The old saying, "No one knows how much you know until they know how much you care," has never been more true in veterinary medicine. The need to convey the reason we entered veterinary medicine is critical to building that client-practice bond. That is called quality healthcare delivery.

The above questions are usually answered the same by new graduates, but then become fractured replies within the practices that have used deep-wallet palpation to determine their healthcare delivery standards. Maybe it is because of our production animal heritage, the linear truck travel from farm to farm, delivering veterinary care based on the pennies-per-hundred-weight (cwt) return to the producer. Those days and habits need to be left behind in most companion animal practice environments.

No one entered practice for the short hours, or for the great hourly wage, or for the job security. Most practitioners have an innate love of animals, compassion to alleviate suffering, and a caring for the humanity we serve, when delivering concerned health care. Sure new graduates know secondary and tertiary care better than they know primary care delivery. They were taught and raised in a referral veterinary teaching hospital! They need primary healthcare education after they graduate, to include effective client communications, such as a Dale Carnegie course. To be successful in a companion animal practice today, providers must be able convey these human/companion animal bonding traits to their clients, and they must be conveyed sincerely and consistently.

In Chapter Three, we discussed the AVMA/AAHA Mega Study at length. There was a lot of money spent on it, and the six critical issues shared with the profession were "targets for blaming", except for the effects of the human-animal bond. In selecting their veterinarian, let's review again the following factors that came into play, in the following order:

1.  Veterinarian is kind and gentle.

2.  Veterinarian is respectful and informative.

3.  Reputation of veterinarian for high-quality care.

4.  Past experience with veterinarians.

5.  Range of services.

6.  Location.

7.  Convenient hours.

8.  Recommendation from friend or neighbor.

9.  Price.

If you recall, when asked if they would stay with their veterinarian if the prices were raised by ten percent, seventy-four percent of the respondents stated they would not change practices.

When asked if they would stay with their veterinarian if the prices were raised by twenty percent, fifty-eight percent of the respondents stated they would not change practices. In demographic assessments, seventy percent of the $100,000 and above households would stay, and fifty percent of the below $40,000 households would stay, at a twenty percent fee increase. This is a very interesting survey question, since we know that the top thirty percent of a practice's clients provide eighty percent of the income. Most of the people that would be lost with a fee increase are the bottom feeders, who leave virtually no net income during their infrequent visitations.

Remember, pet owners said they would be willing to pay $688 on an average if the pet had a seventy-five percent chance of successful treatment. Low fees can never be the key to practice success, it is the client-centered communications, patient advocacy, and standards of care, plus continuity of care based on the medical record completeness between providers and staff members, which differentiates the quality veterinary practice in the client's mind.

Cowboy says, "Nerve succeeds."
Consultant says, "Never apologize for a fee, just use the word, 'only' in front of it."

Client-Centered

There is a "social contract" established when an appointment is made, which means:

 The client will be seen on time, at the scheduled appointment time.

 The patient will be provided quality care in a timely manner.

 The client will be provided adequate knowledge for informed consent.

 There will be a reasonable fee assessed.

 The client will be kept informed of prognosis and healthcare expectations by the providers.

Client-centered services means keeping your promise, but it also means speaking for the welfare of the animal. Most all practice acts state they can do what is needed, and some say they cannot do anything that is not needed. No practice act tells us to confuse the client with words like "recommend", "you should consider", or other waffling terminology that confuses the client.

Concurrently, in many practices, there is a doctor-center instead of a client-center, so clients are kept waiting, the client must ask the client relations staff what the doctor meant, and/or the invoice comes as a surprise. In most of these latter type cases, a fracture line starts to appear in the client bond with the practice.

When an encounter is going to exceed $100, and in southern California or the Northeast, please pick a higher number, or the encounter is for services in excess of what the client has requested, a healthcare plan, located in the left-hand column of the estimate, should be presented by the doctor in the consultation room. Meanwhile, the nursing staff is actually printing the Healthcare Plan, termed an "estimate" in most computer systems. If your veterinary software will not allow you to change the term "estimate", then get a self-adhesive sticker printed to put over the word "estimate", such as the sample is shown below.

When the doctor has completed the explanation of needed care, adding "value" to each line item, and the nurse has re-entered the room, the questions is asked, "Is this the level of care you wish for Spike today?" When the answer is affirmative, the doctor turns to the nurse and says, "Let's get the paperwork signed and schedule an admission." The doctor then turns to the client and states, "Mary will get the appropriate releases signed and schedule Spike's care as we discussed. Thank you." The doctor then departs the room.

As Mary shares the healthcare plan, and the issue of fees comes up as a difficulty to pay, she summons the practice's business manager to work out the payment plans, since we already know the client wants the services. Payment plans, such as those established through Care Credit®, held checks, etc., are not a medical issue, needing the doctors or nurses involvement!

The process of thanking a client must be specific and timely to create an effective bonding technique. The first "thank you for the referral" that a client gets is just that: a tailored letter that reinforces the quality of the practice, the appreciation of the referral, and a hope that you will continue to provide the type of service that they want, to which they will refer friends in the future.

The second "thank you" talks about "thank you for sending another client" and adds a premium as a gesture of appreciation. I have found that practice discounts are perceived as self-promoting, rather than appreciation. A pair of tickets to a local movie, zoo, or animal park reflect a "no strings attached" appreciation. Some practices even send tickets to sporting events or concerts, if they know it is a special interest of that client. But that means you must spend the extra moments to record these factors on the client data sheet of the medical record, and that is another issue.

Cowboy says, "Stealin' for charity is still stealin'.
Consultant says, "Give staff time, or deductible gifts. Never give away net."