Crazy clients, snappy patients: How should a veterinarian warn the team?


A code in the patient record could come back to haunt you.

Leona Potts was crazy about her two dogs, Mutt and Jeff. Her life seemed to revolve around their health and their moods. As a result of her heightened concern, she visited Dr. Jake Sim's veterinary clinic two to three times per month. She would cry if the pets' health reports were anything less than perfect. Her disposition would change from sunny to dark if she noted the doctor deviating slightly from the norm.

In addition, Mrs. Potts' beloved dogs did not like strangers. They would growl and snap at the least provocation, and needless to say, Mrs. Potts always took their side. Nevertheless, these obstacles did not stand in the way of Dr. Sims and his staff offering Mrs. Potts and her dogs the best possible medical care.

Dr. Sims had a thriving practice with four veterinarians and a wonderful support team. It was important to him that team members know the special needs of the clientele as well as the potential of any patients to cause injury. His No. 1 priority was the health and welfare of his staff.

To this end, he incorporated a code into his medical records that alerted his staff to potentially dangerous pets and difficult clients. A circle with an arrow through it meant “use caution when handling the pet.” The staff interpreted the symbol as “will bite.” A letter T with a circle around it meant “difficult client.” The staff interpreted this symbol to mean “crazy owner.”

As harsh as it may sound, these warnings allowed staff members to prepare for possible awkward issues before they became exam room disasters.

There came a time when Mrs. Potts had to take Mutt to a local specialty center for a cardiac ultrasound. Dr. Sims recommended the visit after noting the recent appearance of a systolic heart murmur. Mrs. Potts requested Mutt's records, as opposed to having them faxed to the center. She didn't want to take a chance on them getting lost. She picked them up the day before her specialty appointment.

Of course, Mrs. Potts' curiosity and meticulous nature led her to read Mutt's medical record. She was impressed with the detailed accuracy but puzzled by the circle with an arrow through it and the large T enclosed in a circle. She wondered if these were Latin medical references. She decided to ask Dr. Sims to translate these notations for her.

She called the practice and asked about the symbols' meaning. Dr. Sims told her they were used for internal staff communication and had no bearing on the pet's medical condition. She pressed him for the meaning. He told her that the circle with the arrow through it referred to a nervous patient, and the T referred to a concerned pet owner.

Mrs. Potts may have been neurotic, but she wasn't stupid. She could read between the lines and determine the symbols' true meaning. She told Dr. Sims that if he felt Mutt was "nervous" and she was a "concerned owner" that she would no longer darken his clinic door with her beloved pets. She hung up in a huff.

Dr. Sims still believed it was necessary to include this information in patient records to assist his staff members. However, he decided he would try to find a more tactful way to go about it in the future.

Do you agree with Dr. Sims?

Rosenberg's response

Medical records are like the Internet-what you put in the record stays in the record. I can respect the fact that Dr. Sims wanted this information disseminated to his staff. On the other hand, the client's reaction to discovering these notes should have been expected.

If necessary, there are discreet ways of warning staff of patient and client idiosyncrasies. Every veterinarian has his or her version of a client like Mrs. Potts. These clients and their pets need veterinary services just like everyone else. Dr. Sims learned a lesson the hard way. A combination of softening one's attitude toward these clients and informing personnel of potential issues during staff meetings can help prevent unfortunate confrontations like this from happening.

Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, N.J. He is a member of the New Jersey Board of Veterinary Medical Examiners. Although many of his scenarios in “The Dilemma” are based on real-life events, the veterinary practices, doctors and employees described are fictional.

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