The anatomy of firing a client

The Greens appear unannounced as the staff is finishing the daily close out.

Mr. Green wants "Muffy" seen "pronto" and thinkshis dog may be dying.

Dr. Johnson has wrapped up a busy but rewarding day, but is willing tostay a little longer. The staff, however, cringes as Mr. Green enters. The last time he was in the hospital he created a terrible scene at thefront desk and made Joan, the new office assistant, break down and cry.

As they enter the exam room Doris Green holds Muffy close to her throatand barely lets Dr. Johnson get a look. Dr. Johnson gently and repeatedlyasks Doris to put the animal on the exam table. Doris reluctantly does so. Muffy stands on the table long enough to urinate. With her back legsand feet covered with urine, she climbs back between Mrs. Green's left shoulderand neck.

Jimmy Green pipes in that he is really concerned about Muffy. Whilehe and his wife have been coming to Academy Animal Hospital for more thanfive years, he hasn't been in recently. Actually the only time he had comein the past was to complain about the bill. This time is different.

Recurrent nightmare

Dr. Johnson remembers working with Muffy several months ago trying tostop a nasty cough. Although Dr. Johnson had recommended various blood tests,radiographs and follow-ups, the Greens had only wanted medicines. They werereluctantly given medications and asked to call tomorrow with updates. TheGreens never called and phone calls to the Greens were not returned.

"The medicines you gave Muffy didn't work," offered Doris.Upon further questioning it finally came out that she only got the medicinedown her every three or four days because Muffy didn't like the smell ofthe pills. What pills Muffy did get down were eaten with cheese.

"About a month after we were here we called our cousin in Georgia,"Doris bleated. "She had been reading on the Internet that there isa shot for this kind of cough and so we took her to Elsewhere Animal Clinic.That doctor is so nice over there. He gave that shot while she was undermy jacket without even having to see Muffy."

"We think you should give her the same shot," said Mr. Green."She already had an exam at the other clinic and we just need the shot.We just went by Elsewhere Animal Hospital but they were already closed."

Dr. Johnson now tries to gain some control.

"Mr. Green what makes you think she is dying?"

"Well, we just took her to McDonalds and she would only eat thecheese and just a little of the meat from her cheeseburger. She never failsto gobble it all up so she must be dying."

Decision time

Dr. Johnson now looks at his watch and realizes that his staff is waitingto see what he wants to do. After all, it is now 45 minutes after closingand Jane is already on overtime.

Dr. Johnson's options are:

* Call his wife and invite the staff and the Greens out to McDonaldsto see if Muffy will eat a cheeseburger.

* Call the humane society and see if there are any cages leftfor veterinarians to occupy.

* Kindly ask the Greens to bring their pet in tomorrow so thatyou can find the source of her problems. A deposit will be required. Askthe owner to write an orderly and dated history of the problem.

* Ask all but one of your staff to leave and try to work up thecase on an emergency basis.

The answer is the third option.

Your goal is to satisfy the needs of the client and obtain as much informationabout the pet's condition as you can.

It is obvious that that will not happen under the late evening circumstances.This also allows you to try to let the owner's head clear a bit. Other benefitsinclude:

* Full staff availability

You will be able to better see Mr. Green's reaction upon leaving a sizabledeposit. This will indicate the level of trust he places in the hospitaland staff.

* A linear path to the diagnosis without interference from theowner.

* You will have a written and dated history of the problem.

* You will be able to further evaluate this client's willingnessto follow through with instructions.

* You will better be able to use your professional time.

Some things to consider

Some things to point out concerning these types of client interactions:

* Clients can be insensitive to the needs of others when it comesto their pets. They can be going about their own lives in a structured wayand then at the end of the day seek to unstructure the business and professionalbusiness hours of a veterinary office.

This, in reality, is a form of cheating other clients who, in good faith,make appointments and take time from work to see the veterinarian.

* Many of these clients tend to exaggerate their pets' maladiesin order to convince the staff of the importance of their eleventh hourvisit.

* Some of these clients can become abusive if they cannot controlthe situation from start to finish.

* Some of these clients tend to engage the staff in endless telephoneconversations that get nowhere. This behavior is another form of cheatingthe clients who are patiently waiting their turn to see the doctor and aredelayed by staff telephone interruptions.

* These clients tend to accept veterinary advice from any sourcethat seems "reasonably" willing to offer helpful "hints."

A parting of the ways

There comes a time in the life of every veterinary office where the firingof a client is in order.

The previous scenario could lead to the dismissal of a client dependingon certain factors.

It is imperative that if the firing of a client is proposed that theveterinary clinic be able to say that they have bent over backward to avoidit. Many client relationships can be improved dramatically by simply askingto talk to the clients in a frank and open manner about the issues thatare causing problems. Sometimes a client will not even realize that theyare creating problems.

The Green solution

Mr. Green exhibits all the beginning symptoms of a client who needs tobe fired.

However, this does not mean that you should fire him-at least not yet.After you have determined Mr. Green' reaction to Muffy's work-up you shouldmonitor their willingness to follow through on a therapy plan. This therapyplan may include dental work or even surgery. If it is determined that areferral is necessary, how willing are they to comply?

For Mr. Green the following criteria or in combination (other issuesmay also apply: see sidebar p. 24) would initiate the process of eventualfiring.

* A blow up from Mr. Green concerning issues out of the controlof the veterinary hospital, such as poor response to therapy after an appropriatediagnosis and therapy by the veterinarian.

* Abusive language in front of staff and the public.

* Dictating appointment times along with demanding behaviors outof proportion to real events.

* Threatening to bring suit over trivial matters (there are realevents that lead to legitimate lawsuits against veterinarians; it wouldbe uncommon for these lawsuits to originate from individuals who are justtrying to throw their weight around.)

The talk

It is important for the veterinarian to communicate one-on-one beforeany move is made to ask a client to leave. Ideally this is done in an examroom or in the doctor's personal office at a less busy time of the day.

It helps for only one member of the family to talk to the veterinarianor manager in private. At this point it should be said that veterinarianshate to do this-it goes against human nature to confront an issue in privatehead on. In most cases both parties in question would rather "bad mouth"the other party to friends or anyone other than the person they have anissue with. However at these talks, perceptions of events surface in thatmeeting that neither party had been aware of beforehand.

The talk should address these issues:

* Try to get all issues that bother the client out and on thetable. Do the same on behalf of the hospital.

* Ask the client to look at the issue from the viewpoint of theveterinary hospital.

* If the client has a legitimate concern do not trivialize it-insteadaddress it in a meaningful way. When appropriate, indicate that the hospitalcould have performed better but do not back down on issues that you feelare important from the hospital's viewpoint.

* Ask the client to change the behaviors that cause problems forthe hospital and staff.

* Finally, indicate that if a meaningful change cannot be madethat the client should seek the services of another veterinarian.

If the client shows a willingness to improve and does, in fact, becomesa better client, so much the better. If the client continues to behave badlyyou will need to ask them to seek another veterinarian. This is in the bestinterest of both parties.

What are the chances?

Will Mr. Green improve after a talk? Chances are he will not. But some"Mr. Greens" will become wonderful clients. Happily the Mr. Green'sof this world are not common. Either way you must use an approach that createsthe least amount of conflict. You will also reduce the overall dollars youspend on Pepcid AC and Pepto-Bismol.

Dr. Lane is a 1975 veterinary graduate of the University of Illinois.After graduation he practiced as an associate in California before movingto Carbondale, Illinois and establishing Lakeside Veterinary Hospital in1978. Dr. Lane completed a master's degree in agricultural economics in1996. He is the author of numerous practice management and economics articles.