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Win the skin patient

Make your veterinary practice the go-to place for dermatologic care, from the most accurate diagnosis to the best treatments.

Win the skin patient
One of the most important messages that veterinarians and their staffs can communicate is that skin problems can be tricky and might take time to diagnose and treat.
While dogs and cats don’t need Botox injections to remove wrinkles or injectable fillers to build fuller lips, skin problems are among the most common reasons that clients take their pets for veterinary care. According to Nationwide pet insurance, the top four reasons for a canine veterinary exam in 2017 were related, in order, to skin allergies, ear infections, skin masses and skin infections. Dogs suffering from systemic diseases such as hypothyroidism, Cushing’s disease, cancer, or kidney or liver disease can present with skin problems, too. Cats frequently present with worrisome skin conditions as well. Healthy Paws pet insurance reported this was the No. 3 reason that cat owners sought veterinary care. Cats with underlying health issues such as hyperthyroidism, kidney disease or diabetes often stop grooming themselves when they do not feel good.

It Starts With a Phone Call

The veterinary team is instrumental in recruiting and retaining clients who call about a skin issue. “It’s critical to emphasize that the messaging in a veterinary practice needs to be consistent from vet to nurse to front desk,” said Valerie Fadok, DVM, DACVD, a senior veterinary dermatologist at Zoetis Inc. “One of the things we have learned with our secret-shopper study is that in some practices pet owners are being given advice from the front desk about using over-the-counter antihistamines or making bathing or dietary changes. We think the best approach is to tell clients that they need an appointment so the veterinarian and the team can help quickly. “Skin problems are real problems, and they deserve the medical approach.” Clients will check the internet to research a pet’s skin condition. “Veterinarians know how to help people understand what they read on the internet,” Dr. Fadok said. “Not all information is good information, and the veterinary team can help people find good information that will help, not harm, their pet. While some of the information on skin disease is not necessarily directly harmful, it will delay the best treatment for the pet.”

Zoonotic Threats

What’s important to emphasize to clients is that not all rashes are the same. When a client calls because a patient is itchy or has bumps, the receptionist can stress that the problem might stem from one in a wide variety of causes and that the veterinarian has the knowledge to determine the underlying reason and the best treatment. A customer service representative can explain to callers that some causes of skin disease are potentially contagious to other animals and people. The causes might include sarcoptic mange, fleas, dermatophytes and methicillin-resistant staphylococcal infections. In the case of fleas, a team member needs to emphasize that not all preventives are equal and that in many cases, the products available from a veterinarian might be more effective and safer. Another part of client education is a discussion of the diseases carried by fleas and ticks, ranging from tularemia and bubonic plague to Lyme disease and Rocky Mountain spotted fever, all of which can lead to serious illness in animals and people. The sooner a pet owner addresses the problem with the veterinarian’s help, the better the chance of preventing disease or resolving it in the early stages. While allergies are the most common of the skin problems that lead to a veterinary visit, clients need to be made aware that allergic dermatitis has various triggers. Fleas are one cause, as are pollen, dust mites and mold. Some dog breeds, such as golden retrievers, Boston terriers, West Highland white terriers, Labrador retrievers and Dalmatians, are predisposed to atopy, so a veterinarian and staff members should discuss the possibility when an at-risk patient comes in for a wellness visit.

Wasted Time and Money

Educating clients about the signs of allergy in a pet can make them more likely to contact their veterinarian when symptoms appear. “Skin disease is often a chronic condition, and having the benefit of a professional guiding appropriate therapy will lead to improved success over the long term,” said Texas A&M clinical associate professor Alison Diesel, DVM, DACVD. Pet owners who wasted time and money on internet or pet store solutions frequently show up at an appointment frustrated and at wits’ end. They tried multiple treatments and special foods to no avail. Karin Beale, DVM, DACVD, of Gulf Coast Veterinary Specialists in Houston, who sees these clients regularly, said the key is to make sure that at least some team members are well-versed in dermatology. Sending them to dermatology continuing education is worth the investment, she said. One thing that everyone, from veterinarians to customer service representatives, needs to communicate is the difference between limited-ingredient diets available at pet stores and therapeutic diets sold by veterinarians, Dr. Beale said. Some over-the-counter limited- ingredient diets are produced in plants where cross-contamination with allergenic ingredients can occur, according to a study published in the Journal of Animal Physiology and Animal Nutrition. Therapeutic diets made with hydrolyzed proteins or limited ingredients are produced on dedicated lines where cross-contamination can be avoided, ensuring the food’s quality and safety, the study found.

Failed At-Home Remedies

The latest internet fads can exacerbate a skin problem. Dr. Beale said she encounters pet owners who notice that their dogs’ skin is flaky and assume the reason is dryness. The owner then drenches the dog in coconut oil, making the flakiness worse. The dog actually has pyoderma, and the owner has trapped the bacteria under the coconut oil, allowing the infection to fester. When potential clients call to say they have been feeding their pet a diet recommended by the local pet store or have tried a treatment trending on the internet, but the skin problem isn’t getting any better, the response should be a reassurance that the veterinarian will do everything possible to resolve the issue. Veterinary practices can use their websites and social media platforms to educate clients about common dermatologic problems in the area and the causes. Clinics also can provide information about the diagnostic tests that might be needed so that an effective treatment plan can be formulated. One of the most important messages that veterinarians and their staffs can communicate is that skin problems can be tricky and might take time to diagnose and treat. Managing expectations and making sure clients understand that most skin problems do not occur or resolve overnight is key. What’s also important is to inform clients that some skin conditions, like atopy or immune-mediated diseases, can be managed and controlled but cannot be cured. Finally, pet owners need to know that the veterinarian, veterinary nurse and the rest of the staff are ready to help the client and patient every step of the way. That kind of attention and support cannot be obtained from Dr. Google. Dr. Lori M. Teller is a clinical associate professor of telehealth at the Texas A&M University College of Veterinary Medicine and Biomedical Sciences. She serves as vice chair on the American Veterinary Medical Association board of directors.