Create a complete picture of health: How to cultivate client compliance


Are you puzzled why your clients aren't following through on your advice? Try these five tips, and your practice could be well on its way to good health for all.

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Believe it or not, you are holding all the pieces to client compliance. It’s knowing just the right way to turn a phrase to find that sweet spot where it clicks in for the client, feeling the confidence to say you know the right fit for each pet, and following up to make sure the pieces stay connected.

“That fairytale client who is 100% in agreement with every recommendation we offer is a true rarity,” says Michael Paul, DVM, former executive director of the Companion Animal Parasite Council, a former president of the American Animal Hospital Association, and currently the principal of Magpie Veterinary Consulting. “It is interesting how we take it personally when clients don’t comply or adhere to our recommendations for their pets. There must be something wrong. We make recommendations based on current guidelines for preventive healthcare, yet generally few clients seem to accept our recommendations and even fewer follow through long-term. A good portion of the gap is our responsibility.”

Here we present five pointers for cultivating clients to follow your recommendations, borrowed from Dr. Paul’s article “Lead the way: 7 steps to boost acceptance of your medical recommendations." We’ve paired these pointers with five example areas where compliance can be particularly tough.

Keep in mind that each of the pointers can be applied to any of the five examples covered below as well as to any area where you struggle with client buy-in. So mix and match away, and remember—good compliance is great for your practice, but, most important, it’s vital to every pet’s long-term health and happiness.

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To encourage clients to give heartworm preventives to their pets, it’s important that the entire veterinary staff forms a consensus recommendation and that all employees advocate for that recommendation at various points through an appointment. The American Heartworm Society (AHS) recently wrote about this very topic ( Here are some highlights.

The rule of three

The veterinarians and staff at Animal Center West in Zachary, La., follow a “Rule of Three” to educate clients about heartworm disease. The goal is to deliver a three-point message three times by three team members.

1. Heartworms are a real danger. Heartworms pose a serious threat to dogs’ and cats’ health and are transmitted by mosquitoes.

2. Heartworm disease is hard to treat. A heartworm infestation is difficult and expensive to treat in dogs, and there is no approved treatment for cats.

3. Heartworms are easy to prevent. Heartworm preventives are effective and easy to administer to pets.The receptionist is the first to introduce the message by handing out written materials when a client checks in. The technician is the next messenger, repeating the three messages in the quiet learning environment of the exam room while taking a blood sample for the requisite heartworm test. Finally, the veterinarian validates the messages when prescribing or injecting the preventive medication.

Tried-and-true tips

Sheldon Rubin, DVM, emeritus director of Blum Animal Hospital in Chicago and past president of the AHS, also shared a few tips he’s found effective for heartworm compliance:

1. Use visuals. Pull out that dusty jar of heartworms and place it on the reception desk to stimulate questions.

2. Talk and listen. Have staff place a “not current on heartworm medication” note in a patient’s record so the veterinarian can have a discussion with the client. This is also a good time to remind pet owners that most heartworm preventives also protect pets against intestinal parasites.

3. Don’t be shy. Don’t hesitate to discuss cost as part of your “prevention is important” message. Let clients know that your prices are competitive with online pharmacies.

4. Send reminders. Program your practice management software to automatically remind clients to repurchase heartworm preventives when needed, based on the type and quantity they were originally dispensed.

5. Keep it simple. The easier it is for pet owners to purchase the medication, the better (e.g., provide online ordering and mail items at no charge). And have clients sign up for an online reminder service to help them remember to give preventives year-round.

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You know that performing routine, preventive diagnostic testing is necessary not only for the early detection of disease but also for establishing baseline health values in pets. But getting your clients to agree? That’s no easy task—especially when their pets appear healthy on the outside.

So we went to Fred Metzger, DVM, MRCVS, DABVP, owner of Metzger Animal Hospital in State College, Penn., for tips and advice on how he and his team tackle this common compliance obstacle.

1. Tell the truth. Dr. Metzger is open and honest when it comes to the veterinary care he recommends for his patients. If a pet doesn’t really need that annual vaccination, he lets the client know. But when it comes to annual diagnostic testing, it’s a “must” recommendation for everyone, he says.

Let clients know that many conditions in pets develop before clinical signs or physical examination findings are even evident—and the cost of not catching disease early can be great.

2. Practice what you preach. Do you perform annual health screenings on your own pets? Tell the client so, says Dr. Metzger. Did you recently detect an abnormality on a seemingly healthy pet, thanks to routine diagnostic testing? Let them know that, too.

Real-life anecdotes often pack a greater punch than rattling off a bunch of statistics, and clients will appreciate the personal information you share.

3.Make it relatable. We all know how important diagnostic testing is in human medicine—physicians are always making recommendations for annual health screenings, particularly as we get older. So why should it be different for our pets? To put it in perspective, Dr. Metzger shows clients an age analogy chart that estimates how old their pets are in human years (Download a copy of the age chart now). Just knowing that a 9-year-old dog is actually closer to 60 in human years often provides the nudge they need to understand the importance of your recommendations.

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As with preventive diagnostic testing, performing regular dental examinations can help you catch problems early before serious, even life-threatening diseases develop. If you want to boost dental compliance, make it personal for clients to get them on board with your recommendations. Here are three pointers and ways to implement them from Brett Beckman, DVM, DAVDC:

1. Establish client trust immediately.

  • Walk into the exam room with a smile, shake the client’s hand, and introduce yourself.
  • Acknowledge the pet verbally and through physical contact by holding or petting it.
  • Use the name of the client and the pet often during the exam.
  • If a client’s children are present, acknowledge them and compliment them. Many parents will shut out an adult that shuts out their children.

2. Use multiple senses.

Incorporate the client into the dental examination by using as many senses as possible to help enhance client education. For example, show the client the pet’s mouth and have him or her take a closer look. Ask the client to smell the pet’s breath or have the client move a mobile tooth with a finger. Touch an inflamed area with a cotton-tipped applicator to detect pain.

3. Use pictures. Take a picture of the client’s pet’s mouth and compare it with a photo of another pet’s mouth with an equivalent stage of periodontal disease. The picture can be taken on a digital camera and then transferred to a computer or television screen in the exam room. Pictures of patients, along with the corresponding radiographs of fractured teeth, feline resorptive lesions, stomatitis, missing teeth, and so on, can be used to explain the pathogenesis as it pertains specifically to the client’s pet.

Also send clients home with a personalized handout. The handout should include a picture of the client’s pet, a picture of the pet’s oral disease, a picture of a pet from your database that has a similar extent of pathology, and a radiographic image of that area.

Even if, despite your efforts, your client still leaves the clinic without scheduling an appointment for the recommended procedure, at home he or she may repeatedly encounter the handout you provided, and these repeated exposures may lead the client to have a change of heart and schedule an appointment.

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Communicating with clients sometimes means having conversations about sensitive topics—and weight management in pets is one of them. With dog and cat obesity reaching new heights these days, nutritional guidance should be an integral and focal part of every conversation you have with clients.

For some practical pointers, we reached out to Ernie Ward, DVM, a practitioner at Seaside Animal Care in Calabash, N.C., and author of Chow Hounds: Why Our Dogs Are Getting Fatter.

1. Be consistent. Dr. Ward says it’s critical to check a pet’s weight and do a body condition score (BCS) not just sporadically, but every time you see the pet. Not only that, but make sure you review the results with the client each time as well. Discussing the comparison in a pet’s weight and BCS from one visit to the next is an invaluable conversation starter with clients.

2. Put it in writing. You may think your clients are listening to you in the exam room, but chances are, they’ve only caught a portion of what you’ve told them—and the discussion about their pets’ weight might be one of the first items they forget as soon as they leave your practice.

To combat this, Dr. Ward gives each client a report card that details the pet’s current and previous weight and BCS, as well as specific recommendations for feeding and guidance for reaching the pet’s ideal body weight and condition.

3. Make it a team effort. Your message to clients will have a much greater impact with the support of your entire team, so make sure everyone is on board with your practice’s philosophy for nutritional and weight management.

Dr. Ward recommends training your staff how to estimate caloric requirements for dogs and cats, help clients decipher food and treat labels, and have discussions with them about the importance of maintaining a healthy weight for their pets.

Dr. Ward: What doesn’t work for me

In Dr. Ward’s experience, monetary or material incentives haven’t boosted client compliance when it comes to monitoring and managing a pet’s weight. What has worked for him: Simple, open communication with clients.

“I never want to blur the lines between what’s best for the pet versus what’s best for the wallet,” he says. “I want my clients to return to monitor their pets’ weight because they’re invested in their pets’ health and well-being, not because they’re getting a reward.”

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Flea and tick infestations are almost entirely preventable these days with a variety of effective products available at your clinic to fit any lifestyle. But infestations are still occurring. How is this possible?

Dr. Paul says that people don’t understand parasite life cycles and, more important, aren’t using products that would work if used correctly. Thus, pets are suffering with fleas and ticks and internal parasites—enduring preventable infestations and infections.

And fleas and ticks are much more than pests. They have the potential of transmitting disease to both pets and people. So how can you ensure clients are providing regular flea and tick preventives? And how can you make sure that when they do, they are applying the appropriate products in an appropriate manner? This is your chance to show your value to clients.

“Your education establishes you as an expert in all things animal,” Dr. Paul says. “Know the life cycles of various parasites. Be able to offer advice for additional steps in prevention.”

In fact, Dr. Paul thinks the word doctor should be defined as teacher. “Embrace this role since it is a huge competitive advantage,” he says. “Make a specific recommendation for a specific drug or product and advocate for that product because of your experience and knowledge. Don’t encourage clients to make their own decisions based on the picture on the box. These are things that a sales clerk cannot provide.”

Above all, Dr. Paul says there is one key word you need to remember: Know. Know the product or service you are recommending inside and out so you can understand how your clients perceive the value.

By establishing yourself and your team as the experts on pet care, clients will turn to you when problems or questions arise. You can’t call or go back and visit the big box or online store and expect expert, personalized help. Make sure your clients know this.

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