Pet-Specific Care for the Veterinary Team. Группа авторов

people can become confused when dealing with information outside their area of expertise, particularly in times of stress.

      Clients who don't understand the complexity of a problem or its solution will question the expense. This certainly applies to treating sick or injured animals but fear influences decisions about wellness care as well. Fear of anesthesia, fear that the pet won't be able to chew if you extract those teeth, fear of medication side effects, of overvaccinating, of chemicals in pet food and many other things.

      Clients don't know how to judge risks and benefits, they don't understand the causes of diseases their pet might get (“Where would he have gotten THAT?” “He's an indoor cat, he doesn't need to see the vet every year”) They don't know which of those medications they are giving is the one for the cough and which is the one for pain. They think that blood testing is a waste of money because they don't understand that we have medications or special diets to treat what we find.

      Our clients are paying for our knowledge and guidance. They did not attend veterinary school, so it is our obligation to communicate that knowledge to them. Practicing medicine means being a teacher to pet owners. Every client interaction is an opportunity to teach about pet care, including what problems their pet might have or be susceptible to and how we could address them. Just think – we each have the opportunity to teach and influence thousands of people over our careers!

      1.4.3 Wellness and Prevention are Key

      Clients won't buy products and services if they don't know they are available or don't fully understand the benefits they provide. It is rare that a Great Dane owner comes into the practice whose previous veterinarian discussed gastric dilation volvulus (GDV) and gastropexy with them, nor bulldog owners who already are aware of brachycephalic syndrome and the availability of surgery for elongated soft palate. Many owners of senior pets still have never heard of senior screening and most have never received a specific nutritional recommendation. Most adult cats are overweight but only a fraction of those cats' owners have been told their cats are overweight.

      Whose responsibility is it to teach them about these things if not ours? Every client should be given the opportunity to learn, and every pet should have an owner who knows how to take care of it for a long, healthy lifetime.

      This is a different mindset from what we learned in veterinary school. We learned normals and then abnormals, typically from specialists. We learned very little about maintaining normal. Preventive care focused mostly on vaccinations and parasite control, with a bit of dentistry thrown in. We were not told that it was our responsibility to provide in‐depth client education to every client in a pet‐specific fashion.

      Yet the general practitioner spends more than half of his or her time on wellness and preventive medicine: puppy and kitten visits, annual examination visits, spay/neuter services, dental prophylaxis, heartworm testing, etc. We pride ourselves on doing a good job working up cases yet often neglect the bread and butter of our profession – keeping pets from getting sick. There is nothing more awesome than a successful surgery. Yet, other than specialty surgical practices, only a small percentage of clients will benefit from our surgical expertise, compared to the number that will benefit from working on weight management, helping clients choose a good pet food, and preventing behavior problems.

      1.4.4 Components of Individualized Care

Answer questions, give written materials or refer clients to credible websites. We cannot deliver pet‐specific care until we have delivered client‐specific care. What we are recommending should always be what we believe is in the best interests of the patient. Your body language, eyecontact, and speech patterns need to project a caring message. It may be your 20th appointment today – it may be the client's only visit all year. To you it's another patient – to them it's a family member. These are important conversations!

      In general, the vast majority of pet owners consider their pets to be members of the family. They consider their pets' health to be an important issue. They want veterinarians to help them do the right things right. For example, most pet owners actually want and expect nutritional advice from their veterinarian.

      More specifically, though, every client has a different learning and communication style, different experiences with pets, and a different level of understanding. We have clients who are physicians and those who are truck drivers or office workers. The way we explain things to a medical professional is not the same as the way we would explain for someone with only a high school diploma. The majority of our clients may want nutritional advice – but the rest don't, and if you insist on talking about it anyway your advice may not be well received. We have to get a feel for who each person is, what level of knowledge they already have about pet health care, and what information and help they want from us.

      This means we have to ask questions and listen to the answers. What has been your past experience with dogs? What role does your pet play in your family? How can I help you to feel more comfortable with this decision? Have I explained this well enough or do you still have questions?

      What we choose to recommend or educate our clients about at a given visit is a combination of what the pet owner wants from us and what we want to discuss, based on our risk assessment for the pet (see 2.7 Risk Assessment). We often have to prioritize and we also need to be brief. Most people don't have the time or the attention span for a 40‐minute discussion on flea control. However, you must also keep in mind that the vast majority of pet owners want their veterinarian to tell them about all the recommended diagnostic and treatment options for the pet, even if they cannot afford them.

      1.4.5 Pet‐Specific Care Takes Extra Time and Effort

      The opportunity to deliver pet‐specific care comes with an obligation to present care recommendations well. Take the time to explain and to coach your clients, whether the pet is well or ill. Clients will take better care of their pet if they understand its disease and treatment needs.

      It takes thought and practice to change the way we work. Remembering a new protocol can be hard. Investing more time in each individual client may mean scheduling more time over the course of a year, team training, developing tools and doing performance evaluations and coaching. The opportunity to deliver pet‐specific care comes at a cost. You cannot necessarily deliver high‐quality care while remaining a low‐cost provider, so some consideration is warranted.

      Medical record keeping is very important if you are initiating a new program and a good electronic medical record (EMR) system can facilitate this (see 9.1 Medical Record Entries). We have been taught since childhood to fill in the blanks. Providing a place to document recommendations helps us to remember to make them. For example, let's say I want to start offering Schirmer tear testing (STT) for all my senior canine patients, to catch keratoconjunctivitis sicca (KCS) at an early stage. If an item is added to the exam template where the STT results are recorded, team members will remember to obtain that information.

      If we want to offer a STT or a blood pressure screening to senior pet owners, we also need a handout or laminated sheet or some other tool to be sure we don't forget to do so. That's how we become consistent with client presentations and the care we deliver.

      In addition, we need a plan or program for every type of routine visit. Protocol development includes not just how you will treat a particular patient but also how you will educate the client about the pet's care. You need to document every recommendation and provide written materials. Give your clients all their instructions in writing – every disease or problem, every diagnosis, every medication, every recommendation.

      People comply better with their own physician's recommendations when there is sound education on why a medication or procedure is needed, and there is follow‐up and follow‐through. You have to do these things too, and train your staff to do these things.

      1 Explain the recommendation, and why it is your standard of care.

      2 Solidify