Offering veterinary medical 'choices' may hurt patients

Before we go further—and the hate mail starts rolling in—let me state that I am a fan of choice. I like to choose the color of my car. I like to choose what to write and when. There are many people who don't have the luxury of choice. Choice is fantastic.

And in the veterinary field, choice for clients is just dandy—provided you're a skillful communicator with plenty of time and you're speaking to an intelligent, trusting pet owner. But let's be realistic: How many of us are gifted communicators? And how many clients, intelligent or not, "get" what it is we're explaining?

Dave Nicol, BVMS

What we usually offer are two or three choices with little in the way of useful justification for each. And that leads clients to make decisions based on what they understand best: price. If option A costs $2,000, option B $1,000, and option C a mere $500, in the absence of an overwhelmingly persuasive reason to choose A or B, I'm going with C. So are our clients. And how many veterinary medical situations are best resolved by the third-best option?

ABDICATING RESPONSIBILITY

We've all seen the phrase "Client declined X-rays" on patient charts. But often the client hasn't declined a set of radiographs so much as failed to understand how important they were.

Here's another example: A vomiting dog may be experiencing a life-threatening intestinal obstruction—or just some gastritis. The three options are: 1) Admit the dog into the hospital for blood work and a radiograph, 2) admit the dog for observation, or 3) medicate the dog and send it home overnight. If the veterinarian believes there's a foreign body, only one of these is the right choice. But I've heard all three given together in the exam room with little guidance from the doctor. In that case, the cheapest option—and the one that puts the animal most at risk—wins.

UNCOVERING THE RIGHT CHOICE

Today, after seeing so many bad examples of choice, I urge veterinarians to think through the available choices and select the one they feel is in the best interest of the pet's health at that time. Then make that recommendation on its own without backpedaling or "It might be a good idea if ... ."

Use persuasive language like "What we need to do here is ... " to avoid giving mixed signals to clients. If after some discussion the client doesn't want to follow the best option, respectfully offer a second option. And so on and so forth until you arrive at a solution with the client. However, most of the time the discussion will end with the first choice—the best choice.

We veterinarians are chronically uncomfortable with price. When we offer choices in conjunction with this discomfort, we open the door to misinterpretation and misunderstanding by clients. The result is that many animals don't receive the best care possible at the time they need it. That impacts not just our vulnerable patients and underinformed clients, but our bottom line.

You may think you and your fellow veterinarians are offering choices in the exam room, and you're right. But is choice working for or against the pets in your practice?