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New year, new troubles brewing for Drs. Codger and Greenskin
A survey of the sundry eccentricities between two practitioners trying to function harmoniously in one veterinary practice.
With a new year comes new hope and opportunity for our two veterinary prototypes, Dr. Codger and Dr. Greenskin. Although they've both grown older this year, their relative disparity in age (and philosophy) couldn't be any more apparent. Most of you are on the edge of your seats, waiting to find out how the possible practice-acquisition saga is developing (see the previous episodes featuring this duo at dvm360.com/campfield. You'll have to wait just a little longer, as we're kicking off 2017 by re-examining some of the elements that have led to the ups, downs and shenanigans between these veterinarians who have seemingly spawned from different worlds yet remain as fixtures in the very same hospital on the very same planet.
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Here are some top examples from 2016 to illustrate Drs. Codger and Greenskin's apparent-well … “differences” in handling common cases and happenings around the hospital.
1. Client-centric vs. case-centric. The receptionist says that Mr. Kindaoddfellow is on the phone. One of his hounds ate “some kinda poison in the garage” and “seems sick.”
Dr. Codger delights in picking up the phone to speak to one of his longest-standing and best-paying clients. The two chat on the phone for a long, long time. (Someone overheard them talking about their golf handicap.) The case outcome remains unknown because Dr. Codger is still on the phone long after everyone else has left the hospital.
Dr. Greenskin mumbles, “He needs to bring the dog in,” and turns back to her computer screen. The receptionist, clearly displeased with the interaction, grudgingly relays the recommendation to client.
2. Practical vs. reactionary. Mrs. Twentycats flies into the clinic first thing Monday morning with a piece of dried leather that she claims used to be a felid. “Save him; he was just breathing in the car!”
Dr. Codger takes a listen, puts on his most solemn face, grabs a box of tissues and spends the next 10 minutes consoling the poor lady.
Dr. Greenskin jumps into action: “Code blue-all hands on deck!” A flurry of intravenous catheters, fluid bags, resuscitation drugs and syringes follows. Thirty minutes of perfect chest compressions later, the patient is pronounced deceased via ECG.
3. Learning new things. The two docs want to bring a new surgical technique to the practice.
Dr. Codger buys an actual paper book and then attends a hands-on lab. Time. To. Cut.
Dr. Greenskin spends four days on the phone with most of her veterinary school professors and pores over online articles, emailing every author. We checked in six months later … she hasn't tried the procedure yet but is just waiting for that perfect candidate.
4. Pain management.
Dr. Codger performs a tibial plateau leveling osteotomy (TPLO) and sends the dog home the same day on carprofen.
Dr. Greenskin spays a puppy, hospitalizes her overnight on constant-rate infusion fentanyl, lidocaine and ketamine, and discharges the pup the next day with deracoxib, tramadol and gabapentin.
5. Stocking the pharmacy. A 1-lb toy Yorkshire terrier needs to go home with metronidazole.
Dr. Codger crushes a 500-mg tablet and tells the owner to sprinkle a pinch in the dog's food twice a day.
Dr. Greenskin can't find what she needs, so she shops around every compounding pharmacy in the state. Eight hours later, the most convenient and cost-effective solution is found. Now to track down that client again ...
6. The wonders of variables in client interaction. Mr. Overlyfriendly just learned that his overweight schnauzer is diabetic.
Dr. Codger is overheard joking with the client through the thin exam room door. The owner leaves smiling and ready to start NPH insulin and will return in two weeks for further consultation and a blood glucose curve.
Dr. Greenskin cancels a few afternoon appointment slots. The owner is blindsided, spends an hour in the exam room learning of the horrors of managing diabetes in dogs, leaves with a confused and dazed headache, and plans to buy the small bag of dog food.
7. The ecstasy and perils of referral.
Dr. Codger can do basically any surgery ever described and even has some of his very own “special techniques” that somehow never found their way into the textbooks. Even the most critical of patients can be managed at home. His clients love him, so why refer?
Dr. Greenskin is a pathologic collaborator. It's not uncommon for her to block off a couple appointment slots for (free) phone consults. Limping? Go see a surgeon. FUO? Straight to an internist. ANY eye problem goes to an ophthalmologist. Can't afford to go to the specialty hospital? Eeewwwwwwww... that must be one of Dr. Codger's clients!!
8. Monitoring anesthesia.
Dr. Codger makes sure his technician leaves the operating room as soon as he starts cutting and the patient stops wiggling so much. There's work to do out there, and there's a stethoscope in here, somewhere, if he needs it.
Dr. Greenskin canceled all of this morning's procedures upon learning that the capnograph was acting funny. She's still hesitant to do any procedure on small patients since Dr. Codger still hasn't ordered that anesthetic circuit air warmer.
9. Outlook on life and veterinary medicine.
Dr. Codger knows how hard he's worked and deserves all the spoils that come along with such a long history. These kids today are just too soft. If you want it, work for it, daggumit! The entire staff called in sick today? No problem! Doc Codger can train any client to restrain for a blood draw in 30 seconds. Get 'er done! No excuses and no barriers have been a cornerstone for his decades-old profitable practice. Given that his approach has “worked” (rewarded him personally and financially), I don't think we're going to get this fellow to change his ways anytime soon.
Dr. Greenskin devotes at least a couple of hours each week (out of an already full schedule) to balance her checkbook and make sure she's staying on budget. Some of that time is spent with online support groups where her DVM colleagues can exchange ideas about tax implications of “forgiven” balances on student loans because simple math dictates that those loans will actually not get paid off, even if she did nothing but work a full 168 hours a week for the next 15 years. Kudos to her for realizing early in her career that some things are actually impossible. So she focuses on things that are possible, like her attitude and doing her best to achieve positive client relationships and prioritizing her family and home life.
It looks like 2017 is going to bring another healthy serving of generational prototypes and natural antagonism between our two main characters! But they are both learning so much from each other without even realizing it-and certainly neither would acknowledge it. Will these two caring and compassionate veterinarians, somehow bound by their love for animals and dedication to their profession, find enough common ground to survive another year in the trenches together? Or will this be the year that the wheels fall off? Stay tuned for the next episode of Old School, New School!