Focus on fecal compliance in veterinary practice

If there's one thing we've learned in more than 20 years of association with veterinary medicine, it's this: There aren't many topics here that make for polite dinner table conversation. People don't want to know that the term melena means black, tarry stool—especially when they just named their baby daughter Melina. They aren't interested in hearing about the 32 yards of carpet yarn you helped remove from a pit bull's stomach last week. And they definitely don't enjoy hearing that their dog or cat, their pride and joy, could have worms. The real clincher to that conversation is when you tell them that to find out for sure, you need to examine their pet's poop.

Worms and poop: two sure-fire conversation-stoppers. But it's an important conversation, nonetheless. And since it's definitely not a conversation that most clients will ever initiate on their own, it's important for each team member to play a part in educating clients about intestinal parasites and the importance of fecal testing.

Managers: Poop happens

Chances are, most of your clients have had a fecal test recommended at least once or twice. And chances are, many of those same clients may have chosen to overlook that recommendation. But when your whole team gets involved in educating the client, and the client hears the same message consistently and repeatedly from multiple team members, you provide the knowledge clients need to make an informed decision. More often than not, with proper education, your clients may just start to comply.

People need to have information presented to them multiple times and in a variety of ways for it to become part of their memories and belief system. That's why it's so important for each team member to be involved in making fecal compliance successful. Each team member plays a vital role.

An effective fecal compliance program starts with the practice owner. Before you launch a program, the practice needs a fecal testing philosophy, and this should be based on the practice owner's recommendations. Should fecal testing be done once a year? Twice a year? With every new puppy and kitten? Should testing include Giardia?

Once you've defined the practice's fecal testing philosophy, it's time for the practice manager to develop protocols. Protocols will ensure you're delivering a clear message—and consistency is crucial. We confuse clients when the technician tells a client one thing and the doctor tells a client something else. And confused clients often take the easiest route—doing nothing. When you're developing your practice's program, consider these critical points:

• How much does our team know? Because we all have diverse backgrounds and experience, some team members may not have a complete understanding of intestinal parasites, how they are spread, and the damage they can cause. Some technicians may not understand how to obtain a fecal sample. They may be too nervous to attempt it, or they may find it distasteful. A good fecal compliance program will include preliminary and ongoing staff education. By working together to improve our knowledge and skills, we are empowered.

• Does our team know how to talk to clients about worms and poop? It's not just the average client who will be uncomfortable with those topics. Chances are, team members won't feel comfortable either, at first. To increase their confidence, practice managers should make sure their fecal compliance program includes communication training. Provide team members with talking points to cover every time they discuss fecal testing with clients. Some team members may even need a word-for-word script until they're comfortable enough to put things in their own words. Role-playing the conversations in advance will ensure they don't stumble over their words when they speak with clients.

• How much do our clients know? Most likely, they don't know a lot about intestinal parasites. If you're the manager, you can provide direct education to clients in bite-sized pieces via the website, Facebook, direct emails, and in-clinic materials and displays. You can also set up practice management software to include reminders for fecal testing, along with wellness exams, which increase clients' opportunities to learn.

• How is our program working? Once you've established a fecal compliance program, it's important to continue to monitor your success. When you introduce a new program, it's unfamiliar and strange. Team members will feel more comfortable doing things the "old" way—it's human nature to want to keep to the familiar. If you don't monitor and enforce the new program, it most likely won't achieve the desired results.

Receptionists: Make first contact

Receptionists, you may not believe you play much of a role in fecal testing compliance. But consider this—a client's first contact with your practice is usually with you. A client calls to schedule an appointment for a wellness exam. What could be more logical than for you to plant the idea of fecal testing right then?

For example, you might say, "I would be glad to schedule Fido for his wellness exam. Part of keeping Fido healthy will be to make sure he is free of intestinal parasites. To do this, Dr. Johnson recommends that we do a fecal test. We can obtain a fecal sample while Fido is visiting us. Or, if you prefer, you are welcome to bring a gumball-sized sample with you in a plastic bag when you visit."

From that first contact, receptionists on the front lines can encourage clients to think about the importance of fecal testing. This conversation doesn't need to be limited to wellness exams. The recommendation is equally valid for medical exams and surgical appointments. In fact, surgery is the perfect time to obtain a fecal sample. After all, an anesthetized animal won't be traumatized or tensed up.

Receptionists will further the message about fecal testing when they make reminder calls the day before clients' appointments: "I'm calling to remind you of Rover's appointment with Dr. Johnson tomorrow at 3:30 p.m. I also wanted to remind you that Dr. Johnson recommends doing an annual fecal test to keep Rover and your family free of intestinal parasites, so don't forget to bring a fecal sample with you. Or if you prefer, we are happy to obtain the sample during Rover's visit with us."

When a client arrives for an appointment, the receptionist asks, "Did you bring Fluffy's fecal sample with you today?" If the client answers yes, the receptionist responds, "Great! I'll go ahead and take that now. By running a fecal exam, we can ensure that your pet is parasite-free and that your family is also safe, since intestinal parasites can be transferred from your pet to you. We will get the results of the exam to you in 24 hours." Positive reinforcement helps assure clients they're safeguarding the health of their pets and their families.

Despite the reminders receptionists make, it's fairly common for clients to fail to bring a fecal sample with them. Maybe they forgot. Maybe they didn't have time. Maybe they were too grossed out. Or maybe they don't yet understand why a fecal test is important. Regardless of the reason, when clients do not bring a sample, the receptionist provides assurance that technicians can obtain one during their visit.

Tech talk: Got poop?

Once clients enter the exam room, the technician can reinforce the message about fecal testing. The most important thing technicians can do is to explain the zoonotic properties of intestinal parasites. Many people don't know that intestinal parasites can often be transferred to humans, and that by keeping their pets parasite-free, they are protecting themselves and their families as well. So if you're a technician, encourage clients to ask questions for clarification. For example, some clients think that we check for heartworms through stool samples. If they ask questions like this, don't laugh. Answer as if it's the first time you've heard this very reasonable question.

It's also a good idea to supply clients with written educational materials to look over. Most pharmaceutical vendors will supply your practice with these materials for free. Even if the client chooses not to read the material right then, you've planted another seed about the importance of fecal testing.

Once the client agrees to the test, offer to obtain a sample using a fecal loop. Again, positive reinforcement is valuable: "Good for you for making sure of Coco's intestinal health today!"

Occasionally, you won't be able to obtain a fecal sample during a pet's visit. The pet may be too traumatized to tolerate the procedure, or it may have recently emptied its bowels. In this case, recommend the client pre-pay for the fecal test and provide a clean, labeled container for the client to return with a sample.

Doctors: Seal the deal

It may seem like all of the work for fecal testing compliance is finished by the time the veterinarian enters the exam room, but the doctor's role is just as important. Veterinarians confirm the information the rest of the team has given to the client. Their stamp of approval validates the whole fecal testing compliance program.

When the veterinarian enters the exam room, he or she asks the technician whether fecal testing has been performed. If it has, the doctor's immediate response is, "Excellent! I commend you for having Buddy's best interests at heart and for protecting him and your family from intestinal parasites." Praise from the veterinarian will forever cement the importance of fecal testing in the client's mind.

If the client chooses not to do a fecal test or is still unsure, the veterinarian becomes the closer. He or she reviews the information you've already offered and answers the client's questions. Veterinarians have an obligation to provide their best recommendations. Shielding clients from the ugliness of intestinal parasites and the damage they can cause does more harm than good. Hearing a veterinarian unequivocally state his or her recommendations for fecal testing will often help undecided clients make healthy pet care decisions—and may even change the minds of clients who declined the test.

Fecal compliance programs don't end once you've taken the sample and ordered the test. The follow-through is just as important as the test itself. Your practice needs to contact all clients with the results of their pets' fecal tests. Veterinary technicians or receptionists can call clients to report any non-positive test results. A quick phone call and a simple note of the test results in the patient's record are all that's necessary.

Positive test results require a treatment plan. Once the veterinarian creates the plan, a technician contacts the client, explains the results, and outlines the recommended treatment regimen. Or, to increase your client's perception of value, the veterinarian can personally call the client.

Understandably, clients receiving unpleasant news will be distressed. So it's important to confidently assure clients that their pets will soon return to full health.

Despite your best efforts, some clients will still decline fecal testing. But if everyone has done their job, then at least clients will make an informed decision. Worms and poop will never be anyone's favorite conversation, but with a team approach, it can be an effective one. Just don't bring it up at dinner parties.

Christine Hall Johnson is practice manager of PetsFirst! Wellness Center in Brigham City, Utah. Debbie Allaben Gair, CVPM, is a Firstline Editorial Advisory Board member and a management recruiter and coach with Bridging the Gap in Sparta, Mich. Post your comments and questions on the community message board at dvm360.com/comment.