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Special Ep 7 - Raising the Bar: Anesthesia Standards in General Practice
182 Plays12 days ago
Not all veterinary hospitals approach anesthesia the same way—and that can have a major impact on patient care. In this episode, our trio of veterinary anesthesiologists is joined by Dr. Natalie McShane, owner of East Side Animal Hospital, for an honest discussion about anesthesia in general practice. We explore why the level of anesthetic care can vary significantly between clinics, the challenges GPs face in providing advanced anesthesia services, and whether veterinary schools are adequately preparing new graduates for real-world anesthesia decision-making. A candid conversation about training, confidence, standards of care, and opportunities to raise the bar for patients everywhere.
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Transcript
Intro
Introduction of Dr. Natalie McShane
00:00:39
Gianluca Bini
All right, so tonight we have Dr. Natalie McShane from Eastside Animal Hospital with us. She's our special guest for tonight.
00:00:47
Natalie
Honored. Honored.
00:00:49
Gianluca Bini
Natalie is a wonderful GP out in Charlotte, North Carolina. Thank you so much for being with us. It's kind of exciting to have you on.
00:00:58
Natalie
Honored to be here.
First Encounter with Dr. Natalie
00:01:00
Gianluca Bini
It's kind of exciting to have you on because I met you probably first time about a year ago. And
00:01:08
Natalie
Yes, I was crying on the phone. Do you remember? Do you remember the first conversation we had?
00:01:12
Gianluca Bini
I totally remember that first phone call. I was actually, think at that time I was loguming at U of I, so I was really near Ryan and I was in my Airbnb and I pick up the phone and there's Natalie over there that's like desperate to find solution for her practice. And I was like, well, you know,
00:01:36
Gianluca Bini
you know, we can totally help you.
Anesthesia Progress in Practice
00:01:37
Gianluca Bini
And I love how went from that to the level that you guys have now of anesthesia is incredible, right?
00:01:46
Gianluca Bini
Like you're one of the best access stories I have.
00:01:47
Natalie
Yeah.
00:01:50
Gianluca Bini
And like, how can you change
00:01:53
Ryan Bailey
for you.
00:01:54
Gianluca Bini
the way a practice actually does anesthesia and it's insane. And so I'm so, by the way, extremely proud of you and your team. But, you know, I wanted to have you tonight because I, you know, we see anesthesia in, you know, tertiary referrals. We see anesthesia in like, very highly specialized centers, right? But sometimes we forget or we kind of detach from what actually happens.
Veterinary Anesthesia Standards
00:02:25
Annatasha
Yeah, we detach emotionally on purpose because it's terrible.
00:02:26
Natalie
Yeah,
00:02:28
Ryan Bailey
So
00:02:29
Natalie
because we can't. Yeah.
00:02:31
Ryan Bailey
true.
00:02:33
Gianluca Bini
Okay.
00:02:33
Annatasha
I want to know sometimes what's going on because it's, I'm sure, a terrifying state of affairs, but yeah.
00:02:40
Gianluca Bini
Okay.
00:02:40
Natalie
Literally, we don't even know.
00:02:41
Gianluca Bini
Okay. Well,
00:02:43
Natalie
Well, there is no standard, right?
00:02:44
Natalie
Like, what is really, you know, that, like, we're kind of talking before the pod started.
00:02:50
Gianluca Bini
Yeah.
00:02:51
Natalie
did relief before I was
00:02:54
Annatasha
Well, for everyone, just to be, just to recap the pre-recording conversation, which was, Luca originally introduced Natalie to Ryan and I as being a GP who used to have, like,
00:02:57
Natalie
like
00:03:09
Annatasha
nightmare-inducing anesthesia.
00:03:09
Ryan Bailey
Can you say it? Can you even say it myself?
00:03:10
Annatasha
Yeah. And then because working with anesthesiologists has really brought the level up to far above average, so has been on this extremely positive trajectory, which is a great example. But we were actually chatting about, you know, what is the... what's the bare minimum? What are the best practice standards?
Equipment Shortages Highlighted
00:03:30
Annatasha
And I think Natalie mentioned something like she's probably done relief for locum work in over 30 clinics and maybe one had a capnograph, which is why I drank pure vodka on the podcast. So anyway, so that was the pre-recording. So we have a GP here with us tonight to
00:03:51
Annatasha
Keep us humble.
00:03:55
Gianluca Bini
No, I mean, but, you know, do you think that that's, so, okay, not having the capro nerve is not, you know, a good standard of care, right?
00:04:05
Gianluca Bini
But do you think that, okay,
00:04:07
Annatasha
you're woman who always wants to have a Doppler on a desert island, you know.
00:04:12
Natalie
I know GPs who – I know GPs who – a friend of mine, actually, she doesn't have a cabinograph. She has everything else, but she'll keep the Doppler on them the whole time just playing so she can hear the heart beating.
00:04:25
Ryan Bailey
Yeah, see?
00:04:27
Gianluca Bini
By the way, the monitor does the same thing if you turn up the phone.
00:04:30
Natalie
don't know.
00:04:30
Gianluca Bini
Okay,
00:04:31
Ryan Bailey
Yeah, but the Macho makes a lot of beeps for a lot of reasons that are not associated with actual pulsations. We all know that.
00:04:37
Gianluca Bini
okay.
00:04:37
Natalie
And I think, like, I think this is where kind of you get into –
00:04:38
Gianluca Bini
All
00:04:42
Natalie
the different varieties of standards.
00:04:43
Annatasha
Well, as long as the heart's beating, anesthesia's a win, right, guys? That's the only thing that matters.
00:04:50
Natalie
It's not...
00:04:50
Ryan Bailey
I mean, at the bare minimum, Bartell. At the bare minimum.
00:04:53
Gianluca Bini
right, right.
00:04:54
Annatasha
You think?
00:04:55
Natalie
It becomes what you've been taught.
00:04:55
Annatasha
I'm not going to congratulate people for that, really.
00:04:59
Ryan Bailey
I never said I was congratulating them.
00:04:59
Natalie
It's really what you were taught. That's what she was taught. You what mean? Like, it's like... So when I graduated, was during the time where, like, there were no jobs for vets, right? Right.
00:05:11
Natalie
So the best you had was like the big box corporations that will be no named. And they literally give you like a chart of the protocols that you need to use like or should be using.
00:05:24
Ryan Bailey
Yeah.
00:05:29
Ryan Bailey
The chart I knew about, you had to mix two drugs that us anesthesiologists would have had a fucking aneurysm over. And I was like, what a stupid chart.
00:05:37
Natalie
Like they're not – looking back now and what I know, like I was only in that for a year and when I first got out. But looking back now, especially with what I know, was like it was not – the analgesia and the sedation would not be enough for these procedures like in the patients that we see.
00:05:53
Gianluca Bini
Right.
00:05:57
Gianluca Bini
Yeah. I think that part of this is our fault, right?
00:05:58
Ryan Bailey
Yeah.
00:06:00
Gianluca Bini
Like, I think the fact that, you know, people out there don't have, even today, right? Like, you're talking probably like, what, 2012, 2008, something like that?
00:06:12
Natalie
Yeah.
00:06:13
Gianluca Bini
Yeah.
00:06:13
Natalie
Like 2014. Yeah. Yeah.
00:06:14
Gianluca Bini
Yeah. So, around those times. But, like, even today, right, the fact that people don't have, crack hypnographs around or people don't have, you know, a freaking syringe pump, right? Like people, think that part of it is our fault, right? In vet schools, right? I'm not saying us in terms of anesthesiologists.
00:06:34
Gianluca Bini
I think people that do teach in vet school, think that we giving you this, giving the students this false idea of there's different standards of care
00:06:38
Annatasha
Thank you.
00:06:49
Gianluca Bini
where in reality there is only one fucking standard of care and this is the minimum and like anything above is great, but there shouldn't be anything below that, right?
2025 ACVA Guidelines
00:06:59
Gianluca Bini
Like if,
00:07:01
Gianluca Bini
Thank God now we have a 2025 ACVA guideline that says that Capnograph is the minimum standard, one of the parameters that we need to monitor for anesthesia, right? But like till then, people were thinking that Capnograph was this gold standard and then there was all sorts of shades of standards underneath that, right? When in reality,
00:07:25
Gianluca Bini
There shouldn't there should be a standard of care, one standard of care.
00:07:30
Natalie
100%. But yeah, there's some places that just still, like I see it on the Facebook groups. Where they'll say, know, like working in a clinic today, all they have is a pulse ox.
00:07:37
Ryan Bailey
Thank you.
00:07:39
Natalie
And you're like, or even the assistants that come to work for us, like, you know, we'll introduce them to, which that's the best part about using the service is the techs, our techs have become so well-trained, like in anesthesia and monitoring and adjusting the equipment.
00:07:55
Natalie
Not that they weren't, but I mean, above like what, at relief that come and they're like correcting the relief that on like how the, like, capnograph works and how to fix it and all that stuff so
00:08:09
Gianluca Bini
That's amazing, right?
00:08:11
Natalie
listen this is what it's like in the trenches okay this is like is it too much is that really really hope that's vodka
00:08:11
Gianluca Bini
Gotcha.
00:08:17
Annatasha
I just can't wait to retire. I just can't wait to retire. Yeah, I don't know, Beanie. I mean, I certainly was not trained like that when I went to vet school, and I'm the oldest of all of you.
00:08:31
Annatasha
And I've never been...
00:08:32
Natalie
Yeah.
00:08:33
Ryan Bailey
You also went to VETS school in Europe.
00:08:36
Annatasha
Yes, which is the smarter continent. And...
00:08:39
Ryan Bailey
I'm just saying there may be a difference in the standards that are taught I mean, there's significant difference amongst the standards that are taught within different vet schools in America.
00:08:51
Annatasha
But I guess my question is, is why?
00:08:52
Ryan Bailey
the
00:08:55
Annatasha
Why is this happening? I don't understand because honestly, 90% of it is not that complex. Like I'm not asking you to do lithium dilution cardiac output monitoring. It's like put an oscillometric cuff on and read a number. Like it's, I mean, seriously.
00:09:11
Gianluca Bini
No, but I get it.
00:09:12
Natalie
I we do all that. I always have done all that.
00:09:13
Ryan Bailey
same time, is it art?
00:09:14
Natalie
The only thing that we didn't have was before we met him was the capnograph. That was it. I mean, we do all that.
00:09:21
Ryan Bailey
But maybe we're missing like the larger point. Like, like if you look at what is being done across the continuum of like veterinary medicine, it's, it's so similar what's happening in human medicine. And we're just like, yeah, there's one size fits all. You go to four years of vet school and you're fucking done and you move on and you just get out in the world and you do whatever the fuck you want if you want.
00:09:42
Ryan Bailey
And like, that's totally fine. But like, in humans, you've got to do one year mandatory, like basically in human medicine, far as I'm to understand, have to do one year mandatory, you know, like internship, and then you can go on to whatever you're going to do next. You're not like kicked out the door and going into practice the following day.
00:10:00
Ryan Bailey
And then there's a continuum within human medicine of like, you know, there's your general surgeons, there's your cardiothoracic surgeons, your blah, blah, blah. But like, we're starting to do that, but we haven't actually caught up yet.
00:10:12
Ryan Bailey
So we're like, so in academic institutions, you're doing really high level anesthesia all the time, because that's what those, that's what people in those institutions do.
00:10:22
Ryan Bailey
want to do primarily because they want to push the envelope, advance the medicine, advance the care that we're doing on a daily basis. And the only way to do that is, is to do it at these higher levels where they have access all these tools and equipment.
00:10:34
Ryan Bailey
But then
Training Differences in Medicine
00:10:35
Ryan Bailey
at the same time, it means we're losing that training time where we can actually teach how to do basic day one anesthesia practice, unlike everyday cases that are generally healthy and are all going to do well.
00:10:48
Ryan Bailey
and like teach the ins and outs of like how hypnography works, how ventilation works, what do we do about CO2? Why do we care about the heart rhythm? Blah, blah, blah, all that. So like, I mean, like, I don't have an answer because like, I think.
00:11:03
Gianluca Bini
Absolutely.
00:11:03
Natalie
I had a great, I had a great, like, anesthesia in vet school and then great, like, rotation at NC State.
00:11:04
Gianluca Bini
Right. Yeah.
00:11:14
Ryan Bailey
But how many weeks?
00:11:16
Natalie
Like, two weeks, right?
00:11:18
Ryan Bailey
Right.
00:11:18
Natalie
And then you're...
00:11:18
Ryan Bailey
How many cases did you see in TV?
00:11:19
Annatasha
Rrrrrrr.
00:11:19
Natalie
Yeah, 100%. And then you're studying for boards. You've got internal medicine for four weeks after that, right? You're like barely sleeping. And then you get into the real world, like in practice, right?
00:11:31
Natalie
Like I couldn't afford to do an internship because had to like pay my loans back.
00:11:34
Gianluca Bini
Yeah. Yeah.
00:11:34
Ryan Bailey
For sure. Yeah.
00:11:35
Natalie
That too.
00:11:35
Ryan Bailey
Yeah.
00:11:37
Natalie
So it's like- Then you get into practice, right? So I started working for a big box corporation and you're being mentored by that person and you're given this – like a book essentially of like this is – and then you kind of learn your mentor's protocols and you get used to that.
00:11:48
Ryan Bailey
Mm-hmm.
00:11:53
Natalie
And then you – I don't know. I feel like that's what I hear. I was taught this and that's what you're most comfortable with. And so I feel like I've always been comfortable with monitoring and things like that, but I was never –
00:12:06
Natalie
as comfortable as I am now with troubleshooting.
00:12:11
Gianluca Bini
Yeah.
00:12:11
Natalie
Like...
00:12:11
Gianluca Bini
Do you think the failure...
00:12:13
Annatasha
I find it, go ahead Beanie, sorry, sorry, sorry, sorry.
00:12:14
Gianluca Bini
Right. I was saying, do you think that the gap, so the disconnect comes at the vesicle point? you think happens, like knowing what you know now, right? Like, so now you know...
00:12:29
Gianluca Bini
you know how to troubleshoot things, you know how to work, do a very good level anesthesia, right? Do you think that the disconnect happened, you know, at vet school?
00:12:42
Gianluca Bini
Do you think it happened between vet school and now? Like, was the issue, you know, practicing?
00:12:48
Natalie
That's cool. And going into like general practice because the degree of like standards of are so different. Like I, I make my texts scrub sterile multiple times. Like all the things you might go a place that just does alcohol.
00:13:07
Natalie
Do you know what I mean?
00:13:09
Gianluca Bini
Yeah.
00:13:09
Ryan Bailey
Yeah.
00:13:10
Gianluca Bini
Yeah.
00:13:10
Natalie
Please can I be capping her?
00:13:10
Gianluca Bini
And then you think that tissue has...
00:13:12
Annatasha
Sadly, we do.
00:13:13
Natalie
What?
00:13:16
Annatasha
Sadly, we know exactly what you mean. I mean, what you guys are all describing is what I have struggled with for 25 years, which is the failure of how veterinarians are actually trained and what's used to be prioritized. Like, you know, you get your we always say this like your 10 business days of anesthesia, and then you go out into practice and realize that over 80% of your cases need to be either sedated or anesthetized, if not more to manage everything that you do.
00:13:42
Annatasha
Meanwhile, you know, you've got vet students scrubbed in on TPLOs for eight weeks and, and half of them won't, don't know how to sedate.
00:13:42
Natalie
Literally.
00:13:51
Annatasha
Right. And, and don't know how intubate and don't know how leak check the machine and like seriously one-on-one shit.
00:13:51
Gianluca Bini
Thank
00:13:57
Annatasha
And, I think there's a big problem there has been for a long time in how we are graduating these students and what we consider to be day one competencies and how we're actually then stepping you up from being a student to being an independent clinician.
00:14:10
Annatasha
And I also think it
Undervaluation of Anesthesia
00:14:11
Annatasha
speaks to how we've chosen to value anesthesia as a specialty, which is why I count my seconds to retirement because, you know, you get it's totally undervalued.
00:14:12
Natalie
Okay.
00:14:21
Annatasha
And, you know, most of the time you're learning anesthesia from somebody in practice who's not an anesthesiologist, who sucks as well from these big box booklets, which are trash.
00:14:31
Annatasha
And, you know, like I remember my first job out was also for an American big box vet school, a vet company. And, you know, the anesthesia quote protocols were written by like three GPs on the other side of the country.
00:14:54
Natalie
And
00:14:56
Annatasha
mean, we still admit students based on the same criteria, which we know is in many cases failing formula. We have not changed the way that we choose to educate them. We don't, you know, try to any way, we do not seek out innovation.
00:15:08
Annatasha
It's like we want to backwards melt as a bunch of big glaciers. And, and then, you know, we get out into practice, and it's just the Wild West of clinical practice. And it's disappointing because of the work that you put in and the commitment that you have. And then, you know, that's that that standard that we're pretending exists just plummets. And at the end of the day, what suffers these patients.
00:15:33
Annatasha
Right.
00:15:34
Natalie
Yeah. And not only is it like, here we doing the anesthesia, right?
00:15:35
Gianluca Bini
Yeah.
00:15:38
Natalie
Like- but I'm also removing the 25 teeth. And so it's like, I don't have, sometimes it's, you know, love having the service because it's like, I can focus on what I'm doing and it's hard to do, sometimes to do both.
00:15:43
Ryan Bailey
Thank you.
00:15:52
Natalie
And I used to do both, but having a good tech who's really well-trained, who knows it, because we do the CE, it's who knows exactly what they're, and then having someone, because it is, it's like, I mean, it's like life and death.
00:16:02
Natalie
I mean, they're essentially like
00:16:04
Gianluca Bini
Yeah.
00:16:05
Gianluca Bini
Yeah.
00:16:05
Natalie
You go to a human, you're human, like you're having a C-section.
00:16:08
Natalie
You know, I had The OBGYN's not going, how does the blood pressure look? Like, you'd be like, know, you have an anesthetist and a CRNA. Like, who's handling that? Well, they're doing the bulk of the procedure, you know?
00:16:21
Ryan Bailey
I mean, like, like for me, anesthesia, it's my full time job. It's like I in in every case, I'm using my whole brain to think about the case. And like, when, like, if someone was like, here's a scalpel, I'd be like, cool, I'm just going to slash my throat.
00:16:37
Annatasha
You use your whole brain, Bailey?
00:16:38
Natalie
That's
00:16:40
Ryan Bailey
Yeah, I use my whole way.
00:16:42
Ryan Bailey
I would not be using the scalpel.
00:16:44
Ryan Bailey
Like, if someone had to do scalpel, don't know what the fuck to do with it. I'm just going be like, all right, going to somewhere else.
00:16:49
Annatasha
Yeah, you would. Surgery is not that hard, honestly. Like cut so cut so monkeys can do it. Like, come on.
00:16:54
Ryan Bailey
Yeah, I'm not going to go there, but I think it is...
00:16:55
Gianluca Bini
That's not true.
00:16:56
Natalie
not true.
00:16:58
Ryan Bailey
These are all important skills, and they all need to be recognized for the importance that they are. And I think, interestingly enough, going...
00:17:04
Annatasha
I'm not a surgeon.
00:17:05
Ryan Bailey
Yeah, I'm not...
00:17:05
Annatasha
Don't blow smoke up my ass, okay?
00:17:09
Ryan Bailey
You know, that's not where I come from, Bartel, all right? And, you know, going back to last week's conversation, maybe there's a place, well, not last, for the viewers out there, it's probably like last month, so like, you know, follow along for all of you folks.
00:17:23
Gianluca Bini
Okay. Last episode.
00:17:24
Ryan Bailey
the last episode. But like, I think there's something to be said about like the potential loss of skilled veterinary technicians in the field and like the diluting down of the veterinary technician education, because they were the one, they are the ones doing the majority of the anesthesia. We, the doctors are the ones making, you know, like in GP, you're the ones making the plans for the most part. And then it's kind of like, you've got your own stuff to do. And so they're the technicians, the one usually doing a lot of the active management that I would be doing on a case myself.
00:17:54
Ryan Bailey
And now that we don't have as many skilled technicians in the field, too, and the education they're getting is like fucking way worse nowadays because there's just been a proliferation of schools offering like lower and lower quality education and blah, blah, blah.
00:18:07
Ryan Bailey
It's a fucking mess, if you want my opinion. But I think that also hurts the whole the whole specialty of anesthesia in general.
00:18:13
Gianluca Bini
Yeah.
00:18:26
Annatasha
And, you know, and it's just that you would never get away with this in human medicine, right?
00:18:26
Natalie
Well,
00:18:31
Annatasha
You would never get away with this in human medicine.
00:18:31
Ryan Bailey
But they're one-to-one.
00:18:34
Annatasha
And I totally, and before everyone launches into the explanation, what's difference between vet med and human medicine? I get it. I just don't care. Right? Like I'm just like, just be better veterinary medicine.
00:18:43
Natalie
I mean,
00:18:44
Gianluca Bini
Thank
00:18:45
Natalie
It's that, but you know what? It's like, besides anesthesia, I see it in medicine in general, in the things that I see.
00:18:53
Annatasha
You see it, honestly, I'm picking on anesthesia because obviously the coolest specialty.
00:18:54
Natalie
That's what you got.
00:18:59
Annatasha
But it's true in everything. I mean, because when you work like referral centers, academic, private, doesn't matter. There is a very significant portion of your caseload, which is basically what I call search and rescue, which is saving other people's fuck ups.
00:19:13
Annatasha
you know, these are get these, you know, cases that come days, weeks, months into things where essentially, and I'm going to be very transparent, they have been grossly mismanaged.
00:19:14
Natalie
Thank you.
00:19:23
Annatasha
Right. And it's to the detriment of the pet and it's a detriment to the client because you've used up a lot of their financial resource. And the problem that we see is, of course, we have to be very mindful, right? Like usually the veterinary oath says you can't really drop another veterinarian directly in the shit unless they've actually done something so incredibly negligent or incompetent. And just to be clear, in the last six weeks, I've reported four different veterinarians for incompetence.
00:19:46
Annatasha
because I've had it up to here with the bullshit. But anyway, you see this in referral practice and it's across all the specialties, right?
00:19:50
Natalie
Thank you.
00:19:53
Annatasha
Like things I've seen in my life are TPLO plates being put on back to front, right? Like they're been put on inside out. I've seen non-intramedullary pins being placed through, like, for example, like into a humerus and then it's fractured its way through the illness and the radia.
00:20:07
Annatasha
So, you know, and, you know, things like the patient's being treated for Addison's when it's not Addisonian, you know, so it's, it is wild in general and not specific to anesthesia.
00:20:18
Annatasha
And like I said, when you become a specialist, one of the things that really starts to leach the will to live from your soul is the fact that you see these cases where It actually is quite 101 and we don't hold these people accountable and you know, our re-credentialing of everybody across the spectrum is incredibly lax.
00:20:35
Gianluca Bini
Yeah.
00:20:40
Annatasha
And you know, and again, it goes all the way back and it begs the question about how are training people in the first place and why are we not emphasizing what we call day one competency and why is there not a continuous like, when we were on the podcast with Jen Luca's wife, Kristen, who's both a human and a veterinary professional.
00:20:55
Annatasha
And she was saying, like, you have to recredential continuously and, like, you can't touch, like, the blue button until you've gone through, like, two years of continuous course learning. And I get that that capacity doesn't exist for us.
00:21:06
Annatasha
But, you know, we continue to...
00:21:08
Gianluca Bini
But why couldn't they? Right?
00:21:10
Annatasha
Huh?
00:21:10
Gianluca Bini
That's the problem, right? Like, why couldn't exist for us, right? Like, why there is nobody?
00:21:13
Annatasha
That's...
00:21:15
Gianluca Bini
Like, they're, you know, when you go to England, the RCVS sets the standard, right?
00:21:22
Natalie
So question, in Europe,
00:21:22
Gianluca Bini
Yeah.
00:21:25
Natalie
Are all of the veterinarians practicing like a similar standard of care, would you say?
00:21:30
Gianluca Bini
A higher standards of care, yes.
00:21:31
Natalie
Higher standard.
00:21:33
Gianluca Bini
100%. 100%. Because they lose their fucking license.
00:21:34
Natalie
Because like, Yeah.
00:21:36
Gianluca Bini
That's what it is. But there is an actual, somebody that actually does check on whether you're doing shit or not, right? Like, here, it's the fucking Wild West.
00:21:43
Natalie
Yeah.
00:21:46
Gianluca Bini
You open your practice, and then God the fuck knows what happens in it, right?
00:21:46
Natalie
Yeah.
00:21:50
Natalie
Well, sometimes people...
00:21:50
Gianluca Bini
Like, nobody comes to you and checks.
00:21:54
Natalie
I will say like there is this – this is how I feel like there's almost like this when you're in GP.
GP Pressures and Client Expectations
00:22:01
Natalie
There's – and I don't know if it – it's this feeling of like, oh, you can't do everything. You got to know how to do it. You don't know how to that. Oh, you're going refer.
00:22:08
Natalie
And like I told Gianluca like I refer all the time. Like – If I have a hard derm case, I'm always like, hey, I just let you know. I'm happy to do what I can do for you and try it out and do all the things when I know it's going complicated.
00:22:21
Natalie
But just so you know, there's a dermatologist.
00:22:21
Ryan Bailey
Thank
00:22:24
Natalie
Or I'm happy to do this for you, but we could spend $700 doing anesthesia to do x-rays and all the things, and you still might have to go to the specialist and get all that done. And it's like, even as a practice owner, can put like a pressure on you, like, oh, every dot, like, everything you refer out of the door, like, is, like, you should be, you know what I mean? And, like, I told Jen, like, I don't care about that anymore. Like, I'm going to do the gold standard, the good quality. And if it's a client who wants me to like pin the illness in radio, which I'm never doing. I'm not doing that. I've never done that. It's not something that I'll ever do.
00:23:01
Gianluca Bini
Yeah.
00:23:01
Natalie
Then like, that's not something that needs to come here. Like they can go to the guy down the block or, you know, the other side of town who does like orthopedic surgeries who probably shouldn't be, you know what mean? Like,
00:23:12
Annatasha
I mean, there are still people out there who actually hide referral as an option, which technically is violation of the ethical code, right? Like up here, you can definitely be reprimanded formally for not giving referral as an actual option.
00:23:27
Annatasha
And there's still people who grossly oversee what their capability is. And I know that a large part of that is driven by you want to keep the business in house because you got to keep your head above water. I also understand there's a certain faction where, you know, you do the best that you can because you're the closest veterinarian for 5,000 kilometers.
00:23:38
Natalie
100%, yeah.
00:23:44
Annatasha
Like, you know, it's like, you know, I could be the only person between like Moosinia, Ontario and Saskatchewan, right?
00:23:56
Annatasha
But there are people out there, you know, like they go to one weekend course for, you know, whatever procedure and they market themselves, for example, like there are a number of people who market themselves, quote, as surgeons and they are not board certified.
00:24:08
Annatasha
They've only done additional like lateral suture courses and they'll wear like they talk as if they're surgeons and there's no accountability from the regulatory board. And one of these individuals geographically close to me, like I've personally had to anesthetize probably five patients where we ended up doing amputations on because it was terminal in terms of the ability to salvage the limb.
00:24:18
Natalie
you
00:24:32
Annatasha
Right. And, It is so hard to get another vet to report them, which is part of the problem. It is huge failure associated with the education of the client population about what the difference is between board certification and not.
00:24:47
Annatasha
And it's just like I said, there is a proportion out there of people who are hiding referral as an option because I know they're trying to tag all that business within house. And I'm a chief medical officer, and I often get calls from referring veterinarians who are pissed because, for example, you know, they took the chest rats for cardiology and then we repeated them.
00:25:05
Annatasha
Or we took chest rats and then they were pissed that we didn't send the patient back for them take chest rats. And it literally, like, there is a total disconnect between...
00:25:16
Annatasha
you know, what the variability in terms of quality and necessity are, right? And these people are like, irate, like, how dare you do this? Like, blah, blah, blah, like refund the client. And I'm like, so what you're telling me is that you believe that your cardiac workup is equal to that of a board certified cardiologist.
00:25:32
Annatasha
And they're like, yeah, I can do the legwork. they're just there to interpret. And I'm like, no, right? Like, just, it's just a no. And if you.
00:25:38
Natalie
I'm like, bye, go to the cardiologist.
00:25:40
Annatasha
Yeah.
00:25:40
Gianluca Bini
Yeah.
00:25:40
Annatasha
So I mean, like I said, I think
00:25:41
Natalie
Bye.
00:25:43
Annatasha
It's a huge problem culturally. And I do think there's a lot of variation between where you, where you train and where you practice. Europe is significantly more stringent in certain capacities. But yeah, I, I, in anesthesia in particular, we know that 95% of the anesthesia happens in GP practice. And we know that there's a chunk of that that's being done superbly. And we know that there's a chunk of that that's being done not so superbly and most people probably fall a little bit in the middle and you know it's that old adage right like you know certain x amount of pets are gonna do well no matter what you do certain number of pets are gonna do badly no matter what you do and then a few percentage of them like the two standard deviations when the mean you know they fall into one of the other categories but i you know
00:26:32
Annatasha
Yeah. Okay.
00:26:33
Gianluca Bini
Thank
00:26:33
Ryan Bailey
So, so like maybe not, I, I have a different thought process here maybe, and maybe I'm just going to take everything and go a totally different direction.
00:26:43
Ryan Bailey
But like, maybe the question I have is what can we all do like do better for our patients? You know, like what can we do the anesthesia teams to like help?
00:26:57
Ryan Bailey
And like, what did, you know, Natalie do to like do better for her patients. And I think the thing that I think about from both of our sides is we kind of leave our egos at the door and like Natalie.
00:27:14
Annatasha
That's not necessarily true. You can still have your ego.
00:27:18
Natalie
You're right.
00:27:18
Ryan Bailey
Sure.
00:27:18
Ryan Bailey
But like,
00:27:20
Annatasha
It's ridiculous.
00:27:20
Natalie
It's honestly the communication between the specialists and the GPs.
00:27:24
Natalie
We are really lucky that we have – in this area, we have like a bunch of specialty hospitals and there's one that we work with and like I can reach out to their – if the client doesn't maybe want to go today, I can reach out.
00:27:38
Natalie
It's like having that door and also not feeling like judged by the specialist because sometimes like you're –
00:27:43
Gianluca Bini
Right.
00:27:45
Annatasha
It was judgmental.
00:27:47
Natalie
Oh, please.
00:27:47
Ryan Bailey
It's really easy to like...
00:27:48
Natalie
You're like, what do you mean? You don't even know put a cuff on? You know I mean? Like, we're doing the best that we can. Like, GPs out here, we are in the trenches.
00:27:51
Ryan Bailey
Yeah.
00:27:52
Gianluca Bini
Yeah.
00:27:54
Natalie
We have to know a little of everything, you know?
00:27:56
Ryan Bailey
For sure.
00:27:56
Gianluca Bini
Yeah.
00:27:56
Ryan Bailey
I don't have to know half the shit you know. I know a lot about one very specific thing, which is why I did what I did. Because like, I...
00:28:03
Annatasha
That's true, Bailey.
00:28:03
Ryan Bailey
I...
00:28:04
Annatasha
You also know a lot about hot dogs. Don't undersell yourself.
00:28:07
Natalie
a good hot dog.
00:28:07
Ryan Bailey
My knee goes way too high not know everything about one specific thing. And so like knowing a little bit about everything made me really super anxious. And it's why I went into specialty because like I wasn't comfortable being an ER vet. Like in my internship, it was like,
00:28:23
Ryan Bailey
hellish for me. Like I was so uncomfortable not knowing everything.
00:28:24
Natalie
Oh, I would hate that.
00:28:26
Ryan Bailey
And like, I just want to know everything about one thing and be able to pour all my energy into that. And that's why I had to, that's why I chose to specialize. why I felt like I had to do it probably didn't help that went to a specialty that like, you know, made my anxiety go to like, you know, a hundred out of 10, but you know, that was my choice.
00:28:44
Ryan Bailey
But like, I think, What I was saying about ego is like, I think we all, the collective group of us all have to like, take our egos down a little bit and recognize like we can do more for our patients and we can do we the specialist can do more for the larger population if we're willing to, like, accept and work with and try and find common ground with, you know, the vets who are coming to us for help and who are saying like, hey, I want to find a way to like, do better.
00:29:08
Gianluca Bini
Yeah. Yeah.
00:29:14
Ryan Bailey
Like, hey, I'm going to be able to restructure the way veterinary education is done in America or standardizing is done in America, but I can at least help people who, you know, want to come for help.
00:29:25
Ryan Bailey
And yeah, that's
00:29:28
Annatasha
I like your happy little hopeful vein.
00:29:28
Natalie
Thank
00:29:30
Annatasha
disagree that we should tone our egos down.
00:29:31
Natalie
you.
00:29:32
Annatasha
I think if anything, anesthesia for a long time has had the issue of being tread all over and we don't have enough people standing up for the specialty. You know, like people who are like, well, going to ask surgery's permission or, you know, I'm not going to fight about, you know, this blood work or whatever that I think is necessary.
00:29:47
Annatasha
And I clearly, I do not agree with that approach. And I also think I'm absolutely going be judgmental. But I do agree that we do need, I mean, it boils down to two very simple facts, which is not different than anything else in life, which is education and communication. And from my point of view, still do as much external CE as I can.
00:30:05
Annatasha
And I really focus my CE to be on RVTs and GPs specifically. I have a very like phone me anytime policy for no charges. So when I do speak, I make sure everyone gets my email and my number.
00:30:16
Annatasha
So that, you know, if you do want to talk through a protocol ahead of time or if you have something on the table that's not doing well or you're just generally anxious, I give virtual seminars for in clinic training, right?
00:30:17
Natalie
Thank you.
00:30:27
Annatasha
Like I try to promote stuff like John Lucas company, Safe Pet Anesthesia, where you can have like a phone a friend on board. Right. So I do think that individually, like there's a lot we can do.
00:30:37
Annatasha
And despite the fact that I'm both egomaniacal and judgmental, But for me, that's really a defense mechanism for the fact that my entire career anesthesia has been so like undervalued.
00:30:47
Annatasha
And like I
00:30:47
Natalie
Oh, I couldn't imagine. I couldn't imagine.
00:30:49
Annatasha
I do think that we need to put our dukes up a whole hell of a lot more and not just sort of be so passive about the way that the trends tend to move. But yes, I think that there's a ton that and it's so weird to me because like, for example, Natalie, you were saying like, you know, you came from a really strong school and I know the anesthesiologists there and I have a huge amount of respect for how they actually do train.
00:31:11
Annatasha
and the kind of anesthesia that they practice, except for John Luca, obviously. And anyway,
00:31:17
Ryan Bailey
Amen.
00:31:19
Annatasha
but, you know, it's like, as soon as everyone leaves vet school, they forget that they can still call people for help. right? Like, it's always like, why didn't you call me before this happened?
00:31:27
Natalie
Yeah.
00:31:30
Annatasha
Right? Like, why didn't you, you know, there's 21 anesthesiologists in the city of Toronto, like pick up the phone, like one of us will help you.
00:31:32
Gianluca Bini
Yeah.
00:31:37
Annatasha
But again, that's part of the communication and the education, right? So it's, it's, we're very much like the wizards behind the curtain. And, you know, it's time to pull the drape back and really start to insert ourselves back into the conversation and back into the practice and really If we wanna do best by the pets and we really wanna support vets, particularly when we're looking at things like mental health, because the end she's like a top three source of anxiety.
00:32:03
Natalie
Mm-hmm.
00:32:03
Annatasha
Like we have to take onus for that.
00:32:05
Annatasha
We do, we do. Because like Bailey said, I'm not going to change how we all go to vet school unless I directly get involved in that.
00:32:06
Ryan Bailey
Yeah.
00:32:10
Annatasha
And honestly, I will develop a full-time drinking problem. So, you know, this is what I'm choosing to do. And Bailey, I know you do that kind of stuff. And Beanie, obviously you do that kind of stuff.
00:32:19
Annatasha
And I guess, Natalie, my question for you is, is what more do you think we could do to reach the GP population and sort of bolster that sense of commonality and support.
00:32:30
Annatasha
And like, how do we get more into the trenches with you guys so we can affect a better change?
00:32:37
Natalie
I think it's exactly what you said, like the CE giving out your number, John Lucas service, all
Elevating Veterinary Standards
00:32:41
Natalie
those things. But it's, there are certain vets that are not going to ever ask for help. Do you know mean?
00:32:48
Ryan Bailey
And we're never going reach them, though.
00:32:48
Natalie
Because it's always been this way.
00:32:49
Ryan Bailey
You know what I mean?
00:32:50
Natalie
That's the way it is, you know?
00:32:51
Annatasha
But you know what? You don't focus your energy on the bottom 10%, right? You focus your energy on, you really put it in for the top 10% and you get them as like ground level cheerleaders for you and they will help bring everything up with them.
00:33:03
Ryan Bailey
Exactly.
00:33:04
Gianluca Bini
Yeah. I,
00:33:04
Ryan Bailey
You find the, like, trust me, I have worked places where you find the people who you know are going to be your allies, you make them your allies, you use those allies to then change the people who are not your allies.
00:33:05
Natalie
I try to spread the word.
00:33:18
Ryan Bailey
And so, like, that's what it is. It's focusing you know, people like you, Natalie, who are going to spread the word and say, like, hey, there's these services, there's these people, you can call them, like, da-da-da.
00:33:32
Natalie
Yes. People don't know like about that. You know, I remember putting it in the owner's group and just saying like, oh my God, I feel like a relief because I'm the only vet here.
00:33:35
Ryan Bailey
Mm-hmm.
00:33:41
Natalie
And it always feels nice to have another vet in the building with you. You don't realize like what it's like when you don't have one. And so, and all of our cases are like aggressive, need 37 extractions, have a grade five murmur.
00:33:54
Gianluca Bini
Again, I think that's what she's 100%.
00:33:55
Natalie
Like
00:33:59
Natalie
Like, it's never like, here's Polly Pocket. She's one years old and she's getting a scaling. Like, I've never done in this practice that I own, I've never done just like a simple scaling. It's always like.
00:34:11
Gianluca Bini
But see, I think going back to what you were saying, Dasha, I think that your vision of anesthesia and how it's undervalued, it's true in referrals.
00:34:15
Natalie
Great.
00:34:23
Gianluca Bini
I never had a GP that reached out and the reaction I always had was always, thank God you exist.
00:34:31
Natalie
Thank you.
00:34:36
Ryan Bailey
But that's a selection bias, Gianluca.
00:34:40
Gianluca Bini
But don't know. I mean, do you think because I...
00:34:42
Ryan Bailey
If you're selecting population who's reaching out for help, they're going to be grateful because they're reaching out for help. It's a selection bias. Sorry.
00:34:48
Gianluca Bini
Okay, fair.
00:34:48
Ryan Bailey
Yeah.
00:34:49
Annatasha
It's true. I do think on the whole, no, I actually agree with Beanie and I agree both of you. You're both right. I do think that, I don't think there's animosity towards anesthesiologists from the GP population that
00:35:02
Natalie
No, not at all.
00:35:04
Annatasha
and the VTS. It's not like when I have to have these like smack down stairwell, who's going to cry first conversations with surgeons, not picking a specialty whole, but you know, and PS, it's never me who cries.
00:35:16
Annatasha
But anyway, you know, it's, it's, it's not the GPs and the RVTs.
00:35:17
Ryan Bailey
Yes.
00:35:21
Annatasha
And I always find that even, you know, when you, you do you present or you engage, or like there's word of mouth about like you come into the clinic and you do a case, which is like a teaching case with them.
00:35:32
Annatasha
And, you know, like, I mean, I've had a lot of people reach out to me saying like, we really struggle with re-breathing, for example, during our cases, you know?
00:35:34
Natalie
Thank you.
00:35:39
Annatasha
And so then I'll be like, well, let me come in and run a case with you and see what you're doing. And then we'll talk about what's going on type thing. and so, you know, agree that they, they love it.
00:35:48
Gianluca Bini
Yeah. Yeah. Yeah.
00:35:50
Annatasha
Right. Like they, and, and my hospital and, and even like the, the provincial, RVT conference that happens every year, the single most requested type of CE is anesthesia.
00:36:02
Natalie
100%.
00:36:02
Annatasha
hundred percent. And,
00:36:04
Natalie
You guys are also zebras. Like there were no anesthesia. There's one anesthesiologist here now in Charlotte, but I want to say before her recently, the closest would be State.
00:36:15
Ryan Bailey
Yeah. Yeah.
00:36:17
Natalie
So like, and I went to St.
00:36:18
Gianluca Bini
It's crazy.
00:36:19
Natalie
George's. So like Stefano, uh, he, like I couldn't, like he scared us all because he would like, do you remember I told you about him? What's his last name? I can't remember. Stefano is his first name.
00:36:29
Gianluca Bini
Deconcetto?
00:36:30
Natalie
Yeah, he was like, he's like was real.
00:36:30
Gianluca Bini
I
00:36:33
Natalie
He was a great professor, but he was very like, he made it.
00:36:36
Gianluca Bini
think it's in LA now.
00:36:38
Natalie
He
00:36:39
Gianluca Bini
Yeah.
00:36:39
Natalie
I mean, I remember hearing stories. He used to go, obviously he was watching through surgery when we were doing student surgeries and he would close the pop-up valve and see if somebody was watching to see if they would notice.
00:36:49
Gianluca Bini
I mean, that's where they're lying. I mean, that's... Yeah, that's...
00:36:52
Natalie
No, he was right there. was right there. So he wasn't going let anything happen. But he was wanting to see, like, are they watching the bag? Are they watching the pressure? Are they doing what they need to be doing to know how to
00:37:02
Annatasha
And we need to a sound effect for cringing because Bailey and I both cringed at the same time when Natalie that. We were both like, oh, good. But I understand the principle.
00:37:11
Annatasha
I'm just not sure about the execution. But, yeah.
00:37:13
Gianluca Bini
Yeah, let's try to kill this patient and see if you realize.
00:37:13
Annatasha
Yeah.
00:37:16
Ryan Bailey
I mean, that's like nine times out of 10, my hand is on the pop off while writing a case.
00:37:18
Natalie
I just think
00:37:21
Ryan Bailey
I just stand there touching it just so I know what its status is. And it's like a thing I fiddle with from time to time as just
Role of Anesthesia in Procedures
00:37:29
Ryan Bailey
like a nervous.
00:37:30
Gianluca Bini
Is this the same thing you do with the vaporizer with the same motion?
00:37:33
Natalie
Oh, yeah, with the pretending.
00:37:36
Ryan Bailey
Oh, yeah.
00:37:36
Annatasha
That's that. Yeah. Yeah. That's just to fool whoever's talking about the case, but I also often, I, I'm also one of those people who languishes with my hand on the pop-off when I'm primary on the case too, because I've also left the pop-off closed accidentally.
00:37:50
Ryan Bailey
we all have
00:37:51
Annatasha
Yeah. Everybody has. And you lie if you don't, it's like peeing in your wetsuit.
00:37:52
Natalie
Yeah.
00:37:54
Annatasha
You either pee in your wetsuit or you lie about it. So same thing with a pop-off valve. But yeah, I, I also, you know, my hands often on the pop-off valve, especially it doesn't have a safety release on it too.
00:38:05
Annatasha
So yeah.
00:38:05
Ryan Bailey
yeah mm-hmm mm-hmm
00:38:06
Annatasha
I get it.
00:38:06
Natalie
See, I don't know you guys make it as this, like, I could never be a specialist because it's already really difficult to be a veterinarian and feel like people value, like, you were a doctor and, like, you went to medical school and you know all these, like, physiology of all the things. I could not imagine putting the blood, sweat, and tears into being, like, a specialist and then someone would like, can you do the nail trim while he's under for his cardiac, like, bypass? I'd be like, I'm done. I can't.
00:38:35
Natalie
Like, I don't know.
00:38:36
Gianluca Bini
That totally happened, by the way. Yeah, we don't
00:38:38
Ryan Bailey
I shake my head.
00:38:39
Natalie
But can you clean his ears while he's under for the double amputation?
00:38:42
Natalie
Like, I'm, like.
00:38:45
Ryan Bailey
Thank God we don't deal with clients because I would be like, yeah.
00:38:47
Gianluca Bini
deal with cleansing, which is a great specialty.
00:38:50
Ryan Bailey
Which is both a pro and a con, I will say, I always feel.
00:38:54
Annatasha
I actually deal with clients.
00:38:54
Natalie
And that's too, like.
00:38:56
Annatasha
I don't agree that anesthesia shouldn't interface. I think that's part of our problem of being valued. And so, and I don't like other people talking about like anesthetic risk and what have you. So obviously insert myself with a great degree of distress to the other specialties all the time.
00:39:10
Annatasha
But I mean, it's just wild to me that you go under these crazy cases with anesthetic risk and, you know, and like some first year neurologist has explained it to you. And then like, no, like I'm making that call for sure.
00:39:21
Annatasha
So anyway, that's whole other podcast. But yeah.
00:39:25
Natalie
but also to like tell the clients to give the clients like hey this is the
00:39:28
Annatasha
I mean, Natalie, to your point, I just want to clarify that becoming a specialist is a horror show. And I still have PTSD, which I've now chosen to just block out. And then every time I meet people, like someone was talking me today about somebody who's triple boarded. And in my head, I was like, F-R-E-A-K, what a freak you must be. Like, I don't think that people who are double and triple boarded are necessarily mentally all with it. And so I just want to put that out there.
00:39:55
Annatasha
But I'm like, yeah, no, I wouldn't specialize. I wouldn't be vet again personally, and I wouldn't specialize again. just literally took years off my life.
00:40:01
Ryan Bailey
Our audience is just dwindling at the moment.
00:40:04
Annatasha
Years off my life. But yeah.
00:40:05
Natalie
because like the other thing i was talking to an intern a sailor day like about a case and i'm like god i don't i could not be you because when it gets they're always like okay when it gets to a place where like this is a case that's like way over my head i can like punt them to internal medicine and if i'm the one they're punting to i'd be like oh god you know what mean sometimes you're just like you're the specialist you are like the person you know
00:40:29
Ryan Bailey
Oh yeah.
00:40:29
Gianluca Bini
Yeah.
00:40:29
Annatasha
Well, see, that's the problem, right? Like people peg you as being like omniscient and we're not, right? Like I don't know everything about anesthesia and neither these two. And Lord knows the three of us are just making it up together.
00:40:40
Natalie
You know way more than I would know, right?
00:40:42
Natalie
Like you would have way more experience in doing like a lot of...
00:40:51
Ryan Bailey
Yeah.
00:40:54
Annatasha
So that's always uplifting. But yeah, I think that.
00:40:59
Natalie
a way of fun, John.
00:41:00
Annatasha
But yeah, no, I do think that people like, you know, you are you there's this weird expectation that we're supposed to know everything and have like full capability. And sometimes, you know, specialists, it can be hard to say, I don't know.
00:41:12
Natalie
Oh, 100%.
00:41:13
Annatasha
No, I actually, I haven't seen that paper. I didn't read that. And then the other thing that happens too, right? Like, you know, you study for boards and you would have this for like Navalny and all that kind of stuff. Like your head is stuffed with this and like 90% of it falls out.
00:41:53
Ryan Bailey
Okay.
00:41:54
Annatasha
So yeah, I just, I mean, specialistic, it can be very uncomfortable to have the buck passed to you with the expectation of omniscience, omnipotence, and perfection. And let me tell you, if you think clients are bad, if you guys lose a patient, if you lose a patient as a specialist, I mean, if I've lost a patient under anesthesia, like, they will try to hang me from like a yard arm for it.
00:42:17
Annatasha
Like there's zero forgiveness. And that's part of the anguish, right?
00:42:21
Natalie
That's, I could not, that's, thank you.
00:42:23
Gianluca Bini
I mean, but, you know, I agree with you, but, like, also, like, I feel like what Ryan was saying, like, I think it's, you know, I really commend GPs out there because they actually managed to have the huge, you know, knowledge of, like, different things. Like, I have no fucking clue of vaccines my dogs need.
00:42:47
Gianluca Bini
I tell people all the time, like, I take them to a fucking GP. Like, I don't, like... I don't know. Like, I have no clue what they need. Like, I know that their appointment, it's in two weeks, and I'll find out then what the fuck they need.
00:43:01
Gianluca Bini
You know?
00:43:02
Annatasha
Did you go to GP, Beanie?
00:43:04
Gianluca Bini
What?
00:43:05
Annatasha
Did you ever do GP work or did you just go straight into training?
00:43:08
Gianluca Bini
No. No.
00:43:09
Annatasha
Oh, okay.
00:43:09
Gianluca Bini
Fuck no. I just went straight from vet school into rotating anesthesia in the ships and then anesthesia residency. Boom. That's it.
00:43:19
Gianluca Bini
Like, never stuck a foot.
00:43:19
Natalie
And
00:43:20
Gianluca Bini
Huh? Huh?
00:43:21
Annatasha
Did you do GP Bailey?
00:43:24
Ryan Bailey
Not as a primary, but in my internship, we did do GP.
00:43:28
Annatasha
Gotcha. Okay.
00:43:29
Ryan Bailey
Like, yeah, we did. I mean, we were primary on the majority of the ER cases we saw anyway, and we did have a GP arm, so we also kind of saw ER cases that were GP cases, essentially.
00:43:43
Ryan Bailey
And like, we had no ER doctors to oversee us.
00:43:44
Annatasha
Okay.
00:43:45
Ryan Bailey
So we were kind of winging it because the only person you had to go to was a criticalist. And you ask a criticalist, what vaccine a dog needs, they probably would have killed you like in the middle of something.
00:43:55
Annatasha
Bye.
00:43:56
Ryan Bailey
Like, on your dead body like it was uh was an intense intense experience and and i don't blame them i have a question for natalie what do you what do you think what do you like as someone like in the trenches what do you wish we knew or could do to like
00:44:14
Natalie
Thank you.
00:44:19
Ryan Bailey
help you as you're coming up, like coming through the shit, you know, to like reach these pets that, you know, we're unfortunately not reaching and you're getting kind of a mishmash of like good quality education and then kind of mid tier and then maybe some stuff that's like kind of dog shit because it comes from, you know, like a piece of paper that you were handed by, you know, some faceless person.
00:44:46
Natalie
I think it's the CE and then also being able to talk to a specialist and not feel like an idiot.
00:44:57
Gianluca Bini
Do you think that... Who does that?
00:45:00
Ryan Bailey
Oh yeah, for sure.
00:45:01
Natalie
And I posted one time because I had talked to not a specialist in this area and I asked him a question and I said, talk to specialist today and made me feel like an absolute idiot.
00:45:06
Annatasha
Thank you.
00:45:09
Natalie
Has anybody ever had that? And I'm not even kidding you on the group. It was like 200 people were like, duh, every time, like,
00:45:15
Ryan Bailey
Oh yeah, for sure.
00:45:18
Gianluca Bini
So I'm a specialist, right? And I deal with probably 70% of our clients are GPs, right? And I hope we don't come off this way, right? Like I hope we don't come off as like, you know, we, I can't figure like how does a specialist make you feel like an idiot?
00:45:36
Ryan Bailey
Yeah.
00:45:36
Gianluca Bini
Yeah.
00:45:36
Natalie
I think sometimes they're overworked and they have a lot of patients and you might be like, well, first all, I never try to call a specialist unless I'm referring because I think it's not, they're very busy.
00:45:48
Natalie
And so to be like, hey, can ask you a question about this case? Unless I know them personally and I'm like, hey girl, can I ask you a question about this case? But like, because you have to, if you're going refer, but I think it's because they're busy and then they think like, they forget that
00:45:55
Gianluca Bini
Right.
00:46:03
Natalie
That's all you do. Let's say like cardio. All you do is cardio all day long, right? I'm doing cardio, opto, derm, behavior, like vaccines, heartworm treatments.
00:46:16
Natalie
Like I know a little bit of everything. And sometimes if it, if it's something that maybe I don't see often or, and I need, they'll be like, you didn't know that, that kind of like
00:46:25
Ryan Bailey
Yeah.
00:46:26
Gianluca Bini
Like, behavior, like, they actually act that way.
00:46:31
Natalie
Yes.
00:46:31
Gianluca Bini
Yeah.
00:46:32
Gianluca Bini
That's
00:46:32
Natalie
And yes, ask any GP that will tell you that.
00:46:34
Natalie
Everybody in their career has had like multiple. Yeah.
00:46:38
Annatasha
Well, that's disappointing.
00:46:38
Gianluca Bini
bad, though.
00:46:41
Annatasha
I mean, I don't think should be afraid to reach out to specialists because, quote, we're busy. I mean, everybody's busy, right?
00:46:47
Natalie
Yeah.
00:46:47
Annatasha
And I think there has to be that acknowledgement that that's where you really want to take some time is to support each other because it's already a big enough struggle, as we've all just described, regardless of what area you practice in.
00:46:58
Annatasha
But yeah, I mean, I don't see what purpose it serves to be like
00:47:04
Gianluca Bini
Yeah. Yeah.
00:47:04
Annatasha
This sounds weird coming from me, but to be condescending about it, right? Like I'm actually, you know, very supportive.
00:47:10
Annatasha
And I understand that because you guys are jacks of all trades or because maybe you have like, you know, the RVT has been out for six months and they're terrified and, or you came from a practice, you know, where the ACA did the co-hat and the anesthesia and the monitoring all at the same time.
00:47:23
Annatasha
And so there's this broad spectrum of experience, but I don't see what purpose it serves to be like diminutive in that capacity because you just contribute, you're contributing to the problem, right?
00:47:31
Natalie
I think 95% are fine.
00:47:33
Annatasha
You're contributing to the problem.
00:47:36
Natalie
Yeah. It's 95. I would say it's a small, I would say I don't usually deal with it, but it's like definitely, don't know.
00:47:43
Gianluca Bini
That's sad, right? Like, you know, in the end, like, you know, somebody is asking you, it's because genuinely they, you know, they need help, right? Like, what's the purpose of, like, being a fucking prick when, you know, you either don't handle it.
00:47:54
Ryan Bailey
Yeah.
00:47:57
Natalie
Or to transfer a case, right? Like, hey, I'm transferring this case. Like, did you do the, like, da-da-da-da? And it's like, no, I Like.
00:48:04
Gianluca Bini
Yeah, but I either ignore you. Or if I answer you, I do it with some level of normal, like civil manner, right? Like, add on, you know, what's the point of like answering it and then being a prick about it? Just you either keep quiet and ignore it, right? Pretend it never happened.
00:48:24
Gianluca Bini
Or, you know what I mean? Like you either don't pick up the phone or don't answer the text or pretend you didn't fucking read the email, right?
00:48:32
Natalie
Yeah.
00:48:32
Gianluca Bini
Or if you do,
00:48:33
Annatasha
Thank you.
00:48:36
Gianluca Bini
than do it in a civil manner, right? Like in a...
00:48:38
Natalie
Yeah. And sometimes like, you know, there's a certain like referral, most people that go to referral, like they know what they're getting into price-wise, right?
00:48:45
Natalie
Like you have someone who really wants to pursue that.
00:48:46
Ryan Bailey
Yeah. Yeah.
00:48:48
Natalie
Like we're seeing people who might come in and say, like, I don't have like a lot of money, you know? And like, we're just trying to do whatever we can possibly do for them.
00:48:59
Gianluca Bini
Yeah.
Advocating for Contextual Care
00:49:23
Annatasha
you know, if specialists aren't supporting GPs in that capacity, shame on you, whoever you are.
00:49:23
Gianluca Bini
Yeah.
00:49:29
Annatasha
Shame.
00:49:30
Ryan Bailey
But where's the specialist role in that?
00:49:31
Natalie
Like our neurologist here, she is the best.
00:49:34
Ryan Bailey
Like, where's the specialist role in like, like, because who do you, so who do you go to when you, when you need a specialty consult?
00:49:34
Natalie
What'd you say?
00:49:41
Ryan Bailey
Like ignoring anesthesia, like who would you, like where, how do you resource them?
00:49:47
Natalie
there local places?
00:49:48
Ryan Bailey
Yeah, you go to whatever local specialty hospital is, you give them a call.
00:49:48
Annatasha
think where did you like
00:49:52
Ryan Bailey
And like, they've probably done a CE because they're fishing for business from you and they do a CE and they build a relationship with you. And like what they're doing is trying to get you to refer cases to them, essentially.
00:50:05
Ryan Bailey
But like, where's the broader colleges support of that? Like, where's the ACVA and then even the Navis group of like, where is their, hey, here's your local anesthesiologist.
00:50:18
Ryan Bailey
Give them a call anytime. They're like somewhat local to you.
00:50:21
Gianluca Bini
Yeah.
00:50:21
Ryan Bailey
They have resources, education. They can, I don't know.
00:50:26
Gianluca Bini
I mean, I think a lot of people don't want to be bothered too, right?
00:50:29
Gianluca Bini
Like, you know, I get it. Like if you're busy, like,
00:50:31
Ryan Bailey
We don't know to do it. I'll call, anyone can call me and like, hey, you know, Bailey, I got this case. It's doing super craptastic under anesthesia. I like enjoy that stuff kind of.
00:50:43
Ryan Bailey
It's like, all right, let me think and use my brain for a little
00:50:44
Natalie
Because you guys are like – I'm telling you, you're like zebras. Like –
00:50:47
Ryan Bailey
Oh, I know. But we're not. There's bunch of us who are around. We're not always doing something. We can feel the phone call. Even my old job, I would routinely get calls from our DVMs.
00:50:58
Ryan Bailey
Hey, this dog won't get sedated. What can I do? What can I give it? It's angry. And I've given all the drugs I know. And I'm like, all right, well, just let's double up what you've already done. And it'll be okay.
00:51:08
Ryan Bailey
And oh, my God, it works so great. Thanks so much.
00:51:10
Natalie
I used to be dead, like, and we're also taught to be, like, afraid of Domeator.
00:51:12
Gianluca Bini
All right.
00:51:16
Annatasha
Oh my God.
00:51:16
Ryan Bailey
Well, don't call me.
00:51:16
Annatasha
So in exactly 10 days, I'm giving a talk called Stop Being Afraid of Dexmedetomidine.
00:51:17
Ryan Bailey
Don't call me.
00:51:22
Annatasha
That's the actual title of my talk.
00:51:22
Ryan Bailey
Don't call me.
00:51:24
Annatasha
I'm giving a full-blown CE called Stop Being Afraid of Dexmedetomidine because it's pissing me off, right?
00:51:29
Ryan Bailey
I'll teach you how to not be afraid of ace promazena.
00:51:29
Annatasha
Like...
00:51:32
Natalie
a, I had a, no, okay, I had a friend do her dental, drugs, dental here, and I'm like, I think she's going to need some Domeator. And she's like, no, no, no, no. I think I'll be fine. She did, I think, medazolam and something like a hydro.
00:51:46
Annatasha
Then you just shoot water.
00:51:47
Natalie
And the dog woke up like, not terribly dysphoric, but dysphoric because we had a little domitore on the board.
00:51:53
Ryan Bailey
Sir?
00:51:55
Natalie
She would have been like, yeah. But we're taught to be afraid of it. And then the dosing varieties, right? The bottle, I've never gone off the bottle.
00:52:03
Ryan Bailey
Yeah.
00:52:04
Natalie
I've always gone off the 0.0025 mg per gig.
00:52:08
Ryan Bailey
Point zero.
00:52:09
Natalie
will be, you'll be like given tons based on the, you know, and then.
00:52:12
Ryan Bailey
Hell yeah.
00:52:12
Gianluca Bini
Oh, yeah. Yeah.
00:52:13
Ryan Bailey
Hell yeah.
00:52:14
Gianluca Bini
Yeah. Yeah. Ryan is not the right person have this conversation.
00:52:16
Ryan Bailey
Hell yeah.
00:52:20
Ryan Bailey
I'll give you a nuanced approach to it.
00:52:21
Gianluca Bini
It's from Kevin Davis.
00:52:22
Ryan Bailey
I'm not just going to be handing out like it's fucking candy because it's not.
00:52:22
Gianluca Bini
Yeah.
00:52:27
Annatasha
None of the drugs are candy.
00:52:28
Ryan Bailey
Exactly. Exactly. Thank you so much.
00:52:31
Annatasha
None the drugs.
00:52:31
Natalie
No, but it's a lot worse, right? Like to give. too little, right, to give midaz and torb to a dog maybe that has tracheal collapse and it's going to turn blue because it's so scared you're trying to get its IV catheter in.
00:52:40
Ryan Bailey
Maybe skip the midaz lane. Yeah.
00:52:42
Natalie
You know what I mean?
00:52:43
Gianluca Bini
That's how you kill it.
00:52:45
Natalie
Literally.
00:52:46
Ryan Bailey
Yeah.
00:52:46
Gianluca Bini
That's how you kill it, literally. Question for you. So I want to ask you a couple of questions that are little bit different than what we talked about there. So, you know, you've been...
00:52:57
Gianluca Bini
want to see what do you think is the client perception of anesthesia, right?
00:53:00
Natalie
Oh, yeah.
00:53:02
Annatasha
Mmm.
00:53:03
Gianluca Bini
So when we... For example, right now you've been using us for a year or so like you probably have been offering it
Client Interest in Specialized Services
00:53:11
Gianluca Bini
to your clients, right? Like, so how do they...
00:53:13
Natalie
They don't have an option.
00:53:16
Gianluca Bini
Oh, okay, perfect. So you don't even give them the option, which is great. But like, do you go over what we do? Like why there is this charge that suddenly appears on your estimate?
00:53:27
Natalie
Yeah.
00:53:29
Gianluca Bini
Like what's their take? Like, what do they say?
00:53:33
Natalie
They love it. So they love that anesthesia scares pet owners like 100 – just like it scares – I mean, I'm scared to put my own pet under sometimes, you know, just like it scares us to go under. And I think when we explain like, hey, these are anesthesiologists just like you have an anesthesiologist.
00:53:51
Natalie
And because like I said, our procedures are never simple. People are always like, oh. And so – We go over, we give them the website, they read about it, it's on our website. And so that's why it's included in our fee. And so our charges would be on the higher end, but you're getting quality service. So for example, we had one time we did with you a 16-year-old cat who we were doing a dental on the Extractions Blessings. Bless you.
00:54:17
Natalie
And
00:54:17
Gianluca Bini
Thank you.
00:54:19
Natalie
He got hypotensive while he was under and we were still doing his extractions. And before I worked with SafePet, I would have done everything I know, turn him down, turn up his fluids, all the stuff.
00:54:31
Natalie
And he wasn't responding to any of that. And so John Luke was like, all right, let's get the doobutamine going. And I was like, okay. And what do you know? He did great. We were able to finish the procedure, wake him up.
00:54:42
Natalie
Cat's doing amazing, right? It's been like eight months since that. But in GP before that, I would have been like, okay, he's got to go to the dentist because I can't get his, you know, and he would to have another procedure and all that stuff.
00:54:54
Natalie
So explaining that to people and they're like, they're so, they're so appreciative.
00:54:54
Annatasha
Thank you.
00:54:55
Ryan Bailey
Mm-hmm.
00:54:59
Natalie
They just don't know because nobody explains it to them.
00:55:02
Gianluca Bini
Yeah. So you think it's, you know, in general, like think it's because there is a lack of offering out there, people don't know that this is something that, you know, it's an option out there, right?
00:55:14
Natalie
Yeah. And it's just the whole standard of care. Like it's the whole, they don't know. Like that's the thing for the clients is like, they don't know. And so they come for the skin issue. They don't, they want the steroid injection because they don't know like, yeah, that's the quick fix that you might've gotten at the previous, but that's not like the, the good thing for them, you know?
00:55:35
Gianluca Bini
You know, I've started, know, probably like four, probably six months ago now, we updated our website, right? Like before we didn't have a way to, you know, they could call us or send us an email, but nobody, you know, there was no form or contact us or anything like that.
00:55:52
Gianluca Bini
And we've been getting probably at least once, want to say once a week or every two weeks, we get random requests from clients at pet owners that they're like, you know, what's the nearest hospital or nearest vet that use you, right?
00:56:08
Ryan Bailey
Yeah.
00:56:08
Gianluca Bini
They're like, you know, I'm so worried about anesthesia and I want to know, you know, in my area who's using this service or, you know, can I bring it to my, you know, my GP or whatnot?
00:56:21
Gianluca Bini
But like,
00:56:22
Natalie
We've had clients just come from finding you on our website.
00:56:25
Gianluca Bini
Yeah. I mean, that's crazy. Like, I think, I think actually clients do are interested in something like this is just probably they never had the option. Like that's, that's the thing that kind of like, you know, it's, it's interesting to see. mean, I, at first I thought, you know, when we started this, I was like, okay, nobody's ever going to use this.
00:56:47
Gianluca Bini
I was like, nobody's ever going to want this service. Nobody actually cares about anesthesia out there.
00:56:53
Ryan Bailey
Thank
00:56:56
Gianluca Bini
Looking back at that, I was like, okay, I was totally fucking wrong. Actually, people want it. It's just that they never had the chance.
00:57:05
Natalie
I don't think anybody thought it was like something that was like affordable.
00:57:05
Gianluca Bini
Nobody
00:57:08
Natalie
Right. Like, so when I posted it to the owner's group and everybody was like, tell me more about this. I love this.
00:57:15
Gianluca Bini
Which, by the way, she wasn't sponsored for.
00:57:17
Natalie
was not sponsored. They were like, are you sponsoring this? I'm like, no, I'm just like so grateful. It's just like taking a weight off my shoulders being by myself and having to 45 teeth out. And everybody's like, didn't even know that was a thing. And how much is that? And that's not bad at all. That's doable. And then other people hired you and put the same thing. It's like, we don't know.
00:57:38
Natalie
Nobody knows it's out there. People care. say majority of vets care. They just... don't know what the best option is.
00:57:47
Gianluca Bini
The possibility, yeah, yeah, yeah. I think that that's...
00:58:00
Ryan Bailey
That's who I've always thought our market is.
00:58:02
Gianluca Bini
Like as an anesthesia, like college, you mean, right?
00:58:06
Ryan Bailey
Yeah, it's informing that we fucking exist just in the world and we're available in places and how do you access us? There's just like, we're just
00:58:19
Ryan Bailey
Yeah.
00:58:23
Natalie
were like, whoa, whoa, whoa. So listen, funny story.
00:58:27
Gianluca Bini
We don't do paratarelet.
00:58:28
Ryan Bailey
I mean, we can help you with anesthesia for sure.
00:58:28
Natalie
We don't do that here.
00:58:31
Ryan Bailey
I've done hell