Client connection: Using diagnostics to make cost a non-issue (Proceedings)

In-clinic testing was cutting edge in the 1990's but today it is commonplace. Most practices own in-clinic instruments which may include in-clinic hematology, chemistry, electrolyte and endocrine (thyroid, cortisol) analyzers. In addition, more hospitals than ever now have electrocardiograms, ultrasound, blood gas and coagulation analyzers and tests for proteinuria, and infectious diseases like Giardia, Lyme disease and Ehrlichiosis.

In-clinic laboratories are not designed to replace reference labs; they should augment and compliment the outside laboratory. For example, if performing hematology in-clinic and abnormal cells are visualized on the blood films submit the blood film to the laboratory for veterinary pathologist review. If in-clinic thyroid testing reveals a low total T4 submit a sample to your reference laboratory for a free T4 by equilibrium dialysis.

Improve emergency and critical care patient management.

How do you define an emergency? Is an emergency a dog hit by car at 2AM? A cat with urinary tract obstruction at 3AM? A dog with pancreatitis at 4 AM? A frantic client whose dog is "not herself at noon"? The answer-all of the above cases are emergencies because the veterinarian OR more importantly the client sees the patient as an emergency situation. Emergencies occur at all hours of the night AND during the day. Use the in-house laboratory to rule out more serious diseases and begin treatment immediately. Acute canine pancreatitis is a classic example where the in-house laboratory is extremely beneficial and potentially life saving.

Critical care cases frequently require immediate diagnosis and extended monitoring only available through in-clinic analysis (electrolyte, blood gas testing, lactate, ionized calcium, etc.). The turnaround time from an outside lab may be longer than your patient can afford. Saturday night's case of diabetic ketoacidosis can't wait for a Tuesday diagnosis.

Improve your memory-signalment; history and physical exam

Your technician says Mrs. Johnson is on the phone inquiring about her pet Cuddles lab work you sent to the reference lab yesterday. Do you really remember Mrs. Johnson? Is Cuddles a dog or cat? Is Cuddles male or female? Is the technician sure this isn't your other doctor's case?

Wouldn't it be nice to remember the client and patient? In-clinic testing allows you to remember the signalment (Cuddles is a male, intact Chow-mix), the history ("not himself") and the physical exam (he tried to bite you when you palpated his abdomen). Your in-clinic laboratory improves patient management because you remember the signalment, history and physical exam because you just spoke with the client and examined the patient 30 minutes ago, not the next day when the laboratory profile is received by fax machine.

The best veterinarian to help the patient is the doctor who spoke to the pet's owner and actually examined the pet. The veterinary reference laboratory's pathologist and internists are there to assist the practitioner NOT make the diagnosis for us! By the way I consider a biting Chow Chow a normal physical exam finding!

Better medicine

Treatment should be based upon a diagnosis if possible not speculation. So why do we start treating patients before we diagnose the condition? A 3 year old female spayed golden retriever presents to your clinic with vomiting which started 4 hours ago. She is bright; alert and has a normal physical exam. Fortunately you draw blood for a CBC, chemistry (with lipase), and electrolytes and perform a urinalysis because the history and physical exam don't provide an answer. Within minutes you know whether a patient needs hospitalization now or outpatient treatment. You can prescribe medication and monitor treatment based on scientific conclusions, not speculation-isn't this we all taught in veterinary school?

Better time management for you

Clients never call at convenient times to discuss lab results. Instead, you're in surgery, with another client, or on the phone trying to trace the lab work you sent out four days ago. How often have you explained minor elevations in blood urea nitrogen or alkaline phosphatase to a client, only to repeat the conversation when the spouse calls 10 minutes later? What about discussing lab results over the phone with a client you don't even remember meeting? Now imagine examining the patient, performing lab work, and discussing results and treatment with the client during the initial 30-minute exam. In-house diagnostics can save time, sanity, and lives!

Better time management for the client

Despite our perception that clients love to visit us, the fact remains that we're a time-oriented society. Given a choice, clients would prefer a one-trip solution rather than run back and forth to your clinic while you try another guesswork treatment. Sure, more client visits may help you sell more dog food, but they don't contribute to client satisfaction. In fact our friends at the internet pharmacies constantly advertise to our clients about the "inconvenience of visiting the vet" so make it more convenient and shut them up!

Anxiety relief

How many times have you endured several anxious days waiting for lab results? Remember, most clients consider their pets valued family members. The sooner you diagnose the problem, the sooner you can properly treat the patient and ease your client's concerns. In-hospital testing decreases your stress level as well by replacing "educated guesswork" with solid diagnostic decisions.

Testing is contagious

Do you find yourself so pressed to make therapeutic decisions that you don't order lab work, just because of turnaround time? Would you perform fewer fecal exams if you were forced to send them to an outside lab? In-house biochemical profiling, hematology, and electrolyte units are similar to radiology. Once you use them, you'll realize how limited your diagnostic abilities have been without them. Testing is now considered a standard of care so consider updating your laboratory which includes having two microscopes-a less expensive one for fecal testing and urinalysis and a quality binocular microscope for hematology and cytology.