I saw a sweet little lab mix last Tuesday named Copper, after she was seen by our emergency department last weekend for an exam after one of the small children in the family accidentally closed Copper's tail in a door. Much of the skin on the end of Copper's tail had been pulled off in the injury, and she had soft tissue and bone sticking out the end of her tail with not enough skin left to do a surgical closure over the exposed bone and tissue.
CCU bandaged Copper's tail and sent her home with an e-collar, antibiotics, and pain meds, with instructions to have the bandage changed on Tuesday at the owner's regular vet or at Community Practice. They also advised the owner that it was entirely possible that the tail injury would not heal on its own and may require surgical amputation, but the family had financial constraints that limited them to a bandage and supportive care at this point.
Copper arrived at Community Practice on Tuesday, tail cautiously wagging and e-collar banging into everything in the waiting room, surrounded by a gaggle of children under 5 (four kids, to be exact) and a rather exhausted looking mom.
It was a good thing Copper had a bandage change already scheduled, because her bandage had fallen off that morning anyway.
On physical exam, Copper's tail was very clearly painful and didn't appear to be healing, although it was still a little early to tell, being only 3-4 days out from her injury. We placed a sterile nonstick pad over the exposed end of the tail and wrapped the tail in a sticky, stretchy bandaging material called elasticon.
I sent Copper home with mom & children, with an agreement to see her back for a bandage change and recheck on Friday (3 days later). The hospital has a system for readmitting patients during a Monday-through-Friday time frame called "orange sheeting." Normally, when a patient's visit is concluded, the student turns in the fee sheet to the business office (oops, we are supposed to call it "client services" now), and the billing staff put the charges into the computer then have the client pay for the day's fees and close out the invoice. Every time an animal has a new appointment, there must be an associated charge (unless we do something special to write it off) -- the exception being orange sheeting, where you fill out an orange sheet for your patient and turn it in to the receptionist with a time written on it that the patient will be coming back for a "readmit" appointment later that same week -- then you just keep the fee sheet until all of that patient's appointments for that week are concluded, and turn it in at the end of the week when they have their final checkout -- thus saving the client recheck fees or exam fees or whatever else would have been charged for opening a new set of paperwork every day.
So Copper's mom & I agreed to see her at noon on Friday, meaning I kept Copper's fee sheet and other paperwork and put in an appointment for her at the reception desk.
On Wednesday, I made a quick follow-up phone call to Copper's mom to see if the bandage had stayed on and to ask how Copper was doing overall. There was no answer, so I left a voicemail, concluding with "Please call if you have any questions or concerns, otherwise we will see Copper at noon on Friday."
On Thursday, one of the Community Practice technicians went through the schedule for Friday appointments and called each of the clients to confirm their appointment time on Friday (i.e. "I'm calling to confirm Copper's appointment for a bandage change at noon on Friday, please call back if you need to change this.").
On Friday, noon rolled around and I waited for Copper's appointment to turn green (we have a flat screen TV in each of the rounds rooms that displays that service's appointment calendar; appointments are initially purple or yellow or some other color that denotes what kind of appointment it is, then the front desk makes the appointment color change to green whenever the client checks in at the front desk).
By 12:10 pm, the Copper's appointment wasn't green, so I went up to the waiting area to check and see if Copper had arrived, just in case the receptionists had forgotten to turn her appointment green, or if there was a computer glitch, which is not unheard of. No Copper, no Copper's mom.
I got caught up helping a classmate with their patient for a few minutes, and at 12:30 I finally had a chance to call Copper's mom.
"Hello, I'm calling from the veterinary teaching hospital. We had Copper down for a 12 pm appointment?"
"Oh!" said Copper's mom, clearly surprised. "I was sure her appointment was at 3."
"Hmmm... Can you bring her in any earlier?" I asked, knowing that our last Friday appointment is typically at 1:30 pm, and all the students and clinicians skedaddle as fast as humanly possible once the last appointment and afternoon rounds are over.
"I don't know -- my husband has Copper right now -- let me call his cell phone and I'll get right back to you," replied Copper's mom. I made sure she had the correct phone number for the direct line to Community Practice, and hung up.
By 1 pm, Copper's mom still had not called back, so I tried her number again (the only phone number in her record). No answer, so I left a voicemail asking her to please call back as soon as possible.
By 1:30 pm, my next patient (and the last scheduled appointment of the day) had arrived, so I left one last voicemail for Copper's mom, advising her that we were at the end of our appointment schedule, and I had tried repeatedly to get a hold of her, and unfortunately, she would just have to reschedule Copper's bandage change for Monday and call CCU or Urgent Care over the weekend if Copper needed treatment before that.
I was bummed, first of all because I was interested to see how the bandage I had applied had held up and if Copper's tail had started to show any inclination to heal on its own.
But I was also sorry that Copper's mom will almost assuredly end up paying far more in fees for Copper's care because of missing her Friday appointment. We would have saved her at least $25-35 just from orange sheeting Copper this week, plus we had bought a whole roll of elasticon on Copper's account, and kept it at the hospital, planning to use more of it to rebandage Copper's tail on Friday and teach mom how to do it at home. If Copper needs a bandage change over the weekend, she'll not only have to pay the $89 exam fee but also a bandage change fee and the cost of new bandaging material.
It's really too bad that we apparently had some kind of miscommunication about Copper's appointment time, but I can't for the life of me figure out how that happened. It was Copper's mom who, on Tuesday, selected what time would work for her best to come back on Friday. In addition to us agreeing on noon when she left on Tuesday, she had 2 voicemails after that that both told her the appointment was at noon -- which is one more than most owners get, and most clients still manage to remember the correct appointment time.
Just hope Copper is feeling okay this weekend, and that she hasn't run out of the pain meds that we planned to refill for her yesterday...
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