The Other Side of the Exam Table | Dr. Katie Berlin Deep Dive

[00:00:00] >> Dr. Katie Berlin: There is no veterinarian on this planet who wants your pet to be sick so they can make more money because our entire reason for being is to make sure that your pet is as healthy as possible and lives as long as possible in a healthy way with you. That is the only goal every time we go to work.

[00:00:20] >> Announcer: Welcome to Dog Cancer Answers, where we help you help your dog with cancer. Here’s your host, James Jacobson.

[00:00:28] >> James Jacobson: Today’s show is one of my favorites and I think as you listen, you’ll see why,, that’s because the relationship that you have with your veterinarian is undeniably critical to your success in treating your dog’s cancer. Vets are people too, and understanding how they think is important.

[00:00:46] Our guest today is Dr. Katie Berlin. She is one of the biggest hearted veterinarians that I know. And we’ll be discussing what you should know about how veterinarians think and feel and experience what they do and how they view their clients and their patients. Dr. Berlin is an important advocate in the Not One More Vet Movement, which provides emotional and financial support to veterinarians in crisis.

[00:01:13] She’s the host of the podcast, Veterinary Super Friends, is a specialist in low stress of veterinary visits, is a veterinary acupuncturist. Oh, and she runs marathons. I think you’ll hear in our conversation just how much passion and commitment she has, not just to her veterinary colleagues in crisis, but to you and me and our pets. She believes veterinary medicine treats the bond between the pet and the person.

[00:01:39] And it’s a pleasure to talk to her about her calling. Dr. Berlin graduated from Cornell University’s College of Veterinary Medicine after getting a degree in art history from Williams College. Our conversation ranged over many topics, and I think that if you listen in, you’ll have a much deeper understanding of the challenges and the joys of being on the other side of the exam table. Keep some tissues close by, maybe pour yourself a cup of coffee or tea or some other warm drink. And let’s settle in for a heart to heart with Dr. Katie Berlin. Katie Berlin. Thanks for being with us today.

[00:02:17] >> Dr. Katie Berlin: Hi, thanks so much for having me.

[00:02:19] >> James Jacobson: Now you have been a veterinarian for how many years?

[00:02:22] >> Dr. Katie Berlin: 11 years now.

[00:02:23] >> James Jacobson: 11 years.

[00:02:24] >> Dr. Katie Berlin: Yeah. That means crazy.

[00:02:27] >> James Jacobson: So you have your 10,000 hours of practicing at this point.

[00:02:30] >> Dr. Katie Berlin: It seems like it anyway.

[00:02:32] >> James Jacobson: So what we want to talk about, what I’m really interested in talking about and exploring with you is what I’m thinking we’ll call, the other side of the exam table. Because you’ve been of that for over a decade.

[00:02:44] >> Dr. Katie Berlin: Right.

[00:02:45] >> James Jacobson: And you have seen, my goodness, how many clients do you think you have seen in that time?

[00:02:51] >> Dr. Katie Berlin: Oh, my gosh. I don’t even know. I’m sure I could kind of fudge the math, but a lot.

[00:02:57] >> James Jacobson: A lot.

[00:02:57] >> Dr. Katie Berlin: Yes. Um, some memorable more than others, I think just because their stories stick with you, you know, but a lot.

[00:03:04] >> James Jacobson: Well, what makes a client memorable?

[00:03:06] >> Dr. Katie Berlin: I think there can be good and not so great things that make a client memorable, but the ones that really stick with me are the ones where I found the story, you know, maybe a common ground, or I found the story between that client and that pet really compelling. And that’s what really draws me in. And I feel like that’s why a lot of people stick with general practice because even though it could be a lot of the same every day, every story is a little bit different.

[00:03:32] And so, you know, I like to say, I feel like my client is actually the bond between the person and the pet and not so much just the pet, because everybody has a different philosophy about treating their pets and everybody views their pets as different, you know, different members of the family. And I love trying to figure out what’s gonna work best for that family.

[00:03:54] >> James Jacobson: And is that sort of a calculation that you instantly know when you meet them or is it something that evolves over time?

[00:04:01] >> Dr. Katie Berlin: I mean, I think there’s some things you can definitely tell right off the bat, right? You know, if somebody comes in with their dog in a stroller, you’re dealing with a different sort of bond than you are if the person comes in and it’s like a farm dog that lives outside, you know, that’s a really different type of bond, but it doesn’t necessarily mean that one person loves that dog more than the other person loves their dog. So I think certain elements may seem obvious, but when you dig a little bit deeper and you can get surprised sometimes.

[00:04:30] >> James Jacobson: And I know you’ve worked in a variety of different practices over the years. Give us some secrets from the client perspective. Things that your vet probably doesn’t want you to know about it. They don’t talk about normally like when the first time you see a client, have there been notes passed on the chart, like, oh, this person came in in with a stroller or something like that.

[00:04:49] >> Dr. Katie Berlin: Sometimes. I don’t know that I’ve ever seen the stroller part, but the practice tends to know, you know, they’re like, oh yeah, that’s Mrs. Smith with, you know, Fluffy in the stroller. Like everybody just sort of gets to know Mrs. Smith. ‘Cause she’s usually there a lot.

[00:05:01] >> James Jacobson: She’s a good customer. Yeah.

[00:05:02] >> Dr. Katie Berlin: Yes. Yeah. She wants to take care of Fluffy and she’s gonna be in a lot whenever Fluffy needs something. But there are definitely some notes in the chart about clients. So if a client prefers a certain doctor or really doesn’t get along well with a certain doctor, we’ll definitely make notes about that because we want everybody to be happy, doctors and clients. We definitely have notes about the pets, if they prefer certain treats, or if they like certain types of restraint or, you know, certain technicians, we have notes about that.

[00:05:31] We also have notes of clients have very distinct preferences, you know, and they tend to be very opinionated about them. We don’t want to have drama. We don’t want client to feel like we’re not paying attention. So we definitely like to take notes if clients have distinct preferences they want.

[00:05:44] >> James Jacobson: So that’s a very politically kind way, I can tell you grew up in Washington.

[00:05:49] >> Dr. Katie Berlin: I’m a lawyer’s kid.

[00:05:50] >> James Jacobson: A lawyer’s kid. That’s right. So what’s a more direct way of saying what some of those notes might be?

[00:05:56] >> Dr. Katie Berlin: You know, speaking, frankly, I think if a client gets rude with us, combative with us and we don’t feel like we dropped the ball in a way that justified that behavior, because sometimes we do, sometimes we make mistakes and clients get justifiably upset, but if we have ones that tend to be a little hot under the collar and get a little bit more forthright about that, we will put notes in the chart that this client can be this way and try to make sure that all communication is very direct.

[00:06:24] And that we’re making sure to double and triple check that these things don’t happen again. That’s something that I think is fair to the client and to us.

[00:06:32] >> James Jacobson: Again, we don’t often get to see the chart, is that just basically put in by another vet or by the front office staff or where are those?

[00:06:39] >> Dr. Katie Berlin: It depends what it is, you know. I think a big part are electronic records. A lot of vets now have electronic records, you know. Everything’s in the computer. We used to put little notes at the top of the paper chart, but now we have an alert that pops up when we open the client’s chart. And so we’ll have notes about what the client prefers and the notes about what the pet prefers.

[00:06:56] So each pet has their own alert in our system. Oh, it can be like Fluffy really loves lean treats, but doesn’t care for cheese or Buster likes to be on the table and not on the floor or vice versa. But if there’s something that we really need to know before somebody goes into the room with that pet, we’ll make sure that everybody on the team who’s in that appointment is aware of it before they go in. Again, it’s just to smooth out the communication, because that makes for the best start to the appointment.

[00:07:22] >> James Jacobson: Let’s talk a little bit about communication. Is that something that they teach you in vet school?

[00:07:27] >> Dr. Katie Berlin: I think with varying degrees of success, I think that’s become more of a focus lately from what I hear from students coming out of vet school now. I think it’s definitely more of a focus than it was when I was there. And I’m sure when I was there, it was much more of a focus than when somebody was there 20 years before me. You know, a lot of things have changed and I think everyone realizes that the way pet parents view vet care has changed to clients, have very high expectations and we’re living in the age of Amazon and instant gratification and ordering everything and having it that instant.

[00:08:00] We know that vet care just isn’t always like that. And that means that our communication skills have to be even better because clients will sometimes expect things we can’t deliver. And that’s not unreasonable, but we also have to be able to explain why that might not be the case. So short answer is I think we are not trained as much as we could be, but there’s no teacher like the real world.

[00:08:24] >> James Jacobson: Do you prep before you walk into a client the first time?

[00:08:27] >> Dr. Katie Berlin: Sometimes, I think, you know, if a client’s been coming to the practice for a long time and I’m relatively one of the newer doctors there, I will definitely want to make sure that I am familiar with what that client has done before and seen before the practice.

[00:08:41] So how many pets do they have? Have I met them before with a different pet? That’s very important to me. I don’t like to walk into the room and introduce myself to someone and find out that I’ve euthanized their pet like the year before, you know.

[00:08:52] >> James Jacobson: This is Benji 2. Benji.

[00:08:55] >> Dr. Katie Berlin: Yeah. I mean, you know, we’ve seen so many clients that a lot of times, if we don’t see the client with the pet, they won’t look familiar to us, at least not right away. So.

[00:09:04] >> James Jacobson: Oh, do you look at that guy, you say, oh, that’s the Chihuahua guy or?

[00:09:08] >> Dr. Katie Berlin: Yeah. I mean, sometimes it’s really hard to recognize a client, even when you know him pretty well, if they don’t have the pet with them, ’cause we think of them as a unit. You know, I’ll run into people in Target and be like, oh God.

[00:09:17] >> James Jacobson: Who are you? You look familiar, but I don’t. Do you have a cat? Dog? Parrot perhaps?

[00:09:21] >> Dr. Katie Berlin: Right.

[00:09:22] So I do prepare that way as far as just, you know, and if there’s an alert that says they have certain preferences, I want to know about that. You know, if there’s certain things they always want to talk about or certain things they never want to talk about, we want to be respectful of that. But most of the preparation is done for the case, you know, for what we’re gonna see.

[00:09:40] >> James Jacobson: Now, what happens in your mind when you are about to give someone the diagnosis that their dog has cancer?

[00:09:47] >> Dr. Katie Berlin: What happens in my mind?

[00:09:49] >> James Jacobson: Yeah. Like, do you prepare yourself? Do you steel yourself or is that like something that you do differently than when you walk in for pretty much any other diagnosis or no?

[00:09:59] >> Dr. Katie Berlin: Yeah, absolutely. I think there are certain things that maybe are similar as far as how we feel before we have to tell someone about it, like kidney failure or liver failure or something like that. But cancer is a big one because there’s so many questions that follow, you know, we know a lot about how to treat kidney disease.

[00:10:19] And we also know we can’t cure it. Cancer, there are so many big question marks, and so many of them have to do with money and personal philosophy and that particular animal’s case and that client’s emotional relationship with cancer. It’s a big one. So it is very sobering to have to do that every time.

[00:10:41] There’s never been one time where I’ve had to go in and tell someone that their dog had cancer and it was easy. And I think that’s really important for people to know, because sometimes we can seem, we can come off as cold, I think, because we have to compartmentalize a little bit and sometimes our emotions get the best of us, no matter how much we do try to compartmentalize. I remember one time I used to have a Rottweiler and she’s amazing. And I went in and saw a little Rottie who reminded me of my dog and the nightmare of every Rottweiler owner is that they’re gonna get bone cancer because it is so common. And I went in there and she was limping.

[00:11:26] She was nine. And you just get this sinking feeling in the pit of your stomach. And you’re like, I really hope this Rottie has bad hips because I could give you medication for bad hips, you know, and we took an x-ray and there was a big old tumor there on the bone. And that is a bad cancer. And, um, the owners were convinced that, you know, when they came in, they were pretty breezy about it and they thought they were gonna walk out of there with pain medication.

[00:11:49] And I showed them the x-rays, it was devastating for them. And it really hit me hard because they weren’t expecting it. And I kind of was, even though I didn’t want to be. And it was the moment that I had thought about so many times, what would I do if this were my dog? And there was something about that dog and that family, and it just really got to me.

[00:12:09] And I think we all cried and I was trying to reassure them and give them options. And then I went into my next appointment and I think it was a, I can’t remember it was something pretty routine, a cat with the cat wellness or a dog with an ear infection, you know, something pretty mundane. And I went in and I was running about half an hour late because of this unexpected development with the Rottweiler.

[00:12:32] And the woman was pretty upset about how late we were running. You know, time is valuable. I get that. And I burst into tears in the room with this client who had nothing to do with that Rottweiler and nothing to do with that diagnosis. And she had just said, you know, it’s about time. And I started to cry because all of that just was sitting in my chest, like a big, heavy ball.

[00:12:54] And sometimes it’s just too much to carry around and you got to let it out. But to a certain extent, every case is like that when we have to tell somebody that their dog has cancer.

[00:13:04] >> James Jacobson: Are there any other particularly poignant cases that you recall like that, or where you basically had to give the bad news and didn’t go well?

[00:13:13] >> Dr. Katie Berlin: Sadly, there’ve been so many, you know, so many sad ones.

[00:13:18] And I will say too, that sometimes I’m the one who initially gets the suspicion of cancer and we start diagnostics and then someone else ends up having to be the one who tells them. And that’s something, too, that I think people don’t always necessarily think about is that I don’t ever want to tell somebody that their dog has cancer, but I also want to be there to help them through it. You know vets, we don’t necessarily want to push that onto somebody else because it’s part of the job. And if we’ve established a relationship with that client and that patient it’s part of that relationship and we want to see it through. And so sometimes the hardest cases are the ones that end up gonna the specialist or getting diagnosed by ultrasound somewhere else because I don’t do ultrasounds.

[00:14:05] And so there have been a few cases where I feel like I’ve found out secondhand that the dog had cancer and someone else had to tell them. And that is heartbreaking too, because you think about what that client must’ve been going through in a strange place with a strange person and sitting there holding their dog and hearing this news from a stranger that’s, you know, that’s hard for me to think about.

[00:14:27] And that happened, sort of like that with one of my all time favorite patients who I do have permission to talk about, if it’s okay. His name is Dunbar.

[00:14:36] >> James Jacobson: Sure. Tell me about Dunbar.

[00:14:37] >> Dr. Katie Berlin: So Dunbar, I think I sent you a picture of me snuggling Dunbar. He’s like a Brindle brown dog. He’s amazing. And his family is also amazing. They have several dogs, they have cats and they are just the most fantastic pet people that you could ever hope to meet.

[00:14:54] And, um, Dunbar is just one of those dogs that got to me. He just comes in and it’s like, he doesn’t even look back at his family. He just has to go from one person in the vet clinic to the next person, to the next person and get his butt scratched. And he would just sit in someone’s lap. He’ll just kind of fall over in someone’s lap and then he’ll move on to the next person.

[00:15:11] But he’s like the mayor when he comes in. And he’ll stay with us sometimes if we need to do something as a drop-off appointment, you know, and he’ll just hang out in the phone room, because that way he can just go from phone room person to phone room person and, and brighten their day too. And he’s just the best.

[00:15:25] He just is a good, good, dog. He’s about nine, I guess. And he had a cough recently. He’s actually had a little cough since they’ve had him so several years. Um, and he’s made it through a bunch of different, like weird stuff, you know, parasites and things, ’cause he was a rescue. And he had this cough that just never really went away, but it never turned into anything.

[00:15:42] And then one morning he coughed blood into his owner’s face at like three in the morning. And justifiably, they were alarmed and he came in and had some x-rays and they looked a little bit questionable and they put him on some antibiotics in case he was getting, you know, a little bit of infection. ‘Cause he seemed otherwise fine.

[00:15:59] I didn’t see him for that visit. And he came back for recheck x-rays a little bit later and he had pretty much stopped coughing other than occasionally when he pulled on the leash or something. And we took x-rays and there was this big thing there. I mean, it was just this big thing sitting there in his lungs.

[00:16:13] And you know, you want to think that it could be something else, but there just aren’t that many things that look like that on an x-ray of a lung. And we sent them out to the radiologist. And I remember actually I kind of got a little bit mean because the technicians had turned off the machine at that point that we need to email the x-rays to the specialist.

[00:16:33] It was late in the evening and I got really snippy with them because I was like, we need to send these x-rays now, you know, I did not want to wait an extra day for them to figure out what that was. And I, you know, I was, I was pretty stressed out about it and, uh, of course it came back, they were suspicious of a tumor and Dunbar is like everybody’s heart dog.

[00:16:53] And everybody was just devastated. I mean, I was devastated because usually a lung tumor just isn’t a good prognosis, but the family has insurance and they have pet plan insurance and they went to the oncologist. And they actually went to a specialty hospital and a board certified surgeon took out part of his lung along with the tumor.

[00:17:13] And that dog, let me tell you what, has not missed a beat. So he had the tumor taken out. It was in fact malignant, and it was in a lymph node, which they could not remove. And he ended up gonna the oncologist for chemotherapy and he had, I think, four rounds of chemo and he just blew right through those.

[00:17:29] And I started seeing him for acupuncture and the owners actually are home cooking for him and feeding him supplements based on The Dog Cancer Survival Guide. And he’s doing amazing. Like the oncologist started using words like next year and that was just insane, but there was a period of time where I feel like I was coming to grips with the fact that this dog had a tumor and it was probably really bad and he probably only had weeks to months. And I just couldn’t even, I was kind of in denial about it as if I were part of the family, because it just seemed impossible and he’s kind of a miracle survival story, but at some point it might come back and that’s really scary to me, but he’s one that I will always remember because I feel like we oftentimes view cancer as a death sentence. You know.

[00:18:15] >> James Jacobson: Yeah.

[00:18:16] >> Dr. Katie Berlin: And he, he kind of proved that wrong.

[00:18:18] >> James Jacobson: And it’s not, mayor Dunbar’s doing well now.

[00:18:20] >> Dr. Katie Berlin: He’s doing amazing. Yeah.

[00:18:21] >> James Jacobson: That’s awesome. I love that story.

[00:18:23] >> Dr. Katie Berlin: Yeah.

[00:18:24] >> James Jacobson: So I think what it highlights really is this concept that vets are people too.

[00:18:29] >> Dr. Katie Berlin: Yeah.

[00:18:30] >> James Jacobson: I definitely want to get into that more with you, but first let’s take a little break to hear from our episode sponsor, the book you just mentioned, The Dog Cancer Survival Guide.

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[00:20:27] Okay, we are back and we’re speaking with Dr. Katie Berlin. So we were just talking before the break about how vets are people too. And I don’t necessarily know if clients think of it that way. I mean, it’s obvious. Yes, they’re a person, but the emotions are probably not something that are taken to your account per client. What do you say?

[00:20:45] >> Dr. Katie Berlin: I mean, I do think it’s a very hard job sometimes.

[00:20:48] And I do think sometimes clients don’t realize how invested we get in cases. But I also think that we accept that as part of the job. We are people too, but we took this responsibility on knowingly, and it’s not about us when a patient has cancer and a family is trying to deal with that in their own way.

[00:21:09] It’s not about us. We’re the facilitators to try to help heal and guide and sometimes to let go. But it is always nice when it’s acknowledged that it’s hard for us too.

[00:21:23] >> James Jacobson: One of the sad facts about veterinarians is that they have an unusually high rate of suicide. And I know that’s something that you’ve been involved with.

[00:21:33] >> Dr. Katie Berlin: Yeah. You know, that is definitely true. We have a much higher rate of suicide than the general population and a high rates of depression and anxiety. And there’s some multi-factorial problem for sure. Student debt is a huge player in that and a lot of people do not realize that, that veterinarians are usually drowning in debt when they get out of school and we don’t get paid as much as people think we do, but this type of thing.

[00:21:56] So the emotional involvement that we have with our patients and our clients does play a huge role too. The profession attracts people who are empathetic and who really put themselves in the shoes of their clients. ‘Cause we’re pet people too. Like I’m a crazy person when it comes to my dog, I have no objectivity.

[00:22:14] So if he ever gets cancer, I am gonna be a disaster and I’m gonna need somebody else to handle it for me. We know that, and I think sometimes our clients forget that a little bit. And I think that’s one of the biggest contributors to that suicide rate and the depression and anxiety in the profession is that veterinarians do invest all of themselves in the job, sometimes to a fault.

[00:22:39] And sometimes clients don’t realize that and will direct their anxiety and their fear and their sadness and their emotions on to us as the bad guys. And that is very hurtful for us because there’s nothing worse than telling a veterinarian who could be earning money a lot of other ways, there’s nothing worse than telling one of us that we don’t care enough or that we’re motivated by money.

[00:23:04] >> James Jacobson: I want to get to money in a minute, but first aren’t you involved in an initiative for mental health for the veterinarians?

[00:23:10] >> Dr. Katie Berlin: Yes, we have a, it’s actually a nonprofit now. It’s called Not One More Vet and it’s a support group. It was started as a Facebook group by some friends. And it’s an online group that is dedicated to being a safe space for veterinarians.

[00:23:24] There are separate groups for support staff as well, but this is for veterinarians specifically to vent and unload and sympathize and soothe each other and sort of dump those hard emotions after a really bad day so that they don’t build up. And so the vets don’t feel alone because we don’t want to dump that on our clients.

[00:23:44] Sometimes you don’t want to dump that on your families, you know, or your spouse, because it’s just, you need people who get it. And so groups of vets get it. So Not One More Vet has been around for a while. I guess the way that I’m most involved is that I have a podcast with one of the admins, one of the OG admins of Not One More Vet, Dr. Carrie Jurney, who’s a neurologist in the Bay Area. And we have a podcast where we talk about wellness in the profession, and trying to find our own way to being happy and staying in the profession because a lot of people feel like if they’re not happy, they just, they need to suck it up or they need to leave, and that’s just not always the case.

[00:24:20] >> James Jacobson: We’ll put links to that podcast and also the information for that veterinary group, because we do have veterinarians who listen to this show, in the show notes, but let’s talk a little bit about the money thing, because I think that is a common misconception because gosh, it’s so expensive. I mean, the average cost say if you’re doing traditional chemotherapy is five or $8,000.

[00:24:39] >> Dr. Katie Berlin: Yeah.

[00:24:39] >> James Jacobson: And well, gosh, the vet’s gotta be rolling in it, right?

[00:24:43] >> Dr. Katie Berlin: Yeah, it seems astronomical. I mean, even to me as a vet, you know, it would be hard for me to afford chemotherapy for my dog. That is expensive. And I think it is really important for clients to know, for pet parents to know, that veterinarians are definitely not rolling in it. There’s just.

[00:25:02] >> James Jacobson: They’re rolling in debt.

[00:25:04] >> Dr. Katie Berlin: Yeah. We’re rolling in debt. I don’t know that specific number now. It’s been increasing steadily every year that they measure it, but it is not uncommon for vets to get out of school and, owe a quarter of a million dollars in student loans. That is not an unusual story anymore.

[00:25:18] A quarter of a million dollars in student loans. That’s insane. And the average starting salary for a new vet is somewhere in the 60,000, $65,000 range. Something like that. It seems like you’re just never gonna pay that back. If you work more hours, as you get more experienced, specialists do make more, but they’ve also been through usually four more years of school or more.

[00:25:41] You know, and they have to live in urban areas to get enough business to survive. So it’s more expensive to live there. The vast majority of veterinarians are not wealthy and never will be. And that’s not why they went into this business. I’ve never met a group of people, more apologetic for having to make a living than veterinarians and that is absolutely across the board true.

[00:26:02] >> James Jacobson: I know that there are more and more big hospital chains coming in and basically buying up small, bringing it together and making it a much more corporate environment. How do veterinarians feel about that?

[00:26:13] >> Dr. Katie Berlin: I think that depends who you ask. I think everybody’s had a slightly different experience with corporate vet care.

[00:26:19] I think it can be done really, really well. I think there are advantages to having big corporations behind you. You know, you have a lot of resources and vet teams can get great benefits, which a lot of small clinics can’t afford. So it can be a real advantage to have a corporation come in and buy a practice.

[00:26:37] Corporations can also offer a lot to vets who want to retire. Because they can pay top dollar for these practices that your average vet, who still has $150,000 in student loans, just cannot raise the money to buy. And so for vets who are looking for the exit plan, you know, I don’t blame them for wanting to be able to retire before they’re 85 years old.

[00:26:59] Um, and sometimes the corporations are the only ones right now who can afford to buy a practice. But I think the future of veterinary medicine, I believe absolutely that the future is not all corporate. I think it’s gonna take both corporate medicine and smaller privately owned practices. I think there’s room for both, and we need to learn to live together. They serve different people sometimes. And that’s okay.

[00:27:21] >> James Jacobson: When we’re talking about money, I think one of the things that people are sometimes concerned about is like, oh my God, all these tests are so expensive. Do we need to do this? Is this just another way to ring up the bill?

[00:27:32] >> Dr. Katie Berlin: Yeah. Super good question.

[00:27:34] Because we see that all the time and it’s true. The tests add up so fast. I’m sure a lot of people have heard this before, but if you compare working up a dog with a tumor to a person with a tumor, we don’t question running those tests in a person because A, that’s someone’s mom and we’re trying to have that person survive that cancer and live forever.

[00:27:56] We know a dog with cancer is not gonna live another 40 years, no matter what we do. And so sometimes the goals are different with human and canine cancer, but the tests are often the same. So if we need a CT scan or an MRI or a huge invasive surgery and biopsy, those are just as complicated on a dog as they are on a person.

[00:28:18] We are the same type of organism. We don’t have insurance companies driving up the cost. So if you actually look at the cost of an MRI for a dog compared to a person, it might be dramatically lower because it costs what that vet hospital needs to charge to be able to survive, to run another MRI and another dog another day.

[00:28:36] But it doesn’t have anything to do with the insurance company and telling the hospital what they can charge. So if you look at it that way, they’re actually quite inexpensive. If you look at your own hospital bills, but there’s no question, you know, it’s not to make light of the fact that these are really expensive for the average person.

[00:28:52] Like it’s just a ton of money. So as far as the question of, is it just driving up the bill to run more tests? I can’t pass judgment on the entire vet profession, but I have not personally met a veterinarian who wants to spend the client’s money if it’s not necessary, because we know that’s not serving anyone.

[00:29:12] We might see a better number for the practice that month because of that test, but in the long-term we’re breaking that client’s trust. And if we don’t have that client’s trust, there’s no point in coming to work every day, because we’re not gonna be able to help the pets by short-term monetary gain.

[00:29:29] And so if I recommend a test to a client, I always want to try to explain to them how this test is gonna change what we do. And if it’s not gonna change what we do or what we think we know, then I don’t want to run it. I’d rather spend that money somewhere else.

[00:29:43] >> James Jacobson: Let’s talk about insurance for a moment, because you mentioned in the case of Dunbar, and then we talked a little bit about it here. What are your thoughts about getting insurance for your dog?

[00:29:51] >> Dr. Katie Berlin: I think it’s amazing. I think it’s not always a simple question because insurance can be expensive too, especially if you’re trying to insure an older pet or a pet with pre-existing conditions. But I think overall, whenever I see a new puppy, I tell that client now is the time to get pet insurance because it’s never gonna be cheaper and they’re healthy now.

[00:30:11] So pet insurance for people who aren’t familiar with it, it’s independent in this country. So it’s not like there’s a standardized pet insurance system. Every company is different. They’ll have their own rules and their own things that they cover. Most insurance companies do not cover anything that’s preexisting.

[00:30:26] So if you get pet insurance on a puppy and it’s already had an ear infection or a heart murmur or a kneecap that slides out of place, you’re kind of out of luck when it comes to that problem, it’s not gonna be covered. But if that puppy gets stepped on the next week by your three-year-old and you’ve had that insurance in place long enough, there’s usually a grace period or that puppy gets allergies at a year old.

[00:30:47] We all know allergies with dogs can cost so much money, like so much money. The whole life of that dog and pet insurance can just really be a huge gift then. And in the case of Dunbar, I mean his owners, they said, whatever I want to talk about is fine, ’cause they’re amazing that way, but I don’t know if they would have been able to do everything they’ve done without insurance, because he’s got a team of specialists in his history, you know, with all the weird stuff he’s had and that insurance has been amazing.

[00:31:13] I mean, they’ve covered a huge chunk of all of those medical bills, they even cover acupuncture actually.

[00:31:19] >> James Jacobson: Wow. That’s awesome. For those who are not familiar, if you get it when your puppy is young, that’s the rate you pay or does it go up?

[00:31:25] >> Dr. Katie Berlin: It usually goes up. Yeah, it’ll go per year. As they get older, they’re more likely to have problems, but problems they develop will be covered as long as you’ve continuously had that insurance.

[00:31:34] So the rate will be higher, but you’re also gonna get more out of it as the dog gets older. So inevitably have something that costs money. Most insurance companies now, the newer ones, at least don’t tend to have a lot of wellness coverage. There are still a lot of companies that offer that, but wellness expenses are predictable.

[00:31:51] And so you can set a budget for that. Or you can have a savings account for that, you know, how much that’s gonna cost, but it’s the unpredictable stuff that really gets ya. You know, the dog that eats a sock on Saturday night and you got to go to the ER and get it cut out. That’s a lot of money.

[00:32:05] >> James Jacobson: That’s a lot of money, especially when they’re closed or the emergency vet clinic.

[00:32:09] >> Dr. Katie Berlin: Yeah.

[00:32:09] >> James Jacobson: So are there any other secrets that veterinarians don’t necessarily share, but you’re kind enough to share with us?

[00:32:17] >> Dr. Katie Berlin: Well, I mean, I’m sure there are things that my fellow veterinarians would not want me to say on a podcast.

[00:32:23] >> James Jacobson: But they’re not listening.

[00:32:26] >> Dr. Katie Berlin: I think that vets are human, we make mistakes. And that’s something that, of course we don’t want you to think about, but I think with that humanity and the possibility of us making mistakes comes a really deep well of empathy because we know that clients aren’t perfect either. And so I have had clients who really picked a fight with me, who blamed me for things, who left the practice and came back because of me in the cases where it’s worked out okay. It’s because we’ve been able to communicate with each other. And so the relationship that you have with your vet should not be any different than the relationship you have with your own doctor or with a person who’s giving you advice in any other area of your life. Most big problems in life can be made better, at least if not fixed by communicating openly.

[00:33:15] And I think a lot of the problems that we have between vets and clients, where it seems like us versus them, because sometimes we do feel that way. Sometimes we feel like the world is ganging up on us and we just can’t get a hold on things. It all comes down to, we need to speak up. If we make a mistake, we need to own up to our weaknesses, but we also need to be understanding when our clients may not act the way that we would choose.

[00:33:40] And so as hard as it is, sometimes, we do blame and we point fingers and we talk to each other about how hard this was or how unfair it was. And I think a big path to wellness for us and for pet people, you know, for our clients is to stop doing that. There’s no gain in finger pointing because we’re all on the same side.

[00:34:02] There isn’t a single vet who does not want your pet to be well. And that’s the other big thing that I wanted to say every time, if there’s a microphone in front of me, I want to make sure that I say this because I see it sometimes on boards, you know, if you’re in like a Facebook group for the community or something, and it’ll say, well, this vet wants my pet to be sick because it’ll make him more money in the long run. That breaks our hearts.

[00:34:26] It is heart breaking to see that. There is no veterinarian on this planet who wants your pet to be sick so they can make more money because our entire reason for being is to make sure that your pet is as healthy as possible and lives as long as possible in a healthy way with you. That is the only goal every time we go to work. So, that’s my soapbox. I’m all for that, but it’s absolutely true. There’s absolutely no doubt about that in my mind. That is what we all want.

[00:34:57] >> James Jacobson: I love it. How do you keep yourself emotionally and mentally sane, healthy?

[00:35:04] >> Dr. Katie Berlin: Well, there’s multiple factors to that too. I run, I run a lot.

[00:35:10] >> James Jacobson: You’re a marathoner, right?

[00:35:11] >> Dr. Katie Berlin: Yes. And that is a huge outlet for me. If I can’t run, if I’m injured or something, I get crankier, but the big answer there is boundaries. So that is something vets are pretty bad at historically is boundaries. You know, we, we have historically been on call all the time and you know, you could knock on your vet’s office at 3:00 AM.

[00:35:32] You know, there’s still vets there like that today, where they live above the practice and you knock on the door and they’ll come down and see your pet at 3:00 AM, you know, And that’s just not a sustainable model now because we have emergency clinics for a reason. And it’s partly because clients want so much more of us during the day when we’re open, we need that time to recharge.

[00:35:50] And so if a vet clinic isn’t staffed for 24 hour care, we need to be able to shut off at the end of the day. And so boundaries for me have changed everything. Because I am a much better vet. I’m much nicer and more compassionate and more patient and easier on myself and those around me when I’m rested and I’ve had my run, you know, and I’ve had a weekend or a day off and I’m much more present at work.

[00:36:19] And I think most of us are like that. Whether we’ve realized it yet or not.

[00:36:23] >> James Jacobson: Is that something that evolved, that both the boundaries and I guess I would say the compartmentalization ’cause like, okay, so you go from that cancer diagnosis with the rottie and then you go into the room and there’s a cat wellness exam and you have to basically compartmentalize those skills, I would assume both of those are something that evolve over time, or what?

[00:36:47] >> Dr. Katie Berlin: I think some people are naturally more capable of it than others. I think that’s just gonna be individual differences for sure. I think we all feel deeply when we have to be euthanized a pet or give bad news, but the compartmentalization, I think we can do it short term in the clinic.

[00:37:05] And then we have to go home and feel those feelings. And that’s where Not One More Vet comes in or talking to your friends who are vets or talking to your coworkers, having somebody who understands why that was hard or why this didn’t go the way you wanted it to and you need to talk it out. I think that is crucial because you can compartmentalize in the moment, but you can’t do it forever. It will eventually get to you. So that I think is a skill is not just learning to separate things during the day so that you can get through your day, but then to be able to bring those back to the surface and handle the emotions that come with them later.

[00:37:41] >> James Jacobson: So obviously euthanizing animals is just a daily part or a very common part of veterinary practice. And that’s not what people went into veterinary medicine to do, but it’s just a part of the job. Is there something that you do to prepare every time you have to do that?

[00:37:56] >> Dr. Katie Berlin: I think euthanasia is each one is different. You know, it’s not like you have this sort of euthanasia toolkit where you say are coming to go and do this and here’s what I have to do in my mind, because for instance, if a patient like Dunbar gets to that point, first of all, I would do almost anything, not to be the vet that has to euthanize Dunbar. I would also never forgive myself if I wasn’t given the opportunity, you know, if or, if I was given it and I didn’t take it, it’s more what I meant because patients like him, it’s an honor to have been involved in their life.

[00:38:32] You know, I’ve lost patients where I just felt like it was the end of an era because it was the era of Emmett or it was the era of Buddy. I saw them so often and I knew them so well, but I knew the names of the kids of the owners. And it was just, you know, those things you feel just in your bones and there’s no way to prepare for that.

[00:38:52] So I think with euthanasia, especially if it’s a patient you’re close to, or a family that you’re close to. It’s more after that requires the emotional work, where you have to do something with those emotions, you have to talk about them, or you have to not talk about them and write them down. Or when they come up later, you have to acknowledge that they’re there because tamping those down, it does eat away at you.

[00:39:16] A lot of people say, well, is the suicide issue with veterinarians or the mental health issues that have to do with euthanasia? And I think sometimes it does. It weighs on us each time we take a life. It weighs on us, even if it was absolutely the time for that life to end. But most of the time it is that time for that life to end.

[00:39:35] And we know that we’re doing what we need to do to make sure that that pet doesn’t suffer, which is after all our entire reason for having a job. So a lot of times it’s harder when we feel powerless to do something to help the pet. If a client refuses care and we know we can fix something, you know, the puppy with the broken leg it’s taken home or the dog with the tumor disappears and you never hear from them again and you don’t know what happened. That’s very hard.

[00:40:02] >> James Jacobson: That was really poignant. Anything else that I’m not asking that I probably should ask?

[00:40:08] >> Dr. Katie Berlin: Oh my gosh. I mean, I feel like this is a little window between, you know, it is on the other side of the exam table. What’s going through our brains when you’re standing there with your dog.

[00:40:18] There’s so much I would want to say, you know, I could talk all, seriously, all night about that, because I think it’s a huge gift to be given the opportunity to say, here’s what’s going on in my brain when you and I are looking at each other in an exam room. We don’t have time to talk about that on your average day.

[00:40:35] And, um, there’s so much otherness in everything we do now, especially now when everyone’s wearing masks. You know, the clients are sitting in the car while I’m looking at the dog inside. That is so hard. It’s horrible because if you’re treating the bond between the client and the dog, like how are you gonna do that when there’s all this space in between?

[00:40:55] So that’s really hard right now. That’s hard for us too. So that’s definitely something I want people to know is there’s a pandemic going on and we’re in masks and somebody comes out and gets your dog from the car, your cat, from the car, and then you don’t see what’s going on. That’s also hard for us and we’re not trying to take advantage of you not being there.

[00:41:11] You know, we’re doing everything the same as we would if you were there, but we know it’s stressful. You know, I’ve taken my dog to the specialist and had him disappear into the back. You know, I hate that, the back.

[00:41:22] >> James Jacobson: The back. We gotta get them back for just a few minutes.

[00:41:25] >> Dr. Katie Berlin: Yeah. We’re gonna take him to the back. You know, I hate that ’cause like what’s happening back there. My dog does not do well away from me, you know.

[00:41:30] >> James Jacobson: Right. And you can hear them whimpering through those very thin doors.

[00:41:33] >> Dr. Katie Berlin: Yeah. No, it’s probably a dog waking up from anesthesia and they’re a little disoriented, but it sounds like there’s somebody’s dying back there, you know, it’s terrifying and I totally a hundred percent get that. So during these very weird times, I think there can be even more other where it’s us versus them. You know, the people in the building and people outside of the building, but a good vet, a good vet team will be doing everything the same as if you were there and finding ways to involve you, asking what you need.

[00:42:03] And making sure that, you know, what’s going on inside the building. And if you’re not sure, just never feel bad about asking, you know, not like, what are you guys doing in there, but more, Hey, is there any way that I can see what’s going on? Could we do FaceTime or can you take a picture for me? I’m happy to do. I actually FaceTimed with a client the other day and it was great. We’ve been Zoom calling during my acupuncture appointments, which is really fun. So we want to involve you because there’s no pet without you.

[00:42:32] >> James Jacobson: That’s awesome. So have you had to deliver some really bad news now via telephone that you might’ve previously done obviously face-to-face?

[00:42:41] >> Dr. Katie Berlin: Yes.

[00:42:42] Yeah. At least the assumption of bad news, the very, very high likelihood of a very bad news. That is really hard. You know, there’s just kind of a silence over the phone and that’s really hard. Also good news over the phone, which is diluted a little bit, I think, because you want to go in the room and like, you know, everybody’s face lights up and you can basically like do a little dance, you know, like yay, benign. And it’s a little bit different now.

[00:43:11] >> James Jacobson: It’s much more clinical.

[00:43:12] >> Dr. Katie Berlin: It can feel more clinical. And the difference when you can see somebody’s eyes, even if they have a mask on is night and day. So, yeah. This is a tough time for everyone. And I think people are a little on edge right now, too, you know, I mean duh? This is not an obvious thing to say, but it comes out in ways you’re not expecting.

[00:43:31] So people are less kind sometimes than they would normally be, clients who normally are very patient and kind might not be so much right now. And we may not be as patient and kind as we want to be because our lives are turned upside down, too. We’re all trying to remember that. And we hope that clients are trying to remember that too, that everybody’s in this together.

[00:43:51] >> James Jacobson: Dr. Katie Berlin. Thank you so much for reminding us what it’s like on the other side of the exam table or in this case, in this COVID case, you know, in the car.

[00:43:59] >> Dr. Katie Berlin: Right.

[00:44:00] >> James Jacobson: Through the medium of telephones.

[00:44:02] >> Dr. Katie Berlin: I know, on the other end of the FaceTime calls. These things are still weird right now. Right? But thank you so much for having me. This is so fun.

[00:44:08] >> James Jacobson: Thank you. Yes. Well, you’ve been a joy and hopefully we’ll do this again.

[00:44:12] >> Dr. Katie Berlin: I hope so.

[00:44:12] >> James Jacobson: We’d like to have you back.

[00:44:13] >> Dr. Katie Berlin: Anytime. I’d love to.

[00:44:14] >> James Jacobson: Thank you.

[00:44:16] Well, that’s our conversation with Dr. Katie Berlin. I just loved listening to her and hearing about how she thinks and feels and experiences being a veterinarian. She really made me think a little harder about my own relationship with vets over the years. I was particularly struck by the stress that vets can carry, just going through their day. Imagine having to euthanize a dog, and then 10 minutes later, going to a routine wellness exam, and then a half hour later detect a heart murmur in another patient and then set a bone or take a fine needle aspirate and have to tell a pet parent that the dog has cancer.

[00:44:50] And that might all happen before lunch. It’s a stressful job. And it’s true, I think, when Dr. Berlin says that veterinarians go in knowing that it’s stressful and that they are going to be tested emotionally. Your vet has a heart, which is both their strength and perhaps their weakness. It’s counterintuitive, but they may seem cold because they care too much.

[00:45:13] I get the sense that Dr. Berlin feels like she’s a part of the family for every pet she sees. And I was really struck by the idea that sometimes people just disappear on her and she never knows whether that puppy with the broken leg did well or not. I hope this conversation has inspired you, like it has me, to take a moment to ask my veterinarian how they’re doing and maybe to make a little more effort, to be a little more patient and kind the next time I go in. Anyway, that’s food for thought, because one in six veterinarians has considered suicide according to the suicide prevention group, Not One More Vet. If you are a veterinarian listening and in need of support, please go to their website NOMV.org. Again, Not One More Vet. As Dr. Katie Berlin said it is a community of fellow veterinarians who understand what you’re going through, and they’re here to help you. Links to that website and more are in the show notes to this episode, which you can find in your podcast app or at DogCancerAnswers.com.

[00:46:21] Please subscribe to Dog Cancer Answers in the app of your choice, tell a friend or a veterinarian or anyone who might find this show valuable. The more ratings and reviews and listens and subscriptions we get, the higher we’re ranked in the algorithm, and the more likely people are to find us just when they need us. Or maybe your personal veterinarian just needs to share something important. If there’s even a chance that they have something valuable to pass on, they could be a great candidate for a guest slot on this show. All they have to do is contact our producers via our website at DogCancerAnswers.com.

[00:47:04] And those touchstones remind us that veterinarians are on-call on our listener line. If you have a question for a dog cancer vet, please call our listener lines and tell us about it. We will send it to one of our veterinary experts. After that, your question and answer will appear on a future episode of Dog Cancer Answers. The telephone number is (808) 868-3200. It’s (808) 868-3200. Or visit our website at DogCancerAnswers.com.

[00:47:37] We’d like to once again, thank our sponsor, The Dog Cancer Survival Guide book by Dr. Demian Dressler and Sue Ettinger. It is available online and in brick and mortar stores. And remember getting that book also helps to support this podcast. Get it directly from the publisher, the other website, DogCancerBook.com. You can use that promo code PODCAST for 10% off. That is www.DogCancerBook.com.

[00:48:07] My heartfelt, thanks to Dr. Katie Berlin for being our guest today until next time I’m James Jacobson from all of us here at Dog Cancer Answers and Dog Podcast Network. I wish you and your dog, a warm, Aloha.

[00:48:25] >> Announcer: Thank you for listening to Dog Cancer Answers. If you’d like to connect, please visit our website at DogCancerAnswers.com or call our listener line at (808) 868-3200. And here’s a friendly reminder that you probably already know, this podcast is provided for informational and educational purposes only.

[00:48:44] It’s not meant to take the place of the advice you receive from your dog’s veterinarian. Only veterinarians who examine your dog can give you veterinary advice or diagnose your dog’s medical condition. Your reliance on the information you hear on this podcast is solely at your own risk. If your dog has a specific health problem, contact your veterinarian.

[00:49:02] Also, please keep in mind that veterinary information can change rapidly, therefore, some information may be out of date. Dog Cancer Answers is a presentation of Maui Media in association with Dog Podcast Network.