See the Full Issue
November 2023
Teamwork and Disease Management
Veterinary teamwork improves patient care, client support, and job satisfaction and growth. When each team member works to their strengths and everyone, including clients, values each role, disease management cases and clinical days themselves flow better.
Getting Comfortable with Delegation
Veterinary teamwork improves patient care, client support, and job satisfaction and growth. When each team member works to their strengths and everyone—including clients—values each role, disease management cases and clinical days themselves flow better.
Full utilization as described in 2023 AAHA Veterinary Technician Utilization Guidelines requires full support for each role.
A client once refused to give Ann Wortinger, BIS, LVT, VTS (Emergency/ Critical Care) (Small Animal Internal Medicine) (Nutrition), Elite FFCP, a patient’s medical history. The veterinarian at the practice overheard the exchange, stepped into the exam room, and offered this choice: “You can give the history to my technician, or you can leave.” Wortinger chuckled, “I came back into the room, and I got my history.”
Some veterinary practices already implement team roles well. Jenny Fisher, RVT, VTS (Oncology), asked, “Should it be that way everywhere? Absolutely.”
Fisher explained that when technicians provide additional expertise and access to clients during the management of chronic diseases, it frees veterinarians’ time for diagnosing, prescribing, developing treatment plans, and performing surgery. It also gives practitioners time to think about cases and to collaborate with other veterinarians.
“I think my job as a technician is to make the doctor’s job easier, so delegation is a very big part of that,” Wortinger agreed.
That’s true too for veterinary assistants’ role in supporting veterinary technicians, client services professionals, and veterinary clients. Wortinger described intentionally stepping back to allow others to do important work and develop key skills. She added, “I think that way, nobody is trying to carry the entire load by themselves. It’s not ‘I’m the only one that can do that.’ Everybody wants to be the absolute best at something. That does not mean you’re the only one who can do that.”
More Than Tasks
Job descriptions certainly provide clarity. Consider as well, though, the emotional value of each team member’s place in veterinary experiences.
Customer Care/Client Service. That initial voice means everything to pet lovers seeking routine care or help for something worrisome. They provide:
- Recognition: Knowing people and pets builds connections and loyalty.
- Information: Providing details and connecting clients with accurate answers creates trust.
- Enthusiasm: Offering encouragement and support in good times and tough times makes people feel seen and important.
- Gratitude: Even in transactional tasks such as handling payments and paperwork, customer care folks have opportunities to express gratitude and even praise for clients’ pet care efforts.
- Mitigation: As often the recipients of the brunt of client frustrations, they also provide frontline de-escalation.
Veterinary Technicians. Technicians provide behind-the-scenes patient care, other technical tasks, and traffic-cop-like roles of overseeing drop offs and discharges. Yet, those contacts with clients in person and otherwise serve equally important purposes. “It’s truly almost 50/50, which is a weird split, because you feel like you do so much more in your clinical time,” Fisher said. “But when I step back and think about it, if I were to split my clinical day into hours, into time, and what time I spent answering questions, answering emails, responding to calls, things like that, it is a significant amount of time.”
“I think my job as a technician is to make the doctor’s job easier, so delegation is a very big part of that.”
—Ann Wortinger, BIS, LVT, VTS (Emergency/ Critical Care) (Small Animal Internal Medicine) (Nutrition), Elite FFCP
On top of duties during surgeries, diagnostics, and procedures, including anesthesia administration and patient monitoring, consider the efficiencies and feelings created by these roles:
- Point person: Serving as the primary contact for client questions and case follow-up and coordination keeps patients on track and leverages technicians’ clinical knowledge.
- Buffer: Whether it’s bedside manner or mismatched communication styles, technicians often step into the gap between clients and practitioners to answer questions and provide support when clients feel intimidated or overwhelmed by veterinarians.
- Coaching: Often clients need coaching and problem-solving with meds administration strategies or other at-home care needs.
- Perspective: Sometimes technicians also offer keen perspectives to worried clients. Particularly with seizure cases, Christine Kramer, CVT, VTS (Neurology) finds herself explaining avenues for combining medications or setting realistic expectations about seizure occurrences.
Veterinary Assistants. Veterinary assistants keep the action moving since so much clinical work requires an extra set of hands or help with these tasks:
- Patient movement within
the facility - Client and other phone calls
- Pharmacy and food orders
- Record keeping
- Diagnostic help, including some specially trained to run things like MRI machines
Example 1
Kramer took on the lead neurology technician role for a small, one-doctor service at a specialty practice in Pennsylvania after the passing of another longtime neurology technician. Kramer said of her mentor, “She didn’t know anything when she started, but she took the initiative. She knew so much she trained me. . . . She passed away in January [2022]. So, yeah, at that point, that was when I really had to step up and be like, ‘Okay, I’m in charge now.’ And it was really hard.”
Kramer starts her 10-hour days by going through all the emails to see if anything needs immediate attention. “Because our phone lines get backed up and people will be on hold for like 45 minutes, we do everything through email,” she said. “I have our neuro email open all day, at my computer, so when something comes in, I see that right away.”
Often this includes setting appointments or approving drop-off appointments on tight days for patients needing urgent assessments. Kramer then divides the day’s appointments between the technicians and assistant for taking histories and bringing patients to the back for full neuro exams by the practitioner. After those exams, the veterinary neurologist goes into the exam room to discuss the case with clients.
While he’s in the exam room, Kramer and the others start other appointments, handle client communications, work on meds refills, take care of hospitalized patients, connect with the ICU team about shared cases, and potentially prep other patients for diagnostics or surgery. They sometimes complete four MRIs in a single day, with some of those cases going directly to surgery.
The neurology technicians also see many post-op appointments and routine recheck appointments for long-term cases of inflammatory issues and seizures.
Example 2
Fisher pointed out that cases of lymphoma can stretch out over a couple of years for dogs and even longer for cats. “A lot of us in cancer medicine are really trying to change the perception of how we treat these patients,” Fisher said. “Because there are so many of our cancers that we treat long term now… these patients can be managed chronically like a diabetes patient, like a pancreatitis patient, just the same. These patients are at the hospital even more, especially if they’re undergoing therapy.”
She feels like technicians help people pick up the pieces after getting a tough diagnosis. “I think a lot of times, they’re also intimidated not to ask that question to the doctor, but a technician comes in, and they may feel more comfortable to ask more questions,” Fisher said. “Many times, throughout my clinical career, pet parents might be on the fence about pursuing treatment or not pursuing treatment. After spending time with some of the technical staff, they certainly tend to be more swayed into pursuing treatment.”
Clients often struggle with preconceived notions about certain diseases such as diabetes or cancer from their experiences with the same diseases. This creates opportunities to educate clients about similarities and differences in companion animals.
Like Kramer’s example, oncology technicians often serve as the primary contact for clients when pets are onsite or at home, including answering questions, escalating cases that need urgent practitioner assessment, and coordinating in-treatment days along with administering chemotherapy.
Example 3
Wortinger took as much off doctors’ plates as possible, including many recheck appointments and most discharges. “If it was something that didn’t require the doctor, then I would do the recheck,” she explained. “If something flagged with me, it wasn’t progressing the way it should, it didn’t look the way it should, or the owner is reporting side effects we weren’t used to seeing, then I would go get the doctor. He always knew what I was doing, so he was available if something turned up.”
Clients simply got used to Wortinger being their point person. The team even maintained SOPs for when and how to adjust medications so that Wortinger could alert the practitioner and promptly handle those situations for patients.
She also saved the veterinarians’ time by attending hospital rounds and giving quick updates and preparing each hospitalized patient’s flow sheet.
“Every once in a while when we would need to get blood or do radiographs, clients would say, ‘Well, are you going to do it?’ speaking to the doctor,” Wortinger recalled. “He’d say, ‘Well, not if you’re lucky. She’s much better at it.’ He was a very good advocate for technicians. He was an excellent doctor, but he was a really poor technician.”
Client Communication
Clients often struggle with preconceived notions about certain diseases such as diabetes or cancer from their experiences with the same diseases. This creates opportunities to educate clients about similarities and differences in companion animals.
Remember that people often feel shocked and overwhelmed, which lowers comprehension and communication skills, so be ready to repeat conversations, provide additional resources, and find new ways to explain common things.
Be careful as well with the level of detail provided in less direct communication options such as voicemail. “That’s exactly why I teach what I teach about grief communication,” Fisher said. “This was many, many years ago, but one of the oncology residents left a message for a pet parent about diagnosis of lymphoma in their dog. That pet parent listened to it driving down the road, was hysterical, and got into a car wreck. Survived, thank goodness.”
Taking on the primary contact role means technicians often receive the brunt of strong emotions from clients. Fisher recognizes technicians’ talent for balancing conversations where people rightly feel upset about recent news or even the complicated nature of long-term treatment and case management, especially if/when any glitches happen.
Printable Handouts for Your TeamAs one of the most common chronic pet diseases, diabetes mellitus is something that owners and support staff should know about. “Helping Clients Get a Grip on Diabetes,” and “Does Your Pet Have Diabetes?” are great handouts on diabetes—one for technicians and one for clients. These resources were produced with the generous support of Boehringer Ingelheim Animal Health. |
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Pet Owner Resource |
Veterinary Technician Resource |
Team Communication
Since only veterinarians can provide diagnoses, prognoses, prescriptions, and surgery, that leaves many clinical tasks plus client care and handling roles open to others. Think of practitioners focusing on the big picture and making the big decisions and recommendations plus doing high-level procedures. They also tend to deliver not-great news at the point of diagnoses or following surgeries. They likely spend more time with clients and patients earlier in the process.
As time goes on, though, then veterinary technicians and others can lighten the load with the flow of daily appointments and client communications. Sometimes that means being the voice of quality-of-life issues or the first one to hear when patients start decompensating in long-term cases.
Communication strategies among the team can include quick verbal rounds throughout the day, alerts about incoming patients or cases taking a turn at home, and detailed electronic records notes so that everyone knows what’s been said and done.
When team members speak up about taking on bigger roles, Wortinger suggested saying, “Would you like to delegate that task to me? I can do that task if you would like.” She admitted, however, to it often coming out as “Here, give me that,” when talking to the veterinarian with whom she worked a long time. Over time, she got more assertive “taking away” recheck appointments, discharges, updates for clients, and so on.
Kramer even said that it’s a bit like being a veterinary resident or intern, except without the diagnosing, surgery, and such.
Focused Roles and Outcomes
Ultimately, Wortinger describes veterinary team roles as freeing up time and mental space so that veterinarians can focus on complicated cases without the pressure to do everything themselves.
While Kramer’s turning point came upon the death of a beloved colleague, she describes the arc of careers for veterinary professionals as needing to bat away imposter syndrome and learning from others how to play a bigger role.
“The beneficiaries of full utilization are the patients. Period,” said Fisher. “At the end of the day, utilizing every staff member to their fullest potential improves everything for the patients. That should be the only reason any of us do anything.”
Roxanne Hawn brings over 25 years of experience writing about veterinary topics for professionals and consumers. She maintains an award-winning website called Champion of My Heart and is the author of Heart Dog: Surviving the Loss of Your Canine Soul Mate. Based in the Colorado Rocky Mountains, Roxanne fosters litters of puppies until old enough for adoption as well as hit-by-car dogs needing time to heal and rehab injuries. |
Photo credits: LightFieldStudios/iStock via Getty Images Plus, vadimguzhva/iStock via Getty Images Plus, SeventyFour/iStock via Getty Images Plus, shironosov/iStock via Getty Images Plus