Author Archive

Mayo Clinic – Book Review

Monday, March 21st, 2011

Management Lessons from Mayo Clinic – Inside One of the World’s Most Admired Service Organizations

by

Leonard L. Berry, PhD.

and

Kent D. Seltman, PhD.

Five Stars!

✩✩✩✩✩

This is a really good book about Mayo Clinic, an organization I previously knew nothing about.  And THAT is my favorite thing about it – learning so much about <Mayo Clinic>.  I love to learn.

The cover isn’t awesome.  It is red, white, blue and yellow, but I have not been wearing my fuzzy red mittens in this warm spring weather, so I did not need something to coordinate with them.  I was going to say “Look how much I have matured over this year, no longer judging a book by its cover…” but I just spent an entire paragraph on the cover, so I will not say that.  Maybe next year…

Dr. Berry is a marketing professor and author, and Dr. Seltman was the director of marketing at Mayo Clinic from 1992 to 2006, so they know that of which they write.  They keep the book professional and structured in such a way that even those in fields other than healthcare can extract leadership lessons from the book.  However, the best parts of the book (as is often true) are the stories and pictures.  Even in their strict professionalism, they capture well the love doctors, nurses, support staff, patients and families have for Mayo Clinic, and I loved reading about that.

The history of Mayo Clinic is fascinating.  (Yes!  New thing!  I’m a history buff.)  Dr. Mayo and his two sons started the clinic over a century ago on a solid, medically and ethically sound foundation from which the clinic, now on three campuses and associated with all sorts of other health care partnerships and health care websites, has seemed to stay very true, which is super impressive.

I also loved learning about the excellence of the present-day doctors of Mayo Clinic.  They have to be team players to make it.  Very persuasive cases were made for the validity of standardized procedures and evidence-based medicine, which are big parts of Mayo Clinic.  The typical Mayo doctor is truly on the cutting edge of medicine.  Many of them lead within the organization and research and teach.  That is the part of the book that was most challenging to me as a veterinarian and that will stay with me the longest I would guess.  We as veterinarians have much to learn from our human MD friends, and as often as I can put my scruff down and accept that, I come away a better doctor.

*****

This fits nowhere in a professional book review, as is a subpoint of a subpoint in the book, so I will put it here anyways, because it is too awesome not to mention, and it was one of the first things to really cheer me up during this sad season of Finch pet loss…

As you know, I am unhealthfully obsessed with the show Scrubs.  In one particularly tasteless gag, J.D. tells a family their grandfather has passed away while he is dressed as a clown.

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That really happened in Real Life!  It is in the book!

It was casual Friday…It was Halloween…A doctor was celebrating, as was the rest of the hospital…I will apologize now to the grown grandchildren to whom this happened and who are now dealing with more severe clown phobias than the rest of us, but I am still laughing, and I read that section a month ago.  It is just too horrible to take seriously, and not, as the book authors propose, a valid argument against casual Fridays.  I am quite sure it has never happened before or since.

*****

I honestly can say I agree with the rest of the book and will read it again to find more parallels to my veterinary life.  Whether you are in an entirely different profession, are a veterinarian, or are a realhumanmedical doctor, What in the world are we supposed to call you guys?? …um…you will enjoy and learn from this book.

(B&G Tasty Foods kept a couple of these clown oil paintings from the original restaurant and let me take a picture for my 24 clock project of Blogathon 2010.  In the original post, I cropped the clown out to protect you. I think it fits nicely with the clown paragraph of this book review, though.  The sandwiches at B&G are so good they are worth the clown night terrors you will have for weeks after.)

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Coming Soon to Riley and James…

Do Pets Mourn?  The Story of Joy the Puppy and Ebony Dog

Happy Heartworm-Free April

Happier Posts…

A friend has asked when I will return to my normal, more upbeat posts here…I am working on it Georgia Little Pea!

Summary of the 25 Veterinary Economics Leadership books – two books to finish!  Woo!  This has been such a fun project!

And Elsewhere…

I have taken a break from my monthly column at Omaha.net, but I do miss it.  Genius idea to name the column after a mortal pet.

The Wagging Tail

This is a collaborative blog to which I contribute about once a month.  I think it is time to get back on the ball here as well!

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Paws for Japan

Thursday, March 17th, 2011

Dr. V has a Brody Signal – it is a picture of her super cute pup that she puts over a flashlight and shines into the night.  Other pet lovers the world over see the signal, get the message and join her in her mission to make the world a better place.*

Today’s Mission:

“A Virtual Fundraiser to Aid Animal Relief Efforts via World Vets”

I do not think we even know how bad this tsunami and earthquake disaster in Japan is yet.  Not everyone is found.  The nuclear scare is not over.  I cling to stories of individuals because the big picture is just too much.  Everyone seems to be two degrees from loved ones in Japan.  Or one.  Or zero.  World Vets is in Japan, helping with relief efforts.

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Sometimes people rescuers need to focus on finding and rescuing people and need pet rescuers to come along side of them to rescue the pets.

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Sometimes pet owners need to know they are loved, and we understand how awful it is to be be seperated from and even lose loved ones.

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Sometimes communities need to know that we care and that we long for a concrete way to show that and that we would do anything to make the situation better, even though we cannot fix it.

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Sometimes people cannot take in the horror of an entire country in pain and need to hear one encouraging account of a rescue…a reuniting…a hopeless situation that ended happily.

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Pray for Japan

Reach out

Support World Vets

“Rejoice with those who rejoice.

Mourn with those who mourn.”**

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*Dr. V does not have a Brody Signal.  *sigh*  I wish she did.  But her super awesome blog Pawcurious works just fine when pet lovers need to be gathered for a common goal.  I think she should do both.

**Romans 12:15 (New International Version of the Bible)

March 18, 2011 Veterinary Practice News Article:  Vets, Animal Groups Rally to Help in Japan Relief Efforts

Happy Birthday Petfinder!

Monday, March 14th, 2011

March 15, 2011 is…

Adopt the Internet Day.

Petfinder Adopt-the-Internet Day

In honor of Petfinder’s fifteenth birthday, pet lovers/bloggers everywhere are spreading the word about adoptable pets.  Here are some fun ways you can help…

See full size image If you have a website, write a blog post about Adopt the Internet Day. Dedicate today’s Facebook status and picture to an adoptable pet from Petfinder.See full size image Adopt a pet!See full size image Share an adoptable Petfinder pet on twitter with the hashtag #adopttheinternet.

For more great ideas right from Petfinder, click the super-cute badge.  (Also, you can cut and paste the badge into your own blog post if you would like.)

Happy Birthday Petfinder!

May the next fifteen years bring you even closer to obsolete.

(I mean that in the nicest every-pet-has-a-forever-home sort of way!)

Thank you for being a Pet Saver on the grandest level.

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Also, just as important, today is my Mom-in-Law Karen’s birthday.

HAPPY BIRTHDAY KAREN!!  I LOVE YOU SO MUCH!!

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More Great Veterinary Blogs

Saturday, March 12th, 2011

While I wait for life to get less sad, I have been writing considerably less than usual.  After Fuzzy and Wuzzy Rats and Piggy the guinea pig passed away, I could see where this season was heading, and put a few Very Favorite Writing Projects on hold (The Wagging Tail Blog and ) and cut down my writing here to a much slower pace.  My Carefresh Ask-a-Vet project is still full speed, but that one is Q&A – much easier, and a good respite from the sadness.  Good call on the slowing down thing, though.

best personal essays

 Ebony Dog and Princess Gerbil passed away soon after.  Russ has gotten me “I’m a winner” stickers that I wear every day I get out of bed since Ebony died.

100% success so far.  I am a winner.  75% success staying out of bed.  I am STILL a winner.  I still get a freaking sticker.  (Yes I really wear them.  Unless we just met, and even then, really, it should be obvious what a dork I am.  I LOVE the stickers.)

Anyway, that is all my prelude to my Super Awesome List I have for you.  Until I can get back to writing more regularly (and even then), here are some MORE great veterinary blogs I found thanks to veterinarians on my first list of great veterinary blogs. If there are more veterinary blogs you love, let me know! Yes, this is getting out of hand – I love it!  And yes, we should be out saving and preserving lives.  We take turns.  You know, as a worldwide veterinary community.  Save-write-sleep-repeat.

More Great Veterinary Blogs

Also, I included a few blogs from human medicine, because they are just awesome.

can’t spell, dvm

CantSpell, DVM

Funny Vet

Dr. Scott

The Real Housecats of Orange County

Dr. Kelly Wright

The Story Behind the Pictures

Dr. Leslie Brown Sheridan

VETBLOG

Toronto Vet

A Vet’s Guide to Life

Dr. Chris Bern

Vogue Vet

Vogue Vet

The Weird Veterinary World

C. Todd Dolen, DVM

and 2 people blogs…

Dr. Grumpy in the House

Dr. Grumpy, MD, Neurologist

33 Charts

Bryan Vartabedian, MD, Pediatric Gastroenterologist

And, of course, remember to visit the wonderful pet bloggers in the Saturday Pet Blogger Hop…

Coming Soon on Riley and James (and quite a few other blogs, I have a feeling…)

Tuesday, March 15, 2011

Adopt the Internet!

Happy 15th Birthday Petfinder!

Thank you Pet Savers everywhere for all you do to help pets!!

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Tomorrow Will Worry About Itself

Saturday, March 5th, 2011

Our herd is down from eight to three, 37.5% of capacity, and we are not repopulating.  Fortunately, Max the Cat, Noodle the Poodle and Joy the Puppy all tolerate hugs*, because they have been put on Grief Duty.  I find myself asking “Who’s next?” and waking the poor things up if they are sleeping too comfortably.  Noodle has been known to sleep with all four paws up on occasion.  He has been the recipient of the rudest awakenings.

In an attempt to back off from this dangerous path, I am making the conscious decision to appreciate my pets on a day-to-day basis and enjoy the time I have with them.  Yes, approximately 67% of the remaining herd is oldie-old, but they are also all healthy, and probably tired of being included in my late night panics.  So hold me accountable.  There is much grieving yet to do, but I do not want to miss out on today.

I can’t really pull myself out of this of course, even with all of your wonderful support (And you ARE wonderful – thank you so much for walking through this with us) – This is going to take the power of God Himself.  While I hope you are in a happier season, this next quote is a good reminder to us all, and then a word of “encouragement” from my very favorite singer ever, Rich Mullins.  And then, I will come visit the blogs of other pet blogger friends on the Saturday Pet Blogger Hop.  And then…I am going to go hug my cat.

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“Do not worry about tomorrow, for tomorrow will worry about itself.  Each day has enough trouble of its own.”

-Jesus

“It’s hard to be like Jesus.”

-Rich Mullins

*Note:  Hugging most dogs is ill-advised.  Normal dogs do not like hugs.  Hugging most cats is just asking for it.  Our pets are all sorts of special.  Do not attempt this at home unless you are a Trained Pet Hugger.  I am not.  I just have really tolerant pets.

My Special Stages

Friday, March 4th, 2011

Trying to get back to real time on here.  Today is tough.  I did a three-week postmortem freakout that I had misdiagnosed Ebony’s disease as metastatic neoplasia instead of (still bleak but treatable) systemic fungal infection.  Do not worry.  I did not.  No one is more neurotic, obsessive and self-critical than me when it comes to medical treatment of my patients, which I have never tried to reign in because…well, honestly, it serves me well.

DEFINITIVE diagnosis:  metastatic neoplasia.

Presumptive underlying cancer:  hemangiosarcoma  (That one is an educated guess, not a certainty.  But it sure acted as evil as hemangiosarcoma, wouldn’t you say?)

I will continue through my own special stages of grief…

  1. Despair
  2. Anger at anyone who has a black/old with white face/cute dog, especially one whose tail wags lazily as they walk
  3. Freaking out
  4. Sadness

I am kind of looking forward to the sadness stage.  I am sorry Russ and all of you out walking your dogs around Omaha these last few beautiful days to have dragged you through my anger stage with my scowling and growling.  Your black/old with white face/cute dogs, especially ones whose tails wags lazily as they walk are beautiful, and I am glad that you have them.

In fact I have two beautiful dogs of my own.  And a cat.  Which brings me to what I actually MEANT to say today…I love my pets and I intend to consciously appreciate them on a day-to-day basis. (I was going to spare you all the crazy, but I will leave it as is.  Maybe some day it will be fun to look back and laugh at how neurotic I am.)

I think I will come back TOMORROW and post specifically about Max the Cat.  This is quite enough for one day, don’t you think?  I do.  Apparently the internet does not agree.  When I was frantically looking through radiographs of veterinary and human medical sites, (Yes, why?  How do you freak out?) I switched one search (“thoracic” “radiographs” “neoplasia”) to “Images” and this happened…

*sigh*

Eb, you’re gorgeous.  I sure miss you, Friend.

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Happy Heartworm-Free March!

Tuesday, March 1st, 2011

March 2011…Safety of heartworm preventative medication – Is it safe to give my Collie heartworm preventative medication?  Why is Joy the Puppy getting Proheart but not the old dogs?  Are some pets developing heartworm preventative medication resistance?  Are there valid drug-free options for preventing heartworm disease?

Confused?  You won’t be after this episode of…Pets!

Who knows that super-awesome…I mean cheesy…I mean awesome…reference?  First person to tell me wins coffee…or cocoa…or whatever.  (C’mon, Dad!)*

Is it safe to give my Collie heartworm preventative medicine?

Short answer…yes.  However, this is a very valid concern that stems from the genetic tendency of some dogs (most notoriously Collies, but some herding and other breeds) to process ivermectin and other medications less efficiently than they should.

A veterinarian at Washington State University, Dr. Katrina Mealey, DVM, PhD, Diplomate, ACVIM (American College of Veterinary Internal Medicine), has done a great amount of research on this drug sensitivity issue.  Some dogs have a mutation in a gene (called the MDR1 gene) that should make a protein (P-glycoprotein) that is an important part of the blood-brain barrier.  If they have one abnormal gene, they are carriers (They will not have the drug sensitivity, but their offspring may).  If they have two abnormal genes, they will have the drug sensitivity.  Because the barrier is not normal in these dogs, they are less protected from the effect of some drugs, and doses that would be safe in dogs without the gene mutation can be dangerous.

The amount of ivermectin in heartworm preventative medication is such a low dose that it is safe in dogs even if they have the gene mutation that makes them extra-sensitive.  If you are at all worried, there are many ivermectin-free heartworm preventative alternatives available.

A genetic test is available to determine if dogs have this genetic mutation.  This could be especially helpful if your pet needs to be treated with higher doses of ivermectin than that used in heartworm preventatives OR if he or she needs other medications to which they may be sensitive OR if you are considering breeding.

For a MUCH more articulate discussion of the MDR1 gene and genetic drug sensitivity, you may want the information right from the horse’s mouth (Animal joke in a pet blog!  Always funny!)

Ivermectin Toxicity in Collies

on

Washington State University College of Veterinary Medicine Website

Why is Joy the Puppy getting Proheart but not the old dogs dog?

*sigh*

Proheart is intended for healthy dogs over six months of age who are not underweight.  Not that old dogs can’t be healthy!  And they usually are…but, to be safe, we administer this medication to dogs who are over six months of age and under seven years of age the first time they are given Proheart.  Because Ebony and Noodle were over seven when it came back onto the market, we kept them on monthly oral Wormshield (ivermectin) tablets.

Are some pets developing heartworm preventative medication resistance?

Honestly, we just do not know yet.  I suspect it is the same old compliance issue.  (Please correct me if your pet has been a victim of heartworm preventative resistance – I hope it is not real, but realize it could be.)  If some pets are resistant, it is such a low number of the population, that consistent heartworm preventative use is still warranted.  For an excellent discussion of the issue, see Dr. Lorie Huston’s October 2010 article:

Are there valid drug-free options for preventing heartworm disease?

No!  That was kind of a trick question – there are no valid drug free options that will kill the larval (L3 and L4) stages of heartworm (the little guys in the subcutaneous tissue and bloodstream – ick) but all the medications are VERY safe and used at VERY low doses compared to other things they are used for.So I always always recommend staying on heartworm preventative medications even though there ARE good non-drug ways to decrease mosquito exposure – you just can’t keep every one away.

Georgia Little Pea…I would say your Mama wins coffee for making me think through that question!  Again…as soon as I have my private jet I will come right over!  *sigh*

Next Month: How do these medications work?  Plus I will address any other questions you have!  Let’s do what we did in February – we can discuss it all in “real time” in the comments (or over coffee if you win the contest!) and I will also incorporate your questions and answers into the next month’s post.

Today’s Checklist…

Noodle the Poodle – Wormshield tablet

Max the Cat – topical Revolution

Joy the Puppy received a Proheart injection on February 1, 2011 which has a six month duration.  Thus, she got a biscuit at the exact second Noodle got his Wormshield tablet, which they both deemed “fair.”

*UPDATE: Dad did indeed win the contest – the reference is to the show SOAP, which my parents loved when I was a kid…I think as much as Russ and I love Scrubs.  Dad tied with Russ, who yelled “SOAP!” as I was posting the picture.  I initially called cheating, but revised my ruling to a tie and will be taking both of my favorite guys out for coffee next week.

:)

Articles Originally Written for Veterinarians – Table of Contents

Monday, February 28th, 2011

1

Overcoming Team Conflict

2

Building a Best of the Best Clientele

3

A Dramatic Wellness Exam

4

Recommending a High Level Standard of Care

5

Effective Communication Stratagies

6

Self Evaluation

7

Changing Times

8

Twitter for Veterinarians

9

Year in Review:  2010 in Veterinary Medicine

10

Conflict Resolution

Click on the article title to get to the article itself.  I know it would be cooler if I did not actually mention this and just let people find this out for themselves, but I never claimed to be cool (quite the opposite)…

Every one of the ten articles has a Scrubs link in it that pertains to the article.

Awesome.

Building a Best of the Best Clientele

Monday, February 28th, 2011

This was my second article published in print. I feel safe putting this one out there, because those of you who read Riley and James and are clients ARE the Best of the Best.  I used to put the following on every blog post, I dunno why I quit.  It is still true…

You are awesome, and I love my career because of you.

Thank you.

This article could be helpful to anyone in a service business I suppose, not just veterinarians.  And it could be an interesting peek into my views on clients.  I realize I have a rosy glasses sort of view sometimes, but I am telling you, my clients really are this great.  Every time I get established at a veterinary practice (In as much as it depends on me, I am staying here.  I love where I am right now.) Anyways, every time, my team members remark on how nice the clients are on the days I work.  I was asked so often why that is true, that I tried to explain it in this article.  The short answer:  you.  The long answer…

Building a Best of the Best Clientele

by Shawn Finch, DVM

Imagine if our clientele consisted entirely of clients we love to see, clients we know well and clients whose trust we have earned.  Picture how this would transform your attitude, your day and even your career.  The majority of us probably have mostly satisfied clients.  A few clients drive us crazy.  Let’s call them “meanies.”  A few very special clients, those we would handpick if we could, we will call “best of the best.”  Starting from this assumed demographic, I believe we can shape our clientele to be almost exclusively best of the best, and that will make our careers more rewarding.

Satisfied Clients

Our interactions with these clients will make for a pleasant day for our team and for our clients, and we will meet our goal of maintaining and restoring the health of pets.  If we have a client base that consist mainly of satisfied clients, we are probably doing pretty well.

However, our colleagues at other veterinary hospitals are probably pretty good, too.  Clients may wanter off to another veterinary clinic – not because of malice toward us, or a bad experience.  They are simply sticking around until the next best thing comes along.

Perhaps we can use this window of opportunity to overwhelm them with our excellence.  This “window” may be only the length of the office visit, or we may be fortunate enough to have several months or years to earn their trust.

Meanies

Clients need to be exceptional to fit into this category!  I only classify clients as meanies after severe infractions, such as cruelty to my associates or extreme rudeness or profanity.  These clients need to be either cut loose or given a chance to change their behavior.  It is never ideal to let them coast, because they are the ones whose cats will live twenty-five years due to your awesome care.  That is a quarter of a century that you and your team will have to put up with them.

Whenever possible, give meanies the opportunity to rise to your expectations.  Often these clients are not aware they are being rude.  They may be having a difficult day, or even a difficult season.  Having a sick or injured pet or dealing with the expense of a veterinary visit may also cause or compound anxiety that can manifest as inappropriate behavior.

Calling clients on poor behavior can actually become an opportunity to care for them.  Some of my most heart-wrenching conversations have been after some great empathetic comment on my part, such as, “Wow!  I haven’t heard that one in a while!  Where did that come from?”  Clients are then free to share what drove them to such behavior or at least apologize and start fresh.

Do not “hold on” to a meanie for the sake of avoiding a conflict, not hurting feelings or losing revenue.  Consider changing your goal from retaining every possible client to building the clientele you would love to work with for the next several decades.  You and your team are worth being treated well.  And a good client having a bad day is worth being cared for and called on for inappropriate behavior.

The Best of the Best

When I started in veterinary medicine, my best of the best consisted of my family and a few friends.  And if you have the support of those closest to you, you are well on your way to success.

If you have earned the trust of another person, remember that it is a gift someone has chosen to give you.  Value and nurture that relationship.  Treat their pet the way you hope someone would treat your pet.  Treat the client the way you would want to be treated.  If clients could be in our best of the best group, the ones who can trust us with anything, they would love that almost more than we do.

The entire team should be intentional about building new relationships and strengthening existing relationships.  Transforming satisfied clients – and even meanies – into best of the best happens on purpose.  Does an associate enjoy client communication?  Put him in charge of sending a welcome card to every new client.  Is someone especially empathetic?  Put her in charge of ensuring that clients who are grieving are well cared for.  Figure out what your team members love and do well, and let them do it.  Over time, you will see your existing clients become best of the best, and they will refer clients who also become best of the best.

Working toward an entirely best of the best clientele is a win-win-win situation for clients, pets and the entire veterinary team.

This was first published in Banfield, Achieving Success in Practice as Seeing Our Favorite Clients, November/December 2009.

Joy, A True (Short) Story

Saturday, February 26th, 2011

I reached into my nightstand drawer for a pen and accidently jingled the tags on Ebony’s collar. Joy the Puppy came running into the room full-speed, wagging her tail. She stopped and looked up at me. I did not know how to explain to her what had just happened.

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