Today has been an exceptionally frustrating day. Started out pretty good outside in the wee early hours with the foster pup and the boys but it went downhill pretty fast as soon as I got to work. I really don't know what was up with people today but almost everyone that graced our doors was rude and in a bad mood. Complaints were the rule of the day; some valid, others not.
The groomer / tech who works with me and has been there for years left to bring her sick dog back early in the morning. Call me superstitious or whatever but, as I've mentioned many times before, I really don't have a good track record with employee pets. I had talked to her on Saturday when she described the dog as having neck pain. Being unable to meet her, I suggested crate rest and pain control unless he seemed worse. He improved some then had some diarrhea. The boss examined him Monday and I saw him peripherally; mildly elevated white count and ALT, nothing else significant, tentative diagnosis of gastroenteritis. Today, she brought him back because he was worse.
He is a 3 year old intact male Whippet who has previously been an overall healthy dog. He is used as a stud dog in a breeding program and does travel on occasion, being jointly owned by my friend and a lady out of state. On examining him today, his mentation was very dull, he had neck pain on flexion, an absent menace on the left eye, and absent CP's on all four limbs. He was also mildly ataxic as he walked and would run into things on occasion. We started the referral process and I called to set things up. Told the lady that I was worried by the rapid progression and may need to send the dog as an emergency since the first available appointment was next Monday. I was told that would be no problem, just to call. I was also told that the neurologist would call me when he was out of surgery.
Over the next few hours, he showed even more decline losing the menace in both eyes, becoming paretic and increasingly ataxic. My thoughts were running along the lines of a brain lesion with my top broad differentials being neoplasia, infectious, and inflammatory. I called to tell them that the dog was on his way after jumping through hoops to manage to get him on the road. The problem was that my friend couldn't take him today but the daughter of the boss happened to be in town and lives near the vet school so she offered to take him. When I called, they acted as if they had no idea what I was talking about. When they finally "found" the information and acknowledged that someone had talked to me, they then took forever to patch me through to the neurologist. One would think they had never dealt with taking information and payments, etc. over the phone.
At this point I'm highly unimpressed. This is my alma mater and they had a really good neurologist not all that long ago. As is typical of my school, they let the really good guy slip away and I have a sneaking suspicion it is because they failed to live up to their side of a bargain; but I don't know that for certain. I've heard that this man is a really good doctor. Well, his brain had better be solid gold to gild his bedside manner. He was rude, arrogant, and refused to listen. I started the conversation by attempting to identify myself and the situation and he interrupted to say "Just give me the signalment!" OK. So I started talking about the dog and, correct me if I'm wrong, but I was under the impression that when conversing with colleagues we typically state abnormal findings rather than stating individually what was normal. As I was trying to explain the neurologic picture he kept asking things like was the palpebral normal, etc. At one point, he disregarded everything I had stated about mentation, etc. and asked if I was saying the dog had facial paralysis as the cause of the absent menace. It seemed to confuse him that I was saying the menace was gone but I did not perceive the dog to be completely blind because he was not yet walking into everything (probably could discern light / dark) . He also failed to grasp that the dog was really progressively worsening quickly.
When he finally seemed to get some sort of clinical picture he asked what prognosis I had given the owner. My sarcasm made me want to tell him that if I knew what was going on I could give an accurate prognosis and wouldn't need his fancy doodads (i.e. MRI) to find out. He then asked if they were prepared to spend money on the dog. And then wanted to know if the owner was in the clinic with me (I had already told him the travel situation). And then wanted to know when I had called (told him approximate and that they had said would call after out of surgery). He spent so much time saying "What" while I was speaking that it is no wonder he seemed not to understand anything I said. And he became fixated on the fact that the dog was a little over a month late on having his rabies vaccine. Seriously?
The whole interaction just left me irritable. Although I've not met him in person, he reminded me greatly of the surgeon I worked with at my last job. A "my way or the highway" type of person who seems to feel they are smarter than anyone else could ever be and therefore deserve to be treated as a king. All I can say is that he sure better know what he's doing. From here on out I'm rather disinclined to refer to them and would rather send people to the previous neuorologist; it's too bad it's a longer drive!
One thing good that came from the situation, though. I reached the conclusion that I'm glad I did not take Rusty to see him. If he acted like that with the Rust-bucket, the world would likely be short one veterinary neurologist and I would be incarcerated. I may let the Da-Chi Terror and the Cujo poodle take him on Thursday; now there's a thought to make one smile.
That wound up being the icing to top off the cake of the whole rude people day. I know you really shouldn't hold grudges but I have a feeling I won't remember this guy in a favorable light for the rest of my life. After all, I still get irritable when I think about my first grade teacher who threatened to take away my Honey Bear (my stuffed bear toy with whom I was inseparable for years) if I continued to bring her to school with me. I stopped bringing my bear but I never forgot that teacher and her threat...
If he turns out to be an excellent neurologist, I'll let y'all know. I'm woman enough to give credit where credit is due although it won't make me like him any more. Once again, just like that surgeon. We never got along and, I'm sure, never will but he is one of the best orthopedic surgeons when it comes to complicated fractures and using external fixation devices that I've ever seen. I might even consider using him in an extreme case. Haven't had one that extreme yet so I haven't had to test that theory.
4 years ago
4 comments:
90% of my clients yesterday were rude or mean too! Odd. I checked to see if it was a full moon--it wasn't. After dealing with rude PAYING clients all day, the straw that broke the camel's back was the rude lady from the rescue group who is rude every single time she comes in. She was rude to my techs, again, and then demanded to speak to me even though she was told I was in appointments. She got to talk to me alright! I apologized to my boss for losing my cool but I don't want me or my staff to be walked all over. Especially not for a client we lose money on.
I'm sorry for your day, but it does make me feel a little better that I wasn't the only one.
After a decade of general practice, I simply won't refer to specialists who behave like that. IME, they seem to populate the local veterinary school vs. the private specialty hospitals. I don't know if this is a phenomenon of veterinary school (vs. private hospital) specialists in general or just this veterinary school's culture, because I attended school in a different state.
When a client asks why I'm sending the patient to a far-away specialist I say: "Most of my clients have had good experiences with Dr. Nice 'N' Smart. Dr. NNS is an excellent specialist and treats my clients well." I don't say anything else, and if a client decides to visit Dr. Local 'N' Nasty, oh well. Often, to help ensure a good experience, I tell the staff at Dr. Nice 'N' Smart's practice "I always like to refer my clients here. I know my patients receive excellent care, and I get such good feedback about Dr. NNS and your staff." Most people respond well to positive reinforcement, especially when it's true! :-)
If the veterinary school sends out a questionnaire to local referring veterinarians asking why you refer/don't refer patients, let fly with your comments and name names. If something really terrible happens, don't hesitate to go straight to the top. Veterinary schools are currently competing for a shrinking pool of patients, and want to hear why they may be losing revenue to the private hospitals. I did this on one occasion when the behavior and care was particularly outrageous, and the director of the hospital was very interested in my comments.
My guess is, in academics, practitioners suffer no financial cost for being a butt. While there are butts in private practice, there is strong financial incentive to BE NICE!
My worry would be that if you refer a client to someone who is rude to you, they would be rude to the client as well.
Which exists independent of the competence question.
Yes, that's exactly why I won't refer to rude specialists - their behavior also reflects poorly on ME. Clients can't judge competence, but they certainly remember rudeness. If it's their decision to see someone local and rude, though, that's fine, because it's their decision, not my recommendation.
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