Dr. Andrew Hillier encourage veterinarians to provide itch relief before performing a diagnostic workup, building client confidence and trust in the process.
From the onset of his lecture at the 2018 NY Vet Conference in New York City, Andrew Hillier, BVSc, MACVSc, DACVD, Veterinary Medical Lead, Dermatology, for Zoetis, challenged attendees to abandon the way they diagnose and treat dogs that present with itch. Restructuring the typical procedure, he said, not only will have an effective impact on the long-term treatment of the patient, but it will also establish a positive rapport with clients.
From a veterinarian’s standpoint, determining that atopic dermatitis is at least 1 differential in a case of an itchy dog is the easy part. Veterinarians are largely in agreement that a patient presenting with regional localization of an itch, particularly of the face, ears, ventral area, or feet, is most likely suffering from atopic dermatitis or a combination of atopic dermatitis and a food allergy. What’s more difficult, however, is securing buy-in from the client to move forward with the suggested diagnostic workup and subsequent treatment plan.
Consider these steps to reshape how you approach these types of appointments.
Lead With a Solution
The natural next step after assessing a patient would be to obtain a complete diagnostic workup that leads to a treatment plan and, ultimately, itch relief. Although there is nothing fundamentally wrong with that process, Dr. Hillier suggested to instead consider how that recommendation appears to a client.
“When you present that to an owner it sounds like a lot of work, it sounds like it is going to take some time, it sounds like it will probably be expensive.” They hear nothing that indicates that their dog is going to be comfortable as soon as tomorrow morning. “I am committed to the diagnostic workup,” he added, “but I think we need to change things up.”
Instead of leading with a diagnostic workup, Dr. Hillier said the first priority should be providing itch relief. Once a client recognizes that their dog has achieved some level of relief, they have peace of mind and will begin to develop greater confidence in the veterinary team. After a client has received what they visited the office for—a solution—they are more likely to be open to testing as the second step.
Keep Discussions Straightforward and Positive
As a veterinarian, you know that there are 1000 diseases that could cause itch, but why overwhelm your clients with a laundry list of unlikely possibilities when there is a large likelihood that atopic dermatitis is the cause. Instead, Dr. Hillier reminded attendees to lead the conversation in a way that lets the client know you are taking into consideration every possible angle but are confident you will find a long-term solution. In addition to bringing up the probability of atopic dermatitis, also mention that you will rule out parasites, treat any infections, and possibly conduct a food trial. In most cases, you will not need to go more in-depth than that.
Once you have the go-ahead from the client, you must be positive about every aspect of a diagnostic workup. You also have to explain the value of the workup. Be honest with the clients, especially if this is the second or third time you are seeing their dog for an itch-related issue. Help them understand that the workup is not just a formality and that doing so may help identify a curable disease or an issue that is relatively easy to provide long-term management for, such as through parasite control or the change of a diet. Make the diagnostic workup seem extra appealing by also outlining the disadvantages of not committing to the workup, such as continued skin infections and routine flare-ups.
Consider the Client’s Emotional State
Lastly, keep in mind that although your ultimate goal is to provide veterinary care to your patients, you are also treating a client’s emotional needs. When a client brings their itchy dog to your clinic it is not just the patient that is suffering.
As Dr. Hillier pointed out, 9 in 10 people who bring their dog to a veterinary practice for an itch-related issue have already tried 1 or more over-the-counter products—sometimes up to 15 products. At that point, he explained, the client is not coming to you because they have achieved success; they are coming to you because they have failed.
With these statistics in mind, Dr. Hillier said veterinarians should already be considered the second opinion. “The first opinion was the neighbor, the groomer, the clerk at the pet store.”
If you wrongly assume that just because this is the first time you are seeing the patient that this is a new issue, you are missing an incredible opportunity. Don’t send the client home with just a shampoo and antihistamine, he urged. “You have a choice: Do I fail them by going with the same over-the-counter topical, shampoo, and antihistamine or do I succeed?”
By providing a real solution to the itch that also treats the client's frustrations, you’ve already gone above and beyond all the failed remedies everyone else suggested. And in doing so, you have reaffirmed that you are the expert and your opinion should be trusted. When clients trust you, they are more likely to agree to the diagnostic workup you already know is necessary.
A relationship of trust and confidence is exactly what you need when treating a long-term disease like itch.