Dr. Werber has been practicing veterinary medicine for over 30 years, serves on the advisory board of Veterinary Economics, and often represents the veterinary profession in the media. He owns and operates Century Veterinary Group in Los Angeles, CA, an award winning, AAHA accredited practice.

What is the most profitable room in a veterinary hospital? The surgical suite? As surgeries are probably the most expensive single services? What about the special procedures room? Echocardiograms, advanced ultrasound studies, and endoscopies are not cheap! I would argue, however, the real winner is the examination room. Most of the services, and thus dollars, you bill out are generated in the examination rooms. So, one's ability to "sell" in the exam room ultimately determines the success of a practice.

There are a number of "givens" when considering potential for practice success, but also, of course, a number of "intangibles!" Having graduated from our programs, all of us here today are extremely intelligent and talented. We all began our careers on a somewhat level "playing field." So, why is it, years later, a number of us are extremely successful and loving what we do, while others are experiencing feelings of disenchantment? I believe that those who have mastered the exam room are able to sell the services that will, of course, help their patients, and will bring them practice satisfaction and success! Currently, the industry standard is that only 50% of our clients will act on our recommendations. Our goal is to increase this to 90%!

Firstly, confidence is key! Walking into that examination room without it will often spell disaster! Our clients need to see that we are there for them and for the welfare of their precious pets. They need to see that we truly care. In fact, clients don't' really care how much we know, until they know how much we care! When a procedure or test needs to be performed, we must clearly send that message to our clients. Be careful with the language we choose to use. Don't say "this is what I'd like to do," or "this is what I think we should do," but rather, "this is what we need to do for Buffy." Our focus should always be what is best for the pet.

As with anything we've learned either in school or in practice, mastering certain elements of practice is an art. Mastering the examination room is no different. There are many elements to this mastery - and it will require a multi-faceted approach.

Firstly, you need to truly identify your own personality. Shy? Introverted? A natural "people person?" Do you typically speak clearly? Are you a good listener, and do you know how to "actively" listen? How well do you know your clients? Realize that your "style" for one client may be totally different for another. Female clients are very different than male clients. Women expect more sensitivity and professionalism. Try to exceed their expectations. Men won't ask as many questions, are more apt to want to talk about themselves and their pets, and seem to bury their feelings. How formal is your practice - the tone is set by you, and sometimes even by your clients. Personally, I'm the casual type while I'm at work - I'm most comfortable wearing khakis and a golf shirt, which for me is perfect since I spend most of my time on the floor with my patients crawling all over me. The nice slacks, button down shirt and tie, or the white coat don't work for me.

When you walk into an exam room, especially with a first-time client, walk in with purpose. Make eye contact with your client, and make sure to introduce yourself to a new client the way you would like to be addressed. To my clients I am "Dr. Jeff" or just "Jeff" as I like to keep it rather informal. Next, address the pet affectionately! If it's a small dog or cat, pick it up and pet it (unless, of course, it's aggressive and hissing or growling at you). If it's a larger dog, bend down and pet it. I will usually get down on the floor and start playing with the dog. Clients love to see this, and quite sadly, too many of our colleagues don't do this!!! Say something nice about the pet - "oh, she's so gorgeous," or "what a sweetie," or "what a beautiful coat," etc. If the pet is nervous, try spending a little time calming it first before starting your exam. Do not rush through this - the client should feel that she and her pet are the most important to you at this moment!

Next - a thorough history. Let the client talk, and listen with interest and intent. When appropriate, ask questions for clarification. This also confirms to the client that you've been listening. When ready, proceed to your examination. Don't rush straight to the presenting problem! Even if the problem is a limp of a hind leg, still start your exam at the head and work back. I actually like to save the problem area for last. You'd be amazed how many other problems you'll pick up when doing a thorough exam - some even more serious or concerning than the one the client came in for. As you are proceeding through the different parts of the exam, comment on what you are finding. If you spend a little extra time ausculting the heart without comment, clients will naturally fear a problem. If everything sounds good, let them know. If you are examining a painful area and you expect a reaction from the pet, say something to both the pet and the client - "sorry cutie, this might hurt for a second," or "Mrs. Smith, I'm going to be very gentle, but Buffy might feel this." This shows you care and will eliminate the surprise factor for the client. Also, keep in mind that the "tone" and "style" of your examination may vary depending on the case - is this a new puppy or kitten exam, a basic wellness exam, a sick senior, or a possible euthanasia?

Now it's time to present your diagnostic and/or treatment plan. What makes us truly great (and loved by our clients) is the ability to offer viable alternatives - always with our patient's best interest in mind. Not all can afford the "best of the best!" It is, of course, recommended to discuss, and offer the best approach. In fact, you'd be surprised that even the clients that you may not have expected to grant permission to proceed, will do so. Make sure your clients understand what they should expect from treatment. Clear expectations prior to performing a test or a treatment can make the difference between a client who is satisfied and one who is not. Never promise success! Ask your client if he or she has any questions. Answer them now - this will eliminate problems later. Also, provide estimates and have them approved. Clients dislike financial surprises as much as they do treatment ones. Offer options when appropriate - something clients appreciate. Stress, is that your only motivation in your recommendations is your patient's (then client's) best interest - never your own. If a client ever suspects that your motivation is financial, you've lost that client forever! I've noticed that when given a choice to opt for "plan B," a less expensive option, clients are much more inclined to allow you to proceed to the "A" plan if "B" fails. If you don't even offer a "plan B," and they find out later that a less expensive alternate plan was available, again, you're toast! I am not impressed by the doctor who can run every test in the book and gives me the right answer - I am impressed by the one who can't run every test, but still gives me the right answer! Use your heads! Take the information from your history and physical, then reason, think, and analyze, and come up with a fair, reasonable "game plan."

Make sure your exam room is clean, presentable, well equipped, inviting, and comfortable. The tone of your office and staff should match the appropriate sentiment of the case at hand. You, of course, want to have that cheery staff when a client is coming in with that new puppy or kitten, or that new rescued pet. But if your client is bringing a pet in for a probable euthanasia, you don't want that same happy tone.

Remember, follow-ups! When I follow up with clients, be it post-surgically, after a hospital stay, or even after a new pet exam, I am amazed at how impressed they are. Many have told me they wish their own physicians exhibited that much care and concern.

You now have the tools to "master" the exam room. Practice what you need to, make any necessary changes in your style or approach, and start having fun! This will allow you to promote and sell the services you've been trained to offer, will improve your patients' health, and should endear your clients to you. This will all bring you both practice and financial success.

Collaboration/comments by Dr. Dennis Cloud, St. Louis, Missouri.