Are you patient?

Donna was 30 minutes late but finally made it into the exam room with her new puppy, Rudy.

She scanned the charts and colorful images adorning the walls, courtesy of various unfamiliar drug companies. There was a dank, musty odor of too many animals in too small a place.

The new pup was restlessly circling the room. It stopped occasionally to deposit a small but not insignificant amount of urine on the floor. Donna Ryan repeatedly adjusted her skirt and unwound the leash attached to her new pup. The urine remained.

Dr. Alfred Bain walked into the exam room. Before him was a new "Schnoodle" puppy.

"Good morning, Mrs. Ryan, I am Dr. Bain," he intoned.

"Hello, doctor, I'm Donna Ryan and this is Rudy."

Dr. Bain reached for the pup and pulled the paper chart closer. With the chart were several papers Mrs. Ryan had brought from the breeder.

"The breeder told me he would need his distemperament shot and provo shot today. She said that was all he needed. Rudy is a designer dog, Dr. Bain — half Poodle and half Schnauzer."

The doctor tried to ignore the inanity and looked down at the "medical history" provided by "Pam's Pampered Puppies."

It appeared Rudy had been given a de-wormer on six occasions and had been given a DHLPP vaccination starting at 10 days of age and every 10 days thereafter until he was picked up yesterday at the tender age of 9 weeks. Dr. Bain also noted that Rudy had been on sulfadimethoxine, flagyl and centrine for diarrhea.

Donna continued:

"Doctor, Pam told me that ordinarily she wouldn't recommend any more shots for him, but thought one more in one week would be a good thing since he was the runt."

Dr. Bain looked through the rest of the history, then turned the pup over in time to see several large and engorged fleas "heading for tall timber" laterally into the haired regions of the flanks.

"Mrs. Ryan, it appears the breeder has given Rudy ivermectin on three occasions and an application of a topical flea medication at 10 days and then every two weeks. She also gave some on the day that you adopted Rudy. ... The question is, have you seen any fleas?"

"I haven't noticed any scratching, but Pam said that an occasional flea is normal."

Dr. Bain for the first time noticed the small bottle present near all the paper work. He moved over and read the label: "Give three drops monthly for heartworms."

"Mrs. Ryan, where did you get this medication?"

"Oh, Pam told me she has this very friendly veterinarian that she uses. He gives her bulk medications and helps her figure out how to save money on her kennel. She told me to try him first, but he really is too far away. She told me her doctor would send me medication in the mail if I need it. She also said there's a lot of medication I can get on the Internet if 'normal' vets are too expensive.

"But Dr. Bain, you are nearby — I'd prefer to buy that kind of stuff from you," Donna said.

Dr. Bain rolled his eyes almost imperceptibly.

He looked the puppy over very closely. The upper incisors were a full 14-mm behind the lower incisors. At the south end, tapeworm segments were visible. The puppy was small and had an obvious mitral valvular regurgitation.

The room became quiet.

Suddenly, Dr. Bain's seemingly quiet demeanor and countenance changed. His portly frame and balding head framed by red curly hair seemed to swell. His face became beet-red and his breathing rate accelerated. His right hand trembled.

"Mrs. Ryan, why are you here?"

Mrs. Ryan was oblivious to the impending eruption.

"Why, Dr. Bain, I am here because I need a shot."

"Do you want any advice and counsel from me?"

"Well of course, I would welcome any additional help you might be able to give."

The dam broke.

"Mrs. Ryan, are you aware that I am a doctor of veterinary medicine with six years of advanced training beyond a normal baccalaureate degree? Are you aware that 'Pam, whoever she is,' doesn't know squat about veterinary medicine and is practicing veterinary medicine without a license? She is giving you advice concerning a pet she has relinquished to you for legal tender and making treatment recommendations while no longer in possession of the property in question."

Mrs. Ryan finally blinked. She understood little of what Dr. Bain was talking about.

"Are you aware that this other so-called doctor is practicing veterinary medicine outside the legal parameter of a proper doctor-client-patient relationship? Are you aware that vaccination of young pups with 'who-knows-what' antigens and using 'who-knows-what' vaccination intervals is detrimental to proper vaccination protocols and to the patient? Are you aware that indiscriminate use of topical ectoparaciticides on pets is creating resistance in the parasite populations all across America?"

By now Dr. Bain was holding his right hand to his heart as if the national anthem was about to be played. He now raised his left hand.

Sweat pouring from his brow, he went on:

"Are you aware that unscrupulous Internet pharmacies have flooded veterinary offices with requests for pharmaceuticals that are best handled through veterinarians? This has taken the very essence of medicine and surgery out of our hands and has created a logistics nightmare for our profession."

Rudy now started to bark each time Dr. Bain moved any part of his large frame.

"The infringement on our practices is monumental, beginning with our draconian tax-compliance issues all the way to continuing-education requirements and mandated paper work that makes a grown man want to sit down and cry a river."

He stopped a moment.

"Now you come in here and want me to administer a vaccination that your pet doesn't need until much later and expect me to be happy. Well, I am not. This whole system breeders have created has set the world upside-down. I am tired of the whole stupid breeder scene."

Donna stood up.

"Well, doctor, if you want me to take all my business elsewhere, I guess I'll just do that."

She turned and looked at Dr. Bain one final time.

"You know, Pam was right. She told me you vets are just money grubbers."

Moral of the story

Dr. Bain may have won the battle, but surely lost the war. Any one of us has, at some time, delivered or wished we had delivered a sermon similar to Dr. Bain's. It does us some small bit of good at the time, but in the end our clients don't care about our problems.

THE BETTER APPROACH

Never lose your cool with a client.

Inform, then reform the client's thinking process patiently.

Speak with breeders as needed to keep the paths of communication open. Remember that clients are not concerned with your problems. They shouldn't be — you are there to help them and their pets, not the other way around.

Don't expect breeders to bring you patients. It may happen, however, if you are patient.

Don't expect to educate breeders unless you establish personal rapport. They are learning veterinary medicine through the grapevine and likely feel they are reading the best available information.

WHAT ABOUT EDUCATING THE CLIENT?

The old saw is to educate the client. Is this still appropriate? Well, yes and no.

The problem is that few (if any) clients call prior to a pet purchase for guidance and counsel from veterinarians. We have always been Johnny-come-lately to the scene. Now things have worsened a bit.

Why? Because numerous other players want a piece of the action in the growing pet health-care industry. That is normal in a capitalistic society. These parties are beating us to the information punch through the Internet and other outlets. Often your advice is secondary unless the animal is sick.

The power of advertising has created credibility for these other information source, in the eyes of the public. This is hard to undo during a solitary visit to the veterinary office. Therefore we have our work cut out for us. Be patient. Try to see the patient often.

PATIENCE EQUALS PATIENTS

Model-patient visit 101 —

Pets from questionable sources

Regardless of the medical treatment or mistreatment of a puppy or kitten from a given source, it is wise to treat all visits the same.

• Take a complete history.

• Speak the language of the client — "medspeak" is "misspeak" to the pet owner.

• Perform a complete exam, with full explanations of problems found.

• Provide a treatment plan for each pet for the next several weeks.

• Expect to break the treatment plan and therapies into segments that the client can afford.

• Call the breeder. This will clarify issues and go a long way toward mending fences. It also elevates your position of authority in the eyes of the owner.

• Always make the next appointment — always. Repetitions give opportunity to correct misinformation arising from the original source and the Internet. Repetition at this point in the patient's life bonds the client to your practice.

Tip: If the client wants to call later to make the appointment, offer to make the appointment with the proviso that they can change it when they call back. This keeps the client from breaking the chain of visits needed when dealing with young pets.

"Patience is the companion of wisdom."— St. Augustine

Dr. Lane is a graduate of the University of Illinois. He owns and manages two practices in southern Illinois. Dr. Lane completed a master's degree in agricultural economics in 1996. He is a speaker and author of numerous practice management articles. Dr. Lane also offers a broad range of consulting services and can be reached at david.lane@mchsi.com