Are you lax about including urinalyses in your patient work-ups?
"Raise your right hand and repeat after me: I will not run a CBC and chemistry panel without a urinalysis." Those inspiring words from my professor and well-known speaker Dr. Michael Lappin, ACVIM, at Colorado State University College of Veterinary Medicine & Biomedical Sciences have stuck with me over the years, and I still share them with my practice team today. Although it has become second nature to recommend certain tests or procedures to our clients, I can't help but wonder—why do so many veterinarians offer just the CBC and chemistry panel without the urinary component?
Dr. Jeff Rothstein
I suspect there are several reasons, including force of habit and cost, for failing to offer such an important test. Yet most of us feel the information it offers is not only extremely important, but also provides us with a more complete look at the internal and overall health of the patient. We're already improving client compliance with heartworm and intestinal parasite testing. Now it's time to promote the importance of the urinalysis.
Our hospital group took its first step at improving urinalysis compliance by creating and recommending an "annual health screen" that includes a CBC, chemistry panel, and urinalysis for all our patients. By using this terminology, we can bundle the three tests and lower the chances of a client declining one of them (and let's face it—urinalysis is always the easiest one to decline, right?). You can also use this approach with sick patients—just offer one comprehensive test that includes all three components, rather than breaking down the blood and urine tests separately.
Making this type of combination test a standard procedure at your veterinary hospital achieves two goals: 1) You and your staff are less likely to forget to offer the urine test, and 2) your client doesn't feel compelled to decline something just for the sake of declining an "extra" test. If you truly believe that a urinalysis is a vital part of the pet's minimal diagnostic care and you want to spotlight its importance and improve client compliance, then it's in your best interest to incorporate it into a single, comprehensive test.
Plus, making a habit of practicing good medicine often leads to practicing more—and even better—medicine. In our hospital, we've catheterized a seemingly healthy male dog to get a urine sample only to find that the catheter won't pass. We quickly discovered, with the help of radiographs, that this asymptomatic dog had a bladder and a urethra full of stones.
So the next time you order up a CBC and chemistry panel in your practice, remember the words of Dr. Lappin: "I will not run a CBC and chemistry panel without a urinalysis."
Veterinary Economics Editorial Advisory Board Member Dr. Jeff Rothstein, MBA, is president of The Progressive Pet Animal Hospitals and Management Group in Michigan.