A Day in the Life: General Practice VeterinarianWritten on July 24, 2017 by Krista Vernakelen, VMD Hospital: Bulger Veterinary Hospital

Clients often ask what it’s like to be a vet. The general perception based on comments I’ve heard is that we “get to play with puppies and kittens all day!” While I do get to interact with dogs, cats, and the occasional ferret, guinea pig, or other small mammal, nothing I do would be described as “play.”  The patients I treat are generally somewhat on edge, and not overly happy to see me. More of what I do is interact with owners, develop diagnostic plans, interpret findings, figure out finances for what we need to do, talk on the phone, write up records, mediate disputes with clients, help with ordering hospital supplies, troubleshoot equipment, perform surgery and other procedures, and occasionally take a break to eat or use the restroom.

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Dr. Vernaleken doing what she loves most: treating patients.

 

So, since you asked, here is a snapshot of my life as a general practice vet on a typical day of appointments:

The following story is based on true events. Only the patient names and breeds have been changed to protect their identities.

1:00 PM, A Head Start 

On a typical appointment day, I arrive anywhere from 30 to 60 minutes before my appointments begin.  In this time, I usually do the following:

  • Check my voicemails
  • Look over my schedule
  • Read through patient cases I feel I’ll need a little more time with
  • Check in with my team
  • Tweak my schedule (shorten or lengthen appointments depending on the reason for their visit, block off time for phone calls, consultations, or procedures, etc.)

Today, I’m in appointments from 2–8 PM, so I arrived around 1 PM.  Appointments are scheduled for 20-30 minutes – shorter for well-appointments, longer for sick or more complicated cases.

A Healthy, Happy Lab

13391426_938126049638471_8884950167642241549_o1:45 PM:  My first patient, a young adult Labrador Retriever, arrives. Even though I still have a few minutes before I “start,” I ask my technician to bring them into a room.  You never know what will happen later, so getting a head start on the day is always helpful. My team of technicians, client care coordinators and customer service liaisons are invaluable. So much of what I do is made easier, better and smoother because of their (sometimes seemingly invisible) support, and I cannot thank them enough.

My technician has taken a brief history on the dog and brings back the file for me to review.  It’s a healthy pet, but has had a few mild problems (an ear infection, diarrhea once).  We determine the pet needs a physical exam, a few vaccines, and a heartworm test. I talk to the owner more in-depth about the pet’s history, what preventatives they use, any concerns they have, and what their goals are for their dog. I examine the dog nose-to-tail to make sure there aren’t any detectable problems (there aren’t), and that the dog is healthy enough to receive vaccinations today (he is).  We draw blood for the heartworm test, give the vaccines, and then review the dog’s plan for the next year (e.g. continue monthly heartworm preventatives and flea & tick preventatives). Finally, I answer questions from the owner about flea & tick prevention options and we escort them out front. They get everything they need and head out, probably for a day of Labrador Retriever fun.

A Scared-y Cat

2:10 PM:  The next appointment (a cat for her annual visit) is here, so my technician brings them into a room while I complete the medical record for the last appointment, which must include:

  • Anything and everything I talked about with the client
  • Anything and everything observed on the pet
  • Anything administered to the pet

The technician comes back and tells me that the cat I’m seeing is extremely angry and won’t come out of the carrier. We gather some supplies (towels, thick gloves) and go back into the room together. The cat is just scared and we are as careful, quiet, and non-threatening as we can be while we protect ourselves from sharp teeth and claws.  We carefully examine the cat, administer vaccines, and trim the cat’s nails (which is no easy feat, but we’re the experts and we try to help the owner).  No one is hurt and the owner and displeased cat are sent home with everyone intact.

A Scooting Pooch IMG_0055

2:45 PM:  My next patient arrived 5 minutes late.  No problem – we do the same as for the first patient

  • Take a history
  • Perform an exam
  • Draw for the heartworm test
  • Administer vaccinations
  • Educate the client

The client states that the dog is “scooting” and needs his nails trimmed, so we bring him back to express his anal sacs (avoiding getting this nasty discharge on ourselves so we won’t stink for the whole day) and trim his nails. He goes back to the owner, who checks out while I write up this record, and while my technician brings in my next client.

An Itchy Shih TzuIMG_0904

3:05 PM: Despite my best efforts, I’m 5 minutes late getting into this appointment.  This is a “check eye” appointment for a sweet 12-year-old Shih Tzu, but it’s not just the eyes.

The owners have concerns with the dog’s ears, teeth, itchiness, chronic vomiting, and behavior. I have 25 minutes to carefully review every concern:

  • When it started
  • How it has progressed
  • What the exam looks like
  • What might be going on
  • What tests we should do

We do three tests on the eyes, bloodwork to clear him for anesthesia for a dental cleaning as well as to figure out if there is a reason for the vomiting, a test for the ears to see if we have an infection, discuss but don’t perform x-rays for the vomiting, and briefly review their behavioral concerns but ultimately explain that we need to fix the medical problems first and most likely don’t have time to deeply review behavior today.

We send the dog home with:

  • Two types of eye drops
  • Ear medications
  • Oral antibiotics
  • Give an injection for the itchy skin (allergies)
  • Set him up for a dental cleaning
  • Provide the owners with and review an estimate for the cost of this procedure
  • Discuss anesthetic concerns, which I’ll touch upon more when I call them with bloodwork results the next day

This has taken me 35 minutes, so I’m now running 10 minutes late.  Although I took notes so that I wouldn’t forget anything, I need to write up everything in detail and I can’t leave until every record has been completed. I set aside this record to complete later since I don’t have time to write it now.

A Toothy Problem

3:40 PM:  We go into my next appointment; a big, handsome cat is here for a tooth check. We examine the cat, discuss anesthesia, draw pre-anesthetic bloodwork, discuss dental disease and the likely need for two extractions.

Meanwhile, the client from the 3:00 Shih Tzu appointment calls in. The husband brought the dog in, and the wife couldn’t be there but wants me to review the appointment with her in detail. I let my receptionist know that I’ll have to call them back.

I write up the record for my current appointment while two of my technicians get the bloodwork, write up an estimate, and bring the cat and estimate out to the owner. We review it and the owners let me know that they aren’t sure they can afford it. We discuss financial options and my medical opinion on the need for this procedure.  The owner will schedule it when they can afford it.

Nervous Nellie

4:05 PM: Two-dog appointment for routine wellness with two nervous little Chihuahuas. Chihuahuas are often nervous, though, so this isn’t out of the ordinary. Unfortunately, we do have to muzzle one of them and the other is shaking in his boots during the entire appointment.  Nevertheless, we get through our full exam:

  • A heartworm test
  • Vaccines
  • Conversations – one of the dogs has a heart murmur, so we discuss having a cardiologist take a look at the heart via ultrasound. We give them a verbal estimate and they go home to think about it.

I wrote up one patient record during the appointment and bring back the second patient’s record to finish before the next appointment. I still have the Shih Tzu appointment to write up, and need to call that client back but both will have to wait as my next appointment is in the room.

Puppy BreathDaveSchmidt

4:40 PM: I’m back on schedule, and this appointment is an adorable puppy. All puppies are cute, but this little Golden girl is particularly cute. We review:
Housetraining

  • Feeding
  • Behavior
  • Vaccine
  • Parasite control
  • Nail care
  • Any other owner questions

We examine the puppy for general health as well as any congenital problems (problems he was born with) and find out he’s perfectly healthy! We finish up and give the owner a “new puppy” packet with a heartworm pill, flea & tick prevention, and insurance information, and set them up for their next booster vaccine appointment.

I have time to complete the record for this one but still haven’t had time to complete the Shih Tzu’s record, I always take notes during appointments so that if I can’t do the write-up immediately, I don’t forget the details, and I never go home until all my records from the day have been completed.

While I’m in this appointment, the Shih Tzu’s owner also calls back because they haven’t heard from me yet. I let my receptionist know that I’m not able to call back right now and might not be able to until the end of my appointments at 8 PM.

A Clogged CatHeatherKridel

5:10 PM:  The next appointment, a cat who is not defecating (pooping), arrives on time and is brought into a room by my technician. After discussing the cat’s history with the owner (she hasn’t defecated in a week and a half).I examine her and find her colon packed full of hard feces.  She’s severely constipated, and without intervention there is no way she’s going to be able to pass it all. I review the situation with the owner. We will need to:

  • Hospitalize her cat
  • Run bloodwork and x-rays
  • Give fluids
  • Sedate her so we can manually remove all that poop

This is certainly a costly route but it’s really the only option, and the owner reluctantly agrees. I let the owner know that we’ll be running the tests as soon as we can and that we’ll get her kitty on fluids right away. I won’t be able to do the poop removal until after appointments end, but I’ll call her after that to review the procedure. Most likely the cat will be able to go home tomorrow after she’s recuperated from anesthesia and gotten started on some medications. The owner agrees, signs everything she needs to sign, and we get started with the cat. I work with the technician to draw blood and place the IV catheter, then she is taken for x-rays while I write up a treatment sheet so she can be started on her fluids.

Three’s Company: A Trio of Dogs 4 Collies

My 5:40, 6:00, and 6:20 appointments are all the same family – three dogs.  While it may seem easier to schedule multiple pets together, it can be challenging for both the owner and my team to focus on each individual dog. We talk about each dog’s personal history, examine them, and make sure that they each receive the correct vaccinations and heartworm tests. Each dog also has individual issues to be discussed:

  • One dog needs his ears cleaned more often
  • Another could stand to lose 10 pounds
  • The third is always itchy, so we’re working toward a diagnosis of allergies and talking about changing his diet.

Because this was a very involved appointment, I wasn’t able to complete their records during the exam.

We finish up, give the client their products, and I go back to review the constipated cat’s bloodwork, x-rays and make sure she’s settled in on fluids. I also take this opportunity to calculate and draw up anesthesia drugs.

Coincidentally, this owner calls while I’m doing this because she’s having second thoughts about the procedure and the cost. I talk with her about the treatment plan, procedure and outcome again, and she again affirms that she’s back on board and gives us the go ahead to proceed with the treatment.

BorderCollieItchy Ears

6:55 PM:  My 6:40 PM appointment arrives 15 minutes late. Fortunately, I have used this time to work on the constipated cat and one of the records I’m behind on. Unfortunately, I have two more appointments and the next one is due to arrive at 7 PM.

We offer the client who was late (patient A’s owner), two options: keep the appointment, but with the understanding that it will be interrupted when my next appointment arrives, or rescheduling the appointment. She chooses to keep the appointment. As soon as we begin, my 7 PM arrives and is brought into a room.

Both pets have ear infections. My technician collects an ear swab sample from patient A while I talk with the 7 PM appointment (patient B’s owner), and collect the ear swab. I go back and look at patient A’s ear swab while my tech stains patient B’s ear swab. I’m careful to keep each pet’s records and results separate. Strangely, their ears are nearly identical.

I go in and talk to patient A’s owner, clean the dog’s ears, apply the treatment, escort them out front, and then circle back to patient B and have the same talk, clean out those ears, and apply the treatment.

Both appointments are done by 7:30 PM, but I add those records to the stack I still need to finish.

Another Wiggly Puppy13465934_10207808431301684_6311239592658479488_n

7:30 PM: My last appointment of the day is another puppy. I love seeing new puppies and always try my best to be as enthusiastic and educational as I have been with my other clients. We talk about all the puppy stuff and have a fairly lengthy discussion about housetraining.  We send this owner home with the same packet of “new puppy” items.

Back to the Clogged Cat

8:00 PM: I have a stack of seven files to complete, an owner to call back, and the poop removal to perform. I give the poop cat her sedation injection with a technician’s help, and while the tech sets up the equipment for the procedure, I call back the Shih Tzu’s owner. We review everything that I had gone over with her husband and discuss in depth our plan and each medication.

I also call an owner whose pet’s bloodwork is back from the day before with an update. In the meantime, my technicians are also approving medication refills, calling owners who have more routine questions, and cleaning up the exam rooms. By now, it’s 8:20 PM and the cat is ready for anesthesia

8:30 PM: The cat is fully under anesthesia with fluids running, monitoring equipment attached, and we’re ready to go. I spend the next 30 minutes painstakingly pulling hard feces out of her colon until I think we’re empty. We take an x-ray and see that it’s not all out. I go back in for another 15 minutes and take another x-ray confirming that her colon is empty. The entire hospital smells like 2-week-old cat feces, and the whole team blames me (all in good fun) for stinking up the hospital. Fortunately, I double-gloved because I’ve learned that if you only single-glove, you’ll smell that cat poop on your hands for 2 days no matter how many times you wash. I stay with the cat and technician until she’s recovered enough that we’re comfortable with me walking away. She goes back to her kennel on fluids and continues to recover from anesthesia.

Wrapping Up: Calls & Paperwork

9:15 PM: I check my voicemail again; there are three more messages that were left during the afternoon while I was in appointments. It’s not too late, so I call them back – one is a question about weight loss recommendations in cats, one is about whether it’s time to put a dog to sleep, and one is a dental question. I return those calls and then call up the constipated cat’s owner to let her know that her cat is doing well and we were successful in removing all the feces. We review the long-term care this cat will need (diet modification, laxatives, and maybe someday surgery if we can’t keep this under control).

9:45 PM: With all my phone calls and patient care responsibilities done, I sit down to write up my records. I finish these up in about 20 minutes and write up the discharge instructions for the constipated cat, and make sure all the charges are accurate.

10:15 PM: Time to go home.

This is a long and what seems like fairly crazy evening, but it is pretty representative of what all veterinarians and technicians do at a busy hospital on a daily basis.  At the end of the day, I have:

  • Seen 14 patients
  • Anesthetized one
  • Administered 30 vaccinations
  • Drawn blood from 10 animals
  • Expressed some anal glands
  • Pulled about a pound of poop out of a cat’s butt
  • Spent about an hour and a half on the phone
  • Written pages of medical records, and
  • Correctly diagnosed and treated multiple medical conditions

I have not eaten dinner, and I have had about 2 cups of coffee (although I made about 4 cups, many of which got cold when I didn’t get to drink them). Vets love our chosen profession – all that we ask is that our clients understand that frequently, we have a million other things going on at one time and need your patience. During this day,

  • I was never more than 10 minutes behind,
  • Addressed each and every concern as fully as I could,
  • I called back every owner that needed a call, and completed all of my medical records.

It can be exhausting, but we have to be as emotionally available, friendly, and medically on-the-ball with the last client as we are with the first. Vets often do have the best job in the world, just not always for the reasons the general public thinks.  We certainly get to have so much more contact with animals on a daily basis than anyone else.  We also have an engaging and exciting time being the experts in pet care, advising clients about preventative care, and puzzling through the challenge of diagnosing problems. The downside can be that very occasionally, we are not treated well by clients who accuse us of being “only in it for the money.”  This hurts more than you may know, since we care very deeply and are not as well compensated as other similar professions (who might not ever once have to pull poop out of a cat’s rear end). I love what I do, as do my colleagues and team. My hope is that anyone reading this far can now appreciate that practicing “routine” medicine is far from routine.

 

12:00 AM – Time for bed: goodnight. 

 


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