One algorithm to rule them all

January 8, 2018
Kathryn Primm, DVM
Kathryn Primm, DVM

Kathryn Primm, DVM, owns Applebrook Animal Hospital in Ooltewah, Tennessee, but has a growing career as a writer, a speaker and an online voice for veterinarians and pet owners alike.

I might have stretched the popular clinical acronym a little far to make a point about your practice's health. But, damn it, it works!

A good reason to cuss: better practice management. (All images an industry, we love acronyms. We have ADR (Ain't Doin' Right) and BAR (Bright, Alert and Responsive) and WNL (Within Normal Limits) and all kinds of mnemonic devices to help our thought processes. So, how about one for a diagnostic algorithm for our practice health?

Back in my vet school days, we were taught the acronym DAMN-IT-V to help guide our diagnostic protocols. In a nutshell, each letter represents a broad category where disease processes might occur. Let's take a look at the DAMNIT-V scheme when it comes to the health of a practice.


When we think about "D" as representing degenerative processes, we think of progressive, deteriorating disease. And some veterinary hospitals are suffering from degenerative disease, both physically and functionally.

Physical degeneration is easier to find and fix:

• Is your computer system slow and worn out?

• Should you look into new diagnostic equipment?

• Are old machines hurting your efficiency?

Pretend you're a client, and go through all the steps of a visit-from booking to check out-and see if any bottlenecks could be opened with new or different equipment. Upgrading or adding a new piece of equipment could speed you up or create a new profit center.


"A" for anomalous refers to a defect-like a birth defect-and your practice could be suffering from these too. My practice was born with some physical deficits as a residential home converted into an animal hospital. I've starting a remodel to better match the facility to my current needs.

Accommodating a defect doesn't need to be expensive.

Maybe your practice is like mine, heavy on reception and lean on exam room space. Could you set up a different flow?

Or maybe you don't have enough reception space. Could you invite clients to text you from the parking lot so they can be ushered directly to exam rooms?

Could you shuffle your processes to allow checking out in exam rooms? Be creative.



Metabolic disease in living things implies that certain systems have gone awry, like kidneys or liver. Your practice can have systems gone awry too.

Look at the major systems: reception, exam room and treatment. Is something not functioning the way it should? Are any of the systems compromised? When we treat kidney disease, we try to make the job of the kidneys easier through diet manipulation. Functionality will boil down many times to staff training. Think of an employee who's never been trained on the front desk answering the phone. Are there ways you can make these roles in your hospital easier? Give staff members the tools they need to more easily perform these roles. Practice scripts for common scenarios-like the kind you find in these Team Meetings in a Box.


"N" can stand for neoplasia or nutrition in patients, but for this example, nutrition is the best analogy. Bodies depend on nutrient source to keep up energy levels. How's the energy in your practice? Could you use an infusion of nutrients, energy and excitement?

I tried this out myself several years ago. I realized that every day I came in the door, everyone was grumbling and complaining. It got so bad I didn't even want to come inside. So, I wondered if maybe I was unwittingly setting the mood (in a bad way). I made a concerted effort every day to be happy and upbeat no matter how I was feeling. You know what? It made a complete difference!

Now years later, I always come in the door with a smile or a song. It's an investment in my day, my staff and my own quality of life. Try it! (If you need some inspiration on this front, I recommend the book How Full Is Your Bucket? (Gallup Press, 2004).



"I" for idiopathic means you just don't know what's wrong, but sometimes these patients get better with symptomatic treatment. Your hospital might be like that too. When you don't know what's wrong, communication is always in order. Whenever I slip on this, things start to unravel.

Talk to your practice manager, your team members and your veterinary associates about what they think is going wrong (and going right). Want anonymous feedback? Ask people to fill out an anonymous online survey on the best and worst parts of their jobs. Then try to fix the barriers they tell you about. If you can't fix a problem, sometimes merely the act of caring about what's going wrong can help. You'll probably learn a lot about your practice, your staff and yourself.


"T" is for toxicity-namely, bad attitudes. When you're practicing your “N” improvement by always spreading a smile or a song, you might notice that some team members fail to respond positively. These people might be toxic. Here's some advice I dug up for your problem.





"V is for the vascular life blood of the practice. Like blood carrying oxygen to the cells, our communication systems carry information to our clients, and that fuels visits and use of our services.

Think of this one like a checklist: Is your website attractive and informative? Does it really show who you are (or did you settle for a bland one that looks like everybody else's)? Do you have a reminder system that reaches out to your clients the way they want to be contacted? Have you neglected how you interact with them when you are face to face? How about a brush up on ideal customer service? (I was inspired by this one, humorously titled Super Service: Seven Keys to Delivering Great Customer Service ... Even When You Don't Feel Like It ... Even When They Don't Deserve It! (McGraw Hill Education, 2009).

Where's YOUR acronym?!

OK, OK, so "Fetch" in the Fetch dvm360 conference name isn't technically an acronym, but the problems that DAMN-IT-V solves for you in practice management are perennial subjects for the top-notch speakers-like, say, Dr. Kathryn Primm herself. Learn more at

The answer really boils down to walking and talking. Walk through your hospital and imagine what the experience is like for everyone. Talk to your coworkers and staff to get their feedback and foster your team. One more thing ... while you're walking and talking, you might want to smile or sing a song for good measure!

Kathryn Primm, DVM, owns Applebrook Animal Hospital in Ooltewah, Tennessee, and has a growing career as a writer, speaker and online voice for veterinarians and pet owners alike. Dr. Primm is the author of Tennessee Tails: Pets and Their People. She was also the nation's first Fear Free certified professional.