Knock your clients' socks off with compassionate care: part 1 (Proceedings)

Defining Compassionate Care

When practicing from the perspective of compassionate care, veterinarians and their health care teams dedicate themselves to always advocating for what is best for the pet — advocating on behalf of a being that cannot advocate for itself. By advocating for what is best for the pet, we are actually advocating on behalf of the Family-Pet Bond. Veterinary health care providers make choices daily about the level of care they provide. Every day you have the opportunity to choose compassionate care.

Womb to Tomb Care

The veterinary profession is the only medical profession to provide care to its patients from the very beginning of life to the very end — from womb to tomb. There are many ways the veterinary health care team can have an impact on the Family-Pet Bond during the cycle of life:

Womb

Start with pre-acquisition counseling for the client in order to help a family choose a pet that is a "good fit" for them. What kind of lifestyle do they enjoy? What are their time/work commitments? Are there children? How many? What are their ages? Does this family travel? Once the species of pet is chosen, it is time to think about breed:

Active vs. sedentary

Large vs. small

Long hair vs. short

Must have regular grooming vs. needs no extra grooming

"Brief" the client about what is involved in having the pet — training, feeding, daily maintenance, preventive veterinary care, behavior expectations, etc.

Pet Acquisition

Start with an outline of wellness and vaccine visits. Provide basic behavior guidance, training, and counseling. Discuss the timing of the neutering procedure. Talk about nutrition. Nutrition is a dramatically underutilized facet of wellness healthcare. There are three factors that influence wellness and longevity — genetics, environment, and nutrition. Of these three, nutrition is the one you can influence. Every pet has to eat something every single day. Why not take advantage of this fact and actively make nutritional recommendations? There are excellent options available — choose a line of products you can believe in, do your homework, and then get to it! Just saying, "Get a good brand of food from the grocery store" is not a nutritional recommendation. Everyone on the veterinary healthcare team should be in tune with what nutritional options the practice endorses. Every single practice NEEDS to utilize the new AAHA Nutritional Guidelines and follow the evidence.

Chronic Disease

Sometimes compassionate care means caring beyond a cure. Chronic diseases provide a special context for caring:

Renal disease

Diabetes mellitus

Heart disease

Cancer

Tomb

Your relationship with a client can (and should) transcend the life of the pet. Your handling of euthanasia can make or break your relationship with clients who've lost a pet. What about suggesting a "buddy pet" for an older pet that will help bridge the transition?

Clients don't come into your hospital to be presented with a smorgasbord of options ("Shall we use Plan A, Plan B, or Plan C?"). They don't come to your office to make medical decisions ("Do you want your pet to have pre-anaesthesia blood work, or not?" "Do you want us to treat your pet's pain, or not?"). Your clients come to you because they (their pets) have problems they want you to solve. When veterinary practice is conducted from a "compassion-driven mentality" where the animal's best interest is at the fore, improved job satisfaction and improved practice revenues simply take care of themselves. Better medicine is better business! So… be problem solvers. Be the pet's best and most effective advocate. Help your team stay centered in compassionate care.

Create a Compassionate Corporate Culture

The spirit, energy, and professionalism of your practice team sets the tone of your practice's culture. Recruiting and hiring like-minded, like-valued individuals is all-important. Ask the leader of your practice to spend time sharing his or her vision with the entire team so everyone "gets it" and can transmit that vision to clients. No matter how big or small, no matter if conscious or unconscious, every veterinary practice has a practice culture. You can influence the culture and direction of your practice by leading from within. Once you decide to serve the Family-Pet Bond, you must become the kind of person you want your clients to be. Like attracts like, and so you will attract the kind of clients you are looking for if you are willing to stand up and emulate what you believe in.

Where Do Practice Teams Start?

Healthcare team members must believe they are making a difference, feel they are contributing, and know that their efforts are recognized. In order to practice effectively, veterinarians and their health care teams must be able to articulate their values and dreams, and communicate their vision to clients. To create the desired practice culture, certain steps must be taken:

Decide what is important —

What are the core values of the practice? What are the core team values? What mutual values are shared by members of the health care team? Values create the practice's culture, as they are always being demonstrated. Team members soar when their values and the practice's core values mesh.

Decide where the practice is going —

First define values, then define vision. Without a vision, there can be no focus.

Decide what the practice stands for —

This is really the practice's mission statement. If you as a member of the veterinary health care team had to explain to someone during a 30-second elevator ride just what the practice stands for, what would you say? The mission, once identified, should be the single most important idea to all members of the team.

Decide to risk —

The world is changing faster than ever, and change always entails risk. Risk wakes you up.

Decide to motivate —

Because any vision is intangible by itself, it must be translated into emotional benefits. Be shamelessly enthusiastic about the practice vision and your contribution to it. Just remember that one cannot mandate mutual vision — the people on the team must be believers. Your goal is to have team members who are so excited about what they do that their energy draws the clients back to them. You want your people to think outside the box and find solutions to improve the success of the services you deliver. You want them to be passionate about their work.

Compassionate Care Means Dealing With Chronic Disease and Special Needs Pets

As pets live longer and better, the likelihood increases that a particular pet will eventually develop a chronic illness of one kind or another. These chronic conditions threaten the very Bond you pledge to serve. Examples of special needs conditions include:

     • Amputation

     • Diabetes Millitus

     • Congestive Heart Failure

     • Disfiguring Tumor Removal

     • Chronic Renal Failure

     • Enucleation

     • Paralysis

     • Aging

     • Deafness

     • Blindness

     • Seizure Disorder

     • Chronic DJD

     • DLE (or other immune-mediated disorder)

     • Cancer (chemotherapy or radiation therapy)

Degenerative joint disease (DJD) or osteoarthritis (OA) provides a useful illustration of the concept of advocating on behalf of special needs patients. DJD is a chronic, progressive disease involving deterioration of the structures within the joint causing pain and inflammation. Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain can be explained physiologically, but what is most important is to describe pain and its manifestations in terms that are medically sound and rational, but at the same time do not confound the pet owner.

Every pet owner's nightmare is that a pet will suffer pain. One dilemma the veterinary health care team faces, however, is pet owners' frequent inability to recognize pain in their pets when it exists — particularly chronic pain. Pet owners whose pets are experiencing chronic pain will often use the following comments to describe their pets' behavior — often unaware that what they are really witnessing is pain:

     • Loss of stamina

     • Reluctance to go up and down stairs

     • Difficulty rising from a down position

     • Slower to "get going" in the morning

     • "Grouchiness"

     • Not wanting to be touched over certain areas of the body — particularly the back, pelvic area, or the limbs

     • Decreased interaction with human family members.

Hearing comments from pet owners like: "I thought my dog was just getting old" should raise a red flag. When examining any patient, listen carefully to the owner's historical comments, and then to go one step further by asking open-ended questions of the client to try to get clues about the possible presence of pain. Veterinary nurses should dialogue with the client about the pet's demeanor, looking for clues to pain. The veterinary nurse should also do a preliminary assessment of the pet in front of the client to lay the foundation for the veterinarian to conduct more specific conversation with the pet owner about pain in the pet. If a pet owner hears a consistent message from all members of the veterinary health care team, he or she will be much more open to recognizing that pain exists in the pet and to taking the appropriate measures to relieve it.

Communicating About Pain

When creating language for pain in pets it is critical to start with vocabulary that is already in place and familiar to pet owners. Clients understand words like "ache", "pain", "soreness", "discomfort", "twinge", etc. From there you can extrapolate, adding words, terms, and phrases (that you must be careful to define for your clients) that will expand the client's appreciation and understanding of the presence of pain and your abilities to relieve it. It is easy for veterinarians and members of the veterinary health care team to lapse into medical language. This is a dangerous practice because it does not impress the client with one's intellectual prowess, and it does make it easy for the pet owner to become frustrated and stop listening. Manipulation of the pet in front of the pet owner for the purpose of demonstrating a pain response is a powerful tool. For most clients, seeing is believing, and for many of them it is the first time they have considered that their animals are in pain.

Because chronic pain from osteoarthritis tends to occur in older pets, pet owners often interpret the signs of pain as the result of "old age". It is critical to communicate that old age is not a disease.

When preventing and managing animal pain, the key is effective communication with the client. Eliciting a pain response from the animal in front of the client is just one of many important steps. You must create clear and precise expectations for the client whenever possible. Creating expectations means answering for clients the following questions:

     • How will I recognize that treatments are working?

     • How long will it be before I begin to notice changes in my pet's behavior and mobility?

     • How much better will my pet feel after we begin medication?

     • Will my pet return to a completely normal state once it is on medication?

     • How long will my pet have to be treated for its pain?

     • Additional questions that must be answered in this process include:

     • What medicines will be given to my pet?

     • How often must they be administered (i.e., once daily, twice daily)?

     • How much will the medications cost? Per week? Per month? Per year?

     • How will I know if my pet is having an abnormal reaction to the medication?

     • What are the risks (if any) associated with the medications my pet will take?

     • What kind of monitoring is suggested or required to maximize my pet's safety while taking medications long-term? What is the cost for such monitoring?

Lead Your Team into the Future

The above model — using pain management as our example — will work no matter what chronic problem you are facing. Think about applying this approach in your own practice. Taking the initiative in your practice to be a leader can be rewarding for everyone on the veterinary health care team. You enjoy greater job satisfaction, your patients enjoy a higher standard of care, the practice wins because it is better able to identify needs that must be met, leading to increased revenues — a "win-win" for everyone. The benefits of stepping ahead of the pack are many. Go for it!