Clients generally hate paying for rechecks after a medical procedure. They think they have paid (too much) already and that your time, staff and supplies should be free from here on out. Conveying the importance of rechecks to clients can be difficult. The veterinary profession has no universal guidelines for when they are needed, whether to charge for them, how and when to charge for them, or how to persuade clients to return to the hospital as recommended. For starters, stop calling them rechecks. Better expressions are “progress exams” or “follow-up visits.” In the client’s eyes, “recheck” might imply something that is optional or unimportant. If you offer progress exams at no charge because you feel the cost is offset by the other procedures performed, then the client will equate the free follow-up visit with something irrelevant. The words and the tone you use are extremely important to convey the importance of following your instructions. You can’t say that Kiki “should” come back or that you would “like” to see Kiki or that it would be “nice” if the owner brought Kiki back. Be firm. You need to be your patient’s best advocate. Say, “We need to see Kiki for a splint change once per week.” Then, clearly explain why the weekly schedule is so important to prevent pressure sores. (See “Horror Stories, Chapter 1.”) Make the recheck part of your explanation of the treatment plan. Convey that it is just as critical as the medications you send home or the bandage you place. Part of clients’ reluctance to return for progress exams is they don’t understand the value.
The art and science of follow-ups
What you call a return visit and how you charge for it are up to you, but its importance needs to be clearly communicated to the client.
Plan AheadSituations when follow-up visits should be considered include:
- To ensure the proper healing of wounds and surgical sites.
- To evaluate the efficacy of physical therapy.
- To help new veterinarians gain experience with the response to different treatment protocols.
- To build client relationships.
- To present clients with educational opportunities.
- To make sure instructions were understood, especially when the client seems indifferent or confused.
- To confirm that medications are being administered correctly at home.
- To socialize patients so they are less stressed during future visits.
By the NumbersTo make the approach more visual — before orthopedic surgery, for example — you could create two estimates: one for the procedure and one for follow-up care such as splint changes or X-rays. Both estimates should be understood and signed by the client. Keep in mind that a doctor might not have to see the patient at every visit. Many follow-up tasks can be performed by an experienced nurse. These include suture removals, bandage changes, radiographs and ear cytology. If the patient is not improving because a team member made a mistake of some kind, then you should consider providing a free follow-up. We all get swamped and things happen. In these moments, doing the right thing and making the client happy is really important. This can alleviate serious headaches or even a lawsuit. Examples include:
- Procedures and medications that were forgotten by a team member.
- The quantity of medication to give or its frequency was incorrect.
- Surgical implants such as pins or screws were placed improperly.
- Physical therapy exercises were poorly explained.
- Complications occurred due to the care provided.
- The patient chewed the incision open because the owner didn’t keep the E-collar on (classic story).
- A bandage is filthy because the patient dug a hole in the yard after the client failed to leash him (true story).
- An orthopedic surgery failed because the owner thought that allowing the patient to run up and down the stairs was OK (real story).
- An infection got worse because the client didn’t use the medication as prescribed.
- Use staples instead of skin or intradermal sutures. Then schedule a staple-removal appointment.
- Schedule the next follow-up before the owner leaves the practice.
- Have your nurse escort the client to the checkout desk and tell the receptionist: “Coco needs a bandage-change appointment with Dr. Smith in one week.”
- Use your existing reminder system, whether phone, post card, email or text message, to advise clients of their appointment.