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behavior

Jan 11 2023

Coaching Spicy Tenured Team Members

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and special guest practice manager Maria Pirita break down the problem of what to do when one of your seasoned team members turns spicy! In this question from a conference attendee, we have a lead technician who is not doing the “menial” parts of her job and is being rude to other team members. How are we going to handle it? Let's get into this…

Uncharted Veterinary Podcast · UVP – 213 – Coaching Spicy Tenured Team Members
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You can also listen to the episode on Apple Podcasts, Spotify, Google Podcasts, Amazon Music or wherever you get your podcasts.

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


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

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January 21, 2023 – Start The Year Off Right Series: Loading the Bus with Stephanie Goss

Do you have the right people to go where you want to go? This workshop will help you look at the people in your practice and find their strengths, acknowledge the challenges and still reach the goals of your practice together. We'll help you look objectively to make sure everyone is in the right seat on the bus and discuss what to do when we decide someone needs a new seat or maybe should get off our bus altogether.

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Episode Transcript

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

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

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

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

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

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

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

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

Dr. Andy Roark:
Hey, everybody. I'm Dr. Andy Roark and this is the Uncharted Podcast. Man, it's been a while since I got to do that. Welcome, welcome, everybody. I am here with Maria Pirita today. We are breaking down how to coach the spicy tenured team member. What do you do when you've got somebody who's been on the team for some time? They may be a shift lead, a team lead, a department lead, and they're just not performing.
Maybe they're not doing menial tasks, they're not cleaning cages or cleaning up the surgery suite because they think it's beneath them. Maybe they're just grumbling, maybe they're just snapping at people, maybe they're not treating people in a way that that person feels respected or they're throwing their weight around a little bit. What do you do? How do you talk to that person? That's what this episode is all about. Guys, let's get into it.

Speaker 3:
And now the Uncharted Podcast.

Dr. Andy Roark:
Hey, and we are back. It's me, Dr. Andy Roark and the one and only Maria Pirita. Hello, my friend.

Maria Pirita:
Hello. How are you doing?

Dr. Andy Roark:
Man, I am so good. How are you doing?

Maria Pirita:
I am so good. We just got into Chicago, and we beat the blizzard, so I'm feeling great.

Dr. Andy Roark:
Like you raced to your little den and lit your fire, and then the snow came down outside and now you're toasty as a bug in a rug.

Maria Pirita:
Yeah. I literally got hot cocoa, so now I'm just going to make my hot cocoa and watch the snowfall.

Dr. Andy Roark:
You are who I aspire to be at Christmas time. We did a workshop together, you and I, and it was like 50 doctors. And we couldn't get anything done because Maria has a Christmas tree that rotates and it was behind her, and so everyone was watching her Christmas tree just rotate, and there was like every three minutes someone would notice it and the chat would just blow up with, “I know.” And so you do Christmas really, really well. I have to say.

Maria Pirita:
I love Christmas. I've always loved everything about Christmas. My birthday's 10 days before Christmas, so I don't know if it's a mixture of both of them going together or the fact that my family always did it so big. That rotating base actually was a recommendation for my sister a long time ago. And then one time my base actually broke and I needed to go to get one, and all they had was the rotating one, so I had to get it, and it turned out to be a great purchase until we did the workshop and-

Dr. Andy Roark:
And shut it down.

Maria Pirita:
… we couldn't get through the workshop because everybody wanted to hear about the rotating base.

Dr. Andy Roark:
Yeah. The whole thing.

Maria Pirita:
It's available. It's a real thing.

Dr. Andy Roark:
The whole thing ground to a halt. Yeah. When this episode comes out, it'll be New Year. You're a big New Year person too that you go all in for 20 days.

Maria Pirita:
Yeah. I love New Year's. Man, it's a lot of fun. I prepare a lot for New Year's. My husband and I have a great tradition where we make surf and turf steak and lobster dinner, and we write out goals and aspirations for the new year, and we light a fire. And then once midnight hits, we celebrate with all of these Latin traditions, which are crazy and out there, but I absolutely love all of them. Some of them, a lot of people know about like you wear red underwear if you want love in the new year, or you wear yellow underwear if you want money. You can put lentils in your wallet and that represents that you're going to spend your money well in the new year, and all these crazy things. We do all of them. So we put 12 grapes in our-

Dr. Andy Roark:
Yes. You got multiple pairs of underwear.

Maria Pirita:
Yeah. All at once. You got to want all of them. You got to wear all the underwear. We put 12 grapes in our pockets and you make a wish with each one. But my favorite one is that at midnight you take your suitcase, and you walk around the block with your suitcase and that represents that you're going to travel a lot in the new year. And last year was actually the first year that we did that. And I will say that this past year we went to Paris and Rome, and I got to go to Greenville for the conference, and we went to Indianapolis for work too. So I would say that it worked. So if you're trying to travel in the New Year at midnight, grab your suitcase, go walk around the block with your suitcase, and you'll probably travel is all I'm saying, unless it was just a fluke.

Dr. Andy Roark:
I think some people can just stop the podcast right now. They're like, “I got what I needed for… Yep. I got what I needed.”

Maria Pirita:
Unless this comes out after New Year's, then it'll have them the next year.

Dr. Andy Roark:
Yeah. And they're like, “Ah.” Going to have to put it on the calendar. Yeah. Oh, man. So for those who don't know you, you are a newly minted CVPM. Congratulations on your new certification.

Maria Pirita:
Yeah. Thank you.

Dr. Andy Roark:
You work with us over at Uncharted, you're doing more and more of the lecturing and the lifting. And I've been so happy working with you, and I just enjoy the heck out of you.

Maria Pirita:
Oh, thank you.

Dr. Andy Roark:
And so anyway, I want to talk to you about what we got. It wasn't the mail bag, we got it at a conference. Do you want to go ahead and break down what we're looking at?

Maria Pirita:
Yeah, actually. So we were at a conference in Indianapolis and this amazing practice manager, if you're listening, you are amazing, but she was telling us about a challenge that she's having and it's essentially that she has this tenured team member who's a little spicy, we'll say. She has been with the clinic for a really, really long time. Great skills, however, lately, she's been doing things like she's been not wanting to clean up after surgery because she thinks it might be beneath her, or she's just been a little bit spicier in the way that she talks to people. And what was crazy is we started talking about it and it turns out a lot of people were struggling with this challenge, and that's when we thought, “This would actually make a great podcast episode because there are definitely things that can be done.” And I've certainly been there. Have you been there?

Dr. Andy Roark:
Yeah. Yeah, yeah. Oh yeah, totally. I think we all were. I like the term here for spicy. This is one of the things I think that you do really well. It's like that's your word. And I think it's a healthy way to look at it to say, “Oh, well, this person's a bit spicy.” It's not that they're not aggressive or angry, but once we frame them that way, they take on a villainous personality and you say, “Well, they're spicy.” And I go, “I like that, I can work with spicy. Sometimes spice is okay.”
And so I like that you frame it that way. It also brings across a lot of times what the behavior with the attitude is. And so I just want to start upfront and say, “I like how you frame this question,” and by making this person framing them as spicy, I think you're already opening up a lot of good doors for us to get things done. I don't want to be told that I'm aggressive, I don't want to be told that I'm a bully. I don't want to be told that I'm hard to work with. But if you tell me I'm being a bit spicy today, I'm not going to take that particularly hard. I think language matters and how we frame things matters. And so I like how you set that up. Just open up.

Maria Pirita:
Thanks.

Dr. Andy Roark:
So yeah, I have a lot of ideas on this.

Maria Pirita:
I love the term spicy too because… Well, I think we started using it in clinic because when we became Fear Free, that was one of the big things that they taught you is try to stop using the word aggressive or mean when you're talking about patient because they're not, they're just fearful, stressed, or anxious. And so you changing your mindset there. So we adopted it and we started using it a lot, and one of my favorite things to say to people would be, “Ooh, that came out a little spicy. How can we add some sour cream?” And it became a hit because it'd be like, okay, it's not that you are a mean person. It is totally that it just came out spicy and sometimes we all wake up a little spicy and that's okay. Just get that done and done with some sour cream. That's it.

Dr. Andy Roark:
Yeah. I like that. I think that's part of building a good culture is setting it up where we can give each other feedback that's not catastrophic or devastating, that doesn't strike at who you are as a person. But yeah, it's a little thing. I always say one of the real tricks to giving people feedback is lowering the stakes, trying to make it so it's not a big deal for me to say, “Hey, when you said this, it had this impact that you didn't really anticipate. I need you to do that differently.” How do I make that not a big deal? Like, “Hey, I know you know this.” But whenever you say something that starts with, “Hey, you”, people get real defensive real fast, and I just want to make sure you get heard. And so “let's do that differently next time. Alright. Thanks, man.” And just try to make it so it doesn't matter.
And I think a lot of times we don't say anything when it doesn't matter, and then we wait until it does matter and then we have these high-stakes conversation. So anyway, just anything that just takes the edge off and it's just like, “Hey, man, this is okay. We're just going to break it down a couple notches, but also I need you do this differently for me. Thanks, man.” I think that that's just good feedback coaching headspace.

Maria Pirita:
Yeah. Absolutely.

Dr. Andy Roark:
So speaking of headspace, let's get to headspace here. All right. Cool. So first, we start talking about this. I want to point something out in the question itself. And so one of the examples was, “Hey, this person's not cleaning up after surgery, things like that. She acts like maybe this is beneath her.” I would say, does she say that it's beneath her or is that the assumption that I, as the manager, and making about her, right?

Maria Pirita:
Absolutely.

Dr. Andy Roark:
Because one of the first things we want to try to do is assume noble intent, assume good intent. I don't want to be like, “Oh, she didn't do it.” That clearly means that she thinks she's better than this like, “I don't know what it means. I don't know why she's not doing it and neither do you.” So until we ask her, “Hey, I saw this thing didn't happen. It seems like it's starting to become a pattern. What's going on? What's the story?” That's straight up, those are the exact words I would use. “Hey, I see this, it seems like it's starting to become a pattern going on. Just what's the story here?” And then I'm going to shut up, and I'm going to let her tell me, but I don't want to try to assume what her intentions are. And she might be like, “That's not my job.”
And now I go, “Okay. Okay. I get that.” At least I understand now that she does not believe this is her job. That's not an assumption. That's what she told me. And then we can start to work on that. So yeah, I think we start off assuming good intent. It's our safe headspace, right?

Maria Pirita:
Yeah.

Dr. Andy Roark:
Can I sit next to this person? Can I smile at them? Don't give them the feedback when you are triggered. Just let it go for a day. The key is put it on your calendar. If you're triggered, you're like, “I can't talk to this person right now.” If you're me, I can't talk to this person right now and then tomorrow's not going to seem like that big a deal, and I really don't like conflict, and so I'm not going to do it tomorrow. And then after that it's going to disappear. It's not going to happen. And then we're going to do this again. So put on the calendar, be like, “All right. I'm going to talk to this person on, if I haven't talked to them by Thursday morning, we're going to talk on Thursday morning.”
But can you sit next to them? Can you smile? Are you assuming good intent? Have they been set up to fail? If she thinks this is not her job and it is her job, that's on me because I didn't communicate to her, “This is your job.” And so maybe she's been set up to fail, maybe our job descriptions are not what they should be. Maybe she didn't review her job description, maybe she didn't sign her job description. Maybe she hasn't gotten an evaluation on performance, reviewing her job description, whatever. Maybe she's been set up to fail.
And the last thing is the end result like, “What do I want?” And this is a big thing of like, look, I don't want her to apologize for not cleaning up the surgery suite. I don't care. I just want her to clean it up next time or do what she's supposed to do or come to an agreement with the other tech so that it gets done. But basically, I want it to get done. I want everybody to feel like they're being treated fairly. That's what I want. And so that's the end result I'm working towards.

Maria Pirita:
Yeah. Absolutely. And one thing that I think is really important in that is when you're seeking to understand is that sometimes it could be so many other things as far as why a person is spicy. So it really is important to ask that question, how did this person even get here in the first place? And so having that discussion, you might find out this person might be frustrated from other things happening in the clinic. Perhaps she may need some change here or there. If she's a registered veterinary technician and she thinks maybe she should be doing more as a registered tech. How many of us have credentialed technicians that we're not utilizing to their fullest potential or treating them like assistants? And so the only way you're really going to figure out how this person got here is by having that conversation and, like you said, seeking to understand.

Dr. Andy Roark:
Yeah. Sometimes these people get set up to get caught. Sometimes they're just not as savvy as the people who are really doing the dirty stuff. I hate to compare it to my kids, but it was like with my kids. My older one could just tweak my younger child so that my younger child would go off, and then everyone would look at the younger child. And it didn't take long as a parent before you realize, you're like, “Okay. Hey, older kid, I know that you are the one who caused this problem.” And you put our younger kid in a position where they're going to get in trouble. And sometimes that happens with the staff where the person who gets mad is not the person at fault, they're the person who's reacting and they're probably not reacting appropriately or else they would've done this another way. But sometimes they're reacting inappropriately to something that's not fair or just something else where somebody else has screwed them over. And that's again, that's why you just got to ask the question.
The other thing is they specifically said this is a tenured person. And so there's a couple different types of problems that come up with tenured staff that are less likely to come up with younger staff. This is broad generalities, but to me the term tenured, matters. When there's certain types of behaviors that we get, it's often they're power play behaviors of, “That's not my job, that's someone else's job.” So just some of that stuff. But the other thing is when you have tenured staff members and they're having patterns of behavior, they didn't get that way overnight. It's like you hired this person and then you were surprised that they acted this way. They've been around for a long time. So my question is, what has changed? Has this been a slow steady creep or is this something where there's something going on that has changed their behavior?
The other thing is if they're tenured, they've conceivably had a history of being successful in your practice. And I think that that's something that we can lean on. So we talk about headspace, we go, “Well, this person's been here a long time, why is this becoming an issue now?” And again, I do find it's helpful for me when I can assume responsibility and say, “Well, I've been her boss for some time and this creep has happened on my watch and I haven't corrected it.” So I got to look at myself and say, “Where did I miss a trick?” And that's just a healthy headspace to get into, make you really effective when you go and talk to the person. So that's it too.
I asked myself questions a lot about burnout and fatigue. When I have people who are tenured, they've been doing this a long time, is this person burned out? Are they just done? Is this just a general, not about work, it's just about life or things like that? Is there something else going on with them? Those are all things I'm looking for and trying to figure out, again, what is the underlying thing? Is it just straight up, “I don't want to clean up the surgery suite”? Or is it, “I'm tired, I don't see a future for myself here. I don't feel like I'm appreciated, I don't feel like I'm respected”? Those things matter.
And I'm not saying the person is right, and we may disagree. Sometimes people say, “I don't feel appreciated.” And sometimes that's valid and sometimes it's not. And usually, the truth is somewhere in the middle where they should be appreciated for some things that they do. And there's some other things that maybe they don't do that they should do. It's always a mixed bag. It's always shades of gray with people. But I'm just trying to get down into their psyche of where are they coming from and what's the real issue?

Maria Pirita:
Yeah. And I think sometimes as practice managers too, we're putting ourselves in this position where we think, “Oh, this person has great skills. They've been here a really long time. I'm afraid of losing them. So then we fail to have some of the conversations that we should have.” So another question that I would ask myself is, how often has she gotten away with this without us discussing it over and over again to the point where she thinks that this is now how it should be?
Or in some cases, they try to push buttons… Not push buttons. That's a bad way of saying it. But they try to see what they can get away with because they themselves know they're high tech skills. They know that they have the ability to draw blood, and drop catheters, and they can be in surgery, and they can do all of these great things. So there is something, as a practice manager, you have to ask yourself, “How often has this been happening? Did this become a pattern and I didn't say it so now it has become the norm?” And getting into that space mentally before you have these conversations.

Dr. Andy Roark:
Yeah. I agree with that. And I think the other thing we want to think about with a tenured team member is where do they want to go and what do they want to see in the future? And a lot of times I feel like these spicy team member, tenured team member things, they come from a place from where this person topped out, and they don't really know where they want to go in the future, or what they're going to do, or what's going to be different. So they're like, “I'm the head surgery tech and I don't want to be the practice manager or there's already a practice manager and there's not space for me. And so here I am, but I'm tired of this, but I don't really know where I want to go. And so I'm just generally at a loss for who I am and where I'm going.”
And I think that this starts to really unlock the key for me with dealing with tenured, more senior people. This person has climbed up to a place where let's say their career path may be a bit hazy in the future or they topped out in what they can do, and if they're burning out because of that, if they're bored because of that, if they're just like, “No, no, I don't see myself in the future, so I'm just going to do what I want to do right now.” That's a vision problem. It's a motivation problem. It's a vision problem. And so again, it starts we try to figure out, “Where's this person coming from? What's driving this? Is it that they don't know where they're going?” And you can ask those questions like, “Where do you want to go in next year?”
We just did with our team. Maria and I were talking and the team was there, but I was basically like, “What's your development goal for 2023? What do you want to be? What do you want to learn? How do you want to grow?” You can do that professionally. I want to do it professionally but also personally. And so just like Maria's walking around the block with her suitcase because she wants to travel. I want to know where people want to go. It's not something to hold people to, but I ask people that and now it's a great time to say, “Hey, it's the new year. Where do you want to go in the next year? How do you want to grow? How do you want to develop?” And ask them, and then when they say that, try to figure out how to get them there, how to keep growing. There's a lot more latitudes for people to grow in that medicine than we give credence to.
For example, we're like, “We have a vet assistants, and we have vet techs, and then we have lead vet techs, and that's the end of the story.” And I'm like, “No, it's not.” There's so many different subjects that we can expand to. There's so much expertise. There's credentialing, advanced credentialing, there's technician specialists, there's management credits, there's leadership opportunities, there's communication things, there's workshops, there's skill workshops, there's all these things that they can do. You can spend years getting great at dentistry, and then just roll off of that into anesthesia, and roll off of that into pain management, and into low-stress handling, into fear free. And you can work your whole career learning and growing and learning and growing. But if you think your whole path is assistant vet tech, head vet tech, that's it. That's a very short, stunted path that leads to a lot of frustration.
And so one of the big things is where do these people want to go, and can they see themselves in the future being developed, and do they feel like they're moving towards something greater? And if you can't make them see that, a lot of times you can't coach them very well. And so anyway, when we start thinking about senior people, do they see the vision for the future? Do they see where they can go? Do they see how they can grow? Are they engaged with that vision? And if the answer is no, then from a headspace standpoint, I need to figure that out because this person's going to be consistently hard to manage and they're going to be consistently hard to motivate if I can't make them see a future where they are better and more developed than they are right now.

Maria Pirita:
Yeah, Andy, and I'm so glad you said that because it actually reminds me of a spicy team member who I had when I was a practice manager. And she was amazing. She had amazing skills, the kind that you could always trust to hit the vein or drop the catheter, but she did have a bit of a spiciness around, especially around new people. It seemed like she would get frustrated during the training. So it was one of the situations where I looked at her and I was like, “Man, she could go so far. We just have to work on that one thing.” So I remember sitting down with her and having this discussion and we started on that, and on that topic is development. I asked her, “Where do you see yourself?” And she said, “Actually, I have been thinking about that a lot.” She was a veterinary assistant at the time. She's like, “I think I want to go into CVT school. And I also think that the treatment manager position looks really great.” Treatment manager was taking care of the hospitalized patients, right?

Dr. Andy Roark:
Yeah.

Maria Pirita:
And so I was like, “Okay. That sounds awesome. Yeah. Those are definitely areas we could talk about going.” And as we were discussing the treatment manager role, we got into discussing training. And so it was a perfect opportunity for me to talk to her about, “Well, I've noticed you can get a little spicy around new people. And so if we want to go down that path, there's things that we should work on there, but that's totally normal. We can work on those things. There are tons of leadership webinars that we can talk about books and bottom line, nobody became a leader overnight. And so this is great that this is the route you want to go in.” And so she said, “I know what you're talking about. The issue is that I never notice when I'm doing it until it's too late.” And I said, “I get that. I grew up around siblings, so I have a sassiness to me.” Andy, I'm sure you've seen it at conferences and whatnot, that it can happen to anyone.

Dr. Andy Roark:
You have more than a sassiness to you, just for people who don't know. You have amazing sass. I'm going to stop you right here because this is important. Maria and I were having dinner and we were at Tupelo Honey restaurant.

Maria Pirita:
Oh, no.

Dr. Andy Roark:
And she was looking at her straw. She was like, “I think the straw is made of honey.” And I was like, “I don't think that's a thing.” And she was like, “No, I'm pretty sure this is an organic straw made of honey.” And I looked and there was another straw on the table and it had the wrapper on it. And I picked it up, and it said, I read it out loud, I was like, “Made from 100% pure agave.” And Maria goes, “Who's laughing now?”

Maria Pirita:
It still wasn't honey, guys.

Dr. Andy Roark:
But that's the same thing. But you were like, “It's organic, it counts. Who's laughing now, Roark?”

Maria Pirita:
It's close enough.

Dr. Andy Roark:
Yeah. It's close enough. And I will say, I learned a couple days later, there's a store that sells honey products in Greenville. I looked in there, I was like, “Do you have straws?” And they were like, “Yes, we do.” I was like, “Oh, she could have been right.” But then I thought when they were like, “Yes, we do.” I was like, “Who's laughing now?”

Maria Pirita:
Who's laughing now?

Dr. Andy Roark:
[inaudible 00:25:13]. It's not a little bit of sass. It's a pretty defining characteristic. I love it, but let's not downplay it.

Maria Pirita:
So that's exactly what I was talking about. When I was talking to her about it, I said, “Yeah, I have sass too.” It's a matter of where to use it, and we were out at dinner in this example. So that's when my sass comes out is because I'm not working. I got it, but it's also… Obviously, I didn't talk to her about that because it hadn't happened yet.
But when I was talking to this team member, I basically told her it happens. It happens to all of us. It happens to me. And so I asked her, “What's a good system that you think would work for us to help you in this journey?” And she said, “Well, actually, if you could just point it out when you see it, if there could be a signal?” And I said, “Yeah. Absolutely.” So we decided that I would give her this eye contact and make the peace sign. Eventually, I didn't even need to make this peace sign with my hands. The number two, looks like a two. But I got to the point where I didn't even have to, I would just look over when I heard it, and you could hear her going back in herself, the way she was talking and try to formulate it a different way. And that helped a lot.
And we also talked about leadership as a whole and what kind of resources were available to her and giving her the time to do some of those and some recommendations on books. And I still remember she came to me so excited one time, she's like, “Hey, I spent this weekend reading this book that you recommended. I think it really helped me a lot.” And I will say that there was a noticeable improvement in her because she was striving towards this goal of becoming a manager and a leader because obviously, she had great assistant skills. She had done so much there that she was ready to move up to that next level. And putting in, not only giving her the resources, but also acknowledging that there was this area that we could work on helped tremendously.
To this day, she's still going strong in her position as treatment manager, and she's going to school still for her CVT, and she's loving it. And it's definitely something that I love seeing in people because they got to have that strive to want that, and she had it, and she did it. And big props to her. I hope she listens to this episode one day.

Dr. Andy Roark:
Yeah. Okay. I love that story, and it's awesome. And I want to break it down step by step into action. So let's pause for a second here. Let's take a break and then we'll come back, and I want to run back through that story and just tell you what I love about it because that's going to… I think we should use that story to frame the action steps because that's [inaudible 00:27:50] with us how you do it, you crushed.
Hey, guys, I just want to hop in really quick and give a quick plug. The Uncharted Veterinary Conference is coming in April. Guys, I founded the Uncharted Veterinary Conference in 2017. It is a one-of-a-kind conference. It is all about business. It is about internal communications working effectively inside your practice if you're a leader. That means you can be a medical director. It means you can be an associate vet who really wants to work well with your technicians. It means you can be a head technician, a head CSR, you can be a practice owner, practice manager, multi-site manager, multi-site medical director. We work with a lot of those people. This is all about building systems, setting expectations to work effectively with your people.
Guys, Uncharted is a pure mentorship conference. That means that we come together and there is a lot of discussion. We create a significant percentage of the schedule, the agenda at the event, which means we are going to talk about the things that you are interested in. It is always, as I said, business communication focused, but a lot of freedom inside that to make sure that you get to talk about what you want to talk about. We really prioritize people being able to have one-on-one conversations, to pick people's brains, to get advice from people who have wrestled with the problems that they are currently wrestling with. We make all that stuff happen. If you want to come to a conference where you do not sit and get lectured at, but you work on your own practice, your own challenges, your own growth and development, that's what Uncharted is. Take a chance, give us a look, come and check it out. It is in April. I'll put a link in the show notes for registration, ask anybody who's been, it's something special. All right. Let's get back into this episode.
Okay. Let's get back into this. So you just told the story, I love it. I want to break down some things that I see in the story when you were talking about coaching this person. Number one, the first thing you did, which is absolutely amazing, I love it, is you framed your feedback not as corrective, not as like, “Hey, you really screwed this up and we need to go through, and look at what you did, and you need to apologize.” It wasn't corrective feedback, it wasn't, “I want you to own your mistake.” You 100% were like, “Where do you want to go?” And you got a picture of where she was going, and then you framed your feedback as developmental feedback. This is how we want to get there.
And so especially with your tenured team members, if they've been around a long time, if they're a shift lead, a department lead, stuff like that, they may not take just straight up, “Hey, you messed this up” feedback very well. They can feel like they're being taken down a peg. Really, really dislike that. Those people tend to respond better, in my experience, to developmental feedback of, “I see you, I see your skills, I want to talk about how we're going to grow you and where you go from here and these are the changes you're going to need to make to get there.” And so I think that was just a textbook lesson and how you give developmental feedback and figure out what people care about.
The one thing that the tech had going for her, which I think is really, really important, it's just a self-awareness when she's like, “Yeah. I do that. My thing is I don't realize it until it's over.” I go, man, self-awareness is an underutilized, underappreciated characteristic for people to have. And then the last thing is you talked to her, you came up with a plan about how you were going to help her, and then you were there to catch her in the moment like, “I'll give you the sign,” but you were there to give her the feedback. And when you're like, “I didn't have to give the sign anymore,” probably just the fact that you were there was enough for her to be like, “You are a sign of, ‘Oh yeah, I'm trying to do my best or I'm trying to do better.'” So I don't know. When I lay that down, do you agree with that or are there other pieces to it that you think should be called on?

Maria Pirita:
Yeah. Absolutely. And I agree with all of that. I think it's interesting. I would talk about the sign and just being there because I think we forget that sometimes with sass or with spiciness, coming from an expert in it, it does take the habit. It's a habit.

Dr. Andy Roark:
It is a habit. Yeah.

Maria Pirita:
It is a habit. You have to break a habit in order to be a better leader. And it's something that obviously, being a leader myself, we had to get over that, but it's going to take time to break a habit. And so the other part to that is being able to give them the time to do that but also the follow-up. When we're talking about… In this example, following up later on within the 30, 60, 90-day mark, whatever you decide to do on, and giving them feedback that, “I see you working on this and it's going great. Keep up the good work.” Or seeing, making sure that we don't just talk about it once and then forgetting about it, but also going back, giving that feedback, and talking about it again later on.

Dr. Andy Roark:
Yeah. How do you get tenured team members to tell you what their goals are when they don't know what their goals are? So let me ask you that.

Maria Pirita:
That's a really good question because-

Dr. Andy Roark:
It's hard.

Maria Pirita:
It is hard. It's hard and sometimes they need time to think about it themselves too because they haven't sat down and thought about it themselves to say, “This is exactly where I want to go.” And a lot of times, they don't even know of the possibilities that are out there. You said it yourself, we put them in veterinary assistant, certified tech, practice manager, and there's all these other linear possibilities. Unless we're constantly talking about these things, they're not going to know about them. So if I have a technician or a veterinary assistant that's like, “I don't really know where I want to go next.” I think the most valuable thing you can do be like, “Yeah. Okay. Well, take some time to think about that. Here is a list of just ideas and see which one you feel the most passionate about and think about it in the next couple of weeks, and we'll revisit this conversation in a couple of weeks.”
Because in that time they're going to be like, “Oh, I noticed that I really like behavior, and Fear Free is really important to me, and I realized that I want to do perhaps do Fear Free because I want to become a Fear Free certified professional.” The other thing too is telling them what they're good at. Andy, you're really good at that. You're really good at telling people, “Hey, I noticed that you're really good at this and so would you ever consider doing this or…” Maybe you should talk, and say how you do it because you do it so much better.

Dr. Andy Roark:
No. Well, thank you for saying that. I think that's a good… what's worked well for me is to look at people from the outside because you can see people more clearly than they can see themselves. And we tend to like the things that we're good at. And so if you see somebody who's crushing a thing, you should tell them, “You crushed this thing.” And it's amazing to me, in my life, how many people will be just fantastic at dentistry. They'll just be great at it. And you say, “Well, what do you want to work on? What do you want to grow?” And they're like, “I don't know.” And you go, “Well, I notice you're really good at dentistry.” And they're like, “Really?” I'm like, “Yeah.” And I don't know if their self-confidence doesn't let them believe that they're good at dentistry. They needed some random shmo on the outside to tell them that they're good. I don't know.
But I have found again and again that when I see somebody, they're just doing something that's obviously good at, if I just say, “Hey, you know what, I think you're really good at that. Not like you have to do this, but I'll tell you what I think you're good at. I see you doing these things.” And two things happened. Number one, they get some clarity, and they go, “Well, now that this has been validated, I'm going to own the fact that, yeah, I'm good at these things.”
And the other thing is they rise. They rise to that even more. So if I say, Maria, one of the things that you are really good at is you are a wonderful communicator in how you do developmental feedback, you'll do more of that in my experience. You'll be more ready to do it and more likely to practice and just lean into that skill, and then you really get better at it. And it's just this weird self-fulfilling prophecy when you tell people what they're good at. So thank you for saying that. I do try to call it out, but I'm always amazed by how powerful it seems to be when you just tell people what they're good at. I love the idea of just having people pay attention.
One of the questions that I ask that seems to help a lot is, “What do you love the most about your job?” Just framing it that way. Not what do you want to do, but what do you love the most? And then or I'll ask them like, “Hey, I want you to think about the last couple of weeks. What was the best day that you had? Just tell me what the best day was or squish the last two or three weeks together and make me an imaginary best day. What does the best day look like for you?” And a lot of times they'll tell you what they want to do and they want to… You say, “What do you want to do?” And then, “I don't know.” “Tell me what the best day at the practice looks like though.” “Well, I come in and I hit the dentistry table right off the bat.” I'm like, “Okay.” Not now.

Maria Pirita:
Well, there it is.

Dr. Andy Roark:
Yeah. There it is. But it's funny, and we've all had the experiences where someone asks you a question in one way and I got no answer. You ask me another way and I'm like, “Oh, well, here's the obvious answer.” And so we play the role of therapist in that way of being like, “Hey, I'm trying to tease out of you, what do you like, what makes you happy? What makes you excited to come to work?” And you pair that with the idea of giving them some time to think about it in the coming days. “I think you've really got something,” and then you tell them what you think that they're good at and the skills that you are impressed by them. I like to use the words to say, “You know what I most admire about you is,” or, “The skills that you have that I try to emulate are…” And boy, people really are flattered when you say that. I only say if it's true.
But people are not used to hearing the things when you say, “You know what I admire about you,” or, “What I try to emulate that you do really well is this.” That's just, man, that's powerful feedback. And you make people feel really seen and really appreciated. And again, especially for your tenured people, your upper-level people, that stuff hits them pretty hard and it gets their attention, and it makes them feel like they're doing something that people notice. So those approaches have worked well for me. So I like that stuff a lot. So I think that's a good way of trying to tease these things out of it and then coach them about where they're going. What do you do, Maria, when we don't get traction? We have these conversations and we've got this tenured person, and we talk to them and we're doing the 30, 60, 90 follow-up. What does that look like when the bar is not moving?

Maria Pirita:
I think that that's when you've got to revisit your own policies and protocols on what the next steps are. And as much as we all hate it as managers, none of us ever wants to let anyone go. I get that and then there's anxiety in that, but sometimes you do have somebody that may not be the appropriate fit for your clinic, and that's not necessarily a bad thing. Maybe their heart is set on becoming an ultrasound specialist and you don't have ultrasound in your practice.
You have to sit down with that scenario and really lay it out because at the end of the day, if you do have somebody that's a little too spicy, it's going to affect your clinic. It's going to bring down the tone. Your other team members are going to become resentful. “How come she never cleans the surgery suite? And we always have to clean the surgery suite.” And then you have really key valuable players that may quit just because you're trying to hold on to one player that may have the skills but may not have the tone that you need for your clinic. So those become a little bit harder, but it's a matter of what the disciplinary actions are at your clinic and following through with those because if you don't, it's just going to continue to affect your clinic, unfortunately.

Dr. Andy Roark:
Yeah. No, I think you're right. I think you're smart too. You got to look at the ripple effects. At some point, it's not about the surgery suite not getting cleaned, it's about the fact that the other techs are going to fold if they have to clean up this mess again while this other person refuses to do their part. At some point, it becomes this thing about fairness of this, “We're being treated unfairly because this person's getting preferential treatment.” And it's not about the surgery suite not getting cleaned, it's about, “I'm being disrespected, and I'm being forced to do this and management is not supporting me, and they're allowing this to happen.” And so it's much, much, much more than the surgery suite not getting cleaned. It's a cultural problem that's impacting other members of the team. So a lot of management is picking your poison.
All right. How do you want to struggle? How do you want to suffer? Do you want to struggle and suffer putting up with this person who won't clean the surgery suite, or do you want to put up and struggle with not having that person on board? And I go, “Well, it depends on how much that person is affecting the rest of the team to make that decision.” The last part too is, and it's hard to hear, but I always got to put it back on the table, is people change and life comes in phases. And sometimes people are done. Sometimes they've done the vet tech thing for 10 years, and they're just done. And maybe it correlates with them starting a family. Maybe it correlates with their kids going off to school and their life is just changing or going off to college, maybe their kids moved away. Maybe it has nothing to do with kids, Andy.
Maybe it's just their spouse has a new job and she's wildly fulfilled with the job and this person is realizing, “Hey, I've fallen out of love with this, and I want to be in love with something.” And you can't do much about that. People just change. And so I try to remind managers and leaders and owners that sometimes people are going to leave, and it's not about you, it's just about them and what's going on in their lives and what they want. And I don't think any of us really think that we're going to make a job that people are going to spend their whole lives in. You know what I mean?

Maria Pirita:
Yeah.

Dr. Andy Roark:
And if they leave that's because we failed them. But man, it feels that way sometimes. And so sometimes it's just good just to call it out and go, “Sometimes people outgrow your clinics, sometimes they outgrow the job that they have. Sometimes they just want to change.” And that's not failure. But if they've outgrown your clinic and they've checked out, but they're still showing up, cashing a paycheck, and they're causing headaches for other people, that's not okay. We're not going to do that.

Maria Pirita:
Yeah. Absolutely. I agree.

Dr. Andy Roark:
Cool. Well, I think that's all I got. Have you got anything else to add to this?

Maria Pirita:
No, I don't think so. Other than I hope we see you all in April. Actually, we have Practice Manager Summit coming out.

Dr. Andy Roark:
Oh yeah, the April conference. Yeah. Talk about the Practice Manager Summit. You're speaking at that.

Maria Pirita:
I am speaking. I'm so excited. I have a great workshop lined up for you, guys, on one-on-ones, which actually leads to this episode really well because we're going to talk about one-on-ones, how to make them work for you and how to make time for them because they can be very, very time-consuming. And I think that a lot of us could be having them more often, but we don't because we're like, “Where do you find the time?” And so I have a lot of great information for you, guys. And I think that's something that you could work with these spicy tenured team members. After all, that's where we can find out a lot about their development and what they want for the future. So that's exciting. That's coming up here soon.

Dr. Andy Roark:
Yeah. It's March 22nd is the Uncharted Practice Manager Summit is a virtual event. Anybody's welcome to attend but it is 100% targeted at practice managers. Registration is opening up very, very soon. You can find more at unchartedvet.com. All right. Cool. So thanks for running through everything with me, Maria. Guys, thanks for tuning in. I hope this was helpful and we'll see you guys next week.
And that is our episode. Guys, I hope you enjoyed, I hope you got something out of it. Thanks to Maria for being here. Gang, as always, if you got something out of the episode, if you enjoyed it, share with your friends, help us spread the word, help us get the Uncharted gospel out into the world to light people's lives, or just write us a review on Apple or wherever you get your podcast, that's also a thing you can do. Anyway, guys, enough silliness. Take care of yourselves. I'll talk to you later on.

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

Jan 04 2023

They Admitted They’re Using Drugs… Now What Do I Do?

This week on the podcast…

This week on the Uncharted Podcast, practice manager Stephanie Goss is joined by her dear friend, Dr. Phil Richmond. Phil is the Chief Medical & Team Wellbeing Officer at Veterinary United and the Founder of Flourishing Phoenix Veterinary Consultants. He is an advocate for positive culture and individual, team and organizational psychological health, safety, and wellbeing in veterinary workplaces. Phil was also voted Most Funny in his high school class, was the NASA 1996 FL State Powerlifting champion (Juniors, 23 & under) and has seen Rush in concert more than any other band. That's what I call a bio!

Stephanie and Phil are talking through a recent conversation had with some managers after a team member at someone's clinic called off for several days and then told their manager that they were admitted to the hospital following an overdose. This is someone who is newer to the team, performing well and this manager was asking how to navigate this. The discussion turned towards disciplinary-like actions – taking away keys, possible termination for the no call, no show, drug testing and more. Stephanie and Phil wanted to talk through why the default response is often to frame substance/alcohol use disorder and mental health crises in a disciplinary way; what we can do to examine our own bias when it comes to these challenges and leadership and how to begin taking steps to change the culture within our practices, our communities and veterinary medicine as a whole. Let's get into this…

Uncharted Veterinary Podcast · UVP – 212 – They Admitted Using Drugs… Now What Do I Do?
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You can also listen to the episode on Apple Podcasts, Spotify, Google Podcasts, Amazon Music or wherever you get your podcasts.

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


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

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

Submit it here: unchartedvet.com/mailbag


Upcoming Events

New Workshop Series! Practice Owners and Managers, are you ready for some workshops to help kick-start 2023? Is this the year that you tackle creating a foundation of culture for your organization? Do you want to have a practice vision and values that do more than just look pretty on your wall? Do you want to have the right people in place on your team so that you can move forward in the same direction this year? Are you lost at where to start with leading meetings like this for your team? If the answer to any of these questions is YES, we've got you! The “Start Your Year Off Right” workshops can be taken together as a series or independently based on your practice needs.

Start The Year Off Right: Finding Values & Your North Star with Dr. Andy Roark

Start The Year Off Right: Loading the Bus with Stephanie Goss

Start The Year Off Right: Lead A Vision & Values Meeting with Dr. Andy Roark & Stephanie Goss

Upcoming events: unchartedvet.com/upcoming-events/

Episode Resources

VMX Talk: come see Stephanie and Phil present together: When a Team Member Needs Help… What To Do When

Sunday, Jan 15 at 8am in Hyatt management area

At VMX: Veterinary Recovery Meeting is Sunday Jan 15 at the Hyatt from 4-8pm in Celebration 14.

ACES Assessment/Information

PERMAH Survey Information – Workplace (and personal) well-being assessments

Mental Health Audit – Use the workplace mental health audit tool to find out how your workplace measures up.

Vets4Vets – VIN Foundation Vet Peer Support Network


Episode Transcript

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

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

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

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

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

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

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

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

Stephanie Goss:
Hey everybody, I am Stephanie Goss and this is another episode of the Uncharted Podcast. Just a quick warning at the front of this episode, there is some swearing in this episode so if you are listening with kids in the car or at home, you may just want to be aware of that. Or other people who just don't like to hear swearing. Know that that is a thing that happens a few times in this episode. Number two, we are talking about substance use disorder, alcohol use disorder. We do talk about suicidal ideation and suicide. So heavy topics that we did our best to cover in a way that hopefully is not upsetting or triggering to anybody. And as always, we want to be upfront and make you aware of what's happening before we get into it. So if those subjects are upsetting to you and you may want to take a break from the episode, that's totally fine. We'll see you back next week. If not, let's get into this.

Meg:
And now the Uncharted Podcast.

Stephanie Goss:
Hey everybody, welcome back to another episode of the Uncharted Podcast. Andy is not with me this week and that makes me very excited because sometimes I think we need a break from our energy. And because it means I get to have one of my most favorite people in veterinary medicine with us today. As a special guest, my dear friend Dr. Phil Richmond is here. We are going to talk today about substance use in veterinary medicine. It is a passion, something that is near and dear topically to both Phil and I's hearts. I'm going to let him introduce himself. Phil, welcome to the podcast.

Dr. Phil Richmond:
Hey, thanks Steph. It's great to be here. And I would say, I know Andy's not here, I'm like the Wish app version of Andy Roark. For anyone not seeing the video.

Stephanie Goss:
You're a good substitute for Andy. So for the people who are listening who have not had the chance to see you, hear you, know you, in veterinary medicine. Can you tell us a little bit about your background and how you and I came to be connected?

Dr. Phil Richmond:
So I'm really grateful. I sit right now in a seat with a group called Veterinary United. I'm the Chief Medical and Wellbeing Officer and super cool is Tom Bankstahl, Dr. B who's the CEO. He and I right now are the only two veterinarians in the US who have a certification in applied positive psychology. So he feels really strongly about that aspect of veterinary medicine. So super, super excited about working there. But on a grander level, and this is why all of us are doing what we're doing is trying to change the face of vet med.
And trying to change what has been, keeping what's working well. But then what are we struggling with certainly in work design and that. I also sit as the chair of the Florida Veterinary Medical Associations Wellbeing Committee, and I am super excited, I get to work every time I say this is… So I'm sitting on a committee for the CDC in NIOSH for healthcare and psychological health and safety. And then just really working on a number of projects around that in Vet Med and I get to work with some of the coolest people including you, Stephanie Goss in veterinary medicine. So just very, very grateful and I think we might be able to get into a little bit of my story of that as we go on.

Stephanie Goss:
So you and I are both red dot people as I'm listening to you talking, I'm like, “Oh, that's a lot of projects on Phil's plate.” Let's just acknowledge that right up front. We are red dot people and we bonded immediately I think probably within the first 10 minutes of talking to one another. We did the jumping up and down like, “Did we just become best friends kind of moment?”

Dr. Phil Richmond:
Totally stepbrothers.

Stephanie Goss:
Which I've never actually seen that movie, but I can picture the jumping up and down in my head. Because that's what Phil and I did because we just have a lot in common. And then as we started talking and getting to know each other more and discovered some things about our own personal lives and histories, we were just like, “Oh my gosh, we had way more in common than we thought.” So we have been a part of the Uncharted Community together for several years now and you and I both nerd out about wanting to make change in veterinary medicine. And our work together started in a very small corner within the Uncharted community in terms of creating safety and space for those in recovery in our community and has grown. And we are actually, a few short weeks from doing this recording, we are headed to Florida to do to speak at VMX together, which we are both really excited about.

Dr. Phil Richmond:
Super excited.

Stephanie Goss:
And if you're listening and you're going to be at VMX, you should come say hi. I will drop our session info into the show notes. But we are presenting on Sunday morning together with two human medicine doctors and we're talking about pieces and facets of veterinary leadership when it comes to helping our people. Like when we know that there's a problem, how do we handle crises and support? And so we're super excited to do that and as we are getting ready for that, you and I have started, we have this text chain where we see things or we hear things, we have people ask us questions and both of us regularly get questions from managers but hospital leaders in general asking, “Hey, there's this situation happening with a member of my team. Or someone I know is in this position when it comes to substance use or alcohol use or mental health challenges and I don't know what to do.”
And there was something recently that came up, somebody asked me a question because they had a member of their team who hadn't been with their team really long and they have by their admittance, been a pretty good employee. And then last week they texted and said, “Hey I'm not going to make it into work.” And there was no follow-up and no details. And then a few days later they replied back to this manager that I was talking to and were like, “Hey, I am actually in the hospital. I overdosed last week and I'm going to be here for a little bit and I'm not sure what it looks like from here.” And I thought it was great that this manager was asking questions and in the group that we were having the conversation with a lot of the response, an initial reaction from fellow managers was tread really carefully. And let's look at this from a disciplinary perspective.
They know called, no showed. They should just like what is your policy on that? You can just dismiss them and get rid of the problem. And I immediately texted you and was just like, “This makes me see red.” And you and I had a great conversation, I was like, “Let's do a podcast about this.” Because we get asked questions like this all the time and I think it's one of the things that you and I are both passionate about. Breaking down the stigma when it comes to mental health challenges, substance use in veterinary medicine. And so that's the context of what we're going to talk about today. We're going to talk about our typical headspace and actions in this specific instance. But as I suspect knowing Phil and I's conversations will probably meander a little bit along the way. Right?

Dr. Phil Richmond:
Right.

Stephanie Goss:
So let's start though with a headspace perspective. So why does this kind of thing make both you and I see red? And also how do we keep ourselves from just being angry about it? What do we do about it? Why are we here? Why are we talking about this in vet med?

Dr. Phil Richmond:
Absolutely. And the thing is that in the US the stigmatization of alcohol and substance use disorder is significant. And that's really where the crux of the issue comes up, is that we look at, Oprah just published a book. But there's an excellent psychiatrist, neurologist, and he says what we need to ask the question is instead of saying what's wrong with you is ask what happened to you. And some of the numbers that I wasn't aware of until I got involved in this is one of the things that we know is that in medical professions, medical professionals at a rate of 12 to 15% at some point in their career are going to meet criteria for alcohol or substance use disorder. In two, go ahead.

Stephanie Goss:
That's a huge number.

Dr. Phil Richmond:
Huge number. And so if you don't know that number, that's more than one in 10, is that we're out there. But what do we think about when we think about somebody who's in, when we use the term alcoholic. Even that image that pops up, sometimes It's somebody with an overcoat, in the stigmatization of under the bridge, drinking out of, unable to stop drinking. And that is not what, it can be. Some of us can go to that place, but that is not what it is. Many of us are intelligent medical professionals and intelligence has intelligence, moral fortitude and grit have nothing to do with alcoholism, alcohol use disorder and substance use disorder. It is not a moral failure and that is the thing, it's a mental condition that we have. And so it's really how do we frame it in the first place? And I just love that reframe of instead of asking what's wrong with you, compassion and saying what happened to you. And go ahead and stop.

Stephanie Goss:
I think that's huge, because the stigma, starts with the mental image when you ask somebody. And I think that's why these questions make me see red is because the answer for most of us just as humans is we have been conditioned as a society to look at substance use disorder, alcohol use disorder, mental health challenges as other people. As a problem that couldn't affect us, that happens to other people in this dark and shady and nefarious kind of way. And the picture that comes to mind is a very negative one. And so we start by already being biased in our thinking because of the stigma that surrounds it.
And so when there are challenges in our own backyard, and I love that you brought up the medical professionals because that's huge and we are a part of that as veterinarians. And we also know that on a very, very broad level, I think the most recent numbers that I saw are a little bit older at this point. They're from 2017, but the substance abuse, mental health services administration does a survey and the 2017 number said 20 million Americans 12 and older had been impacted by substance use disorders. That's statistically a staggering number. And so and I were talking about the fact that when we talk to people and you were saying when you lecture, you actually ask the question, “How many people have been impacted or know someone who's been impacted?” And lots of hands in the room go up.

Dr. Phil Richmond:
Lots of hands, most hands.

Stephanie Goss:
And at the same time when it comes to a leadership perspective, when I ask the question, “Hey, have you ever had someone who's been impacted by this in your practice?” I see so many leaders say, “No.” And I think the answer really is yes and they just don't know it. It didn't impact work, it was a secret. And so I think for me a big part of the stigma is to look at the perspective that, not normalize it in the sense that this is okay, but normalize it in the sense that this is happening. And it impacts a vast majority of us and we have to start to talk about it.

Dr. Phil Richmond:
And like you said is that it was a secret. And then we ask ourselves why is it a secret? Why is it a secret? There was a study that just came out, you and I were talking about it just recently. Is in September of 2022 there was a survey that came out. One in seven physicians, one in seven physicians admitted to consuming alcohol or controlled substances at work, one in seven.

Stephanie Goss:
At work?

Dr. Phil Richmond:
At work, that's at work. More than one in five say that they consume alcohol or controlled substances multiple times per day. And then in 2017 there was a survey done by the Mayo Clinic and it was a robust survey. They had, I think it was about I think 7,500 physicians. The 7,400 physicians answered this survey. In that survey, just alcohol is what they were talking about, just alcohol. 12.9% of male physicians and 21.4% of female physicians met criteria for alcohol use disorder.
Almost one in four of us, one in six to one in four meet criteria. So why in the hell are we not, why do we not talk about it? We also know in talking about suicide, just to give a warning is that 50 to 60% of suicides have alcohol or drug relation to it. And so that is something I feel very strongly about and both you and I are certainly advocates for suicide prevention in the profession. But if we're not talking about this, we can't truly be helping one another. And it's like, “Why are we not having these discussions?” And it's stigmatization and then it's the fear of if I come forward with this, what's our knee-jerk response is that it's going to be a performance issue. It's going to be a fitness-to-practice issue. And so what happens is that we hide it.
You just mentioned the secret and this was my story, is I hid it until I couldn't hide it anymore and I almost didn't make it Steph. But yet this could have been, people saw and I'm not saying that, but the signs were there long before I got to that point. And so if the climate was changed and we can have these open and honest conversations and say, “Wow, I've noticed I'm coming home and I'm having three or four drinks where I haven't done that before.” Because what was funny for me is I took that self, the assessment, the 20 questions that see if you're an alcoholic. And I took, I got a 19 out of 20 and it was like there's a hot, and I'm like, “Well this is bullshit, crap.” And I'm like, “Because if this was true-“

Stephanie Goss:
I don't have a problem.

Dr. Phil Richmond:
I do not have a problem, I'm in-

Stephanie Goss:
I'd be falling down at work.

Dr. Phil Richmond:
Right, because I started moving the goalposts. I was like, “Yeah, I can't have a problem.” And that's the old rationalization is because I don't want to be viewed as the person in the overcoat with the bottle in the bag under the bridge. I don't want to be viewed like that, I'm a medical professional, I'm going to school, whatever. But those two things are not…we need to be able to have this conversation in a psychologically healthy and safe space. So that's what we really want to change. And changing the intervention from where there's a crisis where we have to take, where somebody is visibly affected-

Stephanie Goss:
We have to act.

Dr. Phil Richmond:
… at work and we have and we have to act. To where if we roll back the clock or if we go back, we saw those things. And this is, I think what we're going to get into today, is what are we doing in our practices? What are we doing in our workplaces to set the tone to say it is okay to come forward with these things. Are we doing things where we talk about the access to our mental health resources are there. Are we engaged with our employees? Are we somewhat vulnerable with our employees as well about our own struggles as leaders to a safe point? But do we feel safe coming forward with that? And that, the goal is, not when we talk about don't, instead of just pulling people out of the river, let's go a mile up and find out what could we do to help them from falling in the river in the first place. And that's the goal.

Stephanie Goss:
And I love that and I think as a leader and as a manager and from an HR perspective, you and I were talking before we started recording. And I was saying when I became a manager there were no classes on this. I didn't get taught this shit. Nobody said, “Hey, you should think about these things.” Being totally candid and honest, the bare-bones information that I got from an HR perspective was, your handbook needs to have a drug-free workplace policy. And that was it for years and years and years. That was how I managed was, there was one policy in our handbook that we are a drug-free workplace. Because I could then use that to performance manage problems away. So if we had to cross that bridge, we had the safety net that said, “Hey, legally as an employer I've got this in here and if this is violated, I don't have to do anything else but write the discharge and move on.”
And so I think for me a lot of it starts with getting honest about the fact that we don't talk about it and start to talk about it. Start to talk about it more, which is a passion for both you and I, like breaking down those walls because we know that stigma continues to happen because we're not talking about it. And we're not talking about it loud enough and often enough. And that's when change starts to happen and becomes radical when we start to talk about it. So for me, I think a lot of it is starting with looking at our own perspectives as leaders in a candid way. What are our biases? What are we thinking? It's human and it's okay. And I'm saying this from the perspective, even someone who has been a part of the recovery community, someone who has been touched in my own personal life by substance use disorder. And has had family impacted by substance use disorder, I still completely admit that for a long time, the bias that I had was that this is something that happens to other people.
I was raised in a good family, I was the first person in my family to go to college. This isn't something that happens to people like me, that happens to people like my family. And so I had to do a lot of work on a personal level to break down my own bias and my own self feelings but also feelings towards others. And so I think as leaders taking that first step and looking at how are we thinking, how are we viewing it? Because just statistically if we keep thinking about it from the perspective of this happens to other people, it doesn't happen in my clinic. We're going to always be behind the curve. Because the reality is it is happening in your clinic. And if you think that it isn't, if you think that it hasn't, you're wrong. It just happened in secret.

Dr. Phil Richmond:
A hundred percent. And that is interesting and this is and the well-meaning, I mean this out of a huge amount of respect. When I was at UF and we were talking about it and I asked, I said, “How many students have we had referred to Florida's physician's health program?” And they said, “Zero.” And I said, “Okay.” And this is what I'm saying, is that this is an institutional, it's just not something that's talked about. And in human medicine the data's all there. So they see it and they're taking positive actions for this and opening up the conversation. Because again, they have the surveys, they have the data. We have a couple, a handful of studies, but there was one that came out from medical students. And medical students, 32.4% of medical students met criteria for alcohol use disorder.
And there was a study that came out, I think it was in 2017 and they did one with vet students, same thing. This is to everybody in the hospital, is affected, just it doesn't, alcohol and substance use disorder doesn't go, “Oh I'm just going to affect accountants or whatever.” It's that we are human beings who were taught to do the job of veterinary medicine. So we as human beings have things that happen to us that put us at a higher risk of this being there. And that was something that I thought we might step into too, talking about adverse childhood experiences and trauma-informed workplaces, if that feels right.

Stephanie Goss:
Yeah, I love it. So I think that is a good segue for us to talk about what are some of the, so we recognize that there are problems. We recognize that there are challenges and usually for most of us as leaders, because there still is the stigma because it is secretive. There is generally, we're finding out further down the line, like you said, we're a mile down the river. There is a crisis. Someone is actively suicidal, somebody is actively in substance use crisis, somebody has OD'ed at work or at home. And like this fellow manager that I was talking to, we're getting the call saying, “Hey, I'm not coming to work.” Then we're managing in crisis mode. And so I think for you and I, a lot of it is we need to do things better as a community, as an industry, to have resources to support the crisis mode. And that's a whole other soapbox. But I think for you and I, a huge piece of it is how can we start to turn back time?

Dr. Phil Richmond:
Yes.

Stephanie Goss:
How can we wear our Time Turner necklace and flip it back a notch, and be able to look at, how do we start to impact and support the team? How do we start to look at the team as human beings recognizing that this is something that impacts a vast majority of the American population. How do we start to do things to create a safe space in our practices where people can be human, where someone can say, “Hey, I need this help.” You and I are both the kind of people that we might go up to our manager and be like, “Hi, I am in recovery and I need to go to a meeting today.” But recognizing that not everybody is going to be able to have that forwardness and how they address it with their management.
But creating this space where if somebody on our team says, “Hey, I need to go to medical, I need to go to some medical appointments over the next couple of weeks and I need to flex my schedule to make that happen.” Where we create this culture of safety where somebody can say that and we're going to support them instead of being like, “Well we've got patients to see I need you here.” How do we start to look at people as humans? And I think you have so much to share in that arena. So maybe let's take a quick break here and then we'll come back and we'll start to dig into some of the action steps. What are some of the things that we can do as leaders? What are some of the processes that we can put in place? How are ways that we can support and educate our team to be seen as human beings first. And veterinary professionals maybe second. And how do we support each other in that regard? Does that sound like a plan?

Dr. Phil Richmond:
Perfect, love it.

Stephanie Goss:
Okay, let's take a quick break. Hey everyone, it's Stephanie and I just want to jump in here for a quick second and say Happy New Year. I am hoping that in the new year you are thinking about spending some of your CE money and coming to join our community, if you're not already a member. We've got all kinds of great things happening in the community regularly. And one of the big benefits of being an Uncharted member, means you get access to all of our monthly workshops at no additional cost.
But if you're like, “I can't afford to do membership right now, but I would love to get in on some of the things you're doing.” Head over to the website unchartedvet.com/events because we have got a rapidly growing calendar of all of the things that are coming in 2023. Andy and I are kicking off the year with a three-part, start-the-year off-right workshop series in January and February and we would love to have you join us. You can come for one, you can come for all three, you do you, but we would love to see you there. And now back to the podcast.

Stephanie Goss:
Okay, well we are back. So we talked a little bit about the headspace and a lot of it is about just acknowledging the stigma and doing some self-reflection and some looking at how we're approaching things. And it's funny because I get asked questions a lot like this question from this fellow manager and my first response always now, and it wasn't always this way. But now my first response is, “If you had a team member text you and say, I'm in the hospital, I just found out I have cancer” what would you do? Because the response to that should be no different than the response for any other reason that somebody's in the hospital. The reason shouldn't matter. But it does, because as a society there is stigma and there is judgment. And we look at somebody who has cancer as, “Holy shit that's not something they could control.”
Like for them, this happened to them. And we don't afford that same outlook to people who are having mental health challenges or crises or a disease. We don't afford that to substance use disorder or alcohol use disorder. We look at it as they are in control of this, this is their fault. And so we look at it very punitively. And so I think the first thing from an action step perspective after we do some self-reflection is start to look at how can we, we have an incredible power to teach our team that our first response is as fellow humans and is one of empathy.
Which is you are hurting, you are in pain, you are in the hospital. How can I support you? Can I send you food? What do you need? Because it's no different. And so I think for me, it's about how do we start to set that groundwork consciously and unconsciously in our team, to look at substance use disorder, to look at alcohol use disorder, to look at mental health and disease and say, “How can we approach it from a more stigma free perspective?” This is not something that they chose. This is not something that they can control from that perspective. Yes, there are things, I can control my actions and I should be held accountable for my actions and at the same time, this is a disease process. And what would we do if one of our patients had a disease?

Dr. Phil Richmond:
And I think there's a way that we can frame that conversation that makes it easier for us to have more cognitive empathy for what's going on with our team members.

Stephanie Goss:
Yeah, you're doing some great stuff here with your teams. Tell us about some of the framework that you're using for clinics to be able to start to look at this.

Dr. Phil Richmond:
So one of the fascinating things to me was that I found out maybe three or four years ago, maybe not even that long, actually, of this assessment that was done back in the late nineties, early two thousands. And it was a big study that was done by the CDC and Kaiser. And what they looked at is they found that people who have these experiences that are adverse, and that's a kind word and we'll go into a little bit what some of those are. But they had an assessment of 10 adverse childhood experiences that they would ask, they were yes or no questions. Did these things happen to you before the age of 18? The critical point is that our brains are still forming. And that is from a neurobiology and pathophysiology point of view, it is genuinely fascinating. Although these things happened to me, to know what happened in my brain when I was 8, 9, 10 years old.
That set the stage for some of these things that came up later in life. So this assessment is, were you ever physically abused by a family member or someone in the household? Were you ever sexually abused by someone in the household? Were you ever verbally abused? Were you ever felt to feel like you weren't loved? Was there often not enough money to pay for food? Did you have a family member who had an alcohol or substance use disorder? Did you have a family member who had a mental illness? Did you see violence in the home? Did you have a parent who was incarcerated? Those types of things. What they found, and this is amazing, is that if you had four or more of those experiences in childhood, you are seven to 10 times, seven to 10 times more likely to have an alcohol or substance use disorder.
You are 6.8 times more likely to have anxiety and when it comes to depression, five times more likely to have depression. All of these things are connected. And then we talk about suicidal ideation, 10 times more likely to have suicidal ideations. 37.5 times higher rate than someone with zero ACEs to have attempted suicide. So if we had any of our patients have risk factors that gave us those kind of numbers, as clinicians, as veterinary professionals, we would do everything that we could to minimize those. Now we're in a position in the workplace that we can't minimize those, but I want to let everybody know is that 12.5% of Americans have four more of those. So not just in the workplace, but think about, so people that we work with, we're sure they have-

Stephanie Goss:
People we interact with.

Dr. Phil Richmond:
Clients that have it, that act in a way sometimes that we don't like. It's learned behavior that kept them protected when they were children. And I really came onto that when I got some bad feedback. I was like, “Dammit, I act like I was 10 years old.” And it was like this light bulb went on and I was like, “Dammit, it is.” That's part of it. And so neither one of us are mental health professionals. This is just an observation on this. So it just was fascinating to me. And so what we ended up seeing at the practice that I was at before is we had someone who went through, had an issue with feedback and I was very vulnerable and open. Now from an HR perspective, I'm not going to necessarily recommend doing this, so-

Stephanie Goss:
I'm going to stick my fingers in my ear for a second-

Dr. Phil Richmond:
So, “La, la, la, la, la.”

Stephanie Goss:
“La, la, la, la, la.”

Dr. Phil Richmond:
But we are at work practice, we were very intentional about psychological safety and vulnerability and support. And so I said, I felt the same way. And I said, what was interesting is that I had taken this assessment and had this and everybody in our clinic up until, well, not everybody in our clinic. The medical team, up to that point, we had all taken this ace. Remember four or more, you get all these things, six or more, which I have six out of 10. Six or more, we potentially will on average die 20 years earlier than the general pop or people with zero. But all these manifestations come up. Our average in our medical team was six. And so it fundamentally changed how we interacted with one another.

Stephanie Goss:
And you have a small team.

Dr. Phil Richmond:
It's smaller, yeah.

Stephanie Goss:
You're not talking about working in a hundred-person hospital?

Dr. Phil Richmond:
Right. Maybe we had 10 people in the medical team.

Stephanie Goss:
Because I think for a lot of us, when we think about it and we think about this, again, it goes back to that this happens to other people. This is why I love this example from you is we think, “Oh, okay, in a big hospital where they have a hundred people, maybe a lot of the people on your medical team, this could happen to you.” When we think about, “We're a small practice and there's 10 of us, or there's right eight of us, we couldn't possibly have those numbers statistically.” And that's what I think for me, it was so impactful in hearing that. Yeah, absolutely eye opening.

Dr. Phil Richmond:
And so the other thing that's interesting, so we know my source, so I've been in recovery since 2008. But I was on a podcast with a PTSD specialist that works with veterans and first responders and that. And so I was talking about my initial burnout when I was working, on my days off I was working and I was doing all this. And she goes, “Welcome to another trauma response.” So the same behaviors that helped protect it, because the alcohol and substances helped, they were a way to change the chemistry in my brain and for me to deal with that anxiety and the other things that were going on. However, overworking, workaholism, being a workaholic, those type, but what happens-

Stephanie Goss:
Staying till 10 at night in the practice.

Dr. Phil Richmond:
We reward it and we're not watching out for those people. And dammit, those are our superstars, potentially are just manifesting it in a different way. And we got to watch out for them too. And that's what we're going to get into next is how do we then have those discussions? What are we doing structurally as a practice to set the foundation so that these conversations can potentially happen? Not necessarily talking about ACEs, but just mental health in general and normalizing the discussion around mental health. Normalizing taking time off, normalizing utilizing our EAPs. Normalizing utilizing what we have at our disposal.
And then hopefully we can be a mile up the river and help our folks so that we can have these discussions so that we don't have a fear that I'm going to get fired. Or I don't have a fear that this is going to happen. And as a manager, my only option isn't creating a performance improvement plan with the thought that I'm probably going to fire this person in three weeks because they're not… Because if nothing changes, nothing changes. We all know, if there's no intervention and I can't change me with the same brain that got me into it in the first place. You can't just tell me stop doing X because it's hardwired in my brain. I need help to do that.

Stephanie Goss:
And I'm so glad that you brought that up because that is one of the things that is really, it's hard for me to see, and I see it every single day. I check in with the communities and groups in veterinary medicine that I'm a part of, and every single day somebody has made a post about, “Yep, I was here again till 10, and now I'm sitting at home and I poured myself a glass of wine and I'm going to sit here and I'm going to numb my thoughts about the day.” And we normalize that because generally the responses are, “Cheers, I'm sitting here with my glass too.” There are the, “Yeah, but we took care of the patients. Yeah but, yeah but, yeah but.” And I think that for me is one of the most important pieces is to not overlook those things that are not overtly negative. And this is an area where we don't know what we don't know.
And I'm glad that you said neither of us is a mental health professional. And this is where I as a manager had to lean into educating myself, to learning from the HR perspective, certainly. And from the legal perspective as a business person, as an employer, what do I need to do to protect my people, to protect myself? All of those things are valid. But also doing some education about just in general, what is trauma? Learning about tools and resources like ACEs, learning about psychological safety as a topic.
And I think we've come a long way in veterinary medicine in some ways towards opening our mouths and starting to have these conversations, but not far enough. So let's talk specifically about some of the things that you are super passionate about and things that we can do as leaders in our practices to start to open the doors to the conversations. And we're a mile ahead. We're looking at before we know that there's a problem, what are things that we can do to open the door to the office, so to speak. And have the honesty and the vulnerability and the safety for our teams to start to talk.

Dr. Phil Richmond:
So it's very much like when we have an emergency come in, the best thing to do is that everybody has been taught, everybody knows what their role is before that emergency walks in the door. So it's all laid out. It's all set down. We all know how we respond so that it's normalized. That's the beautiful thing about, and it's a beautiful well-oiled machine when an emergency comes, well, when we're doing all those things. And it can be a thing of beauty, why are we not doing that again? Right now, we're in such a reactive, reactionary state in veterinary medicine that we're reacting to a mental health crisis. So let's look, just like we would look if we're checking the books or we're doing that. Can we do a mental health audit of our practices, policies, systems that are in place? And so that's what we can do. We can-

Stephanie Goss:
What does that look like?

Dr. Phil Richmond:
So we can start asking ourselves just some fairly straightforward, simple questions. What's our practices mental health policy? Oh, we don't have one. Let's look into what-

Stephanie Goss:
Okay, let's start there.

Dr. Phil Richmond:
Yeah, so let's say, what's the vision? What do we envision that to look like? What would we want, if we were in that spot, what would we want within the realm of HR? But there are options within that realm that we can do to support people. The US unfortunately is about five to 10 years behind every other civilized country in the world when it comes-

Stephanie Goss:
Not surprising.

Dr. Phil Richmond:
Yeah, not surprising. But Canada, so I'm certified for the psychosocial risks and psychological health and safety process that is the Canadian standard. And then I work with a big group in Australia who's one of the leaders in workplace wellbeing. And so these psychosocial risks, think about it like OSHA for our brains, that's how I like to describe it. We do this stuff for OSHA.

Stephanie Goss:
I love that.

Dr. Phil Richmond:
We do, you go in, you take radiographs, you better damn well have your thyroid shield on your plate. You got to have your gloves on.

Stephanie Goss:
The gloves.

Dr. Phil Richmond:
As low as reasonably available or ALARA, I forgot what the whole radiologist, just skip that. But if we know the things that can potentially increase our risk for psychological damage, what are we doing proactively to decrease those? Are we doing things as far, or do we have role clarity? Do we have job clarity? Do we give autonomy? What about reward and recognition? Are we making sure that our teams know that they're doing a good job? Things that we intuitively know, especially in Uncharted groups. But what's cool is the data supports it, is that we need to be very intentional about crafting these things. How are mistakes handled? That's a big one when we talk about psychological health and safety. Do we have situations where technicians get lit up in treatment verbally by the doctor if they make a medical error? And I guarantee you the doctors have made errors. I mean have, that's part of… A hundred percent-

Stephanie Goss:
And how are we leading by example as leaders when we make those mistakes, whether it's as a clinician or as a leader. Are we leading with vulnerability? Are we leading with candor? Are we saying, “Hey, I screwed this up and I need you guys to know, A, that I screwed it up. But also, B, what I want to do to fix this in the future so that you don't have to feel those feelings that I'm feeling right now. Because I feel horrible.”

Dr. Phil Richmond:
And as diagnosticians, as clinicians, as medical professionals, as people who need data to make decisions, are we regularly assessing those psychosocial risks. And are we measuring the well-being of our teams regularly? Probably not. Probably not.

Stephanie Goss:
Probably not. I knew that this, as it always does, when you and I start talking, time is always the crunch. And I said to Phil, I'm like, “Listen, we got to keep it tight.” And there are people who are listening who are like, “That sounds great. And where do I even start?” And so Phil and I are going to drop a bunch of resource info-

Dr. Phil Richmond:
A hundred percent.

Stephanie Goss:
… into the show notes this week for you guys so that you can find access to learning more about some of the things we've talked about. The ACEs assessment, the mental health and wellbeing audits in your practice, things like that. So we'll give you resource info. So don't panic because we're not going to dive into a lot of specifics from the time perspective, but we'll put some of that in the show notes for all of you.

Dr. Phil Richmond:
And have our leaders gone through mental health awareness training? Have we given them the tools just like everything else? Have we done that?

Stephanie Goss:
How many of us have mandatory training for our leaders? How many of us have our people assessed in QPR training? How many of us have our teams take just, I'm so glad you said the OSHA thing. There should be somebody on our team whose is CPR and first aid certified, who on our team is getting mental health education? Who is getting education in things like substance use disorder, alcohol use disorder. How are we educating ourselves, that has to be a part of the process for us if we are truly running open, honest, caring, people-forward practices. And I think that's the space that you and I both look forward to impacting the most for sure.

Dr. Phil Richmond:
And so just really getting curious about some of those questions. And if we have an EAP, most practices have one and they don't know how to access it.

Stephanie Goss:
Or what's included.

Dr. Phil Richmond:
And is that information, on a regular basis put out? So it's not, “Hey, we have this EAP. What the hell does EAP stand for? Okay, what does that mean?” Really going over what the benefits are during a team meeting and do we address those things regularly? Do we feel that that's important enough to put on our regular team meetings? Do we have a wellbeing update? Do we have a psychosocial risk update? Are we putting those things on the agenda to talk about?

Stephanie Goss:
I love that. And I think one of the other things that as leaders that we can think about is, Andy and I talk a lot about employee assistance programs and EAPs on the podcast. But going beyond that, when I sat down to think about this and I was thinking about what are some of the things that I learned about in my own journey. Things that wouldn't have even occurred to me as a manager to ask. Like what's included when we are providing medical benefits for our team, what's included in those benefits? Is it included for recovery support services? Can somebody go to inpatient treatment or outpatient treatment as part of our medical health plan? What is their access level to meds to treat substance use and manage addiction? Are they wildly cost-prohibitive if the insurance doesn't cover it? Does our medical services offer alternatives for pain management, like chiropractic or acupuncture or physical therapy?
Basic things like that, that are a part of the benefits that we already offer. To your point about the EAP, it's the same with medical benefits. We can be asking those questions not only knowing the answers to those questions, but making sure that we're highlighting that information for our team. So again, they don't feel secretive about it. I make no secret in my practices now. I don't take meds unless I absolutely have to. And so one of the questions that I always ask an employer is, what does the medical plan look like? I've been using acupuncture to help control pain for years. What does acupuncture or chiropractic coverage look like? Asking those questions so that it isn't a secret so that it isn't something that I feel uncomfortable having to ask about, thinking about those things. The other thing that became a passion project for me is how can we help make the community better and decrease risk factors, especially when it comes to substance use.
I live in an area of the country that has really, really high opioid use and we're up near the Canadian border and it's a systemic issue here. And one of the things that I got really passionate about was can we as someone in the community who dispenses drugs to our patients, can we get involved in drug takebacks? Can we get involved in pharmacy blue box projects where the community can bring back meds, no questions asked. And dispose of them safely in conjunction with the DEA, so that we help limit some of the risk factors. Not only for our team members in terms of making our own homes safer, but making the homes safer of our clients and our friends and family in the community. So things like that, that we wouldn't even necessarily think of that really impact how we're showing up for our team as leaders. And thinking about them as whole human beings and not just the person who's showing up to clock in and do the work for us.

Dr. Phil Richmond:
And I would say, if there's one big takeaway of where to focus is that I love the concept in this group that I work with in Australia is very, very big on this concept, which is a me, we and us. So there's individual responsibility and individual things. And this is where I think human medicine got down the road of really pushing resilience training. Resilience training is excellent. Resilience training, individual resilience training will not fix systemic problems. However, and then when we talk about the me part and the we part, me as the team, what makes up a team is individuals, obviously. So we need to have people that can then, and then on a team level, can we create a situation where I feel comfortable admitting a mistake to you. Or I feel comfortable having a discussion with you and you're not going to judge me.
And some of those resilience factors go into the psychological health and safety or the psychological safety of a team. And then on top of that then organizationally is that things that are out of the hands of the employees, what are we doing as leaders and as organizations to facilitate these things? Are we doing our mental health audits? Are we looking at, is everybody taking their PTO? Are we measuring wellbeing? Are we measuring burnout in our team members? What are we doing at that level? And all of those things actually have to come together to create the, as Stephanie Goss's term that I know she loves, unicorn veterinary-

Stephanie Goss:
Unicorn practice. I love it. And I would say as I'm listening to you and I'm thinking about the moving from me to we to us, listening to this, I suspect that there are some people who are like, “Holy hell, this is so much stuff that I never even thought about. And where do I find time for this? Where do I put this on top of the million other things that I have to do as a practice leader, as a business leader?” And I think the thing that both you and I are in firm agreement is this is not a, if you were going along your merry way and you had a drug… If you were me in my early career and you had a drug-free workplace policy and that was it. That was all you did, that was the box you checked. You are not going to be able to go from that at zero to a hundred miles an hour overnight. Recognizing that this is a marathon, not a sprint.
So pick one place, whether it's starting to do some audits with the team, starting to do building, again, psychological safety also doesn't happen overnight. So you can't go from not talking about things that are personal and private and vulnerable with your team if you haven't been doing that. And you all of a sudden are like, “We're going to sit down and we're going to have a group therapy session.” They're going to shit bricks. So it's about finding the places where you can start small and try one thing. Like you said, let's talk about what happens when we make a mistake. How are we going to acknowledge that to each other? How are we going to admit it? What does that look like? Starting small, finding that first building block and then figuring out how do we layer in those other building blocks as we go.

Dr. Phil Richmond:
And on an organizational level, what is our mental health policy? We could literally just ask that question. And that can be our thing for the month is just, do we have one? Can we craft one? What might that look like? And then the other thing that I think about is when we talk about civility in practice, small things that we can do that have a ton of impact, is how would I like to be treated at work? What are three things that we could sit down as a team and say, “When we're talking to another team member, we put our phone down.” We all just have that agree, simple little things like that. And we take three of those things for how we want to treat each other in practice. And that's the step we take. And the thing is that those build on one another and then we have a win. We've done something positive for the practice, and then we just build one on another.

Stephanie Goss:
I love it. As always, you and I could sit here and-

Dr. Phil Richmond:
I know.

Stephanie Goss:
… continue this conversation for half a day. If you were listening to this and you're like, “I'm super enjoying this conversation.” And you're going to be at VMX, I'm going to drop the details on our session into the show notes for you guys, because we would love to see you there. And definitely come talk to us and tell us that you listened to the podcast. That'll make it even more special. But we will also drop resource information into the show notes and some info on how to contact Phil if you have questions or honestly, if you want to nerd out with either of us on these topics, we're always open to further the conversation. And we actually have the first veterinary recovery meeting happening at VMX as well.

Dr. Phil Richmond:
At VMX, yes, we do.

Stephanie Goss:
Which is huge and exciting. That is going to be happening on Sunday afternoon as well. And we'll drop that info in because that is something you and I are both passionate about. Breaking down the barriers so that it's not just about the licensed medical professionals as veterinarians, obviously we need to serve them. But the veterinary community goes far beyond just our licensed veterinarians. And so you and I are both passionate about providing access to recovery resources and just opening the doors to all the members of our team, paraprofessional and professionals. So that is a big win and that's happening at VMX as well. So lots of fun stuff coming in the next few weeks. It's going to be a busy few weeks for us.

Dr. Phil Richmond:
Yes, yes. And I'd also say if you want to get in a meeting, an online meeting, if you're a veterinarian, the Vets for Vets program from the VIN Foundation, Bree Montana, bree@vinfoundation.org, you can get involved with that. We have a great meeting that happens every Sunday. And it's one of my favorite recovery meetings and it's just wonderful and we've got some more resources coming forth as well. So, excited.

Stephanie Goss:
Yeah, I love it. Thanks for being here, Phil-

Dr. Phil Richmond:
Thank you.

Stephanie Goss:
… and starting this conversation. I imagine that as you and I always do, this will spin into multiple other like, “How do we answer this question,” kind of episodes. But this was the first, this was great. Take care everybody, have a wonderful week. Take care of yourselves and hopefully Phil and I will see you in Florida in a few short weeks.

Dr. Phil Richmond:
Looking forward to it.

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

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

Dec 21 2022

When a Great Tech Calls Out ALL. THE. TIME.

This week on the podcast…

This week on the Uncharted Podcast, Dr. Andy Roark and practice manager Stephanie Goss are talking through a question that Stephanie admits she could have written in to the mailbag at one point in her management career. We had a manager write in and ask what to do about a great skilled, talented tech who just happens to call out ALL. THE. TIME? They are amazing for the patients and the team loves them when they are here. This management team just isn't sure how to take it from here. Let's get into this…

Uncharted Veterinary Podcast · UVP – 210 – When A Great Tech Calls Out ALL. THE. TIME.

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

Help Us Make More Great Podcasts in 2023!

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

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

Submit it here: unchartedvet.com/mailbag


Upcoming Events

New Workshop Series! Practice Owners and Managers, are you ready for some workshops to help kick-start 2023? Is this the year that you tackle creating a foundation of culture for your organization? Do you want to have a practice vision and values that do more than just look pretty on your wall? Do you want to have the right people in place on your team so that you can move forward in the same direction this year? Are you lost at where to start with leading meetings like this for your team? If the answer to any of these questions is YES, we've got you! The “Start Your Year Off Right” workshops can be taken together as a series or independently based on your practice needs.

Start The Year Off Right: Finding Values & Your North Star with Dr. Andy Roark

Start The Year Off Right: Loading the Bus with Stephanie Goss

Start The Year Off Right: Lead A Vision & Values Meeting with Dr. Andy Roark & Stephanie Goss

Upcoming events: unchartedvet.com/upcoming-events/


Episode Transcript

Banfield Pet Hospital Logo

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

Stephanie Goss:
Hey, everybody. I am Stephanie Goss, and this is another episode of the Uncharted Podcast. Andy and I had another great letter in the mailbag this week, and we are diving into it in this episode. We got a ask from a manager who is wondering, “What do I do about a great and really high skilled technician who just happens to call out all the time?” And I mean excessive amounts. I actually did the math during the episode and this technician has missed almost 50% of the weeks in a year. And so this manager is wondering, “What do I do? How do I deal with it?” Especially because there have been some conversations along the way, but maybe not as frequently as they should have happened. And I have a feeling that it's probably hit the point where the rest of the team is super frustrated about this situation. This was a fun one. Let's get into it.
And now the Uncharted Podcast.

Dr. Andy Roark:
And we are back. It's me, Dr. Andy Roark, and Stephanie, you're never there, Goss. You're never there. So all right, I just got back from jury duty.

Stephanie Goss:
Oh, yeah?

Dr. Andy Roark:
I just got back from jury duty, and it was an experience. Have you ever had jury duty?

Stephanie Goss:
I have. I'm excited to hear how your… This was your first experience?

Dr. Andy Roark:
Oh yeah. Oh yeah. I don't know how they found me, but they did. I'm worried that… people were like, “Oh, once they get you, they keep calling you.” And it was the experience. I got summoned for jury duty, and I did not have time to go to jury duty. I talked to my brother who's a lawyer. I'm like, “I don't have time.” And he was like, “They don't care.”

Stephanie Goss:
Nope.

Dr. Andy Roark:
They could not care less.

Stephanie Goss:
They give zero figs.

Dr. Andy Roark:
Yes. And I did find that to be true, which is interesting. Because when was the last time that someone just looked at you in your face and was like, “I don't care what you want.” It was when my children were like two years old. Right?

Stephanie Goss:
Yeah.

Dr. Andy Roark:
When a two-year-old would look at you in your face and be like, “I don't care what your schedule is or what you have to do at work.”

Stephanie Goss:
I want it right now.

Dr. Andy Roark:
“You're going to do what I want.” And it was two-year-old and jury duty are the times in my adult life when someone looked at me and were like, “I don't…” And then they carried out the threat. They were like, “Watch how much I care.”

Stephanie Goss:
They're like, “Bam, you're on the jury.”

Dr. Andy Roark:
Yeah, no, it reminds me of when my daughter was two years old and her sock came off as we were driving. And she was like, “You need to stop the car and get my sock.” And I was like, “No, we have places to be.” And she's like, “I'm going to make you.” And then she just melted down until I got off the highway and got her sock. And I'm like, “That's jury duty.” They're like, “I can bend you to my will.” And so they did. They totally did. I went, and I got picked and put on a jury and I watched a case. I watched it because they made me, because they took my phone away. What do you call it? The bailiff?

Stephanie Goss:
Yes.

Dr. Andy Roark:
He takes your phone away from you. And not you can have this back at the breaks. He's like, you can have this back-

Stephanie Goss:
When you leave.

Dr. Andy Roark:
… when you are done. Done, done. So I sat there without my phone, like a caveman. And I watched these two people tell completely contradictory stories about what happened in a parking lot accident. I then I went and [inaudible 00:03:40] people.

Stephanie Goss:
But you lucked out in a way, because it had a relatively short trial.

Dr. Andy Roark:
Oh yeah. It was great. It was a half day. I got the experience of being on a jury in a half day, and then they let me go for the week. And I was like, “No, that was definitely it.” That was the best thing, was I go to-

Stephanie Goss:
Best possible scenario.

Dr. Andy Roark:
I got to go sit in a little jury room, I got to sit in a jury box. I got to see-

Stephanie Goss:
The whole nine yards.

Dr. Andy Roark:
… the whole courtroom thing. And then it was five hours, I was done. The longest part was sitting with the jury in the little back room.

Stephanie Goss:
For deliberation?

Dr. Andy Roark:
They don't let you leave until all 12 of you agree. And I don't know if you've ever tried to get 12 people to agree on anything, but it's a horrible system, I think. They're like, “Nope, you all have to agree.” And we went in, and I, of course, I couldn't not talk, because it's me. And so I was like, “Quick temperature check, who here thinks this person… who thinks they've proved negligence on this person?” Two people raised their hands and I'm like, “Dammit.” It's 10 people were like, “Let's be done.” And two people were like, “No, we're going to do this.” And so we asked the people, “Why do you feel this way?” And they're like, “I just feel this way.” And I'm like, “That's not…”

Stephanie Goss:
Not an answer.

Dr. Andy Roark:
Yeah, you cannot just be like, “I just feel this way,” and go against the 10 of the rest of us who are like… Okay. I was like, “But what does the evidence say?” And they're like, “You know, it's my gut evidence.” And I'm like, “That's not a thing. It's not a thing.” And basically we sat there for two hours and stared at them til they're like, “You know what? It's okay, it's fine.” Then we all left. That was justice that day. We stared at them until the got uncomfortable and just wanted to go home.

Stephanie Goss:
I think that we have listeners who would pay to be on a jury with you, just for the comedic entertainment value.

Dr. Andy Roark:
Oh, it's funny. When you're sitting in the jury room and they take your phones away and then they just leave you there until you can all agree. They come in there and be like, “Hey, it's time for a break.” And I'm like, “What does a break constitute, because we can't have phones, we can't leave the room?” It's like if I put you in a room that was like, “I need you to do this thing that involves talking to the people.” And then I came in, I was like, “Okay, you're on break now, but you can't leave the room and you're still here with the other people and you can't have your phone.” You would be like, “This isn't a break. This is me just doing the exact same thing I was doing minute ago.”

Stephanie Goss:
This is just dragging this out and prolonging it.

Dr. Andy Roark:
Yeah. I was like, “I don't want a break. I want to go home.”

Stephanie Goss:
Oh man.

Dr. Andy Roark:
So [inaudible 00:06:30], it was interesting. It was interesting. The funniest part was, it's a straight-up traffic accident in a parking lot. And one person was like… Both people said the other person was driving like a maniac and slammed in.

Stephanie Goss:
Of course.

Dr. Andy Roark:
“I was basically at a stop and the other person's a maniac.” And they both said that the accident happened in slightly different places, which fit with who ran in into who. Right?

Stephanie Goss:
Right.

Dr. Andy Roark:
If you believe it was this person, it probably happened over here, and if you believe it was that person, it's probably about 15 feet back this way. And there's no footage of it or anything. But one of the people was like, “You could see in the photo they showed us from the arrows that were drawn that this person was not at fault.” And I was like, “That person's lawyer drew that arrow. You can't…”

Stephanie Goss:
It's not actually evidence.

Dr. Andy Roark:
Yes. It's like, “That person's lawyer drew those arrows so that it would look like their client did not do the thing.”

Stephanie Goss:
Oh gosh.

Dr. Andy Roark:
But it was just funny that somebody was like, “If you look at these arrows, it's pretty clear who's at fault.” And I'm like, “You mean the arrows that their lawyer drew to protect their client and explain what happened? Those arrows?”

Stephanie Goss:
Oh, so funny. So funny.

Dr. Andy Roark:
So anyway, I was glad to be done.

Stephanie Goss:
We have a great letter from the mailbag for this week. I'm excited. This is going to be, I think, one of those ones where we go down a little bit of a culture rabbit hole. We got an email from someone asking, “What do I do with having an excellent technician with very skilled, good technical skills. They just happened to call out. And by call out, I mean excessively call out.” And so they were like, “I went back and looked, and this year this person called out over 30 times, sometimes for multiple days at a time for each instance.” And so they were like, “Look, the leadership team, floor lead, practice manager, multiple people have had conversations with them, and in the course of the conversations it's been productive and good. This person has opened up and they're having some mental health challenges.”
And so they were like, “Look, we are in a good place. We have resources. We've got an EAP. We've got a mental health coaching platform that we use. We've got therapy, psychiatry through our health benefits. This person has a lot of resources and they're using them. And the result is still that this person is out a lot, and it's a small hospital.” And so this manager was like, “We're a really small team, we only have four technicians.” And I say only, and lots of hospitals are sitting here going, “I don't even have one technician.”

Dr. Andy Roark:
Sure, yeah.

Stephanie Goss:
“Don't talk to me about being small team.” But they've got three doctors and four technicians to rotate through all the days that they're open. And so they're like, “When anybody on the team, doesn't matter that it's just this one person, when anybody's gone, we're severely short staffed and it puts a significant amount of strain on us. We lose revenue because we can't operate at full capacity.”
And so they were just like, “It's a reoccurring problem. And so what do we do now that it doesn't seem to be changing and there is this pattern? Because every single time it happens, it puts strain on everybody because we're working shorthanded.” And this manager was like, “It's also at the point where it's affecting me on a personal level because I'm the one who has to deal with the schedule, I'm the one who has to rearrange everything at the last minute and try and make it work, and I feel taken advantage of.” And so they were like, “We've tried talking to them, we've tried reducing their work schedule, doing less hours. We reduce it down to the minimum possible to be able to keep their health insurance benefits and none of the things that we've tried are working.” And so they were just like, “How do I deal with this? Where do I go from here?”

Dr. Andy Roark:
How dos from Stephanie Goss? What magic wand do you have that's going to fix this?

Stephanie Goss:
Oh, this is one of those asks where it's like, “What's the magic wand?” There is no magic wand.

Dr. Andy Roark:
It can be a short episode. Make the call. That's it, make the call. Anyway, we'll unpack this. We'll unpack this.

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

Dr. Andy Roark:
But the thing is, you know who this is. It's the story of this lady who finds the frozen snake, and she picks the snake up and she sticks it in her shirt. You don't know the story?

Stephanie Goss:
No.

Dr. Andy Roark:
Fine. So there's this lady, and she's walking home at night in the winter, and she finds a snake frozen solid. She picks the snake up and she puts it into her shirt. And by the time she gets home, it has warmed up to get sort of life back into it, and so it bites her.

Stephanie Goss:
Sure.

Dr. Andy Roark:
And she dies. And as she's laying there dying, she says to the snake, “Why did you bite me?” And he says, “You knew I was a snake when you picked me up.” And that's the story. There's a Buddhist story that's the same story about the-

Stephanie Goss:
That's really funny.

Dr. Andy Roark:
… scorpion and the frog. And anyway, just basically the scorpion says to the frog, “I need to get across this river.” And the frog's like, “Okay.” And the frog swims halfway across the river with the scorpion on its back, and then the scorpion just stabs the frog and kills it.

Stephanie Goss:
Sure, and stings it.

Dr. Andy Roark:
The frog is like, “Why did you stab me?” He's like, “You knew I was a scorpion when you put me on your back.” And again, this person is not bad. It doesn't sound like they're a bad person. It sounds like they're probably really struggling. Everybody's fighting a battle we don't know anything about.

Stephanie Goss:
Yes.

Dr. Andy Roark:
At some point you know what this is and you know who this person is. So that's headspace for me, it's the biggest headspace thing [inaudible 00:12:53], for me is this. And I've seen this. I've wrestled with this so many times in my life, is the if this person would just blank problem, which is when you look at the person like this and you say, “But she's a great technician and everybody likes her, and she's funny, and she's positive. If she would just show up and do her job, she would be amazing.”
I was like, “If she would just not steal money from the cash register, she would be incredible. If she just didn't sell drugs out the back of the practice, she would be awesome.” And again, I'm conflating these things that are wildly more problematic, but you get the point. That's the hardest thing as a manager, is when you see someone who is great in so many ways, but they have this thing that they're doing that is toxic and they will not stop doing the toxic thing. And it tortures me because I desperately just want them to stop doing the toxic thing and this'll be great. I have struggled with these people in my career because I think, “Oh, if she would just stop doing this or she would just do that.” And it is so painful to come to the point of realization that she's not going to stop.

Stephanie Goss:
Well or maybe she can't. Right?

Dr. Andy Roark:
Or maybe she can't, absolutely. Yes, very fair.

Stephanie Goss:
And so I think here that is, for me, part of the headspace is acceptance. For me, that is almost the totality of headspace is acceptance. At some point we have to accept…

Dr. Andy Roark:
It seems that way, because they seem like they've done a really good job.

Stephanie Goss:
Yes. Yes.

Dr. Andy Roark:
It's like at some point it really stinks when people come to us and they're clearly Uncharted listeners or they're Uncharted members and they're in there with us and they do it. It sucks because they come to us and they're like, “I did all of these things.” And I'm like, “Oh, you did all the things. There's nothing left. You did them all.”

Stephanie Goss:
It's so funny you said that.

Dr. Andy Roark:
Congratulations, you're boned at this point because none of this has worked. That's so bad.

Stephanie Goss:
It's so funny that you said that, because in my first thought as I was reading it was… But let's zoom out for the people who maybe haven't, who have been in this position who haven't tried all of the things. Right?

Dr. Andy Roark:
Okay, all right.

Stephanie Goss:
Let's give kudos to this management team.

Dr. Andy Roark:
Absolutely.

Stephanie Goss:
Because they were like, “Let's start with the resources. Here's what we got.”

Dr. Andy Roark:
Totally.

Stephanie Goss:
They're doing the right things. They've got an EAP, an employee assistance program. They have got additional mental health support in a coaching app, which I love the sound of that. I would like to find out more about that. They've got access to therapy and psychiatry through their health benefits which they're providing to their team, so all of these things are great. And they've been super supportive, where this person is like, “Hey, I need to take time off.” “Okay, take care of yourself. We've got it. We'll figure it out.” So big kudos there. That's step number one.
Step number two was they were like, “Hey, culture is important to us. This person is highly skilled and they are a great cultural fit.” And so you know what you talk a lot about how do we evaluate employees and we need to look at fit and we need to look at skill.

Dr. Andy Roark:
True.

Stephanie Goss:
So these managers are like, “We looked at the fit and we looked at the skill. When she's here, she's an incredible fit and she's highly skilled. This is the kind of person that we want on our team. This is the kind of person that we want to retain.”

Dr. Andy Roark:
“When she's here” is the operative words.

Stephanie Goss:
Exactly. That's exactly it. So the head space, I think, and the challenge for this management team is we have to come to a place of acceptance. And so this is a little bit of when the same thing happens over and over again, at some point it's become your business model. And so that is the case here. It has become the business model. There was some information shared, which it sounds like this person is not always necessarily being truthful when they're calling out. There is some far farfetched stories. Because I could hallucinate a planet where if someone is having struggles, whether they're physical health or mental health or within their family or home environment or whatever, at some point I've been there where it feels embarrassing to say the same thing over and over again. And so I could totally hallucinate a place where this person is like, “I can't just say I'm having a hard day again. I've got to come up with a very good reason.”
And so it sounds like they ventured into that territory where some stories have been made up, there's been some crazy-ass farfetched things that have been thrown out there as to reasons why they can't. And as a result of that, the leadership team is feeling like, “Well, now we can't trust her,” which is quite unfortunate. Because they were like, “If they would just say, ‘I need a mental health day,' that's fine. That is something we can support.” But now we're in this position where we feel like we have to deal with a problem that they have created because they're not just telling the truth. I think that that is something that we can pick apart and talk about. But I think overall, the answer is acceptance.

Dr. Andy Roark:
Well, you know what part of all this is? This stuff always gets me. So you've got this practice, and they are doing all of the things, you know what I mean?

Stephanie Goss:
Yes.

Dr. Andy Roark:
They've got psychiatric support, they've the EAP going, they're working on flexible scheduling and shortening hours and doing everything. And I'm like, “Man, these guys are crushing it as far as supporting this employee.” And you know what the experience of the other employees is? If you went and asked them or were like, “Hey, what's it working here?” They wouldn't be like, “These guys are amazing.” They would be, “It kind of sucks because this person just doesn't show up and then we just have to deal with it, and it happens over, and over, and over again. And so what is my experience? My experience is being surprised to be shorthanded again and again and again. That's my experience.” And god that sounds awful, doesn't it?

Stephanie Goss:
Yes.

Dr. Andy Roark:
Tell me I'm off base, right?

Stephanie Goss:
No.

Dr. Andy Roark:
That's how I see it go out all the time, is like you're in the leadership role and you are pouring your heart and soul into this, and the rest of the team is not impressed. In fact, they're just irritated, because what they see is not all the support that you're pouring in. They're seeing their own position, which is, “We're shorthanded again, and again, and again.” And again, they don't know why and they shouldn't know why. Right?

Stephanie Goss:
Right. Right.

Dr. Andy Roark:
We don't share these types of information about why we do what we do. That's an HR no, no. So they don't have the information. And so try to put yourself in their shoes and how does this look to them? It doesn't look good. And it's one of those things where sometimes no good deed goes unpunished, where we do what we can for this employee and we work so hard, that we end up irritating the rest of our staff and now our generosity has backfired on us. I don't know that that's happening here, but again, when we talk about finding balance, that's a big part of it. We want to help this person, and we need to help the staff and make sure that they're taken care of, the rest of the staff.
And we need to take care of clients, which mean clients need to know that they're going to receive a certain standard of care when they come in, and all those sorts of things. It all has to balance out. If you have one person that just keeps tipping farther and farther back on the scale, at some point you go, “We've done everything we can to try and balance this, but we just can't go that far.” I think that's where we come to acceptance, is go, “We've done everything and it's still not going to work.”
I think that's a bitter pill to swallow, but I think sometimes we have to that swallow pill. But let's go ahead and get into headspace here, and talk about where they are from a general place. Because this is pretty far down the line. Let's talk about what they did and how they did it and what we think about that. Does that sound good?

Stephanie Goss:
Yeah.

Dr. Andy Roark:
All right, sweet. We're going to have people who are going to struggle at different times in their lives.

Stephanie Goss:
Sure.

Dr. Andy Roark:
That was the thing I didn't understand when I was younger. But as someone who has had a wife go through breast cancer, and had different employees at different times wrestle with personal things, and these are people I care deeply about. I don't know man, I just didn't understand earlier in my life how hard life is sometimes, and how complicated it is, and how good people go through hard things.
And I also didn't understand earlier on how much it meant to me to be a good employer and a good supporter of my people, how much it meant to me to say, “Hey, I understand you're going through something hard. Take care of yourself and take care of your family, and we're going to help support you through this because we care about you.” That feels great. And that is something that has meant a lot to me. And so I put that forward in headspace and sort of say, “Know what your values are. Know what you care about. Know about the type of employer that you want to be.”
I was… to say, “This is a relationship, and I want you to treat it like a relationship.” And man, I don't want to be in a relationship with somebody who's going to cut me off the moment I don't do everything that suits them. Or, the moment I'm struggling with something they're like, “Sorry, we don't have time for your stuff,” and dump you. I don't want that. At the same time, I don't want to be in a relationship with someone who continues to take, and take, and take, and take, even if they don't mean to. At some point, it's kind of like it is some of those things that I've heard and read something different things about. People who struggle with family members who just continue to drain, and drain, and drain. You say, “This is my family member.” But at some point you've got to say, “I'm sorry, I'm putting boundaries up to protect myself, even though this is a hard decision.”
I think that there's some parallels as employers of saying, “I'm going to be here. I'm going to support you, but at some point I'm going to be a part of the healthy relationship and I'm going to have to do what I need to do to keep my own head above water,” you know?

Stephanie Goss:
Oh yeah, 100%. When you don't do anything to have balance and set boundaries, you are 100% creating the co-dependent relationship. They are taking, and taking, and taking. But by you not creating any boundaries and saying, “Okay, I'm giving grace and these are the rules that we need to play by,” you are equally responsible for creating that codependency. And so I think that's part of the acceptance for sure from a headspace perspective. It's like, “All right, this is where we're at,” and ownership of that.

Dr. Andy Roark:
Well, the lack of truthfulness about what's been going on, I think this is an interesting life lesson. And again, a lot of the stuff we talk about… I think the reason that people like what we talk about and how we look at things in Uncharted is we tend to keep things pretty darn simple. I try to frame them that way, and they are. The truth is, once someone catches you not being truthful or their perception is that what you're sharing is not honest, you're going to lose that trust. Right?

Stephanie Goss:
Yeah, yeah.

Dr. Andy Roark:
Trust is hard to build and easy to lose. And once you lose someone's trust, one, it's hard to get back. But number two, it affects how they treat you and the grace that they extend to you. And so when they say, “We found this person not being truthful about what had happened or given these very farfetched stories,” and things like that, I'm not going to say to these people, “Oh, you can't hold that against this person,” or, “Don't let that factor into your decision.” It does factor into your decisions.
And so I think really, the truth is in personal responsibility, just as an employer or employee, as an individual. I think one of my sayings is, “Integrity above all else.” And the truth is come clean and be honest. And once people question your integrity, it closes a lot of doors for you. And I would say that's another reason… If I sounded flippant at the very beginning, this is part of the reason why, is because it's really hard to go forward with somebody that you're trying to take care of with the knowledge that they have not been truthful and they may not be truthful in the future.
It's really hard to do that. If you're dealing with someone who's struggling and they're being upfront about how they're struggling… And again, that doesn't mean sharing everything. Right?

Stephanie Goss:
Right, yes.

Dr. Andy Roark:
We all have privacy and expectation of privacy. But if they're not misleading us in any intentional way, I'm much more likely to try to keep going with them and saying, “Everyone's acting in good faith.” But man, once people start being less than honest about what's going on with them, that really closes the doors in the number of ways that we can work with them, just because we never know what we're dealing with.

Stephanie Goss:
Yeah, yeah. No, I think that that is totally true. I think the last piece of headspace for me goes along with that. Because, for me, part of the headspace is wrapping my brain around my own acceptance, as a leader, of letting it get to the point that it's at. Again, we're only hearing one side of it, and we're just reading the email and interpreting. But they were like, “We're at the end of the year. I did a look back, this person has called out more than 30 times this year, and there's been multiple wild stories and we've caught them in lies.” My question is acceptance of, okay, I have to own that. Did I have the conversation with them the first time it happened? Did I have the conversation with them the second, third, 10th time that happened?
And acceptance of the fact that, okay, we've gone far enough down the road that now it's not an easy conversation of, “Hey, yesterday when you called out, this is what you said.” I'm going to use a common example, “Then you posted on social media, or you sent a text message to the rest of the team and said, ‘This is what I'm doing.' So I know full well that that wasn't what you needed. I just need you to know, you don't have to give me details. It's okay to just say, ‘I need to take a mental health day.' Or, ‘I can't talk about it, but I need to take a personal day off.' That's what they're there for. I don't need the details, but I do need you to be honest.” Right?

Dr. Andy Roark:
Yeah.

Stephanie Goss:
So for me, part of it is acceptance of my own level of responsibility as a leader. I will tell you, again, this is an episode that there was a time in my career that I could have written this letter.

Dr. Andy Roark:
Yeah, sure.

Stephanie Goss:
And part of it, part of the very bitter part of the pill, was the fact that I was… Like you said, I wanted so badly to support that person and be there and be accepting, that the pendulum swung way too far in one direction. And then when the rest of the team was raising their hands and saying, “But what about us?” I was struggling because I was like, “But I was trying to do the right thing for this person.” And the reality is, yes, I was. I was trying to do the right thing for that person. I was trying to give them grace. I was trying to support them. I was trying to not look like the manager who's like, “Screw that. You called off for this second time, you're fired.”
Because there are managers like that in our industry, and I get that these leaders were trying to do the right thing in supporting their people. There has to be the balance. If they team is like, “Hey, we're constantly short-handed,” and you, as a leader, are saying, “I'm the one constantly having to readjust the schedule and now it's affecting my mental health,” that's part of the acceptance pill to say, “Hey, maybe the pendulum has swung too far and I need to get into a headspace about my ownership of that.” Because in the action steps, in having some of those hard conversations, it'll probably make it a lot easier to potentially have a better outcome if you can own some of that.

Dr. Andy Roark:
Yeah. The last headspace thing for me, which I think is actually probably the most interesting part of this whole quandary here, is the mental health card. And that's an interesting term, but I'm hearing this term more often, the mental health card. And so to me, it's interesting because this has been put forward as this person is having mental health struggles. And that's one of the things that's been put forward.

Stephanie Goss:
Sure.

Dr. Andy Roark:
And I think a lot of leaders out there are struggling with employees that are… or team members, or coworkers, or fellow doctors who are not performing, not meeting expectations. And the justification is, “Well, I'm having mental health challenges.” What do you do about that, and how do you balance compassion and support for this person with the reality that we have to have expectations to get met? We can't have people just not show up for work again and again. It's not fair to the other team. It's not sustainable. It shakes our whole business. Or, the behaviors that are manifesting are not acceptable behaviors.
I understand that you're struggling, and I can be compassionate about that. At the same time, I still can't have you yelling at the staff when you get stressed. That can't happen. And so I think that's an interesting thing. I'm saying I think there's a big spectrum of this. There is 100% the this person has legitimate mental health struggles and are struggling to meet performance. How do we manage someone who's struggling to meet performance because of mental health challenges?
And then there's the far extreme where there is the one that says this person may have other reasons for not meeting performance, but they're saying it's a mental health struggle because they think that that's going to get them more leniency than if they just said-

Stephanie Goss:
Sure, it's a free pass.

Dr. Andy Roark:
… “I just didn't feel like coming in.” Exactly right. And you'd hate to think that anyone would do that, but it's a big world and I'm certain that there are some of that.
And so people say, “Well, how do you manage these things and navigate these things?” And so I think we'll talk about this in action steps. But I think the headspace is assume good intent, assume that everyone is doing their best, compassion first. And this is all about balance, which means I can believe that you're having mental health struggles and I can be compassionate and empathetic, and at the same time just know that my job is to balance the needs of the individual with the needs of the team and the needs of the clients. And so I can be empathetic and compassionate and still say, “I need to balance these things out. And we have to figure out how to make that happen.” And we'll talk about that when we get into action steps.

Stephanie Goss:
Yeah, I like it. Do we want to take a break and then dive into the action steps?

Dr. Andy Roark:
Yeah, let's do it.

Stephanie Goss:
Okay.
Hey, friends, I just want to jump in here for a quick second and say that I am super, super pumped about all of the awesome things that we have coming down the pipeline in 2023. Now, we haven't announced all of the surprises that we have coming for all of you, but there are lots of great things coming to kick off the year. If you haven't signed up for some of the workshops and events that are happening in the first quarter of 2023, you want to head your little self over to UncharteredVet.com/events, and check out what we've got coming.
If you are a member, all of the workshops are listed there. You can log into your account and sign up for free. If you are not a member, you should check out what's coming and consider a membership for 2023, because you could pay $99 per workshop, but you also could pay $6.99 and sign up for a whole year of registration as a member and then you get access, not only to all of the workshops that we do, but all of the amazing content that happens over in our workplace group and our community. It is so fun, it is lively. It is just jampacked with conversation from the community about what's going on in their practices, how to solve challenges, how to support each other. It is one of my favorite places to spend time. I would love to see you there.
If you need that address one more time, it's Unchartedvet.com/events. Now, back to the podcast.

Dr. Andy Roark:
Let's get in some action steps here.

Stephanie Goss:
Okay.

Dr. Andy Roark:
Okay, cool. I'm going to start with your favorite thing. Let's talk about what they did, because they did a lot really well. Let's talk about what they did, and let's walk all the way up to where they are. And so, one of the first things that we've got to do to be successful… And I deeply believe you have to learn this the hard way. Every policy that we have probably came from a mistake that we made in the past. And so it takes a while for people to get here.

Stephanie Goss:
Yes.

Dr. Andy Roark:
You're going to love this.

Stephanie Goss:
Are you going to say it?

Dr. Andy Roark:
But we need to have our handbook. What is our attendance policy? What is it?

Stephanie Goss:
What does your handbook say?

Dr. Andy Roark:
And what systems do we have to support people who are having mental health challenges? I know you love it.

Stephanie Goss:
I do. Can I just bask in that for one second?

Dr. Andy Roark:
Yes, just soak that in. You should have-

Stephanie Goss:
What does your handbook say? Okay, okay. I like it.

Dr. Andy Roark:
What does your handbook say? But that has to be it, right?

Stephanie Goss:
Yeah.

Dr. Andy Roark:
Hear me on this, this is how we make the balance happen, is we sit down, not in the moment, not when we're dealing somebody, not when it looks punitive. But we just sit down and say, “Okay, what is our calling out policy?” knowing that life happens and we want to be generous to people, and we want to be supportive of people. I'm not making some Alcatraz calling out policy where if we can't find you then you can be off for the day.

Stephanie Goss:
Right.

Dr. Andy Roark:
It's not that. But what is the policy here? Because these guys said she's called 30 times. I don't know what the policy is, but it's not 30. That's not where we want to be.

Stephanie Goss:
And I love that. Obviously, I love that you said, “What does the handbook say?” But also I think that that's a good use case to look at and say, “Okay, we feel like there should be some sort of attendance policy, and someone who's called out 30 times feels a little excessive.” Let's look at that. When we think about what is… Okay, if there's 52 weeks in a year and everybody gets vacation and you figure out what is your actual working… How many weeks in a year does your average team member work? It's probably somewhere between 40 and 48 for a lot of people. What does that look like? Look at your own policies and then figure out…
Okay, let's just look at that. What is half of that? What is 50%? When you look at that, even if you just take 52 weeks. I don't know what their vacation policies are, so if I take 52 weeks, half of that is 26. If this person has called out 30 times, that means that they've only been there half of the weeks in the year. That is wildly excessive to me. Clear-cut, no brainer. Anyone could look at that math and say, “This is excessive.” It doesn't feel subjective, it doesn't feel punitive, it just feels excessive. And so it's easy to say, “Okay, if this feels super excessive and we know we want some sort… what does the middle ground look like?” You know?

Dr. Andy Roark:
Yeah. There's this exercise I talk about every now and there called Rawls' veil of ignorance. Rawls' veil of ignorance is the idea that if you look at a system, if you didn't get to pick where you were in that system, would you think it was fair? And if the answer is yes, then it's fair. I've always aspired to that. If I was the CEO, would I think that this was a good, fair approach? And if I was the janitor, would I think that this was a good, fair approach? And if I was a doctor, would I think it was a good, fair approach? And if the answer is all the things is, “Yes, I would think it was fair,” then you're probably doing pretty good.
And so I like Rawls' veil of ignorance, especially in this regard, because my goal is to come up with something that works for me, as the business owner, it would work for me if I was one of the technicians on the floor trying to get the work done. Or, if I was the person who was having some challenges and had to call out, I'd be like, “Yep, the system seems fair.”

Stephanie Goss:
Sure.

Dr. Andy Roark:
And so when they sit to make these, I really like Rawls' veil of ignorance because I don't know if I'm going to be the boss, I don't know if I'm going to be the laborer, I don't know if I'm going to be the person who's calling out sick because I'm having a family emergency or nagging health problems for my kid, or whatever. I think that my goal in this would be to say, “I don't know which of those people I would be in this situation, but wherever it was, I would think it was fair.” That doesn't mean I'd be thrilled with it. That doesn't mean that it would solve all of my problems. But I would understand and say, “Yeah, I think this is fair.”
And so when we start talking about these things, I think that's what we talk about. Say, “What's fair to the person who is out? What's fair to the team that is expecting support and not getting it when the person's out? What's fair to me, as the person making the schedule and scheduling the staff? What's fair there?” I think laying that stuff down ahead of time, I think that that's really key. And that's your attendance policy. At what point do they have to start having to have doctor's notes? Where does that happen? What does that do? But we need to lay those things down.

Stephanie Goss:
Sure.

Dr. Andy Roark:
The other part is to say when we talk about mental health stuff, I'm not a therapist and you're not a therapist. I am not a mental health professional and that shouldn't be part of my business model, I don't expect to be. However, I do what people to have support when they need it. And so when I'm done setting my attendance policy, I'm going to look at my mental health support options and resources and lay those things in and say, “If people are struggling, if they're having mental health issues, this is how we're going to get them support.” That's not me making it up and pulling it out of my ear as we go along.
It's like, “No, this is what we have, and this is how we're going to support these people.” And basically what I want, ultimately, is for those two things to come together and to make a good support structure to say, “This is our attendance policy and these are the resources that we have.” The expectations are that you leverage these resources and still abide by this policy that was put in place with the idea that some people would go through hard times. You know?

Stephanie Goss:
Right. Yeah.

Dr. Andy Roark:
But you can still check those boxes. And when the team comes to me and says, “Hey, Andy, why is Stephanie not here all these times?” I can say, “Hey, she is following our protocols that we have laid down. She has met the requirements to be able to request this time off and do these things. We're supporting her. But I assure you, she is working by the same policies that you would have accessible and available to you if you were in her position.”
And bam, I'm not telling you what it is. I'm not going into resources, or what resources you're using, but I can look at you in the face and say, “She's using the same playbook that is open to you when you face these challenges.”

Stephanie Goss:
It's equitable. Yeah, yeah. I think that's so important. And I think that's the hard part, because… And I will tell you I have done this, I will own this 100%, where as manager, somebody has figured out another loophole. I say that with all the love. And then I'm, “I am going to take my flaming, raging sword of justice and I'm going to update the handbook, because screw this.”
And then it never goes well.

Dr. Andy Roark:
Yeah, sure.

Stephanie Goss:
Everybody can see it for what it is. And sometimes that's a good thing, right? Sometimes, from an HR perspective, I can't share information. I can also let the team know, without saying much, “Hey, here's the new policy I need everybody to be aware of.” You know? Right?

Dr. Andy Roark:
Yeah, yeah.

Stephanie Goss:
And sometimes that is a tool. That should not be the first tool that you reach for. It's really easy when we're frustrated or we're angry, which is reasonable given the circumstances, that it's easy to reach for that tool first, and it shouldn't be the one that we reach for first. But I love that idea of doing it when you're not… Not punitively, not in the moment. But looking at the policies, looking at the protocols, looking at the support systems, I love that, because then everybody knows what to expect.

Dr. Andy Roark:
Yeah. And I find that to be true. I talked about the mental health card, and people say, “Well, what do you do when this person can't perform?” And they're pointing to this and say… If we've set up our systems well, then ultimately they're going to get support. And at some point they're going to come to a place where you say, “Hey, you've used up all your away time without a doctor's note and this is where we are,” and they have access to resources and stuff like that. But at some point you have to say, “This is where we're coming down on this issue.”
I tell you what's a nightmare to do, is to say, “Hey, we don't have any policies, but I feel like you've been gone too much and now I'm going to force this issue.” You don't want to have that conversation. The point of laying in these protocols is to have built in systemic boundaries where you can say, “Hey, just so you know, we're coming up on this and we're going to need to figure out what to do about it. You need to be aware that this is what our policy says and where you are in the program.”

Stephanie Goss:
Yes, and I love that you said that, because, for me, that is a huge part of the action plan and acceptance here, is the fact that we're doing this now. We're doing this as a look back. This person has now missed 30 call-outs in a year… I'm assuming in a year period.

Dr. Andy Roark:
Yeah, sure.

Stephanie Goss:
But whatever period of time. 30 call-outs and now I'm looking at it. And so now I'm like it's not, “Hey, you're coming up on the end of the policy. We get two weeks in a year. You've used a week and a half. Just FYI, I just wanted you to be aware of it.” It's the afterwards. And so it sucks, because in a way, and again, I say this as the manager who has done this, so please, if you're listening, don't take offense to this, you've tied your own hands. Because now you're having to have the conversation way after you should have laid the groundwork and had that framework conversation. Or probably multiple framework conversations and said, “Hey, this is where we're to.”
Now you have no choice but for it to potentially come across as feeling punitive, because no matter what you do at this point, it's reactive, because you're coming at it from a place of, “This has already happened, and now I need this to change,” which is not the place you want to be able to come at it from. You want to be able to come at it, like you said, Andy, from that place of, “Hey, this is how far into it we are, just a heads-up, just an FYI.” Because you're laying that groundwork, because then the conversation becomes easier. “Hey, remember how we had that conversation that you had a week left. You've used up that week, and so we're at that point, I just want to check in. I want to know how you are. How are you feeling? Do you think this is going to be an ongoing problem? Do we need to come up with a new plan? Do we need to talk about FMLA?” What are all of those options? You're doing it ahead of time when you do it the way that you just said.

Dr. Andy Roark:
Well, this philosophy, this approach that we use at Uncharted, it comes from dealing with clients who are strapped for cash, so clients who come in who don't have money for procedures. Originally, I spent a lot of time working on this. Exam room communication's a passion of mine, it has been for a long, long time. I wrestled with this for years. I can't look at somebody and know what their financial status is. I don't know if you have money or not, and I don't want to guess. It makes me feel gross and to look at someone and go, “Do you think she can afford this?” I don't freaking know. I don't know.
If you say to me, “Oh, that's a lot of money.” I don't know if that's because you don't have the money or if you just are someone who is cheap and is like-

Stephanie Goss:
That's a lot of money.

Dr. Andy Roark:
… “I have the money but I don't want to spend it.” And again, I'm never going to know. The place that makes me happy, where I found comfort is to say, “I've built a system for dealing with clients that doesn't…” I don't care what you have. I'm not going to treat you differently based on how much money I think you have. I'm going to make a system where we bring people in, we do our physical examination, we walk them through the process, we articulate what we are doing, we are open and transparent about our prices, and ultimately we come down to a place where we're going to present estimates and say, “This is what we want to do, and this is how we want to go forward.” We may give people options, or whatever we're going to do. But we walk through.
And again, it's not based on how much money we think you have in your pocket. Everybody gets treated the same as far as how things are laid out and what communications we have. And then ultimately, I don't really care if you have the money or not, I just need you to be open about where you are, and I'm going to be open about where I am. We're going to have resources in place to help you. If you don't have that money, we're going to have payment options, we're going to have lending options, we're going to have whatever else, a way to walk you through this.
But what's not going to happen is you're going to come in and make some vague hints about not having the money to take care of your pet, and then I'm going to throw all the rules out the window and just do everything that I can for you, not paying any attention to my staff and what the practice needs. I'm not throwing all that stuff away. That can't happen. And I see a lot of people do that. And so it really bothered me for years and years, until finally we just drilled in and we're like, “This is how we do the exam room.” And that's it.
If you're interested in that, I've got a team training course called Exam Room Communication Toolkit. It's at DrAndyRoark.com, where I do staff training. But all that stuff is 17 tools, but they all come from this type of approach of being like, “This is how we talk to people, and we work everyone through the same system. And ultimately, if there's a money problem, it comes out and we work through it within healthy boundaries.” And so when we start talking about absenteeism, when we start talking about people having mental health challenges in the profession and practices, and again, it's something I've wrestled with.
I went through a period of significant burnout a couple of years ago. It really, really sucked. My practice was greatly supportive of me. They were wonderful, and I would want to give that to other people. And at the same time, I expect the practice to have healthy boundaries and to take care of itself and to take care of the other employees, and take care of the pets. And that means having some guidelines in place before we get here that say, “I want to be supportive of you, and at the same time, you have some obligations here as well.” Whether it's cash-strapped clients or whether it's employees that are having mental health struggles, I think that that's the healthiest, most compassionate approach for everybody. I really do.

Stephanie Goss:
Yeah. And I think we're kind of at that point where we have gone past the pre-work. We talked about action steps that we can do in the future, and things that we can do to set ourselves up better for success next time. And at the same time, with this current technician, I think it's time to sit down and have a conversation. I would do it from a place of compassion and a place of care, but I would just say, “Hey, I need to sit down and have a chat with you.” And then I would kind of just lay out, “Hey, okay, here's where we're at.” This is a potential to own some of it on your own, and I found that it softens the blow.
I like to use this as a tool. It doesn't fit right for everybody, but I would 100% say, “Hey, I wasn't on top of this and I didn't realize that we're at the 30 mark, 30 call-outs for the year. That's on me. And now that I recognize it, I need your help because I can't go into the new year with this happening because it doesn't work for the rest of the team. I want to support you.” And again, I want to recruit them into the conversation. And so the way I would probably approach it is to say, “I can see a couple of potential solutions here, but I want to talk through all of them with you because you might have some ideas that I might not have thought of that I want to have on the table. But we've got to address this, because we can't keep going the way we're going.”

Dr. Andy Roark:
I love that so much. I love it. I love it because you owned it. And the more accountability we can accept, the more open a conversation we're going to have. I just think that, “Hey, it's on me that we got to 30.” I love that so much. I think that's excellent. And another thing that I really love in the wording that you used there is it's very future facing. “This is where we are. We're going into 2023, let's talk about what we're going to do differently, or let's talk about what we need to do in the coming year because we need to make some adjustments. And I said it's on me that we got this far this year. We cannot do this again next year, just so you know.”
And so I love that. I love laying it down like that and keeping it positive, and keeping it future facing.

Stephanie Goss:
And I think the other thing too, is to acknowledge that they may be in a situation that they can't control. Right?

Dr. Andy Roark:
Yeah.

Stephanie Goss:
And so it's okay to say, “We may be in a situation where you need to continue to have time off, and that's okay. And here's how we can support you.” It's okay to say to them, “We can support you in the capacity that you're a part-time on-call, or on-call team member.” That could be a potential solution. It doesn't have to be, “We're going to keep you full-time and keep scrambling at the last minute.” It is perfectly okay to take that off the table and to just call a spade a spade and say, “I can't continue to be in the position where we're having to change the schedule last minute and the rest of the team is working short-handed, because it's impacting me on a mental health perspective, it's impacting the team. Short-handedness, it impacts the clients. I need your help to figure out how I can support you and not continue to be in this situation, because I want to do both of those two things.”
It's okay to put some of the accountability and responsibility back on them, because regardless of what they're going through, mental health or not, it is an unrealistic expectation, for any employee to have, to expect that they can show up when they want. That's not how real life works. I think that for a lot of us, we get afraid to be the adult and put the boundaries in place because we're like… For me, it was always like, “I don't want them to not like me. I don't want to be the mean one.” Right?

Dr. Andy Roark:
Yeah.

Stephanie Goss:
And the reality is, I can't run a business if my team isn't here. And so maybe the answer is I hire more staff, because if I know I'm going to be short-handed, maybe I need to hire more people. That falls on me, not on them. Maybe they need to go to part-time. Maybe they need to be the on-call employee. This is where, for me, it's about the brainstorming. Because I won't know what's possible until we lay all the cards on the table. For me, the best case scenario is for them to be active and engaged in that part of the conversation, and also recognizing that they may be in a place where that's not possible.
If they are really struggling mental health wise, or they are having a challenge, they may not be in a place to contribute to that. I want to create a safe space where they can say, “I don't know. I just know that I need flexibility.” “Okay, then here's what I can do to support that for you. If you need flexibility, here's what I can do to support that.”

Dr. Andy Roark:
Cool. I want to hammer on this right here as well and say, remember that this doesn't have to be one meeting. I really like your idea of going in… Because to me, I always feel there's pressure to go in and say, “Well, what can you do? Okay, then here's what we're going to do.” It's like, “I'm sorry, I'm not that smart. I'm not that fast.”

Stephanie Goss:
Yes. Mm-mm. Nope.

Dr. Andy Roark:
I need to gather information and then I need to go away and I need to think about it. I need to think about what they say they can do or what their needs are, and then I need to think about what my needs are and what that looks like, and then I can come back and say, “Hey, this is what we need to do next year.” But it doesn't have to be at one time. Don't be afraid to step away. The other thing is ultimately you can do information gathering, and you are going to need to clearly communicate what you need to this person. Because otherwise it's not fair to not tell them what the realities are. And so you don't have to do that today, but you need to say, “Hey, we're at 30 days, that's on me. We got to do things differently. Let's talk about what you're looking at. Let's talk about what would be realistic expectations for next year. Let's talk about how we're going to move forward. I just need to hear where your heads at and what you think you could do to help me meet these needs.”
If this person needs to go part-time, then you go part-time. They might not like that, and I might not like that, but continuing to do the same thing again and again, and expecting a different outcome is the definition of insanity.

Stephanie Goss:
Yes.

Dr. Andy Roark:
If you just keep going and go, “I don't know, she just keeps up not showing up. I don't know what to do about it,” I think, “Well at some point it's not a surprise anymore, it's your business model.” And so anyway, I think that at some point, we have to say, “Look, this is what I need.” And you have to say what you mean, and you have to mean what you say. At the very beginning I said, “I see where this is going.” We can do all the things that we said, and ultimately this person… We can't make this person show up for work.

Stephanie Goss:
Nope.

Dr. Andy Roark:
Like I said, we can do all the systems in place and everything like that, and we can't make the person show up for work. There are ramifications of this person not showing up for work. It is going to cause you problems to have someone who no-shows again, and again, and again. It's going to cause you real problems to have someone who no-shows again and again, and there don't seem to be any repercussions for that person. That's going to have fallout, and you need to be honest about it, and you need to use what… You've already seen, I'm sure, to forecast what that looks like. And then, my friends, you're going to pick your poison at some point.
You've got three options. You can end this now, you can keep it going as it is and accept the fallout from this behavior continuing, which I would not recommend, or you can try to modify expectations and come to an agreement, knowing that if that agreement does not work, you're going to move to termination. And I think honestly, that's probably where I'd be, is I'd get real honest with this person. I would figure out what I really need. I would think about what a fair attendance policy looks like that accounts for people who have unexpected illnesses or sicknesses or mental health challenges, but it's still fair to them and to the rest of the team, and to me, as the practice owner.
I would put those things in place and say, “Look, this is where we are and this is where we're going, and this is what it's going to look like when we get close to running out of these days, and this is what it's going to look like when we hit those days. And this is what it's going to look like when we go past those days.”

Stephanie Goss:
Yeah. I love that so much. And I will say that for me, like I said, I was this manager at a point in my career, and I wasn't sure of where to start. And if you're like, “What would that even look like?” My suggestion would be even if you're a small business who doesn't… to whom FMLA isn't applicable, I would look at the Family Medical Leave Act. I would look at the standards there and say, “Okay, if I was a business of this size, this is what would be legally be required of me.” That's what FMLA says, is that when I have over a certain number of employees, these are the things that I have to provide for them in terms of leave.
And for a lot of businesses, they choose to have all of the leaves fall under that similar umbrella. There are other specific leaves of absence we have to be able to provide our employees, military service, domestic violence protection, et cetera. But most people look at it under that FMLA umbrella and say, “Okay, if someone was going to take a leave of absence for a physical health thing, I'm going to apply mental health the same way.” I looked at those guidelines and said, “Okay, this is what would be required of me. Could I make this work? Could I not? What pieces of it don't work for me as a small business?” If this really a small practice and their techs… their ability to lean into other support members is significant different in a practice that has four technicians versus a practice that has 100 plus employees and you have a bigger pool to draw from.
And so that's why FMLA is not applicable to everybody. But I would use that as the starting point. And for me it was like, “Okay, I can't give 12 weeks, but I could find a happy medium between what we currently have and 12 weeks.” To say, “This is what we could do.” Maybe it's some combination of intermittent. Looking at those kind of things and using it as a baseline to figure out where do I go from here, that would be my best suggestion.

Dr. Andy Roark:
Yeah. I completely agree. Yeah, I think that's it. I think that's kind of what I got. I hope that's helpful, as far as just thinking about. I hope he doesn't feel like we're beating up on our writers.

Stephanie Goss:
I hope so.

Dr. Andy Roark:
It's like it's one of those things where when you play the game really, really well, and then you're still like, “And the person still doesn't respond.” I go, “You've done everything right. The problem is, I'm sorry, I don't have a magical next thing for you to do.”

Stephanie Goss:
There's not a magic wand.

Dr. Andy Roark:
I think you know exactly what you're looking at, exactly who this is and exactly how they're behaving and what the pattern is. None of this is a surprise. I think you're at the place where there's nothing else to do but make the call, and the call is either, “I'm not doing this any more,” or the call is, “I'm going to put up with this,” or the call is, “I'm going to go to them and say, ‘This is the cahnge that I'm going to require to go forward. And if this change doesn't happen, then we cannot continue on together.'” I think those are your three options. I think I would go for number three.

Stephanie Goss:
Yeah, me too. Have a good week, everybody.

Dr. Andy Roark:
Yeah, everybody. Take care of yourselves. We'll see you later on.

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

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

Nov 02 2022

Unforgiving Doctor is Ticking Off the Staff

This week on the podcast…

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

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

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

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


Upcoming Events

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

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

More Resources From The Episode

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

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

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


Episode Transcript

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

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

Meg:
Now The Uncharted Podcast.

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

Bret Canfield:
Fabulous. How are you doing?

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

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

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

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

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

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

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

Bret Canfield:
Absolutely.

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

Bret Canfield:
Agreed.

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

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

Dr. Andy Roark:
Exactly right.

Bret Canfield:
It happens. Yeah.

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

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

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

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

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

Bret Canfield:
That's right.

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

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

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

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

Dr. Andy Roark:
Yeah, a golden retriever.

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

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

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

Dr. Andy Roark:
I like that a lot.

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

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

Bret Canfield:
Right.

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

Bret Canfield:
Exactly.

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

Bret Canfield:
Yeah, agreed.

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

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

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

Bret Canfield:
We crushed it.

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

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

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

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

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

Dr. Andy Roark:
Exactly.

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

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

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

Dr. Andy Roark:
All right.

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

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

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

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

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

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

Bret Canfield:
Sure.

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

Bret Canfield:
Agreed.

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

Bret Canfield:
That's true.

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

Bret Canfield:
That's right.

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

Bret Canfield:
That's right.

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

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

Dr. Andy Roark:
Nope.

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

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

Bret Canfield:
That's right.

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

Bret Canfield:
Exactly.

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

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

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

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

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

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

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

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

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

Bret Canfield:
They can't.

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

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

Dr. Andy Roark:
Exactly.

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

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

Bret Canfield:
To the whole clinic, right?

Dr. Andy Roark:
… and danger bells.

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

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

Bret Canfield:
Exactly.

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

Bret Canfield:
That's right.

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

Bret Canfield:
Exactly.

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

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

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

Bret Canfield:
Agreed.

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

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

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

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

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

Bret Canfield:
That's right.

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

Bret Canfield:
That's right.

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

Bret Canfield:
That's so powerful.

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

Bret Canfield:
Totally.

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

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

Dr. Andy Roark:
Yeah, of course.

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

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

Bret Canfield:
I love DISC.

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

Bret Canfield:
Exactly.

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

Bret Canfield:
Or the most influential person. Absolutely.

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

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

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

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

Dr. Andy Roark:
Sure.

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

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

Bret Canfield:
Always a pleasure.

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

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

Oct 26 2022

Consequences When A Client Behaves Badly

Uncharted Veterinary Podcast Cover Image Episode 202

This week on the podcast…

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

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

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


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Episode Transcript

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

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

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

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

Stephanie Goss:
Yes.

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

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

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

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

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

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

Speaker 3:
And now, to the Uncharted podcast.

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

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

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

Stephanie Goss:
Goals in life.

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

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

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

Stephanie Goss:
Oh, poor Skipper.

Dr. Andy Roark:
Oh I know.

Stephanie Goss:
He has such a rough life.

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

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

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

Stephanie Goss:
Oh, man.

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

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

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

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

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

Stephanie Goss:
That's not how that works.

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

Stephanie Goss:
Sure.

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

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

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

Stephanie Goss:
That's awesome.

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

Stephanie Goss:
Nice.

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

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

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

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

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

Stephanie Goss:
Me too.

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

Stephanie Goss:
Okay.

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

Stephanie Goss:
Oh, yeah.

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

Stephanie Goss:
Notes.

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

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

Dr. Andy Roark:
Yeah.

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

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

Stephanie Goss:
Right.

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

Stephanie Goss:
Yes.

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

Stephanie Goss:
Yeah.

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

Stephanie Goss:
No.

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

Stephanie Goss:
Right.

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

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

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

Stephanie Goss:
Sure.

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

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

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

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

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

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

Dr. Andy Roark:
Yeah.

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

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

Stephanie Goss:
Yes.

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

Stephanie Goss:
Yes, are awful.

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

Stephanie Goss:
Yes.

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

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

Dr. Andy Roark:
Yeah, do it.

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

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

Stephanie Goss:
Yes.

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

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

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

Stephanie Goss:
Correct.

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

Stephanie Goss:
Yes.

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

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

Dr. Andy Roark:
Yeah.

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

Dr. Andy Roark:
Yeah. Exactly.

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

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

Stephanie Goss:
Yes.

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

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

Dr. Andy Roark:
Yeah.

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

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

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

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

Stephanie Goss:
Yes.

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

Stephanie Goss:
Yes.

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

Stephanie Goss:
I love it.

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

Stephanie Goss:
Yes. I love it.

Dr. Andy Roark:
Cool.

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

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

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

Dr. Andy Roark:
See you everybody.

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

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

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