Last night was a nice quiet night on call. A good meal and evening in with my spouse, some mindless Saturday television, uninterrupted by laminitics, stitch-ups or chokes. Until at 10.30pm, just as I was about to get into my bed, my phone bleeped and I ended up awake for half of the night. No, not a colic or a foaling, but a notification of a review being posted on our practice Facebook page. And not a favourable one!
The thing about Facebook reviews is that you can do nothing about them. You cannot delete them, you cannot edit them. You can reply to them, but opinion seems to be split between whether this is a good way of heading off trouble, or an invitation to all the complainant's friends to join the tirade. Thus they are inevitably completely one-sided. I do not know the story behind this lady's tale - I have never met her, nor her horse. She is a relatively new client and has been seen thus far exclusively by my colleague. She may well have a valid complaint, she may not. Most likely the truth lies somewhere in the middle, and the time of posting (10.30pm on a weekend night, three days after we last saw her horse) does make me suspicious that there may have been a glass of wine egging her on.
A previously received bad review was of the 'money-grabbing vets who care more about their bank account than the animal' variety. Now, anyone who has worked in practice for any period of time will probably have heard this line more often than they have applied a hot poultice. It is the usual cri de coeur of any client who has been asked to pay their bill. And most vets would reply that if they were in it for the money they would have picked a different career. However on this occasion the complaint was even more spurious than usual. The client had asked us to visit to vaccinate their horse, we had politely asked that they pay for their last vaccination, over 6 months previously, first. Not entirely unreasonable, but it left us with a rather floridly-worded tirade on our Facebook page for all the world to see as a result. I would happily have given some of my own hard-grabbed money to be able to comment on the post with the truth!
Luckily we have a lot of lovely clients who have left us lovely reviews, and it gladdens my heart to read them. However on occasions like last night, even though I was not personally involved in the lady's grievance, reading something like that really knocks me flat. It's a good thing I'm not much good at anything other than vetting, otherwise I might feel tempted to give it all up on the spot.
In these times of all-invasive social media it's far too easy to spread the vitriol of a bad experience (whether real or perceived) far and wide, to a potential audience of millions. However it is worth bearing in mind, before hitting the 'post' button, that you are talking about real people, whose feelings are as easily hurt as your own. I have spent most of this weekend being in turns angry and upset, which has impacted on my family. As vets we don't always get everything right. I can honestly say however that I do try my very best to do my very best by, and for, every horse and owner I meet. If anyone feels that this has not happened our practice is always happy to investigate and respond to any complaints sent to us. Choosing instead to spread this sort of poison across the internet, where professionalism and client confidentiality prevent us from defending ourselves, would seem like the work of a coward and a bully to me.
Sunday, 19 April 2015
Thursday, 26 February 2015
On Money, and the Value Thereof.
I wrote this blog a month or two ago, then shelved it after re-reading, wondering whether I might just be being a little petty. After a second complaint from another client on exactly the same issue I reconsidered. Publish and be damned!
Yesterday I received a complaint. Now for any of us working in the customer service field - and veterinary medicine is very much a customer service profession - we become accustomed to receiving complaints. Sometimes clients do not agree with things that we do, sometimes there is a breakdown in communication, sometimes people have differing ideas of what constitues a successful outcome. Occasionally we make a genuine error whilst treating a horse. All of these situations, and many more, will probably happen to every vet during the course of their career. However the single factor that drives more complaints than any other is money, and more specifically whether someone feels they have had value for money.
Yesterday's complaint really left me flabbergasted. I had driven out to a client's yard, administered a flu vaccination, and driven back to the practice. The yard was about 25mins away and I was probably there for about 15 minutes. Whilst we don't often carry out a full clinical exam at the time of vaccination we do listen to each horse's heart and ask the owner if there is anything they are concerned about or anything specific they'd like us to have a look at. We also offer to check the horse's teeth. So for the price charged the owner gets nearly an hour of driving time, the vaccination itself, a quick health check and the opportunity to discuss any problems that may have arisen over the past year. The price that I charged for all of the above? The 'gross overcharging' that led to the written complaint? £54.
It started me wondering what the client would have considered a reasonable cost for this service. £45? £25? £10?? It also made me wonder when veterinary medicine became quite so devalued. We are highly trained professionals. We have all spent a minimum of five years studying for our degrees. Many of us also have post-graduate qualifications and every single one of us carries out a bare minimum of 35 hours of CPD every single year, at no inconsiderable cost. We all have cars to run, facilities to maintain, heat and light, drugs and equipment to pay for, a myriad of miscellaneous everyday costs and overheads; and then we have to have enough left over to actually pay wages, not just for the vet that drove out to perform your vaccination, but for the receptionist and the nurses back at the practice. And none of us is even close to being rich!
So, does £54 look like value for money yet? If you took a taxi for that 50min round trip the fare alone would be more than £54. It costs more than £54 to take your cat to a small animal vet for a vaccination. £54 would pay for an hour's individual tuition with a well-known dressage instructor - but not if they had to come to you. £54 is less money than it costs to enter any British Eventing event. It is considerably less than the amount the client will hand over to their farrier every 6 weeks, year after year.
Somehow it seems ironic than the £250 bill for the emergency colic is rarely quibbled, but the £54 bill for the once yearly injection (that is a requirement to be able to compete the horse) is the cause of so much drama. We have plenty of clients who appreciate our efforts to keep routine costs down. Why should we be expected to lower those costs to a point where we are making a loss? Both clients said that the cost was 'extortionate' and that they'd be using another practice in future. Frankly, I wish them, and probably even more so their new vets, the best of luck.
Now, if you'll excuse me, it's time I asked my chaffeur to polish the Bentley...
Yesterday I received a complaint. Now for any of us working in the customer service field - and veterinary medicine is very much a customer service profession - we become accustomed to receiving complaints. Sometimes clients do not agree with things that we do, sometimes there is a breakdown in communication, sometimes people have differing ideas of what constitues a successful outcome. Occasionally we make a genuine error whilst treating a horse. All of these situations, and many more, will probably happen to every vet during the course of their career. However the single factor that drives more complaints than any other is money, and more specifically whether someone feels they have had value for money.
Yesterday's complaint really left me flabbergasted. I had driven out to a client's yard, administered a flu vaccination, and driven back to the practice. The yard was about 25mins away and I was probably there for about 15 minutes. Whilst we don't often carry out a full clinical exam at the time of vaccination we do listen to each horse's heart and ask the owner if there is anything they are concerned about or anything specific they'd like us to have a look at. We also offer to check the horse's teeth. So for the price charged the owner gets nearly an hour of driving time, the vaccination itself, a quick health check and the opportunity to discuss any problems that may have arisen over the past year. The price that I charged for all of the above? The 'gross overcharging' that led to the written complaint? £54.
It started me wondering what the client would have considered a reasonable cost for this service. £45? £25? £10?? It also made me wonder when veterinary medicine became quite so devalued. We are highly trained professionals. We have all spent a minimum of five years studying for our degrees. Many of us also have post-graduate qualifications and every single one of us carries out a bare minimum of 35 hours of CPD every single year, at no inconsiderable cost. We all have cars to run, facilities to maintain, heat and light, drugs and equipment to pay for, a myriad of miscellaneous everyday costs and overheads; and then we have to have enough left over to actually pay wages, not just for the vet that drove out to perform your vaccination, but for the receptionist and the nurses back at the practice. And none of us is even close to being rich!
So, does £54 look like value for money yet? If you took a taxi for that 50min round trip the fare alone would be more than £54. It costs more than £54 to take your cat to a small animal vet for a vaccination. £54 would pay for an hour's individual tuition with a well-known dressage instructor - but not if they had to come to you. £54 is less money than it costs to enter any British Eventing event. It is considerably less than the amount the client will hand over to their farrier every 6 weeks, year after year.
Somehow it seems ironic than the £250 bill for the emergency colic is rarely quibbled, but the £54 bill for the once yearly injection (that is a requirement to be able to compete the horse) is the cause of so much drama. We have plenty of clients who appreciate our efforts to keep routine costs down. Why should we be expected to lower those costs to a point where we are making a loss? Both clients said that the cost was 'extortionate' and that they'd be using another practice in future. Frankly, I wish them, and probably even more so their new vets, the best of luck.
Now, if you'll excuse me, it's time I asked my chaffeur to polish the Bentley...
Tuesday, 13 January 2015
Long in the Tooth?
Equine dentistry is an area that seems to be ripe for debate in the veterinary and horse-owning worlds. I see endless articles in magazines about who can do what, and endless discussions on social media about who best to tackle a horse's teeth - vet or EDT?
I'm a vet who loves dentistry. I think that is something that is becoming a lot more common and I suspect those who vehemently proclaim against using a vet to do teeth are probably coloured by experiences from the not-so-distant past when most vets had minimal interest, equipment and, dare I say it, expertise. I qualified less than 20 years ago and distinctly remember being handed a rusty Hausmann gag and two blunt rasps of the old carbide-chip variety. I only got ownership of the gag as my boss thought they were a completely superfluous piece of kit and made a point of never using one! I knew I was doing horses (and their owners) a poor service and I didn't really understand what I should be trying to achieve or how to go about it. A poor workman never blames his tools, but to be honest if I tried to do a horse's teeth now with the kit I had then I would probably still be working on the same horse a week next Sunday.
Something had to change, and my personal epiphany coincided largely with a similar zeitgeist in the equine veterinary world. Meetings were held, committees were formed and discussions with 'equine dentists' led to the instigation of both targeted CPD courses for vets, and exams and accreditation for dentists. I attended one of these early courses and was blown away by the scope of what it was possible to achieve and the display of equipment available from specialist suppliers. And so was born an interest which has remained with me for the rest of my career. I try to keep as up-to-date as possible with my learning and stretch my equipment budget as far as I can. I am a little bit like a magpie - my head always being turned by the latest piece of gleaming shiny-new instrumentation. I am by no means the best dentist in the country, and probably not even in my county, but I like to do a careful, thorough job and carefully assess the work that needs doing and the benefit for the horse. I am always aware that less is often more in this sphere, something that we definitely didn't appreciate in the past.
So, if I weren't a dentistry-orientated vet, who would I have to do my horses' teeth? Well definitely only a fully qualified EDT or a vet with a specific interest in dentistry (and there are quite a lot of us around now). I think most of the approved EDTs do a really, really good job, and they have the benefit of working in horses' mouths all day long, whereas we also see lamenesses and colics and all the other things in between. On the flip-side vets have a detailed knowledge of medical conditions that may have a bearing on what goes on in the mouth, so it's swings and roundabouts. However I do think that the ideal is working on a sedated horse. Even if the horse is generally good to do, the intra-oral examination can be so much more thorough and the work so much more precise if the horse is stationary, with its head still and its tongue relaxed. Obviously it's safer for everyone too, but I am constantly amazed by the things that I see under sedation that I know I would have missed without.
I am quite happy to sedate horses for approved EDTs, with the emphasis on the approved. We are actually not supposed to sedate horses for non-approved dentists. This inevitably causes friction when a client rings and asks for a horse to be sedated for their 'tooth-man' and I have to say no. We have lost business, and on occasion clients, because we adhere to the rules. What really infuriates me are the occasions on which we decline, yet the client manages to find a different vet who agrees to carry this out. Rules is rules, and it really looks bad for the profession when we all seem to have our own personal interpretation of something which is entirely black and white. Some vets either don't know or don't care that it is completely illegal for an un-approved EDT to carry out work with power-tools, but by sedating the horse whilst they carry this out they are giving their tacit approval to these illegal procedures, in the eyes of the client and the dentist.
So, a bit of a serious one from me this time, but something that seems pretty topical. I think the whole situation is actually quite difficult for clients to understand. As a profession we could probably do more to promote the understanding of who can (or more importantly can't) do what, and make sure that our clients are using the best person for the job, whether that be a vet or an approved EDT. After all you wouldn't dream of letting an un-registered farrier shoe your horse!
I'm a vet who loves dentistry. I think that is something that is becoming a lot more common and I suspect those who vehemently proclaim against using a vet to do teeth are probably coloured by experiences from the not-so-distant past when most vets had minimal interest, equipment and, dare I say it, expertise. I qualified less than 20 years ago and distinctly remember being handed a rusty Hausmann gag and two blunt rasps of the old carbide-chip variety. I only got ownership of the gag as my boss thought they were a completely superfluous piece of kit and made a point of never using one! I knew I was doing horses (and their owners) a poor service and I didn't really understand what I should be trying to achieve or how to go about it. A poor workman never blames his tools, but to be honest if I tried to do a horse's teeth now with the kit I had then I would probably still be working on the same horse a week next Sunday.
Something had to change, and my personal epiphany coincided largely with a similar zeitgeist in the equine veterinary world. Meetings were held, committees were formed and discussions with 'equine dentists' led to the instigation of both targeted CPD courses for vets, and exams and accreditation for dentists. I attended one of these early courses and was blown away by the scope of what it was possible to achieve and the display of equipment available from specialist suppliers. And so was born an interest which has remained with me for the rest of my career. I try to keep as up-to-date as possible with my learning and stretch my equipment budget as far as I can. I am a little bit like a magpie - my head always being turned by the latest piece of gleaming shiny-new instrumentation. I am by no means the best dentist in the country, and probably not even in my county, but I like to do a careful, thorough job and carefully assess the work that needs doing and the benefit for the horse. I am always aware that less is often more in this sphere, something that we definitely didn't appreciate in the past.
So, if I weren't a dentistry-orientated vet, who would I have to do my horses' teeth? Well definitely only a fully qualified EDT or a vet with a specific interest in dentistry (and there are quite a lot of us around now). I think most of the approved EDTs do a really, really good job, and they have the benefit of working in horses' mouths all day long, whereas we also see lamenesses and colics and all the other things in between. On the flip-side vets have a detailed knowledge of medical conditions that may have a bearing on what goes on in the mouth, so it's swings and roundabouts. However I do think that the ideal is working on a sedated horse. Even if the horse is generally good to do, the intra-oral examination can be so much more thorough and the work so much more precise if the horse is stationary, with its head still and its tongue relaxed. Obviously it's safer for everyone too, but I am constantly amazed by the things that I see under sedation that I know I would have missed without.
I am quite happy to sedate horses for approved EDTs, with the emphasis on the approved. We are actually not supposed to sedate horses for non-approved dentists. This inevitably causes friction when a client rings and asks for a horse to be sedated for their 'tooth-man' and I have to say no. We have lost business, and on occasion clients, because we adhere to the rules. What really infuriates me are the occasions on which we decline, yet the client manages to find a different vet who agrees to carry this out. Rules is rules, and it really looks bad for the profession when we all seem to have our own personal interpretation of something which is entirely black and white. Some vets either don't know or don't care that it is completely illegal for an un-approved EDT to carry out work with power-tools, but by sedating the horse whilst they carry this out they are giving their tacit approval to these illegal procedures, in the eyes of the client and the dentist.
So, a bit of a serious one from me this time, but something that seems pretty topical. I think the whole situation is actually quite difficult for clients to understand. As a profession we could probably do more to promote the understanding of who can (or more importantly can't) do what, and make sure that our clients are using the best person for the job, whether that be a vet or an approved EDT. After all you wouldn't dream of letting an un-registered farrier shoe your horse!
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