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Welcome to the Veterinary Breakroom! In the breakroom, Alyssa Watson, DVM, and Beth Molleson, DVM, discuss the important, relevant topics affecting veterinarians today. Today, Dr. Alyssa and Dr. Beth shine a light on the relationship between general practitioners and the emergency vets and specialists on the other end of the referral relationship. Has high demand in the veterinary industry strained these relationships? Are there best practices when it comes to communication between vets? Listen in and see if you agree with their take on the vet-to-vet relationship.
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This podcast recording represents the opinions of Dr. Watson and Dr. Molleson. Content, including the transcript, is presented for discussion purposes and should not be taken as medical advice. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast. The transcript — which was prepared with the assistance of artificial intelligence — is provided as a service to our audience.
Dr. Beth [00:00:10] Hi, I'm Dr. Beth Molleson.
Dr. Alyssa [00:00:12] And, I'm Dr. Alyssa Watson.
Dr. Beth [00:00:15] Thanks for joining us in the Veterinary Breakroom. These are short conversations where we chat informally about relevant topics in vet med. And, today, we are going to shine a light on the relationship between general practitioners and their ER doctors or specialists in the area, that referral relationship. So, this topic came about because Dr. Alyssa found a Facebook post that was kind of discussing this relationship, and we thought it would be fun to kind of dive into those dynamics because of course, there's a lot there sometimes. And, I want to acknowledge that, of course, we're both coming more from the general practitioner side of things. So, we don't have the voice of the specialist here, but I think there's still some good things we can discuss because we can, you know, try to see that relationship from all angles. So, Alyssa, do you mind kicking us off by kind of telling us what you saw going on in that Facebook post?
Dr. Alyssa [00:01:10] Yeah. So, the thing that struck me about this post was that the kind of different approaches about especially, and we're going to talk a little bit in the episode about how possibly things have changed post-pandemic and when people are so, you know, clinics are so strapped for time and possibly understaffed about how that relationship has changed. But the big like focus of this particular post was about just calling to when you're transferring and the this idea that sometimes, you know, the ER or the specialty center, you know, wants you to call and fill them in and give them all the information. But to me, and this was very surprising to me, several people said that they had the opposite experience that their that the specialty center or the ER didn't want them to call like literally got kind of a response back, like, yeah, where the ER were open like send it. Why are you even calling me? Which I, I found very surprising and certainly is not the experience that I have had, you know, dealing with several different local ER clinics as well as, you know, our critical care here in Las Vegas that's open, you know, 24 hours a day, 365 days a year. I've always had a very good response when I call and speak with, and even if the doctor's not available, which I totally understand, even speaking, you know, with one of the licensed technicians, or, you know, just giving them a heads up that that case is coming over. And so it just surprised me. And so that was why I wanted to have that conversation with you. What what how do you feel? Do you feel like that kind of dynamic or relationship has changed while, you know, in your, you know, 10... How long have you been practicing now, Dr. Beth?
Dr. Beth [00:03:14] That's a great question. I think almost 12 years. But, we don't need to focus on that number. Yeah. You know, I think you raise a lot of good points, and I do honestly really think that a lot of it did seem to flip at the time of the pandemic. And of course, when we say pandemic, I think what we're really talking about is when so many resources were bottlenecked for so long because I think so much of that relationship comes down to people having time for communication, time to see the pets that you're referring, emotional bandwidth to, you know, be cordial and polite and take on that relationship. And, I do really feel like a lot of that changed at the pandemic. You know, I have heard general practitioners in the area talk about how, of course, with the long ER wait times, you know, sending a patient to the ER because they really felt like their patient needed support and then that ER not being able to see that patient in the, you know, 10 overnight hours and just getting that patient back in the morning with no care. You know I think that as you can imagine can be frustrating to a general practitioner. But at the same time when resources are limited, there's not really much that that ER specialty center can do about it. So I think that's just like one example of the way things have changed. You know, I've also heard GPs talk about referring a patient hope, you know, hope and say an internal medicine case, hoping that that internist would take on that case only to kind of have it be triaged and received back because that internist doesn't have appointments to really manage that case. And I think all of those things start to kind of wear on that relationship. And, you know, going back to your discussion about calling those ERs, you know, I could see how suddenly that phone call that no one thought twice about before these resource bottlenecks, you know, people just would pick up the phone and happily talk to you. You can imagine when you're under so much intense stress that that phone call suddenly takes on more weight and does become a contentious point. So yeah, I can see how how things really have changed in that time period. Do you feel the same way? I mean, you've been practicing while too.
Dr. Alyssa [00:05:38] Yeah. Yeah, I, I absolutely feel that way. And I think another place a lot of misunderstandings come into play is listening or taking the word of the client for what was said. You know, by either the ER or by the specialist instead of, you know, talking directly to that person. And so that's a place where I personally feel like starting off the relationship with a quick phone call, again just reaching out, even if you, you don't actually talk to them, you know, and and, you know, it's it's tough because we talk so much about boundaries and everything. This is a place where early in my career, I, I remember when I first started practicing, you know, the the overnight ER clinic in town, they had a separate number for veterinarians where we could call. Yeah. So and it would still ring through even after their main line was closed. So in the morning at 8:00 am when they closed and transferred their patient, the patients back to us, you know, if I had a question, I just called the after hours line and somebody picked up or I had the numbers for the doctors that were, you know, that I just had their cell phone number. And that's something I did all the time too, you know, I'm like, I'm, I'm leaving, you know, you or the clinic, I'm calling to transfer but the clinic phone has turned off. Here's my cell phone number. Because I want that that receiving doctor to have the information and not to have to, you know, repeat tests or something like that. If there's there's something, you know, that we've already done. There's other times where I've had things like blood samples and I've just called to ask and been like, do you want this? And, you know, I've got, you know, a lavender top. I've got some urine here. Do you want me to send it? Do you want me to send it out to ANTECH and or IDEXX whatever, you know, lab you use and have it forwarded to you? And so I think oftentimes just just the act of reaching out can sometimes help mitigate any hard feelings or misunderstandings, especially when it comes to the client questioning why they might have to repeat tests or something like that. I don't know. Have you have you had that experience?
Dr. Beth [00:08:06] I completely agree, I feel like that little bit of communication can go a long way, not just for that relationship between the GP and the ER doctor or specialist, but also for that pet owner, you know, like like you mentioned. Having to rely on that pet owner's word of mouth, I think can get both all parties in a lot of trouble. You know, if if all if the primary history of what's been done at the GP, going to the ER is coming from that pet owner, I think a lot of miscommunication can happen. You know, even if you're coming with the printed out bloodwork, whatever the case might be. I also think it damages that vet to client relationship. Because, you know, they're not getting that streamlined care. They might feel the frustration from the ER clinic. You know, they might feel that frustration in the room when the ER clinic doesn't know exactly what's going on with the case. So I'm with you. I feel like a little bit of communication through that phone call can go a long way. But I think it goes back to our point of, if the ER staff simply doesn't have time for that phone call, then that phone call that was meant to bridge that communication barrier suddenly becomes a contention point. I think another interesting thing is I almost feel like the dynamic was flipped a little bit when everyone got so busy and there was a surplus of patients where, at least in my area, I feel like the ER and specialty center kind of looked at all of us GPs as the hands that fed them, so to speak. You know, we were the ones that preferred patients. We were where they got their business. Suddenly they have so much business they don't know what to do with it that like, you know, that that dynamic really shifted. I know that was hard for a lot of specialists in my area because from upper management, you know, they are they are given guidelines on how to treat the general practitioners. You know, you need to call after every patient, you see, kind of that that same mentality of these general practitioners are almost your clients in some way, and you need to wine and dine them a little bit with extra communication. I think they really felt the pressure of that when they were so busy and felt like upper management was trying to get involved and and manage that relationship. So yeah, there's there's a lot to it, especially again when stressors are high.
Dr. Alyssa [00:10:21] Yeah, absolutely. I didn't even really think of it from that standpoint that, that, you know, that ER doctor or the, the specialist might have, you know, a protocol set in place by their practice that, that mandated how that communication takes place. And everybody likes to communicate differently. I am a phone call person, and I fully respect the fact that that is changing in our society, you know, and that so many people, I saw I saw a meme the other day that was like, that was like, you know, ways to get a hold of me, you know, and it was like number one text, number two email, number three DM, and then like it went all the way down to like 49 carrier pigeon, 50 call. And so many people were like, oh yes, absolutely, 100% like, I don't want to get on the phone. And I feel like this odd person out that I am like, I cannot stand communicating by text. Email is okay, but I would much rather get on the phone and talk to you because I feel like we can have a more direct conversation. I can answer your questions faster. And so I, I understand that some of this may be, you know, how I approach this may be my personality and that, you know, what seems so obvious to me might not be the best way or so obvious to somebody else.
Dr. Beth [00:11:54] Yeah, absolutely. I think that's funny because you're you're really showing your Gen-X there, Alyssa. I'm more of the, I would say, except I'm with you when it comes to work. Like, I would much rather talk to clients on the phone. I would much rather, yeah, communicate with specialist ER doctors on the phone. Otherwise I'm a big texter. But anyway, I think, like you're saying, I know I have heard specialists say, you know, we are conditioned to call general practitioners after we see their patients. But so oftentimes we can tell that they're too busy to be talking and they don't want us calling in the middle of their day and bothering them. But other people feel like they're not getting the, you know, service or respect or communication they need if they don't call. So I think, you know, they're in a bad position to where you're trying. It's the same way when we're dealing with clients. You know, everyone wants something a little bit different. So it's hard to come in with just a blanket approach. And I think, I think this brings us to the point of have we ever really asked? You know, it makes me wonder in all my time, have I ever asked if they want me to call or have I ever, you know, is what could we benefit from more of like a standard on here's how whether it's an industry wide standard or even just with that local referral center. I don't know. Do you feel like you've asked the the specialist and ERs you work with?
Dr. Alyssa [00:13:17] No. Absolutely not. I feel like it's just I've kind of just adapted over time. You know, certainly one thing that I have noticed that our, our local, you know, specialty center and critical care has kind of transferred, I guess, over to us, which we never used to do was discussing cost. And I get why. Because, you know, I prep somebody to go over there that they show up, you know, they get triaged, they take up all this time and and sometimes they have no idea how much it was going to cost. And I'll tell you, I'm, I'm bad at estimating my own, our own clinics costs. You know, I'm like, I'm going to go make a estimate in the computer because I'm bad at this, you know. And so I need to I need to put these things in the computer. So the last thing I want to do is estimate charges at a completely different, you know, clinic or a specialty hospital where I have absolutely no idea what the fee structure is. And so for a while I, I was, I guess, I mean frustrated or a little bit put off that I'm like, now you've got me talking about your fees. Like, I hate talking about our own fees. Now you've got me talking about your fees. But at the same time, I totally I get it. And so that is one thing that I just I have noted and have now built in to my conversation with clients, you know, and another reason that I do like to call, even if I don't get a hold of the doctor, even if I can just talk to a technician or a receptionist, you know, and I can be like, you know, I've got an an ITP dog with zero platelets. And, you know, I think might need a transfusion. Can you just, like, give me a ballpark for these people so they know whether or not it's even, you know, in the cards for them to drive across town?
Dr. Beth [00:15:13] Right, right. That's interesting because I think you're right. I think the majority of times I do feel like there has been that messaging of, you know, you need to give them some estimate so they know whether or not to come. But at the same time, I feel like I have called and asked for estimates and gotten that little bit of pushback of like, the estimate can vary so much, you know, that kind of like frustration that I think we all get when someone calls on the phone for an estimate and we don't know. But you're right, I think I think that's a good rule of thumb, is to try to make sure that everybody's on the same page before referring a patient, whether for ER or for specialty about cost because that can save a lot of time and communication issues, I think for everybody involved. But yeah, it does make me feel like and I wonder too, you know, if we were to call up our local ERs and say, what is your process for having a, you know, makes me wonder if everyone in that facility is on the same page, if they have thought about it, if they have standardized it, and if it's just us that doesn't know what the standard is. So yeah, it's it's certainly interesting. Do you feel like I know we talked so much about the resource bottlenecks. I feel like the, you know, there's been a surge of these urgent care places that are opening up, which I feel like that will be interesting to see how that relationship develops too between GPs and these urgent care facilities and how that changes the whole dynamic across the industry.
Dr. Alyssa [00:16:41] Yeah, it's funny that you bring that up because there's one opening this summer here in Las Vegas. You know, and so it's I'm really interested to see what it is because definitely there are things like, you know, those those, he vomited twice or, you know, an ear infection that's really probably been going on for a week, you know, but it's an emergency now because the dogs, like, scratching at it so much that it's bleeding. You know, those things where we've had real, real issues in GP, you know, getting them in in a timely manner, but is it really something that needs to go to the ER and take up, you know, their time and resources when they actually really do have very critical, you know, patients? And so they are starting this, you know, they are opening one of these urgent cares here in Las Vegas. They're doing the hours I think during the week are going to be like 3 p.m. to 11 p.m. and then open, you know, most of the day Saturday and Sunday. Which like, I'm sure they, they put it in there for that, this is the after work, you know, time in most places, but there's really no such thing in Vegas because we're like a 24 hour town. I used to get calls all the time when I, when I still took call, I used to get calls all the time at like 2 or 230 in the morning because that was well, that was like the end of the swing shift. And that was when everybody was getting home from the casinos and from, you know, waiting and, and the restaurants and everything.
Dr. Beth [00:18:24] Yeah. Not a good city to work on call, Alyssa.
Dr. Alyssa [00:18:28] Yeah. It's it was kind of a crazy place, but if you could get past that and like, all those people went in to work at 3 a.m., then you were golden.
Dr. Beth [00:18:36] That's right. Oh. That's funny. Well, maybe the moral of our story here should be we should all take the two minutes to communicate about communication...
Dr. Alyssa [00:18:47] Communicate about communication.
Dr. Beth [00:18:49] with our ER specialist, just give them a quick question of, you know, how do you prefer that we communicate? How can we streamline this? So anyway, Alyssa, I think that brings us to our win of the week. Have you had any wins this week?
Dr. Alyssa [00:19:02] Yeah, I did. I actually I had, so I always feel kind of, like, happy sad when my win of the week has to do with one of my my end of life patients. But this win of the week did have to do with one of my end of life patients. So, I had an appointment scheduled for little dog, and the dog's name was spelled C Y L I E. And it was a little female dog. And so I called the owner, and I said I was on my way. I always call them when I'm about 20 minutes away to let them know when I'll be there. And, you know, obviously, you know, the for the vast majority of these patients, unless I've seen them for like a quality of life consult, this is the first time I'm meeting them. And so I, I assumed this dog's name was pronounced Kylie, C Y L I E, but it was actually "sigh" Cylie. And so, you know, and the owner said, oh, you know, actually it's Cylie. And then I felt a little I felt a little bad because I never want to mispronounce, you know, an animal's name in that situation. And so but then when I got there, it was, I walked up to the house and they had a huge Iowa State Cyclones flag. And that's what the dog was named after. The Cyclones, our mascot Cy. And so and so when I, you know, opened the door and the, the owner asked me in, I asked right away, I was like, is she named after Cy? And they said, yes. And then we had a big talk. And I said, I went to Iowa State. That's where I went to vet school. And it ended up just being like this really beautiful appointment. It was my last appointment of the day, and I was probably there for, you know, over an hour. But it was a beautiful appointment, and the owners told me stories about how they had taken her to Iowa State. And it was like just happy and really gorgeous.
Dr. Beth [00:21:06] I was going to say, what are the odds of that in Vegas? Yeah, that's that's pretty cool. I bet that brought them a lot of joy in those dark moments. So that's good.
Dr. Alyssa [00:21:17] Yeah.
Dr. Beth [00:21:17] Well, good news is mine is not quite as sad, Alyssa. That made me tear up a little bit. My win is that I survived my kindergarten presentation last week. So my my daughter is in kindergarten. I had told Alyssa about this, but I was, you know, they asked me to come present about being a vet. And so I thought it was just going to be to like her, I think there's 24 kids in her class, which is already a lot of kids for me. But it turns out it was to all 100 kids in kindergarten, so I had to do a 30 minute presentation. They bundled them in groups of 50, so I had two classrooms full of kids. We did a presentation. It actually went pretty well. The teachers helped keep all the kids in line. They, of course, had phenomenal questions that were hysterical, but also like very intelligent questions, too. They got a kick, I brought some teeth, like extracted teeth, they got a kick out of that, showed them a lot of X-rays. And yeah, it was just, it went really well. I was admittedly very nervous about it. So anyway, it was it was fun. My daughter was very excited. I was there. The real win is they wrote me the most adorable thank you notes. You know, they each wrote a little note with like a drawing on it. My daughter said like, thanks for coming, mommy. I wish you came to school every day with me. So anyway, it was just a very sweet moment. I think those were the moments that we all have to savor.
Dr. Alyssa [00:22:49] Yeah, absolutely. 100%. And I knew that you are going to do great when you told me that you were doing it. So. But, oh, that's wonderful. That's so great. And I'm so glad that, you know, Quinn was happy that you were there. I bet she was so proud of you.
Dr. Beth [00:23:05] Yeah, I was going to say that she's, she's sassy. So, honestly, it wouldn't have surprise me if she was, like, annoyed that I was crashing her classroom, so I should just be thankful that she was nice and sweet about it. But anyway, big win, so. Well, I think that wraps us up. So to our audience, thank you so much for listening in today. And we will catch you guys next time in the Breakroom.
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The Team:
Alyssa Watson, DVM - Host
Beth Molleson, DVM - Host
Alexis Ussery - Producer & Multimedia Specialist
This podcast recording represents the opinions of Dr. Alyssa Watson and Dr. Beth Molleson. Content is presented for discussion purposes and should not be taken as medical advice. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.