Eight steps to crush it in the exam room

Getty ImagesAre you a pro in the exam room? I'm not talking about your medical skills (let's hope those are excellent), but instead your communication skills, your use of support staff and your client education. Here are some tips and skills you might want to work on to improve your exam room effectiveness:

Do you speak in a definitive voice?

Clients come to you for advice to help them resolve problems with their pets, but are you actually telling them what they should do? Too many times in exam rooms I hear doctors go through a litany of things clients could do: “We could take an X-ray … or maybe do some blood work … or we could just send him home on some medication and see how he does.” No! The client is not the veterinarian-you are!

What would you do if that was your pet sitting on the exam room table? That's what I believe you should offer the client, nothing less. Then inform clients of the cost and see how they respond. Don't try to X-ray the client's purse or wallet. Instead, offer clients the best possible care for their pet. You are the pet's advocate, after all.

During a recent consultation at a veterinary practice, I was reviewing numbers with one of the associate veterinarians. This doctor had gone from an average client transaction of $140 to more than $220 in just two months. When I asked the doctor what happened, he told me, “I stopped offering plan B.”

Tell your clients what's best for the patient. Use such statements as, “I would recommend X” or “If this was my pet, I would do X.” You're the doctor, so act like it.

Getty ImagesTake a full-service approach

Here's a scenario: The appointment is for a rabies vaccination, but you've never seen this pet before. Or maybe you have seen the pet, but as you look through the medical record, you find there's no history of any other vaccinations or preventive care. You need to take what I call the full-service approach. Take the time to review all the pet's preventive healthcare needs, and make sure the client knows what needs to be done. Has the pet had a fecal analysis performed in the past year? What is the client using for flea control or heartworm prevention?

Many veterinarians depend on their exam room assistants to review this information with the client. I've watched hundreds of exam room videos, and I have seen assistants who did a very good job of educating clients, but those are more the exception than the rule. The responsibility to educate clients about preventive care must be a whole-team effort. Exam room assistants should have a form or checklist they can review with clients, but the doctor should reinforce these recommendations, especially on services the client declines. Remember to look at <i>all</i> your patient's needs, not just the presenting problem.

Do a comprehensive physical exam

Regardless of what brought the patient into your exam room today, this is your opportunity to do a comprehensive physical exam. As you first enter the room, it may be obvious that the patient has an infected ear, a laceration or an injured paw, but what else might you find if you did a comprehensive physical exam?

Time after time, I see veterinarians walk into an exam room, look at a patient and immediately address the most obvious or admitting complaint without first doing a comprehensive physical exam. The doctor says to the client, “I see Fluffy is here because she's limping on her leg.” Then the doctor never examines the rest of the patient.

You can avoid this pitfall.  In the above scenario, the doctor can say, “I see Fluffy is limping on her right rear leg, but before we talk about that, I'm going to do a comprehensive physical exam. I'll check Fluffy from nose to tail and make sure there are no other problems, then I'll come back and focus on her leg.” Don't miss your opportunity at every visit to make sure there are no other problems.  

Getty ImagesEducate, educate, educate

When clients complain about price, it's usually never really about price. It's because they don't see the value of your services. It is our responsibility to educate them and show or fully explain what your fees pay for in high-quality medical care.

One practice-owning client did just that by creating an educational video that walks clients through a day in the life of a patient having its teeth cleaned at his hospital.  Whenever a dental cleaning is recommended, the veterinarian offers to show the client the four-minute video. The percentage of gross revenue coming from dental work has risen from less than 1 percent to more than 6 percent and, best of all, there are basically no complaints about fees. 

When making a recommendation, make sure you or a team member take the next step to educate clients about what it is you want them to pay for. This can be done with a video (there are excellent videos on YouTube) or with a handout, a digital display board or sometimes a tour of your practice, so that they can see the quality and excellence of your services. 

Leverage yourself

Are you using exam room assistants in the exam room to help you restrain patients, educate clients and make sure you have what you need during visits? You can better leverage yourself as a veterinarian by surrounding yourself with the right team members. Do you need to be the one to give the flea speech or to discuss crate training? Many of these tasks can be done by a well-trained exam room assistant or technician. Of course, the key to success here is to hire and retain a well-trained team. But if you can leverage your team effectively, it will really help you to be more productive.

Getty ImagesMind your body language

If there's a conflict between your words and your body language, which do you think people will believe? The answer is always body language.

Start exam-room visits off right. As you walk into the exam room, extend your hand, make eye contact and greet the client. Say, “Good morning, Mrs. Jones. I am Dr. Smith. It is so nice to see you today.” Say hello to the patient, too.

Don't stand behind the exam room table with your hands in your pockets or leaning back against the counter. Come around the table and talk to your client and your patient. Many times, it makes sense to sit down next to the client, especially when discussing issues such as euthanasia. Ask your exam room assistant to give you some feedback on your body language and you can do the same. You might be surprised at what you will learn.

Be sincere and show empathy

People don't care just about what you know-they want to know you care. Do you take a sincere interest in your clients and their pets? Does this come across in the exam room? Do you listen to them and hear their concerns, or just pretend to listen? Clients can tell, and standoffishness or impersonal relations hurt compliance with your recommendations.

If possible, film yourself in the exam room. Watch your body language, how you say things and how the client responds to you. It's sometimes shocking to hear what clients say to spouses or friends in the exam room: “It seemed like she was doing us a favor by seeing Sam today,” or “She didn't seem to care about him at all.”

Use the three-step approach

At the end of the visit, try the three-step approach:

1) Review with clients why they brought their pet in today

2) Tell them what you did about the problems or issues they raises

3) Tell them what they need to do after the visit.

Here's an example: “Mrs. Jones, you brought Casey in today because she was scratching at her right ear. I did a comprehensive physical exam on Casey and found her to be healthy. In regards to her ear, we did a cytology and found an infection. We'll send some medication home with you today to take care of that ear problem. I would like to see Casey back in 10 days so we can check on the progress. I'll have Susan, my exam room assistant, show you how to medicate Casey's ear. Do you have any other questions for me today?”

If the client has no questions, you can turn them over to your exam room assistant. Then shake the client's hand, say goodbye to Casey and off you go. The three-step approach lets clients know you were listening, reinforces what you did and ensures they know what they need to do to follow up.

Although every veterinarian knows they will either “make it or break it” in the exam room, they often don't pay enough attention to the exam room experience for clients. You need to work on exam room skills the same way you do your medical and surgical skills. Filming yourself in the exam room is one way to do that. Good wireless cameras can cost as little as $150. Whatever method you use, make sure you evaluate how effective you are in the exam room-it's critical to you and your practice's future success.

Mark Opperman, CVPM, is a certified veterinary practice manager and owner of VMC Inc., a veterinary consulting firm based in Evergreen, Colorado.