Of all the people you encounter at the Animal Hospital of North Asheville in the course of your visit, the veterinarian is the person whose job seems to need no explanation. But there are a lot of things that we do behind the scenes to help us provide the best care possible to you and your pet. There are several types of patients. We work with outpatients (the ones we see in the exam rooms), inpatients (the patients in the hospital), emergency patients, dental patients, and surgery patients.
Outpatient Care: We start the day by checking our schedule and going over our recommendations for each patient with our exam room assistants. Each care plan for an annual comprehensive physical examination is individualized to the patient. We review vaccine and testing needs, previous illnesses and current medications as a part of creating each pet’s care plan. Not many clients realize that the annual visit is one of the primary reasons that pets are now living so much longer. If you tagged along with a doctor for a while, you would be surprised at how often we discover a problem in a seemingly healthy pet early enough to correct it. We also review medical histories for all of our upcoming patient illness appointments. Before we start seeing patients, we also review any faxes from REACH, our blood test results from the previous day’s patients, and check for any urgent phone messages.
During each outpatient visit, we focus on several goals, both for the pet and for their people. First, we want the pet to be as comfortable and at-ease as possible; if that means crawling on the floor to examine a shy dog, or examining a cat under a blanket in the carrier, that’s what we do. We always want you to help us understand what your pet likes as we interact with him/her. We perform a thorough physical examination, focusing on normal and abnormal findings. Because our patients can’t talk to us, it is important to stay attentive to even the subtlest of responses, since body language is another way a patient can communicate with us. Owners CAN talk to us, so we make sure we have a clear sense of any concerns, symptoms, and history. We review the owner’s questionnaire and ask in-depth questions that can help us understand subtle problems. We also want to be sure that the owners fully understand the care plan, why we’ve made our recommendations, what the visit will cost, and what the future recommendations will be. We’re here to listen, to educate, and to help. Questions are always welcome!
Once we’re finished with our morning appointment schedule, we shift our focus to phone calls and procedures. Our computer system enables us to keep track of follow-up calls, blood test results, and phone messages. We try to return phone messages or get the answer to your questions to you in a timely manner, and we know everyone is eager to hear about their pet’s lab results. Follow-up calls help us to make sure our treatment plan is working as anticipated and that owners don’t have any questions about their pet’s progress.
We also often have procedures to do during our mid-day, including ultrasound exams, endoscopy, otoscopy, wound repairs, and other tasks that don’t fit within the time period of an outpatient visit. Sometimes we even manage to get a bite to eat before we begin our afternoon appointments!
Inpatients: When we have a patient in the hospital, our goals are to obtain an accurate diagnosis and tailor the appropriate treatment plan, and to keep owners informed about how their pet is doing, the prognosis, and discharge plans. Before the morning appointments begin, we examine our hospitalized patients every morning and determine how treatment should proceed through the day. We keep in close communication with the ward nurses, both verbally and with their notes in the flow sheet. We call the owners of every hospitalized patient with progress reports at least twice a day, and encourage visits whenever possible. When a pet is sick enough to be hospitalized, we know it is stressful on both the pet and the owner, and we do everything we can to minimize stress and separation while providing the care needed. In fact, the current construction will allow much more comfortable family visitations of hospitalized pets. Our goal is to help every patient become well enough to be at home, and treated as an outpatient.
Surgery: Most of the doctors perform surgery once every 1-2 weeks, and Dr. Sim performs dental procedures Mondays, Tuesdays, Thursdays and Fridays. In preparation for surgery days, the surgeon reviews the patient’s medical records, paying close attention to preoperative lab blood tests and medical history. An anesthesia plan is then developed for each patient, with attention to age, health, anxiety, and pain control. The morning of surgery, the surgeon performs a physical exam on each surgery patient, and meets with the family to explain the upcoming procedure and answer any questions. After the surgery is completed, the doctor calls the family with an update, confirms the discharge time, and makes sure that thorough discharge instructions are prepared to go home. If the pet stays overnight, we write up a care plan for the overnight nurse that includes instructions for monitoring and for pain management. There is no pain medication that can guarantee comfort throughout the night and there is no hospitalized patient that could not have an unexpected problem, so every overnight patient has a doctor on call if the nighttime staff identifies a problem. Years ago we made the commitment to provide all night care for our patients for pain control and stress control and at this time we believe that we are still the only animal hospital in Western NC that provides this service (other than a 24hr Emergency Hospital).
Emergency Patients: Despite having full schedules, we often see emergencies such as pets hit by a car, cats caught in car fan belts, gunshots, dog fights, poisonings, urinary obstructions, stomach bloats, and more. Because we have so many doctors, we always have one or more doctors on duty during the hours we’re open. An emergency arriving at Animal Hospital of North Asheville never hears, “The doctors are at lunch or at the gym.” When an emergency patient arrives, a technician will immediately assess the stability of the patient and alert a doctor. Emergency patients take priority, and while we hate to interrupt a regular outpatient visit, we will always tend to an emergency patient first until their condition is stabilized.
Every doctor is under personal pressure to stay on schedule and try to achieve no or minimal client waiting. Some days everything is smooth and other days are a challenge. One emergency or one person arriving late for an appointment can cause other appointments to experience a wait.
The practice of medicine is fascinatingly complex. Some of our patients have simple, obvious problems, but many do not. Our doctors have a strong commitment to each patient. Any doctor can summon “rounds” for any inpatient or outpatient. The doctors routinely discuss an entire case or some aspect of a case. We strongly believe that “more heads are better than fewer heads” when a patient’s life or comfort is on the line. We work as a team because our goal is to help every patient and every client. We consult with each other, as we have over 100 years of combined experience as veterinarians, and every doctor has increased training in an area of his or her choosing. Although North Carolina requires that veterinarians have 20 hours of continuing education yearly, our hospital standard is that each doctor is required to attend one in-depth national meeting yearly and attempt to accumulate 50 hours of continuing education (or more) per year.
Our library is massive and current. Each month various journals arrive almost daily and contain new information. We always strive to keep up with new technology and information in general, but we also have ways of finding the best treatment plan for each individual patient. Additional tools include VIN (Veterinary Information Network), which is an online subscription service with over 200 specialists and a huge database available for research and consultation. We can post cases with pictures, x-rays, ultrasound images for the specialists but also for the thousands of members to review…in essence, VIN is a national medical database for animals. With telemedicine, we can submit x-rays and ultrasounds to radiologists and have a written report returned to us, typically within 30 minutes.
NC State has a cancer consultation service as cancer treatments are constantly changing. We also have a wonderful relationship with nearby specialists, and routinely consult with them. Medicine is truly a collaborative effort, and we’re very fortunate to work within a group of such skilled and knowledgeable colleagues.
In between all of these important parts of our day, we also answer questions from the staff, write up detailed and thorough medical records, help people with end-of-life decisions for their pets, evaluate requests for prescription refills, and much more. We sometimes have a veterinary student spending time with us as part of the fourth year clinical training, and we love teaching these upcoming veterinarians. We also enjoy teaching (and learning from) our staff, and often give presentations during their staff training sessions. We all take time away from our clinical duties to attend continuing education meetings in person, as well as webinars, state and local meetings. Sometimes we are fortunate enough to have specialists come to our hospital, which gives us the chance to learn new ideas and techniques and to meet our colleagues from all over the country. We often volunteer our time to help local animal welfare organizations and the AB-Tech veterinary technician program.
The doctors and staff also rotate weekend and holiday duty…we are staffed 24/7/365. As an example, we may not be “open” Christmas, but a doctor and two technicians are on duty for our hospitalized patients.
A frequent question we receive is, “How long do you have to go to school to be a vet?” The answer is that we attended 4 years of undergraduate school college prior to acceptance into the 4-year veterinary medical program. Veterinary school is very competitive to get into, and it doesn’t get any easier once you’re there! Veterinarians are taught about anatomy, physiology, pharmacology, infectious diseases, blood test analysis, pathology, internal medicine, surgery, bacteriology, virology, genetics, biochemistry and more. We are taught these things about multiple species. The final year of veterinary school is spent in the university hospital and in private veterinary practices doing clinical training. Several of our doctors have gone on to complete a 1-year internship for more in-depth training. All of our doctors spend many hours every year attending continuing education at the most well-known conferences around the United States.
The veterinarians at the Animal Hospital of North Asheville have dedicated our lives to providing excellent care to our animal patients and the people who love them. We work hard, and some days are unbelievably happy and some are just as sad. We are so lucky to have this challenging, inspiring, and rewarding job to come to every day!