Parasitology 101

Joanne listens as the caller, Mrs. Johnson, continues to ramble in all directions concerning Barney's recent behavioral idiosyncrasies.

The client is getting nowhere in her explanations as Joanne looks overher glasses at the reception room full of clients waiting for Dr. Gordon-somehave appointments, others have dropped in to see if Dr. Gordon has a sparemoment for a "few questions." Mrs. Powell, who has an appointment,waits patiently with her cat "Nellie" safely hidden in a cat carrier.She silently frets as the morning scene continues to unfold before her.

Dr. Gordon is behind as usual because he is friendly to everyone andwants to keep up with all the news that the clients are only too happy toimpart.

As Joanne tries to move Mrs. Johnson to some sort of action Junior Smithenters the clinic with three intact male Beagles for vaccinations and nailtrims. The three Beagles claw the linoleum and lunge in all directionson their leashes as Junior tries to talk to Joanne about another two Beaglesstill left in the truck. Junior Smith is oblivious as the Beagles investigateMrs. Powell's cat carrier and one by one urinate through the slits ontothe unsuspecting "Nellie" contained within.

Presidential press conference

Just then, Dr. Gordon emerges. His appearance stimulated several peopleto talk to him at once concerning every conceivable malady known to veterinarymedicine.

As the scene unfolds it vaguely resembles a presidential press conference.Dr. Gordon briefly holds court and finally moves back into another examroom. Unnoticed, Mrs. Powell discreetly slips back out the front door withher dripping cargo and bumps into Malcolm Smith, a drug rep from Acme SmackmeeCompany. Mr. Smith calmly walks into the melee, smiles at Joanne, and walksdirectly to the back to talk to the doctor. As Joanne watches the drug repwalk by, Mrs. Johnson suddenly hangs up. Just then Susan Lewis walks boldlyand directly through the front door, past the crates and clients, and tothe front desk where she plants a stare directly at Joanne. She is upsetand wants to talk to Dr. Gordon ASAP. Mrs. Lewis has been a fairly goodclient over the years but has a tendency to let her animals go until a crisisdevelops. She is highly emotional and Joanne and Kelly, the kennel girl,have taken special care to comfort her during her pet's illnesses. Joanneonce even drove her home when it was apparent she could not drive due tothe emotional stress.

Mrs. Lewis has always taken great pains to call the doctor by his firstname and has welcomed the attention Joanne and Kelly have given her overthe years. Sometimes she has exaggerated her pet's problems in order tocontinue to attract attention to herself and her situations.

A few weeks ago, in a panic, Mrs. Lewis had brought "John Boy,"her German Shepherd, in with a gastric torsion during the noon hour. Dr.Gordon dropped everything to work on John Boy over the next 18 hours. JohnBoy died the next morning in spite of the colossal efforts of everyone involved.

Mrs. Lewis was very emotional over the phone and couldn't bear to comein with her husband to pick up the body. Because the death of a patientis a sensitive time for everyone, hospital policy has been to send a billand a sympathy card at a later time.

A pattern

Unfortunately, a pattern has developed with Mrs. Lewis. When she doesmanage to "compose" herself, she often calls to complain abouther bill. It seems that Mrs. Lewis feels that since she has had such a goodrelationship with the doctor and that she has been coming in for so manyyears she should qualify for a "frequent flyer" type of pricingarrangement. Even though several hundred people in the practice have spentmore money than Mrs. Lewis over the years, she has half jokingly remarkedto various clients that she has paid for about 50 percent of the hospitalby now. Today Mrs. Lewis is not in a joking mood.

Joanne walks to the back and finds Dr. Gordon finishing up a prescriptionfor "Jessie" Jones, an aging English Setter with arthritis. MalcolmSmith is bending his ear about the new arthritis "cure" availablethrough Acme Smackmee at huge introductory savings. Dr. Gordon listens asJoanne states that Mrs. Lewis would like to speak with him now. Dr. Gordongrunts and continues to talk to Malcolm.

Joanne trots back to the front and now sees four people at the counterincluding Mrs. Johnson with her cat, Barney. Three apparently unclaimedchildren have appeared in the vicinity of the over-the-counter display.Just then Dr. Gordon calls on the intercom to ask Joanne for assistancein the back with a toenail trim.

She has several options at this point:

* A. Call 911

* B. Call for an emergency drop shipment of chocolate.

* C. Try to compose herself and manage as best she can.

* D. Videotape the proceedings for Animal Planet.

Although the answer is C, composing oneself in this circus atmospherewill be challenging.

Is this a busy hospital?

Of course this hospital is busy-but is it productive or even professional?As far I can tell, no business has yet to be transacted, yet this hospitalis extremely busy. This is a hospital out of control, and the doctor seemsto be enjoying himself. If this is a typical day at Elsewhere Animal Hospital,then financial and professional success will be elusive for Dr. Gordon.

Out of control

The issue for this hospital is not that it is busy, but that it is outof control.

In fact, the inmates are running the prison. Dr. Gordon obviously relishesthe idea that his opinion is in great demand and that he runs a friendlyand open veterinary clinic. He has, however, let the clients (and the drugrep) run the entire production, and he is merely a puppet in his own puppetshow. Many of his clients have, in fact, become parasites of the practice.

Mrs. Johnson-the time parasite

Most receptionists get calls from this type of client on a daily basis.

They are sometimes lonely people who just want to talk about themselvesand their pet's medical conditions.

Many times they want only free advice. These clients are, by definition,'breaking into line' ahead of good paying clients who are waiting to talkto the doctor and who have made legitimate appointments. Often this personhas a knack of asking leading questions that guarantee that you will continueto talk to them ad nauseam. If you have only one person answering the phoneup front, you will inevitably have this type of client slowing down or bringthe flow of veterinary medicine in your hospital to a standstill. This cannotbe tolerated.

* Solution: Next to hiring people just to answer phone lines,there is only one approach for these clients. They must be encouraged tomake an appointment to see the doctor within the first few minutes, or youmust ask them gently, but firmly, for a time within the next 24 hours thatyou can call them back. This now puts the client at some inconvenience becausethey are now being asked to call back at a time that is convenient to thereceptionist and not the client. In most cases they will terminate the conversationquickly and efficiently.

Additionally, receptionists and other staff should avoid lengthy explanations.This should be left to the doctor in an exam room. If a concise answer toa query cannot be given, the receptionist must either excuse him or herselfor quickly offer an open appointment slot to the caller. There should beno middle ground for the caller to seize upon to ask additional questions.

Junior Jones ­ 'bad neighbor,' inflation parasite

Junior is proud of his Beagles. Even if this type of client should callahead and bring three of his dogs in for shots, he may bring in the wholekennel in to save him 'some time' and trips to the vet. This type of clientalso will bring an extra dog or cat along "for the ride" and suddenlyask if he can work this extra pet in at the same time.

Most vets are only too glad to have the extra business but often findthat managing a whole bunch of animals in an exam room is logarithmicallymore difficult than handling one at a time. Veterinarians often will takemore than an hour for such a visit that originally had a 15-minute appointmentslot. A lot of these clients bring no one along to help them corral thedogs. Often this kind of chaotic visit creates a lot of missed charges.

Junior and his dogs are also "bad neighbors." Junior secretlyenjoys the 'scrappy' nature of his Beagles. Testosterone is a badge of honor.Any damage to other clients' property or hospital property just goes alongwith the program of "havin' dogs." Junior is the kind of dog ownerwhose pets originate many of the wounded pets brought in by responsibleowners.

* Solution: These clients need to be told that they will needto make another appointment for the other dogs or that the doctor will tryto fit the client in around other clients. Try to have no more than twodogs in an exam room at any one time. Watch carefully for missed charges.

Malcolm Smith ­ special privilege parasite

Drug representatives work very hard for a living and deserve our timeand attention. However, no drug representative should be able to short circuitthe flow of paying clients that have taken their precious time away fromtheir homes or work to bring their pet to the doctor.

* Solution: All reps should be told to make appointments withthe doctor just like everyone else. Most already do.

Susan Smith-financial parasite

Susan is a manipulator. This kind of client has many permutations andcombinations. It is common for clients to fancy themselves as special "friendsof the hospital" and excellent animal caretakers.

Often these clients have blind spots when it comes to the care that theyare actually providing for their pets. Although it is always appropriateto give clients estimates of services, there are situations in all hospitalsthat make this difficult or impossible. Emergency situations that end inthe death of a pet create very little opportunity for appropriate financialdiscussions. Clients whose caretaking behaviors lend them to crisis medicinewill always make it difficult for veterinarians if they also try to controlwhat they are willing to pay for services after the fact.

* Solution: Manipulator clients must be identified. Once identifiedthe staff must be careful not to be sucked in by enabling behaviors thatare green lights for the client. These clients should leave deposits forall hospitalizations regardless of how many visits they have made to thehospital. The doctor should be firm and not discount fees. If a disputedoes occur the doctor should hold the line. Most of these clients will becomebetter clients in the long run if they are made to 'toe the line' to beon an equitable basis with other clients.

Discussion

There is no pride in having a busy hospital if most of the activity isaimless and unproductive.

Clients are just human and will approach their responsibilities to theveterinary hospital based solely on their own misconceptions and often misguidedneeds. For veterinarians this will lead to chaotic work environment. Veterinaryhospitals, like all institutions, need some form of appointment and clientflow structure. This is in the best interest of the clients and their pets.A number of clients, if given the chance, will parasitize the time and financialresources of our practices. Some of these clients may not even be awarethat their behaviors actually create a negative environment for every businessthat they enter or interact with.

It is therefore up to us to control the reception room environment. Withoutit we have no hope to control three of our most precious commodities: ourtime, our financial resources and good clients like Mrs. Powell who willleave for other hospitals with reasonable appointment and reception roomstructures.