11-7-2007 -- I am absolutely convinced that veterinarians will be faced with more intrusive government rules and regulations than ever before. I hate to be the bearer of bad news, but it's going to get worse.
Consider the trends: The increasing emotional bond between pets, rising fees, easier access to government regulators and much more sophisticated medical delivery systems.
What if an animal dies suddenly? Who does the owner blame? Was the decline in the pet's health inadvertently caused by the doctor or technician? Was it just rotten communication? Is the owner looking for a scapegoat as part of grieving? In many ways, this client-focused perspective is just as important for veterinarians and technicians as the need for quality record keeping.
That said, I know it's a complicated proposition to run a medical practice and stay in compliance with the multiple state and federal authorities that craft regulations. Think about how many government agencies touch veterinary practice. Here's my short list: Congress, DEA, FDA, USDA, OSHA, IRS, the entire judicial branch, state legislatures, state income-tax authorities, city government and, yes, your veterinary state board. My point? Increasing oversight is the nature of our times.
As our November issue of DVM Newsmagazine makes its way to your office in the next few days, I want you to know it contains a second salvo of stories about veterinary state boards. We chronicled some very important trends last month including a spike in consumer complaints and the first known license revocation for failing to use post-surgical pain relief. Our November coverage arms you with even more knowledge about the state-board process and delivers practical ways to respond to client complaints when they surface.
And I want to know what you think. Send me a note, and if you would consider having it published in a future issue please let me know that as well.
A matter of failed expectations
10-23-2007 -- The way I see it, there is an art to asking tough questions. You do it every day when you ask a pet owner to choose between surgery and euthanasia. During the last two months, the editors of DVM Newsmagazine posed some difficult questions to you as a way to understand, and hopefully counteract, the increase in complaints to state boards. Minimizing, protecting and easing tensions that result in complaints to state boards was one of the reasons we undertook this series for October and November issues.
I sincerely believe that complaints, in most cases, are a matter of failed expectations. Are you managing client expectations to the best of your ability? Is the same true with your hospital team? My hunch is that most of you might hesitate when answering that question.
So, why does a consumer have to pay if you can't deliver a conclusive diagnosis? Of course, we both know the answer. My point is that if the client expectation was managed appropriately, then a pet owner would clearly understand the risks and probable outcomes of any procedure or diagnostic investigation. Do you agree?
My advice: Be upfront about the chances of treatment success. Encourage clients to ask tough questions of you.
I think it will help you keep public trust, and fend off complaints. But, then again, I’m not a lawyer.
10-20-2007- Standards of care are changing regardless of whether you practice in a big city or rural community.
Typically driven by demand in a community, there are other forces at work -- the human-animal bond, the costs of veterinary care, and open and simple access to regulators. What's fascinating to me, is that veterinarians believe the service they deliver clients is on par or better than human healthcare, according to a DVM Newsmagazine survey.
That's a dramatic shift in attitudes. As an editor, it tells me veterinarians not only recognize there is more sophisticated medical services offered and demanded, it says that this profession has risen to the occasion.
Sometimes change is for the best. While our series looks at complaints and effective strategies to dealing with them, we should all clearly appreciate that millions of animals are treated each year in veterinary practices, yet only a minute fraction ever result in an investigation by a state board.
The price of pain
10-17-2008 -- The state board decision in Minnesota regarding post-surgical analgesia touched a nerve in this profession.
In just a week following DVM Newsmagazine's October publication, we received numerous letters and telephone calls to talk about the issues outlined in the story titled The Price of Pain by Senior Editor Jennifer Fiala. We hope to publish all of your responses.
It's been thoughtful dialogue about the boards' actions and the ethics regarding post-surgical pain management for companion animals. As a publication, our goal was to fairly and accurately report the event to our readers. In so doing, the case of Dr. Carl Seemann will likely set precedent in the veterinary profession.
Whether or not you believe his actions were justified clinically is almost irrelevant. Whether or not he wins his case in Minnesota is almost inconsequential looking at the issue from a broader context. The important lesson this case demonstrates is that in 10 short years current medical thinking on the ways animals process pain has changed. New guidelines from the American Animal Hospital Association and American Association of Feline Practitioners add the exclamation point. Now, one state board has taken a stand on the issue. Whether or not it's "for good" is exactly what we want you to talk about.
Storming the castle?
10-16-2007 -- The walls of some state bureaucracies are so well fortified they seem impenetrable even to seasoned journalists. In other states, like California and Texas, the doors of information seem to swing freely. Why is that?
There is a certain dance that journalist and bureaucrat perform when engaged in a story. Typically the tenor is set with the topic. Positive stories flow like a waltz. Stories that are confrontational, maybe like a tango. Controversial stories? Well, have you ever danced in a mosh pit, alone?
Techniques to dodge journalists' questions are equally varied. There's the run-around; or the bureaucratic square dance, a kind of shuffle that passes you from one partner to another so frequently you collapse and give up from dizziness. Sometimes, the bureaucrat's strategy is to offer up a seemingly never-ending paper trail. But, then again, why waste time? At other times, they simply close the gates to an impenetrable state government so laden with rules and language, it's impossible to get a toehold.
My favorite example happened to DVM's Senior Editor Jennifer Fiala when calling the New Jersey State Veterinary Board last month in researching our series on veterinary state boards. The state administrator's response to our request to measure veterinary complaints for a two-year period was swift and to the point. I almost admired it.
She minced no words and offered no excuses.
There wasn't any discussion about living in a democratic land with government built by the people, for the people. Readers have a right to know.
The reality was, we weren't even seeking damning information about two warring parties. We simply were looking for statistics that shed light on a trend, an important trend for veterinarians.
Well, Jennifer never received the information from the New Jersey board, and it wasn't because she didn't try. She logged a slew of telephone calls and e-mails in an attempt to climb over and tunnel under New Jersey's bureaucratic castle. Maybe we will try to catapult a good, old-fashioned Freedom of Information Act request over the walls. If it works, I promise Jennifer will be the first to let you know. Until tomorrow...
Don't underestimate the role the Internet has played. It's breaking down barriers for doctors and consumers by opening access to public records and to veterinary boards charged with investigating consumer complaints. We are truly a global village, and pretty soon we will be able to spy on our neighbors with the precision that would make a CIA-operative blush. The point?
There is a level of transparency never before experienced in our culture. And it's being applied to veterinarians and their clients. All of this is coming at a time when the delivery of veterinary medical care is accelerating and improving at an equally remarkable pace. It was the premise to our series of stories published here, and in our October and November issues.
For the first time, DVM Newsmagazine quantified the number of complaints filed against veterinarians. For the first time, a veterinarian's license was revoked for not prescribing/recommending post-operative pain control. Those are two events that are changing veterinary medicine. We sought to understand these trends, seek input, talk about it and offer solutions.
For a small staff of editors, the undertaking of gathering this amount of information was nothing short of daunting, which brings me to the point of this blog. For the next six days, from a journalist's perspective, I want to tell you what it took to produce these stories and this data. Let me offer a clue. Have you ever dealt with the Bureau of Motor Vehicles on a bad day? We had at least 20 of those bad days in our attempts at gathering data from all 50 state agencies charged with policing the veterinary profession. I'll tell you more tomorrow.