This guy hurts. What will you SAY to FIX it?
The words you use to frame the importance of pain control in veterinary patients can make all the difference in their world.
(Getty Images)There's you--lab coat or scrubs, looking down at an animal you know is in pain. Or will be in pain if surgery or some other sort of invasive procedure is indicated.
And there's the client--heart often in the right place but weighed down by her own financial fears or confusion about all the medical jargon.
And there's the pet--usually furry, perhaps more scared than you'd like, limping or unable to eat or painful under your palpating fingers, trying its best to hide how much it's in pain because of a biological imperative not to show weakness to the world.
That pet probably doesn't know that you're there for it, that you've got its back, that you can make the pain go away. But you know it.
The last trick, the rabbit out of the hat, is translating your compassion for the animal and the sometimes-complicated scientific reasons for procedures--and, maybe most important, pain control--to the pet owner. How to do so to fruitful effect can be gleaned from a recent "Learn then Earn" session at CVC San Diego, where Andrew Claude, DVM, DACVAA, joined his pain-control knowledge with veterinary business expert Karen Felsted, CPA, MS, DVM, CVPM, CVA.
Be painfully clear about it
Both Drs. Claude and Felsted believe the most ethical way to handle pain management is extremely clear and unambiguous communication with the client. One study shows clients are seven times more likely to follow veterinarians' recommendations when clear and unambiguous language and explanations are used.1 Dr. Claude has four ways to achieve clarity here.
Dr. Felsted's thought on what to say? Try, "Unless we use the right medications, surgery can be painful for animals, just like for people. That's why we've included pain medication in this estimate--we give it during the procedure and send some home with you afterward. Have you had surgery before? Do you remember what it was like?"
Or, "Fluffy's not eating because she has an infected mouth and it hurts. Fortunately, cleaning her teeth and extracting the diseased ones will help. We'll also use some pain medication during and after the procedure."
Advocate for the pet without a twinge of regret
After you've made the strong, clear recommendation, it's up to you whether to accommodate the client who does not choose pain control or not. But Dr. Felsted has a powerful reminder to you: "Part of the reason clients are wishy-washy on things is that they are picking out the things they don't think have value." It's up to you to clearly and concisely show them the value of pain control for their pet.
Don't mince words, Dr. Felsted says. Like this: "Without pain medication, this is a painful procedure. Fortunately, we have excellent medications to control Fluffy's pain. We've included our pain management package in this estimate to make sure Fluffy stays comfortable."
Pain assessment at home
Having a good working knowledge of nociception, published pain assessment tools and preventive pain management options are important when educating clients about pain assessment in their pets, says Dr. Claude: "Important features of pain assessment in pets should emphasize trends, changes in behavior, changes in appetite, changes in urination or defecation habits and reactions to being touched." He says you can adapt the Glasgow Short Form (dogs), Colorado Pain Charts (dogs and cats), UNESP Botucatu Multidimensional Composite Pain Scales (cats) or, for chronic pain, the Oxford Chronic Pain Assessment Chart so that clients can use them at home under your supervision.
"Another important detail to remember is the at-home pain assessment must be performed by the same individual, in the same place, under similar circumstances and during the same times of the day," says Dr. Claude.
Show the pain
We believe what we see. Get clients involved in a pet's pain assessment daily--and first in the exam room. How do you know the pet is in pain, or will be in pain? Show the client. Dr. Felsted says that the first thing to do is talk to clients about the signs of pain; often, pet owners don't know. They may think Fluffy can't jump up to the counter anymore because she's old, but it's really because it hurts. Go over specific signs with them: unwillingness to move or moving in a stilted or unusual way, out-of-character aggressiveness, increased panting, changes in vocalization, lack of appetite and others. Follow this up with a written handout.
"Clients are uniquely qualified to assess pain in their pets because they know what the normal behavior is," says Dr. Felsted. "Tell them to trust their instincts. If they think Fluffy is in pain, she probably is. And make it clear what you can do to help, both now and if they think the pain is increasing after they leave the practice."
Dr. Claude adds that educating clients about how to assess their pets' pain or discomfort is essential for two reasons: 1) It's beneficial for the pet, and 2) it requires clients to become an active participant in their pets' recovery. (See the "Pain assessment at home" sidebar above for more.)
Price should not be the pain point
If clients balk at pain control itemized in your estimates, should your hospital itemize it? (If you're not in charge of that, lobby for someone to think about it again.) Is the price of the in-hospital or take-home pain control really accomplishing what you and your team want it to do? "Volume has its place as a money-maker," Dr. Felsted says, as she advocates being creative and flexible with pricing. If your hospital increases volume by requiring the medication for every painful procedure or condition, the bosses increase their revenue and everyone enjoys the knowledge that pets that frequent your hospital live with less pain.
Illustrating the point: Should you even give a choice?
A lot of veterinarians don't think presurgical client consent forms should give clients a choice about pain medication. In a recent dvm360 study, 80 percent of respondents said pain management is a mandatory part of a cat or dog spay or other routine surgery in their practice, while 20 percent said pet owners can accept or decline. Dr. Claude, however, counsels his colleagues to cut the choice: "It's not an adjunct."
Save pets, save the profession
In person during a session, Dr. Claude was almost patriotic about veterinarians' responsibility to take the lead in veterinary pain control.
"Either our industry is going to make strides and continue to help move us forward in pain management and patient welfare," Claude warned, "or the federal or state government is going to do it for us."
According to the Veterinarian's Oath, Dr. Claude said, veterinarians have an obligation to prevent and relieve animal suffering, including pain.
"One of the ways we can do that," he said, "is through providing for patient welfare vigilantly, which includes analgesics whenever and wherever needed. Our only downfall here will be either our refusal, as a profession, to add more pain control or our refusal to charge for the pain control we perform."
1. Kanji N, Coe JB, Adams CL, et al. Effect of veterinarian-client-patient interactions on client adherence to dentistry and surgery recommendations in companion-animal practice. J Am Vet Med Assoc 2012;240:427-436.