Transcript
Gianluca Bini: All right, so tonight we have Dr. Natalie McShane from Eastside Animal Hospital with us. She's our special guest for tonight.
Natalie: Honored. Honored.
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.
Natalie: Honored to be here.
Gianluca Bini: It's kind of exciting to have you on because I met you probably first time about a year ago. And
Natalie: Yes, I was crying on the phone. Do you remember? Do you remember the first conversation we had?
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,
Gianluca Bini: you know, we can totally help you. And I love how went from that to the level that you guys have now of anesthesia is incredible, right?
Gianluca Bini: Like you're one of the best access stories I have.
Natalie: Yeah.
Gianluca Bini: And like, how can you change
Ryan Bailey: for you.
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.
Annatasha: Yeah, we detach emotionally on purpose because it's terrible.
Natalie: Yeah,
Ryan Bailey: So
Natalie: because we can't. Yeah.
Ryan Bailey: true.
Gianluca Bini: Okay.
Annatasha: I want to know sometimes what's going on because it's, I'm sure, a terrifying state of affairs, but yeah.
Gianluca Bini: Okay.
Natalie: Literally, we don't even know.
Gianluca Bini: Okay. Well,
Natalie: Well, there is no standard, right?
Natalie: Like, what is really, you know, that, like, we're kind of talking before the pod started.
Gianluca Bini: Yeah.
Natalie: did relief before I was
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,
Natalie: like
Annatasha: nightmare-inducing anesthesia.
Ryan Bailey: Can you say it? Can you even say it myself?
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? 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
Annatasha: Keep us humble.
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?
Gianluca Bini: But do you think that, okay,
Annatasha: you're woman who always wants to have a Doppler on a desert island, you know.
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.
Ryan Bailey: Yeah, see?
Gianluca Bini: By the way, the monitor does the same thing if you turn up the phone.
Natalie: don't know.
Gianluca Bini: Okay,
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.
Gianluca Bini: okay.
Natalie: And I think, like, I think this is where kind of you get into –
Gianluca Bini: All
Natalie: the different varieties of standards.
Annatasha: Well, as long as the heart's beating, anesthesia's a win, right, guys? That's the only thing that matters.
Natalie: It's not...
Ryan Bailey: I mean, at the bare minimum, Bartell. At the bare minimum.
Gianluca Bini: right, right.
Annatasha: You think?
Natalie: It becomes what you've been taught.
Annatasha: I'm not going to congratulate people for that, really.
Ryan Bailey: I never said I was congratulating them.
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.
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.
Ryan Bailey: Yeah.
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.
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.
Gianluca Bini: Right.
Gianluca Bini: Yeah. I think that part of this is our fault, right?
Ryan Bailey: Yeah.
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?
Natalie: Yeah.
Gianluca Bini: Yeah.
Natalie: Like 2014. Yeah. Yeah.
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.
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
Annatasha: Thank you.
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? Like if,
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,
Gianluca Bini: There shouldn't there should be a standard of care, one standard of care.
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.
Ryan Bailey: Thank you.
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.
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
Gianluca Bini: That's amazing, right?
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
Gianluca Bini: Gotcha.
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.
Annatasha: And I've never been...
Natalie: Yeah.
Ryan Bailey: You also went to VETS school in Europe.
Annatasha: Yes, which is the smarter continent. And...
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.
Annatasha: But I guess my question is, is why?
Ryan Bailey: the
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.
Gianluca Bini: No, but I get it.
Natalie: I we do all that. I always have done all that.
Ryan Bailey: same time, is it art?
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.
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.
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.
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.
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.
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.
Ryan Bailey: But then 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.
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.
Gianluca Bini: Absolutely.
Natalie: I had a great, I had a great, like, anesthesia in vet school and then great, like, rotation at NC State.
Gianluca Bini: Right. Yeah.
Ryan Bailey: But how many weeks?
Natalie: Like, two weeks, right?
Ryan Bailey: Right.
Natalie: And then you're...
Ryan Bailey: How many cases did you see in TV?
Annatasha: Rrrrrrr.
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?
Natalie: Like I couldn't afford to do an internship because had to like pay my loans back.
Gianluca Bini: Yeah. Yeah.
Ryan Bailey: For sure. Yeah.
Natalie: That too.
Ryan Bailey: Yeah.
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.
Ryan Bailey: Mm-hmm.
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 –
Natalie: as comfortable as I am now with troubleshooting.
Gianluca Bini: Yeah.
Natalie: Like...
Gianluca Bini: Do you think the failure...
Annatasha: I find it, go ahead Beanie, sorry, sorry, sorry, sorry.
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...
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?
Gianluca Bini: Do you think it happened between vet school and now? Like, was the issue, you know, practicing?
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.
Natalie: Do you know what I mean?
Gianluca Bini: Yeah.
Ryan Bailey: Yeah.
Gianluca Bini: Yeah.
Natalie: Please can I be capping her?
Gianluca Bini: And then you think that tissue has...
Annatasha: Sadly, we do.
Natalie: What?
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.
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.
Natalie: Literally.
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.
Gianluca Bini: Thank
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.
Annatasha: And I also think it 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.
Natalie: Okay.
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.
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.
Natalie: And
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.
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.
Annatasha: Right.
Natalie: Yeah. And not only is it like, here we doing the anesthesia, right?
Gianluca Bini: Yeah.
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.
Ryan Bailey: Thank you.
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.
Natalie: I mean, they're essentially like
Gianluca Bini: Yeah.
Natalie: You go to a human, you're human, like you're having a C-section.
Gianluca Bini: Yeah.
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?
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.
Annatasha: You use your whole brain, Bailey?
Natalie: That's
Ryan Bailey: Yeah, I use my whole way.
Ryan Bailey: I would not be using the scalpel.
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.
Annatasha: Yeah, you would. Surgery is not that hard, honestly. Like cut so cut so monkeys can do it. Like, come on.
Ryan Bailey: Yeah, I'm not going to go there, but I think it is...
Gianluca Bini: That's not true.
Natalie: not true.
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...
Annatasha: I'm not a surgeon.
Ryan Bailey: Yeah, I'm not...
Annatasha: Don't blow smoke up my ass, okay?
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.
Gianluca Bini: Okay. Last episode.
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.
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.
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.
Gianluca Bini: Yeah.
Annatasha: And, you know, and it's just that you would never get away with this in human medicine, right?
Natalie: Well,
Annatasha: You would never get away with this in human medicine.
Ryan Bailey: But they're one-to-one.
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.
Natalie: I mean,
Gianluca Bini: Thank
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.
Annatasha: You see it, honestly, I'm picking on anesthesia because obviously the coolest specialty.
Natalie: That's what you got.
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.
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.
Natalie: Thank you.
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.
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?
Natalie: Thank you.
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.
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.
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.
Gianluca Bini: Yeah.
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.
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.
Annatasha: But, you know, we continue to...
Gianluca Bini: But why couldn't they? Right?
Annatasha: Huh?
Gianluca Bini: That's the problem, right? Like, why couldn't exist for us, right? Like, why there is nobody?
Annatasha: That's...
Gianluca Bini: Like, they're, you know, when you go to England, the RCVS sets the standard, right?
Natalie: So question, in Europe,
Gianluca Bini: Yeah.
Natalie: Are all of the veterinarians practicing like a similar standard of care, would you say?
Gianluca Bini: A higher standards of care, yes.
Natalie: Higher standard.
Gianluca Bini: 100%. 100%. Because they lose their fucking license.
Natalie: Because like, Yeah.
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.
Natalie: Yeah.
Gianluca Bini: You open your practice, and then God the fuck knows what happens in it, right?
Natalie: Yeah.
Natalie: Well, sometimes people...
Gianluca Bini: Like, nobody comes to you and checks.
Natalie: I will say like there is this – this is how I feel like there's almost like this when you're in GP. 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.
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.
Natalie: But just so you know, there's a dermatologist.
Ryan Bailey: Thank
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.
Gianluca Bini: Yeah.
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,
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.
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.
Natalie: 100%, yeah.
Annatasha: Like, you know, it's like, you know, I could be the only person between like Moosinia, Ontario and Saskatchewan, right?
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.
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.
Natalie: you
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.
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.
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...
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.
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.
Natalie: I'm like, bye, go to the cardiologist.
Annatasha: Yeah.
Gianluca Bini: Yeah.
Annatasha: So I mean, like I said, I think
Natalie: Bye.
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
Annatasha: Yeah. Okay.
Gianluca Bini: Thank
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.
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?
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.
Annatasha: That's not necessarily true. You can still have your ego.
Natalie: You're right.
Ryan Bailey: Sure.
Natalie: It's honestly the communication between the specialists and the GPs.
Ryan Bailey: But like,
Annatasha: It's ridiculous.
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.
Natalie: It's like having that door and also not feeling like judged by the specialist because sometimes like you're –
Gianluca Bini: Right.
Annatasha: It was judgmental.
Natalie: Oh, please.
Ryan Bailey: It's really easy to like...
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.
Ryan Bailey: Yeah.
Gianluca Bini: Yeah.
Natalie: We have to know a little of everything, you know?
Ryan Bailey: For sure.
Gianluca Bini: Yeah.
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...
Annatasha: That's true, Bailey.
Ryan Bailey: I...
Annatasha: You also know a lot about hot dogs. Don't undersell yourself.
Natalie: a good hot dog.
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,
Ryan Bailey: hellish for me. Like I was so uncomfortable not knowing everything.
Natalie: Oh, I would hate that.
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.
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.
Gianluca Bini: Yeah. Yeah.
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.
Ryan Bailey: And yeah, that's
Annatasha: I like your happy little hopeful vein.
Natalie: Thank
Annatasha: disagree that we should tone our egos down.
Natalie: you.
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.
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.
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.
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?
Natalie: Thank you.
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.
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.
Annatasha: And like I
Natalie: Oh, I couldn't imagine. I couldn't imagine.
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.
Annatasha: and the kind of anesthesia that they practice, except for John Luca, obviously. And anyway,
Ryan Bailey: Amen.
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?
Natalie: Yeah.
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.
Gianluca Bini: Yeah.
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.
Annatasha: Like we have to take onus for that.
Natalie: Mm-hmm.
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.
Ryan Bailey: Yeah.
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.
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.
Annatasha: And like, how do we get more into the trenches with you guys so we can affect a better change?
Natalie: I think it's exactly what you said, like the CE giving out your number, John Lucas service, all those things. But it's, there are certain vets that are not going to ever ask for help. Do you know mean?
Ryan Bailey: And we're never going reach them, though.
Natalie: Because it's always been this way.
Ryan Bailey: You know what I mean?
Natalie: That's the way it is, you know?
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.
Ryan Bailey: Exactly.
Gianluca Bini: Yeah. I,
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.
Natalie: I try to spread the word.
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.
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.
Ryan Bailey: Mm-hmm.
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.
Gianluca Bini: Again, I think that's what she's 100%.
Natalie: Like
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.
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.
Natalie: Great.
Gianluca Bini: I never had a GP that reached out and the reaction I always had was always, thank God you exist.
Natalie: Thank you.
Ryan Bailey: But that's a selection bias, Gianluca.
Gianluca Bini: But don't know. I mean, do you think because I...
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.
Gianluca Bini: Okay, fair.
Ryan Bailey: Yeah.
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
Natalie: No, not at all.
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.
Annatasha: But anyway, you know, it's, it's, it's not the GPs and the RVTs.
Ryan Bailey: Yes.
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.
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?
Natalie: Thank you.
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.
Gianluca Bini: Yeah. Yeah. Yeah.
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.
Natalie: 100%.
Annatasha: hundred percent. And,
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.
Ryan Bailey: Yeah. Yeah.
Natalie: So like, and I went to St.
Gianluca Bini: It's crazy.
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.
Gianluca Bini: Deconcetto?
Natalie: Yeah, he was like, he's like was real.
Gianluca Bini: I
Natalie: He was a great professor, but he was very like, he made it.
Gianluca Bini: think it's in LA now.
Natalie: He
Gianluca Bini: Yeah.
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.
Gianluca Bini: I mean, that's where they're lying. I mean, that's... Yeah, that's...
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
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.
Annatasha: I'm just not sure about the execution. But, yeah.
Gianluca Bini: Yeah, let's try to kill this patient and see if you realize.
Annatasha: Yeah.
Ryan Bailey: I mean, that's like nine times out of 10, my hand is on the pop off while writing a case.
Natalie: I just think
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 like a nervous.
Gianluca Bini: Is this the same thing you do with the vaporizer with the same motion?
Natalie: Oh, yeah, with the pretending.
Ryan Bailey: Oh, yeah.
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.
Ryan Bailey: we all have
Annatasha: Yeah. Everybody has. And you lie if you don't, it's like peeing in your wetsuit.
Natalie: Yeah.
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.
Annatasha: So yeah.
Ryan Bailey: yeah mm-hmm mm-hmm
Annatasha: I get it.
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.
Natalie: Like, I don't know.
Gianluca Bini: That totally happened, by the way. Yeah, we don't
Ryan Bailey: I shake my head.
Natalie: But can you clean his ears while he's under for the double amputation?
Natalie: Like, I'm, like.
Ryan Bailey: Thank God we don't deal with clients because I would be like, yeah.
Gianluca Bini: deal with cleansing, which is a great specialty.
Ryan Bailey: Which is both a pro and a con, I will say, I always feel.
Annatasha: I actually deal with clients.
Natalie: And that's too, like.
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.
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.
Annatasha: So anyway, that's whole other podcast. But yeah.
Natalie: but also to like tell the clients to give the clients like hey this is the
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.
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.
Ryan Bailey: Our audience is just dwindling at the moment.
Annatasha: Years off my life. But yeah.
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
Ryan Bailey: Oh yeah.
Gianluca Bini: Yeah.
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.
Natalie: You know way more than I would know, right?
Natalie: Like you would have way more experience in doing like a lot of...
Ryan Bailey: Yeah.
Annatasha: So that's always uplifting. But yeah, I think that.
Natalie: a way of fun, John.
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.
Natalie: Oh, 100%.
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.
Ryan Bailey: Okay.
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.
Annatasha: Like there's zero forgiveness. And that's part of the anguish, right?
Natalie: That's, I could not, that's, thank you.
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.
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.
Gianluca Bini: You know?
Annatasha: Did you go to GP, Beanie?
Gianluca Bini: What?
Annatasha: Did you ever do GP work or did you just go straight into training?
Gianluca Bini: No. No.
Annatasha: Oh, okay.
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.
Gianluca Bini: Like, never stuck a foot.
Natalie: And
Gianluca Bini: Huh? Huh?
Annatasha: Did you do GP Bailey?
Ryan Bailey: Not as a primary, but in my internship, we did do GP.
Annatasha: Gotcha. Okay.
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.
Ryan Bailey: And like, we had no ER doctors to oversee us.
Annatasha: Okay.
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.
Annatasha: Bye.
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
Natalie: Thank you.
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.
Natalie: I think it's the CE and then also being able to talk to a specialist and not feel like an idiot.
Gianluca Bini: Do you think that... Who does that?
Ryan Bailey: Oh yeah, for sure.
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.
Annatasha: Thank you.
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,
Ryan Bailey: Oh yeah, for sure.
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?
Ryan Bailey: Yeah.
Gianluca Bini: Yeah.
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.
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
Gianluca Bini: Right.
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.
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
Ryan Bailey: Yeah.
Gianluca Bini: Like, behavior, like, they actually act that way.
Natalie: Yes.
Gianluca Bini: Yeah.
Natalie: And yes, ask any GP that will tell you that.
Gianluca Bini: That's
Natalie: Everybody in their career has had like multiple. Yeah.
Annatasha: Well, that's disappointing.
Gianluca Bini: bad, though.
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?
Natalie: Yeah.
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.
Annatasha: But yeah, I mean, I don't see what purpose it serves to be like
Gianluca Bini: Yeah. Yeah.
Annatasha: This sounds weird coming from me, but to be condescending about it, right? Like I'm actually, you know, very supportive.
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.
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?
Natalie: I think 95% are fine.
Annatasha: You're contributing to the problem.
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.
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.
Ryan Bailey: Yeah.
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.
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.
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?
Natalie: Yeah.
Gianluca Bini: Or if you do,
Annatasha: Thank you.
Gianluca Bini: than do it in a civil manner, right? Like in a...
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?
Natalie: Like you have someone who really wants to pursue that.
Ryan Bailey: Yeah. Yeah.
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.
Gianluca Bini: Yeah.
Annatasha: you know, if specialists aren't supporting GPs in that capacity, shame on you, whoever you are.
Gianluca Bini: Yeah.
Annatasha: Shame.
Ryan Bailey: But where's the specialist role in that?
Natalie: Like our neurologist here, she is the best.
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?
Natalie: What'd you say?
Ryan Bailey: Like ignoring anesthesia, like who would you, like where, how do you resource them?
Natalie: there local places?
Annatasha: think where did you like
Ryan Bailey: Yeah, you go to whatever local specialty hospital is, you give them a call.
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.
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.
Ryan Bailey: Give them a call anytime. They're like somewhat local to you.
Gianluca Bini: Yeah.
Ryan Bailey: They have resources, education. They can, I don't know.
Gianluca Bini: I mean, I think a lot of people don't want to be bothered too, right?
Gianluca Bini: Like, you know, I get it. Like if you're busy, like,
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.
Ryan Bailey: It's like, all right, let me think and use my brain for a little
Natalie: Because you guys are like – I'm telling you, you're like zebras. Like –
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.
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.
Ryan Bailey: And oh, my God, it works so great. Thanks so much.
Natalie: I used to be dead, like, and we're also taught to be, like, afraid of Domeator.
Gianluca Bini: All right.
Annatasha: Oh my God.
Ryan Bailey: Well, don't call me.
Annatasha: So in exactly 10 days, I'm giving a talk called Stop Being Afraid of Dexmedetomidine.
Ryan Bailey: Don't call me.
Annatasha: That's the actual title of my talk.
Ryan Bailey: Don't call me.
Annatasha: I'm giving a full-blown CE called Stop Being Afraid of Dexmedetomidine because it's pissing me off, right?
Ryan Bailey: I'll teach you how to not be afraid of ace promazena.
Annatasha: Like...
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.
Annatasha: Then you just shoot water.
Natalie: And the dog woke up like, not terribly dysphoric, but dysphoric because we had a little domitore on the board.
Ryan Bailey: Sir?
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.
Ryan Bailey: Yeah.
Natalie: I've always gone off the 0.0025 mg per gig.
Ryan Bailey: Point zero.
Natalie: will be, you'll be like given tons based on the, you know, and then.
Ryan Bailey: Hell yeah.
Gianluca Bini: Oh, yeah. Yeah.
Ryan Bailey: Hell yeah.
Gianluca Bini: Yeah. Yeah. Ryan is not the right person have this conversation.
Ryan Bailey: Hell yeah.
Ryan Bailey: I'll give you a nuanced approach to it.
Gianluca Bini: It's from Kevin Davis.
Ryan Bailey: I'm not just going to be handing out like it's fucking candy because it's not.
Gianluca Bini: Yeah.
Annatasha: None of the drugs are candy.
Ryan Bailey: Exactly. Exactly. Thank you so much.
Annatasha: None the drugs.
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.
Ryan Bailey: Maybe skip the midaz lane. Yeah.
Natalie: You know what I mean?
Gianluca Bini: That's how you kill it.
Natalie: Literally.
Ryan Bailey: Yeah.
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...
Gianluca Bini: want to see what do you think is the client perception of anesthesia, right?
Natalie: Oh, yeah.
Annatasha: Mmm.
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 to your clients, right? Like, so how do they...
Natalie: They don't have an option.
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?
Natalie: Yeah.
Gianluca Bini: Like what's their take? Like, what do they say?
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.
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.
Natalie: And
Gianluca Bini: Thank you.
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.
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.
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.
Natalie: So explaining that to people and they're like, they're so, they're so appreciative.
Annatasha: Thank you.
Ryan Bailey: Mm-hmm.
Natalie: They just don't know because nobody explains it to them.
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?
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?
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.
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?
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?
Ryan Bailey: Yeah.
Gianluca Bini: But like,
Natalie: We've had clients just come from finding you on our website.
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.
Gianluca Bini: I was like, nobody's ever going to want this service. Nobody actually cares about anesthesia out there.
Ryan Bailey: Thank
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.
Natalie: I don't think anybody thought it was like something that was like affordable.
Gianluca Bini: Nobody
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.
Gianluca Bini: Which, by the way, she wasn't sponsored for.
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.
Natalie: Nobody knows it's out there. People care. say majority of vets care. They just... don't know what the best option is.
Gianluca Bini: The possibility, yeah, yeah, yeah. I think that that's...
Ryan Bailey: That's who I've always thought our market is.
Gianluca Bini: Like as an anesthesia, like college, you mean, right?
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
Ryan Bailey: Yeah.
Natalie: were like, whoa, whoa, whoa. So listen, funny story.
Gianluca Bini: We don't do paratarelet.
Ryan Bailey: I mean, we can help you with anesthesia for sure.
Natalie: We don't do that here.
Ryan Bailey: I've done hell
