Archive for the ‘Selecting a Veterinarian’ Category

AHVMA 2011 Pearls

September 18, 2011

I recently had the pleasure of lecturing on veterinarian/client communication skills at the American Holistic Veterinary Medical Association (AHVMA) annual conference. Dr. Doug Knueven, a holistic veterinarian (combines Eastern and Western medicine) in Beaver, Pennsylvania was the conference coordinator.  Much to my delight, Dr. Knueven has graciously offered to provide you with some pearls from the conference (thank you Doug!).  Take it away Dr. Knueven!

Before I give you the goods, I’d like to start with a little background. The AHVMA was founded in 1982 by a hand full of veterinarians who were interested in complementary medicine. It has grown to an organization that is almost 1,000 members strong. AHVMA members practice diverse therapies including acupuncture, chiropractic, herbal medicine, homeopathy, natural nutrition, massage therapy, energy medicine and much more. Most of us continue to practice Western medicine as well (we haven’t thrown the baby out with the bath water) using an integrative model of health care.

The AHVMA 2011 conference provided 122 hours of continuing education for veterinarians and veterinary technicians. Lectures spanned the range of therapies mentioned above as well as client communication (thanks Dr. Nancy!), integrative oncology, nervous system issues, emergency preparedness, and electromagnetic biophysics (Yikes!!). Most lectures applied to pets but we also had a stampede of information for vets who work on horses, cows, and goats.

Approximately 400 professionals attended. Most were AHVMA members but a fair number were conventional practitioners who were interested in learning more about some of our fascinating topics. Attendees came from as far away as Europe, Japan and Australia. Our lecturers had varying backgrounds and areas of expertise. We had several veterinary speakers who are board certified specialists.

So here are some pearls of wisdom from the AHVMA conference:

Dr. Greg Ogilvie, who specializes in both internal medicine and oncology, spoke about how diet influences cancer:

Cancer cells have a “sweet tooth.” Pets with cancer should be fed a low-starch diet.

Docosahexaenoic acid (DHA), an omega-3 fatty acid can help prevent cancer, fight cancer, increase the effectiveness of chemotherapy, and decrease the side effects of chemotherapy. The best source of DHA (highest concentration of active ingredient) is from oils that come from algae.

Do not give your pet high doses of anti-oxidant vitamins A, C, and E concurrently with chemotherapy as they can interfere with the action of the drugs.

Dr. Mona Rosenberg is a conventional oncologist who works with holistic veterinarians to provide an integrative approach to treating cancer.

She turned me on to a great website for the Society for Integrative Oncology (www.integrativeonc.org). Although this group is meant for human patients, most of the basic concepts are equally true for pets.

Dr. Barbara Royal addressed pet diets.

She uses integrative therapies with zoo animals and found lessons for pets from problems encountered while working with wild animals kept in captivity. The bottom line is that zoo animals encountered health problems when their diets varied from what they would get in the wild. Mother Nature is not easily fooled. Many pets benefit by being fed diets with little to no heat processing since this is what they evolved eating.

Dr. Lea Strogdale, an internal medicine specialist discussed diseases common to cats.

It turns out that slow motion video reveals that cats are inefficient at drinking water. This is why some cats like to drink from faucets or fountains. This makes sense since cats evolved from desert creatures where puddles are scarce. Because they do not drink efficiently, cats are prone to chronic dehydration. The bottom line is that many of the chronic diseases we see in cats, such as urinary crystals, chronic kidney disease, and constipation, may be due to the dehydrating effects of dry cat foods.

Do not feed your cat dry food. Many cats benefit from high-moisture canned or raw diets.

To entice your cat to drink more water, keep the bowl topped off or use a very broad bowl so she does not bump her sensitive whiskers against the sides.

I hope you have found these holistic pearls helpful. One final note, if you would like to find a holistic veterinarian in your area, check out www.ahvma.org and click on the “find a holistic veterinarian” button.

Dr. Doug Knueven

_________________________________________________________

Now, Dr. Knueven will be happy to entertain your questions!

Best wishes for good health,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

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The Elephant in the Middle of the Exam Room

August 1, 2011

My dual career as an author and a practicing veterinarian provides me with a unique vantage point. Not only am I privy to the issues my veterinary colleagues are stewing about, I also receive a plethora of emails from my readers candidly venting about their experiences as consumers of veterinary medicine.  It’s rare that those on both sides of the exam room table are growling about the same issue, but these days this is certainly the case.

See if you can identify the elephant in the exam room based on the following data that has appeared in current veterinary news feeds along with quotes from recent correspondences with my readers:

– The number of pet visits to veterinary hospitals is dramatically decreasing (DVM Newsmagazine, June 2011), and a special session was held at this year’s conference of the American Veterinary Medical Association to explore ways to increase public awareness about the importance of annual checkups for pets.

– “In my opinion, most of the decline in veterinary visits is primarily due to the bad economy. If you are barely scraping by, you are certainly not going to the vet for a very pricey annual exam, especially if your pet seems fine.”

– While pet spending is up, the market isn’t growing fast enough to support the number of new veterinarians entering the veterinary profession. (DVM Newsmagazine, June 2011) Veterinarian supply is growing faster than pet owner demand. (The Bayer Veterinary Care Usage Study 2011)

– “Sadly there are some veterinarians who see hospitalization fees as a revenue stream and do not inform clients that no one will be supervising the pet they recommend be hospitalized. While one tends to like to think of their vet as a kind, caring person and many are, some are more business than heart.”

– Eighty-nine percent of current veterinary school graduates have student debt.  The average student loan debt of students graduating in 2010 from veterinary school was $133,873 (15% have debt in excess of $200,000) and the average starting salary was $48,674. (Veterinary Information Network News Service, January 4, 2011)

– “My question is why most vets feel the need to worry about money instead of worrying about taking care of the pets.”

– Although the number of households in the United States with cats is increasing, the number of feline visits to veterinary hospitals is decreasing. (Banfield Pet Hospital® State of Pet Health 2011 Report)

– “I’d love to take each of my cats in for dental cleaning on a regular basis and I have two cats that desperately need attention now. For me, it’s a matter of costs. Vets continue to increase their charges and there’s no break for multiple pets. Dental disease is a precursor for renal failure in cats and yet it’s so expensive for cleaning – yet alone extracting any teeth. Then blood work is usually advisable to be on the safe side. It’s a small fortune when you leave the vet’s office for ONE pet. Next you’ve got the cost associated with monthly flea control. You have to draw the line somewhere and hope for the best.”

– Fifty-four percent of cat owners and 47% of dog owners report that they would take their pet to the veterinary hospital more often if each visit were less expensive. (The Bayer Veterinary Care Usage Study 2011)

– “I am not saying veterinarians can’t charge a reasonable fee for their services, but most people can’t afford $300+ bills every time they step into a clinic, per pet, per year, and that is for the healthy ones who are coming in for regular yearly checkups and not for other medical concerns that require medications, further diagnostics, overnight stays, dental cleaning, blood work etc.”

– Fifty three percent of clients believe that veterinary clinic costs are usually much higher than expected. (The Bayer Veterinary Care Usage Study 2011)

– “I am sick and tired of the way veterinarians financially take advantage of people who are emotionally upset about their pets.”

– Twenty-four percent of pet owners believe that routine checkups are unnecessary and 36% believe that vaccinations are the main reason to take their overtly healthy pet in for an office visit. (The Bayer Veterinary Care Usage Study 2011)

– “We have a lot of price gouging going on here at local vets. A dental cleaning has gone from $75 to $300 and up at many places. A lot of the clinics are buying high tech equipment and passing overhead costs on us so they really shouldn’t complain when clients come for less visits.”

Have you identified the common thread amongst these comments and statistics?  No doubt in my mind that the “gripe du jour” is the “M word.”  Perhaps it is more accurate to say that the real issue is too little money.

This blog is not intended to create or perpetuate harsh judgments. Please hear me when I say that I know that not every veterinarian or every person who brings their pet to see the vet is thinking primarily about money.  Clearly, however, money matters are on the minds of many, in fact more so than I’ve witnessed throughout my thirty year career.   Never before have I observed colleagues declare bankruptcy.  Never before have I spent so much time in the exam room trying to help folks figure out how to do more with less.

My goal in presenting this information is to create some understanding about what’s going on in the minds of individuals on both sides of the exam room table.  Blame this money mess state of mind on the diseased economy, veterinary competition, or the expense of going to veterinary school.  Whatever the causes, there is an awful lot of emotion tangled up in the financial aspects of providing and receiving veterinary health care these days.

What are your thoughts? Let’s talk about it and in doing so we will be able to kick that big ole’ elephant out of the middle of the exam room!

Best wishes for good health,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

The challenges of combining Eastern and Western medicine for your pets

June 6, 2011

Choosing a veterinarian who practices Western medicine (conventional medicine/allopathy) or one who practices Eastern medicine (alternative/complementary medicine) is fairly straightforward.  Successfully combining the best of both medical worlds however can be challenging.  Speaking for Spot fan, Carolyn recently sent me an email based on her experiences:

Hello Dr. Nancy! My question has to do with both holistic and conventional medicine for our dogs. I try to do everything as “green and natural” as possible for my dog: home-made food & treats, non-toxic cleaning products, natural materials in beds and toys … you get the idea. I think supplements and holistic treatments have their place and often are very valuable in maintaining health and even in treating illness. That said, I believe conventional veterinary medicine is valuable too. My conventional vet is great … but she does roll her eyes when I discuss a holistic approach. So how does one balance both therapy options for their dog? Are there any vets who practice both holistic and conventional veterinary medicine, that have a more diverse toolbox so to speak? I sort of feel that I have a foot in both camps and I’m not sure my dog is well served by one approach over the other.

Here’s how I responded to Carolyn. By the way Maggie, the insanely adorable cotton ball flying over the hedge in the accompanying photo is Carolyn’s lucky companion.

Hi Carolyn. How nice to hear from you. Please give Maggie a treat from me! You are correct.  It can be difficult to find a veterinarian who practices Western medicine and supports referral for complementary medicine, and vice versa.  Truthfully, it is difficult for a veterinarian to be extremely well versed in both disciplines (hard enough staying truly proficient in just one of them).  There are a few veterinarians who do a great job with both, but they are few and far between.  Western medicine is the discipline predominantly taught in veterinary schools throughout the United States.  Proficiency in complementary modalities including Chinese herbs, homeopathy, and acupuncture requires additional training and certification.

What can you do to avoid having your veterinarian roll his or her eyes at you? As you know, I am a big believer in picking and choosing your veterinarians wisely. Certainly, open-mindedness is an important trait in any doctor, whether providing service for us or for our beloved pets.  The “ideal vet” is happy to have you work with other veterinarians so that your pets receive the care that is best for your peace of mind.  Just as most of us have a number of doctors for our health needs, it’s perfectly acceptable for your pets to have different doctors for their different health care needs.  Here is an example. The surgical specialists I work with frequently treat dogs suffering from severe arthritis pain.  In addition to prescribing a nonsteroidal antiinflammatory medication and joint care supplements the surgeon may refer their patient to a rehabilitation therapy specialist for workouts on the underwater treadmill.  Clients are also offered the option of consulting with a veterinarian who specializes in acupuncture. The key to success is that all three specialists are open-minded, communicate with one another, and share a common goal- namely what is best for the patient. Can such a winning combination be found in every community? No, unfortunately not, but you won’t know until you look.  What should you do if your veterinarian feigns hurt feelings or rolls her eyes?  Stay true to your goals.  You know what is best for your pet.  Besides, which is more important, your vet’s feelings or your pet’s health?

Have you been successful at combining Eastern and Western medical approaches for your pets?  Do tell!

Best wishes for good health,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

 

 

Reasonable Expectations VII: Discussion and Open-Mindedness About Your Dog’s Vaccinations

December 27, 2010

This is the seventh part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets. Parts one through six can be found at www.speakingforspot.com/blog

As invaluable as vaccinations are for protecting canine health, determining which vaccines are appropriate and how frequently they should be administered are no longer simple decisions. Gone are the days of behaving like  “Stepford wives” simply because you’ve received a vaccine reminder postcard or email. Vaccinations are no different than any other medical procedure.  They should not be administered without individualized discussion with your veterinarian and consideration of the potential risks and benefits. Please know that having such a discussion with your veterinarian is a perfectly reasonable expectation, and your input is an invaluable part of the vaccine decision-making process.

Consider the following:

• There are currently more than a dozen canine vaccinations to choose from! Back in the days when I was just a pup there were only five, and decision-making regarding vaccine selection for an individual dog was far less complicated.
• Over the past decade we’ve learned that, for some vaccines, the duration of protection is far longer than previously recognized.  In the past we vaccinated against distemper, parvovirus, and rabies annually.  We now know that these vaccinations, when given to adult dogs, provide protection for a minimum of three years and, in some cases protection is life-long.
• The duration and degree of immune protection triggered by a vaccine is variable, not only based on vaccine manufacturer, but from dog to dog as well.
• Other than for rabies (state mandated), vaccination protocols are anything but standardized. There are no set rules veterinarians must follow when determining which vaccines to give and how often they are administered. Unfortunately, some vets continue to vaccinate for distemper and parvovirus annually even though we know that these adult vaccines provide protection for a minimum of three years.  Some vets give multiple inoculations at once, others administer just one at a time.
• Increasingly clear-cut documentation shows that vaccines have the potential to cause many side effects.  While vaccine reactions/complications are still considered to be infrequent, they can be life threatening.

What you can do:

As your dog’s savvy medical advocate, what can you do to be sure that he or she is neither under or overvaccinated? Here are some guidelines for making wise vaccine choices for your best buddy:

1.  Educate yourself about available canine vaccinations and the diseases they are capable of preventing (in some cases treating the disease, should it arise, might be preferable to the risks and expense associated with vaccination). Learn about duration of vaccine protection and potential side effects.  Read the chapter called “The Vaccination Conundrum” in Speaking for Spot. It provides detailed discussion about all aspects of canine vaccinations including the diseases they prevent, adverse vaccination reactions, and the topic of vaccine serology (blood testing that helps determine if your dog is truly in need of vaccine booster). The American Animal Hospital Association’s “Canine Vaccine Guidelines” is also an excellent source of information (http://secure.aahanet.org/eweb/dynamicpage.aspx?site=resources&webcode=CanineVaccineGuidelines).
2.  Talk with your veterinarian to figure out which diseases your dog has potential exposure to.  A miniature poodle who rarely leaves his Manhattan penthouse likely has no exposure to Lyme disease (spread by ticks); however a Lab that goes camping and duck hunting may have significant exposure.
3.  Alert your veterinarian to any symptoms or medical issues your dog is experiencing.  It is almost always best to avoid vaccinating a sick dog — better to let his immune system concentrate on getting rid of a current illness rather than creating a vaccine “distraction.” If your dog has a history of autoimmune (immune-mediated) disease, it may be advisable to alter his vaccine protocol or even forego ongoing vaccinations — be sure to discuss this with your vet.
4.  Let your vet know if your dog has had vaccine side effects in the past. If the reaction was quite serious, she may recommend that you forego future vaccinations, necessitating an official letter to your local government agency excusing your pup from rabies• related requirements.
5.  Talk to your veterinarian about vaccine serology.  This involves testing a blood sample from your dog to determine if adequate vaccine protection still exists (remember, vaccine protection for the core diseases lasts a minimum of three years).  While such testing isn’t perfect, in general if the blood test indicates active and adequate protection, there is currently no need for a vaccine booster. Serology may make more sense than simply vaccinating at set intervals.
6.  Talk to your veterinarian about the potential side effects of proposed vaccinations, what you should be watching for, and whether or not there are any restrictions for your dog in the days immediately following vaccination.

What happens if your veterinarian declines vaccine discussion and simply wants to vaccinate based on what he or she thinks is appropriate?  Time to find yourself a new veterinarian who is progressive enough to have a working relationship with people who choose to be a stellar medical advocates for their dogs!  Is your vet willing to have open-minded discussion with you about your dog’s vaccinations?

Best wishes for a happy new year.   

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

A Gift of Spot – Black Friday Special

November 26, 2010

Purchase Speaking for Spot through this link between November 26, 2010 and November 30, 2010 at a special “black Friday” price of $15.00.  Your book(s) will be personally signed and, if desired, receive complimentary holiday gift wrap.

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

What is a Veterinary Specialist?

March 21, 2010

I participate in a list serve for veterinarians who specialize in internal medicine. The list serve “topic de jour” concerns veterinarians who are general practitioners (also known as family veterinarians), yet bill themselves as “specialists” in specific venues such as surgery, dentistry, or cardiology.  The responses have been strongly disapproving, and here is the reason why:  The American Veterinary Medical Association dictates that the term “specialist” be reserved only for veterinarians who have completed all of the requirements to become a “diplomate” within a specialty organization. What must a veterinarian do to become an official specialist/diplomate? Trust me, it is a long and arduous process! After graduating from veterinary school, wannabee specialists must complete a minimum three-year internship and residency training program, author publications in peer reviewed journals, and pass some insanely rigorous examinations specific to the specialty they are pursuing.  (Note that the requirements differ for those who become specialists in complementary/alternative medicine fields of veterinary medicine such as homeopathy, acupuncture, chiropractic, and Chinese herbs.) If one is successful in completing this rigorous and extensive training they achieve “board certification” status and are deemed to be “specialists” or “diplomates” within their chosen specialty.  This is much like the process physicians go through to become specialists.

The world of veterinary specialists has grown by leaps and bounds.  Much like Starbucks®, if there’s not already a group of specialists in your community, there likely will be soon!  Veterinary specialists are found in university teaching hospitals and in some private practices.  They often “cohabitate,” sharing specialty staffing, equipment and laboratory services with specialists in different areas of expertise.  When this is the case, you, the lucky client, end up with access to multiple specialists under one roof.  Not only is this convenient, it also focuses a lot of brainpower and experience on your pet- group discussions about patients (medical rounds) typically occur daily in such specialty hospital settings.

When might you need the services of a veterinary specialist? Just as your family physician refers patients to specialists, your family veterinarian should be considering referral in the following three situations:

  1. A second opinion is desired by you or your veterinarian.  Yes, you definitely have the right to request a second opinion.  I know it can be tough telling your vet you would like a second opinion, but as your beloved pet’s medical advocate, you are obligated to do so just as soon a your “gut” starts suggesting that a second opinion makes sense. I encourage you to read the chapter called, “A Second Opinion is Always Okay” in Speaking for Spot- it will provide you with plenty of helpful coaching about how to tactfully broach the subject with your veterinarian! Hopefully your vet has established relationships with local specialists- the kind she would trust to take good care of her own dog should the need arise. Not all family veterinarians are keen on “letting go” of their patients, so self-referral might be your only way to seek out the help of a specialist.
  2. Help is needed to figure out what is wrong with your pet. Specialists have advanced diagnostic tools (ultrasound, endoscopy, CT imaging, MRI scans, etc.) and have developed the skills to use them. Additionally, because of their extensive experience with challenging cases, specialists often have the ability to hone in on a diagnosis in the most direct and expedient manner.
  3. Your vet doesn’t specialize in the disease your pet has or the therapy he needs.  Just as with our own health issues, treatment is ideally managed by someone who works with that particular disease issue day in, and day out, and regularly pursues continuing education pertaining to that disease.

How can you tell if a particular veterinarian is truly a specialist?  Simply examine the initials following his or her name. See the list of specialties and their corresponding initials below. For example, if you look at the initials following my signature (ACVIM), you can tell that I am a specialist in The American College of Veterinary Internal Medicine. To learn more about any of these areas of specialization, pay a visit to the websites.  Those listed below are within the United States, but you will find comparable organizations in many other countries or continents.

Have you ever taken your pet to a veterinary specialist?  Have you ever wanted to do so, but had trouble getting “buy in” from your family veterinarian?  If so, please share your experience.  I’d love to hear from you.

Diplomate, ACVIM Internal medicine (acvim.org)
Diplomate, ACVIM, Cardiology Cardiology (acvim.org)
Diplomate, ACVIM, Oncology Oncology (acvim.org)
Diplomate, ACVIM, Neurology Neurology (acvim.org)
Diplomate, ACVS Surgery  (acvs.org)
Diplomate, ACVD Dermatology (acvd.org)
Diplomate, ACVR Radiology (acvr.org)
Diplomate, ACVO Ophthalmology (acvo.org)
Diplomate, AVECC Emergency and critical care (acvecc.org)
Diplomate, ACVA Anesthesiology (acva.org)
Diplomate DACVB Behavior (dacvb.org)
Diplomate, ACVN Nutrition (acvn.org)
Diplomate, AVDC Dentistry (avdc.org)
Diplomate, ACT Theriogenology (theriogenology.org)
CVA Veterinary acupuncture (Ivas.org)
TCVM Chinese veterinary medicine (tcvm.com)
AVH Homeopathy (drpitcairn.com) or (theavh.org)
ACVA Chiropractic (animalchiropractic.org)
CCRP Canine rehabilitation (caninerehabinstitute.com)

Best wishes to you and your four-legged family members for abundant good health,

Nancy Kay, DVM
Diplomate, ACVIM
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life

Website: http://www.speakingforspot.com
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller.

Frankly Speaking

December 6, 2009

In 2001, the Journal of the American Veterinary Medical Association stated, “Veterinarians’ responsibilities have expanded to include the mental health and well-being of their clients as well as their clients’ pets.”  For me, this came as no great surprise.  Having graduated from veterinary school in 1982, I’d already learned that if I wasn’t taking good care of my clients’ emotional needs, it was far more difficult to take good care of my patients’ health needs.  Admittedly, it took me a few years to catch on to this notion.  During my formative years, I recall thinking that good client communication would be a “slam dunk”.  After all, I fancied myself to be a good teacher and a nice person.  It didn’t take long for me to realize that the “medicine part” was becoming a whole lot easier than the “client part.”

Thus began my avid interest in the art and science of client communication.  I read whatever I could get my hands on (not much in the veterinary literature at that time) and attended communication workshops. I began studying my clients, trying new tactics and techniques, and asking questions of them not necessarily directly related to their dog or cat (Kleenex consumption increased exponentially).  I founded and continue to facilitate a community Client Support Group (talk about a front row seat in terms of understanding what is going on in our clients’ minds) and have enjoyed teaching client communication skills to local and national audiences.

The unfortunate fact of the matter is that few veterinary colleges provide any formal client communication training to their students- doesn’t make much sense does it?  One of the schools that doesn’t overlook this important subject is Colorado State University.  Here veterinary students receive fabulous communication training via the Argus Institute (www.argusinstitute.colostate.edu).  This organization’s stated mission is “to strengthen veterinarian-client-patient communication and support relationships between people and their companion animals.” In addition to providing formal client communication training to CSU veterinary students, the Argus Institute also makes communication training available to veterinarians.  These workshops are called FRANK (based on the notion of “frank” communication), and the emphasis is on relationship-centered care, an approach that emphasizes collaboration and shared decision-making between veterinarian and client.  Pfizer Animal Health was involved in the creation of FRANK in 2007 and continues to generously fund this program.

I just completed my first FRANK training workshop- what a fabulous experience.  I left the program feeling invigorated, renewed, and eager to apply what I had learned. The majority of the workshop time was spent in small groups within simulated exam rooms.  Professional actors played “the client,” each getting in character with their assigned emotional agendas (they were awesome and totally believable).  Everyone took turns as “the veterinarian” during these mock office visits.   The interactions were videotaped after which respectful, constructive critique was offered within the small group setting. We worked on several communication skills including delivery of empathetic statements, maintaining focus on the “common ground” (the well being of the patient), reflective listening, facilitating silent pauses (time for clients to gather their thoughts), disclosure (sharing stories of our own that might parallel what the client is emotionally experiencing), and asking open-ended questions (allows the client greater opportunity to share their stories).

A veterinarian can be a sensational surgeon or a dandy diagnostician, but such skills may wither on the vine if he or she is not a successful communicator.  More than ever before, people are becoming savvy consumers of veterinary medicine and better effective medical advocates for their pets.   My sense is that these wonderful trends will drive the awareness that client communication training for veterinarians is profoundly important.   Frankly speaking, I think it’s about time!

Wishing you and your four-legged family members a joyful and healthy holidays season.

Dr. Nancy Kay
Specialist, American College of Veterinary Internal Medicine

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller.

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Listen to Dr. Kay’s interview – A Veterinarian Advises “How to Speak for Spot” on NPR’s Fresh Air with Terry Gross