Sure there is a compliance issue with clients. These are the people who learned pet care from their parents, and state, "I will never raise a kid like my parents raised me!" The client education needed to become effective stewards of the other family members, called "companion animals", must be done by the experts, the staff of the veterinary practice.

Very few practices offer a "new client day" for new pet owners. Yet, the ones who do, and provide certificates, such as "A $35 value as a courtesy from the Acme Veterinary Clinic, for new owners attending within fourteen days of adding a pet to their family", to all breeders, pounds, and pet stores in the community, obtain many new clients from this caring gesture.

Compliance means not just good record keeping, it means outstanding record keeping. Meeting all the AAHA Standards for Medical Records is the minimum level acceptable for a any companion animal practice, and the veterinary software needs to be able to track each recurring element. If the software vendor does not care enough to make the software user-friendly to the practice, there are others who will convert the practice quickly, effectively, and for free.

Caring means no animal leaves the practice without being at least one of the three Rs (recall, recheck, or remind). Many are all three, such as: "We need Susie to call you half way through the treatment plan [recall] to see if questions have arisen. We need you to return in two weeks for Spike's sequential urinalysis [recheck], and we are putting you on our mailing list for newsletters and wellness need reminders [remind]. Would you prefer the reminders to be e-mail or snail mail?

What did the AAHA Mega Study find about existing practices and their patient follow-up? The results were dismal:

 Twenty-three percent of the pets with grade 2 dental disease or higher had no recommendation for dental prophylaxis. Ask yourself why didn't they survey grade 1+ dentals, since no gal or guy can ever get a second kiss if they have grade 1+ mouth?

 Twenty-seven percent of pets with medical conditions needing therapeutic diets did not receive recommendations from the veterinary provider(s).

 Fifty-three percent of senior pets did not have a recommendation for any form of senior screening.

 Thirteen percent of the pets were not in compliance with the veterinarian's recommended vaccine protocols.

 Eleven percent of the dogs in heart worm endemic areas had not received a recommendation on heart worm testing.

 Only ten percent of the clients felt veterinary recommendations were based in a profit motive. Only seven percent said cost was a barrier to access of care.

 Seventy-eight percent of veterinarians surveyed said they were satisfied with their compliance, and sixty-three percent of those said they felt their client's compliance was high.

The "lost income" numbers from the programs in the AAHA study are staggering. See Table 5, which follows:

Table 5: AAHA Mega Study "Lost Income" Numbers

In the most simplest of terms, "good medicine is good business". If the standards of care are inviolate, and if there are OPTNs, who are usually skilled communicators, to escort the patient/client into the room, then educate the client after the doctor has prioritized care and before the client departs the consultation room, then there is no reason for clients not knowing. This is not using more doctor time with each client, it is mobilizing the veterinary extenders on the healthcare delivery team to convey the needs ([ ]) to the client, before the client departs the practice, as well as the expectation for the next contact.

Now ask yourself, why was everything in the AAHA survey addressed as "recommendations" rather than "needs"? Why are the major associations in our profession not changing the nomenclature to ensure clients are not confused about the needs for quality healthcare delivery and protection? Answer: the compliance problem is ours, not the client's. The clarity of needs greatly resolves this entire issue.

 All unresolved presentations must be listed on the master problem list, and logged into the veterinary software for tracking.

 All atypical laboratory screens must be listed on the master problem list, and logged into the veterinary software for tracking.

 For anything on the master problem list, a nurse must be assigned to the case, logging it in the veterinary software for tracking, and it must be followed until the condition is resolved.

 If there is deferred or symptomatic care provided, it must be logged into the veterinary software for tracking, a nurse must be assigned to the case, and it must be followed until the condition is resolved.

 Nothing is resolved until the master problem list has been annotated as resolved, and the follow-up closed out in the veterinary software.

 Document medical records with conviction.

We have met the enemy and it is us. The client cannot reasonably decide on the merits of different healthcare delivery issues. That is a graduate veterinarian's responsibility. When the medical records do not match the invoice(s), it is pure fraud from an auditor's standpoint. There cannot ever be "forgotten care" or "forgotten charges," or even falsified information, such as "45 minutes anesthesia" and "30 minute surgery," being invoiced as "30 minutes of surgery and anesthesia". We are required by the respective practice acts to have full and accurate records, and disclosure to the animal steward on patient and professional "needs". The client has the right to allow the animal access to the needed care or not, but at no time are we as healthcare professionals allowed to hide the actual healthcare facts or needs from the client.

"Compliance" to inviolate core values and inviolate standards of care is internal to the practice, not a client issue. Compliance starts from the providers and is reinforced by the staff and providers. When there is consistency in the expected standards of care, the subsequent continuity of care becomes easier, as well as more beneficial to patient, client, staff, providers, and business.