Old Skool Medicine Makes Me Cringe

A veterinary professional who thought they found their dream clinic is starting to see some old-fashioned medicine that needs to go. In this episode of the Uncharted Veterinary Podcast, Dr. Andy Roark and Stephanie Goss address a mailbag letter from a new team member at a rural practice who is alarmed by outdated and unsafe medical practices. Concerned about the lack of physical exams, rushed appointments, and poor surgical sterility, this person wonders how to raise these issues without overstepping their bounds. Andy and Stephanie discuss how to navigate the difficult conversation of addressing substandard care, offering advice on recognizing capacity limits, setting personal and professional standards, and practical ways to advocate for patient safety. Let's get into this episode…

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Episode Transcript

Stephanie Goss: Hey everybody, I am Stephanie Goss and this is another episode of the Uncharted podcast. And this week on the podcast, Andy and I are tackling an anonymous letter from the mailbag because veterinary medicine is a very small world. And this writer is asking us, how do I address some old school practices, medicine that make me uncomfortable, wildly uncomfortable in my new practice.

This one was one of those that Andy and I thought would be probably a short episode and yet turned out to be our normal length. So we had things to say from both the Headspace and Action Steps perspective, so let's get into this. 

Dr. Andy Roark: And we are back. It's me, Dr. Andy Roark and the one and only Stephanie it's time I disappear Goss. They play that song at CrossFit and I, I lose my mind. It's like that Livin On a Prayer by Bon Jovi. Like you can tell, you can tell all the masters athletes get real hype when living on a prayer comes on. That's me. I left all the weights. We're halfway there. Indeed, Jon of course. You and me.

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

Dr. Andy Roark: It's good. It's really good. It's humid as all get out, it's just like, it's like, I don't, I just, I go for swims with my dog around the neighborhood instead of walks because it's 99 percent humidity here.

Stephanie Goss: I was gonna say, how have the storms been? I heard you guys had some big storms come through that direction.

Dr. Andy Roark: Yeah, you know, it just

Stephanie Goss: another day

Dr. Andy Roark: It’s ratcheted the humidity up and kept it there. But yeah,

Stephanie Goss: Gross.

Dr. Andy Roark: Yeah, it's been gross.

Stephanie Goss: It's beautiful over here

Dr. Andy Roark: Yeah, I got yeah, Seattle. It's like, enjoy, in Washington, enjoy the six weeks that's nice every year.

Stephanie Goss: Oh, don't worry, the rain will be back before summer acts. This is, this is this is our first signs of actual spring, like spring here starts in May, when the roadies pop, and summer doesn't start until after the 5th of July, so this is not, this is not actually the end of the rain, there's more coming, but I am in taking every second of the sunshine, and actually you would be super proud. Yesterday I was like, I'm going to channel my inner Andy Roark, and I am going to go work and think about some things creatively, and like, do some work outside and I mowed the freaking ginormous lawn that I have.

And I, and I had my headphones in and I was listening to some podcasts. And then I was playing, I was working on planting some seedlings that I've got growing. Cause now the frost danger has passed. And so I was putting in some stuff, new stuff in my vegetable garden. And it was a very nice day and I did not get sunburned. So, I was very proud of myself.

Dr. Andy Roark: That's amazing. That's, that's, first of all, that's amazing. You don't get much more fair skin than you. That's did you have like, did you have like the old person huge hat? Cause I do, I have one of those. A hundred percent, yeah.

Stephanie Goss: I do.

Dr. Andy Roark: Long sleeves and a big giant hat.

Stephanie Goss: Yes. I have the long sleeves and the giant floppy sun hat and the SPF, you know, 85 and all of the things.

Dr. Andy Roark: That stuff is so important. So, I was looking at the I was looking at the Merck well being study recently. I'm gonna, I'm, I'm, I'm trying, I'm, I'm writing about this cause I'm really into it right now. But I'm always, I just have to pick my words a little bit careful cause I don't want people to feel criticized.

But I just, I feel like there is such a narrative around “vet medicine is awful.” And I, I, like, I hear people that I really love and respect will say things like, well, you know, like, do you know how this profession is? Or in this profession, this is why everybody's leaving the profession. And, and Merck did their well being study this year.

It's really freaking good, and it talks about basically really, veterinarians are not that different from the general population. It's funny when you look at, so they're looking at doctors and looking at doctor wellness. Young doctors are at high risk of leaving the profession. Like, we have a problem with young doctors.

However, we really, it's for veterinarians, I can't talk about support staff, but for veterinarians, we really don't have any different exit from the profession than other professions do. Like we basically mirror, mirror every other profession. And it's just interesting, the big the big drivers that they came up with that, that keep veterinarians sort of in practice are on the personal side, it's work life balance.

It's having, it's having an active social life, meaning spending time with friends and family. It's having positive coping mechanisms. And it's having a financial advisor, which I thought was interesting. But those were like the four big drivers of wellness. When you look at veterinarians the– it's really interesting.

The number of veterinarians who feel reward and fulfilled is pretty darn high. It's over 70 percent are either extremely or somewhat satisfied with their job. But, when you look at how do you think other, the rest of their profession stacks up, the numbers are wildly different. We all think that vets are better are burned out and unhappy, and so we, we think that about 33 percent of veterinarians are extremely unhappy and it's not, it's like 11%, you know what I mean? It's it's, you know, 1 in, 1 in 10 but it's just, it's, it's, I've just been thinking about it, it's just really interesting, but it's, it's, it's kind of weird What I, what I've believed for a long time is that medicine is uniquely challenging and it's hard.

We can do so much for ourselves by having friends and family that we spend time with outside of work and having work life balance, meaning things that we do to unplug and to, you know, and to just get away from the clinic. And the last is the positive coping mechanisms. I mean, that's just, you know, that's the stuff we talk about.

It's mindfulness. It's exercise. Exercise was a huge one. They actually looked at that. They were like, yeah, the happiest, happiest vets exercise, you know, regularly. And it's just, it's all of these sort of basic things that we have all known. But it was interesting to see that sort of displayed back and it's like, you know, our, our profession is, is challenging.

It is not the horrible nightmare place that at least for veterinarians, that people want to make it out to be. I think that's, I just think that's important. I think, I think when we tell ourselves that our profession is broken, everybody's leaving, I think that affects the way we look at our days and think about what we do and in a way that's probably not healthy.

Stephanie Goss: Yeah, that makes, that makes sense. Well, that's a, I mean, it's a good headspace to, to be in, I think, when we think about people. Think about ourselves. And I think headspace is going to be important to this episode today because we got a mailbag and I, it's funny because this one sat in the queue for a little bit because I didn't know what to do with it because I looked at it the first time and I thought, this might be the shortest episode that we ever do.

Andy Roark: That’s exactly what this is. 

Stephanie Goss: And then I thought, is, is it, is it worth doing this episode? Because I feel like it's one of those questions that maybe only has one answer, but then I like forced myself to set my personal, like, filtered answer aside and then like, look at it again. And I was like, you know, I think that this is worth doing.

And I think it could be some interesting conversation. So I'm excited about this one because we got an email from Someone who I'm assuming that they are an assistant or a technician, someone on the, the, the patient care team. But they, and it could be a doctor, I don't know, but they said that, you know, they have started at a new practice and they live somewhat rural Really, and there's not a lot of practices in their area.

So they have started at a new hospital and they are very concerned over some of the medicine that they are seeing and some of the things that they're seeing in the hospital. They picked this hospital in part because it had phenomenal feedback and reviews online and in the community from clients.

So clients rave about this hospital and so they were super excited. And what they have found since being in the hospital is that the physical exams are almost nonexistent. The appointments are really, really rushed through, but their biggest concern, and they're like, I could deal with those things and kind of, you know, focus on the exams and, you know, talking about it within the team, and there's a giant red flag, which is they have some serious concerns over safety, patient safety, and sterility they have they gave us some, some examples, surgeries where the doctor is not gowned up, not wearing a, not wearing a cap in surgery, you know, not wearing a gown, no gloves. 

Dr. Andy Roark: Not wearing gloves, just raw dogging it not wearing gloves. 

Stephanie Goss: You went there. You went there. Pre, you know, pre popped syringes, things, things like that. So their question was, Hey, how do I bring this up without stepping on people's toes? I know that I'm new. I don't have authority within the practice. However, I have serious concerns because I feel like this level of care is not up to par.

With the industry as a whole, and I am actually worried that there's you know, and we're creating an unsafe environment for our patients, and he said, I want to be able to confidently recommend my hospital and feel like it's going to live up to the feedback that I saw. However, they said, I don't even think I would bring my pets here, which is a huge red flag to me and reading all of it.

And so I was just like, okay, this, this is going to be, this is going to be interesting. So, Andy Roark, how do we address the old school medicine and bad practices? That makes someone feel uncomfortable in a new practice.

Dr. Andy Roark: Yeah. Oh no. Oh no That's this is a this is a censored version of in the notes. You'll see the first line contains words in it. I'm not gonna say in the practice because oh no, this is. 

Stephanie Goss: We need a profanity sensor on this episode.

Dr. Andy Roark: All right. Yeah. Okay. Now let, well, let's get into this. I, I wanna make this pre, I wanna make this productive.

Alright, cool. From a headspace standpoint I , I hate, I, it, I really try hard to not be like, well, let's talk about what we should have done in the past. And I really don't wanna do that.

Stephanie Goss: Cause that feels a little bit like I told you so.

Dr. Andy Roark: It does. It feels a lot like I told you so. But I did not tell this person so.

Stephanie Goss: Right. So we're going to say it anyway.

Dr. Andy Roark: I just, but I have to, like, I have to just say the number one thing I recommend to people taking a job in a vet practice is you have got to do a working interview.

And this is why. Like, this is why. And so, there's the, the, the way I recommend it, especially for vet students coming out, and they haven't, you know, I think when you've been in practice for a while, you see red flags. Because you've, you know, because they, you're much more comfortable in the practice. But when you're a brand new vet too, sometimes it's a little tricky, and you don't exactly know what to look for.

You need to do a working, if you're going to commit to a place, you need to do a working interview and then go there. And then, you need to I always tell people this. You need to try to go on Monday or Friday, because that's generally when they're the busiest, and you want to see them when they're stressed.

If you go there and everybody's having coffee and standing around and smiling at you, That's not really what it's like to be there. That's not bad. And they will try to get you to come at a time when they have some free time to talk to you. So they'll try to get you to come. Ask if you can come back at the end of the week and just shadow for a while.

And if they say no, I would be concerned about that. But you want to get there. You want to talk to management leadership. And then you also want to talk to the support staff. And some of my favorite questions for the support staff are, What's your favorite thing about working here? And I ask them that so that I can ask them the next question, which is, What's your least favorite thing about working here?

Because they'll answer that question if you let them, if you ask them the good one first. And so there's that. Things like, do doctors do surgeries the same, or is there variation in what they want? And I like that question, because it tells me a little bit about how the practice runs. But when they tell me there's variation, I'll say, What is it? Give me some examples. How do different doctors do things differently? And this is me digging. And that's kind of what that, what that sounds like.

Stephanie Goss: Yes.

Dr. Andy Roark: What's the, what's the standard surgical induction protocol? That's a big question. Big one for me. And again, I'm not trying to critique your drugs and go, well, they use this and not that. 

Stephanie Goss: Mm hmm. Mm hmm.

Dr. Andy Roark: I'm looking for big flags, you know, we gas them down. I'm like, tell me more about what does it, what do you mean when you say, how often does that happen? What does that look like? What do you guys do for pain control in your space surgeries? I just, if they're like, oh yeah, we're using, we're using lidocaine, you know, you know, in the body wall, and we're doing these different things, and I'm like, I just, I can't, I'm not trying to critique, I'm just looking for big sweeping red flags, or are there places I should dig a little bit deeper.

What do you do about pain control in orthopedics? You guys are out here in the middle of nowhere. What does that look like? I just want to know. Are they using CRIs? Are they using epidurals? It may not be a deal breaker for me, but I'm trying to get them to talk to me about where the rubber meets the road as far as the things I care about in the medical side of practice.

Stephanie Goss: And I think this goes for new people who are new to the veterinary field and especially for our experienced team members. I think the cringe factor for me in this is that I've not yet met a person in veterinary medicine who didn't develop after, you know, at least a job or so, develop a sense for themselves of what feels right or wrong…

Dr. Andy Roark: Mm-hmm.

Stephanie Goss: on a personal level for them when it comes to medicine. And wrong is probably the wrong word, but like what feels comfortable to them? What type of medicine do they want to practice? And I think that there is, when I have discussed this with people in regards to interviews, I have always gotten frowned at by colleagues who are like, people shouldn't be allowed to turn their nose up at what other people are doing.

And, and I can understand that perspective because nobody wants to feel like they're being judged and it is okay to have a personal level of comfort and it is okay. And it should not be. only limited to our doctors. I am an advocate that every single member of your team from the front desk staff to the kennels and everything in between should be able to have a sense of comfort for what they, the type of medicine that they want to be involved in.

And that is a very personal thing. And I have friends who are like, I will not work in a practice if they don't use CRI for pain control in orthopedic patients. That's, that's okay with me. Like, I, I don't, I don't understand why we would find something wrong with people figuring out what matters to them and being true to that.

I can understand wanting people to reserve the judgment and not putting judgment on other people, but I don't think that there is necessarily, there are very few things that that are ethically wrong, and we work in a profession that has defined rules and regulations from a state perspective all the way to a national perspective on the things that should be morally wrong to anyone working in veterinary medicine.

You take an oath coming out of vet school, do you not? talks about what you're going to do for patients.

Dr. Andy Roark: Well, you know, I talk about this all the time. I really think that the relationship we have with work is a relationship, and I talk about it like that, and that's how I think about it. And if you meet someone and they are not someone you want to have a deep and ongoing relationship with, that's not bad.

Like, that's, that's life. It doesn't mean they're a bad person. It's, part of it's just about fit. Now, if you, if you and I go on a date, And then you just decide you don't like me and you go and tell everyone that you don't like me and you go and you tell me that i'm a bad person because I like to eat at the you know, I don't know at the at the at Jimmy John's I took you.

Yeah, if you're like, how dare you take me to jimmy john's on a date? You're a terrible person. I would be offended by that if you enjoyed Jimmy John's we're like, this is great I think I'm gonna go on some different dates. 

Stephanie Goss: On more dates with people. 

Dr. Andy Roark: That's, that's your, that's your thing.

That, that's, that's fine. I think that sounds silly, but it's true to me. But that is how I think about it. When you take a job, you're going to be there forever. 40 hours a week like that is a huge chunk of your waking hours It should be a it should be a fit, you know Like I don't want to be with some with a person that I just do not connect with and does not share my values, you know, and again doesn't mean they're a bad person They're just I, we're just not, this ain't working, the chemistry's just not here.

It can be, it can be that superficial, if this just doesn't work for me that doesn't mean that's not the perfect person for someone else. It's just not the perfect person for me, and I think we all understand that, but I think we should port that over, over to vet medicine, you know. I think one of the big things for me this person said, and this is why it sort of reacts so strongly to it, is when, I think it's a big deal if you would not take your own pet to the place that you work. For me, that's an in, that's an integrity thing. 

Stephanie Goss: Yes. Yes. 

Dr. Andy Roark: I want to look at pet owners in the eye and say, you should bring your pet to our practice and mean it. And if I won't take my dog to our practice, but I'm telling you, you should bring your dog to the practice or your cat to the practice, that's, to me, that feels, let's say, it's kind of unethical.

It's a failure of integrity. It's, it's do what you say you're going to do, you know, it's kind of it. And, it's walking your talk. And, and I, to me, that's a big deal. And the, and the thing I took away from that is in this case, the problem with this. The question is, from the examples given, the gap between where this person is and where this practice is, it feels enormous.

It's one thing to say, this practice doesn't leverage their technicians like I think they should. It's one thing to say, I really don't like the drugs we have in our drug box. Like those are, those are things. 

But, but if you're like, I'm pretty good with everything else, I go, okay, I, I can tell you, there's things my wife of 20 years, and I don't see eye to eye on, and we just kind of, it's uh, Ruth Bader Ginsburg's quote is something like, you know, in marriage, it, it helps to be a little bit deaf.

There's, there's kind of like, there, you should get to the point where you just kind of go, okay, well, I'm not, I'm going to just not pay attention to that and and freaking, and I'm going to be deaf on this point. At some point when your whole marriage is being deaf, you're like, oh boy, this is, this is, this is bad.

And so, so I'm, I'm worried about that. I think that's a problem. To me, to me, this is the easy answer to this is I feel like we're too far apart to, to salvage this. Now, let's play the game in a second if we're in a rural place and there's not another option, which makes it harder, and I can do that, that's fine.

But, for me, if there's two options, which is leave or go, I would say I'm going 99 percent of the time. Like, I'm going. This is, this is too far apart. I think that we have. I think some, some of the, because we're talking headspace here. The old sunk cost fallacy is probably at play, which is, I went through the interview process, and I moved here, and I'm here now when I've come this far.

And I go, okay, just because we've sunk a lot into this, does not mean that we need to continue to spend time here. Just because we put a lot of effort to get here, doesn't mean we should continue to stay here and not be happy. If you were starting over today, would you stay at this practice or would you go somewhere else?

And the answer is I would immediately go somewhere else. Then I think you should go somewhere else. And that's sort of the sunk cost fallacy. The other thing that I'm going to say here, because I want to validate this person in one way of what they see, is that I have been a firm believer that vet medicine is divided into two components.

There's the relationship component and there's the medicine component. And practices can crush at one and not the other. And people can crush at one and not the other. And I had this kind of weird idea, but I still stand by it. When we talk about mentorship and finding a mentor, I think that most doctors benefit from having a medical mentor and a relationship mentor.

And they're usually not the same person. The relationship mentor is someone who they Talk kind of like you do not not in their tone of voice, but the way they talk to clients Matches up with the way that you talk to clients. And so I'm a high eye in the disc scale. As you know, I am a big I like to tell stories I like to And I worked with some doctors who were great storytellers and fabulous relationship builders.

And I learned like a sponge. I just soaked it up. And they were great. And I worked with other doctors who were phenomenal and they had a much more reserved style. And I just, I didn't, the way they talk to clients is not how I talk to clients. Not good or bad. It's just, it wasn't my style. So I found doctors that kind of had a similar sort of outgoing, gregarious style to mine and really learned a ton from them.

Now, some of those really quiet doctors, they thought about medicine the way I think about it and their thought processes made sense and the way they approach cases made sense and they were the ones, not the, not the back slapping, you know, fun guys that I learned the relationship part from but the quiet doctors are the one I went and talked to about the medicine because I Understood the way they thought and again, it's not about being smart because there were some people who were so smart I could not I could not understand like their mind was doing things my brain simply like they were flying an F1 fighter and I needed help running my bicycle.

And like again, not good or bad. They just weren't a match for me. It sounds like this case, it sounds like this clinic has created the relationship part, but the medicine part is just, they're not where this person wants to be. I don't know, are they equally important if you're taking a job there?

Honestly, the medicine is probably more important because you can kind of communicate the way that you communicate. I think they're both important to some degree as far as fitting in. There's one clinic I worked at, and I really like this clinic, but it was, I call it the church mouse clinic, because they were just, they were all very introverted.

They had music that played at a very low level, and in the back was just quiet, and they were not unhappy. That's important. This was not an unhappy place. 

They were just very quiet. And I, exactly, and it's not that I didn't enjoy it there. But I, I always had that feeling of like when you're talking in the movie theater, like before the movie

Stephanie Goss: In the library. Andy's in the library at work. 

Dr. Andy Roark: A hundred percent. That was me in the library, which I'm, I, let's be honest, it's not where I'm most comfortable. But, but I, I, I'm fine with it. But again, it was not the perfect fit place for me. No knock on their thing. But anyway, I think, I've taught myself around circles now, but you get, you get the point. The best job is a good fit on both.

Stephanie Goss: Everybody is enjoying the image of you trying to be in a library every day and, and pull yourself in and rein it in.

Dr. Andy Roark: That, but now I think that's, I think it's a great metaphor. It really is. Like if I had to be in the library 40 hours a week, that would be hard for me and no shade on the library. It's just like, that's a little bit hard for me.

Stephanie Goss: Yeah, and

Dr. Andy Roark: And trust me, let me tell you, it's a little bit hard on the library too.

Stephanie Goss: Yes, it is. And there's nothing wrong with with that and I think I think that's for me. It goes back to the same thing about the medicine piece of it. Like it's okay to say this is what I want to do when it comes to practicing medicine and so I think like from, it goes back to our headspace perspective, although I don't want to say that I told you so it's like thinking about it.

If this, if they weren't writing to us because they were in this scenario, they were writing to us because they're checking out the clinics in their area and they want to know things to look for. One of the things that I suggest to, to, to new grads and to, but especially to my team is you have a say in where you want to be because to your point, like you're going to spend 40 hours a week plus there.

And so know what, know what you want. It's like, it's like dating, you know, I've heard. I've heard so many horror stories from friends who are our age who have reentered the dating field and they're just like it's full of all of these awful people and this and and I will say like I, I feel like I love it because I know what I want and I put it out there like I know myself.

Hey, these are the things that I'm looking for. This is what I want. And I think it's the same way about work too. It's like, if you know what's important to you, you should put that out there. What are your non-negotiables? What are the things that are deal breakers for you? For me, and I'll give a great example.

For me, the first, the first non negotiable that I learned in veterinary medicine was that absolutely, once I left my first practice, I could not work in a practice that had paper charts, ever again. Once I went, once I went paperless, I just knew myself well enough to know. And that, so that became a question that I asked in the interview process.

Tell me about your record keeping processes. Tell me about your charts. What are they, you know, do you have paper? Do you have, do you have digital? If you have digital, what does that actually mean? Do you really have a ton of paper and then you're recording things afterwards or scanning them in, or are you actually truly paper light or paperless?

That was the first one I quickly also learned. That for me, a non-negotiable was only staff members, like we won't see patients, we won't have hospitalized patients that aren't current on their rabies vaccine because we had multiple pets who were there for optional treatment, like a dental who bit a team member and they were not current on their rabies vaccine.

And then I had to put team members through the prophylaxis, like that for me became a non negotiable. And so I would ask that in the interview process, like, can pets come in if they're not current on their rabies? What are those exceptions? Not because I was asking from a medical perspective because I believed that the medicine was right or wrong, but because for me on a personal level, that mattered to me and my comfort as a team member mattered to me and I found it okay to say.

I totally get that you don't want to require patients to have the rabies vaccine. Is this a deal breaker for myself? Because part of that interview process should be, it's just, it's just like, it's just like dating. I hate to put it that way, but like part of the question should be, what are your non negotiables?

What are those deal breakers for you? Because I want to know, I want to find those red flags so I can say thank you and it's not the right fit for me. Cause there's nothing wrong 

Dr. Andy Roark: Yeah, yeah, no, I think you're, I think you're spot on. I think that probably that's why it's so hard to take your first job. That's why I really always like to talk to vet students about it. Just because yeah, I think liken it back to a relationship after a while you kind of know what you're looking for But I remember being a young person who kind of had this deep insecurity of please just like me It's like what if what if no one likes me?

What if this is what it's like? What if this is? You're as good as it gets. And like, it's, it's just unsecured, but I think a lot of people have that, especially early on in your job, until you figure out, like, okay, this is, this is kind of what I'm worth, and this is kind of what I, you know, what I look for and what's important to me.

I think that's true. Okay, let's take a break here, and then we're gonna come back, and then we're gonna do action steps if you stick it out. Like, what can you do here? And again, this is, this is going to be doing the most with a bad situation. And so, yeah, but, but we'll go, we're gonna take a crack at it.

Stephanie Goss: Okay.

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Dr. Andy Roark: All right. So let's say that we have done this. We have had this talk. Let's say that this is the only vet clinic in town and we're tethered to town because I will tell you I wouldn't move away. I would, I would be willing to move away, but let's say we're not able to, let's say we're not able to what, what, what do we do here?

The biggest thing I would sort of say is okay, we're not gonna panic. Rome was not built in a day. We were not going to be able to turn this place around immediately. We can be proud of the relationship part of this business and lean into it. And that can be good. Okay, so let's start to try to talk about some change management when we're not the boss.

Stephanie Goss: Mmm- hmm.

Dr. Andy Roark: The first thing for me is figure out what's under your control and you can almost at least care for the patients that you see. Sorry, you can almost always at least care for the patients that you see. So the first thing is, all right, what control do I immediately have here? I'm wearing gloves. I'm going to put the gown on.

I'm going to use the pain control. Like, do I have that level of control? I hope that I do. Do, are there things that I don't know how to do? Then I'm going to go get some CE on those. There's on demand learning, I am going to, I'll go to some CE, I'm going to go ask for some CE, whatever I need. But, what can I immediately do?

And you say, but Andy, you're still out of practice. And I'll say, well, at least I've already said, I've already made it so, would I bring my pet to my practice? I would bring my pet to me at my practice. I would. And now when I can say, hey, why don't you come see me at the practice, I don't feel bad about that because I am going, you come and see me, and I will, I am going to do what's right. And the way that I see it. And so I immediately get out of the, ooh, I don't know if I bring my pet here. And so, again, it's a small thing, but it's a thing that I can immediately control. And you say, but I'm a new grad. I'm going to say, welcome to the grown up world. We're, like, you're going to have to, you're going to have to get on and get the education that you need, and I'm sorry.

But you can do that. There are lots of opportunities for education now that did not used to exist. And if you are worried about surgery, there's online training options, things like that. There are surgical wet labs. There are some really great opportunities out there to start getting that stuff. If you feel like that's what you need and you're not going to get it at your practice, my advice is take the bull by the horns and go and get what you need to make yourself into the doctor that you want to be.

There are people who became great doctors, not because they had a great mentor, but because they didn't have a great mentor and they went hard in the paint to make themselves what they needed to be. And you can do that. It takes courage and it takes some grit and it takes some resilience, but you can a hundred percent make that for yourself.

You just have to, you have to grit your teeth and you have to do it. And I said there are some great doctors out there who made themselves and you can do that too.

Stephanie Goss: And I think it's important to, speaking to the paraprofessional staff, I think it's important to recognize that there are things that are in your control, and it's easy to think I'm not the doctor, so I am powerless in this situation, and to your point about taking care of the patients in, in your hands, the patients that see you, I think it's not only acceptable, but I, I want to encourage all of the paraprofessional staff to look at it the same way. So, as a technician, I can't tell you how many times I worked with doctors who I truly believed were good doctors. Where we were doing something and getting ready for a procedure and they started to do something and I'm like hi, would you like me to give some some pre op, you know, some pre-op meds or would you like me to give?

And they're like, oh yeah, I didn't think about that. Yeah, please do that. And then come get me right. Like where it's not, it's not intentional. It just is. is the thing that happens. And so recognizing that you are in control of everything that you have the training to do. And it goes the same for the front desk.

Like you can control the service that the clients are getting. You can control the things that you, and it's in how you ask about it. And I can't tell you how many times my dumb curiosity, and some of it is I actually genuinely didn't know and some of it has been plain dumb how the dumb curiosity has solved what could have been big problems for me because I had the courage to ask the question Hey, are we gonna send home pain control with that patient?

Hey, are we putting this patient on antibiotics because they're also on an NSAID? I saw that when I was looking in their chart, right? Like it those are things that I can control even from the front desk. So stepping back and really doing some work on your part to think about what are the pieces of your job that you own?

And recognizing it's okay to ask and ask for what you need and advocate for yourself and say hey, I've noticed that you all are not wearing you know, gowns and surgical caps when you do this type of procedure. Can you tell me more about that? Because I was trained to, to always wear it and here's, here's why, and I would love to understand what, why you guys are doing what you're doing, right?

That can bring about the conversation. It's coming at it from a place of curiosity versus I'm not going to do surgery unless we're all fully gowned. That feels very antagonistic, and I think that that's very important. If you are going to stay and try and change things, I think it's very important to recognize that you are going to have to get them to meet in the middle. And you said in the very beginning, Andy, you worried that this was a huge gap to cover. And I think when the gap is huge is when it is most important to try and approach it from a place of curiosity and kindness and to recognize that a lot of baby steps can still ultimately get you to where you want to be just as quickly as making giant leaps across the space.

Dr. Andy Roark: Well that dovetails into number two for me. I think you're spot on and that's that's pick your battles Like I said Rome was not built in a day. We're not gonna roll in and start changing, you know, how we do emergencies and surgeries and hospitalized patients and fluid like we're not that stuff. We're not gonna do all that. Pick your battles, figure out what your one or two things are That you really want to work on, and then approach them, as you said, with curiosity.

I think that's really the, the right way to approach them is, Help, why do we, why do we do it this way? I'm, I'm new here. I haven't seen it done that way before. Talk to me about, about, about why we approach it this way. Help me understand. But I think that's a big thing. Think about what is most likely to get taken up.

I think that that's, again, in setting our priorities, I wish it could be, this is the most important thing. Well, there's a couple factors. Number one, what do you think is most likely to get people to buy into? And, and sometimes we take the things that we think are most likely to succeed, because if you can start making some changes and people are like, okay, this is good, then it sort of builds some momentum and you can maybe make some more changes.

What will make the biggest difference, and that's difference for you, difference for the patients, but what, what are the big things that make the biggest difference? What might get systematized across doctors and and happen when you're not in the building? Which means, what are the changes that we could get in a system level so that it's not just the things that, you know, we're not doing surgeries differently when I'm there.

They're getting done in a way that everyone who's doing surgery is doing them this way. And now we're really raising the standard across the patient. And again, you kind of have to look at those things and sort of say, all right, looking at all the things I want to change. Which ones are the hills that I'm, that I'm willing to die on, and then also which ones are people willing to take up, and which ones, you know, are going to extrapolate out across the practice.

And all those sorts of things those things all come into, into, into play, whether you're the doctor or the technician. One of the biggest things I try to teach to associate vets, just in general, the biggest, the biggest the most underrated superpower of associate veterinarian is positive reinforcement. It is amazing how much change you can make and how much you can guide your technician teams, not by correcting mistakes, but by praising and using positive reinforcement.

And that is identifying the behaviors that you like, the ones you want to see more of, clearly pointing out this is the behavior that you did. This is the situation. This is the behavior. This is why it was so great. Please keep that up or I just wanted to say thank you. And you can a hundred percent praise people and grow them in that direction.

It takes effort, which is why people don't do it all the time. You know, when I explain it to people, they go, this is so simple. Or if it's so simple, why didn't people do it? It's like, because it takes effort because you have to be willing to have the slightly awkward conversation saying, hey, can I talk to you real quick?

I just want to say I saw you do this and it was, it was really great. I just, I always really like working with you and I appreciate, I appreciate how much care you take with the patients in the treatment room. I just, I want to tell you that that was really great. And it takes, it just takes a moment to do it, but it takes intention.

And then you have to be willing to, to sort of shout people out. So those are, those are, those are big ones. And again, you can do it with peers as, as a, as a doctor, that's how you start to sort of turn the staff as you find them doing the things that you would like to see more of, and you just tell them again, not bad mouth in the practice, not like nobody else does this.

I see you wearing gloves when nobody else is. It's like, no, hey, it's obvious that you care a lot and you have attention to detail and you're paying attention to surgical sterility. And it's just something that I have noticed about you. And I just, I just want to say bravo. Like that was, I love that you do that.I'm always happy when I get to work with you. Thank you for that.

Stephanie Goss: Well, and I think that's 

Dr. Andy Roark: Then you can start to, you can start to turn, you can start to turn things and start to get a little revolution going. And again, I'm not turning against the hospital and I'm not going to be like, those other guys don't do this, but you do.

It's nope, I love this behavior, I, I really, I'm always glad when I get to work with you because you do these specific things. And that's how we start to build that. And then, and then the techs talk. They will say, oh, well, Dr. Roark really likes this. And they take pride in knowing what, what you like, and, and you can, you can make those things ripple out.

And again, you might not be able to get everybody on board, but you can at least start to control the area around yourself.

Stephanie Goss: Well, and I think that applies within the team to like, I don't think it has to be a doctor, you know, I think it's very, it's a very effective tool and it makes sense to speak to it from that doctor perspective. And I think if you're a part of the patient care team, this is where you're going to need friends because if you're going to try and change things, you cannot, you can, the change, you can impact change as a single person and people can enact change on a significantly faster level.

And so I think thinking about it from, how do I make some friends? How do I talk to the other assistant? It may be an assistant and not a technician, but how do I talk to the assistant about the fact that they, I saw them not pre opening or pre popping the syringes. Let me find out why. Why are they doing it differently?

What are they, you know, let me say, hey, I noticed you're doing this and I really like it. Tell me, tell me more about it. Cause I've seen other people who aren't doing it that way and I'm trying to understand, right. It's about recruiting people and making some friends because it takes, you know, the more momentum that you build, you're going to build it faster if you have more people trying to push that boulder up the hill.

Right? So looking at those things that you can control from whatever your position is in the hospital and recognizing that it can go, you know, Significantly faster in particular from the doctor to support staff level and you're gonna need friends in in the team and so finding those things and complimenting them to your point and not to be disingenuous like don't say if you don't actually believe it and it's going to have a big impact if you have some people who you can be like, hey I noticed that enough of us are doing this differently.

I'd really like to bring this up, you know, to Dr. Roark so that maybe we can talk about it at the next team meeting. How do you guys feel about that? then it's, then it's a group of us bringing it up and having a conversation instead of the one person saying, Hey, I disagree with how you're doing this and I would like to see us do it differently.

Dr. Andy Roark: Yeah. I agree. And the last thing I'll sort of say, too, and this is a little bit, this is a little bit bold, but, if you're really tied to this area, and this is kind of what you're looking at again, as I, I don't know if this is a doctor or support staff, but I have loved owning my own business and sometimes necessity is the mother of invention. And if you, if you really don't like it and this is not going to work for you it can be a leap, but sometimes you have to go make your own thing. And the last thing I would say is, you know, if we got this practice and it sounds like it's you know, kind of making its way if, if it is independently owned if you're up for it mentioning to the current owners.

Hey, I was just curious. Do you have an exit plan? It is it's hard to sell practices sometimes and especially hard to sell to other veterinarians, but if you're like, I love the relationships that I love the way we treat our clients I would like to take this place to the next level. It's a bold move but but anyway, it's I, I always love, I love that type of stuff.

I like being my own boss. I like having a vision and seeing what things could be. And then and then take, you have to take the risk and the responsibility, but you, but you get the, you get to make what you want to make in the world. And that's just sort of my love level or my love letter to small business ownership.

Stephanie Goss: Well, and I think that that, I think that that doesn't solely speak to the doctor either because one of one of our Uncharted community members and, and one of our mutual closest friends Jenn Galvin is a Practice Manager. She's not a doctor. She's not you know, was not, she was an assistant, but not a licensed technician. Her practice she co owns with her partner, Erica, who is a DVM. They started their own practice because they weren't happy in the practice they were in with some of the medical things. And they were like, I would like to do this differently. Would you like to do this differently too? Hey, maybe we can do this differently together.

And so I think. Don't rule yourself out and don't sell yourself short. As a paraprofessional team member, you might very well be in a state where you can't be in honor of a practice as a non veterinarian. And that doesn't mean that you can't still get what you need out of it. I had one of my best technicians who was like, I'm really struggling with finding a practice where they practice this level.

They actually were a VTS in dentistry and were in a pretty rural area. And they were like, Hey, I'm going to go out and do like traveling relief and be a veterinary technician to go into practices. There were so many practices who were like, I don't need to have any input on this. Like, please do these, do these dentals for me.

And, and they were like, I'm so much happier because I get to control the pieces that I wanted. And yes, I have the travel, but I still get to stay in the area. I didn't have to move all of those things. So to your point, Andy, like sometimes it takes being creative and thinking outside of the box if you truly are tied to an area, but don't think that it's impossible just because you aren't a veterinarian too, I guess would be my, my love letter to the paraprofessional staff.

Dr. Andy Roark: Yeah. I love it. Well, good deal. I think that's all I got.

Stephanie Goss: Okay. This was fun.

Dr. Andy Roark: I’m rooting for this person. I hope this I don't know, I don't know how it's going to turn out, but one way or another it's going to be okay.

Stephanie Goss: Yeah, this was, this was an anonymous one because the vet world is, it's very small and to our anonymous writer, if you're listening, we would love to know how this turns out.

Dr. Andy Roark: Yeah, definitely. Yeah. Well, there's, there's more, there's more people doing surgery without gloves than than you want to admit,

Stephanie Goss: Oh, yes, Yeah. Anyways have a great week, everybody. Take care.

Dr. Andy Roark: Thanks 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 mailbag at the website. The address is unchartedvet.com forward slash 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.