Life Boost with Amelia

Ep. 83 | Communication Tips for Common Challenges in Vet Med: Delivering Bad News, Imposter Syndrome, Medical Complications, and more with Dr. Josh Rosen

• Amelia Knight Pinkston • Season 2 • Episode 83

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In this episode of 'Life Boost with Amelia,' Dr. Amelia invites Dr. Josh Rosen back for a detailed discussion on applying clinical empathy and communication skills in veterinary practice. They cover how to deliver bad news, manage euthanasia, handle imposter syndrome, navigate uncertainties in exams, and deal with difficult clients. Dr. Josh shares valuable strategies for maintaining professionalism and compassion, improving team communication, and setting boundaries. They also emphasize the importance of self-care, curiosity and a growth mindset, and community support in creating a sustainable and fulfilling veterinary career.

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Disclaimer: The information provided in this podcast is for educational and informational purposes only and is not intended as medical, mental health, or professional advice. I am a certified health and life coach, not a licensed medical or mental health professional. Please consult with a healthcare provider before making any changes to your physical or mental health routines. If you are experiencing a crisis, seek help from a qualified professional or contact emergency services.

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To learn more about my approach and the programs and free resources available to support you, visit my website: www.lifeboost.today

I love to hear from you. You can always reach me at amelia@lifeboost.today.

Welcome to the Life Boost with Amelia podcast where we're changing the narrative around what true health and success look like. They should give you energy, not drain it. I'm your host, Dr. Amelia multi-passionate integrative health and life coach, entrepreneur, and recovered burnout veterinarian. Together, we'll explore the science behind how your brain and body work, including the unconscious mind while also connecting with what your heart needs in order to stand up to the norm of feeling stuck on a hamster wheel-working hard yet feeling exhausted and not where you want to be- and instead live a life that makes you excited to get out of bed in the morning and in love with who you see when you look in the mirror. The reality is if you do what everyone else is doing, you're not going to feel good. Let's break the norm. Hi, friend. I received a lot of great feedback that many of you enjoyed the first episode that I did with Dr. Josh Rosen and so I was excited to have him come back for a part two so that we could go over how to apply clinical empathy and communication skills to specific scenarios and common challenges that you may encounter in vet med. So in this episode we are going to be talking about things like how to be delivering bad or unexpected news, communicating through euthanasias, imposter syndrome, what to do when you are in the exam room with a pet parent and they have just shown you something or asked you something and you don't know What the answer is or what's going on? How do you navigate that? How to navigate when there is a medical complication or something doesn't go as planned, Dealing with challenging clients and more So we pack a lot into this episode. I hope you find it helpful. And if you enjoy it and you'd like more episodes with the both of us in the future, then just reach out and let me know, enjoy the conversation.

Amelia:

Dr. Josh, it's so great to have you back. Thanks so much for being here.

Dr. Josh Rosen:

Good morning, it's a pleasure to be back. So happy to be able to talk about this a little bit more detail today.

Amelia:

Yeah. So this is part two, because you already were on for part one, and you shared so many great tips when it comes to communication and clinical empathy and how to use those tools. Those in challenging situations to make it just less stressful for everybody involved. And so I thought today we could really just dive into more specific scenarios to put that into practice and see how these can work in a variety of different settings and ways. How's that sound?

Dr. Josh Rosen:

I think that's perfect. There's no better way to learn through example, right?

Amelia:

right? Completely agree. Okay. So to dive in, I have a list of certain ones that I think it can be a little bit stressful and one that comes to mind is delivering bad news. And so I can think of, especially when that news isn't expected for example, I'm doing a physical exam. Maybe it's like a 4 year old boxer. We're just like having a nice fun conversation with the owners. I'm doing the physical exam, but I feel the lymph nodes and suddenly I think, Ooh, this could be lymphoma, a cancer. So do you have tips on navigating that and making that transition? We're going from like just playful, lighthearted to much more serious.

Dr. Josh Rosen:

Sure, and to clarify they're for a wellness exam, for lack of a better term, that they're not really there for a particular concern. Correct.

Amelia:

Yeah, exactly. It's like just a wellness visit. They have no idea that anything's off for the pet.

Dr. Josh Rosen:

Yeah, fair enough. I think that, my, my preferred way to go through a physical exam no matter what the concerns that I find are to be able to verbalize what I'm finding as I go through my exam, right? And part of that reason is to be able to have the owner connected with me as I'm going through those findings for a wellness exam. Often that means that you're, reporting back some pretty normal. findings. And that does mean that it can be very easy to have your heart drop or like you lose your breath for a moment or even ooh because you just are not expecting to find what you find. And so I think the biggest thing is just being able to we talked about it last time, the idea of being very mindful of. Your thoughts and the way that you think about your cases is all about what you keep inside your mind. And that is totally fine and fair. It's appropriate as a human being to be surprised when you have to deliver the shocking news, that means to say, you're worried about the pet, you're worried about what that means for their health What you say out loud matters. And it's just very important that If you are along those same lines as me that you'd like to be able to verbalize those findings that you're matter of fact in that moment, it's to say, that's how I like to proceed in these situations is that I'm finding some enlarged lymph nodes right now. I want to be a little bit more thorough and feel the other lymph nodes around the body and see whether or not I'm finding similarities there. We'll talk about what I think that could mean for Bella's situation, make sure that you're using the patient's name so they understand that you're not just treating their situation like any other sick case out there that you're treating Bella's case in that moment, right? And, when I go through my exam, if I don't find anything else, maybe I find that the popliteals are also enlarged, and then maybe the prescaps are enlarged as well as the submandibulars. I have a conversation with them about, what I think The best case scenario could be in a situation like this. I double check with them about flea and tick preventative and whether or not there has been any tick exposure recently. But I also will talk to them and say I think that it would be a disservice if we didn't have a conversation about Bella's breed right now and what this finding could mean in this situation and why I think that it's very important that we take the next steps to be thorough in how we investigate what's going on with Bella. I, I think that, The fact that Bella's doing great at home right now, has a good appetite, good energy. You said that there's no vomiting there. There's no concerns that Bella's acting like Bella. In my opinion, that's the best case scenario in the situation for a dog to present with enlarged lymph nodes. In a worse case scenario that we are talking about a cancerous process, we'll deal with it and we'll talk about what that means for Bella. Right now we're just investigating. There's a lot of different things that this can mean and I want to give you some information about what types of cancer this might be so that we can continue this conversation when we get results of fine needle aspirates of these lymph nodes as well as some tick borne disease testing. I just went over a lot of information. Information that we definitely were not prepared to have a conversation about today. I don't necessarily expect you to have questions immediately, but I want to make sure that you certainly have the space to do so please let me know now if you have concerns or questions so that we can talk about it further. If you need a little bit of time to think about it again, I'm going to send you home with that information. And please let me know if you have further questions after reading through that.

Amelia:

Yeah. I love that. That seems like the most kind of comforting way to support them through that. And some of the things that I'm hearing with, Your strategy is number one I love your emphasis on really communicating the all of the physical exam findings, whether it's normal or abnormal throughout. Just keeping them updated on exactly what you're doing and seeing the value. And then just having it be the facts, not personally getting a lot of the emotions, regardless of what we're feeling inside. And then it sounds like you are really using that signposting as well of helping them to see next steps. What does this look like? And also having that spectrum of, I like that there is, Some focus on some of the positive things or like here would be best case scenario, and, here's what we can be doing from here. And I think one thing I always likes to do as well is if it is something like a wellness visit to say is like really celebrate, this is exactly the point of these so that we can catch things early.

Dr. Josh Rosen:

Right.

Amelia:

Love what you have said. And this is a little detour. But with you talking about going through all the findings with a physical exam I'm curious if you are using any of the A. I scribe options because I think that is one really awesome thing that we now have available because not only can it make it Our notes potentially more thorough and we're not finishing and then Oh, is that the right eye or the left eye? But I do think that it is an opportunity for us to be really present with the owners and it encourages us to be speaking and saying all of the findings. So I'm curious, are you using that now?

Dr. Josh Rosen:

I absolutely am. And it's been a game changer for sure. I have also had the pleasure of working at clinics for the previous two years before I started working locum that had assistants that were trained in scribing in the room as well. And so that teamwork focus definitely allowed for the veterinarian to be more present in conversation. Clinics that I've worked for where the assistant will play, a bilateral role of both assisting the veterinarian and scribing allows the veterinarian to actually be present for the intake and that they can be more involved in the initial questionnaire and history. Honestly, creating more efficient intakes. It's not to say that if veterinarians are being faster or slower or anything along those lines, as much as the veterinarian can immediately zone in on what it is that they're concerned about and also be able to have more time to show that they are empathizing with, they are at least compassionately caring for that pet and in regards to whatever their concerns are Say if that's not an opportunity, it doesn't mean you can't do that, approach. We talked about last time how having that team approach where your assistant, your veterinary nurse, or even receptionist is trained in this idea of the visit from start to finish from the moment they walk in the door to the moment they leave the veterinary hospital, having an empathetic, compassionate approach leads to better patient care, better patient outcomes, better team fulfillment and leaning into that, leads to exactly that. So I don't want to go off too much of a tangent there, but it's certainly something I'm very passionate about.

Amelia:

Yeah. Yeah. I love that. I've experienced that too with relief work at hospitals that do have some staff that are there to scribe and oh my gosh, it is such a game changer. And I did notice it just made me be walking the owner through what I was doing even more. And I loved,

Dr. Josh Rosen:

And the AI scribe, it's the same, it's the same thought, right? The idea that, okay, I get to focus now. And it's to say, when you go from having the conversations where you know that you have to make recommendations, write out your plan on your notes and then move on to your next case, when that's the workflow that you have. And you change to a workflow where an AI is scribing for you. It also makes you think about if I don't say this out loud, It's not going to be documented and to say that's a very different way to think. Of course, we should be communicating everything to our clients, but there are certain aspects of which we may not be as specific as we would otherwise. And it's very helpful for the pet parents because of that. Definitely an awesome Benefit of using those services for sure.

Amelia:

yeah, I think that's a great point. And it just makes everybody more thorough and a little bit more careful.

Dr. Josh Rosen:

Yeah.

Amelia:

So going back to what you were pointing out again, just that teamwork and having everybody involved in the process of supporting pet parents and setting expectations and along the same theme of that bad or tough news. I'd love to get your thoughts on euthanasias, because that seems like an opportunity where the entire veterinary team can really work together, helping to signpost again and set expectations. But do you have specific tips for the veterinary team and individuals with how to support pet parents in those tough times?

Dr. Josh Rosen:

Yeah. And I think that it's a very sensitive topic, right? The idea of what is the best way to be able to handle these situations? Truly, I could not say that there is one individual way, right? I think that the most important thing, like you said, is that teams are working together and that it's not one individual's role to carry that burden of those appointments and that's from the moment that they're Booked as appointments on the schedule. So again, the moment that they're greeted at the door to the point in time that they have paperwork, reviewed and signed, or you're reviewing memorialization services that are provided. I think that. Being able to develop SOPs for your clinic is very important here coming from a compassionate lens. It's not just the idea of being able to, okay, I need to read this, step by step guide and be able to do X, Y, Z. It's being able to know that no matter who the team is that day, everyone is on the same page as to how we manage these cases. I think that whether, these services are in urgent care or if they're general practice, primary care, or emergency, the intake is going to be very different in each of those scenarios. I have I think that pet guardians have had the Most comforting experience when pet hospitals have a quality of life room or palliative care room or something along those lines. So that, one, they have a space where it doesn't feel like I'm in a hospital. It doesn't feel like I'm, there to do anything related to science or medicine or anything that might be a little bit less sensitive and emotional for that individual. I'm here to help them feel comfortable. I'm here to make sure that they have relief. I'm here to make sure that there's no more pain. those rooms Look very different in every hospital. Sometimes it's just an exam room that's only used for that purpose. And so a lot of the decorations in there are very comforting and the lighting is different. And maybe there's some candles that can be lit when you're in there. Always tissue boxes available. There's rooms that I've worked out where there's actually a couch in there and there's a very large orthopedic bed in there and maybe even, with. It's to say that the bed's large enough so that the client can be in there with the pet as well. There's lots and lots of different creative ways that you can accomplish at least putting an effort forward to create that comfort space for them. It doesn't have to be extravagant or expensive. It just has to be the effort and pet guardians will always appreciate seeing that effort. In the conversation, I think that. The thing that I struggle most, I'm sure that other other veterinary professionals relate is just simply having the conversation around, end of life care and it's not difficult because it's the wrong decision or right decision or whatever that might be. It's simply difficult because you have probably had a pet before and. It is really difficult going through that part of their life. And when you have those conversations with the clients, it can either bring you back to those moments yourself, or the emotions from the past are simply just so powerful that you know exactly what they're feeling then. And it's tough to be able to talk to them about it. So don't wait for the conversation with them to prepare yourself. It's tough to say this out loud. But after five, six, seven years in practice it's to say that you've definitely done this quite a few times already, so you have experience that matters and experience that matters and how you help yourself too. Because if you bring your if you bring your baggage, for lack of a better term, in that door, in that exam room, it's going to become an obstacle for you to connect with that pet parent. And I think that the easiest situations to have this conversation are also the most difficult situations because the easiest, in my opinion, as a primary care physician are if I've known this client for a really long time, I know that I don't have to convince them how much I care for them right now and how much I empathize and how much I wish that they didn't have to be going through this. I don't have to spend time making that initial connection and, trying to ensure that they know that they are important to me. But on the flip side, that patient their entire life, maybe, and that cannot be easy as the primary care doctor. So as the operational ease of the conversation may be, it's probably going to be the most difficult for you. So prepare yourself for that and be able to say to yourself that I'm, I may need five minutes at some point today, 10 minutes at some point today to just go on a walk and be able to get these feelings out because they're real. And if you go into this thinking to yourself this is really anxiety provoking because it's always gets to me and it's so hard to process. And I really wish that I just didn't have to feel these feelings. You're going to go in there, you're going to be dissociated, and you're not going to be present for that client. And it's not going to, again, this is not about right or wrong. It's just about understanding how A leads to B leads to C and, Understanding that helps create self awareness so that you can take these measures ahead of time, because this is not as simple as a conversation. It's Oh yeah, all you have to do is X, Y, and Z and you're fine. This always has to do with your own association with those situations, your own history with owning, pets yourself and what that might mean to you. You have to be able to prepare so that you can leave that behind and best support that pet parent. On the flip side, say you're working in urgent care or you're working in an emergency care and this is the first time that you're meeting that pet guardian. Often that means that the most difficult Part of this is going to be, if you want to have a connection, if you want to be there and be compassionate for that pet guardian, you need to be able to help them see that, that you're there for them. And sometimes they don't need that, right? If you're working in the emergency or urgent care, they may not need that from you and you may be able to identify that, but there's no reason to go in with that assumption. You should always be going into these appointments with the idea that your role. Is to assess to obviously make sure that this decision is appropriate for the patient that is It's a very big assumption here, but it's important to state out loud, um, the other very important role is to be a compassionate supporter for that pet guardian. And it's not just the, again, the burden does not lie entirely on the veterinarian. This is on the entire veterinary team to be able to create that space for the pet parent. But to say for that role where you don't have the relationship already, that's where relying on those basic skills in regards to soft skills and communication are very important. Knowing your client's name ahead of time, or I would go in and I would introduce myself and I would ask them for their name if they didn't say it to me right off the bat. And if they don't say it to me right off the bat, I don't, pick at them like they were supposed to and they didn't do it. It's just simply to say Oh, I didn't catch your name. What was it? If you don't mind me asking, and they'll just tell you, and then you can use it multiple times. You can use the pet's name multiple times. You can put your hand on the pet. You probably want to pet the patient and in the situation that they're in, do it. It will help you. It will help the pet parent feel better about what they're going through. They'll feel that you're there for them. And again, That's if you're the vet, that's if you're the veterinary nurse, that's if you're the receptionist. greeting them at the door, and they might be carrying the dog in, maybe the dog's walking in, you can give a little treat. There, there is so many ways to be able to communicate compassion. It does not only have to come from the veterinarian.

Amelia:

Yeah. I love how you mentioned like being there to support them. I think like the words we choose can have such an impact. And I think in these kinds of situations, emphasizing that you're there to support them or that this can be helping to provide Relief or can be peaceful. I think those can sometimes be comforting in these kinds of situations. Thinking back to the last episode, those three steps that you taught of giving some space for them to talk and so that you can identify their pain points and how they're doing and then being able to use whatever they've shared to have those empathy statements and thinking about what words maybe can you use that can provide a little bit of reassurance or comfort for them? I think. Yeah, those tips were so helpful. And I've found too that like for both me and the pet parent, I think that signposting helps where I can go in and just explain here's what to expect, I always like doing a pre med, we're going to do this so that it'll just be like, he's just taking a nap. And so that all of this is really smooth and peaceful and here are the options that you have to be with them or not. I think that can all help with just trying to ground everybody and in feeling at least connected and supporting one another.

After recording this, I realized, especially if you're a vet student or new grad, it may be helpful to actually give a more clear, specific example of what I tell pet parents during euthanasias. So, I'm going to take a moment to go a little more into detail with that. So once an owner has made the decision, that they are going to euthanize. My first emphasis is that we are going to make this as smooth and peaceful as possible for them. And then I walk them through the steps, some signposting so that they know exactly what to expect every step of the way. First we're going to work through some paperwork, then I'm going to give a medication that's going to make them just slowly get more sleepy so that it's just like they're taking a nap. And if you want to, you can be right there with them through all of that. And then once they're snoozing, we'll place an IV catheter, and that just helps to make sure that the final injection goes really smoothly and peacefully for them. And I let them know that they can stay with their pet as much or as little as they want which Sometimes I'll have a pet parent that says they definitely it's just too emotional They don't want to be with their pet during the euthanasia but then when they learn that I use a pre med and that it just It's going to slowly fall asleep and they can be petting them just up until that point and then once the pet isn't kind of consciously aware, then they can leave. That often becomes a great option once they understand the process a little bit more so it's not quite as overwhelming. And of course, every vet has their own protocol and approach. That was one important boundary for me, especially as a relief veterinarian because some hospitals don't do a pre med and they don't do an IV catheter and that's absolutely fine. I think it's so important to find like what helps to create a smooth, peaceful, positive experience for you, but for me, I realized that even if that's not the protocol at a hospital, it is for me. And so I always require a pre med that works for me, that helps the patient to really be snoozing, and then also an IV catheter because for me, that just alleviates one more possible stressor if we have that, when it's possible. There are Sometimes when it's not. and then I just let them know afterwards I'm going to listen for a heartbeat and sometimes they will take a deep breath even after they've passed and that's just a reflex and Usually they don't close their eyes even after they've passed. And I check in with the owners Throughout the process to make sure that they're okay with me progressing to the next step. This part is so individual, but I never want anyone to feel Rushed and so that is something that you kind of learn is like at what speed is right and How to help the pet parents to feel most supported in this moment because it is an opportunity for us to be there for someone during such a hard time And to make that death a good death. And that's what euthanasia really stands for, right? So, just thought I'd add that, and back to the conversation.

Amelia:

And I loved your emphasis of. the emotional part of that for us, because I don't think that's something that is talked about in vet school or that we're really prepared for. And like you said afterwards, and even before, I think, I like how you talk about thinking about how you need to be going into the room. And that's why I love sharing anti anxiety tools, things like tapping or even like a physiologic sigh where you like take a couple breaths in and then you let out that exhale like just letting out a little bit of stress or emotions before you go in but i would love it if we could also normalize Carving out a little time afterwards, like you said, like going for a walk or if we could just have, like five minutes to like, go into the bathroom or maybe you can get a hug from a coworker. But I think the more that we do as a team acknowledge that we are humans, this is tough for all of us and helping to process that. I think that is really powerful.

Dr. Josh Rosen:

And this has to be sustainable, right? Like we have to be able to do this as long as we want to. And, if we are fit into this culture of constantly feeling like, Oh, I can compartmentalize. I just put those feelings away and I never think about them again. That's not what, if you talk to any mental health professional about that type of compartmentalizing, it is a recipe for disaster, but Wow do medical professionals, whether it's vet med or not, love to do that. Myself included.

Amelia:

Oh, I was a pro.

Dr. Josh Rosen:

Because like you're, you naturally want to survive. That's the survival instinct is get through this. Now. Worry about that later when it's a really big problem. But that's not sustainable. And that also has to be important to you as well.

Amelia:

Absolutely. Yeah. And learning about the nervous system. That's where I've realized now, like I would on those hard days, you have the rollercoaster emotions and I would just feel numb by the end of the day or very irritable. Like even though, I love my husband and my dogs, but I would get home after compartmentalizing and just having a smile on my face. And it was like, that was the end. And then I just was irritable, not really wanting to talk or just really wanting to just numb out and not feel anything and

Dr. Josh Rosen:

turn on that TV and not have to think about anything.

Amelia:

Yeah Now I've realized that is a sign for my nervous system. Just being like whoa, that was too much and it is helpful if you notice days that are ending like that to be able to then look back and think okay What happened during my day? And what do I need to Process those and I do think support from others can be so helpful, whether that's talking to a friend who gets it, someone else in the veterinary community or, your partner, friend or colleagues. just that human connection can be so comforting.

Dr. Josh Rosen:

Absolutely. Absolutely. And it's important to have community, right? It's important to know that you're not alone in this this, what feels like a battle and is really just the idea of, I'm really passionate about this and I always want to succeed at what I'm doing. And we're also human. We're not programmed for success a hundred percent of the time, unfortunately.

Amelia:

Yes, so true. And let's go off of that desire to succeed, right? I can think, especially for new grads, but really for any of us, those moments of imposter syndrome. Say you're having a tough case, And you feel like you just don't know what's going on. You feel like you're in a little over your head. Do you have tips for how to be navigating? Say you're in the middle of an appointment and you're just like, not really sure what to say, or you feel like you need help from a colleague. Any tips on navigating those scenarios?

Dr. Josh Rosen:

Yes, I think that there, there's many different times that this pops up for me. I think that as a new grad a very common thing that will happen is you're in the middle of an appointment and maybe it's like something that was found on the skin or maybe there's a weird maybe you feel something strange in the abdomen, but I don't really know if this is something strange or if I just don't know what a normal abdomen feels like yet. I think in those situations, it's very easy to like panic and think how am I going to explain this to the pet parent right now? I think the most important thing in that moment is to take a breath because no one is expecting you to do something sudden. Okay. And, I think that in situations where the client is bringing you and presenting with you something that you've never seen before, it is vulnerable, but still honest and the best thing for you to do that for that patient is to say, you know what? I really haven't seen too many cases like this before, but I know, Dr. So and so is here today. Do you mind if I just bring fluffy to treatment really quick so that they can take a look with me and I'll talk to you about what our combined, a consult is together. And like clients love that. Like I've rarely, I think that our biggest fear in that situation is that the pet parent is going to be like, You don't know what this is? Are you, how can you call yourself a doctor? You don't know what this is? I asked you a question! They will feel so happy that they got two doctors that day. Their pet has such a fascinating thing going on that they got to see two doctors. it's to say, I don't want to, every case isn't going to be like that, but I think in a worst case scenario you're going to have a situation where a client maybe just feels a little bit more worried about what's going on with their pet. And you just may need to be prepared to provide a little bit more compassion for them that if it does end up being A relatively benign or just very treatable, curable issue that you communicate that and that you overemphasize that so that they're very informed as to what's going on in that situation. But be present understand what their concerns are, understand what their pain points are. It's not just what they come in with. It's to say, if you're having that conversation with them and they seem uncomfortable with what information you're presenting, ask more questions. Be curious. Figure it out as far or figure out what it is that is going on as far as their confusion so that you can best help them work through it rather than just leaving them to figure it out on their own. But I think that the biggest thing in those situations, and I'll tell you that I still do it to this day when I don't know what's going on, I tell the client upfront. This is my plan right now. I need you to know that I have not seen too many cases like this before. And often when this happens, I need to talk to my clients about referral to a specialist for this presentation, because I don't want to wait too long to have this managed. And I also don't want to use your resources poorly and how we find an answer here. Clients and pet guardians will appreciate that. They will see that you're looking out for them and their pet. You're not just, making them go through the ringer of just keep coming back every two or three weeks and pay for a recheck and pay for some more meds that may or may not work. Like you're better off being honest with them about how you feel the situation is and something even in my note taking, whether it's with AI or to say your own type of template is including a prognosis. That if you're constantly thinking about prognosis, that you're going to have some form of a conversation in those visits, and it helps guide where the next steps are going. If those next steps don't have a clear resolution, you should be thinking about how that follow up looks in regards to improvement. And if I'm not going to get this to resolution, how long is it going to take to get there? Do I think that it can get there? And if the answer is no, why? And say, that's more of your own conversation for yourself, but those are important factors in regards to how you decide to try yourself versus refer,

Amelia:

Yeah. Yeah. I love that emphasis on just honesty and transparency because what a great way of building trust, I think, with an owner and showing your positive intention when you don't have that fear of them thinking, Oh my gosh, I don't know something. Instead, if you're walking them through Hey, I'd love to have this colleague look at it too. Yeah. I've experienced that completely where early on, I was just so afraid of them thinking that I didn't know what I was doing and then realizing, oh, they actually really like it when I go and, for example, like for eyeballs I still don't feel very confident with a lot of eye things. And so I, if I saw something I wasn't sure about, I'd be like, Hey, my colleague is amazing at eyes and I would love for them to take a second look at this and then I'll come back and we'll go over these findings since I love what you're saying because I think that really does sometimes it even helps to strengthen the relationship in those scenarios.

Dr. Josh Rosen:

And now especially when you're working in a multi doctor practice, like maybe they've never worked with your colleague before, right? And now you've opened up an avenue where. I know that we're not working seven days a week. So if, fluffy gets sick on a Monday and I only work Tuesday through Friday, or I'm only working weekends and they're sick during the week, like they have to have an avenue to still get their pet treated. And yes, there are urgent cares and emergency rooms and things like that. But if there's a colleague that they trust in your hospital, that's all the better. So now you've created even more opportunity for care for that pet.

Amelia:

Yeah, that's so true. I love that and just helping to build that value too for the practice and everyone together

Dr. Josh Rosen:

Yeah,

Amelia:

Yeah, that's a great tip.

Dr. Josh Rosen:

I think that with imposter syndrome it's a situation that is in some regard, always going to be present throughout your career in different ways and identifying it is the most important thing I think that we get hyper, I think we get so focused on the idea of Oh, I'm feeling like an imposter and I'm really like, I shouldn't feel like this and I should feel like the doctor that I'm meant to be. And that's where we fall into the trap. The idea of knowing what imposter syndrome is so that you can have self awareness of it, so that you don't let it interfere with what you need to do on a day to day basis. A way that imposter syndrome can interfere in the situation is if you as a new grad say, I'm not going to worry about that because I don't know what it is. Because it's a mild, you know it's mild. Like you know that it's at least mild and that if it gets worse, we'll deal with it at that point. That's poor habit formation that can easily happen when we let our emotions guide that decision making. And it's, it's tough to talk about without sounding like there's a right or wrong way to approach these situations. It's simply about being human that these things naturally happen. And we have to be aware of imposter syndrome so that we Don't fall into that trap so that we can say to ourselves, am I actually incompetent or is it possible that I've spent way too much money on my education to possibly call myself that word? Like, And that's why I say it's going to come up time and time again throughout your career, because there's going to be new things that you need to learn. If you're not doing that, you're not advancing in your career as a veterinarian, or as any veterinary professional medicine is constantly changing. So you have to be willing to understand that there are going to be times where you don't know and it can be scary to be vulnerable. It is scary to be vulnerable, but if your goal is already connection making with your pet guardians, this is an opportunity they are going to appreciate that you trust them with the areas that you aren't as confident about and that I'm really good at this. I'm really good at surgery. I'm really good at internal medicine when your pet's sick. I'm really good at knowing vaccine protocols, but I'm not good at skin. I really can't do long term skin management or I I, I can treat simple ear infections, but when they become chronic, it really, it's just something that frustrates me. So I'd much rather you work with this colleague of mine that loves these cases and we'll see them start to finish every day because it's. It's something that she loves to do. It's to say there's different ways to have that conversation, but it's the vulnerability that those pet guardians will always appreciate that. Wow. My doctor cares more about my pet than their ego.

Amelia:

Yes, yeah, I think that vulnerability is such an important thing to highlight in having that vulnerability and sitting with that discomfort a little bit, how that really leads to much better medicine because either we are allowing ourselves to admit we don't know. And so we have that ability to consult and to learn and get curious. Versus if we are so afraid that we just avoid it and then don't tell them and just try to guess, that's when that really can lead to those issues.

Dr. Josh Rosen:

And you have so many resources as a new grad to say that like you feel like, Oh, I just don't know. And this is the end of the world because I have no idea how I'm possibly going to find this out. Say you're working for a say you're in a two doctor practice. So every time you're at work, there is not another doctor present for whatever the way the schedule is working. If you work with reference laboratory the major ones that I'm familiar with offer consultation services even to say that you don't even have to talk to a specialist per se, you might just talk to a diagnostic service veterinarian that is very familiar with Abnormalities and what algorithms should be pursued in regards to abnormal findings on lab work. Even if you find something on your exam, the relationship that you have with that reference lab allows you to work with the specialists that are in their facility. So use those resources. It's awesome to pick up some textbooks and do some reading as well. I think that happens when we aren't in between consults, it definitely takes more time to do.. Um, But a 15 minute phone call in between, appointments, or while someone's getting your intake, like you're not necessarily looking for a thorough specialist consult at that point, but if that's what you're looking for, you can set up a appointment to talk to one. Don't feel like you're alone. There's always community in this field.

Amelia:

So true. Yeah, I found those specialists so helpful and I think even there are some great. Facebook groups, or Vin, I spent so much time on as a new grad and yeah, I think there are so many resources available. And when you don't have that judgment, I think it is more helpful to like, if you identify common themes of where that imposter syndrome is showing up, that can be a great opportunity of pursuing some CE or an opportunity to learn. And I think it. Since we're on that topic for imposter syndrome, one thing that helped me is also just realizing that we all have those thoughts. Like it doesn't matter how successful or seasoned you are. We all will, especially in vet med, there's always going to be something that you haven't seen. And it's not a problem. It's really more like our relationship with those thoughts and I think sometimes it can even be helpful to name. It's like that inner critic, right? You have this just judgmental person who has just judging everything that you are doing. And instead, if you can separate yourself from that, I like to call mine BK for buzz kill, because that's what she does when she shows up.

Dr. Josh Rosen:

love that.

Amelia:

It helps to separate you a little bit so you can just call it out and be like, you know what? I don't need to hear that. Or, this is what I'm gonna do instead.

Dr. Josh Rosen:

It's also acknowledging that there is a subconscious, right? There is this idea that you will make decisions that may not help you. And you may not, at first thought, be able to explain why. And being able to have that self awareness, It means so much in regards to growth because it's not about being a good person or a bad person or you should think this way or you should think that way. It's just simply the idea of what has happened throughout your lifetime that has created this inner critic, as you said, that in a really messed up way, simply trying to just help you survive. And we don't need that anymore. Like we're not out in the wild in regards to being in life or death situations every day. So that emotion really doesn't help us as much as it thinks it should and everyone has it. It's important to acknowledge because if you let yourself think that you're just like it almost creates the idea to say that like you, you let yourself think you're crazy, right? Like I'm so out there that I don't even deserve help or whatever the case is. And it's to say that you're, your concerns and your feelings are significant. Also, everyone has them and that's okay. Because we know how to manage them because of that. And being able to talk about them, being able to have that community is so helpful because it allows you to see that, Oh my God, somebody's had to do this before and they did it and. By golly, there's, they're still alive. And like it, it quiets that voice, right? It allows you to have more inner peace that what you're doing is the right thing. Just a quick example. You were talking about Facebook groups before, and this is related. In regards to Facebook groups, there, there are plenty out there that just to say new grads that are listening that you let them know that you're a veterinarian. They ask you for your credentials and you have to prove who you are in order to get into these groups. So the privacy is considered secure because they only allow in veterinarians, or maybe they, maybe there's to say, there's definitely groups that only allow in veterinary nurses and so on. This example is a very big part of this. This veterinarian posted in there asking a very vulnerable question saying, guys, I got to talk about this because I've been up all night and I can't sleep. And I had a dental yesterday. I did the extraction. I was so confident that I got all three roots out that I sutured the tooth and I left and went into my consult and my nurse finished up The dental and took the post op rads and came over to me in my consult knocked on the door and was like Doc, you gotta look at this and what do you know? There's a retained root and the pet's already waking up and The doc is basically you know what? We're gonna do a dental in a year from now It's okay We'll see what it looks like. It's probably going to resorb and they let the dog go home and the doctor was being vulnerable in the Facebook group saying, I made that call and now I'm having second thoughts. And I'm worried because I know that I know that even if that root is resorbed, it could cause pain, it could cause infection. Am I gonna, am I setting up this pet for those things? Did I do the wrong thing? And there's community response because this person is being vulnerable and approaching a genuine concern that they have. With compassion and saying that I'm bringing this up, not because I want you guys to make me feel better, but because I am genuinely concerned for this pet and the overwhelming response that this person got. And by all means we're all veterinarians. Nobody's going to tell this guy you're 100 percent fine. Don't even talk to the pet parent. It's totally fine. Don't worry about it. There is acknowledgement that. Ideally, that root would have been removed at the time of the extraction. That being said, it's not what happened. And at this point in time, there's nothing that you can do to go back in time and do the thing that you want to do. So you have to leave that right at the beginning and say, those feelings those inner, that inner critic that wants you to feel like a terrible veterinarian because you did this, tell them to shut up because they don't know what they're talking about. Listen to your education. You are coming from the right place and asking this question. You know that root should have been removed. So what should you do? You should talk to the client about it. You should say, I was going over my notes last night and I was reviewing their radiographs and I definitely thought in the moment that we got all of the roots out, but there was a root that separated and it definitely got left behind. A lot of times, especially when we pursue a dental in a year from now, we don't end up seeing that route anymore. Either it comes out on its own or it resorbs and it doesn't cause an issue, but it's very important for you to know because if between now. And 12 months from now when we do our next dental, there's any concern in regards to the mouth, and I can point to you in the area of the mouth that I want you to be, aware of, that could be redness, that could be soreness, that could be pawing at the mouth, it could be issues with eating it could be simply that it looks red to you when you look at it. If there's anything in this area that's concerning after it's fully healed, I want you to let me know before a year from now so we can do right by them. And maybe you have to, maybe you have to do a complimentary recheck or two. Maybe you have to offer a complimentary anesthesia when you go back in to remove that root if there is an issue over the next several months. But let me tell you something, the relationship that you have with that pet parent for the rest of that pet's life will be indefensible compared to all the other relationships that you've made because of that vulnerability that you presented to that pet parent. I don't know of a situation where that has gone poorly because you were honest, you approach the situation, not just to inform them, but to make sure that their pet was receiving the best care possible. That is doing right by the pet. And there's no way that they could look at that any other way. It was an amazing thing to see on Facebook, because to be honest with you, I don't don't see that level of vulnerability too often on Facebook. Um, and, And they didn't necessarily make themselves, anonymous. So it was like, Oh, wow this person's really, they care about that pet, that's why they're talking about this and it's related to all of this, the idea that, you don't have to feel like you are a bad doctor, even if you make a decision that you end up reversing your choice on or thinking that there's a better option moving forward. The important thing is that you always. Take the leap and have that communication that you be brave and be courageous and talk to the client about that concern Because it's their right to know

Amelia:

yeah, I think everything you shared was so helpful, and I think it's a great example of how if we just keep all of those fears and negative thoughts inside that can be that can just weigh us down more than anything. But when we do start to be like, aware of these negative thoughts, or the these things that are like spiraling, if instead, we do share them in a way that is authentic and maybe just whether it's with the client, if you're just going over the facts and trying to, focus on the positive and what you'll do, or if you're allowing yourself to share with colleagues then there is that opportunity to establish safety in your own body to and to feel seen and instead of thinking about all these worst case scenarios that could happen You've at least taken an action and now you get to move on instead of being stuck in this like never ending GIF, you know of just like replaying that one moment that Didn't go as planned

Dr. Josh Rosen:

and the panic just getting higher and higher through each cycle

Amelia:

Exactly. Yeah. And I think what you said earlier is so important to highlight of those negative thoughts, imposter syndrome, that is all about how we've been designed and it's for survival, right? But it's not for thriving. And I think it is important to remember that our brains have been designed to see more negative things than positive things simply because from a survival standpoint That was important for us to see Anything that could be a threat, but that also means that we are often not seeing all the things that we're doing Really well, and so I do think for those who struggle with imposter syndrome or feel like Nothing's going right It can be really helpful even at the end of the day to write down your successes, write down like the little moments that went well and that can even be maybe there was a case where you felt like you didn't know what you were doing, but what did you do about it? Or what did you learn from it? How did it help you to grow? All of those things are so helpful for going back to that growth mindset, right? And not feeling weighed down or paralyzed by those negative thoughts

Dr. Josh Rosen:

Absolutely, and it can be like what if I don't? What if I can't think about any successes for the day? What if I don't think that I had any successes that day? I don't want to I personally think no matter who you are, that you definitely had successes that day. But I also relate to the idea that I have had days where I'm I'm feeling so numb or I'm feeling so irritable that. I could get home and feel like I definitely didn't have any successes today. I do think that, and there's some wellness journals out there that have things like that, that incorporate it. I love the idea of how many noses did I get to boop? If you start there every time, you probably will come up with another success right after that, because it got you to smile and it got you to think about what made you happy that day. Maybe you didn't get to boop as many as you'd like, but now you're going to be thinking about it every time you go to work. Oh yeah, I'm not just here to help them feel better, which is extremely important. Like I do this because working with animals is the best thing I could have ever done for myself. And so yeah, I'm going to take those moments a little bit more to heart and not just a way of through the pages and not realize those precious, you know, uh, second. But also it helps you to say that you don't have to have those successes front of mind, that if you start to write them down, it can be something so simple that I took a walk today during my lunch period, or I got a lunch period today. If that's a success, great, write it down because it will, like you said, build that habit that, that subconscious thought to start thinking about those positives more than the negatives, that's really what you need to succeed is to continue thinking about that not what you could do better at. It's to say there's time for self reflection. Don't get me wrong, but it's not to put you down. It's to grow. If you find that the only time you're self reflecting is when you're putting yourself down, you're going to have a lot of trouble growing.

Amelia:

Yeah. So true. Judgment, it just leads you to dead ends, really. Curiosity really opens doors. And I think if you do find yourself at the end of the day and feeling like you have had no successes, then I think it's important to know that is just a sign that your nervous system is in that freeze or shut down, where you will be feeling just depressed, low energy and low motivation. And that is just a signal from your body that it's been a lot. And that can be a signal to pause and right there do some kind of nervous system regulating thing. I have a free resource that shows how to do tapping, which can be really helpful If that negative inner critic is really loud, even a simple trick is like rubbing your fingertips together so that and focusing on the pressure so that you can feel the ridges on your fingertips. That actually will silence your inner critic because when you do this, it increases the activity in your brain of the task positive network, which is more like positive and calm and it decreases the activity in the default mode network where your inner critic lives and they're like a seesaw. So if you're doing something like just tuning into any senses, like you could be petting a pet, anything like that, then that really is just turning down the volume of. of your inner critic, too.

Dr. Josh Rosen:

because you can't have the volume loud on two parts of the brain at the same time that act in different ways. Yep.

Amelia:

Yeah. Yep. And the more you do it, it's like a little rep for your brain, so it helps to make that positive part of your brain stronger

Dr. Josh Rosen:

Yeah. Is that the same feeling as, like, when you're tapping your fingers together like that?

Amelia:

It would totally. Yeah. Anytime you are just focusing on like, that something feels, yeah, how something sounds, what something looks like, yeah, all of those.

Dr. Josh Rosen:

That's cool. I wonder how many people find themselves doing things like that without even realizing Yeah,

Amelia:

just intuitively so often know, or especially you're like, there's a calming, point like right between our eyes. But I know when I'm stressed, I'm like rubbing right between my eyebrows.

Dr. Josh Rosen:

you put

Amelia:

completely. Yep. Yeah, that's cool. The things that we do.

Dr. Josh Rosen:

It's fascinating

Amelia:

One, when you were talking about like being honest about, that dental scenario, when something goes wrong, one thing that did come to mind is that there sometimes can be those owners who. Who, for whatever reason, it may seem like they're taking advantage of that a little bit, or they may take that and run with it and in the future be like, Oh you didn't do this. Or maybe a new complaint comes up with the pet and they're trying to connect it with that other unrelated thing. Do you have any tips for navigating that? Or, I also think boundaries are just really important if

Dr. Josh Rosen:

that's the first thing that came to mind. And I think that the an important factor here, because this is something that I've thought about throughout my career, whether or not I was in a managerial role or not. If you're a veterinarian and you're not. In a leadership role, per se, this may fall into an area where you do need to rely on either your medical director or your manager of your clinic, your practice owner, because you don't want to speak for the clinic you work for if it's not the message that they want to deliver on the. The leadership aspect to it is to say that in, in situations where anyone seems to be trying to take advantage of a situation, in my opinion, the better you get at clinical empathy, as I say it, or just the idea of compassionate communication, effective communication, You will be better at identifying individuals that either lack boundaries or are very clearly trying to take advantage of what you are trying to do and being compassionate, because there is a very big difference between someone that appreciates what you're doing and someone that just wants more. And that, Does not come overnight. So it's to say that I think that this is a very refined, acquired skill that I personally am still working on to this day. I'm sure the majority of people that work in leadership are constantly working to refine the skill is how do you determine the point in time where a boundary has been crossed? And I think that this is a simple one, to be honest with you, because you are in an effort to communicate with this client and be vulnerable with them about potential error that had occurred. And in reality, I don't really like to use that word. I to use the word complication instead because this is a very common complication that happens when we are extracting a three rooted tooth is that a root gets left behind. It's the same thing in human medicine or in human dentistry. If you look at studies about three rooted or even four rooted teeth, the most common complication is that a root gets left behind. So that's how it should be communicated to the client. You should not be telling them that it's a medical error. Like it's to say that's your emotions being put onto the situation because you feel like you messed up and It's, I don't want you to disregard that. Again, it's very important that you process and feel those feelings, but it's not in the conversation that you have with the client. This conversation is about getting their pet to feel better. And it's important that's what you're communicating. It's, you're not communicating that because of this, we're going to cover the cost of X, Y, and Z because of this, we're not going to charge you for anesthesia moving forward. You're not talking like that. You're having a conversation about. My priority is making sure that they get the best care possible. I will often wait for the pet parent or pet guardian to ask me what if they need a follow up? What if they have to come in for a recheck? And does that mean I have to pay for a recheck exam? Of course you don't have to pay for a recheck exam. We would not charge you that day because I want to see you if there's a concern regarding the mouth. That's the only time that I would waive the recheck fee, however. I would only waive it if there was a concern regarding the mouth, because that's what we're talking about right now. Okay but what if you recommend that we need to go back in and remove that root? What if that happens before the dental that we do next year? So that's a really good question. If I, I think that it would have to be quite, moderate to severe if I decided to go back in before a year from now to remove that one root, but if I decided that it was worth it for their health, I would talk to you about the cost of the extraction of that root tip and not talk and not charge the cost of the anesthesia. Similar to how if we did this in a year from now, you wouldn't be charged for us to remove that, that remaining root. You would be charged for the anesthesia for the dental procedure itself, because we're doing that next year, whether or not that root is still present. And so in a situation where they're pushing and saying okay, six months from now, maybe they have an ear infection and they say, I want this covered too, because you left a root in my dog's mouth. I, I would, in that moment they probably wouldn't say that directly to me as the veterinarian. They would probably have said that to reception when they called or my vet nurse. And that's overwhelming for them because it's to say like, how do you respond to something like that? It's very provocative. They're looking for a reaction to that type of language. And so when you're informed as the veterinarian you have to be able to take that breath, like you said before, be able to calm down your nervous system and be able to say that I can handle this. There's a lot of, there's a lot of feelings out there right now, and that's okay, but We're going to just have a conversation about what it is we are concerned about, what their pet needs help with right now, and I've already gotten a signal that this person may not be willing to have a civil conversation. If they are right off the bat saying that to my receptionist or my veterinary nurse and not someone in management, they are communicating to us that they are lacking boundaries. And that is, that's one red flag. It doesn't mean that we just say, nope, we're not going to handle it. We're not going to care. We're not going to do anything. It just keep it in the back of your mind. And when you have that conversation and you explain to them that. We've had this conversation before that if there is a concern regarding the mouth, we have no problem waiving the cost of the consultation fee. But this sounds like it's a concern regarding the ear and there's not really a concern that retained root would cause an ear infection. So you need to understand that minimally you're going to be charged the exam fee today and whatever diagnostics and treatment recommendations the doctor has. If they respond to that saying, okay, I understand. That makes sense. They've had their moment to recollect themselves and recognize that whatever it is, that's not involved in this current situation is causing them to behave in a way that is a little bit outside of the realm of what we consider civil and they've collected themselves. They're in a better place. We can move forward. Forget about it in the sense that we don't need to worry about it right now. I still keep that in the back of my head, because if this is a, if this is a pattern and it's something that we continue to do, that's where having the conversation around, do we need to continue care and in this level at our facility? Because it's if they are continuing to try to harass different employees in regards to the cost of their care. It gets in the way of the care of the other pets that you need to be able to take care of. I don't think that, you know, we're talking multiple times a clear pattern that's documented. There's a lot that goes into something like that, but, um, there's definitely a clear difference in a situation like that, that somebody is trying to take advantage rather than say, advocate for their pet.

Amelia:

Yeah, I love how everything that you share, all these strategies are really giving the pet parent lots of opportunities, right? To like work through their emotions and then for in the end, us to be working Together, and it is about like showing your positive intention and just building trust and mutual respect. And so I think that this, everything you've shared is great because the more that you put this into practice, the more Easy it is to identify those individuals who just aren't a good fit for the practice as well. And where a boundary does need to be made just because there is not that mutual trust and respect that you really need, right? If you have done everything that you can to work towards finding solutions and helping their pet, but they're just looking for opportunities to take advantage or don't have that trust, then it's like nothing good comes from those relationships.

Dr. Josh Rosen:

Absolutely. Absolutely. And it can be something that's a little bit less straightforward. Like maybe every time they come in, they give that problem. But as soon as they see the vet, it's all fine. They'll do whatever that can eventually become an issue as well, because what's going to happen is that your team is not going to want to work with that individual because it feels like a waste of time for them to go in, have the argument for the doctor to just go in and them say, okay, do whatever the doctor says, that is a lot more Complicated because it may not be a breach of a boundary, but it's to say that often boundary issues start small. It's it doesn't often come from a place where, oh, this is out of nowhere. It's often from allowing small intrusions of that boundary over time.

I'm popping in for a moment just to say that this is a great example of why we need to establish a zero tolerance for bullies policy in vet med. If you listened to the last episode about the seven traits of a unicorn, you know that the R in unicorn stands for respect. And mutual respect is absolutely critical between the veterinary team and the pet parent. So if you're interested in diving deeper into this topic, and for more support in that area, Listen to the No More Bullies video in my free Beat the Burnout resource, which is also race approved for four hours of CE. Because I think it's so important that as soon as we recognize disrespect, starting at the support staff level, we make changes in order to show that that is not acceptable. We pause and get curious about what needs to happen in order to re establish mutual respect or we create a boundary. Because if you're in a workplace where you don't feel safe and supported by your team and where disrespect from clients is tolerated and accepted, then there's no way that that can be a sustainable environment. Okay, back to the conversation.

Dr. Josh Rosen:

And it's important that as you're working with your skills and empathy and compassionate communication that it's not the same thing as people pleasing. You don't have to, the goal is not for them to just leave happy. The goal is for you to support them. And so the end result is that the pet gets the care they need and therefore the client leaves happy. There are many ways that a pet parent can leave the clinic happy and a pet not happy. And that's not what clinical empathy is about at all. It's very important to note that it's not people pleasing. It's very important to distinguish the two.

Amelia:

Yeah, I think that is so important to distinguish tuning into your energy can be really helpful for differentiating like after that interaction Are you just feeling like resentful or drained or just this heaviness or Do you feel a lightness or like you were able to navigate that conversation in a way that felt better? That can be a good way to differentiate.

Dr. Josh Rosen:

Absolutely. And as you work on those skills and you get better at forming those boundaries for your pet parents, you may notice that some pet parents start to work with other veterinarians in the clinic. And maybe it's not to say that can sometimes be hard and it can be like, oh, but I really liked that patient. And sometimes it can be like, oh that makes sense. And neither one is good or bad. It's just having self awareness that wow. My boundaries adjusted a little bit and these clients weren't happy with it, which, which is interesting. It's, it creates curiosity. It, it reinforces why learning about these things is so important.

Amelia:

Yeah, absolutely. And I think that self awareness is great for finding your best fit clients. And I know that's one thing I hear with clients a lot, like even if it is a difficult client, if you find out that they have chosen another doctor or maybe they don't want to see you, it can feel so personal and it can feel, yeah, so disappointing. But I think that those are times. To, really just focus on maybe them choosing someone else is a success, right? And just being extra kind to ourselves, noticing those normal human emotions. It's great if everybody likes us, but also it goes back to finding what's sustainable in this career and the more you want to be working with clients who want to be working with you too.

Dr. Josh Rosen:

Especially when you first graduated, it's so easy to think to yourself but I want everybody to like me. What do you mean? I. I want every single client to come in here and leave and say that they love their experience with me. Yes, that would be amazing. That would be the best thing ever. The fact of the matter is that you're not going to go to Starbucks every day and get the same experience, even though that's what you want as the consumer. And it's not personal. It's not that individual. I think it's a poor example, because I don't mean to create the analogy between a corporation and vet med. I think that it can be very personal, even though you may be seeing different people in a multi doctor practice. We're all human beings. Like we, we don't want there to be robots in these roles, right? There is a reason why we are the way that we are, but we do need to understand that it's okay if a client doesn't like your methods, I'll tell you right now, um, it's funny to me to a certain extent, but I would be lying if I told you that it didn't get to me sometimes is that the obvious thing is that pet guardians for me that, that may prefer to see the other veterinarian in a clinic that I'm working at are pet guardians that want their doctor to walk in and say, Oh, we're here for vomiting. I'm going to do x rays. I'm going to give some treatments and make them feel better. I'm going to write the instructions down for you just so that you know what to do at home and just give me a call if there's any questions, have a nice day, be out of the room in 60 seconds. And that's it. They're just going to do whatever I say. And that's great. I think that it's so funny because I think that a lot of veterinarians, that's the perfect situation is that you walk into a room and that you just make your recommendations and they do whatever you want. And then you get to leave. I also think that. It's so hard for me to have those cases because I go into the room and I'm like, no, but I want you to understand why I'm doing these things. I've spent so much time learning all of this stuff. Don't you want to know why? No, I just want you to go away so I can go back on my phone. Okay. I don't know what to do now.

Amelia:

Yes! And that's such a great example of tuning into the parts of Vet Med that are most fulfilling for you, and that give you energy and finding what is your flavor of Vet Med and what works for you, because we all have different styles.

Dr. Josh Rosen:

And those clients that know me will often come in and just say I get it, Dr. Rosen, but let's just do whatever you think we got to do today. And it's funny, it's just a humorous situation because you can't be everyone's doctor. Like you can be there for everyone. Again, you should be there in regards to if there's a client that has a relationship with a colleague of yours. By golly, you should be there for that pet, right? But you're not gonna be the same doctor to that person as their primary care physician is and that's okay. The same thing would be the case for you.

Amelia:

Yeah, absolutely. So many good points. I feel like our time together always just flies by. And I think you really covered so many good tips and hopefully from this conversation, everyone has so many takeaways, but also just a reminder This is all trial and error, finding out how this works for your style of practicing, noticing the days when you feel fulfilled and you have a good boost in energy and collecting data on what things contributed to that, the days that do feel really heavy or you feel weighed down or, Feel depressed. Just getting curious about that and being extra kind to yourself and just that emphasis that we're all in this together. And so the more we can all just support one another, have conversations like this. I think the more we can work to make vet med fulfilling and sustainable.

Dr. Josh Rosen:

I couldn't agree more. I couldn't agree more. Let's all do better to be kinder to ourselves and give ourselves the space to process the difficult world that vet med can be sometimes and also celebrate the victories that we have every day. Because if we're struggling with certain things, we always have to remember that we are succeeding at more.

Amelia:

Yes. So true. So thank you so much for being here for part two and as a reminder, where can people find you?

Dr. Josh Rosen:

Thanks so much. It was a pleasure being here again, happy to come back anytime. If you guys are looking out for me, I'm on Instagram@dogtorjosh, that's D-O-G-T-O-R-J-O-S-H on TikTok as well. You can find me www.dogtorjosh.com or email me at josh@drjosh.com.

Amelia:

Awesome. Thanks so much.

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