False Evidence Appearing Real. I see it and hear it everywhere I go. I can find it in the city and I hear it in the small towns. Veterinarians are particularly susceptible to it. In fact, it seems that we thrive on this form of FEAR! In many cases it seems to be the watchword. “My client won’t pay that much.” I cringe when I hear that. It makes my stomach turn.
I don’t care if you practice in a town of 1500 or 1,000,000 the statement is not valid. The old business adage that 20 percent of your customers (clients) produce 80 percent of your income is true for this profession, too. I have worked in all of these circumstances. For example: a clinic (in need of a bulldozer) that produces $1.1 million per year without a fee schedule, an appointment schedule or a computer, AND the clinic sits in the middle of a lower middle class neighborhood. While working there my average transaction charge was $70.00. Also there is a clinic in a town of 3500 in a rural setting where the small animal office visit is $34.00.
Every once in a while I get a pleasant surprise. A classmate of mine recently told me that his office visit is $35.00 in a town where everyone else is about $22-25.00. He decided to set his fees based on what he thought it would take to run the practice. The highest Texas Office Visit fee that I have knowledge of is a well pet exam of $50.00 and a sick animal or exotic exam of $65.00.
What does False Evidence Appearing Real fear do to you? It keeps you in a position where you cannot hire the help you need…both professional and ancillary. It keeps you from taking 2-4 weeks a year off for a family vacation that is not tied to a tax deductible seminar. It keeps you working after the clinic is closed to see where you can cut corners or pigeon hole a few checks. It keeps you from paying all of your bills on time and taking the deduction in a timely manner, and it keeps you from buying the current equipment that you need to do the best job that we are capable of doing in today’s modern technology medical field.
IS THERE A STANDARD FOR VETERINARY MEDICINE?
Currently we are pretty much on our own. We do not have governmental agencies telling us what kind of equipment to use, but I am appalled at the number of clinics that I find using equipment dated back to the Civil War. In all honesty, I have seen too many “Picker-Clicker” x-ray machines. You know the ones…they have the hand timer and were used by the Army in Korea or Viet Nam. They do a “fair” job taking a picture of a dead dog, as long as you don’t want to define much in the thoracic or abdominal cavity. I visited one clinic where I saw two of the oldest machines I have ever seen, and I have been around this profession since 1960. I am sure that the two were used in battlefield conditions during the Civil War. If we do not police ourselves someone eventually will.
Here is a list of what I feel should be basic standards for a small animal practice anywhere in the State of Texas:
1. 3-5 Surgical Packs containing 15-25 instruments each with scissors that cut. I carry my own packs because too often I have been asked to do surgery with instruments that should have been thrown away 10 years ago.
2. Good quality clippers and new blades in each exam room. Blades only sharpen so long, then toss them. I carry my own.
3. No clinic…none…should be without a good computer system!
4. A great binocular microscope for slides and cytology, and a separate one for fecals as an option. Don’t ruin your best scope with fecal solution. At least assign someone to keep it clean. In my first college micro course we spent the first full week of lab on how to maintain a microscope. It was a graded week, too.
5. No clinic should be without a 300ma x-ray machine, automatic processor, adequate view boxes and a high intensity lamp.
6. Basic laboratory equipment for chemistries, CBC and electrolytes…even if you live in College Station, next door to TVMDL. Veterinarians have in-house lab. equipment in order to facilitate results to clients fast. We do this better than the human counterpart.
7. Dental Equipment that allows for proper cleaning, polishing, and extractions via gum flaps, etc. Proper training for ancillary personnel. Good hand instruments too. I think you will find that the evidence also shows that you need gas to do adequate dental work.
8. Isoflurane gas anesthetic machine(s). Isoflurane is the current standard, and I am glad to see that a number of clinics are buying sevoflurane vaporizers and gas; and adequate endotracheal tubes.
9. At least one, but preferably 2 or more, good quality, working fluid pumps.
10. A current policy of pain management that is properly marketed to the pet owner and understood by staff. Surgery is painful, as are dental extractions.
11. Modern surgical tables, exam room tables and treatment tables that put forth a good impression of the profession.
12. A good, clean, working autoclave. If they die, repair or bury them.
13. Adequate ancillary trays and sundry jars that are kept clean weekly.
14. Adequate sharps containers in all locations. I am surprised at the number of place that are still trying to sell the idea that they save money cleaning syringes. If you save a few syringes to send home oral medications that is not a problem, but people are buying cheaper syringes and still trying to clean them. They won’t clean regardless of the cost. NO ONE SHOULD BE RE-USING NEEDLES, BUT SOME STILL DO.
15. Odor control. There are ways to make your clinic smell pleasant, but it takes work and proper ventilation.
16. Cleanliness is one of the biggest problems I see. Sure we work in a hairy, dirty field, but it doesn’t have to be that way. I cringe when I work in a clinic where a dog urinates on the floor, a staff member goes and gets a wet mop and proceeds to mop up the spot. I want to scream….”STOP.” It happens all the time. Don’t they know that they are just spreading urine all over the floor? I try to teach them to blot the urine dry with paper towels, discard the towels, spray the spot with parvosol or something and wipe dry. The reason so many clinics are dirty and smelly is because of inadequate cleaning in the past and now the smells are part of the building.
There is one clinic I am mindful of that is so cluttered with old syringes, papers, and stuff everywhere that I can’t for the life of me see how they can get anything done. It is a mess everywhere. There is one room that was so disheveled I was afraid to walk through it. I am not sure why some people prefer to live like this but it is sad to see good minds give way to this substandard of practice. In my opinion, if a facility is not kept at a respectful level of cleanliness it should be shut down. It is a blight on the profession.
17. Adequate drug/supply inventory, but not overstocked like some clinics
I visit. However, it is ridiculous when you run out of K-Y Jelly
or tissue glue.
“GOSH, JIM I CAN’T AFFORD ALL OF THIS THAT YOU HAVE OUTLINED.” Have you been talking to your clients? Isn’t that the same thing you say about them? (My clients can’t afford those prices) Well, the reason you can’t afford what it is that you need is because you won’t charge the fees to support yourself. It is False Evidence Appearing Real. Your fear is not real.
All of this said, it is just a lot of words if you are not willing to re-train yourself, your staff and your clients. We are in the communication business as much as a radio station is in the communication business. If we cannot communicate to ourselves, our staff, and our clients we need to find another line of work.
James A. “Jim” Wilson, DVM
1412 Southern Plantation
College Station, Texas 77845-8775
979-690-8115
979-690-9219 (fax)
[email protected]