Understanding, follow-up keys to compliance, psychologists say

Understanding reasons for non-compliance with medical recommendations is the first step to improving success, according to two expert psychologists.

The challenges veterinarians face in achieving client compliance are the same issues that surface for pediatricians.

The difference is that veterinarians work with the physiology of their patient in order to diagnose them, and the psychology of the client to be able to treat them.

Reaching the client requires a strict regimen that begins with education and understanding the reasons clients do not comply with recommendations.

Compliance between patients and their veterinarian isn't much different than compliance questions pediatricians face, says Dr. Sandra Haber, private practice psychologist and associate clinical professor of psychology at the Derner Institute at Adelphi University.

The parent-child relationship is very similar. "A young non-verbal child relies on their parent/guardian to care for them, Haber says. "They have no say in what happens to them."

Dr. Sandra Haber

As compliance rates vary from clinic to clinic, the reasons for lack of compliance are very similar.

The road to better compliance can be broken up into three manageable steps for the doctor:

• 1. Create understanding.

The guardian must understand why they need to pursue treatment/prevention.

• After describing the problem, ask the client if they have heard of the ailment before.

• Ask if it makes sense to them and have the client repeat the problem back to you in his or her own words.

• 2. Make the solution easy.

"Break it down into bite-sized pieces."

• Describe the steps. For example, tell why an animal shouldn't eat after a certain time before a procedure.

• Always reiterate why the steps are important.

• Ask the client if your solution works for them. Check after each step of the solution to see if your solution works and that they understand.

• 3. Follow up.

A step would be to call the client after a major procedure to see how the pet is doing.

• "People crave a personal relationship with those who take care of them," Haber says.

• It would be ideal if the doctor made these calls, but if that is impossible, a knowledgeable staff member would be better than no one making the call.

Dr. Rudy Nydegger

Dr. Rudy Nydegger , a clinical psychologist at Union College and chief of the division of psychology at Ellis Hospital, says veterinarians need to emphasize that the doctor, staff and client are working together for the same outcome. Encourage clients to call with questions after they have had a chance to think about the recommendation, he recommends.

Client perception

When people are really alarmed they tend to be more compliant, Haber says. "They often wait until there is a real problem."

Human cancer patients have reached a crisis level and are afraid of the situation and outcome, Haber says. "Compliance isn't usually an obstacle at this point." Haber works with cancer specialists on client compliance issues.

"The goal is to get people to comply earlier and educating clients helps the process."

• Brochures and pamphlets are good instructional sources, but showing clients photos within the brochure is better strategy.

"If there are progression photos, write the pet's name next to the photo representing the phase their pet is at," Haber says.

• Simply handing a client a flyer is too detached from the immediate situation. Make it personal.

• Ask the client if you can call to remind them of various recommendations. Simply calling the client without getting their consent may seem too pushy, Haber adds.

Trust is crucial

Establishing a relationship early increases the trust a client has for the veterinarian and will be more compliant when a situation arises.

If the client respects the veterinarian, compliance increases. Discriminate between what is essential and what would be nice to have/do, Haber says.

Be sensitive to issues like expenses that concern the client, and be ready to discuss considerations, alternative steps, Nydegger says.

Unified voice

"When benefits are not clear and seem as if they can wait, compliance levels decline," Haber says.

• Make sure your staff is sending a universal message to the client. "If each staff member relays the same message to the client, the importance of the recommendation is increased, Nydegger says.

• Tell clients how the situation will improve if a procedure is performed. "If the perception of the situation does not seem urgent, delays set in, Haber says.

"When people have a toothache, they tend to go immediately to the dentist," Haber says. "When following up on by-yearly exams, people tend to be less compliant."

Additional compliance issues may lie with the Internet, Nydegger says.

"People look up ailments and get conflicting opinions. They tend to go with the opinion/recommendation that suits them best," he adds.

"The Internet provides such a large amount of information on any given topic it can be hard to digest - what is valid and what is not."

When lack of compliance is associated with a complicated procedure, it may be because the client heard through the grapevine that an animal died during the operation, Nydegger says.

• Explain the implications of treatment and no-treatment. "What outcomes are likely without treatment?" Nydegger says.

• Describe the expenses and tell the client what their money would be used for.

• Communicate with all staff to work as a team so questions by the client are answered consistently.

There will always be clients you cannot reach no matter what attempts are made, Haber says. "Focus on the 90 percent of clients you can make a difference with."

Editor's Note: Medical compliance with recommendations can seem allusive with some veterinary clients. For the first time,DVM Newsmagazine sought the opinions from two nationally recognized psychologists who have worked in human medicine to help doctors understand and improve client compliance rates.