Just Ask the Expert: Three keys to orthopedic postoperative care compliance

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How do you get clients to comply with your orthopedic patients' postoperative activity restriction instructions?

A. Ah, the inevitable question of how to promote client compliance-at times that seems to be the Holy Grail of veterinary medicine. Often during a recheck examination, I find myself asking, "What were they thinking?" Why would someone interpret "six weeks of cage rest" as the equivalent of "take your dog on long walks"? Although there are no magic bullets for the problem, over the years I have settled on three approaches-communication, detail, and honesty.

Communication

My first step toward postoperative compliance is preoperative communication. Before an animal is even admitted for surgery, I try to make it clear what the postoperative instructions will be. I acknowledge that the clients' role will likely be harder and certainly longer than my part. I spell out the consequences of failure to adhere to instructions-basically instilling some level of fear. Often, I will phrase this partially in terms of financial impact, such as, "It would be a shame to spend that amount of money and invest so much time only to have it fall apart and need to be done again."

Detail

Next, I try to be detailed in my instructions. Recognize that restricted activity is a pretty vague term and, therefore, open to interpretation. Specifying the size of a cage, the length of a walk, or the specific activities that are harmful can eliminate some of the misunderstandings. I make it clear, for example, that I want an animal restricted not just for eight weeks but until radiographic healing has been documented. That way if a client is late scheduling an eight-week recheck appointment, the animal should remain confined.

Honesty

Finally, I try to be honest with myself and clients. If I realistically know a given level of care won't happen, I look for something doable-there is no sense setting someone up for failure. On the clients' part, I try to encourage them to take responsibility. I let them know that this is what needs to be done, that it is possible because other people have done it, and that they should tell me if they are willing to follow through. By putting that question to them, I get an oral commitment and acknowledgement of responsibility or else get the issue of noncompliance out in the open where I can either decline to proceed or find some level of care that is more likely to occur and still be effective. If nothing else, I can document in the record that they were told what is needed and agreed to do it.

Follow-up

It is always nice to assess how clients are doing with compliance. When they return for a recheck appointment, I try not to ask a leading question, such as "Are you doing X as we instructed?" Instead, I ask about Fluffy's typical activity or ask what Fluffy is able to do at this point from an activity standpoint. This approach, I hope, is more likely to get an honest response. We all want to please, and our clients are no different. A leading question will generally elicit a response designed to conform to expectations.

If I don't get the impression that a client is following instructions, I will casually look through the discharge instructions and gently say something such as, "Let's see, we were wanting Fluffy to stay in a crate for a total of six weeks-were you able to do that?" Where I go from there all depends on how the pet is doing.

Walter Renberg, DVM, MS, DACVS

Department of Clinical Sciences

College of Veterinary Medicine

Kansas State University

Manhattan, KS 66506