This week on our bonus episode of the Uncharted Podcast, practice management nerd Stephanie Goss is joined by special guest, Dr. Phil Richmond. When Stephanie saw this letter in the mailbag, Phil was the first person who came to mind to tackle this topic with. Dr. Philip Richmond, DVM, is the Founder and Chief Consultant of Flourishing Phoenix Veterinary Consultants, LLC. As a practicing vet, he champions a positive work culture, emphasizing psychological health, safety, and wellbeing in veterinary settings. He has taken pivotal roles in both state and global initiatives to promote workplace wellbeing in veterinary medicine. Among his roles, Dr. Richmond has served as Chief Medical and Wellbeing Officer for Veterinary United and currently chairs the Florida Veterinary Medical Association's Professional Wellbeing Committee. Beyond his advocacy, he contributes as a writer, speaker, and podcast guest, and has earned various certifications in positive psychology, workplace wellbeing, and suicide prevention.
Stephanie and Phil are taking on an email from our mailbag that addressed the concern that one of the most stressful instances for vet professionals can be when they have to downgrade treatment, or euthanize due to the owner not being able to afford treatment. We immediately knew this would be an amazing discussion about wellbeing in our practices along with how we can support clients from a financial planning perspective. TThis episode is brought to you all ad free today, thanks to our friends at CareCredit and Pet’s Best. Let's get into this…
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If your practice is not talking to clients about ways to pay for care, including the CareCredit health and pet care credit card, please consider accepting it in your practice! You can find out more about how your practice can help empower a lifetime of care, together, here.
Additional Resources:
Australian Workplace Psychosocial Hazard Standards
National Standard of Canada for Psychological Health and Safety in the Workplace (the Standard)
Canadian Standard Resource Page
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Submit your questions here: unchartedvet.com/mailbag
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Episode Transcript
Stephanie Goss:
Hey, everybody! I am Stephanie Goss, and this is another episode of the Uncharted Podcast. This week on the podcast, I invited my dear friend, Dr. Phil Richmond, to join me, and it's for a very important reason, because there were some mailbag questions that I've gotten recently about the impact that some of the challenges we face and practice are having on the team from a mental, emotional, and physical perspective. Phil and I were chatting through. I asked him for some input on some of the challenges, and we got to talking, and we realized, “Wouldn't it be fun to do a podcast, and talk about some of Phil's passion work, some things that I am passionate about as a practice manager, which have to do with creating systems and processes to support our teams?”
We brought those two things together to bring you all an episode about creating psychological safety, but it goes a lot more than that. So if you're like, “Oh, those are fun buzz words, I'm going to ignore this podcast,” please don't, because we get into the things that emotionally and psychologically impact the team that we can't take away from practice. We can't stop doing euthanasias for our patients, because it's necessary at points in time. We can't stop working necessarily prolonged hours in surgery when an emergency patient walks in the door, and it's a surgery that takes hours. There are things that we cannot avoid, and that doesn't mean that there aren't things that we collectively as an industry and in particular as practices and leaders of practice can do to support our team in those situations.
That's a little bit of what Phil and I get into this week. I think we had a lot of fun with this one, and I'm hoping you enjoy it. Just a reminder that Synchrony shares the information on today's podcast solely for your convenience. All the statements made are the sole opinions of myself and Phil Richmond, and Synchrony makes no representations or warranties regarding the content of today's episode. Now, let's get into it.
Speaker 2:
Now, the Uncharted Podcast.
Stephanie Goss:
We are back. It's me, Stephanie Goss, and I'm joined today by a very special guest, one of my dearest friends who happens to be a colleague, the wonderful, the kind, the amazing Dr. Phil Richmond. Phil has been with me on the podcast before. If you have not heard our prior episode that we have done together, you're in for a treat, because he is a wonderful human being. Phil, welcome to the podcast today.
Dr. Phil Richmond:
Thank you, Stephanie. It's always a wonderful opportunity to share space with you.
Stephanie Goss:
I love spending time with you, friend. Do you want to… It's hard for me to imagine people in veterinary medicine who have not experienced Phil Richmond, because you are just one of those people who knows everybody. When we go to conferences, or we go places in veterinary medicine together, you are like a pingpong ball. You are bouncing around, and you're just up and down saying hi to everybody. So, it's hard to imagine people who have not met you, but will you tell us a little bit about yourself for our listeners who might not know who you are?
Dr. Phil Richmond:
Sure. So, Phil Richmond. I'm a practicing veterinarian, so I get to do all the cool things that we talk about, but also the founder and CEO of a consulting group called Flourishing Phoenix Veterinary Consultants. What we do is work on psychological health and safety. We work on flourishing in the workplace, workplace wellbeing, but on an individual team and organizational level. I'm also very grateful I get to work on a lot of exciting projects with a lot of cool people on a state, national and international level around psychological health and safety, workplace wellbeing, resilience, those types of things in veterinary medicine, and of course very personal to me just because those things, not only am I professionally excited about, but they also genuinely and without being over the top helped save my life a number of years ago, and really gave me the tools to love veterinary medicine.
So, that is it in a nutshell.
Stephanie Goss:
I love it so much, just as much as I love you. I'm so glad you're here today. We are going to talk through some stuff. I got a handful of letters in the mailbag that had to do with stress for the team, and I was talking through a couple of them with you, and trying to figure out like, “What's the best way to tackle some of these.” As you and I do, we got a little squirrely, and our conversation took an unexpected path, and we started talking about the impact that really euthanasia, but also the changes to care and treatments for patients, especially when it comes to clients not being able to afford the treatment plan that we're proposing for a patient, the impact of all of that on the team.
We got into some serious conversation, and you and I were like, “This would be a really fun thing to talk through on the podcast, because there are so many facets of it.” I think it's a piece that, as we're going to talk about here in a little bit, we address some pieces of it. I think we've gotten more and more open in veterinary medicine about addressing in particular one area over the last few years, but there's still a whole lot of the conversation that I think we don't address as much or as well, and I know you are doing some… You have some background knowledge to share with us, but you also are doing some cool stuff around this very subject, and so when we were talking about it, we were like, “Hey, let's do a thing.”
Of course, because our friends are amazing at Pets Best and CareCredit, we were talking with our friend Colleen and Stacy, Jennifer over there, and they were like, “This fits right in line with a lot of the things that we are working on supporting in Vet Med, and we would really love for you guys to bring this topic outward on the podcast, and really talk about it because it highlights the need to talk about things like financial care for clients, spectrum of care from a medicine perspective, but also about the support and mental health and wellbeing of our teams, which is your passion project.” So, it felt like a perfect storm to bring all of us together, and for you and I to be able to have a conversation.
So, I want to give another shout out to our friends at Pet's Best Pet Health Insurance and CareCredit and Synchrony, because we couldn't do this without them. I think it's a really important topic, and I'm excited to dive into it with you.
Dr. Phil Richmond:
Awesome. So, shall we start on where some of these events can really affect us from a wellbeing point of view as team members, as veterinary professionals?
Stephanie Goss:
Yeah.
Dr. Phil Richmond:
There's this concept called moral injury. So, moral injury was studied a number of years ago, and really, it was seen through the lens of war veterans, soldiers that were in these situations where you could see these sometimes horrific, sometimes just things that could be traumatic, that for one reason or another, we were unable to step in and change the course of what was happening, and that it went against our moral beliefs and the things that we held true or that the soldiers and the people that were veterans. Well, what was seen is over time, and I think as veterinary professionals, we can really relate to this, is that we hear a ton about burnout and burnout in veterinary medicine.
Certainly considerable, when we look at the statistics, burnout is a system's issue, is that it's an overwhelm issue, is that our capacity to do the thing outweighs, or I'm sorry, the demands that are put upon us outweigh our capacity to do the thing. What they saw in human healthcare is that burnout didn't exactly 100% fit with what was going on with physicians and other healthcare providers. What they saw was that there was something else that was in play, and it's a little bit different in human medicine, but that same concept of, “I have the knowledge to do this job to serve my patients.” Something outside of that between me and that patient, something outside of that is keeping me from doing that job.
Now, that can be due to a number of things. Now in human healthcare, they talk about potentially sometimes having to ration care, or there are barriers from a bureaucratic standpoint, the rules of the hospital or other things happen, and then certainly overload as being short-staffed, these types of things.
Stephanie Goss:
Sure.
Dr. Phil Richmond:
So, we think about that very much from a veterinary lens, and say, “What are the similarities there, and what are the things that impact us?” Well, what is one of the biggest things that externally keeps us as veterinary professionals from, say, treating… Not always going through advanced veterinary care, tertiary level care, but what are some of the things or what's the main thing that keeps us from performing the test or performing the treatments that-
Stephanie Goss:
Sure.
Dr. Phil Richmond:
Almost always, not always, but almost always, that's financial constraints.
Stephanie Goss:
Sure.
Dr. Phil Richmond:
How many times have we written that in the record, or noted that in the record that owner declines due to financial constraints? So, knowing the impact that that can have on us from a wellbeing and job satisfaction and position is that it opens the door for this condition called moral injury, which causes this distress in professionals, and it does in veterinary professionals as well. Where I'm going with this is there's a concept of psychological health and safety. So, Stephanie, if we're going into radiology with a patient, and we're going to take X-rays, before I take those X-rays, I have to do something to protect myself. What do I need to do?
Stephanie Goss:
You have to use your PPE. You've got to put on your gown. You've got to put on your gloves.
Dr. Phil Richmond:
Right. Your thyroid shield. Why do we do that?
Stephanie Goss:
Yes. Because we're protecting ourselves.
Dr. Phil Richmond:
Because we're protecting ourselves, and we're protecting ourselves because we know that's a hazard. We know that that ionizing radiation is dangerous to us.
Stephanie Goss:
Sure.
Dr. Phil Richmond:
However, think about that too is that we know that moral injury is dangerous to us as well. So, what potentially are some of the ways? If we know that that's injurious to us as veterinary professionals is what are some of the things that we can do to prevent that? One of those does go around. It starts getting into this discussion of insurance and getting… Is there some way to facilitate that care before that emergency comes in for that patient? That's around either pet insurance, or if they don't have access to that, then spectrum of care.
Stephanie Goss:
Sure.
Dr. Phil Richmond:
Again, saying that it's these deeply held moral beliefs and that we can have beliefs around spectrum of care, and why that's vitally important in veterinary medicine and general practice, but also, is there something where… Stop, and I'm going to say another example. We've all been in that position where we go into a room, and an emergency comes in, and the owner says, “Please do whatever.” Money is no object, and it's a human being in pain, scared, frightful for this-
Stephanie Goss:
For the pet.
Dr. Phil Richmond:
… delightful being that they love, and I just please save… That's the only thought that can step into our mind as a pet owner.
Stephanie Goss:
Sure.
Dr. Phil Richmond:
Then we end up, because of the nature of veterinary medicine, we then have to… We need to go in and then discuss a treatment plan.
Stephanie Goss:
Sure.
Dr. Phil Richmond:
Then it's saying, “Oh, I don't have those resources.” Then we get into… Potentially, the client goes into threat mode, which is the normal human response that client wasn't expecting to get potentially hit that.
Stephanie Goss:
Sure.
Dr. Phil Richmond:
They're potentially going to respond. That can escalate. If we don't have tools of conflict resolution and being able to throttle down our response, that can obviously negative affect our wellbeing and then the wellbeing of the client.
Stephanie Goss:
Well, or even just the benign response of, “Oh, I mean, of course I want you to do whatever you need to do to save my pet, but I can't pay for that. What are my options, or what are the other… Is there anything else you can do to save them that doesn't cost this?” Even without the escalation or anger or emotions that we seek come out, sometimes, as the care provider, you still have that, “Okay, now, I have to respond to this, and I have to figure out how to help take care of them while at the same time taking care of the patient.” So, I think that whole we've done… You said a couple things that are, I think, really, really important and worth unpacking. This is where I said, I think, in veterinary medicine, we've come a long, long way, especially in the last few years.
I remember, and for those of you who can hear that, I did not all of a sudden get a bunch of birds. Phil has a whole zoo at his house, and it always makes me happy when we talk, because I can hear the menagerie in the background. It's the best. But in veterinary medicine, we have come such a long way. I remember when I started, the tools that we had for those conversations was you just did whatever the owner… We didn't do treatment plans for everything. If an emergency walked in the door, it was like, “Give us the basic information. We take care of the patient.” Go in the room. You have that conversation. They're like, “Well, I can't pay for that.” Then you have the follow-up conversation, right?
So as an industry, we have grown tremendously in the sense that we recognize that that's problematic, and we've taken steps to address it. Now, I don't know anyone whose clinic doesn't have a process or, to your point earlier, a system to help prevent that from happening. So, we are getting smarter in that regard. I don't think that even though clinics are more aware, we're doing things like treatment plans. We're being preventative in the sense that we start the conversation about finances, about the financial implications of taking care of a pet far earlier than we ever did. We're talking to puppies and kittens, pet owners about things like pet health insurance, about alternative payment options like CareCredit.
We're doing those things, so we are being more proactive. I think something that you and I have had the conversation about is that that is wonderful. There's been a ton of conversation over this last probably two years about the idea of spectrum of care and that it's okay as clinicians, as care providers to work with a client like, “Yes, we might want plan A, and we're willing to go to plan B, C, and D to discuss with the owner like, “What care can we provide with this patient?” That all is a radical shift, I feel like, that we've made in over the last 20 years that I've been in veterinary medicine. Even with all of those changes, I feel like there's not a lot of focus. I've not seen a lot of education for ourselves and for our teams of the impact that the emotional weight that that has on us, right?
I have friends that work in ER, and they're the only ones that I have ever seen in veterinary medicine who put a focus on the fact that euthanasia in general takes a toll on us, but also the high stress, high-risk day in day out of having those financial conversations with owners about having to talk about financial euthanasia, about having to really lean into spectrum of care in a way that a lot of times we don't fathom. I don't think in general practice. It's very different level in ER and 24-hour care. We don't do a whole lot to talk about that and the impact that that has on the team.
So, that's part of what I love about the work that you're doing, which is, “Hey, hi, this has a really big impact on the team, and if the only time we're talking about it is when people are so far impacted by it that they're leaving the profession, we're never going to get ahead of this.”
Dr. Phil Richmond:
I agree. So, going back to the idea of protecting ourselves against ionizing radiation is that the fact is that we know that that situation when veterinary professionals are put in that situation, that it opens the door for emotional distress, spiritual distress. That is a hazard of the profession. So, then we say, “What are the ways,” because the best thing to do… When we look at risk management in that regard, the best thing to do is totally remove the risk. So, it's either the client has resources to be able to do that. Then we talked about insurance, and we talked about doing it all for free, which is not an option.
Stephanie Goss:
Not an option if we want to be able to pay everybody's paychecks.
Dr. Phil Richmond:
Right. Then getting into then spectrum, “Okay, then how do we mitigate it? How do we try to lessen it as best we can?”
Stephanie Goss:
Sure.
Dr. Phil Richmond:
I want to give an example, so let me say this, is that the group that I worked for, again, we knew… This was before a lot of this came. This is probably 10, 12 years ago. We sat down, and we said, “Okay, there are certain cases that when they come in, we know that we can positively impact that patient if we do this one thing, if we unblock first time black cat.”
Stephanie Goss:
Sure.
Dr. Phil Richmond:
I'm not saying this goes along the lines of everyone, but realizing back then the impact that that had, and we just asked. We said, “Look, we'll…” We came up with a way to pay for it, and I am like, “I don't care if you can take it out of whatever. Just if… Can we come up with a way that the team doesn't have to make that potential decision?” I'm not saying that that way is for everyone, but we recognized even back then the impact, and I did, that it had on the team. So, what are the things proactively that we can do. I mean, if we are talking about that when they're kittens before, and puppies, if they're already covered, if they're already protected, and they come in.
Stephanie Goss:
Sure.
Dr. Phil Richmond:
So, what I would say too is thinking about that emotional situation that we've all been in, and when we have a client that potentially will say, “Do whatever. Money is no object,” and cynically, sometimes we've heard that where it is, it's just that in that moment, I can't make that decision as a client versus if the client says, “Do whatever. I have pet insurance.” I mean, being in that, that was just something that really struck me a number of years ago when I had that self-awareness of walking into that room with a case that I really wanted to stabilize and transfer to Blue Pearl to the specialty hospital to work with, and it was like saying, “That's now an option,” where-
Stephanie Goss:
So, there's two things that you just said that light bulb for me. One, I love that you distinguish between the feeling. I don't know how many people are listening or this is going to resonate with, but I've always had this feeling. Having started at the front desk and being the one to be calm in an emergency, I always got sent into the exam room when we had emergency cases come in to be the client partner. There is this spidey sense that always goes off when a client says to me, “Do whatever they need. Money is no object.” There is a very radically distinct difference for me in hearing that versus hearing, “Do whatever they need. They have pet health insurance, or we have CareCredit. Do you need my card?”
There is a very big difference in that to a veterinary professional. I will tell you, my body physiologically changes when I hear a client say that, because those things feel different. I hate to say it, but I am always second guessing when they say money is no object. Do whatever my pet needs. I'm like, “Wonderful. I will put together a treatment plan for you, and I will be right back so we can talk about it.” Not that I don't believe them, but I've just… Experience tells me that to your point, a pet owner who loves this being, and wants to do everything for them is saying yes. Then they're saying yes from an emotional place, and they have no idea the detailed, rational medical place that we would be coming from, and so many times, those are opposite ends of the spectrum.
I love that you pointed that out, because that very much was my experience as a team member is I always… My stomach clenched up, but I felt this pit until I would go in and actually show them a treatment plan, and talk through it with them, and get a sense of, “Okay, yes. I'm going to sign for this or not.” That's not to say that that couldn't be alleviated, because to your point earlier, pet insurance, pet health insurance, CareCredit, alternative payments, even a traditional credit card, that's only one tool in our toolbox, right? We know that there are other tools that we can reach for, and we can talk about spectrum of care.
We can talk about alternatives. We can talk about community support options for paying for care, but it still gives you that stressful feeling physically when you're the team member involved in those conversations.
Dr. Phil Richmond:
Absolutely. Again, just going back to, and this is… You and I have had the opportunity to speak at conferences on crisis management, and what do we do when a team member is in trouble? One of the things that we talk about is having a plan before we're put into that situation. This is very similar to that is that, again, we know that this causes psychological harm to veterinary professionals. So, what are the options that we have to ameliorate to either remove the risk, remove the hazard, which again is that finances don't have to be discussed? That would be the wonderful thing is then we've removed at least that parti… Not saying that that completely removes moral injury, but the financial resource constraints aspect of it is taken off the table.
Stephanie Goss:
Right.
Dr. Phil Richmond:
Again, do we offer pet insurance? Do we offer CareCredit? Do we then say, “Hey, the other option too is like we did at our practices in these certain situations, before it happens, can we have an agreement that this will be a teaching case, or this will go against my CE money,” or whatever that looks like to each individual practice, their value system and what they can put together, but knowing can we have something in place before we're put in that situation? So, it's something that we don't talk about as much the importance of it, but it really is vitally important. I mean, there are certainly other aspects of moral injury, so not just focusing on the financial aspect in veterinary medicine, but it's the one that we encounter more than…
Stephanie Goss:
Sure.
Dr. Phil Richmond:
They just don't see that as much. Obviously, in human medicine to that degree, the moral injury that they see is usually for different reasons.
Stephanie Goss:
But I will say too on the human side, I can appreciate the impact even with insurance, the impact that has for providers. I've been going through some health challenges myself, and have been going through the diagnostic process. I have insurance, but the hoops and the bureaucracy and the waiting and seeing the toll that it takes on my healthcare provider, I just saw them this morning. I could see it on her face when we were having the conversation, because she knows how long I've been waiting for the next step in this process, and she knows some of the physical symptoms that I've been dealing with every day. She is such a wonderful kind person.
I was like, “Are you sure you don't want to go to vet school, and be a veterinarian, because you'd be great at it?” But I can see the appreciation she has for the impact that it has on me, and it has nothing to do with the financial piece of it. It has to do with taking care of this human that you care about and that you can see the frustration and the suffering and the physical impact. It's that same perspective I feel like amplified a million times in veterinary medicine, because none of us got into it for the money. We all got into it because we care about the patients. I know I've been in that room when you have to have a hard conversation with a pet owner, because to your point, you just want to take care of the patient.
So, I want to go back to what you said about creating some systems in your practice, and talk about our personal experiences there, because I have a question for you about how it impacted your team when you guys put that system in place. I had a very similar experience. We went through a horrible, horrible case where a patient came in on an emergency. Our practice owners weren't in the practice. We had one of our newer doctors there, and there was a lot… Anyways, the pet was in significant pain, and the owner was like, “I can't pay for it,” and the team was left going, “Well, how do we take…” We really want to take care of this patient, and so the response of the team that was on that day, plus the doctor was very similar to yours, which is like, “If you have to take it out of my paycheck, go ahead. I just want to take care of this patient.”
So, of course I was like, “I'm not going to take it out of your paycheck, and I'm going to have a conversation with our practice owner.” We sat down, and I said, “Hey, the team needs a way to deal with this. We need systems,” and it brought up a bigger conversation for the team. Having worked for really compassionate practice owners, they were like, “We never want a patient to suffer if there are always tools that we can reach for in our tool bag that yes, they cost us a little bit of money, but you can always offer a client at no charge if it's warranted, which is pain control and euthanasia.” They were like, “If a client is like, “I can't afford a euthanasia. I understand that that should be what should happen right now, but I can't afford it,” we'll take care of it,” or if this patient could be dramatically improved, even just while we're waiting to try and get a CareCredit application go through, take care of the patient first.
The impact that that had on the team, I could see on their faces the look of relief knowing that it didn't matter. The money wasn't the issue. Nobody had to go, “You can take it out of my paycheck,” ever again. That dramatically impacted their mental health and wellbeing. Because we live in a rural area, we don't have a blue pearl and emergency hospital right down the street. So, we do see a lot of cases that they would have to go far away. So, it's not always just the money thing. They're like, “I don't want to drive two hours to the specialty hospital or across the water to the ER.” So, seeing the impact that that had on them was huge for me.
What was your experience with your team when you guys started talking about those systems and structures, because I think I would have to think that it was similar?
Dr. Phil Richmond:
What we definitely saw… When I think about holistically and in Toto, what we saw with our team is that… I'll say this right off the bat. What are some of the things that impact us that we are thinking about right now in veterinary medicine? Recruitment and retention. Not that this is why we did it, but I just went back to the group that I used to work for. All the technicians that I've worked with all those years are still there. So, what I would say is that we know that that's important to us. Again, it's one of these things that being real about, “What do we do? We are not accountants. We're not electricians, and we don't make widgets.”
I mean that, not saying anything about those other professions, but delivering what we are trained to do has an impact on us if we can't do it. To give you an idea, and this is our practice, it was our group, but we just had an agreement again. For financial reasons, we wouldn't ever put a pyometra to sleep, and we wouldn't put a black cat, or I should say we had the option to not do that if it wasn't-
Stephanie Goss:
Sure.
Dr. Phil Richmond:
That, and we also did payment plans where it was their work-
Stephanie Goss:
In house.
Dr. Phil Richmond:
… and in-house payment plan. Stephanie, I mean, we just didn't have those people. Whatever it was that they paid, generally speaking that they took care of it, but it was that knowledge that we weren't going to have to… that we knew that that would negatively impact the emotional and psychological health of our team. Plus, it got into the meaning and purpose obviously of what we did. There are certain things, and again, this was something that we just worked together as a team that we said, “What are the things that we know if we do this one thing that it's going to potentially save that patient's life, we'll say?”
Those were two of the things that I just said, “Please don't ask me to do those things.” I was an older… I was six years out or something when I asked for that. For me, knowing that I was able to do that, it was like I didn't have to… We were able to do those things, and make them into teaching cases and that sort of thing, but what I would say is that that really impacted the team. So, what I want to also say is there's a new study that came out. I may have the description of this a little off, but our friend, Josh Vaisman, will be writing an article on this for today's veterinary business. They looked at what had some of the most impact on people staying in a job.
Essentially, it was if leaders… What they did as far as integrity, and what they said when we look at values is that if that was done on a daily basis, that was always their north star when given, that that had the biggest impact in people staying in the job. Again, just that thing. I mean, I was at my practice for 12 years, and then I came back. I did, because, again, we're not in it for the money, but I love them. I love what we do, and I know that those things like, “I'm not going to give away the farm necessarily,” but if I think something is there, I have the autonomy, and the team has the autonomy to do it.
So, everybody's situation is different, but knowing that having some say in when we're faced with these situations that it's not just a line item decision that is made, that it's bigger than that, that makes me happy. Like you said, like… Go ahead.
Stephanie Goss:
No, I want us to talk about… One of the things… When you and I have done the what do we do when team members are in crisis, one of the biggest pieces is how do we get ahead of it, right?
Dr. Phil Richmond:
Right.
Stephanie Goss:
We know that the best time to prevent it is before anything is actually a problem or before it happens. That is the case here, which is very much what we're talking about. I love your point that every practice is different, and so there is no one size fits all approach here, just like anything else in veterinary medicine. I have to call out a podcast that Andy did. Andy did an interview on the Cone of Shame podcast with our friend Tannetjé Crocker. Dr. Crocker's a practicing veterinarian. She's a practice owner, and she also works in emergency. She works for VEG. They did a podcast where they talked about intentional discounting and the north star and the philosophy that VEG has about supporting their team and their patients and their clients.
I remember when the podcast came out, and Andy was really worried and was stressed out because there was a lot of people who were just up in arms about it. I listened to it, and I was like, “I love this conversation,” because here is a hospital, here are teams who are proactively saying, “How can we support our patients and our clients, and also, how can we support our people?” Tannetjé talked about the impact that it had on her. If you haven't heard the podcast, you should go listen to it, because it's a great episode, but she talked about the impact that it had on her as a team member and as a veterinarian, and her support staff that she works with to know that they had the ability. Now, everybody got all up in arms about it, and my first thing to Andy was, “Did anybody actually listen to it?”
Because what she was saying wasn't that there was no system, that there was no structure, that it was a free for all, and that the team could just discount anything that they wanted, because that's not the case. The case is that they have a system, and they have a structure, because they sat down and made a plan for it. They said, “This is what we're going to do and how we're going to deal with it.” I said to Andy, “I love this episode so much. You and I could have had this conversation on the podcast, because that's what I did in my practice too.” It came about as a result of this case about halfway through my career with the practice owners that I was talking about previously. I said, “Hey, okay, so if we've defined this boundary, what are the other areas where we can intentionally get ahead of some of this stuff?”
So, when you and I started having this conversation, we were talking about it's not just limited to when a pet owner can't pay. That's certainly one aspect in it impacts us on a daily basis, particularly our colleagues who work in specialty and ER where the bills are often multipliers of what we see in general practice, and they're seeing cases 24/7. It is very impactful to all of us in veterinary medicine, but especially to them, but it impacts the team in other ways too. It's not just financial. It's the, “Hey, what about those times of year where it's a euthanasia cycle?” It's a weird freaking thing that I didn't believe was actually a thing in veterinary medicine when I started, and someone told me, “Oh, there's kitten season, and there's euthanasia season.”
I said, “I'm sorry, what?” I remember just thinking that was the weirdest thing ever, but it's true. Looking at, “Okay, when euthanasia season does happen, what are we doing to take care of the team? Are we talking about it? We do morbidity rounds when we have an anesthetic death in our hospital, but what are we doing when we have a rash of euthanasias? How are we checking in with the team and saying, “Hey, how are you all doing?” How are we supporting the mental health and wellbeing, because that has an impact on us? Whether we do one euthanasia in a day or we do 10, the reality is that we're all in veterinary medicine for the patients, and it is a beautiful…”
Euthanasia is a beautiful part of veterinary medicine, and that we can help pets pass peacefully and without pain and suffering. At the same time, there is absolutely a emotional toll and impact to that. So, things like that where we look beyond the money conversation, and start to talk about, “How do we create this safe space to be honest about the things that are impacting us as team members, and then how do we go into creating systems and processes to help support that?”
Dr. Phil Richmond:
There's an old saying down here in the south that is, “Don't hit your shin on a stool that shouldn't have been there in the first place,” is that essentially though… I mean, I suppose, but it's that we-
Stephanie Goss:
You and Andy and the southern sayings, it kills me.
Dr. Phil Richmond:
But knowing that something can cause this, and some of those things, there are other things. I mean, this can be a whole nother show of things that we know that can cause a psychological harm in the workplace. So, that is one of those things is personally for me as a veterinarian, as a GP veterinarian, I've just… This is me, but I've noticed for me is that if I have three or more euthanasias in a day, because, again, I'm not in a hospice situation where I'm, “Go. Go. Go,” and then having to shut down, compartmentalize and do that is I feel it. Sometimes I'm all right, and then sometimes, I'm like, “I am just…” I got to throttle down a little bit. This is where some of the burnout, because my capacity, my emotional capacity goes down.
Being able to honor that is important, but those are those things like, “What do we know in the workplace that can cause those harms?” Again, going back to one of the things obviously that can cause harm is conflict, violence, these types of things in the workplace. So, I genuinely look at the financial stuff as like, “What are some of the ways that we can ameliorate or mitigate those things so that something is already in place?” I just go back to, “Yes, it's a feeling,” but knowing when a client says, “Do whatever. I have pet insurance,” is that knowing how I felt with that, it was like, “Wow, that's just a fundamentally different situation than I was girding myself up for.”
Stephanie Goss:
Sure.
Dr. Phil Richmond:
Then again, also on that line is knowing that that's a conflict. I mean, we can go into a whole thing on conflict, but the financial thing is that what things do we have in place to minimize the stresses and the risks too? Our team members, but I mean also obviously then our patients are going to get care, but what are the things that we can do before that's an issue that we say, “Okay, we know this is something, and let's be intentional about decreasing those harms?” Because when we do that, it's less that gets taken out of our battery every day.
Stephanie Goss:
I think you just moved us into… Anybody who listens to the podcast knows Andy, and I usually talk about the Headspace, which you and I covered early on here. This moves us really nicely into the action pieces, because the first question, when you and I did our conversation about crisis, and we both shared why it was important to us, and some of the study information is statistical information. The firsthand that was raised in the audience, and the question that we get is like, “But how do we deal with it, and where do we even start?” I think you just hit on the two answers, and it's not… Some people are like, “That seems so overly simple. That can't be the answer.”
I think that it really is, and the first question we have to ask is, “What are the things? What are the circumstances? What are the situations? What are the things in our jobs in veterinary medicine, but really any place of employment that are causing us stress, anxiety, emotional distress, put our bodies into fight or flight mode,” looking specifically at those situations. So, we have to identify the situation. Do you have any tools or resources or suggestions for practices in terms of how to audit that with a team other than just asking them, “Hey, let's make a list.”
I mean, that's literally where I started was like, “Hey guys, let's…” I literally got a giant post-it board, and put it on the wall, and said, “What are the things that stresses out the most?” We got the euthanasias, and we got the money conversations, but where can teams start with assessing that piece?
Dr. Phil Richmond:
Cool things. I'm actually working on this with an awesome group of peeps, where we're creating psychological health and safety standards for veterinary medicine, which answers exactly that. Think of it as OSHA for the brain, as the things that we know that cause us emotional and psychological harm. Is it that we don't have autonomy in our job? Is it that we are not clear on what our job is? Is it that sometimes our workplace isn't fair? Are we getting enough reward and recognition equally for what we do? Then am I isolated at work? Am I always… Especially if I'm working remote, if I'm a remote CSR or something like that, am I having connection there?
Stephanie Goss:
Sure.
Dr. Phil Richmond:
Then some of these other things, certainly conflict, workplace relationships are important, supervisor support. So, all of these things are vitally important to all workplaces. What I'll say is almost every country other than the U.S., and I shouldn't say, because the surgeon general just came out with some great workplace wellbeing strategies, but the U.S. is probably about 10 years behind other countries as far as psychological health and safety.
Stephanie Goss:
It's not shocking in the slightest.
Dr. Phil Richmond:
I'm excited. I've partnered with a group called the Wellbeing Lab in Australia. Australia, again, they're 10 to 15 years ahead of us as far as that, and they measure those things. If you're in HR, there's the ISO 45003. Those are the International Psychological Health and Safety Standards. Canada, so I'm certified in the Canadian standard. They have 13 healthcare providers, or healthcare organizations have 15 standards. So, you can look up the Canadian standards, but it gives you an idea initially of where to look.
It's just… Again, the first thing is just awareness and curiosity is that we really haven't been in a veterinary workplace. Sometimes we focus on so much of self-care and individual care, but we've got to be looking at the team level, the things that happen to us and our leaders.
Stephanie Goss:
Right. Yes.
Dr. Phil Richmond:
Then also organizationally, what are we doing, like workload and harassment policies and bullying policies and all of these things? EAPs, are all of these things in place? So very much, the overall thing is preventing harm. Where can we prevent harm, and then where can we also promote flourishing? Hopefully that in a short period of time gave you what you were looking for.
Stephanie Goss:
No. No. No, I love that, and so I think the answer is that it starts with asking the question. It could be as simple as… I mean, don't get me wrong. I love to nerd out, and so by all means, especially if you are a practice manager listening, do your research. Do your homework. Like you said, Phil, we can drop some links in the show notes as well, because there are some amazing information and standards that other countries who are light years ahead of us have put together, and it can be… I think a lot of us don't open the can of worms. I know I was afraid to open the can of worms with my team, because I sat down…
When I did this exercise most recently, I sat down with my medical director, and I was like, “Hey, look, I want to ask the team what stresses them out at work.” You should have seen the look on her face. It was like, “Why would you do that? You're going to open a whole can of worms.” I was like, “Well, what do you mean?” She's like, “Well, what can we do about it?” I said, “Well, if we don't know what is overwhelming, what is stressing them out, what feels emotionally dangerous to them, we can't do anything about it. We have to know what we're facing before we can come up with a plan of attack.” So, I think in talking to colleagues, there's a lot of fear, because the second piece of this is it goes back to your illustration, which is so perfect of what do we do before we go into x-ray?
We put on our lead gown, and we put on our thyroid shield. That's like a tangible… We know what that is. We know what the protection measures are. You could get a checklist on the internet of, “I've got to do these things,” and so many of us are like, “Well, if our team tells us that euthanasia is emotionally taxing for them, what do I do about that, because we can't stop…” We can't just say we're never going to perform a euthanasia in our practice anymore.
Dr. Phil Richmond:
The same thing is we can't say that we're not going to take X-rays, and that's from a risk management. The best thing to do is to get rid of it totally, but what if that's not a possibility?
Stephanie Goss:
We can't do that.
Dr. Phil Richmond:
So, then we go down the… How can we minimize it? How can we ameliorate it? Then the very last thing is putting on the lead. Lead is actually the PPE, from a physical point of view, is the lowest thing, but what can we do? Can we work on… For instance, with euthanasia, just throwing this out there, can we put something in the PIM system that puts us in alert, “Hey, by the way, Dr. Smith has been scheduled three euthanasias. Just put an alert up there that maybe we need to just check in with Dr. Smith,” or, “Hey, I just noticed that Mary actually ticked all three of those rooms. Let's-
Stephanie Goss:
Sub out for somebody else.
Dr. Phil Richmond:
Can we do that? The differences, though, is that may be something that actually is deep meaning and purpose for Mary. So, it may not be something that is… But still checking in because-
Stephanie Goss:
We won't know if we don't talk about it.
Dr. Phil Richmond:
We don't know because of the secondary… The situation may have been not a peaceful transition of an elderly pet or something of that nature. So, it's just those things where we're like, “Hey, let's just be aware that these things cause harm, so let's check in.” Again, just like wearing the badge, we know what the dosimeter is. It's like, “What's going on with our team?” That gets into a whole other thing is are we measuring these things, which is I'm a huge proponent of checking in on the wellbeing, measuring the wellbeing, measuring those things. It's that if we're not measuring it, it's hard to manage it. Then if we're just throwing stuff up against the wall, anyway, I'll go down the rabbit hole with that.
Stephanie Goss:
I was going to say we can't measure it if we don't have a system. So, I think that for you and I for today, that was where we wanted to start and stop, which is that it really can be as simple as asking the question. This is where you do you. You know your team best if you're a manager or practice owner, leader of your practice, asking them like, “What emotionally takes a toll on them?” When they go home at the end of the day, and they just feel like they want to cry or they're exhausted, why? Is it because of interpersonal conflict or emotional things or the workplace things that you mentioned? Is it the nature of our business? Is it doing euthanasia? Is it being in surgery by themselves with nobody else or only one other person for the day? What are those situations?
Then the second piece of it is then what do we do about it? That's where so many of us freeze, because it will feel like an elephant, so I asked my team. The first time we did this exercise, I had 22 of them, and I had probably 52 different answers from the 22 of them, because everybody's individual, and the things that impact them, they're filtering it all through their own lenses and their own experiences. So, to your point, being involved in euthanasia might give life purpose to Mary, but for me or you, that might be a huge stressor for us when we do more than three euthanasias. So, everybody on the team is going to be different.
I was sitting there looking at this giant list, and I remember thinking, “Well, I promised my partner that this was not going to go sideways, and that it's not going to backfire on me.” I could just see the look on her face. We're looking at this giant list, and I said, “Great. Now, we're going to talk about what is one thing off of this list that we can tackle.” So because I had already done it, I started, like you, with, “Okay, somebody had put up there, “Well, it really stresses me out when pets come in, and they're in pain, and the owners can't afford any care.” I said, “You know what? I've got a solution for that. Here we go.”
We laid out the system for the whole team, and I said, “This is how we document it. This is how we…” But never once will we deny pain control to a patient that comes in our doors, because that is something that we can absolutely take care of every time. The relief that the team experienced was great. Then I said, “You know what, you guys, we're going to tackle this one thing, and then when we've got the system down, then we're going to pick another.” We just worked our way through the list, and it is that eating the elephant one bite at a time, because it will feel overwhelming, and you will have the individual pieces, and some of it will be very individual.
I had a member on my team who was struggling with handling stress, and so part of it was, “Hey, look, this is not a thing for everybody else, and I recognize that it's a big thing for you. So, your support is going to look like using our EAP, and having access to some additional counseling to get some coping mechanisms for the stress of our job and the reality of our job.” It can be individual. It doesn't necessarily have to apply to the team as a whole, but I think only then when we define why is it happening, and what can we do about it, can we move into your super happy place, which is how do we measure it? How do we keep tabs on it, and how do we get even better down the road, right?
Dr. Phil Richmond:
Yeah.
Stephanie Goss:
Oh, man, this has been so much fun as always. I love nerding out with you. I'm hoping that this was a good conversation for our listeners, and that they weren't just like, “Stephanie and Phil went down a rabbit hole,” because we can do that sometimes. I'm going to drop some links in the show notes for some of the resources that I know that you have. If you are a practice who's listening to this, and you're like, “Where do I start?” Even the outline that Stephanie just gave feels really overwhelming. I'll tell you, the easiest place you can start is if you don't already have alternative payment options in your practice.
If you're not leveraging the resources that have come out in the last couple of years on spectrum of care, or you're not leveraging the giant resource that is pet health insurance, start there, because those are the easiest things that you can do, because we know, and it has been studied, statistically, the impact that that has on our teams.
Dr. Phil Richmond:
What I would say too is along those lines is just recently, this website policy was set, because that was one of the things is we did as a practice. We believed in it, but, well, which one would you recommend? It's like, “Well, we-
Stephanie Goss:
You're talking about pet health insurance?
Dr. Phil Richmond:
Yeah, pet health insurance. So, it was just… That was one of those things like, “Hey, here's this option. Go.” I don't have to necessarily come up with the answer, but I can say, “Hey, here's the way to make the best decision for you is go. I think it's Pawlicy.com or some such, but like a something.
Stephanie Goss:
I was going to say, I don't have it in front of me, but I'll drop it. I drop it in the show notes, because I'm a big policy fan as well. I am so old that I remember when there used to be the AAHA preferred provider list. I'm totally dating myself down, but I remember the relief that it had to be able to say, “Well, our clients use a whole bunch of companies, and we don't have one that we recommend, but you can go to this one place.” I love that there is that resource in Vet Med again, because I was really sad when it went away, because it takes the stress of, to your point, having to choose because there is no one… Again, there's no one size fits all approach for anything in vet medicine.
I've been saying this forever, and pet health insurance is no exception to that. There's the right thing for the family, for the practice, and all of those things combined. So, to be able to send them to a neutral third party who has all of the information, and be able to give them a resource location as a clinic takes that weight and that stress off of your team as well. I love that you brought that up, Phil, and I'll put it in the show notes as well, because like I said, if you're stressed out over where to start, a great first place is with those three tools. Thanks for joining me, Phil. This was wonderful. I had a great time.
Dr. Phil Richmond:
Oh, thank you. Thank you, Stephanie Goss.
Stephanie Goss:
We will be back, I am sure, because you and I could have endless conversations.
Dr. Phil Richmond:
This is a fact.
Stephanie Goss:
Take care everybody. Have a fantastic rest of your week.
Dr. Phil Richmond:
Bye, everybody.
Stephanie Goss:
Well, that's a wrap on another episode of the Uncharted Podcast. Hopefully you enjoyed this episode. I know it was a little bit different not having Andy and I together in the copilot seats, but hopefully you enjoyed Phil and I's conversation today. Before we go, I just want to take one more opportunity to say a huge heartfelt thank you to our friends at CareCredit, at Synchrony Financial, and at Pets Best Pet Health Insurance, because without them, we couldn't do this podcast. There are a lot of people doing exciting and wonderful things for the veterinary profession as a whole, and we couldn't do them without them. So, thank you all for making this episode possible and brought to you ad free today. Have a great rest of your week, and we'll see you all next time.
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