In Defense of Being Nice

June 15, 2013 //
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There is a bad joke / semi serious statement amongst veterinary practice managers; “no good deed goes unpunished.” And while I see the reality in this, and have even said it few times, I ultimately do not subscribe to the point of view. What is wrong with being nice?

I get it, I really do, being nice is hard. But being polite and showing respect for your peers,  those you interact with, those who report to you and those you report to is not only the right thing to do, it is in your interest.

Since being a manager, and someone who hires and fires, I have always been shocked at those who felt that just not turning up for work, and refusing to communicate was an acceptable way to hand in one’s notice. Despite the obvious impoliteness and unprofessional behavior of leaving your co-workers in the lurch, there is the added inconsideration of those who feel at least partially responsibility for your well-being. Stories abound, and I have personal experience of, employees with limited family in serious trouble at home which is only discovered when an employer starts inquiring after their well-being after they fail to show up for work. I never even considered doing this, and I’ve seen this behavior from young and old so the generational clichés don’t offer any answers.

As I discussed in another post, the superstar employee who feels they are above the general rules of behavior in the workplace is another example of a failure to be nice. I don’t have a lot of sympathy for this kind of behavior and generally find it to be counterproductive – the exceptions being just that and not proving anything.

And then there is the Dunkin Doughnuts Lady…

The following video is pretty offensive but it does prove a point. A customer feeling that they have been wronged videos herself claiming free food from the day shift of a Dunkin Doughnuts  after she feels her receipt was not given to her in a timely manner the night before. While all the time informing anyone who will listen that she is filming the encounter, and that she is going to post it on Facebook, she delivers an avalanche of racial slurs, abuse, and is generally obnoxious. The employees, to their extreme credit, keep their cool, try to make the customer happy, and are professional throughout despite extreme provocation.

(WARNING: THIS VIDEO CONTAINS VERY OFFENSIVE LANGUAGE )

The story of the video however, does not end with the video. After being posted online last week it went viral, but not in the way that the original poster had hoped. A tirade of negative comments about the behavior of the customer led her to delete her Facebook account and one can only imagine the personal repercussions – the least of which is finding out that the majority of people do not think the way she does.

This incident also shows of the worst side of social media, where someone tries to leverage it for their own ends and as a shield for their own bad behavior or sense of being wronged. This can also be called the Yelp Effect. I am not a Yelp hater, but I do think it is a flawed system and one that rewards bad behavior from both businesses and customers with little recourse. The Better Business Bureau had its flaws but at least there was an attempt a resolution.

In the veterinary world, an often heard phrase is “you don’t care about animals” often paired with “it is all about the money.” Although uttered by people in difficult circumstances, and born out of frustration, it is still extremely hurtful for anyone who has choose to make their career working with animals and has caused more than a few sleepless nights for a lot of deeply caring people.

We all have difficult customers, employees, and colleagues - it is how we deal with them that counts and makes a difference from one business or organization to the next.  The bottom line is that doing the right thing, being polite, professional and, I guess for want of a better word nice, is the only way to behave for your interest and for everyone else. It is the only way to guarantee that things will not get worse.

And you never know, it might rub off on to someone else.

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Categories Business, Customer Service, Leadership, Management, Social Media, Veterinary

Eight Tips for Job Seekers

February 10, 2013 //
2

Over the years I have, and continue to, hire a lot of people.

Due to my own personal preference I also tend to interview a lot.

I work in the veterinary profession. Which is one of those professions that many people feel they would like to try even though the reality is sometimes not all that it is cracked up to be.

The obvious extension of this is that I see a lot resumes, applications, and applicants.

Some are excellent.

Some are bad.

Some are just not right.

And some make such basic mistakes that it overshadows everything else.

So for those on a on job hunt, or starting on the career ladder, here are my top eight tips.

1: Read the job posting!

If the job posting says no phone calls, that means no phone calls.

It is not unusual for companies to receive hundreds of applications. For small businesses, receiving hundreds of phone calls checking the status of applications can be a serious burden. I know a lot of employers, myself included, who automatically disqualify applicants who call when the job posting specifically says not to. It indicates that the applicant has not read the posting or can’t follow written instructions. Don’t be that person!

If the job posting says you need a license, or some kind qualification, that is generally not negotiable. If you still think you are right for the job make sure that you address the fact that you do it have the right license / qualification in your application letter. This shows that you have read and understood the job posting. It does, of course, not guarantee that you’ll even get an interview – but it should stop automatic disqualification for not reading the posting properly.

2: Your résumé should be the right length for the information you wish to present.

There is nothing worse than a two or three page resume squeezed into one page. It is almost impossible to read. Likewise a one page resume stretched to fill two or three pages just wastes times, paper, and shows that the applicant is trying to be something they are not.

3: Fill out an application if asked.

If you are asked to fill out an application, even if you have a resume and letter of application, fill out the application! Yes, it is double work and it may not present yourself in the way you wish to be presented, but that is normally the point and it is what your potential future employer wants – so start off on the right foot.

4: Be contactable. Be professional.

Your phone number must be right, you must have voicemail, and you should check it at least daily.

The same goes for email.

Take a good long hard look at both your email address and the message you have on your voicemail. You might want a funny message on your voicemail for your friends – but potential employers will not be impressed. Likewise, if your email address can say a lot about you. But if it says any thing other than your name, it probably does not say anything good. Email addresses are generally free, so make them professional.

5: Dress for Success – what to wear to an interview.

My personal take is that you should dress at least one level above the person you are meeting. How can you tell what they will be dressed like? Look at the website! If the person interviewing you is in scrubs then business casual will be fine. If they are wearing business casual, then you should probably be wearing a tie. If they are wearing a tie you should probably be wearing a suit.

Please remember that business casual does to mean what you would wear for a night on the town.

If you have tattoos or piercings and you are prepared to take them out / cover them up for work then do so. Some employers don’t care about such things, but many do.

Flip flops, jeans, revealing attire, and aggressive piercings are all inappropriate for almost all interviews.

6: Honest is the Best Policy.

If you have things in your past that you are not too proud of, or if their are holes in your résumé, be honest about them. Being open and honest may be looked on positively. Trying to hide things or lying is always looked on badly.

7: Working Interviews

Many Veterinary practices use working interviews as a way of ensuring that new employees have the appropriate skills and are a good fit. If you are asked to take part in one, it is important to remember that this is your chance to shine. However, many practices have rules about what you can and can’t do on a working interview. It is never wrong to ask, but it can be very wrong to assume.

8: Getting Turned Down

Don’t take not getting a job personally. If you never get called for an interview for your dream job the worst thing you can do it call up and berate a potential employer. Likewise don’t be too pushy about why you haven’t heard back. ,A simple email thank you for the interview and the chance to meet is a simple professional way to say that you are interested without intruding on the employers timeline for hiring. It is a rare employer indeed, who looses the application and all the contact details for some one they want to hire.

Getting a job is hard. Don’t make it harder on yourself.

Not employer has ever said – that person is too professional to hire.

How not to behave in an interview, courtesy of the excellent Trainspotting (Warning Very Strong Language).

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Categories Career Advice, Veterinary

The New Manager’s First 30 Days

September 16, 2012 //
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How do you handle the first 30 days at a new job, where you are the person that everyone else looks to for how things should work?

For various reasons, I like to think the onward and upward trajectory of my career, I have been an outside manager / administrator to an existing business twice in the last two years. Here are my top ten must do things when in this position and why. Some of these are second nature to me, and come out of my individual management style, and others I have to remind myself to do everyday.

1: Connect with whomever you report to.

If you do not have a rapport with the person who you report to then a good question to ask is why did you take the job in the first place? This is essential. Do not fall into the trap of thinking “I can make this work,” or “they are not so bad when you spend a little time with them.” If you don’t connect when they are on their best behavior because they want to hire you, then you are not going to connect when the gloves come off.

2: Who or what are the major roadblocks?

It is imperative to find out what is going to stop you from being your best. That could be a person, a policy, or a resource (or lack of one). You can’t overcome a roadblock if you don’t know it is there. This should be something that you are always looking for anyway, but it is most definitely a priority when you are newly in the job.

3: Introduce Yourself!

Say hello, good morning – engage in small talk, shake people’s hands. The size of business you are going to will impact how you achieve an introduction to the people at the sharp end; But I would suggest that even if you have a staff of a few thousand there is nothing wrong with touring the facilities and saying hello and introducing yourself to everyone you can. Politicians have been doing this for decades because it works.

4: Look, Listen, Learn!

No two businesses are the same. The day you walk in the door, almost everyone else in the building knows more about that business than you. You need to walk before you can run, but you also need to understand what walking actually is. Show some respect for your new place of work: watch how things work, take notes, ask questions, and don’t be in too much of a hurry!

5: Meet with Everyone (part one).

Meet with as many people as you can.

One on one if possible.

Doesn’t have to be a long meeting, but use it to explain your basic style and philosophy. If you have an open door policy then explain that. I always ask what I can do to help the staff do their job better, mostly because it is my management style, but also so that I can identify any issues that need attention or trends that I might otherwise have missed.

6: Be Humble.

A lot of this comes down to individual management style; however, I feel it is important that the staff see that their new manager is happy to get their hands dirty and to pitch in when appropriate. I think this is an important trait in any manager; however, it is doubly important in a new manager who the staff do not know. Don’t be afraid to say you don’t know. You can’t know everything straight away and almost no one will expect you to. Having said that it is important that if you are asked a question you don’t know the answer to that you try to find the answer and get back to the relevant person.

7: Find your Allies.

In all organizations there will be people who will welcome change, and others who will not. Try to identify who they are and what their motivations are. If you can be sure of their motivations, the people who embrace change are your allies and will make your job much easier if work with them.

8: Look for the Easy Wins.

The little things that have not got done that drive the staff mad; or just make their lives difficult! The programs that never happened because there was nobody to head them up. The piece of equipment that had not worked properly for ages if ever. These are all examples of opportunities of easy wins. Easy wins will help prove to your new staff that you are here to make their lives better not more difficult. Be careful however, pick things that are not too controversial – remember you have to walk before you can run. Also, make sure that they are things that you do. Not things that you just palm off on someone else to do. The easy win is much more effective if you are the one who solely delivers it.

9: Meet with Everyone (part two).

A general staff meeting to layout some of your vision is important. Just make sure that this meeting is not on your first day. If you must hold such a meeting on your first day, make sure it is extremely short and more of a very brief introduction. Wait till nearer the end of your first 30 days to have a more formal meeting. Hopefully, by this point in time people have got to know you a little and get a sense of your intentions and therefore will be more likely to give you a fair hearing. Of course, it goes without saying, that you have to be really prepared for this meeting. Get it right and you buy yourself an enormous amount of goodwill and buy-in. Get it wrong and you have an uphill struggle ahead.

10: Communicate, comunicate, comunicate…

Make sure that everyone who should know what you are doing, and why, does so. Remember, you are the new guy and so by definition you don’t know everything. The others on your team, however, do know a lot and may be able to prevent you from making a huge blunder. But they will only be able to do that if they know about what you are doing. This also helps your potential allies from becoming disillusioned because there is too much happening that they don’t know about and find themselves too exposed when they try to defend you.

Do you have any tips for new managers in new jobs? I, for one,would  love to hear them!

One final comment, don’t be David Brent from the UK’s original version of The Office!

Categories Business, Leadership, Management

Book review: The Book of Business Awesome by Scott Stratten

August 18, 2012 //
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“It was the best of times, it was the worst of times…”

– Charles Dickens, ’A Tale of Two Cities.’

Scott Stratten’s excellent new book is actually two books, printed back-to-back under the same cover.  “The Book of Business Awesome,” as its name suggests, is a collection of examples, ideas and concepts on how businesses can deliver extraordinary customer service through actually communicating and connecting with their customers. The flip side, “The Book of Business Unawesome,” shows the price of not communicating, not thinking, and not caring  about your customers.

As you might expect, social media plays a large role in both the positive examples and the negative examples of this book, but it is not a book about social media per say. Those looking for a nuts and bolts how to I do X, Y, and Z on Twitter, Facebook or practically any another sphere of social media would be better served by Arnie Kuenn’s excellent: Accelerate! that I reviewed this time last year. ”The Book of Business Awesome,” however, is more of a call to arms for brands and companies to be something other than normal – particularly because normal can be so crappy – and to go out of their way for their customer.

To be funny.

To be honest.

To be human.

And to apologize because they genuinely regret a mistake, or bad customer experience, not because they got caught or called on it.

Really, this book is about culture and people. The stories that are replayed in both their awesomeness and unawesomeness throughout give a window into the soul of the featured companies. It shows ordinary front line employees doing extraordinary things and those extraordinary things having an impact far beyond the normal, or even intended, business interaction.  As Scott states on numerous occasions: social media doesn’t fix anything – it just makes things louder. If you don’t give a damn about customers when you transact with them – this will be heard loud and clear online and will also come across in your social media interactions.

Filled with links to additional content and even the odd QR code (I’d actually would have liked to see more QR codes, the link typing thing got old after a while) the Book of Business Awesome also has an excellent couple of chapters on public speaking and panel discussions. As a side note, if you ever get a chance to see Scott speak at a conference, or on his book tour, do so – for the rest of us there is YouTube!

Not as funny as Scott’s in-person presentations, The Book of Business Awesome is, however, just as passionate and quite amusing. And this is actually a very minor quibble consider that many business books are about as entertaining as a tax audit. It also probably says more about Scott’s skills as a public speaker than any lack of skill as a writer.

The Book of Business Awesome is nothing short of a bible for customer service in the Social Media age.

Categories Books, Business, Customer Service, Marketing, Social Media

Social Media, ROI, and the Cost of Talking to your Customers

July 29, 2012 //
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I am all for Return On Investment (ROI).

However, defining ROI in any small service business, particularly in marketing, can be incredibly difficult to be even remotely useful. Most businesses don’t bother except when it is easy. But for some reason, when it comes to social media, ROI is mission critical.

Why?

You can place an ad for discounted services, with a coupon, running for a month, and a unique web address, and  a unique phone number, and track that (but honestly how many actually do this?) But how can you track the person who becomes aware of your business through that ad, spots your sign one day while driving by, and then six months later needs and uses your services unrelated to the ad?

What is the ROI of your fax machine?

What is the ROI of customer service?

What is the ROI of a strong brand?

How do you place a value on communicating with a significant proportion of your clients every day?

Most businesses consider word of mouth one of the most important forms of promotion. It is essentially free and it is highly effective. With social media, we have the opportunity to insert our businesses into the “word of mouth” of our customers, and thereby their friends, and their friends friends. Why would you not get involved and take advantage of that?

Facebook for my business probably takes up 15 minutes of my day on average. An email, or even a call by the time I’ve documented it, to an upset client can easily take an hour. Should I not deal with an upset client when I don’t have to because the ROI is lousy? Yes, you can place a value on a client and on retaining that client. You can even track that you do get some clients from Facebook, but you may also get clients because you have an email address or a telephone number. When was the last time that anyone figured out the ROI of their email system? Even when buying a new phone system most businesses to not justify it with ROI, but rather than as the cost of doing business.

Small businesses often look up to companies such as Nike and Apple and see their devoted, and almost rabid, fan bases as evidence of marketing in action. I would argue, however, that companies like Apple and Nike create devoted fan bases is by being approachable and interacting with their clients – Apple in particular. I’m not the greatest Steve Jobs fan, but there are lots of examples of Steve taking the time to reply to ordinary consumers and being very interested in what they had to say. HP, Dell, et al. for a number of years, sold dramatically more computers than Apple, but it was Apple who held Mac World every year. Nike became cool because they did not go after deals, they went after people who actually used their shoes – athletes. They engaged their most high profile target market.

Of course, there is a lot of other marketing involved, but remember Apple’s most famous ad only ran once in most markets. Apple, and Nike for that matter, opened their own stores that operate on a quite a different model from other retail outlets. There is some argument that this was to help control the customer experience, but I also feel it was to be able to respond, and engage, with customers. Like all companies, they do not always get it right, but I do think that it is the willingness to attempt true engagement, and a real concern for the customer experience, that breeds fierce loyalty.

Social media is not a strategy – engagement, however, is.

So how to do social media and get some results and some traction?

To me, a major issue for small businesses is when they are on Facebook, Twitter, Google +, YouTube, and are doing all of them badly. Focus on one, and only one, and do it well. Then you can move on to another one.

Create things,or provide a service, using social media that other people will value.

Share other people’s content sparingly.

Self promotion has to have value, or at least not look like self promotion.

Don’t be afraid to ask questions of your fan base or ask them to share.

Drive fans to your website, or blog, from places like Facebook or YouTube not the other way round.

Pick your social media sites carefully. In my opinion, YouTube, for example, is very useful and can expose you to an enormous audiences, but the attention span is fleeting and the sense of community is almost non-existent. Embed videos in your site or page. Facebook works for my business and my previous business. Twitter does not. However, Twitter will almost certainly work for my new business, and it works for me personally. This has a lot to do with the small towns versus large cities and the  nature of my business – it may well be different for yours. Google+ has some personal value, and some SEO benefits, but has little real world value at this point in time in my opinion. But it does look very pretty!

Numbers of likes or followers are pretty irrelevant. It is the level of engagement that counts. I’d much rather have two hundred relevant, and engaged, fans or followers than 6,000 just making up the numbers. As someone much smarter than me once said: “If you believe business is built on relationships, make building them your business.”

And finally, don’t cross post, post from one social network to another, unless you really know what you are doing.

And even then just don’t do it.

Please.

I beg of you.

I see people I respect and who should really know better, cross posting and it is counterproductive. Content for Facebook does not translate well to Twitter because of the character limit. Twitter’s special characters are not understood by most Facebook users.

There are social networks where cross posting seems to work pretty well, but again, it is a black art, and if you are questioning the ROI of any social network, cross posting from a different network is not any kind of an investment.

To sum up this long, and sprawling post, the ROI of social media is the ROI of engagement. If talking to existing and new customers is not for you then I wish you well.

That just means more customers for the rest of us.

Many thanks to my friends and colleagues on the Marking in Veterinary Medicine LinkedIn group for the conversation that this post was cannibalized from. Also many thanks to Ali Burden-Blake (@inkspotsocial) for her excellent blog post: “Stop! Why using social media won’t work for your veterinary practice.” which inspired the conversation in the first place.

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Categories Business, Content Marketing, Customer Service, Marketing, Social Media

It’s Basic… Stupid!

July 10, 2012 //
12

Want to know how to increase sales, breed loyalty, and save money on expensive marketing? You would think everyone would. Even if you are not a business owner, or manager, you must realize that if you deal with clients it is in your interest to increase sales, breed loyalty, and save money on marketing.

However…

It never fails to amaze me how many businesses just throw it all away by forgetting the very basics of being in business. I hate buying anything – not because I don’t want to part with the money, I just want to make the process as simple as possible. I can’t be alone in this. Why does me – giving you my money – have to be so complicated?

The Basics:

1: Answer the G.D. phone!

Here is a revelation. If your phone is ringing, and it is going unanswered, then by definition you are not answering the most basic needs of your customers. They actually WANT to talk to you – the least you can do is answer. Please note: voice-mail is not answering a phone call. If you are paying a receptionist to put calls through to your voice-mail all day, why not just get a automated phone tree to do it for you! People really hate those, but at least you’ll save some money on the receptionist, and clients will appreciate the honesty of you not wanting to talk to them.

2: Answer Emails!

See all the above, and…

Email is easy! I’m not expecting an instant response. I have not tied you up on the phone for a couple of minutes trying to give you my money. I am all but inviting you to make me wait. You don’t even have to read my terrible handwriting – I’ve typed everything out for you! But please have the courtesy to at least think about answering my email with 24 hours (I’ll even give you more time if it is a holiday or a weekend). To be honest, there is not a lot of excuse for not answering within a couple of hours – but I understand, who needs customers!

3: Don’t insist that I use your website if a: has the wrong information on it, b: has out of date information on it, or c: has no information on it at all.

4: Don’t ignore me in person…

You know, I hate pushy sales people just as much as the next person; but there has to be a happy medium between being accosted every few feet in a store and being unable to find anyone or feeling you are interrupting a social event with your pesky request to give them money.

5: The Tyranny of Choice:

“I’d like to buy a widget to fix my whatsit”

“What kind of widget?”

“Don’t really care as long as it fixes my whatsit!”

“What color of widget would sir like?”

“Eh, red I guess…”

“We don’t have any red widgets sir.”

“Well I don’t really mind what color it is I only want to fix my whatsit – what colors do you have?”

“*sighs* I’ll go look for you. We have X widgets in green or blue, Y widgets in blue or black, and a Z widgets in green and black.”

“What is the difference between an X, Y, or Z widget?”

“Well they come in different colors and the prices are different.”

“Is that it?!”

“I’ll have to get Terry from technical Support to talk to you about that, please hold…”

“But…”

“This is Terry, I’m sorry I can’t get to the phone but please leave your message after the beep and I’ll get back to you as soon as I feel like it… maybe.”

*click*


As I explored in the post Marketing from the Ground Up, what a business sells and what their customers buy are not necessarily the same thing. The staff member in the above example is selling (and I use that term in its loosest possible sense) widgets; but the customer is trying to buy a fix for his whatsit If the business aligned its goals with that of the customer the interaction would have been over  in seconds.

6: Just sucking in general.

Do I really have to call / email you 2 -3 times to get anything done? Could you at least pretend like you are pleased to see me when I walk through the door? How about sweeping or mopping the floor once in a while? If you know you are about to screw up – how about a little warning? And if you are really feeling like pushing the boat out – how about an apology for the screw ups when they happen!

You know, the customer is not always right but the basic concept of a customer can’t be wrong all the time.

For your viewing pleasure, Monty Python open a cheese shop and get a customer!

Categories Business, Customer Service, Management, Marketing

Book Review: The Carrot Principle by Adrian Gostick and Chester Elton

June 10, 2012 //
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“When I make a mistake I’m recognized 100 percent of the time; when I do something great, I’m not recognized 99 percent of the time.” – A complaint from a hotel industry employee identified  in The Carrot Principle.

At times it seems like books on leadership and management are a dime a dozen. Yet it is rare to find a book that deals with the traditionally warm and fuzzy areas of recognition and people management that actually tout the results of studies and delves into statistics. That is what makes The Carrot Principle different.

“I’ve come to realize success doesn’t come from being a powerful leader; it comes from leading powerful people.” - The Carrot Principle.

Based on a 10-year study of 200,000 managers and employees, The Carrot Principle’s central theme is that managers who provide frequent and effective recognition generated significantly higher levels of employee engagement, productivity, and retention. Of particular interest, however, is that recognition levels also have an impact on operating margins. This takes The Carrot Principle out of the fuzzy box and into the profit and loss one. What is quite startling about the results of the 10 year study is that the need for recognition by employees from their employers is a global requirement but that the nature of that recognition changes from country to country.

In a bid to seem like a serious business book, The Carrot Principle can at times be a bit on the dry side – we are talking statistics after all for the first couple of chapters, but the book more than makes up for it in the later chapters. Perhaps the most surprising thing about the carrot principle is that the book actually gives useful ideas and tools for implementing its suggestions.Charts, templates and lists and lists of suggestions are all here. My particular favorite section of the book deals with all the usual excuses that managers give for not recognizing their employees and knocks them down one by one – including budgeting and complaints from upper management.

If I have to pick a fault with the book it would be that it is very much written with the large corporation in mind. This, perhaps is not surprising given that O.C. Tanner, the appreciation consultants behind the  research for the book and its supporting documentation, are writing for their clients. However, this is a minor quibble in an otherwise excellent book and a superb set of tools.

Categories Books, Business, Leadership, Management

Compounding the Issue

May 31, 2012 //
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The legal status of compounding, particularly in Arizona, has come into sharper focus of late with the never ending stream of pharmaceutical products going on back order which has left compounding pharmacies as the only source for several medications.

After numerous articles appeared in the AZVMA’s magazine regarding the legal status of compounding multiple people asked for my input and so I decided to reach out and do a little digging. Because I did not explicitly state that I would be writing about this situation when I talked with various people, I have decided not to quote anyone. Therefore this post is purely my opinion as to the current state of regulations in the State of Arizona and how they are interpreted by the various boards and agencies. Some of these issues may well transfer to other states, but regardless I would urge anyone with an interest in this subject to contact the agencies most directly responsible – including the agencies in Arizona (in your State or Providence you may find that not only are you under the State VMA practice act but also must follow the Pharmacy board Practice Act – which is the situation in AZ). I have no great expertese in this area at all other than an interest in the subject. From my personal experience and that of the friends and colleagues who helped collate this information for this blog post all the various agencies and players has been very open and honest about the current state of play in Arizona regaurding compounding.

What is Compounding?

This is a surprisingly complicated questions to answer. In essence, compounding is the act of changing the nature of a FDA approved pharmaceutical product. Adding a flavoring to a medication, crushing a tablet and combining it with a liquid medication, and obviously creating a medication from a set of ingredients are all examples of compounding. Interestingly, taking a liquid inject-able medication and dispensing that medication for use orally is also considered compounding as the method of FDA Approved administration is being changed.

So what is the difference between compounding and “off label use?”

It is my understanding that “off label” essentially means using a product in a way that is consistent with the labeling of that product but is not explicitly defined. For example, using an inject-able medication that is licensed for dogs as an inject-able medication for a cat would be an example of off label use. However, taking that same inject-able medication for dogs and using it as an oral medication for a cat would be an example of compounding.

It should also be noted that the “off label” use of medications carries considerable risk to the prescribing veterinarian and it is always recommended to get the owners express consent and be sure to check the latest literature about using any product in this way.

Can a Veterinary Hospital Compound for its own internal Use?

Technically no. Only a pharmacy can compound, but it does seem that the major issue for the Pharmacy board and the State Veterinary board is the dispensing and re-dispensing, of compounded medications.

What is the legal issue with dispensing compounded medications?

TITLE 4. PROFESSIONS AND OCCUPATIONS

CHAPTER 23. BOARD OF PHARMACY

 

Supp. 11-4

 

Authority: A.R.S. § 32-1904 et seq.

ARTICLE 1. ADMINISTRATION

Section

 

Neither the pharmacy permittee nor a pharmacist employed by the pharmacy permittee provides a compounded pharmaceutical product to a pharmacy, medical practitioner, or other person for dispensing or distributing except that a compounded pharmaceutical product may be provided to a medical practitioner to administer to a patient of the medical practitioner if each container is accompanied by the written list required in subsection (I)(5) and has a label that includes the following:

a. The pharmacy’s name, address, and telephone number;

b. The pharmaceutical product’s name and the information required in subsection (I)(4);

c. A lot or control number;

d. A beyond-use-date based upon the pharmacist’s professional judgment, but not more than the maximum guidelines recommended in the Pharmacy Compounding Practices chapter of the official compendium unless there is published or unpublished stability test data that shows a longer period is appropriate;

e. The statement “Not For Dispensing;” and

f. The statement “For Office or Hospital Administration Only.”

The upshot of above article is that medical practitioners, such as veterinarians, in the state of Arizona cannot purchase a medication from a compounding pharmacy and then repackage it for sale – dispensing in other words. A compounded medication can be bought and used internally but if a patient needs compounded medications to go home they need to be dispensed directly by the compounding pharmacy.

What does the Future Hold?

The re-dispensing of compounded medications by medical practitioners, according to the Arizona Pharmacy Board, will never be allowed. However, veterinarians being able to compound medications themselves and then dispense them to their clients does have a brighter future.

The AZVMA are planning to submit legislation to ask for a compounding exemption for veterinarians. However, this legislation has not been written and its passage is by no means guaranteed. It is also worth noting that if an exception for veterinarians is passed there will be significant regulations that practitioners will have to comply with to allow for the creation of compounded medications. There are also potentially areas where Federal law will trump State law with regards to compounding.

So Where does this Leave Us?

I have been informed by several reliable sources that both the pharmacy board and the veterinary medical board are not currently actively seeking out compounding cases to find veterinarians in violation. There is an understanding that compounding should be a tool available to Arizona veterinarians and it is considered a significant priority to have the law changed. However, it should be understood that should issues arise it is against the law and is potentially a source of liability.

The re-dispensing of compounded medications, however, is a black and white issue. Patients who need a compounded medication must have it dispensed by the compounding pharmacy.

This post is only meant as a starting point for your own research on the subject, and as a primer as far as the various issues.

As usual, comments, questions, and general abuse are always welcome.

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Categories Arizona, Regulations, Veterinary

Killing Kittens with QR Codes

May 1, 2012 //
10

A QR Code - I dare you to scan it!

QR Codes are those funny square barcodes that have popping up on magazine ads all over the place for couple of years now. The idea is to allow an easy way for smart phone users to enter a web address or contact information by just “scanning” the code on the printed page. A paper hyperlink if you like. Unfortunately, there seems to be huge misunderstanding about how QR Codes are actually used in the real world. This leads to an unsatisfactory user experience which hurts the brands involved and the entire concept of QR codes. QR codes have enough problems without brands making things worse!

QR codes are a short term fix until smart phones are clever enough to read and follow printed links for themselves. This technology is very nearly there, but until it is all the way there we are stuck with QR Codes. To make matters worse, there are two competing systems: the Microsoft Tag and the more conventional black and white QR codes that everyone but the Microsoft fan boys use.

There are four huge implementation mistakes that I see on a daily basis – I have got into the habit scanning every QR code I see in the hopes of seeing something cool, but mostly so I can feel superior to whomever implemented yet another bad QR code.

QR Code Mortal Sin #1 – Making the QR code too small to scan

Yes, I kid you not. Considering how expensive ad space is in most magazines and newspapers it always amazes me when I see QR codes that are so small that my iPhone 4S (arguably one of the most advanced smart phones currently out) cannot focus on them. I do understand that ads get re-sized for different magazines and different months but that copy often stays the same, but it all just feels lazy. Get rid of the QR code for crying out loud if you are going to perform a major re-size on a regular basis. Think of it as printing the wrong phone number or web address.

QR Code Mortal Sin #2 – Not having a landing page that is optimized for mobile devices.

What is the basic concept of a QR Code? To get a user to take out their smart phone and try to interact with your brand! So why make the experience horrible by making them constantly re-size and peer at a tiny writing on a tiny screen?!

QR Code Mortal Sin #3 – Using QR codes in Stupid Places.

Why, oh why, oh why, would you put a QR code in your email signature? Who is it for?! Are you really expecting a user to open up an email from you on their computer, see the QR code in your email signature, and then get out their smart phone and then try and scan the code from screen of your PC?! How about a simple link in your signature instead that you can just click on, or when you get the email on your smart phone, just touch! Because you can add a QR Code to your emails doesn’t not mean you should. This also goes for using a QR code for a picture on social media sites or on billboards on the side of the freeway.

QR Code Mortal Sin #4 – QR Codes that give a page not found error (also known as a complete waste of everyone’s time).

*sigh*

Nobody wants to do this!

As a little experiment, I scanned all nine QR Codes in the May 2012 edition of Veterinary Practice News that flopped onto my desk the other day. I used my iPhone 4S and the QR Reader for iPhone App by Tap Media (one of the most popular readers on the App Store) and if I encountered problems I also tried Red Laser App that includes a QR code reader. For Microsoft Tags I used Microsoft’s own reader App.

I only one bad URL during this test, and that was solved by using a different app do kudos to everyone involved for avoiding the most heinous of the QR Code mortal sins! Unfortunately, the new app just brought me to a slightly more involved , but admittedly mobile friendly, version of the same ad I was already looking at  (this actually happened to me twice during this experiment). Points for mobile friendly chaps, but a little originality would not go amiss either. I only had one QR code that was too small and therfore impossible to scan with any of the apps – they shall remain nameless but will surely burn in hell. Sadly, five of the QR Codes I scanned led to non optimized sites that were difficult to interact with on a mobile device. That leads me to believe that someone in a meeting somewhere said “we need to have QR codes on our ads because they are cool,” but did not actually think about what they were actually going to use the QR Codes for.

One company, however, did a really nice job however: Erchonica – who make cold lasers for wound therapy. They used both a standard QR Code and the Microsoft Tag which led to an optimized YouTube page with videos of Erchonica’s lasers in action. Very simple idea , and gave the reader something that they could not get with the printed page – video. Interestingly enough, another QR Code I scanned also took me to a YouTube page – however it had not been defined as a mobile page which seemed like significant missed opportunity. So nice job Erchonica – I even watched the video!

The rather nice implimentation of QR codes on the Erchonia ad in this month's Veterinary Practice News.

The bottom line of all this is that QR Codes can be a great little tool but are seriously misused. This hurts wide scale adoption and wastes a lot of time, energy, and money. As for the title of this post? I invite you to watch the great Scott Stratton, who is responsible for my current obsession with QR Codes, on the subject.

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Categories Content Marketing, Marketing, Veterinary

Dr. House’s Gifts to Veterinary Medicine

April 3, 2012 //
3

As House M.D. ends its eighth and final season I wanted to say thank you to the show for a number of things as they relate to my professional world and give it a (little) bit of a hard time for couple of others. I should make perfectly clear that I am a huge fan and that apart from a couple of minor missteps the show has been amazing television. I apologize for any spoilers!

Parasites and Zoonosis

I freely admit that I do not watch a lot of hospital shows. Apart from the odd episode of ER, House is really the only medical show I have had much time for. But House, as far as I’m aware, has had more than its fair share of parasites. From a veterinary perspective this is amazingly refreshing. As someone who seems to spend their life talking about zooanosis to doctors, staff, and the public, it is great to see some worse case scenarios played out in fiction, with a grounding in scientific fact.

Any one remember the episode with the giant tapeworm? I bet if you’ve seen the episode and your pet(s) have ever had tapeworms you won’t soon forget it. Or there is the episode autistic boy with roundworms, the team members infected with Naegleria fowleri, the homeless woman with Rabies, or the woman who catches Bubonic Plauge from her pet dog. Admittedly these are all extreme cases, but the mere fact that they are on television in some ways is a minor miracle considering that most people do not even want to talk about parasites and zoonosis.

So thank you Dr. House for spreading the word about zoonosis and parasites. Every little helps!

The Diagnostic Process

One of the great gifts that House M.D. gave the veterinary, and probably the wider medical community at large, was giving the public a greater understanding of the diagnostic process. Admittedly, House’s methods are often very unsound, but that fact the he and his team regularly are a loss for what is going on is extremely refreshing. We all in the veterinary profession have heard the complaints:

“Why do you have to do that Parvo test?”
“Why do you need that bloodwork?”
“You did that expensive bloodwork and there is nothing wrong!”

Even a casual viewing of House M.D. shows what is supposed to be one of the world’s foremost diagnosticians performing tests that come out negative and going down blind alleys searching for an elusive diagnosis. By bring the diagnostic process into the living room, House has helped acquaint the public with the idea that a certain level of trial and error are to be expected in any evidence based search for answers.

On more than one occasion I have used the show to help explain to a frustrated client why it took three separate diagnostic tools or lab tests to get diagnosis and why we couldn’t just immediately go to the correct one. So thank you Dr. House for helping to shed light on the diagnostic process!

Superstar Bad Behavior

I went into at some length in a post a couple of months back about what I call “The Steve Jobs Effect.” This is this the phenomena of some doctors, and other professionals, feeling that because they are so good at what they do, it excuses almost any level of behavior. Now House M.D. is very much fiction and levels to which the character of House delves would lead to his dismissal by pretty much any employer – never mind at a medical facility. The sarcasm, plain offensive behavior, and even harrasment, does make for great television, but, although it rarely reaches the epic proportions of House – it does happen in real world.

So not so much thanks, Dr. House, for reenforcing the stereo type that great skill can excuse bad behavior!

The Cuddy Episode

Every now and again on a long running T.V. show the writers shake things up by imagining the world they have created from a different perspective. On the show House M.D. this took the form of a very underrated episode from the perspective of Dr. Lisa Cuddy, the Dean of Medicine (Hospital Administrator to you and I).

The episode (5 – 9), shows the administrator doing very administrator type things – facing off with a vendor, placating the Board, dealing with major H.R. headaches (being short staffed and theft). The episode also deals with the thorny issue of billing and a patient who does not feel they should pay their bill (sound familiar). It is great to see these challenges, admittedly extremely exaggerated for added drama, and that these types of issues as just as much the part of running a medical facility as what the viewers watch Dr. House do every week.

I do have a problem with the episode however. After doing a great job of explaining to a patient why their bill is fair, the episode ends with Dr. Cuddy ripping up the patient’s check. I understand that it is supposed to show how kind-hearted the star of the episode is, but it undermines everything she states earlier in the episode. I also don’t buy that the character would do this.

So thank you Dr. House, sort of, for a great episode showing the role of administrators everywhere.

I, like a lot of people, am going to miss House M.D. But I am grateful that we’ve been able to have eight great seasons of television, and even more grateful that an intelligent show has shown some of the issues that I personally and professionally care about. So long Dr. House, for all your faults, we’ll still really miss you.

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Categories Management, medical, Veterinary
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