It should be straightforward: You tell your clients what to do, and they do it. Aren't client relations supposed to work this way? After all, you're a doctor, you have command of the English language, and your clients love their cats and want to care for them. Unfortunately, compliance doesn't happen as frequently as we'd like, even with intelligent, committed clients. Reversing this trend means understanding-and eliminating-the reasons for client noncompliance.
It should be straightforward: You tell your clients what to do, and they do it. Aren't client relations supposed to work this way? After all, you're a doctor, you have command of the English language, and your clients love their cats and want to care for them. Unfortunately, compliance doesn't happen as frequently as we'd like, even with intelligent, committed clients. Reversing this trend means understanding—and eliminating—the reasons for client noncompliance.
According to a 2003 American Animal Hospital Association compliance study, 23% of owners with pets suffering from grade 2 or higher dental disease did not receive dental care recommendations. Similarly, veterinarians did not recommend senior screening for 53% of owners with senior pets.1 Of course, failing to recommend a treatment or product is easy to do when you work in a busy practice. Sometimes your schedule is booked solid when a mid-morning, hit-by-car case arrives. When you examine a cat with mild diarrhea later in the day, recommending a dietary product slips your mind.
What's the solution? You need to institute medical protocols for your practice. Protocols are crucial because they:
And remember: Protocols don't equate to one-size-fits-all medicine and a loss of control. Doctors can always modify them for individual patients when needed.
Let's assume your practice wants to set a protocol for mild cases of acute diarrhea. The veterinarians meet to determine the protocol, which might include a client history focusing on exposure to new substances or diet changes, a full physical exam, a fecal analysis, and treatment with a gastrointestinal-friendly food and an antidiarrheal (assuming the history and physical findings didn't reveal a need for further diagnostics or treatment).
Mission accomplished? Not yet. Everyone in the practice—not just veterinarians—must understand all protocols because it increases efficiency and consistency. When the day's schedule is ruined by an emergency and the practitioner tries to cram six patients into the time normally reserved for three, a well-trained staff member says, "Dr. Felsted, did you want me to send Fluffy home with a can of Brand X in addition to the antidiarrheal?" Another example: If staff members know that you always perform an ear swab for pets with itchy ears, they can have slides and other necessary items ready before you ask.
Finally, use your computer system to remind you about recommendations by assigning group codes for common diseases. In the above example, the group code name could be "mild diarrhea," and charges could include the exam fee, fecal analysis, medication, and food. It's easier for staff members to delete unused items than to add extra procedures or products sent home with clients. But beware: Don't create codes for every possible diagnostic test or treatment—only include the items most commonly used.
"You'll need to flush Fluffy's ear once daily." "I recommend a dental prophylaxis soon." "Please bring a sample to your next visit so we can test for internal parasites."
These statements sound simple to veterinarians and staff members. But think about the first statement from a client's viewpoint. What does flush mean? How will I hold the cat as I put that stuff in its ear? Or the second statement—a dental what? And the third—what kind of sample? Instead, make your recommendations in client-friendly words, repeat them several times, demonstrate any treatments, and use visuals to enhance understanding. For example, recommending a dental prophylaxis should go something like this:
During Fluffy's annual physical exam, you notice a buildup of plaque on her teeth. You tell the client that Fluffy needs a dental cleaning and explain why it's important. Because people absorb pictures better than words, you show the client Fluffy's teeth and pictures of cats with healthy teeth as well as cats with varying stages of dental disease. After you use a dental model to reinforce your points, you give Fluffy's owner a pamphlet explaining the importance of dental care. When she checks out, the receptionist can also answer questions because you've trained your staff members to intelligently discuss dental care.
Clients can also become confused by inconsistent instructions between doctors. Let's say Mrs. Johnson brought her cat in for an ear infection. Dr. Hill gave her medication to apply once daily and scheduled a recheck in two weeks. Several months later, Mrs. Johnson comes back with another cat with an infected ear. Dr. Hill was on vacation, so Dr. Suri examined the cat. Dr. Suri recommends flushing the cat's ear once daily and applying an otic ointment twice daily. Mrs. Johnson remembers Dr. Hill's recommendations and decides that Dr. Suri's recommendations are overkill. After all, Dr. Hill wouldn't steer her wrong.
It's nearly impossible for all doctors in a practice to agree on the same protocol 100% of the time, but if they have significantly different approaches to medicine, confusion will reign between clients and staff members and pet care will suffer.
Consider this scenario: A client brings in a cat with a red eye and ocular discharge. After examining the eye, staining it, and diagnosing a corneal ulcer, you instruct the owner to apply antibiotic drops every four hours for one week. The owner becomes upset, saying the treatment is impossible, so you tell her to try to apply the drops at least once a day. But what have you just said? You've told the client that your original recommendation wasn't important. In this instance, a better answer would have been, "I understand how difficult it can be, but putting these drops in Fluffy's eye every four hours is important to prevent infection so the eye has time to heal. Would you like to bring Fluffy here in the mornings so we can medicate her throughout the day? You could pick her up after work."
Another excellent way to determine if clients are providing at-home care properly is to make follow-up phone calls. Even if everything is going smoothly, the call shows the practice's concern for the pet and gives the owner an opportunity to ask any additional questions. A doctor or knowledgeable staff member can make the calls—just be sure to set aside enough time every day.
Most clients work outside the home, making it very difficult to give treatments two or three times a day, much less every four hours as mentioned above. So if you have a choice, consider drugs with simpler dosing regimes, even if they cost a bit more. Clients are more likely to comply with once-a-day antibiotics than those requiring administration two or three times a day.
Also consider how clients will administer the treatment. No one wants to stick his hand into the mouth of a fractious cat, so consider using a topical flea preventive instead of an oral one. Even friendly cats can be difficult to medicate, so offer a liquid formulation or flavoring system to make medications more palatable. The easier your recommendations are, the more likely clients will comply.
Many recommendations are for future tests or treatments, such as rechecks or dental exams. Because people remember only a small portion of what they hear, remind owners of recommendations multiple times and in multiple ways—both verbally and on paper. Try to schedule procedures before clients leave the office. If clients don't want to make an appointment at that time, give them a handout to take home and follow up with a letter or phone call one week later.
In addition, use your reminder system for more than just vaccinations—remind clients of upcoming lab work or medication refills and reiterate the key points of preventive treatments. You can also cover important topics by sending out newsletters or updating your Web site.
Although it's unrealistic to think you can make every single feline client comply with all of your recommendations, you can maximize the number of clients who do comply. If you state your recommendations clearly, explain their importance, and make it easier for clients to heed your advice, they won't have a reason to do anything but comply.
Dr. Karen E. Felsted is a practice management consultant at Brakke Consulting, Inc. in Dallas, Texas and a member of Veterinary Economics' Editorial Advisory Board. Dr. Felsted holds a veterinary degree from Texas A&M University, a masters degree in Management and Administrative Science from the University of Texas at Dallas, and a marketing degree from the University of Texas at Austin.
The path to high-quality care: Practical tips for improving compliance.
Lakewood, Co: AAHA, 2003;15.