How to maintain sanity, schedule with new client

You open the door to the exam room. On the other side of the table andoccupying what seems to be half the room sits John Smith, 20 minutes lateand weighing 350 pounds. Beside him is his similarly obese Saint Bernard,Ranger- restless and salivating onto all flat surfaces.

At the sound of your voice, Ranger emits a low growl and urinates freelyon the floor. In John's arms, present for moral support, is "Pixie,"a 4-pound Yorkie terrier. In the corner sits 5-year-old nephew, Jason. Yourseemingly simple job is now daunting: In 15 minutes you are to give Ranger'sannual vaccinations, annual lab tests and a physical examination for lumps,bumps and constant scratching. Suddenly, John's cell phone rings.

Veterinarians are presented daily with similar situations. How you handlethem affects your professional reputation, income and, ultimately, youremotional health.

If you and your staff don't have a game plan it will ultimately leadto burnout.

Avoiding burnout

Over the past several years clients have complicated our patient examinationsby bringing with them a second pet (along only for the ride), cell phones,beepers and assorted gadgets, children, and physical limitations.

The landscape has changed forever. Bottom line: the owners are overburdenedand preoccupied.

Asking them to lift the pet and restrain it on the exam table for evena small period of time is problematic and unsafe-for both you and the client.

In addition, educating a distracted client under these circumstancesis challenging. Since clients often bring multiple problems and circumstancesto us, the traditional 15-minute office visit is out the window.

An unorganized visit by Mr. Smith and his dogs can cost your clinic bothtime and money. Several questions need to be addressed.

* Can you maintain your emotional balance?

* Will this client and pet have a positive experience at your office?

* Will you be able to manage all the needs of this patient in a timelyand efficient manner?

* Does this pet present a safety issue for the client and staff whilein your clinic?

Short answer

While this article does not address staffing issues directly, the shortanswer to these questions begins with proper staffing.

If you are still practicing by yourself with only a receptionist anda kennel worker because you cannot afford to hire more staff-think again.The economics long term are against you. There is no substitute in today'sfast-paced world for properly trained staff-especially exam room assistants.Whether you are a solo practitioner or have multiple associates, staffingfor the exam room is essential.

Can you maintain your emotional balance?

Before meeting John Smith and Ranger, you had just left your other examroom where Mrs. Brown had brought "Jake" to have a nail trim.

According to Mrs. Brown, only the veterinarian appears qualified to trimhis nails. Jake had never been on a leash before today and was full of smellyhair-mats. In addition, he was dripping with mud from the morning rainfall.

Much of your staff's time was spent mopping the floor and changing smocks. While we wrestled with Jake, Mrs. Brown tries to balance her checkbookand groused that she was late for her daughter's soccer tournament.

After your encounter with Mrs. Brown, you try to recoup your composureas you enter to work with Ranger.

Having reviewed the scene, you wait as John Smith finally clicks hiscell phone shut. He seems agitated that he had to wait an extra few minutes.How do you react?

The battle now is to retain your professional deportment. As difficultas your day may get, you must maintain your composure. Otherwise, you willlash out at the people who are there to support you and your patients-thestaff. Here are some tips.

* Take a deep breath-it works

* Avoid petty arguments with clients. Instead, be supportive and understandingof their point of view. Never play the 'bad guy'.

* Always thank your employees for working through difficult situations.

* Maintain an exercise program. This helps balance your physical andemotional body chemistry.

* Never degrade or talk about a difficult client after they leave. Thistype of behavior is self-defeating and is the hardest thing of all to do.It sets a negative tone for your whole hospital environment. Once you start,your employees will follow your lead.

A positive experience

Your reputation may hinge on a positive or negative experience peoplewill have in an examination room.

Bad news spreads quickly. People will gauge your competence not on yourknowledge but on our compassion and care for their pet. Remember that thisis the owner's baby. An animal's negative behaviors such as biting, scratchingand elimination behaviors will likely be attributed to the veterinarianand not the animal itself. In other words, the patient doesn't "like"the veterinarian.

Unfortunately, an owner often tends to harbor lifetime attitudes andbiases based on a single experience. Things that can improve your chancesof creating a positive experience:

* A lowered and softer voice

* Calling the pet by its name and using "baby talk."

* Lowering your position or first examining the animal while you siton the floor.

* Avoiding eye contact with aggressive animals.

* Gently separating the animal from the owner.

* An assistant for restraint during the exam.

* A professional and friendly attitude in the exam room and at the frontdesk.

Time efficiency

For Ranger's annual visit to be handled efficiently, the needs of theclient and the needs of the patient should be organized in such a way thatthey are crystal clear to all staff members. These issues should be arrangedin such a way as to reduce the total time your client spends in your office.

First things first

Certain procedures should usually be attended to first.

If the owner needs medicine refilled, find this out up front so thesecan be done in the background while the owner is waiting to get into theexam room or while the pet is being examined. Your goal should be to handleRanger's visit with the greatest time efficiency possible while attendingto the total needs of the client and patient.

Exam room

* Weight and temperature recorded

* History and concern of the client should be written into the chart.

* Lab tests should be taken and running before the veterinarian entersthe exam room.

Three golden needs

There are three basic needs that should be addressed during each officevisit.

Remember that client needs and patient needs are separate issues. Rememberingthem will save you and your client a lot of time.

Have you met the owner's needs? No matter how appropriate the therapy,if it does not address the owner's chief complaint you have achieved nothingin the eyes of the client. You must address the problem as perceived bythe client with either appropriate therapy or be prepared to justify yourreasoning for not treating the owner's chief complaint.

Not addressing the chief complaint is one of the worst time wasters inveterinary medicine because it creates unnecessary recalls and frustrationfor the client. Education of the client is the key.

Have you met all the current real medical needs? The pet has certaincurrent needs. Have you addressed them all? Have you recorded these needson the medical record?

Have you made proper provision for future needs? Do you have a writtenfuture therapy plan for the pet that has a guaranteed follow though? Thisissue is critical to the health of your patient and practice. This is bestdone with a three-pronged approach: appointment cards and confirmed appointmentsfor the next visit, postcard reminders for annual exam and vaccinations,phone calls for future surgeries and procedures, and written instructionsfor the client in the exam room.

If you cannot connect the patient with the next visit, you will delayor miss 50 percent of the work needed for the pet. This is not good medicine.