Sunday, August 23, 2009

Crazy clients and Post-vet school trauma

As usual, my post will be a bit tangential with rabbit trails. I was looking at Dr. Grumpy's recent posts and was reminded of a story from New York that I had intended to share and, of course, I also feel the need to commiserate again about my rapid loss of brain cells.

It's hard to understand how someone can go through vet school, be practicing medicine and teaching but find it so hard to communicate in simple language. I worry myself on a daily basis and I'm not even the worrying type (unlike Can'tSpell). Currently, I'm driving myself crazy with the spelling of "weird." As previously spelled is, obviously, correct but I wrote it that way then began to question whether it should have been "wierd" instead. I mean if you follow the little rule "'i' before 'e' except after 'c' or when sounded as 'a' as in neighbor or weigh" it's all wrong spelled correctly!!! This has been bugging me since Friday when I titled an e-mail "Weird" (spelled correctly) then received a reply and became convinced it was wrong (you know how when you stare at a word long enough it no longer looks right??). I then had to look it up and prove to myself that it was correct. Then I kept worrying about it with the little rule above that obviously has exceptions (another being caffeine). I know, odd thing to keep one up at night isn't it? Ironically, the word facetious was included in the same e-mail but I had no problems with it or other multi-syllable words...I think vet school really does something to your mind....

Now for my story which I think you will find amusing. On my last overnight rotation in New York I was having a rather busy night with some "real" emergencies when an assistant brought back a large malamute who appeared to be the picture of good health.

"Why is he here," I asked.

"His owner is worried about a bump on his nose," my assistant replied.

In the hopes of "triaging away" something simple I went over briefly and asked to be shown the "bump." A tiny little raised lesion approximately 1mm in diameter with no signs of inflammation on the side of his muzzle where the whiskers arise (probably an ingrown hair follicle) seemed to be the source of concern.

Everything else was reasonably under control so I did a quick physical exam and saw nothing at all concerning so I quickly ran out to the waiting room to chat with the owner while I waited on diagnostics on my other cases.

There were multiple people in the waiting room, all of whom I had already spoken to besides the malamute's owner. As was often my habit in less emergent cases, I took her to a quiet corner of the waiting room rather than into an exam room to discuss what we should do. My plan was to tell her it was not of major concern, take her dog to his regular vet in the morning, and not charge her anything.

As politely as possible under the circumstances I ask, "So what prompted you to bring Sebastian in tonight? Has there been a change in the appearance of the bump or is he bothering it?"

Very matter-of-factly she says, "Oh, no. I brought him because I also have a rash and it itches!" then turned her rear toward me, pulled up her shorts exposing much more than I cared to see (in the waiting room with other people remember), and said, "See!! What do you think it is, doctor?"

I'm not really sure how I managed to refrain from saying, "How could I possibly miss seeing it?" but somehow I did and kept a reasonably straight face.

"Ma'am, I don't work on people," I replied.

"I know, but what do you think I should do about it?" she asked.

"I would advise you to see your dermatologist tomorrow and take your dog to his regular vet tomorrow," I replied.

She persisted and would not drop the subject. I decided that she had taken too much of my time not to be charged so I charged her the $140 emergency fee, wrote her some lovely discharge orders with a little fear factor involved (i.e. told her worse case scenario was that could be a mast cell tumor and that she should have her regular vet aspirate the "mass." To whomever is her regular vet, apologies. I was being honest, though, it could have been a tumor and I'm required to give all options, right?) and reiterated that she should see her own doctor!!! I got an e-mail a few days later saying she had been diagnosed with ringworm and did I test her dog for that? I, once again, had to reiterate that we had done no testing and that she should follow-up with her regular veterinarian.

Gotta love people!!!

I've threatened Can'tSpell to post her three best urination stories on here and not to wimp out on me by not telling the whole story. She promised to do so...we shall see. I may be forced into action of some kind to push her into it but it is always more difficult from long distance....

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