Archive for the ‘Client expectations’ Category

The Cookie Thief!

December 18, 2011

I have the good fortune of lecturing professionally, and what I most enjoy presenting is the topic of communication between veterinarians and their clients. In every communication lecture I emphasize the importance of empathy. This involves veterinarians putting aside any preconceived notions and judgments about their clients so they can better recognize how their clients are feeling and what they are truly needing. In order to drive this point home during my presentation, I usually recite a poem I adore called, “The Cookie Thief.” While preparing a lecture earlier this week, it dawned on me that you might like this poem as well. Enjoy!

The Cookie Thief

A woman was waiting at an airport one night, with several long hours before her flight. She hunted for a book in the airport shops, bought a bag of cookies and found a place to drop.

She was engrossed in her book but happened to see, that the man sitting beside her, as bold as could be. . .grabbed a cookie or two from the bag in between, which she tried to ignore to avoid a scene.

So she munched the cookies and watched the clock, as the gutsy cookie thief diminished her stock. She was getting more irritated as the minutes ticked by, thinking, “If I wasn’t so nice, I would blacken his eye.”

With each cookie she took, he took one too, when only one was left, she wondered what he would do. With a smile on his face, and a nervous laugh, he took the last cookie and broke it in half.

He offered her half, as he ate the other, she snatched it from him and thought… oooh, brother. This guy has some nerve and he’s also rude, why he didn’t even show any gratitude!

She had never known when she had been so galled, and sighed with relief when her flight was called. She gathered her belongings and headed to the gate, refusing to look back at the thieving ingrate.

She boarded the plane, and sank in her seat, then she sought her book, which was almost complete. As she reached in her baggage, she gasped with surprise, there was her bag of cookies, in front of her eyes.

If mine are here, she moaned in despair, the others were his, and he tried to share. Too late to apologize, she realized with grief, that she was the rude one, the ingrate, the thief.

Have your preconceived notions about someone ever been completely upended? Do you think your veterinarian has preconceived notions about you?

Happy holidays to you and your loved ones,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Does Your Veterinarian Hear Your Concerns?

July 18, 2011

Until a few years ago it was darned near impossible to find much in the way of useful research about communication between veterinarians and their clients.  Nowadays, several wonderful studies are surfacing.  It’s about time I say, and the results have been fascinating! The newest communication study appears in the June 15, 2011 issue of the Journal of the American Veterinary Medical Association and is titled, “Analysis of solicitation of client concerns in companion animal practice.”

The purpose of this study was to determine what percentage of veterinarians evaluated effectively solicited their clients’ concerns at the beginning of the office visit.  When veterinarians did solicit concerns, the client’s responses were referred to as their “opening statement”.  What we know from research pertaining to human physicians is that only 23% to 28% of patients are allowed to complete their opening statements.  On average, they are interrupted by their physicians within 12 to 23 seconds. Research has also documented that physicians often mistakenly assume that the first or only concern expressed by their patient is the main concern or only concern.

In addition to learning how many veterinarians effectively solicit client concerns, this study also determined if there is a difference in the way clients respond to open-ended versus closed-ended solicitations.  Open-ended questions such as “What brings you in today?” cannot readily be answered by a simple “yes” or “no”.  Rather, they require more expansive, thoughtful responses.  Closed-ended questions such as, “Has Peanut been vomiting?” can readily be answered by “yes” or “no” and may entice a client to focus on what they perceive the veterinarian thinks is important rather than what they are truly concerned about.

Here’s what this study’s researchers learned by reviewing 334 videotaped veterinarian-client office visits:

– Solicitations for client concerns were made in only 37% of the office visits.
– Of the office visits that included solicitations, 76% of the queries were open-ended and 24% were closed-ended.
– In response to open-ended solicitations 76% of clients expressed one or more concerns.  In response to closed-ended solicitations, 40% of clients expressed one or more concerns.
– Clients spoke more than twice as long in response to an open-ended solicitation compared to a closed-ended solicitation.
– Clients’ opening statements in response to the solicitation were interrupted by the veterinarian 55% of the time, on average after only 11 seconds!
– Following an interruption, clients returned to and completed their response only 28% of the time.
– Appointments in which the veterinarian did not solicit client concerns at the beginning the office visit were significantly more likely to have concerns raised at the end of the office visit.
– Open-ended solicitations were more likely to occur during “well pet visits” than visits initiated because of a medical issue.

Are you surprised by these results?  I’m a bit surprised by the numbers and, admittedly, as a veterinarian, I’m feeling a bit of professional embarrassment. This study underscores the fact that veterinarians could be doing a much better job soliciting and listening to their clients’ concerns.  By learning from studies such as these, there is so much potential for greater success, not only in terms of doing a better job for our patients (gaining an accurate assessment of all concerns is certainly in the best interest of the patient), but also in terms of our clients.  Actively listening to their concerns without interruption conveys empathy and what person worried about their best buddy’s health couldn’t use a good dose of that?

As a consumer of veterinary medicine, what is the take home message for you?  I hope this data will prompt you to be persistent in expressing all of your concerns to your veterinarian at the beginning of the office visit.  And, if interrupted, do your best to return to your original train of thought!

What is the take-home message for veterinarians?  It is clear that we could and should be doing a much better job consistently asking open-ended questions at the beginning of office visits and then actively listening, without interruption to hear what our clients have to say.  Perhaps before entering the exam room we might remind ourselves of the saying I’ve always loved, “Don’t just do something, stand there!”

 

Best wishes for good health,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

When the Doctor Becomes the Patient: Not Always a Pretty Picture

May 2, 2011

While in the midst of my post-surgery “down time” I’ve been chuckling a bit about what my own physicians have endured as a result of my medical background.  How commonly is a surgeon interrogated about what type of suture pattern and material he intends to use? How often does an anesthesiologist need to provide a detailed pharmacologic rundown of the anti-emetic (anti-vomiting) drugs that will be used to keep the patient with a queasy stomach from puking post-operatively? 

© Steve Horton

I remember one particular appointment with my family physician a few years back.  When we discussed the reason for the visit I began with, “I think I have cancer!”  I explained that I’d been losing weight even though I’d been eating normally.  After all, a diagnostic workup on a middle-aged dog or cat losing weight in the “midst of plenty” often results in the diagnosis of cancer.   My physician worked hard to hide a grin as he explained that, given my age, sex, and overall vigor, other diagnoses were far more likely. Thankfully, he was right, and the next time I saw him he asked for permission to share this “amusing patient story” with some medical students he was training.  

Sometimes, the medical knowledge I have can be a detriment to my own peace of mind.  As the story above illustrates, I’m always keenly aware of the worst-case scenario (tough on a person who is a natural born worrier). Would I trade being a veterinarian for any other profession?  Not in a million years.  Not only do I love what I do, I love that my medical background (along with a bit of chutzpah) allows me to be a stellar medical advocate for myself.  And if you’ve read much of what I’ve written in the past, you know that I am all about medical advocacy! 

Do you work within the medical profession?  If so, how has this been helpful or detrimental when interacting with your health care professionals (including your veterinarian)? 

Best wishes for good health,             

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

A Truly Hands-On Physical Examination

March 24, 2011

Have you ever gone to the doctor and realized after the visit that those healing hands never actually touched your body? C’mon now, that’s not okay!  Nor is it okay for your veterinarian to skimp when it comes to examining your pet.  In veterinary school, we are taught to perform a thorough physical examination on each and every patient.  It would be a travesty to miss a new heart murmur or enlarged lymph node on a patient that presented for limping.  The sooner abnormalities are detected the more likely we are to gain an upper hand.

 

Listed below are the elements of a thorough physical examination for your dog or cat.  Bear in mind, it takes no more than a minute or two for a seasoned vet to competently complete the following (by the way, it helps if you are not talking when the stethoscope is being used!):

  • Assessment of overall alertness and appearance
  • Evaluation of gait
  • Evaluation of the skin and haircoat
  • Measurement of body weight, temperature, heart rate, respiratory rate, and capillary refill time (the time it takes for the gum line to become pink after it has been blanched by finger pressure)
  • Examination of the eyes, ears, nose, and oral cavity
  • Palpation of lymph nodes
  • Palpation of the thyroid gland (specific for cats)
  • Auscultation of the heart and lungs (listening with a stethoscope) on both sides of the chest
  • Palpation of the abdomen
  • Rectal examination (specific for dogs that are middle aged and older)

Vets perform physical exams differently in terms of order of events.  No matter in the least as long as everything is included. And please remember, such thorough exams are not to be reserved for only the annual office visit. If your kitty is vomiting or your dog has an ear infection, you should expect the whole shebang (although your dog or cat would probably prefer a mini-exam).

Is your veterinarian “hands-on” and doing one heck of a thorough job when it comes to the physical exam?  Please share your experiences.

Best wishes for good health,  

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook  

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Reasonable Expectations X: Saving the Best for Last!

February 18, 2011

This will be my tenth and final blog post describing reasonable expectations as they pertain to delivery of veterinary care (parts one through nine can be found at www.speakingforspot.com/blog).  This time, however, the tables will be turned- rather than describing what is reasonable for you to expect of your veterinarian, I am going to discuss what is reasonable for your veterinarian to expect of you!      

© Juli Dell'Era

Here are a dozen reasonable expectations.  By complying with as many as possible, not only will your vet and the hospital staff sing your praises, your efforts will directly benefit your pet’s health- and nothing is more important than that.       

  1. Arrive on time for your appointment. This means being present in the waiting room, not hanging out in the car finishing up your cell phone conversation or meandering with your dog outside the building (please read below about the importance of arriving with a full bladder, your dog’s that is). When you arrive late, not only will you and your pet be shortchanged on time spent with the vet, there’s a chance the staff will remain behind schedule for the rest of the day.  If you and your pet are new to the practice plan on arriving 10 to 15 minutes early to fill out necessary paperwork and be sure to bring all prior medical records including X-rays, ultrasound reports, and laboratory test results. (Old invoices are no substitute for the medical record). If you are tempted to arrive late because your vet consistently runs late, call ahead and chat with a front office staff member who will know if it’s “safe” to arrive after the scheduled appointment time. 
  2. If you suspect your pet has a contagious disease such as an upper respiratory infection, forewarn the staff.  For the sake of other patients in the waiting room, they may recommend that your little snookums remain in the car until it is time for the doc to see you.
  3. Unless instructed otherwise, do your best to bring your pet in with an empty stomach and a full bladder. This means taking the litter box away a couple hours ahead of time and foregoing the popular doggie p-mail spots outside the clinic.  Your vet may want a urine sample for testing and if procedures are recommended, better that breakfast was skipped.  Don’t worry, your dog or cat is unlikely to urinate on the hospital floor and if it does happen, guaranteed there’s a mop in every hospital!
  4. Please turn off your cell phone.  Not only is the ringing phone a distraction, answering it while in the midst of conversation with your vet conjures up adjectives I’d best not mention.
  5. Come prepared to provide a thorough history.  Believe it or not, your observations may provide more clues for a correct diagnosis than the actual physical examination.  In fact a solid history can make the difference between having to run one diagnostic test or five. Do some sleuthing around the home front to make sure there’s nothing unusual your dog or cat may have been exposed to. Your vet will want to know if you’ve observed any vomiting, abnormal stools, coughing, sneezing, decrease in stamina, or change in bladder or bowel habits.  If you don’t deal with “poop patrol” talk to the family member who does!
  6. Bring along all of your pet’s current medications (including supplements, flea control products, and heartworm preventive) so your vet can confirm that everything is as it should be.  At a minimum bring along a written list of what you are giving your pet including the name, strength and frequency of any medications- not just a visual description of the tablet. (Many medications come in the form of small, round blue pills!). Yes, the information is in the medical record, but, you’d be surprised by how often discrepancies are discovered.
  7. Know the name(s) of what you are feeding; in fact bring along a label just in case.  It’s remarkable how often clients can describe the appearance of the bag or wrapper “to a tee”, but for the life of them, cannot remember the name of the product. If the diet is homemade, bring along a copy of the recipe.
  8. Do your best to directly answer the questions asked by your veterinarian, without a lot of embellishment.  For example, if your vet asks if you have been filling the water bowl any more or less than usual, your answer should begin with “Yes,” “No,” or, “I don’t know.” “I give her only bottled water.” or “She absolutely adores water.” is not the answer your vet is looking for.
  9. If your pet is sick, try to have all the decision-makers present at the time of the office visit.  If this is difficult to arrange, the person present should take notes, and even consider audio-recording the conversation.  This is useful since details inevitably get lost in translation, especially when traveling from spouse to spouse!
  10. By all means, let the staff know if your pet is aggressive.  All animals are capable of unpredictable behavior.  A savvy veterinary staff can usually peg aggressive dogs and kitties within seconds of meeting them.  Occasionally one surprises us and bites or scratches- either a staff member or the client.  Everyone feels terrible but it’s made far worse when we learn that the client knew it could happen, but failed to warn us.
  11. Yes, I know it can be awkward, but I strongly encourage you to discuss your financial concerns before services are provided. When it comes to ways to pay your bill, there is no standard veterinary clinic menu, though most accept cash, credit/debit cards, and checks.  Do your homework to find out which ones apply to your facility. What receptionist hasn’t heard, “What do you mean, you don’t take Discover?” 
  12. Treat the entire staff well.  I get really peeved when I learn that a client, who has been sweet as can be with me, has been abrupt, condescending, or rude to one of my staff.  Keep in mind that everyone who works in the veterinary clinic plays an important role in keeping your pets healthy.   They all deserve to be treated with equal respect and without a doubt, the entire staff will know if this has not been the case. 

There, I’ve done it!  I’ve said what all vets long to tell their clients, and I sure as heck hope you’re not offended! Do you think these are reasonable expectations?  Are there others worthy of adding to the list?      

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook      

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Reasonable Expectations VIII: Written Cost Estimates

January 8, 2011

This is the eighth part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets. Parts one through seven can be found at www.speakingforspot.com/blog.

You’ve just taken your best buddy to see your veterinarian because he’s been vomiting for three days and is now beginning to refuse his food. Your vet performs a thorough physical examination with all normal findings, so she recommends blood tests along with X-rays of your dog’s belly.  If these tests don’t provide a diagnosis, she tells you that the next recommended step would be abdominal ultrasound.  Of course you want to proceed with this testing because your dog is a beloved family member and you want him to get better, but do you know how much the recommended diagnostics will cost?  Will you be charged $300, $800,  $1,300? Unless your dog is a “repeat offender” how in the world could you possibly know? Three hundred dollars might be completely within your budget; whereas $1,300 might mean coming up short on your mortgage payment.

Whether you are independently wealthy, barely making ends meet, or somewhere in between, know that it is perfectly reasonable to request a written cost estimate from your veterinarian before services are provided.  Why must you be responsible for asking- shouldn’t your vet automatically offer forth a written cost estimate?  Much to my chagrin, I must tell you that only the minority of vets voluntarily provide written estimates. This was documented by veterinarian/researcher, Dr. Jason Coe and his colleagues. Their research appeared in 2009 within the Journal of the American Veterinary Medical Association.  The article titled, “Prevalence and Nature of Cost Discussions During Clinical Appointments in Companion Animal Practice” documented the following:

• Actual cost is addressed in only 29% of veterinary appointments.
• When cost is discussed, 33% of the time it is the client and not the veterinarian who initiates the discussion.
• Talk related to cost information constitutes a mere 4.3% of the total dialogue time.
• Written cost estimates are discussed during 14% of appointments.
• Written cost estimates are actually prepared and delivered to the client in only 8% of appointments.

Dr. Coe’s research certainly supports the notion that veterinarians are squeamish when it comes to discussing fees for their service.  I must admit it is certainly one of the least favorite parts of my job.  Nonetheless, I consistently provide written cost estimates, particularly if I’ve recommended something other than a single treatment or test, in order to avoid communication snafus and clients who are disgruntled when it comes time to pay their bill. 

Why is a written estimate preferable to a verbal estimate? Written estimates require time and focus. Guaranteed such estimates are far more likely to be accurate than those prepared by the vet using mental math while “on the fly”.  Additionally written estimates avoid uncomfortable conversations such as, “You told me it would be $100, not $300……..” and, “But you never told me you were going to do that……”.   So, please don’t encourage your vet to simply give you a “ballpark estimate” or an estimate “off the top of his or her head.”   I avoid providing such guesstimates at all costs (no pun intended).  Try as I might, I invariably lowball such estimates because of my innate desire to make the cost for my client as reasonable as possible.  And when this happens I end up cutting corners (not a good thing for the patient) and/or having to make uncomfortable phone calls advising clients of added expenses (and I definitely get called into the principal’s office).

It is completely reasonable to receive a written cost estimate before services are provided, but keep in mind, you may need to be the one who initiates this process!  With written estimates everybody wins- communication is so much clearer and there are no surprises when it comes time to collect fees.  Additionally, a written cost estimate provides an itemization for you of everything that is planned for your pooch. Have you received estimates from your veterinarian?  If so have they been delivered verbally or in writing?

Best wishes,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Reasonable Expectations VII: Discussion and Open-Mindedness About Your Dog’s Vaccinations

December 27, 2010

This is the seventh part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets. Parts one through six can be found at www.speakingforspot.com/blog

As invaluable as vaccinations are for protecting canine health, determining which vaccines are appropriate and how frequently they should be administered are no longer simple decisions. Gone are the days of behaving like  “Stepford wives” simply because you’ve received a vaccine reminder postcard or email. Vaccinations are no different than any other medical procedure.  They should not be administered without individualized discussion with your veterinarian and consideration of the potential risks and benefits. Please know that having such a discussion with your veterinarian is a perfectly reasonable expectation, and your input is an invaluable part of the vaccine decision-making process.

Consider the following:

• There are currently more than a dozen canine vaccinations to choose from! Back in the days when I was just a pup there were only five, and decision-making regarding vaccine selection for an individual dog was far less complicated.
• Over the past decade we’ve learned that, for some vaccines, the duration of protection is far longer than previously recognized.  In the past we vaccinated against distemper, parvovirus, and rabies annually.  We now know that these vaccinations, when given to adult dogs, provide protection for a minimum of three years and, in some cases protection is life-long.
• The duration and degree of immune protection triggered by a vaccine is variable, not only based on vaccine manufacturer, but from dog to dog as well.
• Other than for rabies (state mandated), vaccination protocols are anything but standardized. There are no set rules veterinarians must follow when determining which vaccines to give and how often they are administered. Unfortunately, some vets continue to vaccinate for distemper and parvovirus annually even though we know that these adult vaccines provide protection for a minimum of three years.  Some vets give multiple inoculations at once, others administer just one at a time.
• Increasingly clear-cut documentation shows that vaccines have the potential to cause many side effects.  While vaccine reactions/complications are still considered to be infrequent, they can be life threatening.

What you can do:

As your dog’s savvy medical advocate, what can you do to be sure that he or she is neither under or overvaccinated? Here are some guidelines for making wise vaccine choices for your best buddy:

1.  Educate yourself about available canine vaccinations and the diseases they are capable of preventing (in some cases treating the disease, should it arise, might be preferable to the risks and expense associated with vaccination). Learn about duration of vaccine protection and potential side effects.  Read the chapter called “The Vaccination Conundrum” in Speaking for Spot. It provides detailed discussion about all aspects of canine vaccinations including the diseases they prevent, adverse vaccination reactions, and the topic of vaccine serology (blood testing that helps determine if your dog is truly in need of vaccine booster). The American Animal Hospital Association’s “Canine Vaccine Guidelines” is also an excellent source of information (http://secure.aahanet.org/eweb/dynamicpage.aspx?site=resources&webcode=CanineVaccineGuidelines).
2.  Talk with your veterinarian to figure out which diseases your dog has potential exposure to.  A miniature poodle who rarely leaves his Manhattan penthouse likely has no exposure to Lyme disease (spread by ticks); however a Lab that goes camping and duck hunting may have significant exposure.
3.  Alert your veterinarian to any symptoms or medical issues your dog is experiencing.  It is almost always best to avoid vaccinating a sick dog — better to let his immune system concentrate on getting rid of a current illness rather than creating a vaccine “distraction.” If your dog has a history of autoimmune (immune-mediated) disease, it may be advisable to alter his vaccine protocol or even forego ongoing vaccinations — be sure to discuss this with your vet.
4.  Let your vet know if your dog has had vaccine side effects in the past. If the reaction was quite serious, she may recommend that you forego future vaccinations, necessitating an official letter to your local government agency excusing your pup from rabies• related requirements.
5.  Talk to your veterinarian about vaccine serology.  This involves testing a blood sample from your dog to determine if adequate vaccine protection still exists (remember, vaccine protection for the core diseases lasts a minimum of three years).  While such testing isn’t perfect, in general if the blood test indicates active and adequate protection, there is currently no need for a vaccine booster. Serology may make more sense than simply vaccinating at set intervals.
6.  Talk to your veterinarian about the potential side effects of proposed vaccinations, what you should be watching for, and whether or not there are any restrictions for your dog in the days immediately following vaccination.

What happens if your veterinarian declines vaccine discussion and simply wants to vaccinate based on what he or she thinks is appropriate?  Time to find yourself a new veterinarian who is progressive enough to have a working relationship with people who choose to be a stellar medical advocates for their dogs!  Is your vet willing to have open-minded discussion with you about your dog’s vaccinations?

Best wishes for a happy new year.   

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Price Shopping: To Be Avoided at All Costs

December 13, 2010

I recently exchanged emails with a woman who was feeling frustrated while searching for a new veterinarian.  Her search included some “fee shopping” and she was disgruntled to find that some vets had the nerve to mark up lab fees more than others.  She wrote to me to find out how she might gain access to the fees charged by commercial veterinary laboratories so she could figure out how much mark up each veterinarian applied. She mentioned that she’d found one vet she really liked, but she was “out of the running” because her office charged double the lab fees (exact same test) as two others she’d investigated.

Here’s how I responded.  I encouraged my email buddy to consider reasons why fees are not uniform from hospital to hospital. In some cases, laboratory testing is run “in house” requiring on site technician time and costs involved in maintaining equipment.  Certainly charges to the client for this should be higher. The expertise a veterinary specialist brings to interpreting laboratory test results may be greater than that of a general practitioner.  Shouldn’t a client pay more for this? Additionally, every clinic must pay its overhead to continue to provide good service, and the more “bells and whistles” the hospital has, the higher that overhead will be.  For example, if the hospital employs sophisticated equipment to monitor anesthesia, that’s a really good thing, right?  Chances are, the fees for surgery there will be higher in order to cover the costs of this advanced level of care.

I went on to explain that I truly discourage people from price shopping when it comes to veterinary care unless it is an absolutely necessity.  A sweet six-month-old Labrador is currently being treated at my hospital because she sustained a horrific thermal burn all along her back from a faulty heating pad used during her surgery at a low cost spay/neuter clinic. This has necessitated major reconstructive surgery over her back- a tremendous price to pay both in terms of money and what this poor dog is going through. By the end of our email thread my correspondent seemed convinced- she told me that she’d decided to use the vet she really liked in spite of more expensive lab tests. Hurray!

Now, I’m not completely naïve when it comes to how our current economy is influencing delivery of veterinary health care.  I realize that for many folks, price shopping has become a financial necessity.  When this is the case, I encourage the following:

-Do your best to avoid sacrificing quality of medical care.  The old cliché, “You get what you pay for,” is often true.  Be thorough in your investigation: don’t make up your mind based on brief over-the-telephone price quotes.  Visit the clinic, tour the facility, and meet the staff to feel confident this is a place you and your pet will feel comfortable.

-Watch for “hidden” fees.  Some clinics may offer an extremely reasonable quote for a surgical procedure, but then charge additional fees for the initial office visit or for post-surgical necessities like removing stitches.

-Keep in mind the potential for complications.  If a significant complication occurs due to substandard care (such as occurred with the Labrador mentioned above) you will end up spending a great deal more money treating it, not to mention associated emotional energy, than you would have spent at the better more expensive clinic to begin with.

When you chose your veterinarian, how did fees enter into your decision-making?  If so, how did things turn out? I’d love to hear about your experience.

Now here’s wishing you and your loved ones (including those who are furry or feathered) for a peaceful and healthy holiday season.   

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller. 

Free holiday gift wrap with books purchased between now and December 25th (www.speakingforspot.com/purchase.html).

Reasonable Expectations VI: The Ability to Discuss Your Internet Research With Your Vet

December 7, 2010

This is the sixth part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets. Parts one through five can be found at http://www.speakingforspot.com/blog.  Please take your time with this one- I realize it is a lengthy post, but there is a great deal to say about this worthwhile topic!

When your beloved pet develops a medical issue, chances are you’ll be inclined to do some Internet research and then talk with your vet about what you’ve learned.  Know that having this discussion with your vet is a perfectly reasonable expectation as long as you are careful to avoid using valuable office visit time discussing “whackadoodle” notions gleaned from cyberspace.  Here are some pointers to help you find instructive, accurate, worthwhile Internet information while avoiding “online junk food”. By the way, although I’m a veterinarian teaching people how to better care for their furry and feathered family members, please know that this information also applies to your own health care.

So, let’s begin.  How can you determine whether or not a website is dishing out information that is worthy of your time? Here are some general guidelines:

1.  Ask your veterinarian for her website recommendations.  She might wish to refer you to a specific site that will supplement or reinforce the information she has provided.

2.  Veterinary college websites invariably provide reliable information.  Search for them by entering “veterinary college” or “veterinary school” after the name of the disease or symptom you are researching.

3.  Web addresses ending in “.org,” “.edu,” and “.gov,” represent nonprofit organizations, educational institutions, and governmental agencies, respectively.  They will likely be sources of objective and accurate information.

4.  If your dog has a breed-specific disease, pay a visit to the site hosted by that specific breed’s national organization.

5.  Avoid business-sponsored websites that stand to make money when you believe and act on what they profess (especially if it involves purchasing something).

6.  Be ever so wary of anecdotal information.  It’s perfectly okay to indulge yourself with remarkable tales (how Max’s skin disease was miraculously cured by a single session of aromatherapy), but view what you are reading as fiction rather than fact. 

7.  I really love disease-specific online forums.  Check out those sponsored by Yahoo (http://groups.yahoo.com).  Not only do many of them provide a wealth of educational information, members can be a wonderful source of emotional support- always a good thing for those of us who share our homes and hearts with an animal.  If you are considering joining an online forum, I encourage you to look for a group that focuses on a specific disease (kidney failure, diabetes, etc), has lots of members, and has been around for several years.  For example, an excellent Yahoo group AddisonsDogs has 3,391 members and has been up and running for eight years.  A large group such as this typically has multiple moderators who screen participants, screen comments to keep things on topic, present more than one point of view (always a good thing), and provide greater round-the-clock availability for advice and support.  Look for presentation of cited references (clinical research that supports what is being recommended). Such groups should have a homepage that explains the focus of the group and provides the number of members and posts per month (the more the better).  They may have public archives of previous posts that can provide a wealth of information.

I happen to enjoy hearing about what my clients are learning online.  I sometimes come away with valuable new information, and I’m invariably amused by some of the extraordinary things they tell me- who knew that hip dysplasia is caused by global warming!  Surf to your heart’s content, but be forewarned, not all veterinarians feel as I do.  Some have a hard time not “rolling their eyes” or quickly interrupting the moment the conversation turns to Internet research.  What can you do to realize the expectation of discussing your online research in a way that is neither irritating to your vet nor intimidating for you?  Listed below are some secrets for success:

-I may be preaching to the choir, but I cannot overemphasize the importance of working with a vet who is happy and willing to participate in two-way, collaborative dialogue with you (please reference my earlier blog about relationship centered care- http://speakingforspot.com/blog/?p=1174). Your opinions, feelings, and questions are held in high regard and enough time is allowed during the office visit to hear them. A veterinarian who practices this “relationship centered” style of communication is far more likely to want to hear about your online research than the veterinarian who practices “paternalistic care” (far more interested in telling you what to do than hearing about your thoughts, questions, or concerns).  Remember, when it comes to veterinarian/client communication styles, you have a choice. It’s up to you to make the right choice!

-Let your vet know that you appreciate her willingness and patience in helping you understand how best to utilize what you’ve learned online.

-Wait for the appropriate time during the office visit to discuss what you’ve learned on line.  Allow your veterinarian to ask questions of you and examine your precious poopsie rather than “tackling” her with questions and discussion about your Internet research questions the moment she sets foot in the exam room.

-Be brief and “to the point” with your questions.  Remember, most office visits are scheduled for 15 to 20 minutes, max.

-Let your veterinarian know that you’ve learned how to be a discriminating surfer!  You know how to differentiate between valuable online resources and “cyber-fluff”. You ignore anecdotal vignettes and websites trying to sell their products in favor of credible information provided by veterinary college sites and forums that are hosted by well-educated moderators who provide cited research references that support their recommendations.

-When you begin conversation about your Internet research, I encourage you to choose your wording wisely. Communicate in a respectful fashion that invites conversation as opposed to “telling” your vet what you want to do.

In the Internet, we have an extraordinary tool at our fingertips. I encourage you to be selective when choosing which websites you intend to take seriously and which ones you wish to visit for a good chuckle.  Approach conversations with your vet about your Internet research thoughtfully and tactfully.  These strategies are bound to facilitate constructive conversation and create a win-win-win situation- for you, your veterinarian and your beloved best buddy! 

Have you had conversation with your vet about your Internet research?  If so, how did it go?

Now here’s wishing you and your four-legged family members abundant good health.  

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller. 

Free holiday gift wrap with books purchased between now and December 25th (www.speakingforspot.com/purchase.html).

Communicating About Communication

November 8, 2010

I’ve just returned from the International Conference on Communications in Veterinary Medicine (http://www.iccvm.com).  This was a gathering of folks from all around the world eager to share their research, report their observations, and learn more about communication in the world of veterinary medicine.  The majority of information shared at this meeting pertained directly to how veterinarians communicate with their clients.  From my perspective, this is such exciting news! As little as a decade ago, barely a trace of research existed on the topic of client communication in veterinary medicine.  Now there are a reasonable number of studies underway, many of which are geared towards figuring out the best ways to incorporate and teach client communication within veterinary school curricula.  While the Canadian veterinary colleges seem to really be leading the charge in this research, what’s clear is that more and more veterinary school faculty around the world are grasping just how important it is to teach client communication skills to their students.  Hurray!

I was asked to provide a lecture/workshop for this meeting and chose, “The Internet and the Vet: How the Worldwide Web is Changing the Way We Communicate”.  I presented the data about email communication between veterinarians and their clients that you were privy to via this blog a couple of months ago (http://speakingforspot.com/blog/?p=1363). We also discussed how to interact with clients who do Internet research pertaining to their pet’s health (These days, who doesn’t do this?). We did some role-playing to try to identify ways to make our clients feel more comfortable when discussing their Internet research.  We all agreed that most clients are a bit bashful when broaching this topic- by doing so they fear that they may be conveying mistrust in their veterinarians.

Take home points emphasized repeatedly at this meeting were the importance of empathic communication (delivered verbally and nonverbally) and relationship centered care- the communication style that emphasizes collaboration between veterinarians and their clients. The payoff for utilizing this style of communication is greater job satisfaction for the veterinarian and greater client satisfaction with the services received.  I feel wonderfully fortunate to be practicing veterinary medicine at a time when a conference about communication in veterinary medicine exists. 

Over the years have you perceived ways that communication between you and your veterinarian are changing? If so, I would love to hear from you.

Now here’s wishing you and your four-legged family members abundant good health.  

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller. 

Free Christmas or Chanukah guft wrap with books purchased between now and December 25th (www.speakingforspot.com/purchase.html).