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Veterinary dermatologist Dr. Ashley Bourgeois shares how to bend clients’ ears while you’re examining the ones on their pets.
While the ears on your patients should get the bulk of your attention during otitis externa diagnostic exams, the ones on your clients deserve your attention as well in the form of education. In addition to helping you get to a diagnosis more quickly, educated pet owners are better positioned to partner with you on treatment (and to see the need for and benefit of it). At a recent Fetch dvm360 conference, Ashley Bourgeois, DVM, DACVD, shared three ways to involve clients in the diagnostic process.
Taking a thorough history is the first step in the diagnostic process, said Dr. Bourgeois. “Is this the first ear infection this dog’s ever had? Does it happen every summer? Has it been happening since it was 6 months old? Has it only been a problem since it turned 10 years old? All of these things really matter.”
One question Dr. Bourgeois doesn’t ask: Is your dog itchy? Clients, she explained, think itchy means scratching, because that’s what it means for them. So if they haven’t seen their pup pawing at its ears, there’s a good chance you’ll miss out on vital information. Dr. Bourgeois advised asking specific questions about things like paw licking and head shaking. Clients tend to mistakenly interpret such signs as behavioral issues, attributing them to their dog’s personality instead of evidence of discomfort. But once they know what to watch for, they’ll be able to partner with you both in and out of the clinic.
Clients don’t just anthropomorphize their pet’s clinical signs—they do it to their anatomy as well. “I explain to pet owners that the canine ear canal is different than in humans,” said Dr. Bourgeois. “We have a straight canal, so it’s pretty easy for us to visualize and treat the ear. But dogs and cats have L-shaped ear canals.” Thus, if the outside of the ear looks normal, your client may need a little convincing that they aren’t seeing the full picture.
Knowledge of the L-shaped ear canal is also key to a proper flush. “Sometimes clients just wipe the outside of the ear and think that’s flushing,” said Dr. Bourgeois. “Explain that you need to get all the way down into the horizontal ear canal.”
With its ability to significantly magnify and improve visualization of the ear canal, fiberoptic video-enhanced otoscopy (FVEO) is obviously a useful diagnostic tool. “We can get up-close views of things like the tympanic membrane and can identify pathology, such as a mass that’s deep in the canal,” explained Dr. Bourgeois. But one of her favorite ways to use FVEO is for client education. “I love taking pictures through my scope to show clients and even send home with them because they get to see where their money is going,” she said. “It’s one thing to say, ‘That’s a really bad ear.’ It’s another thing to show them the ear.” Dr. Bourgeois also likes to take photos after treatment, as a reminder of how the client’s investment was put to good use.
Of course, one of the most powerful forms of client education will ultimately come from the patient itself once it gets relief from the condition. Dr. Bourgeois noted how many of her clients are astonished by the behavior of their pets post treatment. Previously unaware of how painful and irritating otitis can be, pet owners will describe their dog as “acting like a puppy again.”
Now the only thing clients will be in the dark about is how painful and irritating otitis can be for you.
Sarah Mouton Dowdy, a former associate content specialist for dvm360.com, is a freelance writer and editor in Kansas City, Missouri.