Dr. Lord is an excellent veterinarian. He's a social, outgoing person who loves his pet patients and their owners. When he first walks into an exam room he says, "Hi, I'm Dr. Jack Lord. Please call me Jack." He then proceeds to address the client by his or her first name to make everyone feel at ease. Dr. Lord thinks that this familiarity makes the pet owner more comfortable and relaxed during the visit. After all, he addresses his patients by their first names.
Dr. Lord conducts a full examination and determines that Sunny in fact has tracheobronchitis and not lung cancer. He assures Jane that this condition will resolve itself in the next seven to 10 days. In his traditional congenial way, he gives the pet owner his cell phone number in case she has any concerns over the weekend. Jane says to him, "Jack, thank you very much for saving my dog's life."
At 11:30 that evening, Dr. Lord receives a call on his cell phone from Jane. She says, "Jack, this is Jane. I think Sunny is choking to death."
Dr. Lord assures her that this isn't the case but that this particular virus infects the trachea or windpipe and often leads to some disturbing gagging. Jane listens but isn't convinced. She proceeds to call Dr. Lord at home on his cell phone twice more, at 1 a.m. and 3:30 a.m., because Sunny is still choking. At this point, Dr. Lord thinks he should tell Jane that she's overreacting and the late night calls aren't helping Sunny. He goes on to tell her that he needs some sleep and that he'll check in with her the next day.
Suddenly client Jane reverts to Ms. Fisk. The following day she calls the clinic and talks to the hospital director about Dr. Lord. Ms. Fisk feels that Dr. Lord encouraged her to call him on his personal cell phone should she have problems. She's disappointed that he has suddenly become distant and "unprofessional" because she called him at home with her emergency.
The hospital director assures Ms. Fisk that her pet is very important. He adds that there's an after-hours emergency number available to all clients at any time. But Ms. Fisk feels betrayed by Dr. Lord. She acknowledges the help the hospital director has given her, but she never returns to the clinic for veterinary care in the future.
Dr. Lord maintains that his first-name relationship with clients and personal after-hours accessibility are practice-building tools. He concludes that Ms. Fisk is overreacting and that her behavior is inappropriate. He thinks her decision to leave the practice is her loss in the long run.
On the other hand, the hospital director thinks it's in the best interests of all concerned to maintain a professional demeanor and distance between doctor and client. This helps the veterinarian speak honestly and unemotionally when addressing the medical needs of the patient. When these boundaries are blurred, misunderstandings in stressful situations can rapidly escalate and damage the client-doctor relationship.
Dr. Rosenberg's response
When a pet owner visits a veterinarian, the expectation should be that of a relationship between a professional service provider and client. It's inappropriate for the clinician to assume that a client wants to be addressed by a first name in what essentially is a business relationship. The veterinary professional should be viewed as a caring health service provider who may be friendly but is not a friend.
These boundaries allow both the client and clinician to speak freely and objectively without the clutter of friendship. This ultimately allows the pet to receive optimal health care. Private after-hours access and a first-name relationship are often initially comforting to a client, but these can be intentionally or unintentionally abused, leading to a doctor-client relationship risk that's not worth taking.
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Dr. Rosenberg is director of the Voorhees Veterinary Center in Voorhees, N.J. He is a member of the New Jersey Board of Veterinary Medical Examiners.