Client education keeps door open for compliance

Client compliance is directly related to client understanding. Clients should not be expected to accept that which they cannot understand or see value in. Simply put, if you spend enough time educating a client on the need for a particular service or product, he or she will generally accept it. This sounds easy, but it requires looking into other issues first.

Identify and address your clients' barriers to compliance

In order to educate a client effectively you must first identify the barriers to compliance. Is it financial concern, is it fear of anesthetic complication or is it due to a lack of perceived value in the recommendation? Once the barrier has been identified it can be addressed. Each client will likely have a different barrier and that barrier must be identified and addressed through education before compliance can be expected.

For example, let us look at a recommendation for a dental prophylaxis made on an annual vaccination visit. After examining the pet the doctor recommends scheduling a prophy. Upon hearing the recommendation the owner appears uninterested and blurts out, "What do I care how pretty the teeth look?" Obviously the owner has missed the medical message and needs to be educated on the long-term effects of bacterial infection in the mouth. Or the client shows reservation stating, "I have heard that anesthesia is needed and that sounds dangerous to me!" In this situation the owner needs to hear reassurance about safety precautions, such as thorough pre-anesthetic exam and blood screening. Or the client complains about the fee, "Why should I spend $120 on my dog's teeth? That's more than I spend on my own teeth!" This client needs to hear the rationale about how preventative medicine is cost effective in the long run. Recognizing the barrier and properly addressing it will make for enhanced compliance.

Table 1. Compliance Issues

Build a trust connection

Second, education must come from a position of having the client trust their relationship with you. Without this strong client bond, education may fall on deaf ears. Yet client trust develops over time. Practitioners build trust with their clients early in the relationship such as during the puppy or kitten series or a comprehensive first-time visit. Demonstrating a dependable, sincere, and caring attitude is critical in developing this bond. Once this bond has been developed, gaining client compliance becomes a much easier task.

This may be more difficult to accomplish in a multi-doctor practice. Here, efforts also must be focused on staff uniformity in client education. The entire practice team should carry the same message. Failure to recognize this need will contribute to a lack of trust, and compliance with recommendations will be lessened.

Maintain a position of credibility

Third, credibility of the educator, whether it is the doctor or a member of the support staff, is important. Clients are more likely today to make judgments regarding the doctor's level of knowledge on an issue by comparing it to information that they have pulled off the Internet. Compliance will be minimal if the practitioner lacks credibility, fails to demonstrate thoroughness, or fails to accurately educate the client. It is valuable for clients to become aware of doctor and staff continuing educational accomplishments. Over time clients should become aware that their doctor (and associated staff) are knowledgeable and current on their information. Education thereby becomes anchored to a foundation of credibility.

Dr. Gwen Schlueter of Sulphur Springs Veterinary Clinic, St. Louis, Mo., is demonstrating periodontal disease to a client. Notice that the client is not holding his own pet for exam, thereby freeing him to better visualize what the doctor is demonstrating. Restraining and assisting is dental hygienist Lori Pogue, who will further explain and schedule needed procedures once the initial exam is completed.

Demonstrating thoroughness is important in being credible. To illustrate, consider a situation where a client presents a pet with an illness. In scenario one, Dr. Hurried takes a superficial look at the pet and immediately makes a recommendation for hospitalization and a complete laboratory work up. Only a very loyal client would be compliant to Dr. Hurried's approach. Contrast this to scenario two where Dr. Methodical took a more thorough approach by attentively listening to the client, carefully reviewing patient history, noticeably doing a thorough physical examination and then engaging the client in creating a plan of action. Using this protocol, most clients would be readily compliant with the veterinarian's recommendations.

Build value for compliance through education

Having a solid foundation based on trust and credibility, the client will at least listen to the recommendation but now the doctor must spend time and effort building value to their recommendation. Clients should not be expected to blindly accept a recommendation; nor should they be expected to accept something that does not appear to be of value. Educating the client on the need for compliance will endorse the value and lead to compliance.

Table 2. Methods To Educate & Stimulate Compliance

All too often practitioners are disappointed when clients do not eagerly accept their recommendations. They are angered by the client's quick refusal and may even give up the cause, ultimately subjecting the pet to less-than-adequate care. What they should do is spend more time and effort educating the client on the reasoning behind the recommendation, engaging the client in the process. Each client's level of interest and comprehension will differ and should be easy to recognize.

For example, let's return to scenario two. Dr. Methodical has just completed his recommended laboratory evaluation and begins discussing the findings, face-to-face, with the owner. Dr. Methodical uses the initial lab report as a work sheet to outline the differential diagnosis and develop a rule-out plan for each item on the differential. By visualizing the doctor's thought process and recognizing the importance of each step, the client is far more likely to accept the necessary additional recommendations for proceeding with the diagnostic plan. The client will accept additional laboratory tests, radiographs or ultrasound or other necessary diagnostics. Building value to these follow-up tests by client education will usually help in gaining the necessary compliance. This same philosophy applies to recommendations for surgical, dental and other procedures.

Table 2. The 5 steps to gaining compliance.

Reflect on the latest challenge - that of maintaining the "annual visit" without the "annual vaccination." Practitioners will need to use every morsel of credibility and client trust they have hopefully built over the years in facing this new compliance challenge. Getting clients to bring in their pets for annual exams when they may not need an annual vaccination will be the supreme test of the practitioner's compliance skills. See this month's DVM Newsmagazine's InFocus supplement for ideas.

Common obstacles to educating clients

• 1. Insufficient appointment times. All too often practitioners become frustrated about getting a client to accept a particular recommendation. The problem often starts with scheduling appointments. The allotted times are often not sufficient for spending the necessary time to make a client aware of the need for complying with a recommendation. Without adequate time the client doesn't have the time to ask questions and gain the necessary knowledge to comfortably make a decision.

• 2. Lack of sufficient visual aids.Special effort must go into creating a visual image. A drawing, picture, model, live animal, computer or video monitor is extremely helpful in educating a client. In my practice, we use an LCD screen attached to a camera on a microscope to help the client gain knowledge and build trust in the recommendation in prolonged treatment necessary for a difficult mange case. By seeing the organism on the scope it creates a strong mental image that will greatly enhance owner compliance.

• 3. Lack of sufficient exam room help.Taking time to vividly demonstrate periodontal disease to a client will convince an owner to comply with a dental prophylaxis recommendation. But this cannot be accomplished if owners are expected to restrain their own pet during the examination. A major shortcoming in demonstrating dental disease in many practices is simply due to the inability of the owner to visualize inflamed gums while they are struggling to restrain their pet.

• 4. Not building an adequate case for compliance.Many times the busy practitioner fails to build an adequate case for compliance with the recommendation. A concerted effort must be taken. Being in a hurry and skipping key educational steps will lessen compliance or may cause buyer's remorse later on. Time spent in this area will also improve client acceptance of higher fees that often result from complex workups or procedures.

The ability to acquire compliance with recommendations is usually related to paying attention to many issues over time. It is important to have created the proper groundwork for client compliance by building a solid connection based on trust and credibility. Assessing individual client's preconceptions and spending effort addressing them is very important. Spending adequate time and energy, using visual aids, charts, drawings and worksheets to engage the client is indispensable. Most of all, building an adequate case for compliance with recommendations by thoroughly educating and engaging the client will boost client value perception and usually result in compliance. The practitioner's ultimate goal should be to educate the client so well that the client can only arrive at one logical conclusion, that of compliance with his or her recommendations.

Suggested Reading

Dr. Irwin has been a small animal practitioner for 31 years. He has owned and managed three practices in suburban St. Louis for more than 20 years. He has spoken on topics including practical hematology, diagnostic testing, wellness screening, using high technology equipment such as a CO2 laser and other in-house diagnostic equipment to enhance the quality of practice. He has lectured to veterinary groups throughout the United States, Canada, Australia, New Zealand, South Korea, England, France and Germany. He has written and published more than 30 articles in veterinary books and journals. His topics include the use and marketing of in-house laboratory diagnostics, CO2 laser and other higher technology equipment to improve the level of practice. He received his veterinary degree from Purdue University in 1971.