The Other Side of the Exam Table

Posted: Oct 8, 2012
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Over the last month I’ve been entirely consumed by my year-old cat’s rapid progression down the FLUTD path of horrors. After four deobstructions and five hospitalizations, I agreed to have Dr. Magee (one of our surgeons) perform a perineal urethrostomy (PU) surgery.

The care Alistair received from my coworkers was extraordinary, with special emphasis on the surgical team that facilitated his PU. Dr. Magee, if you’re reading this, Alistair’s incision looks as if the very hand of God threw his sutures. Beautiful.

Alistair Van Fleet

Throughout the process, I couldn’t remove my quality improvement nerd and patient advocate hats. And in keeping those hats firmly in place, I learned some very important lessons in how to best work with clients under duress (anyone who saw me visiting Alistair can testify that I was an utter wreck).

Lesson #1: Communicate about how to communicate.

Life outside of the hospital continues. The evening of Alistair’s surgery I had to attend a movie pre-screening I helped organize, to represent my school. During his many hospitalizations I was forced to keep appointments, leave the house for groceries, and continue as if I were not stressed and grieving for my ill pet. The world, sadly, doesn’t often make allowances or offer forgiveness for responsibilities forgotten during a pet’s illness.

To that end, it’s important to coach clients in how and when they can expect updates, how and when they can visit, how and when they can call, and who they will be able to talk to. While some clients will make this easy and tell you when they would like updates, visitation times, etc., others may seem unsure. I would encourage you, at that point, to be assertive and suggest a specific time window for such interactions, rather than accepting that they don’t want updates or don’t want to visit. However, do not neglect the needs of the client’s basic waking hours schedule-take a few seconds to ask!

I call this idea “road mapping,” because you’re providing a system for navigating both hospital policies and preferences of the medical staff. Furthermore, providing a road map takes the pressure off clients to make decisions beyond what they need to focus on for their pet. Again, this isn’t applicable to all clients, but may be useful for those cases where the client appears overwhelmed. If all else fails, I would err on the side of over-communication (different from information overload!).

Lesson #2: When teaching, consider the learning style of your client.

Even as a veterinary professional with many years of experience in specialized practice, I like pictures. I’m a visual and kinetic learner-first I like to see, and then I like to do. Drawing a simple picture (such as the one provided below) can give visual learners a better idea of the basic mechanics of a surgical procedure. Video tutorials may do the same. Ask if the client would like time to read discharge instructions before you talk them through home care. Offer the client the ability to demonstrate any skill you’re asking them to practice at home. Remember that, even when you’re rushed, the client may need to walk through a concept more than once before putting it in to practice at home.

Lesson #3: Continuity of care is REALLY important.

Let me say that again; continuity of care is REALLY important. We want our patients to undergo as smooth a transition as possible from the hospital to the home environment, which includes considering medication administration, the scheduling of follow-up care, and access to necessary resources. The following list, while not exhaustive, outlines some considerations to make when sending patients home after hospitalization:

  • Are you recommending a follow up appointment? With who? Do they have the information they need to get in touch with another vet or a specialist? This may include providing phone numbers, addresses, business hours, and copies of records.
  • Have you coached your client on how to appropriately care for their pet’s basic needs at home? Do you foresee any difficulties in the pet performing basic functions such as eating, drinking, or eliminating? Think about things like e-collar induced messes, sling walking, or special supplies needed.
  • Think about medications. Are you prescribing anything compounded that the client won’t be able to get for 1-2 days, or more if prescribed on a weekend? I’m currently unaware of any compounding pharmacists that work on the weekends. Are you sending the client home with a reasonable medication schedule? I recommend clients use Microsoft Excel or some form of calendar to have a written record of medication administration. Have you asked how the pet best takes medication?
  • If the client needs to follow up at your facility, have you given them expectations of scheduling, or lack thereof? Again, coaching clients on what to expect is part of patient-centered care and necessary to help them navigate the complex medical system that is a hospital.
  • Does the client need access to some sort of social services? In my opinion, everyone in veterinary medicine has some degree of responsibility to help clients who cannot afford care, even if it’s just by way of referral to another organization. Not only are you helping the pet, you’re also demonstrating your investment in making your community an equitable, compassionate place for pets.