5 hazards lurking for veterinary associates in the exam room
These are the ways we stumble into traps in the exam room and undercut out medicine, our patients and ourselves.
Steer clear of these five hazards in the exam room. All images/Getty Images.Failing to cultivate client relationships can derail the many great things we veterinarians do in practice. To connect with clients, I steer clear of a number of pitfalls waiting in every exam room. But I want to be open about the fact that I don't do it right all the time.
Consider one big part of my client-facing strategies: a good physical-exam routine. I know it's easy to get complacent, because I mess up too. I was doing an exam once and told the client at the end that "the eyes and ears look great, the skin is perfect and the heart and lungs sound fantastic." Once I left the room to check the diagnostic tests, the technician looked at me and said, "I know you said the heart and lungs sound great, but you never actually listened with the stethoscope."
I was stunned. Had I actually gotten in such a hurry that I didn't even listen to the patient and said what I tell so many others when giving their pets a clean bill of health? I returned to the exam room and confessed my mistake. I was honest about it, and the client busted out laughing. I got lucky-that won't ever happen again.
So at the same time as you steer clear of exam-room traps that turn off clients, remember you're only human …
1. Being forgettable
Make an impression on clients to help with word of mouth.You might not like the idea of marketing yourself to clients, but it works, makes clients happy and helps you. It's a win on every front. I make a point of introducing myself to clients and address the pet by name after entering the exam room. If they're familiar faces, I shake hands and welcome them back.
Expert move: If you're an associate at a multi-doctor practice, be sure to include your business card with medicine and handouts. Contact information for a particular doctor can also be put on discharge paperwork to remind clients which veterinarian they visited.
It's easy to dive into the appointment with, “Teddy is here for itchy skin, right? Let's get started.” You may do a great job fixing that problem, but how will the client remember which veterinarian to recommend? Word-of-mouth requires a name (your name) to go with the client's success story.
2. Flaunting your smarts
Don't alienate clients with language they don't understand.Our clients already know we're smart, so we don't have to beat them over the head with medical jargon to prove ourselves. I try to use the precise medical terminology when clients need it, but I follow up by explaining in lay terms what it all means.
For instance, during a physical exam I explain what I'm looking at and feeling for and discuss any abnormalities. If the patient is sick, the blood work is done in-house (or explained clearly and helpfully over the phone later on), and I explain why I recommended the blood work. Once the results are ready, I note what each value means on the printout. For example, I'll write "liver" next to the ALT and ALKP and "kidneys" next to the Creatinine/BUN. The client also takes a copy of the paperwork home.
At the end of the conversation, I doublecheck that the client understands the issue and treatment. First, I ask if they have any general questions or if there's anything that doesn't make sense. I reiterate the diagnosis, explain how we're going to start the treatment and say when a recheck is necessary.
Expert move: The best visits don't stop when the client walks out the door. I send home detailed handouts on conditions, ask clients to read them over and follow up by phone or email a couple days later.
Sometimes I email clients, especially when I'm dealing with a chronic disease or a patient on a weight loss plan. This allows me to easily convey information (websites, charts, pictures, etc.) in a timely manner, and it keeps me from having to make a long phone call on a busy day. I don't text them often because I only share my phone number with a few clients. I would rather email because that's a much easier way to communicate than texting about veterinary care. However, for me, nothing trumps an in-person conversation or a phone call.
3. Appearing aloof
Don't give clients the cold shoulder during exams.Every client deserves at least a few minutes of our undivided attention.
Expert move: For many of us, cats can be the toughest customers when you're trying to create a calm, pleasant atmosphere for owner and pet alike. To gain the trust of owners of fearful cats, I usually take one of three approaches:
1. I take the carrier top off and leave the cat in the carrier during the examination and discussion with the client.
2. Prior to the examination, I leave the cat in the carrier while talking to the client.
3. Occasionally, I'll use pheromones such as Feliway.
By doing this, we gain clients' respect and prove that we care about them and their pets.
During this time, I recommend holding the pet or playing with it on the floor while maintaining eye contact with the client.
4. Ignoring exam-room strategy
Have a strategy when you enter the exam room.Have a client communication strategy before, during and after visits. Experiment! (Click here to read my easy 12-step process for examining patients.)
For example, I've learned to leave conversations about pet obesity until the end. I've had the most success in discussing pets' weight issues by waiting until all the good news is shared. Some clients will get defensive and tune out everything else I discuss after hearing their four-legged friend has put on too much weight.
Expert moves: Take time to listen. Many veterinarians don't take the time to lend an ear to clients. We send a technician into the exam room first with a history form to get initial information. Then I enter and summarize that history and listen to the client for a minute or two. If clients get long-winded or start to repeat themselves, I'll give the pet attention before starting my exam while clients talk. I maintain some eye contact with clients so they know I'm still paying attention.
I recommend using the term "ideal weight." For example, "Newt is looking good today. His eyes and ears look great. He has mild tartar on his teeth, but overall he's doing very well. My only concern is that he's a little over his ideal weight."
I then explain that Newt, unlike the ideal dog of his breed, doesn't have the tummy tuck or hourglass appearance through his waist. I tell clients that most loving pet owners don't realize their pets are above their ideal weight.
Then I get into food. I'll say, "Newt's ideal weight should be X, and this is how we need to get there. What's Newt's diet?" I share a healthy treats list and a handout that breaks down how much food to measure out during each feeding. (Here is a form for dogs and cats. Need help talking to clients about weight loss? Click here.)
I then schedule a recheck appointment to evaluate weight and progress.
5. Silently examining patients
Don't be the silent type during exams.My physical examinations are never quiet-I'm always talking and explaining even normal things I'm seeing:
> “The vessels in the eyes look great.”
> “The heart and lungs sound great.”
> “The hips and knees feel perfect.”
> “The skin looks excellent.”
> “You're doing a great job keeping Fluffy's coat clean and shiny.”
Expert moves: No matter how busy I am, I address client concerns during an appointment. If I'm rushed and clients have questions, I tell them we need to focus on the current issue now and discuss other questions during the recheck examination. If the other concern is a pressing issue that needs to be evaluated immediately, I make time- but this is usually not the case.
If I have a concern the client doesn't know about (remember the obesity conversation before?), I cover it at the end of my conversation with the client. If I mention it earlier, the client won't hear another thing because they'll be preoccupied with the issue.
Another way I manage my time well when clients have multiple questions is by making a list of the client's questions and then emailing/calling them at a later time when I'm less busy. I tell clients their questions are important to cover in detail, but we can do it best at a later time when I can concentrate. I haven't avoided the questions-I've allowed myself to manage my time, proven to the client that his/her concerns are important to me and promised the client I will be in touch.
Every client interaction is a two-way street, so no veterinarian has the power to guarantee that every client conversation or appointment will be rewarding and pleasant. But with these tips, you can make a few less mistakes that alienate clients.
Dr. Jeremy Keen is an associate at North Madison Animal Hospital in Jackson, Tennessee.