How (In)competent Are You?November 1, 2009Some vets are constantly questioning themselves--not because they lack confidence, but rather because they wonder how they could have done better. Are you confident in your diagnostic and therapeutic capabilities? Here is an interesting way to look at competence: There are four stages in every endeavor, whether you are doing a laparotomy, learning photography, perfecting your golf swing or landing a plane on the Hudson River. They are: Unconscious incompetence Conscious incompetence Conscious competence Unconscious competence. Unconscious incompetence is when you have no clue what you're doing. But worse, you don't even realize that you are incompetent. Ouch. This is the baby trying to crawl. Or the toddler learning to eat with a spoon. Sadly, this is also the case of many people learning the ropes, including in medical professions. Of course the good news is that babies, toddlers and medical professionals have someone to guide them. In time, they will climb the ladder … of incompetence. Conscious incompetence is when you have no clue what you're doing, but at least you're aware of it. I think we can honestly say that this is how many of us felt when we first started working "in the real world." Conscious competence is hopefully …
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Is Losing A Patient Worth $1.77?October 1, 2009I recently had a skin biopsy performed by a dermatologist. When the results came in, I asked the receptionist to kindly send me a copy of the biopsy report. "Are you aware of the $1.77 fee?" she asked. After I fell off my chair, I managed to ask why there is a fee. And why $1.77? She didn't have a good answer. She just works there. I considered never going back ever again. But I thought that talking with the dermatologist would be the mature thing to do. Amazingly, he called back. He explained that some patients have very complicated files, sometimes with hundreds of pages. That surely is a good reason. But I just needed one copy, not hundreds. He could not explain why the fee is $1.77, as opposed to $1.78 or $2. But he seemed to realize that the fee was a little bit silly, and spontaneously offered to waive the fee "as a professional courtesy." Obviously, because Veterinary Practice News is a very generous employer, I could easily have afforded the $1.77 without skipping a meal. The amount is not the issue. The issue is the concept. In our surgical referral clinic, we routinely render free …
Welcome To "Cutting Edge"October 1, 2009Welcome to "Cutting Edge," a blog provided twice a month by Veterinary Practice News and yours truly. The blog will appear on the first and third Mondays of each month, and will deal with a variety of veterinary life topics--surgical or not, scientific or philosophical, deeply profound (let's even say earth-shattering) or ever-so-slightly impertinent. We will explore surgical principles, new products and emerging concepts, current techniques, oncology, anesthesia and pain management, relevant articles and recent professional meetings. We will shatter misconceptions, blow apart urban legends and expose bad habits--of course, always in a respectful and ethical way. We will share thoughts on communication and relationships with pet owners, colleagues and specialists. The concept of this blog is to present, in a few paragraphs, topics that can't be addressed in "Surgical Insights," my monthly surgery column in Veterinary Practice News. But topics won't be confined to surgery. Feel free to comment on my future rants so that we can start a dialogue, share stories and help each other out. Who knows, maybe ideas for future blogs will come out of your feedback! See you on the Net. Welcome to "Cutting Edge," a blog provided twice a month by Veterinary Practice …
Beware The Silver Bullet Solution To Pet Health Insurance ReimbursementAugust 21, 2009 As a practicing veterinarian, an original board member of the country’s oldest (27 years) and largest provider of pet health insurance, Veterinary Pet Insurance Company (VPI), and current member of VPI’s external Veterinary Advisory Board, I believe I have a unique perspective on the pet health insurance industry. As such, I think Dr. Jack Stephens’ article “80% Reimbursement: A Straightforward Model for Pet Health Insurance” needs some clarification and comment. Dr. Stephens argues that an 80 percent reimbursement insurance model is preferred because it is easier to understand and provides greater transparency to policyholders regarding actual claims reimbursement amounts. Dr. Stephens indicates that the following concerns have been raised regarding the 80 percent reimbursement model: (1) costs will rise due to increased veterinary fees and greater utilization, (2) rates and claim costs cannot be predicted with any accuracy due to constantly escalating utilization and fees, and (3) 80 percent reimbursement will lead to financial collapse or at least bad results for the insurance company, resulting in its pulling out of the market or going insolvent. As evidence that these concerns are invalid, Dr. Stephens indicates that two pet health insurance companies that pay 80 percent …
Planning Is Pivotal To Tax Season SanityAugust 21, 2009 Veterinarians not investing in a practice overhaul need to dig deeper to find deductions and loopholes this tax season. Smart tax planning is key in optimizing an annual return and starts by finding a certified CPA with industry experience. A CPA will help veterinarians avoid an audit and maximize the benefits of state and federal tax laws. A professional accountant who understands the ins and outs of the profession can provide a check-off list of the type of tax information that should be gathered throughout the year and can show how to catalog those expenses. Bonus Depreciation Practices that struggled financially in 2009 should be looking into bonus depreciation. Section 1201 of the 2009 American Recovery and Reinvestment Act allows additional first-year depreciation of 50 percent of the purchase cost by extending for one year the depreciation bonus created by the 2008 Economic Stimulus Act. Depreciation bonus helps businesses that buy equipment this year decrease their 2009 tax bill. This rule applies to purchases of tangible personal property with a Modified Accelerated Cost Recovery System (MACRS) …
8 Tips For Treating Oral TumorsAugust 20, 2009 Oral tumors account for 6 percent of all neoplasia in dogs1 and 10 percent of all neoplasia in cats.2 The practitioner and staff in general practice are on the frontline of diagnosis of oral tumors, and early detection is imperative. Here are eight tips for treating oral tumors in your practice, from initial presentation to definitive treatment. Click to enlarge Radiograph showing left total and right partial mandibulectomy in a cat with squamous cell carcinoma presenting to the Dentistry and Oral Surgery Service of the University of Pennsylvania. This cat is still alive five years after surgery. (Photos copyright University of Pennsylvania) Oral tumors are not necessarily a death sentence. The majority of oral tumors in dogs are benign. Even the dreaded canine oral melanoma shows variability in its likelihood to metastasize. A recent manuscript found a median survival time of almost three years with small, well-differentiated oral melanomas (most were less than 1 cm) that were excised without any further radiation, chemotherapy or immunotherapy.3 Even with larger melanomas, …
A Rash Of Reasons To Investigate Itching And TreatmentsJuly 24, 2009 Most dermatological issues that make their way to veterinary offices present when the pet’s incessant itching spurs the owner into action. According to veterinary dermatologists, about 25 percent of general practices’ cases are skin-based and 10 percent of those cases are allergy-related. Sunburn on the muzzle and around the eyes. Itchy dogs and cats referred to specialists’ care tend to be lifelong derm patients and are controlled rather than cured, but general practitioners’ clients pressed by the economy want the issue handled in a fast, financially feasible way without the added cost of prolonged specialty care. While some dermatology cases take diligence that comes with a price tag, manufacturers provide a plethora of treatments that can prevent skin maladies and treat existing ones cost effectively. Bull terrier with a sunburned face. “For the past three summers I’ve seen about two patients a day with cheyletiellosis, or walking dandruff,” says Alice M. Jeromin, DVM, Dipl. ACVD, of Veterinary Allergy & Dermatology Inc. in Richfield, Ohio. “We’ve seen more of these cases than fleas. We can treat this easily enough with Selamectin or Ivermectin, but most derm cases aren’t so clear cut. Environmental, …
How To Avoid Tracheal TearsJuly 24, 2009 A review1 of tracheal rupture in 20 cats is very helpful to better understand and prevent this unfortunate iatrogenic complication. Intubation of a patient and insufflation of the cuff of the endotracheal tube are not risk-free procedures. Clinical signs can occur within a few hours to a few days. Classic signs include subcutaneous emphysema (100 percent), dyspnea (30 percent) and respiratory stridor (15 percent). Thoracic radiographs always reveal subcutaneous emphysema in the neck, and sometimes a pneumothorax or a pneumomediastinum. Early signs are due to physical damage to the trachea because of overzealous inflation of the endotracheal tube cuff. Delayed signs are related to progressive ischemic injury of the trachea, also because of overinflation of the cuff. In another study2, 1.6 ml was enough to ensure an airtight seal, with a maximum of 2.3 ml. Injecting 6 ml caused a tracheal tear in most cases. Most tears occur at the thoracic inlet, at the level of the cuff. The classic location is dorsolaterally, at the junction of the cartilagenous rings and the tracheal muscle. Fifteen patients with moderate dyspnea are treated medically, with cage rest and oxygen therapy. The subcutaneous emphysema …
Practitioners Should Consider Professional And Personal Insurance NeedsJune 29, 2009 Veterinary practitioners may well prefer handling unruly animals to handling their own insurance. But insurance smarts are as crucial to sustaining a successful practice as is knowledge of animal diseases and vaccines. Purchasing veterinary insurance is “all about planning for the unknown or planning for surprises,” says Thomas McFerson, a partner with Gatto McFerson, CPAs, a veterinary consulting firm in Santa Monica, Calif. Such surprises might include: Losses to buildings, business vehicles or clinic equipment taken on house calls. Losses of animals in a clinic’s care. Claims of malpractice by an animal’s owner. The death of a practice owner. Protection typically starts with a business owner’s basic policy covering physical damage to a veterinary office or clinic and on-site, non-employee accidents. The policy also should cover specialized veterinary tools such as radiographic equipment, says Rodney Johnson, DVM, a representative of the American Veterinary Medical Assn.’s Professional Liability Insurance Trust (PLIT). Indeed, “The dilemma the veterinarian faces is finding an insurance agent who is knowledgeable about his unique exposures,” says Brent Allen, the owner of Allen Financial Insurance Group of Phoenix. Those exposures, or risks, loom large. “We’re not seeing any large increase in …
Respect And Accept: A Look At Grief With The Veterinary ClientJune 22, 2009 Death and dying are uncomfortable subjects. For some, it stirs up painful memories of past losses. For others, it is a reminder of our mortality or the mortality of those we love. As we tend to the animals in our care, we will lose patients to death despite our best efforts. Often at these times, we are exposed to the emotions of the families who have loved them. For some, there are dramatic outbursts; for others, emotions will be put on hold for private moments. As different as people are, so are their reactions. No right or wrong. We must respect and accept the fact that we all grieve and express grief in our own way and in our own time, and we must be there to support our clients through this time. Often, we’re uncomfortable with client reactions. No one likes seeing someone sad and crying, and we fumble, sometimes, in an attempt to make them feel better. Recognize, first of all, that it’s not possible to make them feel better at that time. With that in mind, there are some things you can do and some things that shouldn't be done during those times of …
