Keep some skin in the game

Your dermatologic recommendations and products might be only scratching the surface. Client education, stocking the right items and other approaches can make a big difference.

Keep some skin in the game
Skin conditions are often long-term problems with some seasonality or chronicity. Clients get frustrated when the symptoms don’t get better.

Numbers tell a story, so think about these facts:

  • More than half of all pets are overweight.
  • 85 percent of all pets over age 3 have some level of dental disease.
  • 100 percent of pets have skin and therefore face the risk of a dermatologic disease.

In light of the plethora of shampoos, conditioners, food additives, brushes, combs, spray-ons and topicals that line the shelves of pet stores and the shopping carts of online retailers, a veterinary professional is competing not only with colleagues but also with amateur “veterinarians” — the pet owner and the sales clerk who think they know how to diagnose and treat skin conditions.

Your vocabulary word for today: cyberchondria. Wikipedia defines it as “a growing concern among many health care practitioners as [clients] can now research any and all symptoms of a rare disease, illness or condition, and manifest a state of medical anxiety.” It touches all aspects of the veterinary profession and all aspects of the client experience.

Whether clients research a pet’s symptoms and arrive with a litany of obtuse diseases or whether they pull out a iPhone in the exam room and second-guess your diagnosis, some pet owners want to control the experience completely with or without accurate information.

More and more frequently, patient care is being delayed or compromised because the consumer wants to look for a deal. Shopping for the best price (not necessarily the best product) has become an American pastime. And anytime a veterinary product is prescribed, it is fair game for purchase from a multitude of outlets.

The Skinny on Skin

After you have done skin scrapings, fungal cultures, impression smears or biopsies, you will have more information to help you understand what is going on with a patient’s skin. Whether you have a confirmed or suspected diagnosis, it is time to treat the problem or, in many cases, the symptoms.

Treatments of choice for allergic or other skin conditions most frequently include one of a number of prescription and non-prescription approaches, including:

  • Injectable medications.
  • New-era dermatologic medications such as Apoquel,
  • Atopica and Cytopoint.
  • Anti-inflammatories.
  • Essential fatty acids.
  • Food additives.
  • Therapeutic diets.

Given the prevalence of online suppliers of prescription meds and brick-and-mortar sellers of non-prescription meds, how can a veterinarian keep control of dermatological treatment options and not lose them to the competition?

Systems or Checklists

Having systems in place to ensure you do a thorough workup and diagnostic testing on skin cases is a good idea. Because of the vast number of causes of pruritus and pyoderma, it behooves you to have a diagnosis or short list of rule-outs before you start treatment. A clearly defined system and associated checklists helps you remember what needs to get done. You might be asked to treat only the symptom because “That’s what good ol’ Doc Dolittle did. He’d give her a shot and she’d be right as rain that night.”

Your challenge is to explain to the pet owner the benefits of making a correct diagnosis and then treating appropriately.

Why is the diagnosis so important? Skin conditions are often long-term problems with some seasonality or chronicity. Clients get frustrated when the symptoms don’t get better. They seem more understanding about the challenges of diabetes than they do the challenges of atopy. Having a diagnosis shrinks your therapeutic options as well. You can make a pet feel better with symptomatic care. You can make a client feel better with symptomatic care — for a while.

With a confirmed diagnosis, the client can go online and Google the diagnosis and not a symptom. And when you can discuss a specific diagnosis, you can shrink the treatment options and focus on educating the client about the long- and short-term implications of the disease.

Get Total Buy-In

Your team must be a part of skin cases. Hold staff meetings to discuss skin conditions, fleas, ticks, infections, fungal issues. Share the results of testing through cultures or whatever you use to get to the bottom of a problem. Send staff members home with the dermatologic products you want to dispense and have them report back on the effectiveness. Your team members can be advocates and storytellers for products that you sell, but only if they try the products first. If team members aren’t happy with an outcome, they can help keep your inventory under control as well.

Since your staff will be going over the products with clients, they need to know everything about the treatment: how to apply and how often, what to look for if it is working or not, when to call your clinic.

Have your well-educated staff hand out business cards showing your clinic’s phone number and email address so clients can easily report problems or ask questions. The pet store doesn’t do this. PetMed Express won’t do it. Be in control and give clients an experience they can’t get elsewhere. Have your staff lead the way, but educate them first.

Know What to Say

Part of the education is the creation of scripts or talking points. The conversation might include:

  • “This product is not available in the pet store because it includes the strongest ingredients available for this condition.”
  • “I have used this on my own dog. It was a miracle.”
  • “The pet store doesn’t really have medicated products. It may sell some natural products, but the severity of the condition warrants and requires a veterinarian-prescribed medication.”
  • “We can do the first bath for you since we use the products here, and then you can continue at home.”
  • “The products we sell and support come with the backing of our team and doctors. That alone is invaluable and not available online.”
  • “We offer only the products that we find most effective for this condition.”

Know What to Stock

Too much inventory is not too good. Research into consumer buying shows that too many choices is detrimental to decision-making.

The internet can be more confusing than your practice because of this. However, better choices mean fewer choices.

Veterinary-specific products might come with a higher unit price, but if you keep your markups under control, the products can easily compete with over-the-counter choices. Better for you to make a dollar than the internet getting it.

Know What to Endorse

In many dermatologic cases, we have too many options for treating the symptoms. Diets, shampoos, topicals and supplements are just a few of the non-prescription resources that your hospital has to offer and that the internet has as well.

To stay in control of the client and patient experience, you have to position yourself as the expert in patient care. You have to identify the one product you have found to be most effective. And if this is a veterinary-specific product, even better.

What helps is when the products you offer are used on patients admitted for bathing, are used by your employees on their pets, and are readily available and competitively priced.

Know What to Charge

Which is better, making $5 net on a product sale or $0 net on a product sold by somebody else? You net zero every time a client goes on the internet or visits a pet store to buy a product you carry.

Veterinary pricing in many cases has driven consumers to look for competitive sources of shampoos, additives and food. And in some cases when they can’t find the exact product you want to dispense, they buy a less-effective knockoff.

Set up your online store to provide you with a net for your product sales and thus a price that is competitive. Again, what is better than nothing? Something.

Don’t shoot me when I suggest that you offer a money-back guarantee. If a product doesn’t work, have the owner return it for a refund. I would bet that most of your vendors would support this 100 percent. The pet store and online merchant likely won’t do it. If you want to be different, think and act differently.

Know How to Be Different

Try saying this: “We know it is not easy to stop by here whenever you need something. You can use our online store or just let us know, and then we can mail what you need.”

We are in the experience era. How can you create the client experience for dermatologics? A clinic’s online store allows competitive pricing, the convenience of ordering at any hour and home delivery.

Have you considered a subscription service? If you know the client will administer a product for months on end, why not set up an auto-delivery program and discount it? You can truly improve compliance through convenience and competitive pricing. This works for over-the-counter, veterinary channel and prescription products.

Education, Price and Service

The ideas above only scratch the surface when it comes to staying in control of treating skin conditions. Each individual thought can make a difference, but using them together will stop you from pulling your hair out and keep your patients from chewing theirs.

The differentiators in keeping skin in the skin game are education, price and service. The more your team knows and the more your clients understand, the more likely a pet owner will believe in your products. The more you create a great experience and a value to support your pricing, the more likely your products will be the first choice.

Dr. Peter Weinstein owns PAW Consulting and is executive director of the Southern California Veterinary Medical Association.