Mystery dermatology diagnosis at your veterinary clinic

Imagine for a minute your furry friend is itchy. She scratches all night long, sometimes until she bleeds on the carpet. Maybe she's losing hair or her ears ache. The veterinarian tries to help, but she needs to run tests to find out what's wrong. The tests take time and cost money, and you have other expenses on your plate. Are you feeling stressed yet?

When pet owners visit with dermatologic conditions, these mysteries can take time to unravel. Sometimes they even require a referral to a board-certified veterinary dermatologist. So you can begin to see how these clients might be curt, on edge, or even downright rude on occasion. But you can help. By caring for clients when their pets suffer from chronic illness, you can improve the care these itchy pets receive and increase the chances their owners will offer the high level of care pets may need.

Scratch the surface

One of the most important skills you can cultivate is listening, says Lisa Petty, BS, RVT, a technician at Animal Dermatology Clinic in Indianapolis. Petty works for boarded veterinary dermatologists and sees exclusively dermatology cases.

"The best thing to do is to empathize with clients. Listen and see where the frustration is coming from," Petty says. "Is it because they're not sleeping at night because the pet's scratching so much and keeping them awake? Is it because they don't have the money to continue an expensive medication? If we listen and uncover the root of the frustration, we can usually find ways to help."

Remember, in some cases pet owners have been dealing with a pet's illness for a while. Petty says it's not usual for clients to look up their pet's symptoms on the Internet, which can spark new worries about their pet's health. And sometimes clients are juggling several issues, such as a sick family member, which can lead to a shorter fuse when they're grappling with their pet's condition.

Avoid crimes of omission

"How much is this going to cost?" This is often one of clients' top questions, Petty says. Practicing patience and empathy can be key to negotiating these delicate client interactions. As a technician at a referral practice, Petty hears this question regularly. In many cases, clients already feel financially exhausted because they've been battling their pet's condition with the help of their primary care veterinarian.

"One of the most important things we can do is to sympathize and never brush off clients' concerns," Petty says. "We all have pets who have most likely had a costly problem. So I'll use an example of my own cat who has dietary allergies and loves to eat things around the house."

She says she explains that her own cat has a habit of eating things and vomiting, which means she's had to pay for radiographs several times to rule out a foreign body. Telling her own story helps, she says. And she often follows up with a comforting statement, such as, "I know that this is expensive and you guys have been through a lot. Let's try to find a way that works for you and for your pet."

A key point: Don't argue with clients about whether the diagnostics or treatment are expensive. "Yes, it does cost money and it can be expensive," Petty says. "Relating shows your clients that you do know what it's like to have a pet that's expensive."

Next, make sure you're up front about costs at every visit. "We give a lot of estimates here, so we're all on the same page as far as what testing might cost for a certain issue—or once the diagnosis has been made, what they can expect moving forward," Petty says.

Estimates often include the frequency that they plan to see the patient to help pet owners prepare for the costs of follow-up visits.

"We like to be as specific as possible if we can. For example, if the pet suffers from an autoimmune disease and is receiving medication that requires frequent rechecks to monitor progress, we would give them the cost, say that they would be back every two weeks for the first couple of months, and give them an estimate of what they will spend for a recheck and blood work each time," she says.

It's also a good idea to remind clients that estimates may change based on the pet's condition and how it responds to treatment. For example, you may need to add an additional medication, which could increase the cost.

Review the evidence

While affording their pet's care is a big issue for clients, another common concern is when their pets will to return to normal. And this can be a tricky question to answer, Petty says.

"This is a tough one, because most of the cases we see in dermatology are not able to be completely cured. A lot of the conditions we see, such as allergies, require long-term management. It's our job to come up with a plan that the owner can live with, yet keeps the pet comfortable with the lowest risk of potential long-term side effects," Petty says.

A common related question is, "When will my pet's hair grow back?"

"Often clients want a specific date and time, and it's really hard to give that to them. It depends on how the pet responds to the treatment," Petty says. "So allergies and autoimmune diseases that we see require a lot of follow up after the initial diagnosis and throughout the pet's life."

Avoid finger pointing

Sometimes your veterinarian will decide to refer big mysteries to a board-certified dermatologist. This can be tricky business, and it's not uncommon for clients to express frustration with your practice because you couldn't resolve their pet's problem, Petty says.

In these situations, remind pet owners that your primary care facility must specialize in several different aspects of veterinary medicine, including surgery, wellness, emergency, nutrition, puppies and kittens, and geriatric medicine, while dermatologists are able to focus solely on diseases that affect the skin.

Finally, it's important to explain to pet owners that once the veterinarian unravels the mystery of their pet's condition, you can manage several of those conditions with medication and other therapies. And addressing these conditions may require their dedication to lifelong care. Managing clients' expectations, Petty says, will improve your relationships and smooth the way for more effective home care.

Portia Stewart is a freelance writer in Lenexa, Kan. Please send your questions or comments to firstline@advanstar.com. And visit dvm360.com/community to share your strategies to support clients whose pets suffer from skin conditions.