Funny Vet

I received my monthly newsletter from our friends at AVMA PLIT with its prerequisite number of horror stories to prove why we need insurance.  I always get the impression that the insurance companies are just contemporary Mafioso enforcers.  They come to your business and say something along the lines of, “You got a nice place here.  I’m sure you wouldn’t want anything to happen to it.  It would be a tragedy.  You know we could provide you some…..protection, if you know what I mean.  There would, of course, be a nominal fee, but I’m sure you can see how reasonable we are.”  A few things I get from reading the stories.  One: someone doesn’t even really need to do anything wrong; it can just be the client’s alternate-reality version of events.  Two:  don’t do equine medicine; who would ever think such a large expensive animal can break like the most fragile crystal.  “Whoa!  Your technician looked too hard at my mare three years ago and now her (name any leg part) is broken!”  Third:  does anyone else notice that it’s the same doctors who are in trouble every month?  What is up with these guys?  Drs X, Y, and Z are constantly in trouble!  They’re like the Three Stooges of the veterinary world.  Seems to me if we can just get these three guys to stop messing up, perhaps our insurance rates would improve.
So, Mariah Carey isn’t able or doesn’t wish to pay her vet bills.  What kind of message does this send to our average clients?  I can already hear it.  “See, how expensive veterinary medicine is?  Poor Mariah can’t even afford it!  That vet of hers just charges way too much!”  Which, then, would lead to the next logical client conclusion: “If someone as well-off as Mariah doesn’t have to pay her vet bills, why should I?”  This is just the latest entry in the long list of justifications as to why they cannot pay or go forward with diagnostics or treatment.  One of my favorite entries on that list: “We can’t afford to do (treatment X) because we just got back from vacation in the Caribbean!”  I don’t know what services and over what period of time would eventually amount to $30,000, but I’m certain that it wasn’t just a spay.  Veterinary medicine continues to be an amazing deal, especially in comparison with other medical professions, for the money involved.  While in veterinary school, my wife had to have her gall bladder out – no insurance at the time.  Came to about $10,000.  A veterinarian could have done the same procedure for $1,000 or less.  And, though we had to make payments and had to deal with a less than sympathetic hospital bureaucracy, we still paid the total of the whole bill over time.  I’m sure few people will get the point that Mariah’s veterinarian probably let things slide for quite awhile before being pushed into having to pursue the matter legally.  At least with the vets I know or have worked with, it would take a lot for them to become confrontational about a client paying their bill.  No one wants to be that paperboy from Better Off Dead shouting, “I want my two dollars!”  And it’s weird, too, because every year we top the list of most respected and most honest of professions, but I don’t see that translate to real life.  Respect could be represented by accepting our fees, accepting our advice, showing up on time for appointments, clients paying their bills, etc.  Too many clients continue to respond as if we are used-car salesmen or auto mechanics that are trying to take advantage of them in some way.  If Mariah doesn’t pay her vet, where does it end?  Next thing you know, Angelina Jolie doesn’t pay her vet, Tim Robbins doesn’t pay his.  It may even get so bad that Betty White and Bono don’t pay theirs!  Then wholesale anarchy and economic collapse descends!  So, Mariah, for the sake of the world, pay your vet!
PetMedExpress commercials are shortening my life-span.  Between the insinuation that veterinarians are just ridiculously expensive to the fact that the mailman in some way is related to the whole PetMed happiness scenario with the dog greeting him so enthusiastically.  It’s the mailman!  He doesn’t work for PetMed!  The dog isn’t greeting him because of the amazing convenience provided.  What’s strange, too, is so many clients order the medications on the same day or the day after being at the vets.  So, where’s the convenience?  You were just there!  You could have just had your meds filled right then!  And, truly, have we become such lazy asses that it’s become impossible to drive a couple of miles to pick up medications?  “Well, I’d have to get dressed.  And tie my shoes.  And then there’s the traffic.  And what if I have to wait for them to actually fill it?  It’s just so tiring.”  The phrase so often repeated in their ads is how their medications are “a lot” less expensive.  Not  necessarily.  More often than not there is less than a dollar’s difference.  Nothing like supporting your local businesses.  If you don't support your local vet, how do you expect them to stay in business?  Don’t think you can call PetMed up should you have an emergency or need surgery or hospitalization.  I’m amazed by how little clients will actually research to see if the medications they are ordering are less expensive on-line.  Sometimes they’re not and we point that out to them.  I had one client who still wanted to get the medication on-line, though we explained that it was more expensive, with the wonderful logic of, “Well, you can tell me anything, but that doesn’t make it true!”  Really?!  What would I benefit from lying?  You can verify it for yourself!  Here’s our cost and you can look up for yourself their cost.  Oh, shoot, that’s right.  That would require effort.  I forgot.  You’re still trying to tie your shoes.

Saturday Jan. 16th 8 CE hours Equine Medicine emphasis

In this last segment, let’s discuss a process that has been implemented in keeping track of CE credits.  Now, this won’t be inclusive as I’m not conversant in what all vet conferences are doing in this matter, but speaking more to what I have experienced at NAVC in Orlando.  There we are given an identification badge that is then scanned at the door of each veterinary lecture attended which logs (in that mysterious 21st Century electronic way) our hours in the great database in the sky.  Sounds good in theory.  However, (and you know this wouldn’t be my blog without a “however”) watching this process in-action reveals so many holes that it essentially obviates what it is trying to accomplish.

Sunday Jan. 17th 8 CE hours Staff/Team Building Exercises

Let me first, however, express my instinctive resistance to just such flawed procedures.  Year after year surveys come back describing us as the most trusted, most respected, most ethical of groups.  Yet, veterinary leadership does not seem to believe this and feels the need to secure a way to ensure vets are going to lectures and getting their CE credits properly.  It wasn’t that long ago that people attending conferences relied on some crazy old-fashioned notion called the “honor system”.  Bunch of liberal, weirdo, hippie-freaks I’m sure.  I put forward two possibilities as to why this change has occurred.  One, there were some people who weren’t taking advantage of the educational opportunities, fell behind the curve, and were caught being deficient.  The logical course, therefore, is to put a system in place that aims at this lowest-common-denominator of our profession, ignoring the insult it causes to the other 99.9%.  Has no one heard that you can lead a vet to a lecture, but you cannot make him think?  Establishing a tracking system does not necessarily equate to learning occurring.  Possibility number two is that some entrepreneur thought what a great idea it was to gain financially by inventing a “needed” tracking software system for a credulous veterinary group. Because, far be it from the mind of an entrepreneur that the antiquated “honor system” had any merit. I don’t even want to think how much of our registration fees go to feeding this monster.  
Now, I am, in California-parlance, a “good doobie”.  Meaning I go to all the classes I should for both helping me buff the rough spots in my knowledge and to get the proper CE numbers.  Doing what I’m supposed to do but then having to prove my integrity through some fallacious system is what grates me.  I have to question leadership that treats us as presumptive slackers while putting out a conference program whose first forty pages consist of everything you can do other than go to the lectures.

Monday Jan. 18th - 8 CE hours with Fluid Therapy Lab

Let’s examine this CE tracking system.  My first class of the first morning had no one present to scan my badge.  So, according to the system, I didn’t learn anything during that hour.  Might as well not have even gone.  After all, if the system doesn’t log you as present, it must be true.  Seems to me, also, that once you do get scanned in there is no barrier to just walking away, ignorance intact.  During one hour I just went door-to-door, like some rabid Trick-or-Treater, getting my badge scanned.  I ended up accruing enough CE credits to last me until 2032.  Assuming that this system is geared to that negligent 0.1%, I’m sure it would never cross their mind to give their badge to a buddy who’s going to a lecture anyway and getting it scanned as well.
What I found really funny was the lack of confidence that the leadership showed in their own process.  Repeatedly we were told to check our CE log for accuracy.  This was when I discovered that you can manually add or subtract classes yourself.  One guy I spoke to said his list was all messed up, showing he had classes he hadn’t attended, classes he had gone to that weren’t logged, and multiple classes that had been held at the same time, which I explained to him wasn’t impossible as long as you ignored Euclidean geometry and Einstein’s Theory of Relativity.  Okay, follow me on this, if the process isn’t even accurate, requiring manual manipulation of the classes attended by the affected participant, isn’t this, defined, the honor system?  And if we agree on that why, then, do we have this ridiculous, unwieldy mechanism in the first place?  We have now turned otherwise respectable,intelligent people into nothing so much as badge-tapping monkeys futilely hitting the feed-bar waiting for some CE manna to be dispensed.

The presumption also is that CE forms a direct correlation with keeping up with current medical trends and thoughts.  Yet you can spend all five days attending business-related lectures.  How are those counted toward CE

Tuesday Jan. 19th 8 CE hours emphasis on Aquatic Medicine

?  Besides the fact that if you purchase the Proceedings books you are basically packing the combined intellectual force of our entire profession in just under five hundred pounds of paper.  Why can’t one just read the allotted number of lectures to fulfill CE?  After all, that’s all a lot of the lecturers do anyway.  And what about the inability to enumerate CE from the contemporary information obtained from interactions in the exhibit hall with the companies and their representatives?  These are, after all, the places making advancements in medicines and techniques we will use in practice.                      Here are some other ideas our veterinary leadership have under discussion to keep us on our toes and compliant:   1) Quizzes at the end of every attended lecture – you must get a passing grade to get the full CE for that class.    2) Badge scanning both entering and leaving restrooms.  If this occurs during lecture times, the time spent in porcelain contemplation is deducted and only fractional CE given.    3) Roving bands of specialists employed to perform spot-checks within six months of the conference.  Similar to business and professional regulation inspectors, veterinarians will be picked randomly to be tested on how much information they have retained.    4) Monetary compensation given to fellow veterinarians who report infractions or abuses of the system.    5) Clients can bring in their pets with surprise disease processes that the vet then has to reference and treat accordingly.  Oh, wait, that’s right.  We do this kind of thing day in and day out already.
Far-fetched you say?  Remember, it was only about ten years ago that the honor system was still considered viable and, well……honorable.

Wednesday Jan. 20th 8 CE hours Wildlife Medicine emphasis

I was particularly upset that it wasn’t until the last day I found out that some lectures are televised.  What?  Really!?  I can watch lectures in my hotel room?  This seems to really subvert the whole badge system!  I mean, if I can do that, coupled with room service, I’ll never have to leave my room.  This would be conference nirvana!  I always thought the lecture hall experience could be accented by having food brought in while lounging in my underwear.  Sweet!  And then I’m already in a more comfortable position for sleeping during certain lectures.  I can’t wait until my next conference!
I continue to use a simple and effective system to track my own CE.  I take the program schedule provided, circle the classes I attend, rip the appropriate pages out at the completion of the conference, staple them together, and file them in a drawer, ready to be retrieved if someone requests them.  In seventeen years no one has asked.  Now that I write this blog, I await the possibility of being audited.

My next thoughts are offered as both complaint and advice regarding those that put these lectures on.  Jazz it up, people!  I mean, really, is it that difficult to come up with ways of educating others in a stimulating manner?  It’s like the lecturers are in a competition to see how many attendees they can lull into somnolence and how fast.  I can get the same results with a moderate dose of valium and the Home Shopping Network on low volume.  I don’t think I’m going out on a limb here to say that most attendees are practitioners who are looking for useful, applicable information, not a review on all of the properties of Descemet’s membrane or a way-too-long-a-time spent on the statistics behind a research study.  It becomes very obvious that these lectures are the same ones that they give in veterinary schools with no tailoring toward a different audience.  We don’t need to know your credentials, your graphs, your diagrams, your research papers, or your affiliations with certain companies or products.  All of this just takes up way too much time and wears deep ruts in our frontal lobes and cause lesions in our hypothalamus (look it up).  We trust you.  You are at a level in your field where you get to go and present lectures at national conventions.  Yay!  Good for you!  Now get down to the essential, practical details.  While some people believe we can learn while we sleep, typically this is not considered the best approach to higher education.  With that in mind, don’t give the good stuff in the last ten minutes for this same reason.  You’re not Lynyrd Skynyrd and your material is not “Free Bird”.

Here was a conversation I had with one person (this was during that awkward time when you‘re sharing a lunch table with a stranger and feel the need to fill the silence):

Stranger:  “It’s hard, with all of these choices, finding a good lecture.”

I think the biggest problem is that the lecturers feel compelled to fill their fifty minutes of infamy.  This isn’t their fault.  And whoever decided that CE should be based on amount of time?  Isn’t it interesting that something like education is based on a quantitative and not a qualitative scale?  I’m just saying.  Perhaps they could show more case studies if they really needed to fill the time.  I would think there would be all sorts of unusual cases that these specialty lecturers see.  How about showing cases that didn’t respond to certain treatments or those that had complications?  How about describing how you go about convincing clients to pursue treatments, especially long-term or expensive ones?  You certainly don’t use your lecture material to get them to do it, that’s for certain.

I will admit, I do seem to have the worst luck in picking lectures.  So, maybe my perspective gets a little skewed from that.  It often seems like the good lectures are occurring where I am not.  I’ll hear people all the time talking about how useful so-and-so’s lecture was.  I don’t know why they called him so-and-so, but apparently he was good.  I wandered into a good class randomly once and they stopped talking until I left.  I even ended up in the same bad class twice.  It just had a different name on a different day and it took me about half-way through to realize, “Hey!  These slides look really familiar!”  Oh, look, the exit door is just five feet away! There was one anesthesia class where all I remember is the lights going out and waking up feeling a little groggy and I was missing some twenties from my wallet.  Another time I followed an eight dollar hot dog with a gastrointestinal lecture - bad idea!  I got a cramp from an uncomfortable chair during a lameness lecture.  And there was a dystocia class that was so full I was really worried about being able to get out when it ended.

I’d like to point out the phrases that seemed to keep recurring no matter what lecture I was in, as if everyone attended the same public speaking seminar.  I have also provided my interpretation in italics for each phrase: