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Surviving Veterinary Medicine

Dr. Nancy Bureau and Her Bond-Centered Practice

Surviving Veterinary Medicine. Be smart, be bold, be creative and be your own boss. At the very least, find a practice where you can do what you do in the most positive way that gives you the space to practice medicine as you see fit. Because at SVM we set a higher standard for medicine than what you learned in school.

I’m your host, Dr. Narda Robinson, veterinarian, osteopathic physician and leader of the Vet Med Revolution, calling for safer, gentler and more effective medicine for animals and their people.

Dr. Narda Robinson (NR): Hi, everybody, thanks for being here today to Surviving Veterinary Medicine. I’m so happy to have a friend and colleague here, Dr. Nancy Bureau, and she’s going to discuss her bond-centered practice, bond-centered care, in Niwot, Colorado. So, thanks for being here, Nancy.

Dr. Nancy Bureau (NB): You bet. I’m happy and honored to be here. I’m Nancy Bureau. I am a veterinarian and co-owner at Left Hand Animal Hospital in beautiful downtown Niwot, Colorado. I say it that way. Niwot is a very cute town. It personifies Americana and it has all of two thousand amazing people in it. And my business partner and I, we have a practice there.

There’s six doctors and a team of twenty five of us total that are there and we have a bond-centered practice and that’s why we are able to be a practice of this size in an amazing town of two thousand people. Most of our parents come from outside the community and come to visit us because of who we are and what we do.

(NR): I didn’t know that and I didn’t know how big you’ve grown because I know every time you come teach for us at the Medical Acupuncture for Veterinarians course you’re looking to add people. I mean, like several of our other docs. But boy, you are just growing.

(NB): Yes. Acupuncture, honestly, is a huge piece of our practice. It helps drive our practice and it helps drive our practice in lots and lots of ways. And one of those ways is through bonding our pet parents to us and to our nursing team and honestly to our reception team. So, we integrate acupuncture into virtually everything we do, whether it’s seeing someone for mobility problems and challenges, internal medicine cases, wellness cases. A lot of our pet parents really appreciate our whole body, whole being bonded approach to their family members, their furry family members.

And so even wellness exams we talk to parents about, “Hey, here’s the subtle differences we’re seeing from the last time we saw your best friend. And here’s the things we can do to help make sure that you and your best friend have years and years of healthy time together.”

(NR): Yeah, even saying best friend, that makes me start to tear up and not to interrupt your momentum, but I think that whole best friend concept is so important now, with 2020 being all a pandemic and then we have societal upheaval and everything, and even though there’s, I think, pressures from all around, that it’s when you come back home and you have this one being who’s a constant that you’re so bonded with, it just puts that whole lifeline for some people front and center. So, it’s like you’re right there. It’s a societal aid for you to strengthen and protect that bond.

(NB):Absolutely. I think the pandemic in particular has brought forth a whole lot of things that we didn’t expect. And one of those things is how important our furry family members are to us. They let us do a whole bunch of things. They get us outside. They get us to meet our neighbors, because right now, a lot of us, the only social interactions we’re having are with our own family or with the people right next door to us, and though we’re all being socially distant, you can still wave hi to your neighbor and say, “How’s Fluffy and how’s Bob?” and stuff like that. And then you’re exactly right. A lot of us, especially during pandemic times, are super, super, super stressed. And there’s a whole bunch of wonderful, wonderful studies that talk about how much animals help us as humans decrease our cortisol levels, our stress ratios, and help us rebalance and refocus as to what’s important in this world.

(NR): Yeah, so how does that play out as a bond-centered practice?

(NB): Acupuncture helps us a lot as part of our bond-centered practice. Honestly, clients are happy to talk and share with us, which is good for them. Right? It’s good for them to have an outlet to be able to say, “Here’s what’s going on in my home. Here’s what’s going on with my pet.” And so that helps them and helps us understand what’s going on with their pet at home so that we can do a better job as a veterinary team. And honestly, most of the animals really love coming in, and that’s part of bond-centered practice. It’s not just a bond with the pet parents, it’s the bond with the animals and the pet parents see that. They see that their animals are happy to come into our practice and they therefore bring their animals in a little more often. They make sure that their animals get the care they think they need and want, which is great. And it’s great all around for my team also because my team builds bonds with those animals and with those families, those human families.

(NR): Right. I bet they build bonds with each other more in that context of an open hearted, or whatever it is, that it’s so different than one of these big box places, I would think.

(NB): Yeah, it’s really nice because, you’re right, the team I work with, they develop these great bonds with each other as team members and they develop these wonderful bonds with the pet parents and with the pets. And it works out really well because it’s a win win win all around. I’m all about win win win situations, but it works out as the pets get great care. The pet parents feel like they’re understood and listened to. The team does what they do best and what they want to do. We all come into veterinary medicine because we want to help the animals. And so the team gets to do that. As part of bond-centered practice and bond-centered practice encourages the team to do that. And then at the end of the day, my team goes home and they’re like, “Hey, I had a really good day.” And that’s a good thing for lots of reasons. It improves how they feel about their jobs. It bonds them to us as a practice. It’s great because it keeps the team bonded to us and helps with not having as much turnover in veterinary medicine. Veterinary medicine is fraught with high turnover and it really does help with their compassion fatigue because they know they’re actually there to help the animals. So, that helps decrease their compassion fatigue. It helps prevent burnout because they know that bond is there.

(NR): Yeah. How long are your appointments typically?

(NB): Our average appointment time honestly is about forty minutes. And I recognize that for some practices, that’s just not a model that works.

And you can still build bonds with smaller appointment times. We enjoy and appreciate the longer appointment times. I say “we,” my whole team does. The doctors really appreciate it because it allows them to talk with the parents, ask other questions about how is the rest of the family, how’s things going if we’re seeing one dog and we know they also have cats in the family, how is the dog getting along with the cats, and vice versa? So, that way the pet parents know we’re here to listen to them and help them. And those longer appointments help decrease our stress overall as a team because instead of it being hit the ground go running as fast as you possibly can until the end of the day, it provides a little bit of a buffer time, a little bit more time. And those longer appointments help us to build those bonds with those pet parents. Overwhelmingly pet parents will tell us, “Thank you. I really feel like I got a lot of information out of this visit and I really felt like I was listened to.”

(NR): Oh, wow. Yeah, it must be night and day. And I’m so glad that people can find you and that you’re there. How did things go, how did you arrive where you are from the time of vet school or before? And did you anticipate that this would be where you would arrive to or what was your evolution to this place?

(NB): I say I’m blessed as a veterinarian, but honestly, I actively worked for this. I set out from vet school to find a practice. All of you vet students go find the practice that’s a good fit for you. Don’t just take the first job. So, that’s a whole other topic. But I actively sought out a practice that would allow bond- centered practice and then we evolved from there. I have been a veterinarian for a very long time. It’s got to be over twenty years now and I was blessed enough to find a veterinary hospital and mentorship that encouraged, “Hey, look, you want to be able to have that bond because that bond actually turns into again a win, win, win situation, it ends up as best care for the animal. Great care for the pet parent and it allows the entire team to do what they do best.”

And as an extra win, it ends up creating a lot of revenue.

Those pet parents end up bonding to you, not just for the pet you’re seeing then at that moment, but also for all the other pets they might have in their household and also for the next generation of pets that they’re going to have. And it works out great because they go and they talk to their family and their friends and other people and talk about, “I love my veterinarian.” Oh, my gosh. Who can say they love somebody that’s a professional in their lives? Just just yesterday I was talking to a pet parent. We were just chatting while I was doing acupuncture on her dog, and in coronavirus times, we do all this by curbside. So, I say it was chatting, but I was talking by phone with her while her dog and I were in a different room. And she was saying she was just at her banker’s office the day before. And her banker had asked, “What do you do for a living?” And she explained what she did for a living. And she said, hey, her dogs are really important to her and that she and the banker got into a conversation about her dogs. And then as part of that conversation, she started talking about my dog’s love going to my vet. And the banker said, “What do you mean, your dog’s love going to the vet?” And she got into this great conversation about actually my pets love going and they can’t wait to get there. And because they can’t wait to get there, we go every time they need something. We don’t always just wait things out. And so she made sure to give that banker my business email and my business phone number and maybe we’ll end up seeing that person. Many, many times I meet parents that do that. And really a lot of us, when we meet someone we don’t know very well, our banker, the person that’s checking us out at the grocery store or stuff like that, we talk about kids and pets, right?

So, think of all the opportunities that all of each of our clients have when they’re talking about their pets with somebody else. And if they can also say, “Hey, I love my veterinarian, my pets love my veterinarian,” that’s a great practice builder.

(NR): Right, right, right. And when you said just to prevent burnout and compassion fatigue, I mean, there have been studies on physicians anyways that when a position is stressed or depressed, that they don’t practice medicine as well. And so, yeah, so it’s not only like the experiential thing of being at a place that is bond-centered, but also without that stress and with that joy of what you’re doing, that you’re offering better medicine, better diagnosis, more expanded treatment options, and not just feeding some corporate master that says you have to refer for surgery as much as you can and run up the bills and everything like that.

(NB): Honestly, for us, as part of bond-centered practice, it sounds odd, but we regularly tell pet parents, I don’t care where they go for care or help. My job is to provide care and help. And if it’s not with us, then that’s OK.

And if we can help them get to the resources that they need and want, then just tell us what they need and want and we’ll find them that resource. One extra step on my team’s end, but again, it helps them do the thing that they do best. It helps them to be able to provide care. It also helps, again, decrease their compassion fatigue because they know it’s not just about “you got to make the dollar, you got to make the dollar.” It’s about providing care. And from a business perspective, it makes sense. Those pet parents, when we say, “Hey, you know what? You can get this medication cheaper at Walgreens than you can get it from us” or something like that. Those parents say, “Whoa, you’re not here to make a buck, you’re here to help.”

And that helps, because then later, when I say “Your pet needs some bloodwork or your pet needs an ultrasound,” or something like that, they’re more likely to do it because it’s obvious that we’re not there to make a buck.

So, it sounds odd, but from a business perspective, part of our bond-centered practice is to do what’s best for that pet parent and for that pet. And that ends up actually earning cash in the long run, even if initially the cash is not with us.

(NR): Right, right. Anywhere I go in town just locally, it’s like I would rather purchase it there, if there was a need for antibiotics or something like that, I would rather buy it in the place where I feel good. And it’s like I want to support this establishment.

(NB): We have a lot of parents to do that, that even though we tell them, “Hey, look, this medication is cheaper here, cheaper there, stuff like that, or, hey, we’re happy to say your adorable six month old fabulous golden retriever and the Humane Societies, locally for us, do a good job and are much more cost efficient A lot of our parents say no. They want their animal friend with us because their animal friend likes us, loves us, they trust us and the pet parent trusts us. And they’ll say, “You know what, I’d rather have you do these services or provide these medications or provide these supplements” because of that trust that they have with us.

(NR): Right. Right. Well, and I would think that that transforms into a physiological thing if the animal feels better and then whatever resonance there is with the person as well. But just that psychological factor, whenever you go into a place, I mean, their ability to heal will be better when they’re feeling safer.

(NB): Absolutely. Honestly, from a medical perspective, any of us know that if your cortisol levels are lower, your tissues are better able to heal. And so that’s a great thing. And if the pet parent’s cortisol levels are lower then those pets are less stressed. So, it’s about the pet parents and about the pet. That same pet parent that I was chatting with yesterday was talking about that. She was saying she’s not stressed about bringing her pets to the vet and that helps a ton for her. And she knows that it helps for her pets. She remembers quite vividly that she used to be stressed when she would take her pets to the vet. And she said it was a totally different experience. Her dogs used to be whining and nervous and anxious in the car. And now her dogs, they’re still whining, but it’s because they’re happy and they’re saying, “Why can’t we get there? Can’t you drive faster? Let’s go. Let’s go.” Which is so, such a different experience for her and for her dogs. And she’s ecstatic about that.

(NR): Right. Right. Yeah. And another difference between you and maybe other places is that you have integrative medicine there, too.

(NB): Absolutely. We use integrated medicine as part of that whole idea to keep that bond going. That for us, integrative medicine helps a whole lot, because that way we can talk to pet parents about multiple different options. And pet parents don’t feel like we’re pushing anything. They feel like they’re part of the decision making process and that they can say, “That’s not my belief system,” and we’ll say “Great, how about this other option?” whether they’re people who prefer Western medicine and we say, “Hey, do you want to think about acupuncture, supplements, herbs, stuff like that?” And they say, “I’m a Western medicine person,” and we’ll say, “Fine, let’s chat that way.” Or whether they’re people that would rather not use Western medicine and then we can have an open discussion with them about choices that way also.

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(NR): I’m curious what you do like in the following. I want to also just get back to the inviting people to go elsewhere, if they need their drugs elsewhere, there’s been a couple of times during my veterinary practice as well as my human, but I remember more vividly with a veterinary thing where I just was not getting along with the client, and that’s when I kind of fired them and invited them to go elsewhere. And I don’t know if that happens with you, but it does go into this next thing I was thinking where one of these people was so just devoted to just really nonsensical, irrational, holistic stuff. And you might face it more in the environment, the Niwot-Boulder connection. Not that there’s anything wrong with that. I practiced in Boulder and I loved it, but she came in with her hair analysis sheets with supposedly diagnose the animal based on hair cutting. All kinds of things.

There’s been a place where I’ll go up to here, if you want to talk to me about Reiki and blah, blah, blah, and I won’t challenge you. She was just so angry. So wondering if you see that.

(NB): So, I tell a hilarious story. It’s true for me, but it is a story. There’s no facts and it is truly just a story.

But I remember absolutely when I was a much younger me a long time ago, I was a veterinary technician and I got a job with a veterinarian who did a whole lot of acupuncture. This is a long, long, long time ago. And I remember kind of being like, “I don’t know, acupuncture? How does that work?” and I remember absolutely thinking, I totally get it. I get why people would answer to acupuncture. You go see your people acupuncturist. You lay down on some warm, lovely, cushy, fabulous table, someone plays some lovely music, or there’s a water fountain that’s trickling in the background making beautiful sounds. They put some needles in you and then they walk away and you get a nice nap for an hour. Who doesn’t feel better after that? Who doesn’t? That’s great.

And then I remember seeing acupuncture in the animals. And I was astounded because those animals, they should not know that. And it’s not the same experience for them. In our animal friends, typically, there might be nice music, maybe there’s not. The practice I worked in that I initially saw acupuncture was a busy practice. There was a lot of noise, a lot of animals coming in or out. In the background the nursing team would be playing like rock music, stuff like that. Stuff that’s not really animal-tastic necessarily. I’m sure there are some animals that really love rock. And still, those animals would get better. And what really shook me was, I remember this really vivid case for me of a dog that had a foreign body and the pet parents were thinking about euthanizing rather than going to surgery. And they were like, “Look, she’s already 10 years old. She really has a hard time with the stairs. She really can’t get in the car, in and out of the car without assistance. And she just swallowed this tennis ball. And you’re telling me it’s going to be X number of dollars to go ahead and go to surgery?”

And as part of what that doctor did during surgery was to do acupuncture. So, that dog was anesthetized. That dog did not know that acupuncture was performed. That dog woke up, and remember, this was a long time ago when pain relief was not very good, it wasn’t done very well. We’ve all learned a lot in veterinary medicine. And that dog woke up from its gastrotomy and was leaping around its kennel. We have to call the pet parent and say, “Your dog feels really good. You gotta come get her. She’s not staying overnight. She’s going home now.” And that pet parent took that dog home and said “She feels really good. She’s racing up and down the stairs.” And she felt really good. And she was told, “Hey, look, you need to come back in probably five days or so for your next acupuncture appointment.” The dog felt great, took out the stitches. And I remember three weeks later, them calling and saying she can’t climb the stairs, she can’t get in the car again.

It’s because they didn’t come back for acupuncture and then they came back and let us acupuncture that dog again. And she felt amazing again. And so it was hugely vivid to me to see that. So, when I have pet parents, and the rest of my team is counseled not to judge pet parents as part of bond-centered practice, we don’t know everything about everybody.

And so when I think of different modalities, so long as it’s not harmful for the animal, if it’s not going to hurt someone, or it’s not going to replace other adjunctive care that could be done, we tell the team, “Look, there’s so many things in the universe that I do not know, and there’s so many things in this universe that I can’t explain.” Just like the younger me could not explain acupuncture. I can now because I have all of that education and knowledge. But oh gosh, I couldn’t then. And maybe there’s other things in this universe that we all will learn more about as time goes by. So, we tend to try to counsel with pet parents.

And if there’s a challenging pet parent that we’re like, “We don’t know about that,” we’ll talk about, “Hey, we’re here to support you. We’re here to partner with you as part of bonding we’re here to partner with you. We’re here to make a team.” So, whatever the animal’s name is, if the dog’s name is Fluffy or the cat’s name is Fluffy, we’ll say, “Hey, we’re part of Team Fluffy now.”

So, what is going to be best for Team Fluffy? What can we do to support Fluffy as part of Team Fluffy? And maybe it’s some things that we don’t understand. Maybe it’s a bunch of things we do understand and we can pick and choose from multiple modalities to come up with the best plan for Fluffy.

(NR): Yeah, yeah, that sounds very good and workable, I guess one thing where that might get tripped up could be, “Well, I’ve been to the animal communicator and Fluffy says she doesn’t want her antiepileptic meds anymore,” which I can understand, I guess. But so when the spirit guides talk to the psychic and the animal spirit guide supposedly talk to the psychic as they come up with a different recommendation. I guess that could be challenging. I mean, it can be navigated set up a conference call, I guess.

(NB): For us, part of  bond-centered practice, because we have that gift of time, when a pet parent says something like that to our team, we actually ask a couple of questions. We ask, “What did the animal communicator actually say?”

And if they can tell us that, then we can say, “Look, are we sure that Fluffy saying she doesn’t want her anti anxiety meds, or is Fluffy saying she doesn’t like the way she feels with her anti anxiety meds?” I can work with that.

Or is it that Fluffy says she doesn’t like all the doctor visits that are involved in her antiepileptic medicines? OK, I can work with that. What did they actually say? And then I’ll tell the pet parent, “Why don’t we try this? (Whatever the “this” is), “Would you mind going back and talking with your animal communicator again and saying, could this be an interpretation of what your pet was saying?” Usually that works out pretty well. I’ve had a few pet parents that say, “Nope, that’s not it. This is what my pet said.” And I’ll say, “OK.” And usually those pet parents, because I phrased it differently, they usually just won’t come back. I’m not trying to be mean, but they’ll fire themselves because they wanted someone to either fight with them or they wanted someone to absolutely agree with them. And if instead we say, “Hey, let’s go back and let’s just check this out, could you clarify this with your beloved pet?” and it’ll open a door for them.

(NR): That’s great. How did you learn? Like, where do you go to learn about becoming a bond-centered practitioner?

(NB): You don’t.  You become one, you decide. I encourage other veterinarians, just pick one or two things that would allow bond-centered practice. Acupuncture absolutely is one of those. My doctor team, the doctors that do acupuncture talk about they love being able to do acupuncture as part of a bond-centered practice, that literally acupuncture kind of drives you towards a bond-centered practice because you have a little bit of extra time hanging out with that animal. You’re hanging out with that pet parent. You can talk about the weather. That’s great. Or you can talk about whatever else you want to talk about and you’re probably going to talk about pets and kids.

(NR): Because you can’t talk about politics and religion.

(NB): I don’t, but some of our doctor team actually does, and that’s OK, and especially as you build that bond with those pet parents, honestly, a fair number of our doctors actually are friends with their clients and interact with them socially outside the practice, which is wonderful. And so it ends up working well to have acupuncture as part of bond-centered practice. So, you could do that if you’re an acupuncture certified veterinarian, just embrace that extra bit of time that you have with each of your acupuncture appointments and utilize it. Ask how’s the rest of the family. Great question. And parents will be shocked that you’re asking and they’ll answer you something. Maybe they’ll answer “fine” and that’s OK.

Or maybe they’ll tell you something. And the conversations I have with parents about how their kids are doing in school or the ups and downs of their personal jobs or their own families or the other pets in the family. If you don’t want to talk about how the rest of the family, you could talk about how is the rest of the pet family. Those things can help with being a bond-centered practice. Other things are we empower our reception team and our nursing team to ask some of those questions, “How is the rest of the family? Hey, what did you guys do for fun today? Hey, what do you guys do for fun when you have time together, you and Fluffy the dog, or you and Fluffy the cat? What do you do for fun? What’s the favorite game for Fluffy the cat?” It doesn’t have to be that you ask about the humans necessarily.

You can ask questions about the animals and you can ask what seem like non veterinary questions like, “Hey, what’s their favorite game to play?” Or something like that. But that does help me as a veterinarian a whole lot, because as a veterinarian, if I know that, hey, Fluffy walks six miles a day or Fluffy used to walk six miles a day, but now they’re down to one mile a day, then that helps me ask questions. Is it because Fluffy is painful? Is it because Fluffy’s being overfed and is getting obese? Then I want to have a conversation about that. Or is it because something’s happening at home? The pet parent’s job changed and now they need to allot of time differently.

And a lot of parents then have thoughts and emotions and guilt about things like that. And we can come up with, “Hey, I totally get it. You used to work a 10 hour day and now you work a 16 hour day and you still want to spend valuable time with Fluffy. Why don’t we come up with a couple of things that you and Fluffy can do that are one minute or three minute games or one minute or three minute fun things you can do together?”

And that helps a lot because then the parent says, “Oh, my gosh, you’re in it not just for the cash, you’re in it to help me and help Fluffy have a great life.” That we’re invested in their bond with each other.

(NR): Right. Right. And your life, it sounds like from the get go, you have been in a really healthy practice environment. So, it’s not like you had to escape corporate.

(NB): I did not. I elected to join a private practice and grew with that practice for quite a long time. And then my business partner and I started Left Hand Animal Hospital a few years ago and started as a two doctor, one and a half team members. I know you can’t really have a half a team member. And now we are who we are. And it’s been a journey. It’s been a lot of learning and we’ve made sure to keep bond-centered practice stable through all of that because it gives us a place for all of us as veterinary professionals, the reception team, the nursing team, the doctor teams, it helps all of us come back to that central point. Why are we here? We’re here to help the animals.

(NR): Right. And didn’t you just expand? 

(NB): We did. We were leasing a place for the first five years of practice and our practice grew. And we were able to purchase a building in that same adorable teeny tiny town and convert that building into a veterinary practice for us. And truly, as part of bond-centered practice, we actively, as part of our as part of converting that building, we did a bunch of things. We actively reached out to the neighbors and said, Hey, we’d like to be part of your community. Would that be OK?” The neighbors at first were kind of shocked and surprised and it really helped because that way the neighbors literally were on our side as we did construction. Truly, as we did construction, we abided by what the neighbors wanted. The neighbors wanted us to start work at a certain time of day and end work by a certain time of day. We absolutely did that, which sounds, again, like it was not a good choice, but it worked out really, really, really well, because that way, again, the neighbors were very happy to have us move into their neighborhood. And as part of converting that building, we actively worked with an animal architecture team, Animal Arts is their name, and made sure we explained to them our practice philosophy and that we were a bond-centered practice. And the first design they handed us was like, hey, this place is going to look like a house.

It’s not going to look like an animal hospital. So, when you come up to Left Hand Animal Hospital looks like you’re walking into someone’s home. That also does help the animals a whole lot because their first experience is not “Whoa this looks like a commercial building. It looks like a house.” And so a lot of the pets are more willing to come in.

As part of a bond-center practice, we hired a landscaper who again would have the landscaping be environmentally friendly. So, water conserving and would be pet friendly. So, no stabbing things. There’s no rose bushes on the property, for instance, because you can’t have that.

And there’s no grasses that have seed pods to them because those become foxtail. Here in Colorado, we talk about the foxtail grass that the animals get stuck between their toes or their ears. And it helps as an educational programming so that pet parents, as they’re waiting for their animals, they can walk around the property, check out the plants. Some of the plants have signs on them saying it’s this kind of thing or that kind of thing. So, they can then go home and say, hey, we want to build our own yard to be environmentally friendly and pet friendly. And in a weird way, that does increase their bond with us also, because they know we’re there to help them with their pets and give them ideas of what they can do with their own yards, stuff like that.

(NR): That’s so good. I think it was Gandhi that said “Be the change you want to see in the world,: or somebody, you hear that, and just your level of compassion and concern for others is so precious, and ideally, contagious to others, because it just puts you in a different frame of mind and is, I think, just positive because it feels good to be in that space.

(NB): Yeah. The pet parents, when they come to Left Hand Animal Hospital, they say that regularly. It literally feels different when they walk in the door. The reception team always greets them with a smile. A lot of times they know, because it’s a bond-centered practice, a lot of times they know those pet parents’ names or they know the animal’s name. So, they’re not saying, “Oh, you’re here for an appointment. Who are you and who are you here to see?” Instead it’s “Mrs. Jones! You’re here and Fluffy’s here. And this is great. And we haven’t seen you in a couple of months. And how are things going?”

In coronavirus times my reception team does say that this is different. They say the big thing they actually miss is that one on one interaction with the pet parents, because a lot of things now are done through either email, phone, Zooms, stuff like that.

(NR): Yeah, yeah, yeah. I can visualize that reception area and how the animals are more relaxed. And I think that that itself lends to doing a better job with diagnosis because they’re not rigid. And when you get to your palpation, you’re palpating an animal that is not in a heightened state of anxiety, which changes so many physiologic factors and somatic pieces.

(NB): Yeah, the majority of our dogs love coming in. They usually are dragging their pet parents in or dragging the nurse during concierge service. And the dogs come running in, we teach the dogs, you come running in, you jump on the scale, you get a snack, you go running into your exam room. There’s dog beds there, there’s toys, there’s snacks.

But that does absolutely change their physiology and lets us actually accurately diagnose what’s happening in them. So, instead of it being, “I don’t know, are you just worried and tense and that’s why your belly is so tight or is it that you have abdominal pain?” We can more clearly identify that. Never mind the animal who is lame. And when any of us are in a heightened anxiety state, we will be less lame than we were. So, it helps us absolutely with our diagnosis for those animals to be more relaxed and for the pet parents to be more relaxed.

(NR): So, it sounds like it’s very successful, very busy and growing, but you still have to take care of yourself and pace yourself. So, I’m wondering, do you decide how many days you’re going to work and not work? And then you have outside activities that you do. And I’m also curious if you perform euthanasia, because I know that would just disintegrate me. So, that’s not something I can do. But is that part of what you offer?

(NB): Absolutely. Yeah. Yeah. We’re honored to be able to help some pets pass. Euthanasia can be sad, but that doesn’t mean it has to be bad. Right? So, we encourage the team, whatever emotions they have about euthanasia, feel free to express those. It’s not bad to cry in front of a client. Just know that some clients may not need or want that. And so we try to feel things like that out ahead of time.

If the pet parent, because we’re a bond-centered practice, if the parent, wants a particular nurse there or doesn’t want a particular nurse there, we try to abide by that. If we can’t abide by that, then we tell the pet parent up front, here’s what we can and cannot do. And euthanasia can be a gift. Veterinarians, we’re taught that in vet school it can be a gift. So, we try to approach it as that. So, absolutely, we do perform euthanasias.

The hardest part, honestly, probably is making sure that the team doesn’t get overworked. Because we are a bond-centered practice, there’s a lot of emotion that’s involved. And instead of squashing that emotion down, we encourage the team. It’s OK to express it, just express it in healthy ways. Each of us expresses emotion in different ways. Some of us use language, some of us use body gestures, some of us swear or kick or scream or whatever. And some of those things may not be appropriate in front of a pet parent. Maybe they are, maybe they’re not. So, we let the team know it’s OK to do that. The team is absolutely allowed to refuse to participate in any activity that they don’t feel is right or that they don’t feel up for.  So, our team members are allowed to say they don’t want to participate in that animal’s euthanasia or in euthanasia at all on a particular day, because that’s the day they’re having or they’re also allowed to refuse if they don’t want to take part in chemotherapy or certain surgeries, things like that, if that’s not in their belief system and that’s OK, or if it’s just how they’re feeling that day. And the hardest part really is making sure that the team takes care of themselves. So regularly we have compassion fatigue programming within our team. So, every month we have a few minutes that we talk about that. Initially those conversations were super hard to have. They were hard to have for all of us as management. They were hard for the team to have because they were like, “Should I really be expressing this to my boss or to my coworkers?” Things like that. But as the team gets more comfortable with it, it’s a lot easier. And at all of the technician meetings, all of the CSR meetings, they have opportunity. There’s a space, a time set aside saying, how’s everybody feeling? And the hardest part is to make sure we take care of the team. We run our practice, as part of bond-centered practicing, based on our core values and a couple of our core values are kindness and compassion. And part of that means being kind to each other. And we teach the team regularly “It’s not kind to overbook ourselves. It’s not kind. It’s not providing best care for that animal. It’s not providing best care for that pet parent. And it’s certainly not providing best care for us, the caregivers. You need to take care of the caregivers, otherwise they burn out.” So, that is the hardest part honestly.

(NR): How many days, when you said you were treating somebody yesterday, it’s like that was a Saturday?

(NB): Oh, yeah, yeah, yeah, yeah. That was a different circumstance. So, that’s honestly where my business partner and I fail, is we don’t take good care of ourselves. We do actively work on that. So, we honestly had a sit down session about what are we going to do to actively take care of ourselves.

And so my business partner and I typically do work long weeks, long hours. We typically are there depending on the week, 60 to 80 hours. We do try sometimes to do work from home instead of work at the practice. There’s interesting concepts about this that it doesn’t have to be that you have a 40 hour work week, so long as you enjoy it. And so changing our mindsets. And then my business partner and I, we divided up what we each do well. And so not all of us have to be amazing at everything. And so that helps. And as a for instance, I do probably ten to fifteen hours of management stuff from home. The happiness piece to me there is that I’m at home, I’m surrounded by my own pets, I can have cooking shows on my TV while I work, so I can turn it into something positive. My business partner does some great things. She comes to work, but she takes time out. I’m going to say it’s three times a week. It might be four times a week, to go to a yoga class. She stops work and goes to yoga and then comes back with the idea of, hey, it doesn’t have to be a set schedule. Come up with what’s going to make you happy and do that.

(NR): Right. And so that, I think, brings us to some of the things that I’ve discussed earlier in this podcast series about being in charge of yourself and deciding what you want and you build your life around it rather than getting into other people’s, or your antique concepts, or what your parents wanted you to do. And you knew that right away, it sounds like. Sounds like you knew it.

So, if we were thinking about vet students and giving advice to them, it’s like you came out saying, I thought I heard you say that you want wanted to find or be in a bond-centered practice. How do you even know that?

(NB): I was a veterinary technician for a very long time before I went to vet school. This tells you lots about my age, which is OK. So, I was a technician for a long time. I worked in multiple different practices, saw practices that I thought, “Hey, this is a good thing and this is a bad thing over there.” And then was able to say, when my business partner and I started our practice, we sat down together and said, “What do we want this practice to look like?”

And the way to do that is to come up with your mission statement. To come up with your core values.

And for my business partner and I, what we decided was, we would sit down and have a discussion about what we wanted, the mission statement for the practice to be like, what we wanted the core values for the practice to be like, and what were our personal mission statements? What were our personal core values and how would that all mesh together or not? And so that helped to give us a clear path and continues to give us a clear path.

So, if I was talking to any veterinarian, but especially a younger veterinarian, come up with that, what are your core values? What’s your mission statement? What do you want out of your professional career? And go with that, and see where it leads you, remembering that you can change your mission statement. You can change your core values if you wish. And that’s OK. That’s part of learning and growing. And that’s what all of us do as people.

(NR): That’s really great. And so two things come to mind there is that’s part of why I love for you to teach with us and just that we can reach out to to the profession as well as to vet students, because I think that some of them haven’t even known that this could exist, like when I found out about acupuncture in medical school, but it wasn’t until I had my human practice in Boulder on the Pearl Street Mall, at Pearl and Broadway, best place it could be. And I still wasn’t happy because I wanted to work with animals. And so that’s when I just said, I have to try this. I have to try to get into vet school. Before that it was one of my human patients that says “I’m taking my dog for acupuncture.” I mean, she was coming to see me for acupuncture and I thought, what veterinary acupuncture? So, I didn’t even know that that existed. So, just to get that information out there to vet students, but also still having lived in Boulder, I don’t know, I’m just impressed with how together you are, because I feel like that doesn’t just happen to you, that those years I did spend in Boulder were healing and illuminating to me because I had been through everywhere else, but it allowed for a lot of introspection and growth and you’re among the community that it can cultivate those things.

And you either, you were born with it..

(NB): No. I actively learned it. I know that my base nature is, I am absolutely an introvert, absolutely. I’m an introvert and getting comfortable with who each of us are and then actively learning what’s going to keep you healthy, just like we all can learn, oh, here’s how I’m supposed to eat to be healthy. And here’s how much exercise I’m supposed to get to get healthy. You can learn how to keep your professional self healthy. It’s the same things we all know or hopefully we know them. And if we don’t, we need to learn them and then actively use them. I’m not telling you I’m perfect about it all the time. I’ve already shared with you I work many, many, many hours, too many hours and it still can be OK.

More and more in business, people are talking about being vulnerable with your team as part of that it is supposed to help and this is where you can tell I’m obviously learning things because I’ll say it like “It’s supposed to help. It’s supposed to help you.”

It’s supposed to help the business entrepreneur or leader to not feel like they’re isolated and alone because a lot of veterinarians do feel like they’re isolated and alone. If you’re vulnerable and it helps your team learn to trust you and bond to you because they know you have vulnerability. And so, yeah, I regularly tell my team, honestly, one of my de-stressors is I watch a whole lot of cartoons. It’s absolutely what I do.

And I go run a whole lot and I exercise a whole lot. And I spend a whole lot of time hanging out with my dogs, my cats, and teach them hilarious things because it makes me laugh and it’s funny. So, doing a lot of the things that we all know are supposed to help us. Those are good things to do. Eat healthy, get exercise, spend time with the ones you love. Come up with borders for yourself, not barriers, borders for yourself, what’s OK, what’s not OK. And then embracing all of that.

(NR):  I’ve already known you forever, but also just talking like this one on one, I’m so impressed with your sense of self and everything else, and I know that it takes ATP, it takes work to maintain your own nature against the pressures that decompose us a little bit.

And I just really love seeing that and hearing that from you and that you’re a beacon of that and an example of that for others.

(NB): Thanks. Yeah, it takes work. Just like eating healthy or exercising does. We’re all practicing it. Right? None of us are perfect at it. We’re not here to be perfect.

(NR): Yeah. Yeah. Although I think you’re perfect just the way you are.

(NB): Awww, thanks.

(NR): I don’t know how I would survive any other way, but being the master of my own existence, I wouldn’t be able to work for others and do a nine to five or be in an environment that I didn’t feel comfortable.

There’s also probably a piece that helps you survive. I mean, that’s how you have to do it, because you’ve had the experiences of what you don’t want to do and are really sure about what you do want to do, I think.

(NB): Yes. We counsel our team and people who are joining our team so we call it a Happiness Package. Come up with what’s going to make you happy at work. Tell me about it. I may not be able to provide all of it, but then I can have an honest conversation with you as to here’s what I can provide and here’s what I cannot provide. And for a lot of folks, that’s kind of like it’s phenomenal to them to think about that because they’re accustomed to people saying, “Here’s what you’re going to do,” and flip that equation around. What do you want to do? And then find that space.

(NR): That is it. That is it. What do you want to do. For anybody in this profession because we have so many opportunities. You started as a smaller practice. You can start small. You can start with low overhead.

(NB): Very low.

(NR): Yeah, right. Well, thank you.

(NB): Thanks for taking the time today.

(NR): Yeah. Oh I love this. I feel better already. 

(NB): Oh good. That’s good.

(NR): Yeah it is. All right. Well I’m sure that I’ll be seeing you in some of our future meetings.

(NB): Yes. Have a happy day everybody. Take care of you.

(NR): Thank you.

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Thanks for listening to another installment of Surviving Veterinary Medicine.