:
Self care is in the initial stuff for servant leadership, but in those later works, that's not spelled out explicitly. You can read between the lines and find it, but if you're doing the Cliff's Notes version of the servant leadership work from when I was trained in leadership and sort of gaining my skills to be a leader, that's not there. And it's also, then looking back, it's reflected a little bit in pop culture too. So the first thing I went to was Harry Potter. And spoiler alert.

Dr. Andy Roark:
Yeah, of course.

Dr. Michael Miller:
If you haven't read Harry Potter, spoiler alert, hit the ahead 15 seconds, whatever. A lot of leaders die in Harry Potter.

Dr. Andy Roark:
Yes, that's true.

Dr. Michael Miller:
And I love my team, but I do not love my team that much.

Dr. Michael Miller:
So again, here's this sort of zeitgeist that I grow up with is to be a successful leader, I have to be willing to make the ultimate sacrifice for the people that I'm leading. And I think that's dangerous. That's a dangerous story for us to keep telling. So here's another analogy. We'll run the gamut with random analogies.

Dr. Andy Roark:
Sure. Yeah, I love it.

Dr. Michael Miller:
Women's gymnastics.

Dr. Andy Roark:
Okay?

Dr. Michael Miller:
So I remember as a child watching Kerri Strug land that vault. And I'm like, “American hero. This is the best thing ever.” Go back and watch that now.

Dr. Andy Roark:
Yeah. I did that. Actually, I know exactly what you're talking about. I had that exact same experience looking back.

Dr. Michael Miller:
Can you name Kerri Strug's coach?

Dr. Andy Roark:
Oh no, I can't.

Dr. Michael Miller:
So it was Bela Karolyi. Can you name Simone Biles's coach?

Dr. Andy Roark:
Okay. No, I can't.

Dr. Michael Miller:
I can't. But that coach had more of an impact by supporting her player instead of pushing them to do something that they were unable to realize was safe or dangerous for them in the moment. And so that is what Gen Z is watching right now. That is what our next generation coming in, those are their role models of what leadership looks like. And so we have to internalize that because that's not what leadership looked like when I was learning how to be a leader.

Dr. Andy Roark:
Yeah. Some of the best business advice that I ever got that I use all the time, it's just a statement that I found that I make and it smooths everything out, is generally in any business interaction I'll say, “Look, this has got to work for everybody.” And I mean that; it's got to work for everybody. And I don't think most veterinary practice owners have sat down and said, “This has got to work for everybody.” I think a lot of people are like, “No, it has to work for the pets, and it has to work for the pet owners, or it has to work for my staff.” It's like, “No, it has to work for everybody and that includes you.” And if it's not working for you, you need to say, “This is not working for me.”

Dr. Andy Roark:
And that's how we delegate calling back the angry clients. If this is hitting you like a Mac truck, because you take this personally and you can't not take it personally, you need to have somebody else calling the angry clients to do crowd control. And you empower them to take care of those clients and give them what they need. “But you throwing yourself into this emotional meat grinder because you feel like that's your role as the leader,” I go, “that doesn't make any sense.” This got to work for everybody. There's some people I know who are largely unfazed by conflict with pet owners. I would much rather have those people do those conversations. And granted, if you talk to one angry client a month or a quarter, then maybe you suck it up and you do it. But if you have a big hospital and you're dealing with customer service stuff all the time and it's taking a toll on you, you need to find somebody who's got thicker skin than you do and empower them to do the job.

Dr. Andy Roark:
And that's not failure. That's not failure as a servant leader, that's you making a business that works for everybody, because the clients still get taken care of. That's the thing, you've got to make sure you empower the person so the clients also get taken care of. And you need to make sure that you get the right person so that you're not putting someone in there who's feeling it just as badly as you are. It needs to be someone who's more comfortable these types of conversations, or can shrug them off, or, honestly, just someone who's not the practice owner is going to be less likely to take this personally than the practice owner who feels it deeply.

Dr. Andy Roark:
And so I'm really loving this idea of this has got to work for everybody and I think that maybe that should be the normal. But it's funny, it's contrary to the vet culture, right? The vet culture has always been James Harriot goes out and saves the day and makes it happen. James Harriot is not like, “Oh, it's got to work for everybody,” but James Harriot didn't live in a world… Well, first of all, he didn't have a 10-vet practice and a bunch of other people to juggle. He didn't have the population density that most of us have right now. He didn't have a cell phone where people could text him all the time. He didn't have social media where local groups are saying things about your business 24/7, 365, regardless of what you do to make people happy. He didn't have Google reviews where you get a one-star review from someone who's reviewing the wrong vet clinic for God's sakes. He didn't have any of that stuff to deal with.

Dr. Andy Roark:
Then I go, “Well, yeah, when you had one landline and no answering machine, then you can just kind of throw down and do what you can do because, ultimately, you're going to be able to handle it.” We don't live in a world where people can throw down and just handle everything coming at them anymore. It's a different world and we're playing a different game, and medicine is different, and now it's time to shift that mentality from, “I am a sacrifice that I'll put forward to the world,” to, “This has got to work for everybody.”

Dr. Michael Miller:
So I just read a book that I'm going to hold off on telling you the title of the book until the end because it's going to blow your mind.

Dr. Andy Roark:
Okay. Is it a Harry Potter book?

Dr. Michael Miller:
No, it is not a Harry Potter book.

Dr. Andy Roark:
Oh, okay, then I'm going to guess this.

Dr. Michael Miller:
It was a business book.

Dr. Andy Roark:
Okay, I'm going to guess this.

Dr. Michael Miller:
But in it, the author talks about how we make a mistake in thinking that history repeats itself. And if we're basing our current decisions off of what worked in the past, we're bound to make mistakes, because we are not living in the same world that the past was. And so if we're looking to James Harriot as the model of veterinary medicine, we're basing that off of a system that is not relevant anymore in most practices. Yes, there are things we can learn from the past in history, and I get that, that's fine, but you can't do everything the way that it's always been done. That was one of the key things in my sort of management journey was realizing, are we doing something because this is the way it's always been done, or are we doing it because this is what we need to be doing right now?

Dr. Andy Roark:
Yeah. No, I agree with that. I think that makes a lot of sense. So there's a number of different things here that we're putting together. So what's sort of spider webbing together in my mind is history repeating itself, are we doing this just because it's the way we've done in the past? I think that's a great question to ask ourselves, that we need to be willing to make changes, and that's sort of scary.

Dr. Andy Roark:
There's the other part that we were sort talking about earlier where we were talking about finding balance and you said, “I don't get this right. I keep trying new things and making mistakes.” And I say, “That's true.” I think a lot of times we do what we did in the past because we know it, right? It's the devil known versus the devil unknown, and the devil that we know is not nearly as scary as the one we don't. And so I think owning that idea that this is not perfect, and I'm not going to get it right, and it's always going to be hard, I think that liberates you to try some new things and say, “Yeah, I don't care that this is how the practice owner before me did it. I don't care that this is how the vet that I watched when I grew up did it. This is not working for me as an individual, in this time, in this place, in this culture, in this society, in this general geographic location. It's not working for me and so I'm going to do it differently.”

Dr. Andy Roark:
The other thing that comes along with that is I just want to smooth things out. Because I think a lot of people feel like, “Oh, well, if I got this right, if I really set this up the right way, if I set boundaries for myself, if I got this balance right, then this pain would go away and I would have it figured out.” And I also like the fact that you said, “I don't have this figured out.” And I think it's just really important for everyone to know is balance is an act of process.

Dr. Andy Roark:
I'm looking at a BOSU ball that I have. You know the BOSU ball, it's got the flat side and then the round side? It's a fitness thing. All right, so how do you tell people that you do physical therapy without telling them you do physical… Tell them you have a BOSU ball. All right, so yeah, a BOSU ball. It's a thing that you balance on. And I will tell you, you stand on this thing, and after about a minute, it burns. It burns. But stand on one foot, and after a minute, it will burn, because you're actively balancing yourself. That is what balance looks like. It is not a passive process where you get it and you just stand there forever, it burns. It is a constant adjustment and readjustment.

Dr. Andy Roark:
School is getting ready to start back. I know that's a big deal for you. That's a big deal for me and my family. I've got kids going to new schools, meaning going to high school and going to middle school. My life is going to change, and the systems that we had to keep balance are not going to work. And we're going to have to find new systems then. We're going to have to reevaluate how we do things and what that looks like. That's life. And that's not failure. But don't think that constant readjustment is failure because it's not.

Dr. Andy Roark:
One of my favorite sayings that I think makes a big difference and I think about business is the difference between a struggling business and a thriving business is this: The struggling business makes the same damn mistake again and again and again, and the thriving business makes a different damn mistake every day; and that's the difference.

Dr. Andy Roark:
And so it's never, “I got this right and I got it figured out,” it's always a struggle. But to me, as you brought up earlier on, if you got a problem again and again and again and again, at some point it's not a surprise, it's your business model. And so that's doing the same damn mistake again and again and again and again. And so I really like this idea of setting the expectation of active management is what it's going to recall. Are you going to make it work for you today? And after a week or two weeks or a quarter or six months or a year or three years, it's not going to work for you anymore and you're going to say, “Things have changed, my life has changed, I'm in a different place. I didn't have kids when I started this practice and now I do.”

Dr. Andy Roark:
And that's not bad, but it does mean that things are not what they used to be. And the fact that we did things one way does not mean that we're going to keep doing them now that I have kids, or we did them this way… And I can see the time when my kids… I've got a kid that's getting close to getting a driver's license, Michael, and my life is going to change. It's going to change. And the way that we as a family have done things in the past is not going to be how we're going to do them in the future when I've got another driver around. Oh, that gets to be a lot. Uber for the younger one just became a reality. But you get the point, right? Just because that's how we do it when the kids can't drive doesn't mean that's how my life is going to be when they can drive.

Dr. Andy Roark:
And I think about the practice, I think about the speaking and traveling, and I've really geared my travel down because I can see my kids getting close to the time when they're not going to hang out with me, and so I'm going to be here as much as I can right now with them. When they leave and they're off driving and doing stuff for their friends, then I love going out and talking to vet people and being on the road and seeing people. And you know what? That day will come back and I'll do things differently then than I do them now. But I think that's healthy, I think that's part of the journey.

Dr. Michael Miller:
Yeah. So I came back from the April Uncharted with a 13-point plan to help my business that I brainstormed, “Here are the 13 things that we're going to deal with.” And I went back to that last week and I think three of them have actually gone as planned. But that's sort of the point is you develop a plan, you try it, and then you have to adapt and not get too set into, “Well, this is what I said we were going to do,” and realize that, you know what? My plan for my practice in April, those circumstances are not the same thing that I'm dealing with here in going into the Fall. And so some of those initiatives and things, it's not that I'm throwing it away, but I'm definitely adjusting it. I'm not trying to force the shoe to fit when the foot has changed. I don't know why I picked that analogy, that's weird.

Dr. Andy Roark:
Yeah. That's what I'm saying, you're nailing it. Great analogy.

Dr. Michael Miller:
I guess maybe as a toddler, the toddler's getting bigger feet? I guess that makes sense there.

Dr. Andy Roark:
Okay, yeah. And maybe so. Let's not think too deeply about it. Okay, one of my epiphanies this pandemic inspired that I have kept since then is I have really come to the belief that planning is absolutely vital and plans are basically useless. And I have just found that to be true again and again and again and again, is that you make these plans and the world changes. And you have so little control in the world, and people don't realize that. You're like, “I'm going to do this, I'm going to do that.” I have never successfully executed a plan, I don't think, with more than a one-year timeframe. The world just changes.

Dr. Andy Roark:
Now, I have set general goals and very much achieved them over a period of longer than that, but there's just so much uncertainty. You set this great plan and then the person that the plan depends on leaves your business or gets promoted or moves somewhere else, or this other person you're working with moves away. It's so out of your control. But having a plan is so vital because you're constantly adjusting. And really, I feel like our careers and our lives are a lot like sailing, where you think that you can set a point on the horizon and just go there, but you can't control the wind and which way it blows. And so for the most part, you actually end up tacking one way and then back the other. And you keep moving in that general direction, but you're not going to set one target.

Dr. Andy Roark:
Boy, we're all over the place with metaphors today. You're not going to set one target and just go there directly, it's going to be moving in that way. But you do that by making a plan, starting the plan, running the plan, learning what you don't know, seeing the world and the circumstances change, and then readjusting the plan. And that's not failure either, that's life. And so we bring people together, we do our Uncharted, we do our planning, we go home. You did three things coming out of uncharted, that's a massive win. That is a huge business-changing step to do those things. And the rest of them, we learn some things, we make some changes, we readjust, and we come back and we reset plans and we go forward again.

Dr. Andy Roark:
Anyway, that makes tons of sense. Michael Miller, you are amazing. Thank you so much for being here and talking through this with me. I feel inspired. I got so much out of our conversation. I really appreciate it. Real quick, let me ask you this. So you pushed back on leaders eat last, do you have resources? I know you're a big reader, what resources would you recommend for people who are like, “Man, this is speaking to me and I would like to dig deeper into this”?

Dr. Michael Miller:
Okay, so get ready to have your mind blown here. Ready?

Dr. Andy Roark:
Okay.

Dr. Michael Miller:
So I read a book by Margaret Heffernan titled Uncharted.

Dr. Andy Roark:
I see, yeah. I knew it.

Dr. Michael Miller:
I was like, “Hey, I'm going to get the business book that's titled Uncharted.” And that was the book I read earlier this year that was all about… The basic thesis was that business projections that are more than 400 days in advance are pretty much useless.

Dr. Andy Roark:
Okay, that's amazing.

Dr. Michael Miller:
And so she goes on to talk about a whole bunch of other things.

Dr. Andy Roark:
That's going on my list.

Dr. Michael Miller:
But if the discussion that we just had resonated, you need to read that book, because that opened up my mind and it gave me the freedom to realize that the things that I was working towards, it's okay when things don't go as planned, and gave me some tools of what do I do? Because I want to have a plan. And so having different scenarios and things. So that was the book that has opened up my perspective recently and it just happens to be named Uncharted.

Dr. Andy Roark:
I love it. That's fan-freaking-tastic. I love it. All right, cool. Where can people find you online?

Dr. Michael Miller:
Yeah, the most interactive is usually on the vetstagram community on Instagram, @HarryPotterVet. If you really want to get ahold of me, do that. And I will say that, for anybody who is listening, I listened to previous podcast episodes and there were some things that started to talk about servant leadership in burnout with leaders, and I contacted the previous guests, so feel free to contact the guests because they reply. And it was a great dialogue and it helped me sort of move on to the next thing. So if you're listening to these podcasts and you're like, “I can't contact that person,” no, we're all people. We wouldn't have put ourselves out there if we weren't open to discussions. And so for any of these podcasts, if you hear the guest and they give contact information and it's something that resonates, go ahead and contact them.

Dr. Andy Roark:
Yeah. Okay, I wasn't going to touch on this, but now I will. Okay, you beefed with one of the guests that I had on my other podcast. Do you want to explain what your beef was?

Dr. Michael Miller:
Very quick. It was not a beef, it was a question.

Dr. Andy Roark:
It sounded like a beef.

Dr. Michael Miller:
It was not a beef, it was a chicken.

Dr. Andy Roark:
Okay. Okay.

Dr. Michael Miller:
So you had Dr. Clinton Neille on and it was Cone of Shame episode 120: The Economic Toll of Burnout in Vet Med, and he made a comment about how practice owners do not feel the same level of burnout as the rest of the support staff. And that was like-

Dr. Andy Roark:
Yeah, I was…

Dr. Michael Miller:
That was like the moment of, “That is dissonance. That does not make sense with what I'm hearing.” So I emailed him and I said, “Hey, I'm working on this servant leadership stuff. I'm interested in this comment that you made.” And he said, “Well, it comes down to the definition of burnout. When they looked at the studies, they defined burnout as leaving that job, and the practice owners have more barrier to leaving that job.”

Dr. Andy Roark:
Yeah, absolutely.

Dr. Michael Miller:
And so maybe it's semantics in my mind, kind of back to servant leadership. In my mind, what I was calling burnout wouldn't have been classified as burnout, but it didn't feel like it was wellness.

Dr. Andy Roark:
Right.

Dr. Michael Miller:
So some of this is maybe we need to think about the words that we're using and how it applies, because how it's perceived may be different than what the sort of academic definition of that word actually is.

Dr. Andy Roark:
This has been one of the most intellectually stimulating conversations I've had in a long time, which is saying a lot because I had a lot of great conversations. But yeah, I love it. Thanks for bringing that up. Thanks for talking about it. Because I tell you, I have 100% been burned out. It was a number of years ago; I had a serious bout of burnout. I did not leave my job. And if that's the criteria for burnout, then I didn't burn out. But I can tell you, boy, it felt… One star, would not recommend. But yeah, okay. Awesome. Thanks, Michael. Guys, take care of yourselves. Everybody, be well. We'll talk to you later on.

Dr. Michael Miller:
Bye.

Dr. Andy Roark:
And that is what we got, guys. I hope you enjoyed it. I hope you got something out of it. I mean, I could have talked to Michael for another hour or so. Gang, if you are thinking about, “Oh boy, how are we going to update our practice? Are there ways that we do things that I would like to do them differently?” I'd love to help you out if I can. Check out the Uncharted community where we work on this stuff all the time.

Dr. Andy Roark:
If part of your doing things differently is empowering your staff to do more with clients and do more client communication, check out my training programs over at drandyroark.com. I've got Charming the Angry Client and I've got Exam Room Communication Toolkit. They are both fan-freaking-tastic for getting your clinic up and trained to be effective working with angry clients and not angry clients. But boy, I put my heart and soul into them. I think that they're really, really good. The feedback on both of the classes has been amazing, but pick one and you can use it with your team, and just maybe I can help you get people trained up so that they can take things off of your plate.

Dr. Andy Roark:
Anyway, guys, that's all I got. Have a wonderful, wonderful rest of your week. Be well. I will talk to you next week.

This week on the podcast…

Dr. Andy Roark and practice manager Stephanie Goss relish in living in the shades of gray. We received a mailbag letter from someone who asked “Is it just us or do any other hospitals have the struggle of whether or not support staff should be taking a detailed history from clients before the doctors get in the exam room?… Should full medical history be the doctor's responsibility?” Andy and Stephanie get lively when it comes to should – it's a four-letter word in veterinary medicine, friends. They jump into a great debate about medical records and have a blast doing it so… let's get into this.

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

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

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

Upcoming Events

Upcoming events: unchartedvet.com/upcoming-events/

Join us for LEVERAGING TECHNICIANS – MAKING PRACTICE LESS STRESSFUL FOR YOU, THEM AND YOUR PATIENTS! We discuss ways to balance leveraging technicians while creating a positive culture of respect for all team members! We all recognize that every member of the veterinary team is valuable. In this workshop, we will:

• Explore how to create trust among your team so that veterinarians will fully utilize technicians and technicians will fully utilize veterinary assistants
• Discuss how to cultivate a well-balanced team resulting in less stress for everyone to create positive client and patient experiences.

Join us on Wednesday, October 19 from 7-9 PM ET/ 4-6 PM PT for $99 (FREE for Uncharted Members!) Register here

Episode Transcript

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Stephanie Goss:
Hey, everybody. I am Stephanie Goss and this is another episode of the Uncharted Podcast. This week on the podcast, Annie and I are diving into the mail bag. And tackling another question from a listener who is asking a “should” question. And I love this so much because it lets me talk about one of my favorite answers as a manager which is, “It depends.” If you are one of those people in veterinary medicine who struggles with living in the shades of gray, this episode might make you a little bit uncomfortable, because we're going to dive in and we are going to relish in the shades of gray here and talk about who should take the medical history in a practice and we're going to have a lot of fun with it. And let it be noted for the record that I hopefully have not actually been fired through the course of making this episode, but I'm not entirely sure. Will I be back next week? You'll have to tune in again and find out. Let's get into this one.

Meg:
And now the Uncharted Podcast.

Dr. Andy Roark:
And we are back. It's me, Dr. Andy Roark and Stephanie More is Better Goss.

Stephanie Goss:
I like it, how's it going, Andy Roark?

Dr. Andy Roark:
Oh, it's so good. It's so good.

Stephanie Goss:
Good?

Dr. Andy Roark:
It's so good that I'm going to break one of my cardinal rules of social media and podcasting right now at the very beginning.

Stephanie Goss:
Uh-oh.

Dr. Andy Roark:
Yeah.

Stephanie Goss:
Uh-oh.

Dr. Andy Roark:
So, I have a rule where… I really don't like how social media is so performative, right? And everybody shows their front stage but they don't show their backstage and it makes people feel crappy about themselves. And you see people like Instagram influencers and they're on the beach and you're like, “I never go to the beach and wear a thong,” and you feel bad about yourself.

Stephanie Goss:
Oh God, is this …

Dr. Andy Roark:
And so anyway, that's why-

Stephanie Goss:
This is a 1-800 HR moment because I did not need to think about my boss in a thong in the same thought process there. Thank you so much, Andy Roark.

Dr. Andy Roark:
I am confident that the social media team pushes back on this post because of the fact that they're damaging to people's self-esteem, not because they have concerns about my thong pictures.

Stephanie Goss:
Right. Okay. Fair.

Dr. Andy Roark:
Okay? Anyway. Anyway, I am not one to share things that make other people feel less than, but I'm going to right now so buckle up, peasants. I'm going to tell you about the thing that I have that is amazing.

Stephanie Goss:
I think this might be a record for us. We're not even a minute and 30 seconds in and we've gone off the rails.

Dr. Andy Roark:
Oh no, I had something to talk about when I sat down.

Stephanie Goss:
All right. Let's do it.

Dr. Andy Roark:
So I have a yard which I talk about and it's in the woods and the front of the yard is up by the road as fronts of yards are. And I want to have plants up at the front of the yard where people … What are you laughing at, Goss? I haven't even …

Stephanie Goss:
Keep going, because I know where this story is going.

Dr. Andy Roark:
Oh, you know where it's going? Of course, you do.

Stephanie Goss:
I know where the story is going.

Dr. Andy Roark:
So I want to have plants up at the front of the yard and I got empowered and inspired, and I called the plumber and I said, “I want a faucet in the yard up near the front.” And he looked at me and he came out to look at the [inaudible 00:03:28]. And he looked at me and I said, “I want a faucet.” And he looked at me and he said, “You mean a yard hydrant?” And I was like, “Yes, I do. That's exactly what I mean.” And he said, “What kind of yard hydrant would you like? Do you want a yard hydrant that stands up like a old school water spout or do you want a yard hydrant where it's buried under the ground under a trap door?” And I was like, “I want a trap door yard hydrant.” And he came out yesterday and I just want you guys to feast your eyes on a man who owns a yard hydrant.

Stephanie Goss:
I can't.

Dr. Andy Roark:
I watered. I watered so many things today at the front of the property and it is, God, it was everything I thought it would be.

Stephanie Goss:
When you talk about trap door yard hydrant, all I can think about is bugs and spiders that will be living in there before you know it, because you live in the middle of the woods.

Dr. Andy Roark:
Right now it's pristine. I had not considered the fact that's going to be a nest of spiders in no time. I just want to thank you for sucking the joy out of my … Stephanie's like, “Oh, you like that thing? Let me stamp on it. Crunch. Oh, did I break your thing, Andy? Oh, I'm sorry.” Thank you very much. Every month you're like, “Why am I not employee of the month at Uncharted?” And I'm always like, “Let's go to the tape.”

Stephanie Goss:
This is a moment. Case anybody's wondering, this is reason probably 200 why Andy has fired me and it's only September 2nd or two days into the month. This is probably reason 200.

Dr. Andy Roark:
That's fine.

Stephanie Goss:
No, I'm really excited for you and your yard hydrant. The first thing, the first thing-

Dr. Andy Roark:
I'm not questioning my decision to get the underground yard hydrant. Thank. Now that.

Stephanie Goss:
The first thing I thought of when you were telling it was like, I'm just imagining the average run of the mill spigot just sitting in the middle of your front yard.

Dr. Andy Roark:
It's in a hole under a trap door in the middle of my front yard.

Stephanie Goss:
Which is fantastic.

Dr. Andy Roark:
You're picturing like the Indiana Jones tomb when they unearth it, and you can see the floor is just snakes. It's not going to be that. It's not going to be that. It's not going to be that. I'm going to have a yard Swiffer to Swiffer out all the spiderwebs with.

Stephanie Goss:
So just so you know, I am never going to reach my hand in your yard hydrant.

Dr. Andy Roark:
Oh. It was going to totally happen 'cause I was going to be like, “Stephanie Goss, turn on my yard hydrant.” And that was going to happen.

Stephanie Goss:
That's a hundred percent a thing that will never occur in our relationship.

Dr. Andy Roark:
All right. That's fine.

Stephanie Goss:
You have bears. You have spiders. You have snakes.

Dr. Andy Roark:
See. This is why I don't flex on people online, because I always get knocked down like six pegs and I just suck the fun out of my thing.

Stephanie Goss:
But you've now given Kelsey and Tyler 10 million ideas for doing fun things with swim swimwear on social media. The memes are going to be epic coming out of this podcast episode, just so you know.

Dr. Andy Roark:
It's fine. It's fine. Let's move on. I don't want to talk about my yard hydrant anymore.

Stephanie Goss:
I'm very excited for you. So what are you going to do with all the extra hoses?

Dr. Andy Roark:
No, I don't want to talk about this anymore. I think, are you trying to point out that there's no place to keep a hose in the yard hydrant in the front yard?

Stephanie Goss:
No, I imagine that there's lots of extra room but you don't need nine of them because now you have a yard hydrant. Right? That was the point?

Dr. Andy Roark:
That was the point. I just. Let's just move on. Let's just move on. We're here.

Stephanie Goss:
I've crushed.

Dr. Andy Roark:
We're here to answer mailbag questions.

Stephanie Goss:
The soul out of Andy today.

Dr. Andy Roark:
No, it's fine.

Stephanie Goss:
Well, we have a great mailbag question if you want to know what's happening today. So we got an email from someone who loves the podcast and loves the flaming, raging sort of justice. And I feel like Andy's about to smack me down with that sword today, probably more than once. So they were asking is it just us or do any other hospitals struggle with whether or not the support team should be taking detailed history from clients before the doctors get in the exam room?

Stephanie Goss:
One doctor in particular on their team keeps adding questions that they want the team to ask when they're already have a whole list of things that have to be done before the doctors can get in. And they were saying half the time doctors are walking into the exam room before the history taking's complete. And then they start asking either questions that have already been asked or different questions. And clients, or we've all been in the exam room when somebody takes a history that's not the doctor and you get one and then the doctor comes in and then you get a second history from the client that's completely different.

Stephanie Goss:
And so they're like, okay, we all know that all of these things are happening. So my question is, should taking a full medical history be the doctor's responsibility or is it the support team's responsibility, and or how do we find a balance between those two things?

Dr. Andy Roark:
Yeah, I've gotten this question a number of times. First of all, this is one of the many, many, many consulting questions that they ask you. And the only answer is it depends. There is not a right way to do this. It depends. And so I always just like to put that out at the very beginning. So head space, let, let's start. I always like to look at problems like this and say why is this happening?

Stephanie Goss:
Sure.

Dr. Andy Roark:
I really do feel like that is the first diagnostic step in problems like this is why is this happening? I think, and I've gotten this question many times in my travels. The first thing is it's always pointed out that pet owners will tell the doctors things that they don't tell the staff. And so they'll say, “Well, I do it because…” Sometimes they'll tell me things and we have all been in the exam room and had the pet owner tell the nurse one thing and then tell the doctor I completely different thing.

Dr. Andy Roark:
I had a video. I think it's with Kelsey. I think Kelsey was in the video. No, it was Meg Pearson when she was doing videos with us. So I had a video of Meg sitting down with this pet owner and she was like, “So why is Boudreau having diarrhea?” And the guy's like, “I have no idea.” And then I walk in and sit down and go, “Why is he having diarrhea?” And the guy goes, “Oh, he ate a whole meatloaf,” and that's the whole video. It's like 30 seconds long and makes me chuckle every time I see it.

Stephanie Goss:
Cause it's true.

Dr. Andy Roark:
Totally true. So that is totally true. There's also, there's a list of reasons why we do this. Number one is there is a mentality that more is better. More history is better history. We should ask all the questions. And we have a lot of type A perfectionists who are like, they got trained in vet school and graded on the robustness of their medical records, which is, this is a trigger for me.

Dr. Andy Roark:
I hate it. I hate that in vet schools we positively reinforced volume of medical record creation. Like a medical record that's 10 pages long is clearly better than a medical record that is a page and a half long. And that is because if you're a completionist and you are like, “I want all the differentials and all the things it could possibly be,” then you want the 10 page record. That is wildly inefficient and ineffective in practice. Writing a 10 page medical record is no better to me. Hardly than writing no medical record at all because I'm not going to read it. ‘Cause it's 10 pages and I have 20 minutes for this whole appointment. And so anyway, I'm on a bit of a soapbox here and I know I'm speaking in some extreme terms, but it is true.

Dr. Andy Roark:
And I think that a lot of us are like, “Oh no, we need to have a medical record that is large and has all the details captured in it. And I don't have time to get that. And so I'm going to send my poor assistant technician CSR into that room and make them invest the amount of time it's going to take to generate chapters one through six of this visit. And so that's part of it. There is pressure I think, and again this is not, I've not seen this published anywhere. There is some pressure on GPs from specialists to ask all the questions. So for example, and my other podcast, which if you don't listen do you should listen to, it's called Cone of Shame Veterinary Podcast. And I bring specialists on and I ask them how to treat cases and they come on and this is all the different specialists and they all are like, “Make sure you ask every pet owner this thing.” And every different specialist has got.

Stephanie Goss:
There's like, 19 different questions.

Dr. Andy Roark:
They're like, “Oh, well, clearly you want to do this.” And the nutritionists have 18 questions that you should ask every pet owner and the ophthalmologists want, they want their questions about eye health answered and I get it. And when that's your jam, you're like, of course you're going to spend your time talking about this thing. And so for a while I kept a list of the questions I was supposed to ask and when it broke into the second page, I was like, this is ridiculousness. As a pet owner, I would never fill this out. And so I think that that's a part of it.

Dr. Andy Roark:
There's a lack of awareness about what the techs have on their plates.

Stephanie Goss:
Yes.

Dr. Andy Roark:
And I say this as someone who has that lack of awareness. I think a lot, as a doctor I can be like, “Hey, look, why don't you just talk to them about this thing and then I don't have to talk to them about the thing,” or, “You talk to them and then I'll come back over and I'll ask the relevant questions that I need to ask on top of it.”

Dr. Andy Roark:
And again, everybody is, everybody's looking at the world through their own lens. Everybody's looking at the world through what they have to get done and what's on their to-do list. And again, I'm not bashing on doctors at all and I am a hundred percent guilty of this. I know I am, but I really don't know what the techs have to get done this afternoon. I know what I have to get done this afternoon, but I really don't know. So I can have a tendency to be like, “Hey, why don't you just take care of this thing?” And really I'm piling extra work on a people who are already super busy just because I don't understand the other things that they're trying to do.

Dr. Andy Roark:
And then the last thing that I will say as I sort of laundry list out the reasons why this happens, I do believe that there's a phenomenon where, and I've probably been guilty of this before too, if I'm running behind, I really hate the idea of the pet owners sitting in the exam room.

Stephanie Goss:
Sure.

Dr. Andy Roark:
Alone. And so I'll be like, “What? Get in there. Get in there and entertain. Get in there and make them feel important by taking a significant medical, expand this history into basically a Late Night with Conan O'Brien style interview to keep this person entertained until I get there, so they won't be mad at me because I'm a half an hour late. They will feel like something positive is happening.” And again, I can't remember last time I did that, but I have a hundred percent felt that pressure of please go in there and make this person feel like their time is not being wasted while I dig myself out of the lateness hole that I put myself into or that someone dumped on top of me when an emergency came to the door.

Stephanie Goss:
Well, and I can tell you that as a technician a lot of the time that is completely unintentionally. I think that's how I approached. I am one of the, shocking, this is going to come as a shock to you, Andy Roark, or I am one of those people that the details are important and I will write more than probably a lot of other people. And unintentionally, I think that's how I approached it as the technician. If I was working with a doctor and I knew that they were running behind, I would totally go into the room and be that person to ask them the questions. And I would find myself taking way more of a thorough history because I was trying to come at it from a customer service perspective of I still want their appointment to start on time. I still want them to feel like they're getting value out of this visit.

Stephanie Goss:
And so I look at it as a technician from two perspectives. One, can I keep the client happy but also can I do a better job for you as the doctor? Maybe I can save you some time on the background by on the back end by asking all of these other questions. And at the same time, nothing would frustrate me further than when I felt like I had gone to that effort because I wanted to help you as I want to help you, Dr. Roark, and I wanted to take care of the client. And then you come into the room and ask the same questions, it would just make my head want to explode.

Dr. Andy Roark:
Yeah, I think that's so valid. I said all the reasons like, oh, this is why the doctors do this and this and this. At the same time, it's not hard, I don't think for any of us to empathize with the person who just went in there and spent their time asking these questions, listening to these rambling stories about like, oh, what does she eat? Well, my sister Mabel comes over on Tuesdays and Mabel always says, and you're like, why are you telling me this? And you have to set through it, because at the end what happens is that she gets a dog treat on Tuesday from Aunt Mabel, and that's where this is going. But you have to listen to seven minutes of people talking about and Mabel coming and their stupid yard hydrants and things like that before you get to the thing you actually care about.

Dr. Andy Roark:
I know how it is. I get it. And so it's not hard to empathize with the person who goes in there, does all this stuff, and then just gets ignored because the doctor comes and goes, “Ah, just tell me what's going on.” I'm like, I get it. So I think that's true. So now sort of head space, right? Yeah. The good news in head space is this is one of those beautiful problems where sorting this out is good for everybody, right?

Stephanie Goss:
Yes. Yes.

Dr. Andy Roark:
Sorting it out saves the pet owner's time. It makes for better medicine. It can take work off of the techs' plate. It gets the doctors what they need in efficient way. By freeing up the techs, they can end up being involved in other parts of getting these cases out the door. Getting efficient in how we do this is good for the pet owner, the doctor, and the team that are in the room, the team.

Dr. Andy Roark:
And so to me, the nice thing as I get into head space is this should not be conflict. There shouldn't be conflict here. This is a mutually beneficial problem solving exercise. And to me, I really like problems like that because I go, okay, I have to frame this the right way and I have to present it. But really we all want the same thing, which is for my time to be maximally valuable and for you to get what you need to do this appointment and for the client to feel heard. Let's just figure out what that is because I don't think that we're doing that now.

Stephanie Goss:
Right. Yes. And I would say the last thing for me from a head space perspective is just remember as we dive into action steps, should is a dangerous word.

Dr. Andy Roark:
Yes.

Stephanie Goss:
It's a four letter word, friends. Because what should happen in one practice, not necessarily the same thing that should happen in another practice, right? And should is full of the best intentions. And so I think for me from a head space perspective, what you just said, Andy, about we want it to be good for the doctors. We want it to be good for the clients, and it is also important that it be good for the team. And so I think it's great that the question is being asked and I think this is a good, this is for me an example of where this can be excellently healthy conflicts, talking about this as a team and bringing up each bit of the team's perspective and their insight. You guys, it may be uncomfortable. The text may be like, “Dude, I don't want. I want to be respected. And when you go in and ask the same, I've had this conversation with my doctors, when you go in and ask the same questions, Dr. Roark, that I just asked, I feel devalued as a technician.”

Dr. Andy Roark:
Yep. I've had this conversation.

Stephanie Goss:
Right. And we think about it and we think about, oh, this is super negative. But you guys, this is good conflict. This is healthy. Being able to talk about it as a team and figure out what works best for us and for our clients, I think that's diving into the action items. But just remember getting out of the head space, think about should very much with a grain of salt because should what works in one practice is not necessarily going to work in another. And I think you can't compare yourself to other practices here. And I think that's why you said, Andy, it's all relative and it's not necessarily going to be the same answer for everybody.

Dr. Andy Roark:
No. It's not remotely going to be the same answer. I think that that's the first part of diving into this question. So there's really two things there. One of it was I really like how you put when I ask these questions and then you ask the same ones, it makes me feel devalued. I think feeling valued and feeling that our time is well spent. I do think that that's a big part of this. So like you said that. But the other thing too is I like this question because how you do history taking, it really fits in an important way with the identity of your clinic and your practice. And so, of course the technician who works for the veterinary nutritionist or the veterinary neurologist is going to ask a detailed history about those specific subjects because they are really digging into this.

Dr. Andy Roark:
The clinic that charges $42 for a physical exam and vaccines, I don't think that you expect to have that technician in there doing a 22 minute history for what's essentially a low cost visit. And again, nothing wrong with that model, but if you're lower, low cost or lower cost, and I'm not saying 42 is low or lower. It depends entirely on where you are and your area. But if you are a low cost practice or a lower cost, you're probably not going to be able to afford to have your technicians in there taking huge histories, right? Because you need to move efficiently through the rooms.

Dr. Andy Roark:
On the other hand, if you charge $89 for a physical exam and that seems, I think people will expect that your technicians would go in and spend some time and get a good history and talk to them about their pet to prepare the doctor and to flesh out the medical records so that they are going to get the white glove service that they're paying for and they expect. And again, it's not right or wrong, it's just about what is your practice and what are your cultural values? I do see a lot of times when there's a mismatch between how we get the history and who we are as a practice. And I always think that that's really interesting.

Stephanie Goss:
Yes. And now I will tell you, I love that you said that and I think a lot of it has to do with how your exams are structured and timing and everything like that. And I can tell you, I was trained in a practice that had longer appointments and I will tell you, I will say straight up to my team, “I am not the technician to send into a room if I'm helping out at a clinic that is high volume, fast appointments. If you're 15 minutes double booked, I am not your tech, I not your technician.” And I'll tell you straight up because my process is one where at our appointments ranged anywhere from 30 to 75 minutes depending on what they were there for. And so I struggle, and I am not the one. And at the same time, if you are the kind of person who needs someone to build the relationship with the client and ask the probing questions, that's my jam.That's where I feel comfortable.

Stephanie Goss:
And so I think your point is spot on Indy. You have to look at who are you serving, what kind of clients are you serving, what is your culture as a team? And also who are the people that make up that team? And what do all the doctors need? And so for me, I think you're right, head space perspective, this is a good thing. Sorting this out is, no matter what, is a good thing for everybody, and I think the head space where I end head space and move into action for me is it's about balance and it's about figuring out that balance as a group.

Dr. Andy Roark:
Oh, I love that example. I think that's fantastic. You are such a relationship building person that you in a role where you're supposed to get in and out in four minutes.

Stephanie Goss:
I can't.

Dr. Andy Roark:
First of all, it would be hard on you. But here's the thing too is it's such a missed opportunity for you to shine in this role. And we hear from so many people who think that they're bad at their job or they're a failure. And I'm like, no, you are in the wrong system.

Stephanie Goss:
Yes.

Dr. Andy Roark:
You are struggling here, but boy, you'd be an all star down the road at the hospital that runs in a different way or runs in a way that matches your priorities. I'll tell you from personal experience, I had a technician who was amazingly skilled technical technician, not a people person. And she did not want to be a people person. And ultimately she did not work out at the practice that we were where, because it was a white glove, high touch, high communication practice.

Dr. Andy Roark:
And she went to another practice and was very happy there and it was a lower cost, higher volume practice. And she rolled in, she did a short history, went to work, and she was on it. Good for her. It's not about good or bad. It was about she did not match the system. But boy, when we get her into the right system, she absolutely blossoms. And I think a lot of us are there in that way. And so that's why I really like this question is there's not a right or wrong way. It's really, and I think you summed up so well, it's about the culture of the practice and also who are your people. And I will tell you another thing is it's my belief that those things change over time. And so you might end up shortening up your history taking. So for example, right now a lot of people are real shorthanded and they're really overwhelmed.

Dr. Andy Roark:
And I would say you can tighten the nuts and bolts on your history taking and it might not be the history that you would love to have.

Stephanie Goss:
Yes.

Dr. Andy Roark:
Or that you plan to have for the long term. But right now you say we need to be efficient in our history taking. We're going to take a stripped down version of what we had before because we need to be moving quickly between the rooms, and this is not how we plan to do it in the long term, but it is what we're going to do now. And so that history may get shorter and then it may link them back out later on.

Stephanie Goss:
And I love that you said that and that part of why I love this question and go ahead, you can make fun of me, but I love this because ultimately if you are a practice that is thinking about this and having these conversations, at the end of the day you are working towards systems and processes and that is going to help your team overall. And so I will tell you I love that. And ultimately the best system for me as a technician, as a team member, is a system where I know, okay, our ideal is this and our minimum accepted standard is this. And I get to make a judgment call. My doctors get to make a judgment call. We change it as we need, whether it's because of the patient's needs that day or the client's needs or the team's needs. But I feel like I have a guardrail on either side and I know what is expected of me and that's what I mean about this is a good kind of conflict.And we shouldn't be afraid to have these conversations as a team.

Stephanie Goss:
But a lot of us are because they're not easy conversations and they're hard conversations. And especially if you're a technician writing this question, it can be hard to feel like you are potentially challenging your doctors by saying, “Hey, when you ask these questions that I've already asked, I feel like you're just walking all over me.” That's a hard thing to stand up and say. Likewise, as a doctor sometimes I've had doctors be like, “I need the questions asked in this way and I know you're trying to help, but this doesn't get me everything that I need.” Those can be things where we take it personal and it's not meant to be personal.

Stephanie Goss:
And so this is where from a head space perspective, I think it's super, super important to say we are going to talk about this and we are going to look at this as a team, and we are going to look at it from a systems and structures perspective. And everybody has got to take a deep breath because there might be some hurting feelings here, but we're going to work through it because we're doing it for the needs of the patients, the needs of the clients, and the needs of the team.

Dr. Andy Roark:
Yeah, I completely agree with that. I like that a lot. Now the other thing I would say too is if you are someone who's listening to this and you're like, “Oh man, that's really interesting,” and “What kind of practice are we? And what's our culture and should we be doing these longer things, then how does that work?” If you're interested in that and you just go, “Oh I see how the differences are between the practices,” you might be an uncharted practice, 'cause that's kind of how we roll. And it's beyond I think us sitting down here talking about history taking to figure out what kind of practice you are, but that's what we do in our community. It's getting in there and talking about how different people do it differently and why they do it that way and what works for them. And really digging into the culture of who your people are and who your practice is and how they communicate so that you can answer questions like this in a way that is going to work really, really well for your people.

Dr. Andy Roark:
So that's just sort of the last thing I was going to say. That's why I really enjoy this question I think is really great. Let's take a break and then we'll come back and then we'll get the action steps of like, oh great, we've talked about the philosophy. We've talked about the head space. Let's get into actually making this conversation happen and what we're going to try to accomplish.

Stephanie Goss:
I love it.

Stephanie Goss:
Hey everyone. I just want to make sure that you know about some upcoming events from Uncharted that you are not going to want to miss. We have a workshop that is happening in October and it is the wonderful, the amazing Melissa Entrekin LVT. For those of you who don't know Melissa, she is an amazing technician and she helps out our team on the Dr. Andy Roark side of things, on the medicine side of things, and she is doing her very first Uncharted thing. And I am so excited about this. Melissa is going to be leading a workshop for us in October. It is happening October 19th and it is called Leveraging Technicians: Making Practice Less Stressful for You, Them, and Your Patients. I cannot wait for this one. It is going to be happening at 7:00 PM Eastern. So that's 4:00 PM Pacific on the 19th and it will be a two hour workshop, which means it'll be over at 9:00 PM Eastern, 6:00 PM Pacific.

Stephanie Goss:
It is, as always, free to our members. So if you are an uncharted member, head on over to the website at unchartedvet.com forward slash events. You can click the register button and register for free. And if you're not a member of Uncharted, you can join us. It's $99 for the workshop. Or you can look at all of the awesome upcoming events that we have. And it may make sense very quickly for you to say, “Hey, I'd like to get an Uncharted membership because you get all of this stuff for free.” So come join us for Melissa's workshop. You don't want to miss it. And hopefully we'll see you in the community soon. And now back to the podcast.

Stephanie Goss:
Okay, so now we've talked about how do we get into a good head space.

Dr. Andy Roark:
Yeah.

Stephanie Goss:
Let's talk about what do we actually do with this? So we asked the big should question.

Dr. Andy Roark:
Yeah.

Stephanie Goss:
We both agree that should is a dangerous word, but we still have to talk about solutions here. So what do you with this challenge?

Dr. Andy Roark:
Well, a lot of it depends on who you are. And so I'm going to take this. Let's eat the meatballs off the top. That's a metaphor I just made up. I like it. I'm going to stick with it. Let's the meatballs off the top. That's when you take the good stuff and just handle it before you have to get into a bunch of noodles and sauce. If you are another doctor or if you are the practice manager or the medical director, just a little bit of coaching and feedback is really easy. Because the medical, the doctor that's like, “Hey, I'm going to add some questions,” or “Hey, make sure you add some of these things.” Stuff like that. They probably don't have any idea what the impact is.

Stephanie Goss:
Sure.

Dr. Andy Roark:
You know what I mean? They probably don't understand of hey, you just don't think about, hey, these questions are getting long answers and they're asking them in every exam room and so they're in 15 exam rooms a day and it's adding an extra two minutes to the history and that's a half an hour a day that they have lost in productivity beyond asking these questions, which are just two quick little questions you wanted to answer or to ask.

Dr. Andy Roark:
And so if you are the medical director, the manager, something like that, just a quick little coaching thing of “Hey, I need to talk to you real quick about the histories going into the exam rooms.” And then just say when we add extra questions to the techs, they ask in every room across every doctor, and it really backs everything up really fast. And so if there's questions you want to add to the history, just let me know and we'll talk it through or we'll run it through or we're compare it to other questions or things like that. But it's just, it's important for us to have consistency across the doctors as far as what's getting asked. And small questions, when all the doctors just add them, they add up really, really fast.

Stephanie Goss:
Yeah. Yeah. And I think you don't think about it and as a technician, your brain having to switch back and forth between, “Okay, what questions does Andy want me to ask? What questions does Dr. Sarah want me to ask?” When you make those switches a million times a day, it is exhausting. And also from the doctor perspective, having been the practice manager who strong armed, I'm going to say strong armed or forced my doctors to sit down at a table and have some of these conversations, the perspective afterwards from them was there are times where they get frustrated with each other because another doctor is not asking the questions that they would necessarily want to have asked. And so on a peer level, the benefits of being able to have some of these conversations and think about why are we asking what we're asking and are we more alike than we are different is super, super helpful process.

Stephanie Goss:
And so I would say if you've never, and particularly if you're a bigger hospital that has multiple doctors, if you've never taken the time to just run a poll and ask the doctors, say, “Hey, what questions are you asking? What questions do you want to have asked?” And as colleagues go back and forth and pick each other's brains about why are you asking that way, what are you asking? It was enlightening to me as a manager to sit in on that and hear the commonality amongst my doctors and also be able to pick out where are the differences, but in a really good way of, “Hey, I learned this time, this technique in school and here's why I do it.” And have other doctors be like, “Oh, I had no, that makes total sense to me, but I've never done it that way. Can we do it that way?” It doesn't have to be negative.

Stephanie Goss:
But to your point, starting with the coaching in the moment and just getting them to think about how it affects everybody and not just them, but then also being able to talk about it as colleagues I think is a unintended bonus side effect that for me in my experience has turned out to be really positive.

Dr. Andy Roark:
Yeah, I completely agree with that. It really depends on the relationship. So now I'm switching over to the technician side here. So you're the technician. You're doing this, you're taking this long history. The doctor's coming in and asking the same questions that you've already asked and you're kind of feeling like your time is not valued. The way I would approach this from the technician standpoint, the first thing I got to say is what's your relationship and how much trust do you have? And I would tell you that as a doctor, I aspire to be a doctor that my technicians can look at me and say, “Hey, Dr. Roark, I'm struggling because I feel like I ask these questions and then you come in and you ask the same questions and I feel like I could be using my time better somewhere else or I kind of feel like I wrote all this stuff down and then it gets ignored.”

Dr. Andy Roark:
I want you to say that to me that is great. I think I understand that a lot of technicians would say, “I don't have that relationship with my doctor.” I want to be the person who's big enough to take that feedback in a stride and say, “I don't want you to feel that way when you work with me. And so let's, let me either explain why we do it this way,” and we're probably going to talk a little bit about how you might get things, different things than what I get and whether or not that's worth the time to suss that out. We might talk about why we do our medical records the way that we do, however it interfaces, but we can always talk about why. But I would like to hear that and I have heard that from technicians in the past. You can imagine. You know me well enough, Steph. You know that there's a protocol for what gets asked. And I walk in and I'm going to improvise. And I did that until one of my technicians said to me, “I write all this stuff down.”

Stephanie Goss:
And you're stressing me out.

Dr. Andy Roark:
And then you come in and put on the Muppet Show and I'm just like, why did I do this? If you want to do your Andy thing, just do it, but don't make me do a 20 minute interview before you ignore it. And I'm like, unfortunately that's a very fair criticism at the time. But hey, this is the thing where it's like, one of my dad's favorite sayings was always, “Good judgment comes from experience and experience from bad judgment.” It's like I think that's how you become a good doctor. I think it's how you become a good anything is, you know, you make mistakes and hopefully when someone points them out to you or how they're affected by what you're doing, you adjust course and you get better.

Dr. Andy Roark:
So again, I'm very forgiving of doctors in this regard. So ideally, you have the relationship and you can say, “I'm just going to tell you how you made me feel because I trust you. Because I trust you and I believe you care about me.” And I think we should all aspire to that. That is the place that I want to work. That is the doctor that I want to be.

Stephanie Goss:
Yeah, yeah. No, I think that's great. And really I think for me, a lot of the answer to the should lies, the actionable answer, lies in the fact that we're a team and this is a relationship on all sides with the client, with each other as a technician team helping the doctors, as a doctor team working together to see patients across the board, and as a doctor tech team. And so I think for me a lot of the should falls in looking at that and trying to figure out what are our superpowers? And I'll tell you as a technician who, shockingly I know, likes to talk. You guys, I like to talk and I like to talk to people. I have worked with doctors who struggle building relationships in the exam room with clients and they have said to me, “I want you to take all of my histories because you get way more information out of them than I get, and that is helpful to me as a doctor 'cause I feel like I can do my job better.”

Stephanie Goss:
And I've also worked with doctors who are like, I want to do this piece and this is how you can best support me. And it's give and take. And so I think for me a lot of the action in the should is what are we trying to accomplish here and how can we best do it together collaboratively as a team? And it is a team of at least three, right? It's me as a technician, it's the doctor, or it's me as the history taker, however that looks in your clinic, and the client. And you got to be able to work together or else, let's be real, all of us will be in the exam room for two hours if we don't figure it out.

Dr. Andy Roark:
Yeah, absolutely. Yeah, I completely agree. So yeah, it's a cultural thing and there's a big culture that I see. It's a cultural shift, and I feel like we're on the downhill side of it, which is good. But there for a while, it is different. Vet medicine is a team game and I try to hammer that into doctors' heads and I think the support staff have known that for a long time. I think the doctors kind of want to hold onto the old way, which is a James Harriet way, which worked a lot better when was one vet practices and you held, hung your shingle out.

Dr. Andy Roark:
And now though, as the demand for our services that have gotten higher and higher, we can't be a one person operation. We have to function as a team to, one, to meet the needs of pet owners, but two, in order to be able to have some downtime and to unplug and to not be on call. It is just a requirement that we have got to play this as a team game. And if you play it as a team game, then coming together to figure out what the history is and what it includes, it just makes sense. It's just a smart part of running our business and everybody should benefit from it.

Stephanie Goss:
Yeah, I love it. So if we agree that it's going to be cultural and each practice is going to have a different approach based on who makes up their team and who their clients are, then how do we figure out whether we do or don't take history before the doctors walk in the room? Because really at the end of the day, that's part of the question here. How do we figure this out for ourselves as a team, right?

Dr. Andy Roark:
Yes. Right. Perfect. So here's how we do it. So these are the action steps. So we got in a good head space. We've talked about where we're going, what we're doing. I'd love to have that trust in a relationship where I could just say this, I feel of us don't. So here's how I'd do it. So number one, I'm going to go as the tech and I'm going to ask to discuss this and I'll ask the practice manager, probably, especially there's multiple doctors. But remember when you're the tech and you go and you talk to the doctors, you talk to the practice manager, it's always smart and it's always safe to make it about the pets, the people, or the practice. And so those are big things for me, the pets, the people, or practice. And so you can absolutely go to the practice manager and say, “I feel like I'm being ignored and my time is being wasted.”

Dr. Andy Roark:
And you could be a hundred percent right. That doesn't hit the eardrum in a way that stimulates warm fuzzy feelings for other people, even though it should. If you want to get heard, remember communication happens at the ear, not the mouth. And I was like, how do I say this in a way they're going to hear me? Make it about the pets, the people, or the practice. The pets, meaning how does reconsidering this end up in better medicine? How do we get better patient care from talking about how we're doing our history and talk about patient care. People, what is the client's experience with this? Do they find it confusing when they're doing all these things and they have to do them again? Are they frustrated when they have to answer these questions twice and they feel like this is a huge process that doesn't need to be there?

Dr. Andy Roark:
And the last thing is the practice and that's the team game. How does this affect the practice and our ability to get cases done? To be available? And again, I always phrase it, try to frame it into a positive way for the person I'm talking to is, how does taking history make me available to support you, doctor so and so?

Stephanie Goss:
Right.

Dr. Andy Roark:
Let's talk about the best way that I can support you and I just want to make sure that the way we're doing histories is the best way I can support you as opposed to other things I could be doing to move things along and be a benefit to the practice.

Dr. Andy Roark:
And the other thing is you can even practice it, depending on who you're talking to. If you're talking to the managers, it could be a revenue thing where you say, Hey, I want our practice to be financially viable. Can we talk? I'm spending a lot of time doing this, and then the doctor's just asking these questions anyway. And so I don't know if this is a good investment in time and really which one you use of that, it depends on who you're talking to and what they care about. And so anyway, pets, people, the practice. And I would couch my request in that way, saying these are the things that I'm seeing and I wonder if we could do that. I would also start to sort of say, I want to understand what's important about the history. And I say it that way. I would say it to a doctor that way. I would say it to the manager, I would just sort of say, I think we should talk about what's really important about taking a history so that we can decide if we're doing it in the best way.

Dr. Andy Roark:
And that's me getting into the culture. And so when I talk to the doctor, then I say, “What is the most important thing for you about the history?” What I would say if you ask me is I tend to get hyper focused on the problem I'm presented with.

Stephanie Goss:
Sure.

Dr. Andy Roark:
And the most important thing for me is to make sure that someone is checking the major boxes to make sure this pet is getting the other things they need. And I'm not zeroing quickly on the focal point and missing other things. And so if it's my practice and they say to me, “What do you want?” I say, “I want us to come together and figure out what should we ask every pet owner when they come in to get any hidden information or information I'm going to miss.”

Stephanie Goss:
Yes.

Dr. Andy Roark:
And then I would say, “I don't want you to spend a ton of time flushing out the specifics of the condition because I'm going to do that.”

Stephanie Goss:
Right.

Dr. Andy Roark:
And that's redundancy. And that's what I want. Other people may absolutely want different things or there's different things that are important to them about the history. What's important to you about this history? What's important to our practice about this history? What's important to our team about this history? Those are good, open, nonjudgmental, non-pointed help me understand questions that start to generate that conversation of this is what I like and this is what's important to me. And I guarantee you'll have one doctor who says, “Well, I want to know all of the things.” And the other doctors who see the world differently like myself will push back and say, “Well, I want to have technicians who are available to help me when I'm-

Stephanie Goss:
And not stuck in an exam room.

Dr. Andy Roark:
And so I don't want my technician to wrestle that doctor. I am perfectly willing to wrestle that doctor on behalf of the technicians, for selfish reasons as I go. I understand that they want a million questions. I don't want the techs tied up doing history when I need them back in the treatment room, or I need them helping me with communications, or the other things that a well licensed, well leveraged team uses technicians for.

Stephanie Goss:
Yeah.

Dr. Andy Roark:
Anyway, that's kind of how I would do it. But as the technician, I would set the table for the doctors to, I'm looking for a metaphor, so the table. I'm actually, my metaphor, I almost said I would set the table for the doctors to dance and then I'm like, why do the doctors need the table set to dance? How are you going to bring this home, Andy? And I'm like, I'm sorry. I'm still reeling from the realization that my yard hydrant is going to be a spider pit. I'm going to lose a finger in there. It's just a dirt hole with a wooden flap on top and I feel like an idiot.

Stephanie Goss:
Oh God, it's fine. I'm getting fired. I think the flip side of that, also for me, is as a team member, whether you're a doctor who's questioning this or you're a technician or a CSR, it doesn't matter who you are in the practice. A great, this, you guys, this is a great topic for a team meeting. And it's a great thing for me to think about asking why are we doing it the way that we're doing it? And really everybody on the team understanding because again, every practice's makeup is totally different. And so if you're working in a practice where doctors are double booked, and what I mean by that is you're dancing. You have one doctor who's dancing between two appointments at a time and you have a fully leveraged tech team. It may be, the why may be that it's important for the techs to, in room A, to ask this set of questions because the doctor is in room B doing this portion of the appointment. And that may be part of your dance as a team.

Stephanie Goss:
And that why is very powerful and it's very important because to your point, it speaks to the client experience, it speaks to the practice experience, it speaks to the team's experience. It's okay to ask and it feels very non-threatening to ask why. I want to understand the why here, because you should want every member of your team to understand what that why is. And if by asking the why question, you unearth, “Well, Dr. Roark does it this way and it's just because that's the way he likes it. And Dr. Sarah does it this way and she doesn't really care one way or the other. And Dr. Smith on Thursdays does it this way because that's the way they do it at the other practice that they work at.” It may unearth some of those answers that allow you as a team to say, if this isn't working for us, we can ask the questions that help us change it in a way that is healthy and has that healthy dialogue and creates the space to ask those questions. And so I think that the starting with the why is a very powerful tool here.

Dr. Andy Roark:
Yeah, no, I completely agree. So anyway, I think that's how I would put it forward. I think this is a good, healthy conversation. I think every team should probably talk about this every couple of years.

Stephanie Goss:
Yes.

Dr. Andy Roark:
I just think that what we're asking for or what we need or where we are, it just changes over time.

Stephanie Goss:
Yes.

Dr. Andy Roark:
I think that this is a cool problem because it gets into culture and what's important and why do we do this job?

Stephanie Goss:
Yes.

Dr. Andy Roark:
And how do we move appointments efficiently and effectively through our practice? And it's all fairly low stakes way to really talk about what matters to us. No one's like, “Ah, I went out of business because I asked the wrong medical history questions.” It's not that. It's just, it's good for the doctors to even talk to each other about what's important and why do we do this history and what's important to you? What's important to me? It is a very good team building discussion that I have found brings groups together pretty well.

Stephanie Goss:
Yeah, I love it. I think this is a great topic to have, ask at a team meeting.

Dr. Andy Roark:
Yeah.

Stephanie Goss:
It's going to be fun, I think. And so I think we end up here with who should take the medical history? It depends.

Dr. Andy Roark:
Yeah, it depends. Yeah, absolutely.

Stephanie Goss:
This is my favorite answer of vet med. ‘Cause 99% of the time the answer is, it depends.

Dr. Andy Roark:
Yeah. I hope that's helpful to our writer. I hope they're not like, they're listening to the end and they're like, “Ah. Sat through an hour for that.”

Stephanie Goss:
They're like, “That's the last time I send something in through the mailbag.”

Dr. Andy Roark:
I sent them a question. I heard about this doofus's lawn hydrant. And the answer was basically, it depends. But I hope you don't feel that way. It depends on the practice, but you can reach a consensus in your practice.

Stephanie Goss:
Yes.

Dr. Andy Roark:
Following our simple, simple system. All right. That's it. I'm done. I'm going to go water some plants.

Stephanie Goss:
Water your lawn.

Dr. Andy Roark:
Yeah. I'll see you guys later.

Stephanie Goss:
Take care everybody.

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