Bad reaction: How to prevent your veterinary practice from falling in the reactive medicine trap

One Friday afternoon, Dr. Jennifer Hayes of Mountain View Animal Clinic entered an exam room to find a young couple nearly hidden behind their large 4-year-old Rottweiler, Brutus. Brutus was perched precariously in one of the fiberglass chairs, wedging his owners, Julie and John, into a corner.

For Dr. Jennifer Hayes of Mountain View Animal Clinic, caring for Brutus the Rottweiler was the least of her worries. Learn from her mistakes and make proactive medicine standard in your practice. (THINKSTOCK/MOODBOARD)

"Don't worry, Doctor, he does this all the time," said Julie. John stayed silent, watching Dr. Hayes intently.

At that moment Brutus shook his head, and Dr. Hayes could hear the thud of his right ear against the exam-room wall. The result was a bloody ear print, and the ear hematoma was obvious. The pungent odor of underlying infection filled the room.

Before Dr. Hayes could address the owners, she was interrupted by a quiet knock on the door. It was Tamara, her receptionist, who beckoned her outside the exam room.

"Doctor, I'm sorry, but I had to put them in the room ahead of a few people because Brutus was making everyone in the waiting room nervous," Tamara said. "And there's something else. They were at Academy Animal Hospital this morning, and apparently they told the receptionist there that they couldn't afford surgery for Brutus. They didn't tell me this until just now—as I was walking them back."

Dr. Hayes thanked Tamara for the information, then headed back into the exam room to ask her new clients some questions. Julie gave Brutus' pertinent history and mentioned that the veterinarians at Academy Animal Hospital were only interested in money. Dr. Hayes asked how much they had quoted.

"Well, they said they needed this and that and that Brutus needed to be anesthetized, plus the aftercare ... I think they wanted $1,200 for everything," Julie said.

Dr. Hayes listened carefully and approached Brutus with her hand in a friendly manner. His eyes grew large and he growled deep in his chest.

"Is he friendly?" Dr. Hayes asked, knowing what the answer would likely turn out to be.

"Usually," answered Julie. "Well, he's pretty nice most of the time."

"Did the other veterinarians this morning have any problems?"

"Well, yes, that's part of the situation. Brutus was scared and the other doctor didn't seem to want to do the surgery. In fact, they had originally told us the price would be $900, then after they dealt with Brutus a little bit, it went up to $1,200 for some reason."

Academy Animal Hospital was Dr. Hayes' top competitor. Though known to be expensive, the 24-hour hospital still lured clients in with low vaccination and exam fees. Any sign of trouble, though, and prices jumped.

Dr. Hayes took the opportunity to discuss Brutus' underlying ear disease and the aftercare involved, plus the possibility of his condition affecting the other ear in the same way.

Julie piped up again: "Doctor, I should tell you—my husband and I only have $200 between us. But we want the best care for Brutus."

Dr. Hayes quickly assessed the situation. She needed new clients, and if she played her cards right, this couple that ostensibly wanted great care for their pet could become great clients as well. She was running behind and didn't have time to make a proper estimate. So she blurted, "We should be able to do this for about $800, plus medications, this afternoon. Tamara will help you go through Zoo Cross Credit. If you're approved, we can proceed." With that, she exited the exam room and headed to her next appointment.

A half-hour later, Tamara caught up with Dr. Hayes in the hall. She told her that Zoo Cross Credit would only approve Julie and John for $400. The couple would pay their own $200 on top of that. Dr. Hayes was conflicted but made a hasty decision. "Oh, all right. Tell them we'll do it for $600."

With adequate muzzling, premedication and a lot of attention to detail, the surgery went well and Brutus was discharged the next morning with an E-collar. That morning was a busy one, and Dr. Hayes didn't end up talking to Julie or John on their way out. Tamara gave them an ear surgery aftercare handout and they paid with Zoo Cross Credit and $200 in cash. Tamara told Julie and John to call and talk to Dr. Hayes if anything came up or if they had any questions.

Unbeknownst to the staff at Mountain View Animal Clinic, things were about to get dicey.

"You took us to the cleaners!"

Monday morning came and went without much fanfare, but then, around noon, John showed up at the front desk. He was fuming. Tamara did her best to calm him down, but he demanded to see Dr. Hayes.

When Dr. Hayes approached the desk, he shouted, "You! You took us to the cleaners! I can't believe we ever trusted you with Brutus!"

As it turned out, Brutus' ear had begun to swell up again on Saturday, after Julie and John took the E-collar off at home. They arrived at the conclusion that the surgery had been done incorrectly and took Brutus to Academy Animal Hospital, where the veterinarian on staff said nothing could be done other than lancing the ear. Julie and John elected to do the procedure. Brutus was doing OK until Sunday night. When Julie called the Academy veterinarian, he told her to take Brutus back to Dr. Hayes to have the surgery done over again.

John was still seething. "You guarantee your work, don't you? We went into debt over this simple ear problem. We want our money back and we want you to fix Brutus for free. Oh, and you better believe I'm going to post online about what a terrible job you did!"

Dr. Hayes knew what she was up against. She went through the usual disclaimer discussion, the degree of difficulty and every other defensive move she could muster. But the longer she spoke, the more she realized this was a no-win situation and began to soften. Dr. Hayes, like so many veterinarians in similar situations, prepared to make a financial sacrifice for the sake of Brutus.

Combating reactive medicine

There are three separate issues that cause almost all veterinarians to work in a reactive mode:

> Private practice does not lend itself to easy patient planning. Animals get sick regardless of time and circumstances. Walk-ins and acute crisis management are part of daily practice.

> Veterinarians are busy even when there are no patients. There is a lot of uncontrolled and unproductive time spent each day.

> Veterinary medicine is a helping profession. By nature, we veterinarians want to react and make things work out for both the client and the patient.

Dr. Hayes was working in reactive mode. Let's review what she and the rest of the staff at Mountain View could have done differently to be proactive rather than reactive.

Arm the troops. Anything out of the ordinary needs to be reported to the doctors before an appointment begins. A "heads-up" is always appreciated. Dr. Hayes should make this a part of her employee training.

Expect the unexpected. Veterinarians will always work with unpredictable problems and patients. It's crucial to educate clients about your plan of action and incorporate multiple outcome scenarios—this should take place before you move forward. And writing these plans down is important. Dr. Hayes started out well with John and Julie but did not follow through.

Don't be an auctioneer. Because Dr. Hayes needed to move on to waiting clients, she did not take the time to offer even a general estimate to the client. This was a critical mistake. If you are willing to come down in price after offering a reasonable estimate to the client, you are conducting an auction. This is unfair to everyone—including the patient. You must make time for an estimate. Clients should be told that estimates are just that—charges vary depending on changing circumstances. Estimate preparation should be the responsibility of an employee in the practice so the doctor can focus on seeing patients.

Watch for red flags. A client will drop a wonderful veterinarian in a heartbeat. When a client disparages another veterinarian in your presence, it's always a red flag. Trust is on the line. Once John turned on Dr. Hayes, she made the mistake of defending her actions, which is always unpleasant music in the ear of the client. Take the client's perspective and find ways to solve the problem for them, even if it's just asking them what they want.

Be wary of the beck-and-call. A veterinarian coming to the phone any time a client calls in will lead to reactive chaos. Clients calling in to "talk to the veterinarian" should be told the veterinarian or technician will call them with a report within a given time range. After reviewing the chart and the estimate, the veterinarian or a trusted technician will need to go over the patient care with the client on the telephone and likely outcomes under specified home care. If you have given a proper estimate, you do not need to go over charges.

Focus on the follow-up. Someone in every veterinary practice needs to be assigned to follow-up cases and call clients proactively. Julie and John would probably have come in to Mountain View Animal Hospital with Brutus on Saturday—if they were called and prompted to. This seems difficult, but checking on patients is much easier than the reactive scene that unfolded Monday morning.

Strategize social media. Remember—most satisfied customers don't take the time to post positive comments. Cross a client (even innocently) and they will tell as many people as possible that they have been wounded. Add social media to the mix and you can have an explosion of negative comments seemingly worldwide. This is all the more reason to be proactive.

Improve your outcome. Reactive medicine leads to poor patient care and client headaches. Being proactive means anticipating problems and planning for better outcomes. So don't tell clients to call if problems develop. Clients who say they have no questions after an appointment mean they have no questions for the front desk. If the veterinarian were to suddenly appear, you can bet the questions will spill out. In this case, Dr. Hayes should have called John and Julie after the procedure or seen them in the exam room for a scheduled checkout appointment.

Much of our job as veterinarians is simply to convey an understanding of the different scenarios that a client may face. Everyone wants a better outcome for both the patient and the client. And above all else, we should practice what we preach—especially when we preach preventive medicine. After all, that's what being proactive with client relationships is all about.

Dr. David Lane owns and manages two practices in southern Illinois. He has a master's degree in agricultural economics and is a consultant, speaker and author of numerous practice- management articles. He can be reached at davidlane1948@yahoo.com.