Dr. Peter Brown is president and co-founder of Cara Veterinary, a network of family-owned veterinary hospitals.Read Articles Written by Peter Brown
We all know that successful treatment outcomes start with knowing what we are battling. The key then is having the client, who controls the patient and the credit card, say “yes” to our diagnostic recommendations.
The steps I will discuss in this article have proven successful in my hospitals. But first, let’s briefly discuss what is a diagnostic.
I like to break down diagnostics into two categories: illness and preventive care. Illness is when a pet presents to us because of a specific change from the normal — lameness, vomiting, weight loss, et cetera. Preventive care is when a patient presents for a vaccine visit or annual exam and the owner is unaware of any problems. Diagnostics during an illness visit often include a physical exam, bloodwork and imaging. A preventive care visit often includes a physical exam, parasite screening and bloodwork.
What is important for the pet’s health and the health of the practice is for clients to say “yes” to our diagnostic recommendations at all types of visits.
Be in Agreement
The first step to driving diagnostics in the practice is to align all the doctors on care standards. This is often the hardest step. I do not promote cookie-cutter medicine, but without hospital-wide standards, we see client confusion and disengagement. For example, a practice where some doctors recommend a senior canine screen at 7 years of age and others recommend starting at 10 creates doubt among clients. They hear different things, so their natural reaction is to say “no.”
Team alignment does not remove the art of veterinary medicine. Rather, it creates a consistency that drives compliance. I recommend that you review every reason a pet comes to you and talk through your standard process for the presentation. For example, a lame dog at my hospital will receive a complete physical exam and, if indicated, a lameness exam. Afterward, further diagnostics might be needed and could include bloodwork and radiographs.
Another example: An itchy dog will get a complete physical exam and history. Further investigation might be needed to look for secondary infections and might include allergy tests, skin scrapes and skin cultures. These sound very basic, but I have been surprised by the inconsistency in hospital teams.
Educate the Staff
The second step to drive diagnostics is to educate your team. When I say team, I mean everyone from office manager to kennel assistant. Any staff members we hire are viewed as experts in veterinary medicine. Our job is to make sure they know what we recommend as a practice and why. If you include SDMA in all your chemistries, teach the team why we do so. Today’s hospitals cannot be 100% dependent on the veterinarian educating clients. We need the team to be helping, too.
Do not assume that everyone on your team knows why we run preoperative bloodwork and an EKG on surgery patients. Teach them. A major benefit of educating the team is that job satisfaction and employee retention will improve. I recommend doing this at every team meeting. (Yes, you need to have regular meetings.)
Educate the Client
The next step is educating the client about the diagnostics you recommend and why. This starts when the client calls to schedule the appointment. Prepare the client for what to expect. Tell her that because her Labrador appears to be lame, Dr. Brown might need to take X-rays after he does the physical examination. I was amazed at how this approach increased client compliance with an imaging recommendation. The more prepared a client is for what to expect, the more likely she is to be compliant.
Other ways to educate clients:
- Add preventive care diagnostics to the patient reminder system.
- Have handouts, models and videos ready to show clients the importance of heartworm tests, pre-anesthesia bloodwork and medication monitoring.
- Explain to the owner of an ill pet why you recommend the diagnostic. It is not complicated. Just express what you are thinking: “I need to run the pancreatitis panel on Sammy to make sure the vomiting is nothing more serious than the fact he got into the garbage last night. My hope is that all will be normal on the test and that we can feel comfortable sending him home on medication for a few days.”
The Price Is Right
How we price diagnostics can be a barrier to “yes.” While I firmly belief lack of compliance is much more likely due to the lack of perception of value, I have seen some clinics price their diagnostics to unaffordable levels. Factors to consider are price sensitivity of the service and what often happens because of the testing. Price sensitivity is dramatically different for the 2 a.m. vomiting patient and the six-year vaccine visit. Both patients might need a blood screen, but the test doesn’t need to be priced the same.
A routine preventive care chemistry test will result in 10% to 15% of pets having clinical signs of abnormality, resulting in more testing and potential medications. If we price preventive-care testing to the point where most clients will say “yes,” we will improve revenue and the pet’s life.
Reduce Sticker Shock
The last step in getting clients to say “yes” to diagnostics is the “Wow!” factor. How we present results of our diagnoses will drive future compliance. If we do a poor job of showing the value of what we did for the pet, the client will be more likely in the future to say “no.” All consumers are value conscious and will be much more likely to spend money if they see a direct benefit. If all a client gets for a $150 blood panel is a voice mail saying that all is normal, how long before the owner starts doubting its worth? Our job is to present the data in a format the client perceives as having value.
Humans understand more if we use a combination of verbal and visual communication. Email the lab results and talk them through with the client. Send ultrasound and radiographs home with a description of what you saw. Celebrate the normal with the client and explain all you learned from the diagnostics test.
One question I like to ask is this: Can my client explain to her partner at home why she just spent $500 at my hospital? Give her the tools to do so.
For me to be a successful veterinarian, I need to perform diagnostic tests to be sure I am approaching treatment the right way. My goal is to always decrease morbidity and mortality. Diagnostics are critical to this, both with sick patients and patients that present for a wellness visit.
Our patients do not make the decision to visit us. Our job is to get the client to say “yes” to diagnostics so that we can do what is best for the pet. Taking a few simple steps to improve communication will drive diagnostics in your practice.