Exam room dialogue: What clients must be told to protect yourself

The examination room can be a horridly stressful place. The stomach butterflies often begin before the veterinarian even walks in the door.

You pick up the record and look at the receptionist's comments: "Cough has been present ever since vaccinated here five weeks ago," or perhaps: "owner refuses to see Dr. Phillips…" When you see these sorts of notations, you bristle in anticipation of what likely awaits: an argument or argumentative client.

This month, I have compiled a number of steps, comments, actually, which veterinarians can employ to help prevent the development of misunderstandings or problems later on. These are remarks which should be made to clients during the office visit which can, at a minimum, prevent client dissatisfaction and possibly even insulate the DVM from subsequent legal liability.

We are all well aware that many clients have selective hearing and many others are somewhat short on common sense - problems facing any person in the business of dealing with the public. If we make sure to mention certain facts during the time we have with clients in the examination room, we are helping to avoid having our intentions misconstrued or our competence called into question.

1. My presumptive diagnosis may not be correct.

Some young veterinarians are afraid to appear uncertain in the presence of a pet owner. Some older doctors consider the possibility of a diagnostic error to be a threat to the ego. Neither of these emotions should control our "performance" in front of the client. Clients need to hear, instead, that your training and experience lead you to believe that the problem is likely "x" but that other problems can masquerade as "x." Sometimes, I will explain that a diagnosis of "x" is my best educated guess, but that as in human medicine, nothing can be certain until all diagnostic tools have been exhausted. However, I go on, we should begin with the diagnostics that make economic sense, keeping in mind the limitations that strategy involves.

Of course, when the clients says, "Do everything, Doc, I don't care what it costs…," go forward with your coagulation panel to autoimmune evaluation after you check the client's credit history.

2. In a small number of cases, vaccination reactions occur, and here is what you would do…

Why upset a client unnecessarily when vaccine reactions are so unusual? There are two benefits. For all of those who receive the warning and then nothing happens, such clients are usually pleased that you took the time to advise them of a possible risk.

More importantly, for the few whose pets experience significant reactions, you are more likely to be thought of as a thoughtful practitioner rather than a jerk who forgot to mention that something might happen which could scare the client out of her wits.

3. Food trials and allergy testing are available.

Some of us are tempted, when faced with an allergic skin problem, to bypass the diagnostic and treatment options because of cost. We may know that this client just got laid off or that a certain client never spends any money unless it involves a life-threatening emergency.

Some practice management consultants would insist that you must offer the testing and treatments because some might unexpectedly accept the suggestions, and they can be money-makers. While that might be true, I believe that the offers must be made so that when they are declined, the refusals can be noted in the patient record. That way, when hepatic or adrenal disease appears years later, the client cannot claim that your office administered steroids without exhausting all alternatives first.

4. Our office has a technician who would be thrilled to restrain Fluffy.

A client can only decline an offer to have a staff member restrain his pet if the offer is made. If you make the offer, and it is declined, and then the client ends up getting bitten, you might be in legal hot water. If the same bite happens, and you didn't offer, you are absolutely in hot water. If a scratch or bite occurs, document your offer of restraint assistance in the record before you leave the room. If a staffer hears the offer, jot down his or her initials.

5. Feline leukemia testing is like insurance against economic and emotional loss.

Many clients aren't expecting to have to spend money on diagnostic bloodwork when they walk in the door with a newly-acquired cat or kitten. They can often interpret the suggestion of FeLV/FIV testing as a make-money scheme for the practice.

Consider the approach I take. I explain to clients what they really need to know: Neutering and spaying and several years of vaccinations and annual health examinations add up to a fair amount of money.

Unidentified FeLV or FIV infections can lead to that money being spent on an animal that may live a much shorter period than expected. While that reality may not affect the client's decision to keep the cat, the failure to explain these facts would be a disservice to the client.

Clients just love it when you point out how you have saved them time, money or heartache. Your insurance adjuster will love it when he spots the "FeLV test declined" notation in your record after the malpractice claim is filed.

Dr. Allen is a partner in Associates in Veterinary Law, P.C., a law practice specializing in business and legal counsel for veterinarians and their families. He can be reached at www.veterinarylaw.com or call (607) 648-6113.