Posts Tagged ‘reasonable expectations’

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.

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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).

Reasonable Expectations Part IV: Communicating With Your Vet Via Email

September 27, 2010

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

Have you any interest in emailing rather than calling your vet when you have questions? This is certainly a reasonable expectation assuming that your vet is willing to communicate online. Email communication with doctors is not a new concept.  The Kaiser Permanente “My Health Manager” program with an “email my doctor” feature has been wildly successful.  Not only are more and more patients using the program (and Kaiser is promoting it in their marketing ads), a study on more than 30,000 Kaiser Permanente patients with high blood pressure and/or diabetes documented that those who communicated via email with their physicians enjoyed better health outcomes! 

I recently surveyed 120 of my northern California colleagues about email communication with clients and here is what I learned from them:

•58% of the vets who responded are communicating with their clients via email
•62% of those who use email are selective- they do not provide email access to all of their clients
•26% of those using email set “ground rules” with their clients; interestingly, many commented that they strongly feel the need to set email ground rules, but have been too “wimpy” to do so
•Receptionists communicate with clients via email in 37% of the practices polled
•Technicians (nurses) communicate with clients via email in 21% of the practices polled
•95% of the veterinarians who use email reported it to be a mostly positive experience

The veterinarians using email unanimously reported that it is great for simple, non-urgent communications (emphasis on non-urgent). Just imagine every veterinarian’s nightmare- you check your email in the evening and find a message that is eight hours old from a client describing their pet who is struggling to breathe and has blue gums!  Vets using email enjoy the convenience- for many, not only is email less time consuming than telephoning (avoids phone tag), they can respond to emails at their convenience.  I can relate to this- I sometimes don’t finish up with my patients until 8:30 or 9:00 at night at which point I’m worried that it may be too late to return client phone calls. 

Along with the fear of not receiving urgent messages in a timely fashion, here’s what the vets I surveyed told me they do not like about email:

•Clients wanting a diagnosis via email rather than via an office visit
•No simple or easy process for transferring the email communication to the patient’s medical record
•Too time consuming for vets who have remedial word processing skills or feel the need to carefully edit their “written words”
•Clients who take advantage of the system and begin emailing too much and/or too often
•Receipt of “cutesy” emails (photos or stories that are incredibly cute, but only in the mind of the sender)

I happen to be a speed demon when it comes to word processing, and I would love the flexibility of communicating with my clients in the wee hours of the morning or late into the evening.  So why have I not jumped on the email bandwagon?  If you’ve read Speaking for Spot you know that communication between veterinarians and their clients is a topic near and dear to my heart.  So much of what is perceived during communication has to do with body language and voice inflection, neither of which can be perceived via email (unless I begin Skyping with my clients, God forbid!). I worry that, by using email, I will miss out on what’s happening emotionally for my clients. Even with this concern, the results of my survey have motivated me to dip my baby toe into the email whirlpool.  I think I will invite my clients to email me with really simple questions such as, “When am I supposed to bring Lizzie back in to see you?” or “Is it okay to give Radar his heartworm preventative along with the other medications you prescribed?”  Anything more than that, however, and I’ll be jumping back onto the phone in the blink of an eye. 

Do you communicate with your vet or your physician via email?  If so, what has the experience been like for 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.

You can support your favorite rescue group.  The Speaking for Spot Gives Back Program shares a portion of the sales proceeds with approved non-profit organizations when you purchase a book via the Speaking for Spot website and designate the organization at the time of purchase.

Reasonable Expectations Part III: Access to Round-the-Clock Care

September 12, 2010

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

If your dog is sick enough to require hospitalization or has just undergone a major surgical procedure, how will he or she be cared for overnight and on weekends?  As much as the mere thought of this makes me cringe I must advise you that even though your dog or cat is “hospitalized”, in some veterinary clinics this will involve no supervision whatsoever from closing time at night (perhaps 6:00 PM) until early morning when the first employees arrive back at the hospital.  What if your dog manages to slip out of his Elizabethan collar and chews open his surgical incision? What if your kitty begins experiencing pain during the night?  What if your dog vomits and aspirates the material into his lungs? All these “what if’s” are what make me crazy whenever I think about a hospitalized animal left alone for 8 to 12 hours at a time.  And here’s what makes me even crazier- some people don’t think to even ask how their beloved family member will be supervised when the clinic is closed, likely because they cannot fathom the possibility that adequate supervision would not be provided.

Please know that it is perfectly reasonable for you to expect that your hospitalized family member receive round-the-clock care.  There are a few different ways this can happen.  While a 24-hour hospital staffed with a veterinarian is ideal, this simply does not exist in all communities (but if it does exist in your neck of the woods, by all means take advantage!).  Here are some other viable options:

-A veterinarian comes into the clinic multiple times during the night and on weekends to check on the hospitalized patients (some vets prefer to take their patients home with them to help make monitoring and supervision more convenient).

-A skilled veterinary nurse (technician) comes into the clinic multiple times during the night and on weekends to check on the hospitalized patients and has access to contacting the vet should the need arise.

-Your dog or cat comes home with you, but only after you receive thorough monitoring instructions along with a way to reach your vet should questions or concerns arise.  As scary as this might sound, this remains a better option than leaving your best little buddy left completely unsupervised overnight.  Just imagine how you would feel lying in a hospital bed, hooked up to intravenous fluids, and no one entering your room to check on you for twelve long hours!

How would your dog or cat be cared for overnight and on weekends should the need arise?  Please do tell.  And if you’re not sure, no time like the present to find out.

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.