A couple of years ago, I received a complaint against my license. It was the only one I have received in 27 years of practice—and God willing, the last.
The letter arrived a few months after COVID’s onset, back when my work life was stressful enough without the addition of a legal hand grenade. In retrospect, it was a landmark moment. It marked the exact date I had been forced to alter my fundamental conception of the veterinary client and the quality of my work in general.
The work/life-changing event
The patient in question had died on my watch during the first week we had installed our curbside protocol. It happened three days after a client had refused to hospitalize her 16-year-old Chihuahua. When she had finally brought him back, he was a limp, desiccated husk in a hand towel.
After much cajoling, she allowed us to take the dog from her for assessment and care. Thirty minutes later, it passed. The Chihuahua’s stay with us was just long enough, apparently, to give the owner the impression I had let her dog die.
If you think back to those first few weeks of the pandemic, you will remember the disorganization, inefficiency, and initial client outrage over social distancing protocols. It was a messy, stressful, baffling time—as close to mayhem as I’ve ever experienced in practice. While confident in the care my patient had received, my records were admittedly slapdash. My notes had suffered an equivalent degree of chaos during that period, and I felt sure I’d be dinged for my record-keeping, if nothing else.
The experience was equal parts mortification, self-recrimination, and anger over being unjustly accused of neglect and abuse (both were explicitly alleged in the written complaint). How could this happen to me when I consider myself fair, honest, communicative, and cautious in my client interactions?
Given this complaint, along with the storm of demanding client interactions during that time, I had to wonder: Has something fundamentally changed in veterinary medicine? Do clients now hold us to an even higher standard than we hold ourselves to?
In the end, I was cleared without so much as a footnote on my record-keeping. That does not mean I did not spend several anguished months wringing my hands over the prolonged license complaint process; nor, once acquitted, did I neglect to indulge myself a heartfelt, Scarlet O’Hara-style declaration: “God as my witness … I will never keep crappy records again!”
As you might imagine, exoneration did little to assuage the frustration, anxiety, and feelings of inadequacy derived from my lapse in record-keeping. I atoned by pledging myself to a new medical records system. I settled on a PIMS with a provider-friendly interface flexible enough to accommodate a variety of different record-keeping styles and a laser-like focus on client communication. For good measure, I applied myself to the task like a pug to its bowl. My records would be nothing short of relentless—not a morsel left behind.
Defensive record-keeping would save my skin and alleviate my anxiety, I reasoned. For good measure, I elected to improve my approach to client communication by sending a report card to each client after every visit, procedure, or hospitalization. This way no authority could find fault with my medical records and clients would have tangible evidence of my attention to detail.
Evolution of an obsession
Fast forward two-plus years and my clients have seen the process further evolve. I now include detailed explanations, links, future plans, and more in my records. While I typically save time by pasting text from pre-written templates (briefly adopting and discarding a speech-to-text approach along the way), the process has turned into a daily slog that inevitably runs into the evening hours and requires attention on my “days off.”
The upside is most of my clients are enthralled. They love the personalized attention. As a result, they are more compliant. A greater percentage follow my instructions to the T and return for their rechecks on command (the most objective measure of compliance). They also enjoy better continuity of care should they present after hours or on a day I’m off-duty (my notes are now minutia-laden and hard to misinterpret). It also improves patient care directly by helping me keep track of chronic cases more carefully. So much so I wonder how I ever managed complex cases before this. So, what’s not to love?
Where shall I begin?
On the surface, the problem should be obvious: It’s damned hard to keep up with this level of detail. If I do not finish my notes within a day or two, I will forget things, which means I have to stay up late or come in early to get my notes done ASAP. The memory of this peri-menopausal woman, being what it is, there is almost zero room to maneuver here.
Another issue comes down to the inevitability of entropy: the occasional report card will fall between the cracks. I do my best to keep track, but the caseload makes it challenging. As most of you well know, we are chronically overworked and understaffed. We are mentally exhausted and physically done-in by the end of the day. So, if a couple of report cards a week end up unsent, you would think I might be excused the oversight, right?
A new source of client indignation
Not so. Instead, I seem to have invented a new wellspring of grievance. Upon not receiving report cards in what they deem a “timely” fashion, some will lodge complaints with reception, demanding their expected communication immediately. It’s impressive, really, the extent to which we can unwittingly create client monsters by actually upping the quality of our care.
The irony, of course, is ratcheting up the quality of my professional service to help address higher client expectations and a personal source of work-based anxiety has done quite the opposite. I’m working longer and harder…but catching more crap for it. Sure, I’m pleased with the positive impact on patient care and I won’t stop doing it, but I’ll openly admit to being one step closer to hanging up my stethoscope.
A cautionary tale
For me, the above story is a cautionary tale; one that aptly describes the moment we are experiencing in veterinary history. Consider this: Our clients have high expectations—which, for the most part, we do not begrudge them. They spend more of their disposable income on their pets than ever before and, as an industry, we have risen to the task. We also understand the nature and degree of their emotional attachment and know their higher demands vis-á-vis their pet’s healthcare are often backed up by their compliance along with their cash. That does not mean their expectations are always realistic. Yes, some clients will always be outliers on the crazy scale.
However, it is also important to point out that our clients cannot fully comprehend the industry economics, operations, and logistics we currently labor under. They do not know veterinarians are being economically squeezed and chronically overworked. In other words, their excessive expectations are often innocent enough. Not that it makes their complaints any easier to abide or our professional anxiety any less real.
Patty Khuly, VMD, MBA, owns a small animal practice in Miami and is available at drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.