Trust and Delegation

I've never been the trusting type in part, I'm sure, because I learned very early that you couldn't depend on people.  Your dog, your horse, and your cat, yes, but not other folks.  People keep telling me I need to delegate responsibilities more to help decrease my stress level but how can I when 1) I already have this distrustful attitude and 2) people keep proving me right by not being responsible or trustworthy???  I thought about titling this post "Crack Head DVMs" since I'm about to talk bad about so many of my colleagues but changed my mind because the scope is wider than just vets.

Naming no names, I want to share a series of mostly recent scenarios - facts have NOT been changed.  There really are some scary practicing DVMs out there and a lot of them are apparently in my town!! 

Case transferred to me from another hospital due to finances.  Very small toy breed having a seizure, we check a glucose which is 29 and give glucose and the seizure stops.  I look at the transfer record which states, checked glucose=39, administered valium.....

A relative's dog goes to the ER clinic for breathing difficulties.  Owner expresses concern that maybe the pollen is causing the problem.  Vet says no, dog has heart disease.  If pollen were causing problem, gums would be blue instead of pink like they are.....

Same dog, really does have heart disease with pulmonary edema, is treated with lasix (appropriate), IV fluids (WHAT?!?), and NO oxygen.....(and ends up with a bill of nearly $1300).....

Regular client of mine who is a very good client, also an MD but a good one not a pain, takes her Chih to the ER clinic for ADR (ain't doing right for those of you not in the know) and is told that there was no need to bring the dog, nothing to worry about.  They then reach me, I see a dog with cyanotic gums, significant dyspnea, tachycardia, and clearly distressed.  Chest films show pneumonia.....

Another vet tells an employee that it doesn't matter if you use a U-40 or U-100 insulin syringe, there's no difference.....

Another vet states that he doesn't understand why a rescue group is spending money on a sick dog, after all, it doesn't even belong to anyone.....

A cat with pyelonephritis fails to receive its antibiotics for 2-3 days while the primary vet on the case is off.  And the other vets and technicians didn't think this was important why?????

Patient hospitalized for resistant urinary infection is left off IV fluids for 24 hours while receiving Amikacin even though the orders clearly state must be on IV fluids.....

Patient orders are clearly written in multiple places and verbally communicated to the vet taking over the case for the weekend but are not carried out.....

Intern on ER takes in dog in fulminant right heart failure and attempts to start IV fluids only to be stopped by the student.  Refuses to listen until senior clinician is notified.  Reasoning behind fluids?  That's what you do for "emergency stuff".....

Cat patient of mine that was highly suspicious for asthma or HARD (heartworm associated respiratory disease) or Toxocara cati larval migration whose owners kept putting off diagnostics due to money wound up at the ER.  Chest films were taken and they were told completely normal, no evidence of above.  I requested a copy and there are the most lovely "railroad tracks" and "doughnut holes" you could picture.  In other words, a beautiful bronchiolar pattern suggestive of above listed differentials.....

Heart failure dog referenced earlier is told at discharge that dental disease was the cause of the mitral valve disease in a senior Yorki-Poo and that the teeth must be cleaned within a week (remember this dog was hospitalized for congestive heart failure).  I advised that if the owners felt compelled to follow this advice they could take her back to that clinic and let that doctor practice CPR since I'm quite comfortable with my skills.....

And the list could go on and on and on.....those are all (except two) from the past couple of weeks.  And everyone keeps asking why I'm in a bad mood and never trust others.  Heck, that's the main reason I pursued vet school.  While I care about my patients, the most important thing to me is that my kids get proper care and I couldn't find anyone I trusted for that!  Even now, if a specialist is needed I hand pick who we see.

Yes, it is also a job and a means of living but, I have to comment that if you chose this profession, regardless of the reason, you damn well ought to be doing the best job possible.  Not saying I've never made a mistake but I know my crap and if I don't I tell you so and go look it up.  I'm really sick and tired of shoddy, non-caring work not only from my colleagues but also from my employees, my mechanic, my personal doctor, my friend's doctor, students, etc,etc,etc!!!!  Not everyone gets to "live their dream," in fact very few of us do.  I'm far from where I truly WANT to be but you better believe that every day I give my work and my family and my home all that I have. 

And a last comment seemingly unrelated but I can't help but wonder if it played a role in the congestive heart failure dog receiving fluids.  While Pro-Sal sounds like it is the best financial option for vets, I'm not so sure if it causes certain vets to do things that are unnecessary in order to increase their production.  Of course I've also worked with some vets who do that anyway when production is not even involved in salary, just trying to increase the bottom line.  That relationship did not last long.

I guess I'm just wound up a bit over a couple of my usual beefs meaning justice / fairness and doing things right rather than just doing them.  My latest life plan is to run away to Antarctica because 1) I'd never get too hot, 2) I could go for months without having to talk to anyone, and 3) since nothing can grow nothing can possibly bloom.  And I wouldn't have to worry about any of this!