How to Find a Great Veterinarian | Dr. Judy Morgan Deep Dive

>> Dr. Judy Morgan: For a traditional vet to have somebody call up and say, Hey, I’m new to the area I’m going to spend $50, I want to come in and talk to you and talk about your philosophy and my philosophy and make sure that this is a good fit. They might be a little put off, they might be a little defensive, but you know what? If they’re defensive and in the first five minutes, you can’t break the ice and get past that then you probably haven’t found a good match anyway– because you don’t want to be working with someone who’s always going to either be on the defense or on the attack. You want a conversation.
>> Narrator: Welcome to Dog Cancer Answers, where we help you help your dog with cancer. Here’s your host, James Jacobson.
>> James Jacobson: Hello friend. Thanks for joining us this week on Dog Cancer Answers.
Finding the perfect veterinarian for your dog can be difficult. And when you have a dog with cancer, managing that relationship with your vet or your team of vets can be extra challenging.
What if you move to a new place and have to find a new vet, how do you do that? What are the questions that you ask and how can you confidently make a decision today that could possibly one day in the future have life and death consequences for your, fur babies.
That is what today’s deep dive episode is all about– finding the perfect veterinarian and our guest today is Dr. Judy Morgan. Dr. Judy, who has more than 35 years of clinical experience was a recent guest on the show, when we talked about home cooked meals and cancer-fighting foods. During that conversation, we briefly touched on the topic of managing your dog’s vet team and she had some amazing insights and that gave me the sense that there was a lot more there. So, we invited Dr. Judy to come back today and as you’ll hear it turns out that she recently moved and she’s looking for a veterinarian for her own dogs.
Dr. Judy, thank you for being with us again on Dog Cancer Answers.
>> Dr. Judy Morgan: Thank you so much for the invitation. I had so much fun last time.
>> James Jacobson: And the reason that I wanted to invite you back is you mentioned something in that last interview that I thought, huh, we need to explore this because this is a big topic for people. Which is this concept of managing the relationship with your veterinarian, especially if your veterinarian isn’t exactly into all the things that you are finding out on the internet and in your research.
>> Dr. Judy Morgan: Yes, it can be very difficult.
Social media is good and bad. You can find a lot of information, some of it good and some of it bad. And veterinarians are traditionally very busy and probably not spending as much time on the internet and seeing what is floating out there. So, sometimes when you approach them with something that they haven’t heard of or don’t know anything about, they get a little bit wigged out.
>> James Jacobson: Is that sort of a knee jerk reaction?
You bring up a good point. They are not sitting there they’re practicing medicine. They are dealing with clients. They’re also running a business, which I think I want to get into because that whole thing is an interesting dichotomy about you also have to be profitable and sustainable. Why don’t we start there because I think that is foundational to getting into the head of a veterinarian.
>> Dr. Judy Morgan: So, it is a business and it is a very difficult business from a business standpoint. Associate veterinarians, most of them are coming out of school with anywhere from $200,000 to $300,000 dollars in debt.
>> James Jacobson: Wow.
>> Dr. Judy Morgan: I recently saw the figures for this past year, and there were students who had a half million dollars in educational debt.
The average starting salary for a small animal veterinarian in the US right now is around $82,000 a year. And if you figure they’re a new graduate, they’re probably either having to rent a place to live or buy a house, buy a car, maybe starting a family, and they’ve got that kind of debt load before they ever do anything. It can be pretty daunting.
So frankly, they’re running as fast as they can just trying to keep their head above water. For practice owners, I would say 15 years ago, our net, after paying all of our bills ran about 40%. We’re down to about 10%.
>> James Jacobson: And why is that? Why is it less profitable to own a vet clinic now?
>> Dr. Judy Morgan: It’s less profitable because salaries for staff in general have gone up. We at this point really need to cover healthcare insurance for our employees. Healthcare costs have gone through the roof and in order to attract good employees that are educated technicians, you know, educated people that are going to help. We’re going to pay them a very good salary and we’re going to have to include retirement benefits, health benefits. My top technicians were making about $55,000 a year. I had five licensed graduate technicians in my practice, as well as two associate veterinarians, myself, and then we’ve got all the front office staff.
You pretty much have to have an office manager to manage all the human resources and keep track of payroll and everything else that’s going on.
Because litigation can be a problem with employees, keeping a legal team and accounting team and our drug costs have just skyrocketed.
So, when you put all of that together, it’s a very different scenario. And one of the other things that is interesting– the IRS won’t like this, but back when I started and probably the first 20 years in practice, our income was split about one third cash, one third checks, one third credit cards. Now it is about, well, especially with COVID and doing curbside, it’s a hundred percent credit cards. So, you’re not hiding cash anywhere. You’re not sticking $20 in your pocket for lunch. So, there’s no cash flow and credit card companies are charging us two and a half to three and a half percent. So, that’s just one more layer of something else we’re adding on.
>> James Jacobson: I think this is sobering and I appreciate your candor about this because not a lot of veterinarians will talk about this, especially publicly. And I know that you go to big conferences and they sit around and they talk about, oh, this is not a very profitable business– I don’t know why I got into it.
And you also see skyrocketing levels of suicide among vets, in part because of the financial stresses. So, your willingness to discuss this I think is really sobering and also is foundational to this idea, that when you start to work with a veterinarian, there are so many other considerations in their head that you, as a client, as someone who has a dog with cancer, have to at least understand and appreciate, even if that’s not top of mind for you.
>> Dr. Judy Morgan: Exactly. So, little things– I’m a veterinarian who promotes homemade food or buying raw food. Veterinary clinics aren’t selling those things. When we go to conferences or we go to business meetings, one of the things they talk about is prescription diets– they’re like, that’s a huge profit center. Twenty percent of your income can come from selling prescription diets. And when you’re somebody who’s trying to pay the mortgage and keep the lights on, you look at that and say, well, that’s great, if I prescribe a food, they have to come back every month, pick up more of that food from me. If I give them a recipe for a homemade diet, I might make some money giving them that recipe or not. And then after that I got nothing coming in.
>> James Jacobson: It’s Safeway or whole foods or whatever.
>> Dr. Judy Morgan: Exactly. Somebody else just got all that profit margin. So, you can understand it. And the other thing is the traditional veterans truly do believe that those diets are beneficial for the animals. And so, they’re not selling them just as a profit center. They truly believe they’re good. I do not. I come from a different place. But, it is a profit center.
The second practice I worked in out of school, I was there for about five years. Every animal in that practice was on some sort of prescription diet. We sold the food for every patient, every patient. That’s a huge profit center versus me saying, well, go home and cook them up this in your kitchen, and that profit just left.
>> James Jacobson: And we won’t get into the efficacy of some of those prescription diets.
>> Dr. Judy Morgan: Let’s just say, I’m not a fan.
>> James Jacobson: You’re not a fan. I think that’s a nice way of saying it.
So, for veterinarians who are not fans of prescription diets, that’s yet another level of previous for revenue generation that they are taking away. So, it narrows down how profitable and therefore how stressful it is on them.
>> Dr. Judy Morgan: Exactly. And I can pretty much say as a whole, holistic veterinarians, the majority do a really bad job charging for their time and being profitable.
>> James Jacobson: Talk about that. Why is that?
>> Dr. Judy Morgan: Well, we do things like we don’t sell prescription diets. We don’t sell drugs, which there’s a huge markup on drugs. We’re tending to sell herbs or telling you to go get these supplements that we are not necessarily selling.
It was interesting. I had a client phone consultation the other day and the client said, she could get acupuncture locally. And I said, Oh, that’s great, why don’t we add acupuncture on to your pets protocol. And, she was being budget conscious. She said, Oh, well this one clinic that I go to has a couple of doctors– this one where I go, acupuncture is only like $10 or $20. And as my jaw got picked up off the floor, I said, where are you going for acupuncture for $20? And as it ends up, the veterinarian was somebody I knew. And I said, why is he charging $20? I said, do you know what it would cost to get acupuncture in my office? It’s $120.00 a session. And she went, Oh, I couldn’t afford that. I said, yeah, no kidding.
And if you thought it’s only worth $20, Yeah, it would be sticker shock to walk into an office where it was six times that.
>> James Jacobson: And so is it the types of veterinarians who choose to do the holistic approach that tend to maybe be less expensive? Is that–
>> Dr. Judy Morgan: I think they don’t value their time as much or their educational value. I’m not really sure, either that or it’s just that we’re all just so sweet and wonderful and love the animals so much that we just, we really want to help people and help the animals and I think we’re not good business people.
I owned two practices. So, I learned the hard way, how to be a good business person when I almost went bankrupt fifteen years ago. And I said, well, I’m working a hundred hours a week and I’m not getting paycheck, there’s something wrong. So, I hired consultants and changed the way that I practice, but most veterinarians will not hire business consultants. So, there’s the business aspect.
>> James Jacobson: That’s the business aspect. And I think it’s a good foundation to understand that this is what the veterinarian is coming in with.
So, let’s talk about a new vet. The first year you moved to a city or your other vet is out of the picture for some reason. How do you go about finding a new veterinarian, and how would you recommend or counsel beginning that process?
>> Dr. Judy Morgan: Well, this is pretty near and dear to my heart right now, because as I just said, I sold my practices. I still have a veterinary license in the state of New Jersey, but I’m about to move to the state of North Carolina. And I don’t plan on practicing down there. I may or may not get a license– I haven’t decided yet. But that means I’m going to be dependent on other people for my pets care. So, the first thing I did is I asked my daughter, who’s been living down there for a few years and she said, well, this is the specialty center I use. And I use the veterinary school for this and that. And she said, I’ve used you for everything else. She’s been bringing her dogs and cats to New Jersey. And I said, well, if you had to pick a practice, who would you choose? She said, I haven’t found one that I like yet.
>> James Jacobson: Wow. I think a lot of people look at it like finding a dry cleaner. It’s convenient to the house, right?
>> Dr. Judy Morgan: Yes. Statistically, most people will not go to a practice more than five minutes, five miles-ish from their house. So, the first thing that I started when I started the search is I said, all right, first, I’m just going to Google the area and see what veterinary practices there are in the area. And then I look at the staff profiles that are on there– Where the doctors went to school? What the doctor’s favorite topics are? Whether they’re into sports medicine or surgery? What is their focus?
Certainly, I would love to find a holistic practice, I haven’t found one yet, which is why everybody wants me to open one down there. But I’m retired. I like, really don’t want to– been there, done that.
So, I look at the profiles of the doctors and the staff, and I want to see what the training of the staff is because in a lot of States, the staff, the technicians, the assistants, they don’t have to have any training. Some States do require licensing, some do not, but I want to know if my animal’s going in under anesthesia, who’s running that anesthesia. Who’s doing that dental? Who is going to be giving injections to my animal, giving sub to fluids? I want to know that they’ve had more training than just some kid that was pulled in off the street.
And as a matter of fact, one of my friends, she was a horse chiropractic client of mine and she was in college to be a schoolteacher. And so, she started working as a receptionist at one of the local high volume, low price animal hospitals. And she was there as a receptionist for two weeks and they offered her the head technician job. She was smart enough to say, I don’t know anything about that position. I do not want that responsibility, why would you give that to me?
>> James Jacobson: I think that’s something else we need to talk about. This idea of when you were saying in New Jersey, all the people who were paying $55,000 to, were trained, but each state has different licensing requirements when it comes to veterinary technicians, veterinary nurses, all these people. So, is it possible that you could be in a state or in a place where the person who’s running the anesthesia machine is–
>> Dr. Judy Morgan: Had zero training? Yes. Many States, most States, sadly.
>> James Jacobson: And that’s dangerous, I’m imagining.
>> Dr. Judy Morgan: Well, it depends how well they’ve been trained by the doctor– but remember those doctors are those busy people running around like crazy. And if you’re the only doctor there and you’re in surgery, you’re pretty much concentrating on the surgery in front of you and you’re depending on someone else to be concentrating on the anesthesia and monitoring that animal.
My technicians were so good. My head tech had been with me for 25 years and she was so on top of things with the monitoring, that if there was a blip in the EKG or the oxygen saturation or the blood pressure or the temperature or the pulse, anything, she was on it so fast. Most of the time, I didn’t even know anything was going on. We’d get done and she’d say, Oh, well, you know, we had this little blip in the middle. Here’s my notes, everything was fine– and I’m like, of course it was fine, it went well. But she’s good enough that she knows when she has to interrupt what I’m doing and when she is just handling the process.
And with her, I don’t know that we ever lost an animal under anesthesia in 25 years, she was just good.
>> James Jacobson: So, how do you go about asking? I mean, you’re a veterinarian, so it’s a little easier for you to be able to do the due diligence by both looking at their website– and some vets don’t have great websites.
>> Dr. Judy Morgan: Some of them do not have websites, especially in, you know, some of the more remote areas, and some of the older veterinarians that are not embracing technology at all. If you’re in one of those areas where one, there’s not very many choices or there’s no website for you to look at, then pick up the phone and call.
I tell people that it is worth scheduling an appointment. And again, that’s a little tricky with COVID right now, but schedule an appointment and pay for it. Whether you take your animal or not. Cause if you can’t get the information that you need, either off a website or over the phone, then go in and have a conversation.
>> James Jacobson: With your animal? Or is this–
>> Dr. Judy Morgan: It’s up to you?
>> James Jacobson: This is not even a wellness check. This is just like interviewing, but you’re buying the veterinarian’s time.
>> Dr. Judy Morgan: Right. You’re paying for an office visit to meet them. It could be $50 very well spent because you’ll know in that 15 minutes, when you ask a few questions, whether this is somebody that your personality mixes with theirs, or this is a huge red flag.
So, I had a client in Ohio and she wanted to find somebody who was a little more holistic or integrated, and we had done phone consultations, seven hours apart. So she said, I’m going to see if I can find a vet who agrees a little more with what I’m trying to do. And so she went to a website of a bigger practice and found this description of this veterinarian that she thought was more holistic and that she could really work with well. It was an hour away from where she lived, so she made an appointment, took her dog, took her little bag of goodies with her, with what her dog was eating, the medications and supplements– everything that our dog was on, which I do recommend that you take all of that, so you can have a conversation and they know where you’re coming from– or at least bring the label off of what you’re feeding.
And she walked into the practice and the first thing she saw was a whole wall of prescription diets. And then in the display case, in front of the receptionist, there was all of these chemicals. All the flea and tick stuff, all the heartworm chemicals, all these topicals. And she just said, Oh my gosh, what have I done? This is the wrong place, I don’t want to be here. And then she sat down and thought about it for a minute while she’s waiting and said, well, I’m at least going to meet the doctor. She got into the exam room, meets the young doctor and they hit it off just talking. And she said, well, look this is the way I do things, and out of her bag of things that she brought with her was my first book “From Needles to Natural”. The veterinarian burst out laughing, said, I’ll be right back. Ran out of the room, came running back in with my book, “From Needles to Natural”. And the two of them laughed and the woman said, I have found my veterinarian.
>> James Jacobson: Ask them what they read.
>> Dr. Judy Morgan: Yes. It was the caveat of when I call to make an appointment, I get to see you, right? Because clearly everyone else in this practice does not have the same beliefs because of what’s in the waiting room.
So, you can go to a practice where one of the doctors speaks your language, even if the others don’t and you just have to be very clear about what it is that you want and make sure that you are going to get along with that doctor.
>> James Jacobson: That’s a really good tip. And I imagine also if you put on your veterinarian hat for a moment, the fact that a client would come in and spend 50 bucks for just a visit and not even bring their pet, speaks volumes about you as a client, to them.
>> Dr. Judy Morgan: Yes.
>> James Jacobson: Which they would note in the record?
>> Dr. Judy Morgan: Right. They might be a little put off by, Oh geez, they’re here to interview me– I had a lot of people do it in my clinic. People would come in to interview me all the time to see whether I was a good fit for them. Particularly earlier, before I had a big social media presence, but people would come in to interview me because we advertise that we were holistic and the holistic clientele tends to be pretty particular. They know what they want and they know that they don’t want vaccines pushed, and they know that they don’t want drugs and chemicals push. They want to know that there are alternatives and that you’re not going to yell at them for being a raw feeder or making your own food.
So, it is not uncommon for holistic veterinarians to get people that come in and do that. But for a traditional vet to have somebody call up and say, Hey, I’m new to the area, I’m going to spend $50. I want to come in and talk to you and talk about your philosophy and my philosophy and make sure that this is a good fit. They might be a little put off. They might be a little defensive when you walk in, especially when you, you don’t have your animal with you. They might be a little defensive, like what’s this about, but you know what? If they’re defensive and in the first five minutes, you can’t break the ice and get past that. Then you probably haven’t found a good match anyway. Because you don’t want to be working with someone who’s always going to either be on the defense or on the attack. You want a conversation.
>> James Jacobson: $50 well spent. Cause this could turn into thousands, tens of thousands of dollars.
>> Dr. Judy Morgan: Oh yeah. Listen, most of us have more than one animal.
>> James Jacobson: Right.
>> Dr. Judy Morgan: So, if I find a veterinarian that I can work with down there, I’m not sure if I can. I’ve already told my associate who bought my practice, that twice a year I’ll be bringing the motor home and all my animals up to get everything done there.
>> James Jacobson: So, you look for things within the vet clinic. You look for these clues, you look for what they’re selling. You look for how many vets are on staff, because that’s not to say that a single practitioner practice, is bad, but you’d better like that vet. But you’re saying that in a practice with a lot of vets, there may be one that you really resonate with and you can say you’re the one I want to see. I don’t want to–
>> Dr. Judy Morgan: And you need to make sure that when you call that you can request someone. And with that in mind, ask them, how far out do you usually book up? If my dog has a problem tomorrow and I need to get in, do you reserve some appointments for those, you know, sick animals that might need to come in emergently? Will I have to see someone else in the practice and will that person in the practice respect the way that I want to do things? But if they say, well, normally to get an appointment with me, it’s one week or two weeks, well, you can plan ahead a lot of times– there are times something’s going to happen. Your dog’s going to get his foot sliced open, whatever– you’re going go in and you’re going to get it stitched up by whoever is capable of doing that. But find out and try to plan ahead and being proactive and practicing good preventative care with your pets, with diet and, you know, supporting their immune system, all that sort of stuff. You’re not going to need to be there all that often.
I had clients who would drive four hours, six hours each way, but we knew they only needed to come in twice a year. And in between, if the dog got an ear infection or something, they would go to their local person. And then before they would allow any treatment, they would call me and say, okay, this is what they found. What do you recommend that we treat it with? But I could do that because I knew their animals.
>> James Jacobson: You knew their animals and you could call the vet.
>> Dr. Judy Morgan: Yes. So, if you find a more holistic veterinarian, but it’s a trek to get there, maybe you do that a couple of times a year for getting your blood titers, instead of getting jabbed with a million vaccines. You do that to have lab work run and a good going over a wellness check. But then you’ve got to have a local place, which I will pick one in North Carolina– probably the specialty and emergency center that my daughter has used. Because the only thing my animals are going to go in for is if they’ve got a major problem, because I still can manage to do a lot of things at home.
But if somebody breaks a leg, I got to have somewhere to go.
>> James Jacobson: Yeah, you need that. You don’t have an x-ray machine at home.
>> Dr. Judy Morgan: I do not.
>> James Jacobson: How important is it to have a 24 hour emergency vet clinic available? And should that necessarily be part of the practice that you go to, or do you view it as an ancillary service?
Because from my experience, dogs only get sick, you know, at 10:00 PM.
>> Dr. Judy Morgan: We have never covered emergencies in the practices that I have worked in. We’ve always used the 24 hour services and there’s a million of them around us. I think that you need to find a doctor that you want to work with day to day. Whether they are a single practitioner, whether they’re in a specialty in 24 hour center– whoever that person is that resonates with you. I think you need to know where the closest 24 hour facility is, in case you do have a disaster. You need to know how to get there. You need to know the phone number. You need to know how to dial them on speed dial while you’re driving 20 miles, like crazy.
I, whatever. I think you need to know what that practice is. Now with that said, I can tell you that the 24 hour and specialty centers tend to be the ones that freak out when you mentioned raw feeding, because these are the ivory tower people. These are the people that have done internships and residencies. They’ve spent a lot more time at universities and they freak out. So, you might want to not say that.
>> James Jacobson: Yeah. Unless your dog just ate a bone or something from the raw food.
>> Dr. Judy Morgan: I just, I know all of the specialty centers around us are totally against raw feeding. And when my dogs have had to go, God forbid, they ever spend the night, but a couple of times they have, they will not allow us to bring raw food. And one of my dogs got stuck in an isolation ward and everybody had to put on caps, gowns, booties, gloves, and masks. This is not COVID. This was raw fed dog, because they were all afraid that they were going to die from, I don’t know, salmonella, E coli, whatever–
>> James Jacobson: And this wasn’t like distemper or something like that?
>> Dr. Judy Morgan: He went in for ear surgery. And because he was raw fed, they were like, Oh, he has to be in isolation. He can’t be around anywhere else, he’s like shedding bacteria everywhere. I was kind of like, are you crazy?
>> James Jacobson: Oh my. Did he enjoy his kibble for that day in isolation?
>> Dr. Judy Morgan: Oh, no. We took food. Of course they sent the raw food back home. So, my husband came home and cooked some food and they said they would do the cooked food, so.
>> James Jacobson: Wow. That is interesting. And then, I guess, while we’re talking about this, cause we’re sort of revealing things that most listeners probably don’t know– which is that these 24 hour vet centers, they may look like they’re in a regular veterinary clinic, but from my experience, they’re oftentimes like totally separate businesses, right?
>> Dr. Judy Morgan: Oh, yes.
>> James Jacobson: Walk us through how that works? From the outside, you go on the outside and I was like, Oh, it’s a vet. It’s just 24 hours– must be the same vets, but it’s not.
>> Dr. Judy Morgan: No. Back in, oh, Lordy, let’s see back in the early nineties, for about 10 years I worked in emergency medicine and I actually loved it. It’s really high paced, high volume, crazy–
>> James Jacobson: It’s the ER adrenaline rush, right?
>> Dr. Judy Morgan: ER Adrenaline rush. I can see why human doctors– I don’t have the energy now, but we were short doctors for a while. I would go in Friday at 8:00 PM and stay until Monday at 8:00 AM and then work Monday through Friday, too. But I loved it. I learned how to do more weird surgeries because I was the only doctor on and it was like, Oh, he needs his kidney taken out, huh, okay, I guess I’ll figure out how to do that.
So, I got to do some fun, weird stuff, learned a lot. It was great. But the emergency service was actually in the same building as a regular daytime practice that had four doctors that worked for the daytime practice. And then at night it was a totally different staff, totally different team. They just use the same building.
So, some are still run that way. Most of them tend to be 24 hour emergency and critical care, but then they also have specialists who generally are there during the day, but sometimes they’re on call. So, they might have a board certified surgeon or cardiologist or radiologist or neurologist that works during the day in that specialty practice, but may also be available on call, nights and weekends, if there’s some really crazy thing that needs to be done. So, like a bloat surgery. A lot of general practice veterinarians won’t do that. So, you’ve got to have these board certified higher-end, especially now I’m finding that the new graduates, if they don’t do an internship and residency, they have had very minimal surgery experience. And so if they’re going into general practice, they’re not going to learn that.
When I graduated– it’s pretty much, we didn’t even have emergency services and we had to do everything. We were the Jack of all trades. And I got to be very good at surgery because we didn’t have board certified surgeons. There was nobody else standing behind me to do it. So, it was up to me. So, that is changing a lot. And I think it’s hard to find general practitioners who will do a lot of these more specialty surgeries now.
>> James Jacobson: Okay. So, I think this is really important to understand these various relationships and things that are going on. So, when you go in and you’re interviewing and you’re doing your due diligence, you kind of understand the platform, so that when you do need a veterinarian, you can get what you want.
>> Dr. Judy Morgan: Right. And that’s one of the questions you should ask. So, if you find a local practice, that’s got one to four doctors, whatever, and you go in for your interview with the one that you’ve chosen off the website– if there’s a website, the one that you’ve chosen that you think meshes the best with what you’re looking for.
That’s one of the questions to ask– hey, how do you guys handle your emergencies? How do you handle hospitalizations? In the state of New Jersey, back in, I guess it was in the nineties. There was an ophthalmologist who did a surgery on a dog. And he’s a good friend of mine, actually. He was the only ophthalmologist in New Jersey for many, many years, and we all used him. But he did a surgery on a dog and had an E-collar on the dog, in the cage overnight. And the dog somehow managed to strangle itself overnight. And there was no one in the hospital overnight, and that’s how it always used to be. And in some places it still is, but there was a big lawsuit that came out of that because the dog was hospitalized overnight with no one there with the dog. Now, the dog could not have been left without an E-collar, because you know, you didn’t want him to destroy his eye surgery.
And it totally changed the way I ran my practice. We used to hospitalize animals on IV fluids, post-op, everything spent the night. We would come in in the morning and have 25 animals we had to treat. After that, we all said, Oh, that’s a liability issue. I’ve got two choices, either I hire somebody to sit here all night and babysit these animals. Which by the way, really needs to be somebody who’s trained–
>> James Jacobson: Who knows what to do. It’s not just like– yeah, CPR, and whatever.
>> Dr. Judy Morgan: Right. So, if that animal is crashing or his fluids aren’t running, or he’s not urinating. They need to be able to do something, not just sit there. So, there’s that option or at the end of the day, you say, well, okay, Mrs. Owner, now you have to come get your dog, transfer him to the 24 hour care center where he will spend the night, and then you get to bring him back to me for the day. And then you get to take them back there for the night. And so, these animals that need to be hospitalized for a week at a time, it became very difficult. And again, another profit center went out the window. We weren’t getting to charge for hospitalization and all this in hospital care.
The way that I changed, the way I practice based on that, was that we did an awful lot of– our surgeries we would send them home the same day. We would get them done early in the day, make sure they were wide awake and we would send them home, because I knew without a doubt that that owner would sit there with both eyes peeled on that animal overnight. Made sure they knew where the emergency service was, if they had anything happen.
If we had an animal that was critical, that we were worried about, certainly we would send them to the 24 hour critical care. We started doing our IV fluids– and this is something that clients don’t think about asking for, but we would bring the animal in first thing in the morning, eight o’clock in the morning, get them going on their IV fluids. At the end of the day, maybe six, seven, eight o’clock at night, we would unplug their fluids, wrap up their leg with their catheter in, send them home overnight and say, bring them back, drop them off in the morning. We’ll run his fluids again. And we could do our 24 hours of fluids in that 12 hour period. So, they were still getting the same treatment, but they were getting to sleep at home with their parents at night.
I do a lot with Cavalier King Charles Spaniels, obviously, and a lot of them have heart disease. And one of the most traumatic things that we deal with is when these dogs go into congestive heart failure and they need to be on oxygen. Many of these owners are dropping their animals off at a 24 hour critical care facility and walking away and leaving their pet there because the pet needs oxygen– I did that with one of mine and the critical care team killed my dog. And it wasn’t a heart failure problem, she needed oxygen for a throat problem. And they killed my dog and I was livid. And it was because I didn’t have what I needed at home. So, many of my Cavalier owners now have oxygen cages at home because most of us, and you’re dealing with a lot of dogs with cancer and now there are a lot of hospice care veterinarians who do home visits, and we have things like Lap of Love, which is a nationwide group that does in-home, euthanasia’s, they’re awesome.
But most of us want to be with our pets when they pass. And most of us don’t want them being tortured in that last 24 to 36 hours. I’m all for trying, believe me. I will try with my animals– I would go to the ends of the world for them, if I feel that they’re not suffering and that there’s any chance at all. But this is another question to ask when you’re interviewing a potential veterinarian. How do you handle euthanasia’s? Do you have a special room? Do you do it at the end of the day when nobody else is around, do you do home visits for that? If I wanted hospice care for my pet and I wanted to do most of that at home, are you willing to do that? Will you provide me with the fluid bags, the IV lines, the needles, the injectable medications, comfort care medications that I might need for my pet?
More veterinarians are becoming more aware of hospice care and getting much better about providing that kind of care for our pets. And those are all questions that you need to ask if you have pets with chronic conditions.
I’m moving somewhere where I don’t have a practice and I’ve got dogs with heart disease. I’ve got dogs with neurologic diseases and I’ve already been researching, where am I going to take them? And I think the veterinary school was actually for my heart dogs, that’s where we will end up. But if you happen to be lucky enough to be near one of the veterinary colleges, that can be a good resource– sometimes it can be a horrible resource, but it can also be a good resource.
>> James Jacobson: Let’s take a break right now and when we come back, let’s talk about those things. Let’s talk about the idea of managing a team of veterinarians, because if you’re dealing with something critical, you’re probably not just going with your one doctor. And then let’s also talk about the subject of agreeing to disagree with your vet, because you’re the boss.
We’ll be right back after this.
We’re back with Dr. Judy Morgan.
Let’s talk a little bit about this concept of managing a team of veterinarians. Before the break you were talking about, maybe you want to avail yourself of the local university, where there’s an interdisciplinary team. And then you have a lot of different vets to manage and work with. What tips do you have for that?
>> Dr. Judy Morgan: Oh, man, it can be so complicated. And you know, sometimes the complaints that I get from clients are that specialists are busy. I mean, right now because of COVID and everybody’s way far behind and everything, to get cardiology appointments, some of my clients are having to wait three months. Yeah, you can’t wait three months. Let’s go find another cardiologist. So, sometimes you have to jump ship and find somebody else who can help you if your person is not available. They’re not always great about getting back to your emails. So, I would say be judicious in how many emails you send and get straight to the point or if you’re making a phone call, get straight to the point, don’t send them a three page– well, Fluffy did this and then he kind of went, and I’m not sure. If you send them a three-page email, they’re not going to read it, they don’t have time. So, get to the point. Here’s my questions from the last visit you prescribed this medication. He’s now has vomiting and diarrhea. That’s a problem. What are we doing?
And if you have multiple veterinarians on the team. The right hand, doesn’t always know what the left hand is doing. Particularly, if your cardiologist is at one practice and then your neurologist may be at another practice. Your internal medicine person may be somewhere else. Make sure you get copies of everything and request that copies of everything are sent to the whole team. But I would recommend that you keep your own notebook with copies of all lab work, all veterinary records. You’re entitled to them, so if after your visit, just say, Hey, I’d like a copy of the doctor’s notes sent to me for my notebook, so that if my dog has to go into emergency– and this is really something you should do anyway, if you have routine lab work done, or routine visits, just ask for copies of the notes– keep all that.
>> James Jacobson: Digital. I mean, they email those or they–
>> Dr. Judy Morgan: You can get it digital, you can get paper copies. It doesn’t matter. Some of us old folks, we’d like to have paper. I’m learning how to do things digitally, but it’s tricky. But you should have all that stuff available. And if you have it in a digital file, that’s great because you can just email that to whoever you’re going to. Or even if you have to go to an emergency service, you can say, look, I’m on my way in, I’ve already sent you an email– or give me the email address, I’m sending over my dog’s last lab work, what his issue is, what the medication is that he’s on.
The more organized you are with all of that, the easier it will be to manage all the different parts and pieces.
>> James Jacobson: That’s a great tip. Any other suggestions for managing a team?
>> Dr. Judy Morgan: Good luck, getting them all to talk to each other.
>> James Jacobson: How do you facilitate that?
>> Dr. Judy Morgan: What I would say is, whoever your lead veterinarian is, which might be your general practitioner that you use on a daily or weekly, whatever, you know, the guy or gal–
>> James Jacobson: The guy you vetted. The guy that you spent, the $50 a while ago–
>> Dr. Judy Morgan: That person that you hired and you have a rapport and a relationship with. If your pet is having to go to multiple specialists for different things, you might need to get that person to intervene and say, look, I need this one to talk to that one, or I need to get the records from this one, and I need you to look at the two doctor’s notes and figure out how they match. Cause sometimes they will give conflicting information. And so you need that kind of neutral party– and please offer to reimburse them for their time, because if they are going to make five phone calls. And then they’re going to read reams of records, because these specialists really like to have reams of records, and they’re going to put all that together for you. Then you should be willing to say, Hey, look, you’re going to get 10 pages from this one, I’ve already got 15 pages from that one. I don’t understand what they’re saying. Could you explain it to me in terms that make sense for the average pet owner. I’ll pay you for an office visit to do that for me– or whatever it is.
>> James Jacobson: Let’s talk about that. How do you figure that out? Should it be an office visit or should we say, like, I’ll pay you for your time on an hourly rate or–
>> Dr. Judy Morgan: Most veterinarians have no clue what their hourly rate is.
>> James Jacobson: So, it can get pretty expensive if your 15 minute thing is 50 bucks. So, it starts to get really expensive.
>> Dr. Judy Morgan: Right. But most of them, if you say, look, I’m willing to pay for an office visit– and they’re probably going to spend more time than that, getting the information, reading the information, and then talking to you about the information. But they’ll probably not pay much attention to the time that they spent getting everything, they’re going to pay attention to the time they spend talking to you.
>> James Jacobson: Interesting. So, that’s sort of a frugal tip, really. Because it’s going to take a little bit more time, but they’re going to prepare, and then they’ll focus on that. Because they got to do the prep. But I think, I would imagine that most veterinarians who you would want in that position are going to embrace the fact that, Hey, this is a different thing. This client is really going far outside of what most clients do.
>> Dr. Judy Morgan: Right.
>> James Jacobson: And they would reciprocate.
>> Dr. Judy Morgan: And it’s somebody who is very organized and trying to manage things. And make sure you have all of your questions written down. So, from a Chinese medicine standpoint, there’s five personalities and the people who are really organized and do spreadsheets and all that stuff, they’re metal personalities. I’m not a metal personality. My mother is, she makes me crazy. My clients who are metal personalities make me crazy because they will come in with their notebooks– and now I’m telling all of you to do this. So, you’re gonna make your vet crazy.
But they come in with their notebooks and their spreadsheets, but they have every question written down and very organized. And in five minutes we can go through three pages of questions and tick them off and go, yes, no, do this, I don’t know, I’ll find out, this is what that lab work means. But the more organized you are, the easier you’re going to make it for them– and have everything written down. And I’ve been telling people this, even with COVID, I don’t care what you’re going in for. If your pet’s going in just for their routine visit, write everything down. And all your questions should be written in there. What you do want, what you don’t want, if you want lab work, if you want vaccines or not, if you want to nail trim, ears cleaned, anything you want, write it all down, send it in with them, and then you should expect to get that page back with the answers written on there.
>> James Jacobson: That’s great. And also back when we get to where you can actually go in for an office visit, whenever that happens, a tip that I found helpful and most vets will agree with is like, Hey, can I use my voice recorder just to record? Because you’re talking so fast and I can’t understand it all and I want to review it.
>> Dr. Judy Morgan: Yes, absolutely. And right now COVID protocols, most veterinarians are calling. We have the technicians, bring their animals in, and then we call the owner on the phone and discuss their list that they’ve sent in and our findings and what we’re recommending.
So, feel free to record that conversation that you’re having. Like, I frankly wish that my entire career, I recorded every conversation I had with every client, because when people call me up and say, You never said that, or you said, blah, blah, blah. I wish I had a recording–
>> James Jacobson: Go to the transcript.
>> Dr. Judy Morgan: Right. No, two people remember things the same way. We could both look at a wall with a bunch of stuff on it, and then we’ll both describe it and we’re going to see totally different things.
>> James Jacobson: So, bring a cinematographer next time you go to your vet, or just your iPhone.
>> Dr. Judy Morgan: Yeah, record everything.
>> James Jacobson: So, let’s talk about when you decide to agree to disagree with your veterinarian, because there are those times when the vet’s going to advocate one thing and you just know as your dog’s primary healthcare guardian, that that’s not the right course. How do you do that? And how do you do it so that the vet’s feelings aren’t hurt, but you can feel good with your decisions so that you don’t have regrets later on.
>> Dr. Judy Morgan: So, I think the first thing is you have to not appear to be angry or mad. We don’t want to have a battle. You don’t want to appear threatening and you don’t want to say, I’m not going to do that in a way that makes it sound like you think they don’t know what they’re doing.
It’s very important to respect their expertise because let’s face it they spent eight years in college learning how to do what they’re doing and then however many years they’ve been doing it. So, if they say, that this is the prescribed treatment that I would recommend for your pet, and it happens to have a bunch of prescription diets or chemicals that you don’t know anything about, one of the things that you can say is, you know, I really like to have more information about the medications that you’re prescribing or the food that you’re prescribing. You can ask for the drug inserts. Certainly, I would ask what are the potential side effects for these drugs? Half the time they don’t know. Because they just listen to the drug reps who tell them it’s wonderful. But you can ask to see drug inserts. You can say, you know, I’d like to research that a little bit, especially if you’re not in a critical do or die, like I have to do it right now situation. Feel free to say, I’m going to say no today to doing that, I want to do a little bit of research.
You can ask them if they have a recommended website for you to look at or any literature that they have on what it is that they’re recommending. That puts them in a position of power. You know, what we know is going to happen is you’re going to go home and you’re going to get on social media and you’re going to go, Hey, who knows about this drug? What are the side effects?
And I get a ton of emails from people saying, Hey, you know, my dog has allergies– he’s scratching and the veterinarian, wants to give him Cytopoint and Apoquel. What do I do? My answer is don’t use either of those. And then they’re like, okay, what do I do? We’ll tell your vet you don’t want to use those. These are the reasons why. And you can do that with any drug, and all of you, if you have a computer, you can look up the drug inserts and you can look for the side effects on any medication that is recommended for your pet. So, really you can agree to disagree.
I have many clients who are raw feeders– they’re clients through social media and phone consultation stuff, but they use a traditional vet for their everyday care and a lot of them will say to me, look, I go to a traditional vet, he’s a great guy. We get along really well. He knows I raw feed. He’s totally against it, but he knows I do it and I’m not going to change, and my dogs look great, so he can’t really complain. He knows I won’t vaccinate, so every time he tells me my dog is due for a vaccine, I go, that’s nice, I’m going to decline.
Where you get into the big battles are over the rabies vaccine, because there are some veterinarians who are really crazy about every animal that walks in their door has to be vaccinated. So, you either have to pick that battle with that practice or find a practice where you don’t have that battle, or I don’t know, you can say, well, he had it somewhere else.
I’m not advocating, lying, whatever you want to do.
If you can find somebody who says, look, I know that you are a holistic person and you really don’t like the medications and you’re going to come to me all the time with all these crazy things that you’re giving your dog. He’s on slippery elm and he’s on ginger tea and all these things– okay, fine. You know, and if you can laugh about it with them and say, look, you know, I’m going to do this crazy stuff, but look how great my dog looks. I’m here right now cause he’s got gunk in his ear, I just need you to tell me, is it bacteria or yeast? You know, could you give me that answer? And then I’ll figure out what I want to do about it. And if they say, well, great, you’ve got both. Here’s the medication we recommend, then it’s up to you whether you say, yeah, I’ll take that or I’ll research that or I’ll use my own, whatever.
>> James Jacobson: I love it.
Dr. Judy Morgan, you are full of wonderful advice. This has been fantastic. Thank you for being with us again today. If folks want to get in touch with you, what’s the best way.
>> Dr. Judy Morgan: My website, drjudymorgan.com. Drjudymorgan.com. And Facebook is Judy Morgan, DVM as in Dr. of Veterinary Medicine. I got tons of blogs, my books, lots of information.
>> Jacobson: Judy Morgan. Thank you so much.
>> Dr. Judy Morgan: Thank you.
>> James Jacobson: There you have it. As always, Dr. Judy Morgan dishes out some tremendously helpful advice on how to become the leader of your dog’s, veterinary pack.
I hope you found today’s episode helpful, and that you will consider some of Dr. Judy’s great tips during your next vet visit or the next time you’re on the hunt for a veterinary professional for your dogs.
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Did you hear those delightful touchstones? Dog Cancer Answers has a 24 hour a day, seven days a week, recorded listener line, especially for you. If you have a dog cancer question or an idea for a future show, just call us and tell us about it. We check our messages often and we’ll make sure that your question is addressed by one of our veterinary experts and it might even appear on a future episode of Dog Cancer Answers.
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Well, we are at the end of this week’s show. Again, thank you for tuning in. Until next time, I’m James Jacobson and from all of us here at Dog Cancer Answers and Dog Podcast Network, we wish you and your dog, a very warm Aloha.
>> Narrator: Thank you for listening to Dog Cancer Answers. If you’d like to connect, please visit our website at dogcanceranswers.com or call our listener line at (808) 868-3200.
And here’s a friendly reminder that you probably already know. This podcast is provided informational and educational purposes only. It’s not meant to take the place at the advice you receive from your dog’s veterinarian. Only veterinarians who examine your dog can give you veterinary advice or diagnose your dog’s medical condition. Your reliance on the information you hear on this podcast is solely at your own risk. If your dog has a specific health problem, contact your veterinarian.
Also, please keep in mind that veterinarian information can change rapidly. Therefore, some information may be out of date. Dog Cancer Answers is a presentation of Maui Media in association with Dog Podcast Network.