Managing your practice from the road

Someone needs to call Mrs. Smith and tell her that her dog died during the night. It will be a touchy situation, as we expected him to do fine. I'm sure she is going to be shocked and distraught."

Charles E. Gardner DVM, MBA, DIPL. ABVP

These were my words, spoken into the handset of the two-way radio in my truck. I had admitted Mrs. Smith's dog to our clinic the previous evening for a medical workup of what appeared to be mild gastritis. Before leaving on an early call this morning, I had checked on him, and was very surprised to see that he had died during the night. I thought it best not to awaken Mrs. Smith with this news at 5:30 a.m., and therefore was informing our receptionist of the situation shortly after she arrived at 7 a.m.

There was a pause of a few seconds, and then I heard my partner, Dr. Greg Leck's voice. "Dr. Gardner, cease transmission." Upon hearing that, I sat in the truck and stared at the radio. "What does he mean 'cease transmission', " I wondered.

Greg tended to talk like that.

My other partners would have said "Gardner, shut up." Before I came to any conclusion, our receptionist got back on the radio and asked me to call in a.s.a.p. from a land line. (This incident happened long before the age of cell phones.)

I proceeded as directed, to learn that Mrs. Smith had decided to come down early to visit her dog. She was standing in the waiting room when my radio message came blasting in. That is how she learned of the demise of her beloved pet.

The resulting scene was not pleasant.

This story represents the worst-case scenario of trying to manage practice situations from the road.

I'm sure that all of you who spend most of your day away from your office have similar stories, hopefully handled a little better than this one.

So, what are some guidelines to follow to help you manage your business from the road? The first, and most important one, is to avoid doing it.

Avoid the behavior

This, in turn, means having the right people and the right protocols in place. Then you are free to focus on your clients and their needs when you are with them or between calls.

Before cell phones became ubiquitous, "car phones" were fairly common. For those with short memories, these were usually mounted on the dash of a vehicle, connected to an antenna. They improved communication while traveling, but could not be actually carried into a barn. One feature of them was that they could be installed so that if the phone rang, the horn would blow, thus alerting anyone within earshot of that horn that the phone was ringing. I actually knew of bovine practitioners who had this feature activated while doing farm calls, so that they could run out and get the phone if it rang while they were in the barn.

Imagine how that made the client feel. "Here hold this uterus a few minutes while I get the phone." Saying that while replacing a prolapse is probably not good client relations. Okay, so that is an extreme case, but you get the point. When with the client, we need to be free to focus on the client. Even when between calls, it is best to be thinking of how to serve the next producer.

How would it feel?

The larger point of this column is to be proactive in managing your practice instead of reactive. Hire and train an office manager who can attend to the day-to-day details that require decisions. If you need to regularly be involved from the road, then either your people or their training is deficient.

Let's go back to Mrs. Smith's dog.

While that was somewhat of an extreme situation, it was a fact that people's pets died overnight at our clinic. It also happened that the attending doctor was not present when the staff arrived in the morning. Therefore, some protocol should have been in place, which precluded me having to give instructions from my vehicle. Since I had checked on the dog before leaving, I could have left a note, but in some cases no one knows a patient has unexpectedly expired until the staff arrives in the morning.

A protocol to cover this is outlined in Table 1.

Cover the bases

Table 1: Notification of owners when patients die

This protocol may or not be the way you would handle the situation in your practice. My point is that some protocol should exist, and both the lay and professional staff should know the protocol. Just as I called in this particular morning to try to manage the practice while doing farm calls, I also remember calling home from vacation to instruct the staff. It always made me popular with my wife!

There will always be some situations where your staff needs to contact you to get input for some specific situation. If that happens once a week, you have a well-trained staff. If it happens three times a day, you need to write more protocols and do more training.