2.7 Risk Assessment). We often have to prioritize and we also need to be brief. Most people don't have the time or the attention span for a 40‐minute discussion on flea control. However, you must also keep in mind that the vast majority of pet owners want their veterinarian to tell them about all the recommended diagnostic and treatment options for the pet, even if they cannot afford them.
1.4.5 Pet‐Specific Care Takes Extra Time and Effort
The opportunity to deliver pet‐specific care comes with an obligation to present care recommendations well. Take the time to explain and to coach your clients, whether the pet is well or ill. Clients will take better care of their pet if they understand its disease and treatment needs.
It takes thought and practice to change the way we work. Remembering a new protocol can be hard. Investing more time in each individual client may mean scheduling more time over the course of a year, team training, developing tools and doing performance evaluations and coaching. The opportunity to deliver pet‐specific care comes at a cost. You cannot necessarily deliver high‐quality care while remaining a low‐cost provider, so some consideration is warranted.
Medical record keeping is very important if you are initiating a new program and a good electronic medical record (EMR) system can facilitate this (see 9.1 Medical Record Entries). We have been taught since childhood to fill in the blanks. Providing a place to document recommendations helps us to remember to make them. For example, let's say I want to start offering Schirmer tear testing (STT) for all my senior canine patients, to catch keratoconjunctivitis sicca (KCS) at an early stage. If an item is added to the exam template where the STT results are recorded, team members will remember to obtain that information.
If we want to offer a STT or a blood pressure screening to senior pet owners, we also need a handout or laminated sheet or some other tool to be sure we don't forget to do so. That's how we become consistent with client presentations and the care we deliver.
In addition, we need a plan or program for every type of routine visit. Protocol development includes not just how you will treat a particular patient but also how you will educate the client about the pet's care. You need to document every recommendation and provide written materials. Give your clients all their instructions in writing – every disease or problem, every diagnosis, every medication, every recommendation.
People comply better with their own physician's recommendations when there is sound education on why a medication or procedure is needed, and there is follow‐up and follow‐through. You have to do these things too, and train your staff to do these things.
1 Explain the recommendation, and why it is your standard of care.
2 Solidify the recommendation, by selling the product, scheduling the appointment for the procedure if you can, or calling back later.
3 Remember the 3 Rs. For every patient and every disease process there should be one of these: a Reminder entered for the next exam, vaccination or blood test; a Recheck appointment scheduled; or a Recall to contact the client again.
4 The client education, call‐back and follow‐up should be done in a kind, gentle, and professional manner by well‐trained employees.
Include STT with senior wellness panels for dogs.
Include blood pressure measurement for every senior feline exam.
Offer preanesthetic ECG screening for every patient, not just blood testing.
Monitor blood pressure every six months for dogs on phenylpropanolamine.
Offer ECG screening annually for every large‐breed dog with genetic risk for cardiomyopathy, including boxers and Doberman pinschers. VPCs often precede heart failure in dogs of these breeds when cardiomyopathy is developing.
Offer NT‐ProBNP screening for giant breeds, which don't usually develop VPCs with their cardiomyopathy.
We have hundreds of opportunities every week to teach our clients about what is available to them, why it's important for their pets, and how we can deliver it.
What we choose to recommend or educate our clients about at a given visit is a combination of what the pet owner wants from us and what we need to discuss, based on our risk assessment for the pet. We have to prioritize, and we also need to be brief.
We need a plan or program for every type of routine visit, in order to maximize our opportunities.
The pet owner has the right to make the decisions for their pet's care. It's our job to give clients the information they need to make responsible choices.
The opportunity to deliver pet‐specific care comes at a cost. You cannot necessarily deliver high‐quality care while remaining a low‐cost provider.
Abbreviations
DNADeoxyribonucleic acidECGElectrocardiogramNT‐proBNPN‐terminal pro B‐type natriuretic peptideVPCVentricular premature contraction
Reference
1 1 Institute of Medicine Committee on Health Literacy, Board on Neuroscience and Behavioral Health, and Institute of Medicine of the National Academies (2004). Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press.
Recommended Reading
1 Baldwin, K., Bartges, J., Buffington, T. et al. (2010). AAHA nutritional assessment guidelines for dogs and cats (Canine & Feline). Journal of the American Animal Hospital Association 46: 285–296.
1.5 Feline-Friendly Care
Jane Brunt, DVM
Cat Hospital At Towson (CHAT), Baltimore, MD, USA
1.5.1 Summary
Cats are the most unique and ubiquitous household pet. As a species, they are obligate carnivores and normally exhibit behaviors related to being both predators and prey, hunters and hunted. As such, cats are frequently lumped together as if they are all the same when, just like people, they are individuals with different experiences, different
