Wellness: The Cornerstone of Compassionate Care

Robin Downing, DVM

It is an all too common refrain: "Even though I recommended to Mrs. Smith that her healthy 10 year-old dog have blood work and a urinalysis, she declined. I know what is best for my patients, but I can't seem to convince my clients to say 'yes'. How can I get my clients to accept my recommendations for their pets' wellness healthcare?" You don't want to surprise clients with your recommendations for their aging pets. Instead, use these guidelines to help your clients look ahead at every visit.

Womb to Tomb Care

Think about how the veterinary health care team serves its patients. We are the only medical professionals to care for patients from the very beginning of life until the very end. A pet's life expectancy of 10 - 15 years puts us in the unique position of providing care from "womb to tomb". This gives you the opportunity to anticipate issues specific to various life stages - - hyperthyroidism in the older cat, chronic renal failure in older dogs and cats, and the general risk of cancer in the middle-aged and older pet, to name just a few. The health care team is well trained to understand the cycles of pet patients' lives and how their bodies change over time. You understand the increased risks for certain disorders within various breeds of dogs and cats. You are sensitized to aging pets developing organ system failure. You know how to prevent as well as manage the many issues that can face a pet throughout its life. You benefit almost daily from new and updated information to help you do a better job for your patients.

It is so easy to take for granted the sophisticated medical options that are available for animal patients. The medicine is second nature. It is so easy to fall into the trap of thinking that your clients know what you know about keeping their pets healthy. After all, clients have easy access to lots of information through the Internet. Your clients want what is best for their pets. They want to have their animal companions with them for the longest time possible. But how can your clients possibly know what you have to offer them and their pets - - what you can easily do to prevent problems - - unless you educate them?

Client Interactions - - Investments in the Future

It is well understood that each interaction with a client can be an installment in a long-term investment. Do your part to move veterinary medicine out of the "accidents and illnesses" paradigm by recognizing your opportunity to provide a "map" to guide your clients through the life-stage specific issues they will face with their pets. With a good foundation in wellness healthcare, you could interact with your patients and their human companions for many years. What better way for you to invest in your clients' long-term relationship with your health care team than to provide them with valuable information that will help them sustain their relationship with their beloved pets? And what better time to start creating awareness and expectation in a client's mind than with the pet's very first visit?

Dig Your Well Before You're Thirsty

Business guru, Harvey Makay advocates proactivity in any business venture. And let's not forget that veterinary medicine is a business! One very important point he makes is the "dig your well before you are thirsty" - - that is, invest in your business future (in your clients) before you are in need. Build a foundation with your clients upon which the future care of their pets will rest.

For example, if you wait until a pet is old before you open a discussion of geriatric issues with your clients, you have lost an incomparable opportunity to build momentum. If you do not spend time creating expectations of the possible consequences of aging, your client has no real context within which to place your recommendations once the pet is an aging adult. If there have been no health crises during the pet's life, clients may simply disbelieve you and ignore your comments. They may feel they need time to "process" what you have shared with them, creating avoidable delays. Your recommendations may take them by surprise or even frighten them because they haven't thought of their pet as "old". By the time you have a chance to provide the services you have suggested, there may already be problems you could have addressed earlier if given the chance.

It's Never Too Early to Start

Kittens and puppies grow up so quickly! Talking with pet owners about adult pet issues is best begun when those animals are still juveniles. You can set the scene for the 2 year-old or 3 year-old wellness visits beginning at 12 and 16 weeks of age. In addition to the puppy and kitten issues you usually address during juvenile wellness visits - - housetraining, obedience classes, young animal nutrition, crate training for puppies - - it is easy to add a quick overview of topics that will be revisited when the animal comes for its next wellness examination.

It is never too early to talk about geriatric issues! It is well established that pets are considered geriatric when they reach approximately eight years of age. (The exceptions are the huge and giant breed dogs whose life expectancy is seven to nine years - - they are geriatrics by the time they are five years of age.) Many practices begin annual metabolic profiling of older patients when they reach eight years of age. Your clients should begin hearing about geriatric profiling when their animals still very young. By the time your patients cross the threshold to their golden years, your clients may remind you that it is time for blood work!

Get Everyone on Board

There is only one way client education from day one can succeed - - all members of the veterinary health care team must be involved. From the receptionist, to the veterinary nurse, to the hospital manager, and the animal caretakers, everyone on the team must understand the long-term investment in the practice's relationship with each and every client. The doctors in the practice are responsible for determining precisely what topics team members will use to coach clients through the various life stages with their pets.

Once you establish the topics you will cover, vocabulary that is accessible and helpful to clients. It does no good to try to educate clients by slinging medical lingo their way. Your everyday vocabulary must be "translated" in order for you to get your messages across effectively. For instance, it is easy for a member of the veterinary health care team to think in terms of a "CBC, Chem Panel, and Urinalysis" to look for "chronic renal failure". This is language sure to make your client's eyes glaze over! How can you better explain this to your client?

Remember that you are talking with some one who probably has no medical training. The "CBC" must become the "Complete Blood Count" that helps you understand how well the bone marrow is functioning. The test shows how many red and white blood cells are circulating, as well as the distribution of various types of white cells. The "Chem Panel" is really the "Chemistry Panel" - - a series of tests run on blood serum that reveals both the function of various organs and the blood levels of various substances and minerals. A "U/A" is a" urinalysis" - - a complete analysis of a urine sample, measuring concentration and looking for blood, protein, sugar, and other abnormal substances. "Chronic renal failure" means more if you say "kidney disease" or "kidney failure". Let your clients know why the information you are gathering is important - - what are you looking for and what will you do about it if you find it?

Get your team involved in developing the "meat and potatoes" of your client education program. Let each of them choose a life-stage of interest, read and research relevant issues, and create a tentative outline. Help your team members formalize and finalize the details of the information they will present to clients. Take advantage of the tools that are available. The Health Care Connection program offered by Hills' Pet Nutrition, Inc. provides an excellent foundation in the use of clinical nutrition to manage both wellness and disease. In addition, there are sections devoted to helping veterinary team members appreciate the "big picture" of veterinary practice with insights into practice management. Novartis has a self-study behavior management program for veterinary team members. Invest in continuing education or on-site training for team members on topics that will be included in client education. Lifelearn, located in Guelph, Ontario, Canada, has an ever-expanding library of training CD's for conducting on-site or individual continuing education.

In addition to team training tools, there are many terrific client-training aids to help clients get the message. Color anatomic atlases with laminated pages allow for graphic explanations. There are 3-dimensional models available of teeth, joints, the skull - - nearly any body part you might need to discuss with a client. Don't overlook commercially prepared, as well as internally created client hand-outs.

Help your team members finalize the details of the information they will present to clients, and then incorporate the information into staff training sessions. Use role-playing, or have each team member make a mini presentation during staff training to make certain all team members are "on the same page". There is no better way to learn a topic than to be asked to teach it to someone else. By allowing each team member to "teach" first within the safe environment of a staff meeting, you allow everyone on the team to help that individual to fine-tune his or her delivery of information. Each member of the health care team must be proficient in delivering every core client education message. This takes time, and a commitment by both the veterinarian and team members, but the increased efficiency of delivering information to clients, increased job responsibilities and satisfaction, and better use of the veterinarian's time make it all worth while.

When all members of the veterinary health care support team are involved in educating clients about their pets' upcoming wellness needs, it accomplishes several important functions:

•  Sensitizing the pet guardian about the long-term commitment your team is making to the animal's health and well-being.

•  Creating awareness in the pet owner of the issues and concerns that must be addressed as the pet lives out its life.

•  Encouraging clients to accept the doctor's recommendations for nutrition, laboratory analysis, dental procedures, etc. Once clients have heard a particular message delivered by several members of the veterinary health care team, it becomes familiar and easier to accept.

•  Better use of health care team members, thus freeing the doctor to spend more quality time with clients.

•  Leveraging team members to conduct client education, leading to greater job satisfaction as nurses, receptionists, animal handlers, etc. contribute to building a stronger Family-Pet-Veterinary Bond.

•  Providing the pet with the very best options to stay healthy and happy - - a "win" for all involved!

Informed clients are compliant clients. Give your clients the opportunity to become informed consumers of your services. Allow your team members to assist you in helping your clients say "yes" to your life-stage specific recommendations. Bond your clients to your practice and your veterinary health care team by creating discussions with them around the important issues they will face with their pets. Open your clients' minds to the importance of wellness health care and preventive medicine beginning with their first visits. Educate your clients from day one. It works!