On Thursday Oct 15, 2011, I paid a visit to my mentor, a senior vet. I asked if he has an X-ray of urinary stones in the cat as I had not seen one in over 30 years of practice. He said that cats usually suffer from urinary sand and he had none. At that time, he showed me an X-ray of the Chihuahua with at least 10 urinary stones stuck in the os penis. The bladder was full due to urethral obstruction and there were no radio-dense stones seen in the bladder. A younger vet had referred this dog to him. Well, this is the type of surgery with wounds that are difficult to heal sometimes and so it is wise to refer to this senior vet.
"Do you use urohydropropulsion by syringing saline to flush back the stones to the bladder and then remove them from the bladder?" I asked him, just in case I can get some tips from his long hours spent in veterinary medicine and surgery. He is likely the most experienced vet in Singapore as he puts in the long hours over 40 years of practice when many vets would have been burnt out or work short hours.
Obviously the most efficient and simple way is to cut a hole into the urethra behind the penile bone and take the stones out. Then stitch up the urethra. Where the complications come in is that the urethra does not close properly and the male Chihuahua will leak urine through this hole, soiling the apartment floor. If the healing is good, the male dog pees normally.
"No point opening up the bladder as there are not stones seen inside," he said. "The bladder is full and any stones inside may not be visible but are likely to be small."
On another matter, I was surprised when he asked me whether the presence of 50 veterinary practices nowadays can be supported by the number of dogs and cats.
He said: "30 years ago, there were only 5 practices - myself, Deveraj, Cho Chak Nam, Animal Clinic and The Veterinary Surgery. I estimated that the number of dogs have increased twice but the number of vet practice has increased 10X. Many dog owners did not license their dogs in the old days. What do you think (of the impact of so many vet practices)?"
"I estimated that the number of dogs would have increased at least 3X based on the number of licences issued and the fact that micro-chipping of dogs is compulsory and enforcement action for unlicensed dogs," I replied. "Some newer vet practices will not be profitable as prices will have to be below costs for such practices in order to attract clientele.
"However, Singaporeans tend to go for proximity and therefore, convenience and affordable costs will bring some business to the new practices and with good personality, some of the newer practices will do very well. Experience and white hairs don't count for most Singaporeans. It is proximity and personality of the younger vets."
I was surprised to see a notice on his reception counter educating members of the public not to be abusive towards his staff. Such notices have been put up by the Singapore General Hospital some 2 years ago but no longer seen and are put up in some government offices or statutory boards like the National Library Board.
Life must be more stressful for some members of the public nowadays such that they become abusive at serving staff. Three Sundays ago, I was on the receiving end of the abusive dog owner who made an appointment to consult Dr Vanessa. He was rude and shouting inside the consultation room where Dr Vanessa and I were present while Dr Vanessa examined his dog's paw. Dr Vanessa kept mum and I left the room, forgetting about the behaviour. At the end of consultation, this man forced his way into the Surgery room where I was consulting with another dog owner and shouted at me to go to the back of the practice and pay him for advice as to what's wrong with my management of Toa Payoh Vets. He was loud and his adult son pulled him away. Such type of clients should be banned and I told Dr Vanessa how to handle such clients in the future. If she keeps silent, she encourages repetition of anger and abuse to me and the staff, except to herself.
Another of Dr Vanessa's client, a young Indian man, punched his fist into the gypsum wall of the consultation room when his family members and him were performing rites on his old dog with oral tumours. The dog had just been put to sleep by Dr Vanessa and the family had prepared some flowers and funeral paraphernalia for the farewell ritual and to wait for the cremation man. Dr Vanessa left the room to attend to another dog at the kennels. I was at the reception area. Suddenly, there was a loud explosive bang on the wall separating the reception from the consultation room. I went inside the consultation room to investigate the bang and since the family was grieving, I did not raise any complaint about the damage.
You can see the dent on the wall when you enter the consultation room of Toa Payoh Vets.
I spoke to Dr Vanessa recently about these two clients of hers. In my 30 years of veterinary practice, I had not encountered such rage. I told her that she had to let such clients know that their behaviour is not acceptable by me, the Principal. If she keeps silent, such behaviour will continue.
"What will you do?" she asked me. "I don't talk to them about their behaviour but focus on consultation."
Well, such anger was not directed at her in the first place. In fact, she was the doctor in charge and consulted. But ignoring such misbehaviour is not good for the team as she obviously cannot work alone. If the vet does not care for the team, the vet should not be accredited to work at Toa Payoh Vets. This is my policy.
This is how she should handle this matter.
I said: "Ask your client courteously - 'Is there some deficiency in my veterinary services to you? How may I help you to improve our veterinary services?"
This is better than keeping silent. I am prepared to ban such abusive clients from Toa Payoh Vets even if they say Dr Vanessa is the best vet in Singapore! Poor anger management is very dangerous to veterinary staff as some angry males do assault and kill. So, it is wise that the Principal or the associate vet know how to handle such clients. Putting up "educational notices" on the walls of Toa Payoh Vets telling clients not to abuse staff is not the answer, in my opinion. This is because the vast majority of Toa Payoh Vets clientele is excellent. The abusive ones make up 1% of the clientele and so I don't permit such "educational notices" to be put up.
The younger generation is into a new golden age of the internet. Those that can manage their anger will prosper. As for those that cannot, the service providers will shun them and not provide them any services if they think that "cash is king" and that they are masters of the universe.