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Can Vet J. 2010 August; 51(8): 902–903.
PMCID: PMC2905017

The art of veterinary practice: When too little is as bad as too much

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Bill Metcalf was a retired widower who lived in a low-income community where he was known as a great animal-lover. But although Mr. Metcalf took in lots of strays, he was not a hoarder. As soon as the animals were fit, he found good homes for them. Because of his limited income he had worked out a monthly payment schedule with Dr. Levesque, the owner of the local veterinary clinic, to ensure quality veterinary care for his charges.

About a year ago Mr. Metcalf took in a bedraggled kitten in such deplorable condition he immediately had her examined by Dr. Souter, Dr. Levesque’s associate. At that time Dr. Souter discovered that the animal was actually an abnormally small, but mature adult cat. He offered no opinion regarding whether this was related to her deplorable condition or something else. Nor did he venture any opinion about how this might affect her health as she grew older. Nonetheless, after extensive treatment the veterinarian pronounced the cat cured.

One weekend last spring Mr. Metcalf noticed that the cat was not eating as much as usual. But because the activities of the free-roaming neighborhood cats had always distressed the now house cat, the owner attributed this change to the increased seasonal activity in the local feline population. When her decreased interest in food continued, he decided to have her examined the first thing Monday morning even though the cat was acting normal in every other way. When he awoke the next morning, the cat was moribund and he immediately rushed her to the veterinary clinic.

Later that day after the animal had died, the distraught owner asked Dr. Souter if he could have saved her if he had brought her in sooner. Without a moment’s hesitation, the veterinarian unequivocally replied, “Yes.”

When Dr. Levesque heard this tale from an irate friend of Mr. Metcalf (and a highly valued client), his associate’s response to Mr. Metcalf and his cat generated a feeling of uneasiness long before that final pronouncement to the owner. Once again the practice owner put aside his other duties to address a problem generated by a staff member’s lack of communication skill. He took little consolation from the fact that he had become familiar with the best way to do this.

The first step was to thank his client for her concern and assure her that he would discuss the matter with Mr. Metcalf and Dr. Souter as soon as possible. By doing this he accomplished several objectives. One was to communicate that he valued this client’s input. The second was that he communicated his intention to address the issue in a timely manner. And the third was that he intended to verify the story with Mr. Metcalf as well as his associate.

The third step is an especially important fact to tactfully share with those reporting failures on the part of staff or colleagues. Upon learning that all parties involved in the perceived wrongdoing are going to be contacted, some over-zealous reporters or those with a grudge against a particular staff member may alter their stories. Even if Dr. Levesque’s comment does not reveal that any details of an event have been altered, it does prevent the practice owner from reacting to unverified information.

Next, Dr. Levesque contacted Mr. Metcalf. He did not do this because he valued the client’s input more than his associate’s, but simply because Dr. Souter was tied up with office hours at that time. Mr. Metcalf confirmed his friend’s story, but also added that he had no desire to make trouble for Dr. Souter.

“I guess I shouldn’t have said anything at all,” he told Dr. Levesque. “Even though he said she was cured after all that treatment when I first got her, I knew she wasn’t a normal cat. That’s why I gave her the best food I could afford and made her a house cat. When Dr. Souter later said that I killed her, it made me really angry.”

Later that afternoon, Dr. Levesque got the other side of the story from his colleague. As so often occurs in such cases, what the younger practitioner said was the result of a medical thought process that he did not share with his client.

“I didn’t say anything about how those multiple problems and whatever else may have limited her physical development might affect her future health because I didn’t know,” he explained. “When I said the cat was ‘cured’ after that first big round of treatment, I was referring to what I treated her for—the dehydration, malnutrition, external and internal parasites, that sort of thing. I wasn’t saying that I thought she’d be perfect from then on. All you had to do was look at her to know there were a lot of variables involved that could blow up at any time.”

In retrospect, the veterinarian admitted that he should have made this clear to Mr. Metcalf at the time. Ironically, because he did not verify what the client believed to be true, Mr. Metcalf was left with two equally troubling but opposite conclusions. One was that his cat had problems that he could see that the veterinarian could not for some reason. The other was that the veterinarian knew something about the cat’s prognosis that he did not wish to share with the owner. Either way, the veterinarian’s reticence created problems for the client as well as the animal. Even more ironic, the veterinarian did not communicate his doubts about the animal’s condition because he did not want the client to think less of him.

How much simpler things would have been for Dr. Souter and Mr. Metcalf if the veterinarian had more clearly articulated his thoughts when he first saw the cat! Mr. Metcalf would have been much happier with a statement such as, “Well, we got her immediate problems taken care of. But because she’s so much smaller than normal and we don’t know what all she went through before you got her, keep a close eye on her and bring her in immediately if she has any problem.”

This brings us to Dr. Souter’s second communication faux pas, the one that did the most damage to his relationship with his client. By now Dr. Levesque can understand why Dr. Souter may have been angry when the cat died. But was the clinician angry at the client or himself when he essentially blamed the client for the animal’s death? The answer to that question would determine the practice owner’s response to his associate.

“I was frustrated and angry with myself because I was afraid something like this would happen when I first saw the cat,” Dr. Souter admitted without hesitation. “When it did and I couldn’t save the animal, I lost it and went off on Mr. Metcalf. I knew as soon as I did it that I was wrong, but…”

But as more than a few practitioners know, sometimes it takes more effort than one can muster to admit one’s communications blunders while smarting from the loss of a patient.

“So what’s our next step?” Dr. Levesque asked his younger colleague.

Although as the practice owner Dr. Levesque knew he could tell Dr. Souter exactly what to do, he also knew from experience that it would be better all around if Dr. Souter came up with the solution himself.

“I’m going to call Mr. Metcalf and apologize,” Dr. Souter replied with little hesitation. “I should have shared my concerns about the animal with him from the beginning. And I shouldn’t have blamed him for not getting help sooner because I gave him no reason to think he should. He did his best.”

His response pleased his employer for two reasons. Not only did Dr. Souter’s willingness to apologize for his contribution to the breakdown in communication with the client demonstrate his colleague’s integrity, he also believed Dr. Souter would never make this same communication mistake again.

Shortly after his meeting with Dr. Levesque and fueled with his employer’s assurance that the worst thing kindly Mr. Metcalf would do is yell at him for being so insensitive, Dr. Souter called the client. When he did, the client’s response made it clear that the apology and the lessons learned gained Dr. Souter much more than any loss of face he had feared.

“I could’ve asked more questions about her problems instead of just letting it go,” Mr. Metcalf reminded the veterinarian after he accepted his apology. “And I know you did your best to save her.”

Dr. Levesque was fortunate in that his associate and the client were willing to accept the responsibility for the negative effects that arose from their mutual reluctance to communicate with each other in a meaningful way. And once again he was reminded of how much time and energy an avoidable communications problem can drain from a busy practice.

Footnotes

Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office (gro.vmca-amvc@nothguorbh) for additional copies or permission to use this material elsewhere.


Articles from The Canadian Veterinary Journal are provided here courtesy of Canadian Veterinary Medical Association