Pillars of prevention: Getting to "yes" for parasite control-a roundtable discussion (Sponsored by Merial)

Now more than ever, pet owners have greater parasite control options for their pets — not only in terms of product choices, but also in the places where they can purchase these products. This has made the role of the veterinarian and veterinary team even more critical in guiding clients through this ever-changing landscape. It has also made it more frustrating for the veterinary team, who can sometimes wonder why they should make the effort to discuss parasite control with their clients. Yet, every office visit is an opportunity to get to "yes" with pet owners for providing parasite control for their pets.

During a recent roundtable discussion, leading experts in the fields of veterinary parasitology, dermatology, behavior, and client communication gathered to discuss parasite control opportunities in clinical practice. The topics they discussed included:

• Identification of practice barriers to providing parasite control for their patients

• Keys to getting agreement with pet owners about the importance of parasite control

• Proven processes that can convert agreement into a protected pet and a satisfied client

The Veterinary State of Mind

Dr. Michael Murray (moderator): Based on your recent conversations with veterinarians and veterinary staff, what do you think their frame of mind is regarding parasite control?

Michael Murray, DVM, MS, DACVIM (moderator)*

Dr. Valerie Fadok: I think veterinarians in my region (Texas) believe that they're losing control over parasite management in their clients' pets, because of over-the-counter (OTC) sales. They believe that they don't have as many opportunities to make recommendations as they used to.

Valerie A. Fadok, DVM, PhD, DACVD*

Dr. Michael Dryden: One of the frustrations that I hear a lot is that veterinarians are overwhelmed with product choices today. There has been an explosion in the number of parasiticides available over the past several years, and they just cannot keep up with all the conflicting information.

Michael W. Dryden, DVM, MS, PhD, DACVM*

Steve Dale: Pet owners also have more choices than ever before, and can purchase OTC products. The problem is that they may choose the wrong product for their pets or their lifestyle. The veterinarian should be the trusted expert. But too often either the pet owner makes a choice without a veterinarian's input or the veterinarian does not provide a specific recommendation.

Steve Dale*

Julie Mullins: My impression is that many veterinarians leave it up to the client to decide what product they want.

Julie Mullins*

Dr. Mary Ann Vande Linde: Veterinarians often don't get to the level of discussion about what a particular pet needs. They just talk about fleas and ticks generally and don't actually get to the individual pet's needs.

Mary Ann Vande Linde, DVM*

Dr. Michael Canfield: Rather than putting yourself out there to make a recommendation and risk hearing "no," or having to address questions from "Dr. Google," it's easier to just play it safe. You can say, "You should treat your dog for fleas and ticks, and we've got lots of products to choose from. Tell the receptionist what you'd like."

Michael Canfield, DVM, DACVD*

Dr. Vande Linde: But because veterinarians play it safe and leave the decision up to the client, the client is totally confused. I've watched people's faces when doctors give them all the choices for fl ea and tick control. I feel so sorry for these clients. They can't remember what this drug does or that drug does. They don't know what to choose, so they don't make any decision at all.

Dr. Murray: So on one hand, veterinarians today feel like they don't have control of parasiticides because pet owners have so many choices outside the veterinary clinic. But on the other hand, I'm hearing that veterinarians are struggling with the choice of products that they offer and that they often leave the decision up to pet owners. It sounds like we're talking about two sides of the same coin.

*See page 11 for biographical information.

Getting Agreement Starts With Building a Rapport

Dr. Fadok: Pet owners are watching online pharmacy commercials, many of which are somewhat derogatory to veterinarians, and that creates a trust gap for some clients. It's a small percentage, but these are the clients who push back and are not establishing the kind of relationship with their veterinarian that they really should have to have a healthy pet for a long time.

Dr. Susan Little: Yes, and it's complicated further by the fact that these clients will eventually have problems with the do-it-yourself approach. Then they come to the veterinarian to solve that problem. The veterinarian was never part of a solution to begin with and is now faced with the very frustrating task of trying to sort out what went wrong.

Susan E. Little, DVM, PhD, DACVM (Parasit.)*

Dr. Murray: It sounds like veterinarians are being asked to use their veterinary skills to fix a problem that might have been avoided had the client come to them in the first place. No wonder they're frustrated.

Dr. Little: Right. Plus, the client shows up already frustrated, and the veterinarian hasn't even started working with the patient yet.

Dr. Murray: The veterinarian walks into the exam room to find a frustrated client. Maybe the veterinarian has already had a tough day. So, what's the energy level going on in that room?

Dr. Vande Linde: Very low.

Dr. Murray: How likely is it that anyone in that interaction is going to get the outcome that they're hoping for?

Dr. Vande Linde: Very low.

Dr. Murray: In a practice, what proportion of clients buy OTC parasiticide products?

Ms. Mullins: According to a 2010 American Animal Hospital Association survey, one-third of the pet owners preferred to buy parasiticide product from somewhere other than a veterinary practice.1

Dr. Murray: On the other hand, two-thirds of pet owners are ready and willing to purchase parasiticide product from the veterinary clinic. But other industry data show that about two-thirds of pet owners leave the veterinary clinic with no parasiticide (Data on file at Merial). What do you think is at the root of that disconnect? Are veterinarians and their staff focusing too much attention on the people who say "no," rather than those who are ready to say "yes?"

Dr. Dryden: We don't like to hear "no," but we're not going to hear "yes" from everybody. That small percentage of disgruntled clients can set us off, and at the end of the week or the end of the year we can look back and often only remember the disgruntled clients.

The keys for getting to "yes" with parasite control

Dr. Canfield: You can name them all.

Dr. Dryden: You can name them all. It's who we are.

*See page 11 for biographical information.

Dr. Murray: How does it make you feel when you make a recommendation based on your assessment of the pet — whether it be for a parasiticide or some other treatment — and the client questions or disagrees with it or just flat out rejects it?

Dr. Canfield: It's not pleasant. Where I run into problems is when I am in a hurry and I have not established good communication with the client. That's when I'm more likely to get the "no." Then I have to take a deep breath and go back and say, "Obviously I didn't present this right. Let me fix this."

Ms. Mullins: If a client declines their recommendation, veterinarians will feel bad. They really want to meet the medical needs of the pet. They don't want to leave that room feeling like a failure. If I, as a veterinary professional, make a recommendation, but I don't convince you to follow my recommendation for what would be best for your pet, then I believe I failed.

Dr. Dryden: At some point, you're going to feel defeated.

Mr. Dale: Of course veterinarians don't like to hear pushback from clients about the price of products. That's a normal human response, but it can also lead to veterinarians assuming that clients don't want to spend the money.

Dr. Vande Linde: Veterinarians don't want to feel like they're selling. But when somebody says "no," there may be a reason for that initially. They may not understand that what you want to provide is something that they really want and that their pet needs to keep healthy.

Dr. Canfield: It isn't selling so much as it is helping the client understand your recommendation and making sure that we have taken the opportunity to provide the client with what the pet needs. If the answer is still "no," that's fine. But you can't assume that the next client is going to say "no," just because the last one did.

Mr. Dale: The bottom line is that, without a specific recommendation, the pet loses.

Dr. Murray: What you just described is a scenario in which nobody is satisfied. It's a real lose-lose situation. And it seems like it's stemming from taking the path of least resistance, which is a completely normal response given the circumstances that you have described.

Dr. Vande Linde: It's also that veterinarians may be seeing 12 to 16 clients a day. They're going from seeing puppies and kittens to acutely sick animals to animals brought in for wellness appointments. They've got 20 minutes allocated to an appointment, and they can get overwhelmed by the busyness of the day. The risk, though, is that the pet loses and the client loses.

Mr. Dale: In that situation, how often are parasiticides even brought up? And when they are, do people leave the clinic with a product in hand but not understand exactly how or when to use it? Then when they come back with a problem, they will blame the product or blame the veterinarian.

Dr. Murray: What else can get lost in the "busyness of the day?"

Dr. Vande Linde: Often we don't ask clients questions. We just tell them the answers. There's a gap in communication, and within that gap is what the client wants from the veterinary experience.

Dr. Murray: What are key questions that can be asked during a wellness visit to give the veterinarian the opportunity to understand what the pet owner is wanting and needing?

Ms. Mullins: We generally ask: What fl ea product are you currently using and have you seen any fleas or ticks? What is your lifestyle with your pet? Where do you go with your pet?

Dr. Vande Linde: I ask the owner what concerns they have about the pet.

Mr. Dale: I think the first question should be, "How are you doing?" or maybe, "You look so suntanned. You just get back from Florida?" That 30-second connection that you make with the pet owner is invaluable.

Dr. Vande Linde: Yes, and I would rephrase it to say, "It's really good to see you, Ms. Jones. You look great. Have you been on a trip?" Ask a question that is more specific or that shows your concern. It's called a hinge. "Muffin looks phenomenal. I can see that you've been doing what we discussed. How has that been for you?" Clients just glow when you compliment them and their pets. But if you ask clients a question, you have to be present enough to hear their answer.

Dr. Little: I think we can unconsciously create a space between the client and ourselves. I'm the doctor and deserve respect or I feel like I need to have a professional demeanor. However, we are not as effective as when we have built rapport. Rapport is a key part of your medical skills. During first-year veterinary school, we all learned that the most important part of the exam is the patient history. You don't take a history. A history is a communication that is given to you. You don't get the history through a barrage of questions. You get the history by building trust and respect with the client.

Dr. Canfield: There are veterinarians who enter an exam room and don't even say "hello" to the owner. They just walk in and start doing their examination.

Dr. Little: Practitioners with that approach might say that they're trying to be medically professional. Maybe they were even trained that way, but what they lose is the rapport. I agree that the first question should be, "How are you doing?" People dismissively call that small talk, but it's a critical part of human communication. It can then be followed with, "How is your pet doing today? Have you noticed anything new?"

Dr. Murray: Sometimes how we were trained in veterinary school doesn't lend itself to making a connection with a client.

Dr. Canfield: In our clinical rotations in veterinary school, instructors would find me in the exam room sitting on the floor, petting the dog and talking to the owner. That's how I got the history while examining the dog. But I was counseled for not having a professional demeanor. I was on the floor. I got dog hair on me. When they counseled me, I told them, "I'll be doing it again tomorrow, and I'll continue to do it every day." And I have.

Dr. Murray: What I am hearing is that with better connection to the client, which we call rapport or engagement, a practitioner is more likely to make recommendations and the pet owner will be more likely to act on those recommendations, which will help protect the pet.

Dr. Vande Linde: Pet owners want our medical knowledge. That's why they walk in the door. But they're more likely to take a recommendation when they feel like we actually care about them and their pets, when they feel like we've listened.

Dr. Canfield: They should be part of our practice family.

Mr. Dale: Dr. Canfield said the magic word — family. As a pet owner, I want to feel like I am a part of a practice in some way; these are the practices that do well. It's like going home when you go visit the veterinarian.

Dr. Vande Linde: I've had a client tell me, "I didn't come to you, Dr. Vande Linde, because I think you're the smartest veterinarian. I came to you because I know that you care and will treat my animal with respect. And if you can't treat it, you will help me find an answer." I think that is what clients want.

Ms. Mullins: Leading with compassion is key to opening the door to being able to make a recommendation. Clients are more likely to accept your recommendations, because you have that relationship.

Dr. Murray: Few veterinarians would read this discussion and say, "Well, I don't want to have a good relationship with my clients." Of course veterinarians want that. But in many cases it's not happening. So, what are the benefits to the veterinarian to develop better engagement with clients?

Mr. Dale: One benefit is loyalty. If you have loyalty, which includes trust, clients will come back to you again and again and again. And the pet is healthier. And when the pet succumbs, they're going to come back to you with their next pet. That's huge.

Dr. Little: I think the immediate benefit is that it makes you happy. When you have that relationship, when you get that feedback, when that circle of connection is fl owing between you and the client and the pet, it makes you feel good. That happiness is what gets you through the day.

Dr. Canfield: It makes a few clients saying "no" to your recommendations seem pretty insignificant.

Ms. Mullins: Veterinarians and the veterinary team want to feel like they've really done their job. That they've satisfied their clients. That they've protected the pets. Pet owners want to be able to enjoy their pets and have the peace of mind that their pets are protected from some health risks. When you do meet those needs, it's like magic. It is the feeling that this is what I'm supposed to be doing.

Dr. Fadok: The benefit to me is that I better understand how to help a client. That makes me feel great. When I was younger, I think I tried to be a colder professional. I didn't do well. It felt like I was not doing what I was meant to do. Being like that made my already introverted nature even worse. I worked to get past that introversion and reach out to people, and it's so satisfying. Now I rarely use the exam table. I even examine little dogs on the floor, because they're not going to roll over on a table. That way I can do a complete dermatologic exam without the client even knowing that I'm doing the exam.

Dr. Canfield: By nature, I would rather be the introvert. I had to reach beyond that tendency, because the only way you're going to be successful with a veterinary practice is to engage clients.

Dr. Murray: So you're really bringing a different energy into the exam room.

Dr. Vande Linde: I learned to relax. I learned that with any animal, whether it's a dog or a cat, it's better to give them time to observe you "making nice" with their owner. That makes it so much better for the pet and the client.

Dr. Murray: Because the pet is really connected to the owner.

Dr. Canfield: When you have a connection with the client, you see the dog's expression relax or the cat becomes calmer.

Dr. Fadok: Yes, if the pet sees that its owner likes you, it makes a huge difference.

Dr. Dryden: Another thing is that if you have good rapport with clients, they're far more likely to accept your recommendations. They're far more likely to come back to the practice and to refer other people to your practice. With regard to parasiticides, at the end of the day, we're talking about pets receiving more doses per pet per year. So, there's everything from the emotional benefits of positive interactions with clients to the health benefits for the pets to the financial benefits for the practice. It's a win-win situation.

Dr. Canfield: When you have good rapport, you're much more likely to make a recommendation because you feel like you understand the client's and pet's needs. If we don't understand their needs, then how can we make a good recommendation?

Dr. Little: I think you make the recommendation with more confidence, too, because it's well based. It's grounded in that pet's actual needs rather than being something you repeat to every client every 15 minutes.

Dr. Canfield: It also seems like the choices become a lot fewer and less confusing.

Ms. Mullins: Then once that choice is made, it in fact, becomes the recommendation.

Dr. Murray: I think that's the outcome we're all looking for. How does one attain that? How do you get started?

Better Practice Processes = Improved Parasite Control

Dr. Vande Linde: The best way to get started is to reach an agreement within the veterinary team that parasite control is a pillar of prevention in your practice.

Mr. Dale: The three words I am thinking of are standard of care. These aren't just products; they are treatments. Parasite control needs to be considered a standard of care.

Dr. Murray: One of the standards of care in the practice is parasite control. Parasite control is a pillar of prevention.

Dr. Vande Linde: If a practice doesn't believe in the fundamental principle that parasite control is a pillar of prevention for every pet to be healthy, it's going to be hard for that practice to attain a goal, a number that they set.

Ms. Mullins: In our clinic we have found that identifying our pillars of prevention and keeping them in front of the staff helps all of us remember to follow through with the plan that we have in place.

Dr. Murray: So a practice should first establish parasite control as a pillar of prevention, and then set a specific goal?

Dr. Canfield: Initially you have to evaluate the practice itself. The only way you can set a goal is if you first know how many pets are receiving effective parasite control right now. Of course there will be a percentage of clients who purchase product somewhere else, but if most are willing to buy from us, are we selling product to most? That's the gap we can close by setting goals.

Dr. Dryden: Most veterinarians tend to overestimate the number of pets in their practice that are on flea and tick control or heartworm preventive. When you analyze the data from the practice management software, it is almost always significantly less than what they think it is.

I agree that the first thing to do is to assess how many pets in the practice get parasiticides, how many doses per pet per year. There has got to be a true numerical assessment. Because until you know that, you can't set a goal. It's impossible.

Dr. Murray: We learned from the 12.12.12 Campaign* that when practices set a goal that was clearly communicated to the team and they also tracked their results, they had a 9% increase in the number of dogs going home with 12 doses of monthly heartworm preventive (Data on file at Merial). When it comes to flea and tick control, how should practices set their goals for more pets getting flea and tick control?

Dr. Vande Linde: Start with goals that are achievable. I would do it in increments of three to four months. If you set it too far out, then the team may feel overwhelmed and get discouraged. They need feedback weekly, monthly, and then quarterly.

Dr. Murray: A typical clinic may have only one-third of canine patients going home with any flea and tick control products. We know we can do better than that, but this is our starting point. What would be a reasonable goal for the first three or four months to improve upon that?

Dr. Vande Linde: I would set a goal of 10% to 15% growth over what the practice was doing at the same time the year before, comparing the numbers from the same quarter of the year before.

Dr. Little: If you're seeing 12 to 16 patients a day, that's just one or two more clients saying "yes" per day.

Dr. Fadok: I like that. Instead of percentages, think of it as one or two more yeses every day.

Dr. Dryden: We're only talking about one or two more clients per day. If you've seen 15 clients today and one-third of them are going to leave with product, that's five. So six or seven is what we're after. You've got to expect you are going to get a "no" from some clients.

*Merial's 12.12.12 campaign was directed at veterinarians and intended to help spur a 12% increase in the number of pets receiving 12 doses of heartworm prevention in 2012, in accordance with guidelines from the American Heartworm Society and Companion Animal Parasite Council.

Dr. Murray: What about tracking your progress or rewarding the staff for doing a good job?

Ms. Mullins: It's important to reward the entire team when they achieve the goal, because then everybody's working together and reminding each other.

Dr. Murray: Everybody's got everybody else's back; they're all in it together.

Mr. Dale: Practices succeed if they find a champion for whatever the cause is — someone who is particularly interested and who leads the effort.

Dr. Murray: Simply setting a goal, tracking results, and keeping the team accountable can improve results. What about developing a process to help the team succeed? What would that process look like?

Ms. Mullins: We begin talking about parasite control from the first phone call the client makes to set up an appointment, just to put the thought in the client's head. Next, when technicians begin the appointment, they should go through possible parasite risk factors for the pet. Uncovering the pet's risks together with the pet owner will ensure that owners have buy-in. With that information, the veterinarian and the owner can come to an agreement about what parasites need to be covered. Then the veterinarian can make a specific recommendation for what the pet needs.

Dr. Murray: You're planting a seed toward getting an agreement, rather than confronting them all at once with, "You need to do this. You need to do that."

Ms. Mullins: Yes, it's not perceived as a sales pitch from the veterinarian. The pet owner is already thinking, "I need to get these things when I come into the clinic." We set the stage for them, so they're ready to hear it. Then the technician goes over it again, and then the doctor will make a recommendation. We found that this works. By the time the veterinarian makes a recommendation, the client has heard about parasiticide products a couple of times and thinks, "Yeah, based on my lifestyle and my pet's activities, we're going to go with this."

Dr. Murray: What are some ways that the veterinary team can come to an agreement with the pet owner, so that they hear "yes" more often?

Dr. Dryden: First of all, if any recommendation we make is difficult, time-consuming, or expensive, why would we expect any clients to comply if they don't understand exactly why they need to comply? I've gone to more than a thousand flea-infested homes, and I can tell you that to just tell a client to do something is not sufficient. We need to explain exactly why every dog and every cat in the household needs a flea and tick product every 30 days.

Dr. Murray: And what's the benefit to them if they do that?

Dr. Dryden: The first benefit is the prevention of a potentially horrendous flea infestation, and the second is a more rapid eradication of an existing infestation.

Dr. Vande Linde: The frustration level of the client will go down because they know they have an active plan to prevent a flea infestation.

Dr. Dryden: We also need to understand what they really can do and then use that feedback to make a recommendation that they can afford to do and will be willing to do.

Dr. Canfield: I want clients to feel as if they are a part of the decision and the product choice. It's important not to say, "Do it because I said so." Explain what's in it for the client.

Dr. Murray: So you're shifting from "You need to do this" — and possibly hearing "no" or even "okay," but it never gets done — to "Let's you and I figure out what works best."

Dr. Canfield: Instead of saying, "You need this," the message is often better received if I say, "Based on the information you gave me — you take Buster to the dog park and you live in this area — Buster is at increased risk for flea exposure. Based on what you've told me, I think the product that best suits you is Product X." I've just reiterated what the client has told me, and I've interpreted what I was told to arrive at a specific recommendation.

Dr. Murray: You're giving clients an opportunity to either agree with your recommendation or you can seek clarification. With that clarification, you can get closer to what a client is really looking for.

Ms. Mullins: It's vital that in addition to instructing the client about what they need that we also acknowledge that they came in with a desire as well. If those two things don't match up, the client may go home feeling like we didn't listen.

Dr. Vande Linde: It's the difference between telling someone what he or she needs and uncovering what the parasite risk is together, so that you can get agreement.

Dr. Murray: What are some important risk factors for fleas and ticks? Please include factors that may seem mundane or that might not come up in a patient's medical history, but that are relevant to the way people enjoy their pets.

Mr. Dale: Cats.

Dr. Dryden: And where does that cat spend its time? What proportion of its time is spent outdoors or indoors?

Dr. Fadok: Many people with great hearts feed feral cats. But they're technically not their pets, so they don't admit to owning those cats. Feral cats are a huge source of flea eggs. Plus, their pet cats congregate with those feral cats. They may be indoor cats, but they go outside.

Dr. Little: I also worry about ticks and intestinal parasites, which are huge with feral cats. Toxocara cati is very common in feral cats. They're eating wild prey and so they're likely to be infected. They're passing eggs into the environment, which infect more animals. Plus, if your household cats are hanging out with feral cats, they're also consuming rodents and birds. It's a huge risk.

Dr. Murray: Dr. Canfield mentioned dog parks, which have become a popular way to enjoy your pet with other people and their pets. What are the parasite risks of taking your dog to the dog park?

Dr. Dryden: Just about every parasite that a dog can get could be encountered at a dog park. Fleas, ticks, roundworms. Dr. Tom Mather has found ticks all along the fences and in the foliage at a dog park in southern California.2 Researchers went into Chicago's city parks and in all of them they found Ixodes scapularis infected with Borrelia burgdorferi.3 So if you take your dog to a dog park, it absolutely must be protected from a variety of parasites. You also cannot know whether the other animals at the dog park are receiving any parasite control.

Dr. Murray: Should people stop taking their dogs to dog parks?

Dr. Dryden: No. We have the tools, the education, and the appropriate parasiticides to help protect our pets when we take them to places that we enjoy but that pose a risk from parasites.

Dr. Murray: It sounds like one of the more important things to discover when talking with pet owners is how they enjoy spending time with their pets.

Dr. Dryden: When we establish a rapport with our clients, we learn about potential risks. We can medically manage those risks and then we can foster the human-animal bond that's so important to those individuals. We reinforce that bond.

Dr. Murray: When you uncover these risks together, you are more likely to reach agreement that the pet needs parasite treatment and preventives. You're now at the point where you can discuss what the best product choice would be for that pet. What are the factors to consider?

Mr. Dale: We want to provide them the choice that gives them the best chance to be successful.

Dr. Canfield: The ability to administer or apply the product is absolutely huge.

Dr. Vande Linde: A lot of times the dog won't take an oral product, and it can be a chore to administer.

Dr. Canfield: A lot of my clients don't like having to pill their dog.

Dr. Fadok: Aesthetics are important too. Some people do not like topicals because they don't like the wet patch on the pet's fur. They don't like the aroma, or dogs don't seem to like it.

Dr. Murray: When would a topical product be the choice that works best for a pet owner?

Dr. Canfield: There are some clients who do not approve of systemic products for fl ea and tick control. For those clients, topicals are a better choice.

Dr. Little: A topical product, in general, can be easier to administer to a pet unwilling to take an oral product. Cats are often unwilling recipients of oral treatments. I do think topicals are a better choice for cats.

Dr. Canfield: I have a lot of product options in the hospital, but I never offer multiple product options. In the grand scheme of things, after we have discussed all the factors, we recommend a topical or oral product to best fit the needs of the pet and the pet owner. After that, is it fl ea only or is it fl ea and tick? Where I am on Florida's west coast, many of my clients are concerned about ticks.

Dr. Murray: So you've determined that parasite protection is a pillar of prevention in the practice. You have established a relationship with the client in the way we discussed. By uncovering the risk of specific parasites to the pet with the client, you've reached an agreement about what the pet needs. You have then narrowed down what the best product choice is for the pet and the pet owner, and that leads to a specific recommendation. Now, how do you make sure the pet owner takes it home?

Dr. Canfield: We have computers in each examination room, and the technicians enter the product onto the invoice right there.

Ms. Mullins: We take the doctor's discharge orders, with the specific recommendations, into the exam room and review the discharge instructions with the pet owner. We talk to them about the product and show them how to use it.

Dr. Murray: How do your clients respond to that?

Ms. Mullins: They love it. They love that everything's together. If there happens to be a money issue that you didn't pick up on, you're able to discuss that in the exam room.

Dr. Vande Linde: Also, the conversation happens with the same people with whom they already agreed that this was important, as opposed to the receptionist who hasn't been a part of that discussion.

Dr. Canfield: My staff comes into the exam room, reviews my typed discharge notes with the client, and asks whether they have any questions. The staff member can pull up the invoice on a computer in the room and can tell clients the total amount before they ever leave the exam room.

Dr. Vande Linde: I've always felt that is the best approach, because who wants to stand out there in front of everybody and have your bill discussed by a receptionist.

Mr. Dale: I think it's a brilliant idea to do it all in the exam room. Until I came here, I never thought about it.

Dr. Vande Linde: You're much better getting everything to the client in the exam room, so that they have it and they have the discharge information right there. They can see the product, touch the product, see what you've recommended, and why you've recommended it.

Dr. Murray: Dr. Fadok, at the beginning of our discussion, you talked about veterinarians being concerned that they don't have control over these products. Based on what we've talked about, how does this sound in terms of regaining that control?

Dr. Fadok: This is perfect because I think our ultimate goal is to help protect pets. The other thing that we do is show clients how to apply the product. It's amazing to me how many people do coat treatments. They don't apply the product to the skin or they apply it to odd places on the pet's body, usually where they last saw a flea.

Dr. Dryden: The pet visit is another opportunity to demonstrate how to correctly administer these products. Help the client be successful!

Dr. Murray: What are some reasons that practices don't dispense the product in the exam room?

Dr. Canfield: Traditionally, that's how we've always done it.

Dr. Dryden: Yes. In both of the practices I worked in, all of those transactions occurred at the reception desk. None of that occurred in the exam room. As a veterinarian, you were disconnected from that.

Dr. Vande Linde: By taking the transaction outside the exam room, it's taking the money part, the perception of selling product, away from the veterinarian. But if we look at flea and tick control not as product but as a solution for the client, then providing the product in the exam room and reviewing how to use the product makes the take-home message much more powerful.

Dr. Dryden: You didn't go to veterinary school to be a salesman. So you were disconnected from it. That's how the tradition was. The situation we face now is that by being disconnected from providing the product, veterinarians don't know whether they are actually providing the protection their patients need and their clients want.

Dr. Vande Linde: We still do a lot of things the way they've always been done in veterinary practice. Why not say, "If we were going to create the perfect veterinary experience, what would it be?"

Dr. Murray: I love the way you call it the "veterinary experience." So what does the veterinarian want that experience to be, and then how does that look from the perspective of the pet owner? If we can align those two, we're gold.

Mr. Dale: A positive experience for the pet first. That way the owner is more likely to have a positive experience and to feel like they got value for their visit.

Dr. Canfield: I want clients to feel like they're part of our family. A lot of times I walk in and I give them a great big hug and say, "Hey, how have you been?" I want them to know that we love them and care about them, that we're happy they're here and we're trying to meet their needs.

Dr. Murray: By the way, if you had done that in school you might have gotten in trouble.

Dr. Canfield: I got counseled about that, too.

Mr. Dale: But that's the right answer. That's what people want.

Dr. Dryden: In my private practice experience, I perceived myself as a problem solver. I wanted to solve the problems that clients and pets had. If you can solve their problems, you have healthier pets and happy clients. From that comes professional satisfaction; you feel good about what you have achieved. To be the best problem solver, you need not only the best medical information, but also the best understanding of your client's needs.

Dr. Canfield: As a profession, we want to fix problems, but I think we often overlook another aspect of our profession, which is listening. There are problems for which there may be no medical solution or cure, but by listening we provide the client with what they need.

Dr. Murray: Yes, listening and understanding the other person's perspective. That does not come naturally to most. It may even be uncomfortable. But it's the secret sauce.

Ms. Mullins: We need to be an advocate for the client. Every client comes in looking to get something of value from the appointment. Our job is to listen to what they need and come to an agreement about how to meet that need, using the veterinarian's expertise and recommendations. When those two things mesh, the client leaves thinking, "They really listened to me."

Dr. Fadok: I want to partner with the client. We both care about their pet. I provide something for their pet that they cannot provide, and they provide things that I cannot. So how can we work together to make sure that their pet lives a long life? This goal requires that we listen to each client individually and work together to make a health plan for the pet that fits the family's lifestyle. Then we are all happy.

Ms. Mullins: The best experience is being able to hear the pet owner say, "Based on what you've told me, this is what we want to do." That comes from listening to the pet owners, mirroring what they have said, and making recommendations at the standard of care that you believe is best for their pet. Then, as a veterinary team you feel that you have made a difference.

Summary

Most pet owners who bring a pet to a veterinary practice look to that practice for what is best for the pet's health needs. They want to enjoy their pet and have the peace of mind that they are taking the steps necessary to keep their pet healthy. They also want to feel like the veterinary practice team cares about them and the pet and that they've been listened to.

Parasite control is a pillar of preventive medicine. When a veterinary team takes the approach of "Let's figure out how we can help your pet," they can collaborate with the owner and reach an agreement about what is best for the pet and what best fits the pet owner's needs. This creates the veterinary experience that the pet owner and the veterinary team all desire, and it can lead to more pet owners saying "yes" to the veterinarian's recommendation for flea and tick control.

Dr. Murray is Technical Marketing Director for U.S. Pets Parasiticides at Merial Limited. In addition to serving in other roles at Merial, Dr. Murray was on the faculty of the Virginia-Maryland Regional College of Veterinary Medicine (Equine Medical Center) and in companion animal practice. Dr. Murray is also a certified leadership coach.

Dr. Canfield is a veterinary dermatologist at Animal Dermatology South, a specialty referral service in Florida. In addition, he owns and operates Animal Hospital of Regency Park, a general veterinary practice, in New Port Richey, Fla. Dr. Canfield's clinical interests are dermatology, including allergic skin diseases, otic diseases, and endocrinopathies.

Mr. Dale is a dog and a cat behavior consultant (certified by the International Association of Animal Behavior Consultants), based in Chicago. He is a syndicated columnist, blogger, host of two nationally syndicated radio shows, a contributing editor at USA Weekend and Cat Fancy and a regular Advanstar Communications contributor. He has authored or contributed to several books, most recently as an editor of Decoding Your Dog, published by the American College of Veterinary Behaviorists. He speaks at veterinary and animal welfare conferences around the world.

Dr. Dryden (affectionately known as "Dr. Flea") is a University Distinguished Professor of Veterinary Parasitology in the Department of Diagnostic Medicine and Pathobiology at the Kansas State University College of Veterinary Medicine. He is a founding member of the Companion Animal Parasite Council. He is author of more than 120 journal articles and nine book chapters. He has lectured in 21 countries, presenting more than 850 seminars at national and international meetings. His current research interests are flea and tick biology and control, urban wildlife as vectors of parasitic diseases, and the diagnosis and control of gastrointestinal parasites.

Dr. Fadok is a veterinary dermatologist at North Houston Veterinary Specialists in Spring, Texas. She has given scientific and clinical talks at 150 international and national meetings. In 2010 and 2011, she won the American College of Veterinary Dermatology Excellence in Teaching Award. Also in 2010, she won the ACVD Award of Excellence.

Dr. Little is a regents professor and the Krull-Ewing Endowed Chair in veterinary parasitology at the Center for Veterinary Health Sciences at Oklahoma State University. She teaches veterinary parasitology and oversees a research program that focuses on zoonotic parasites and tick-borne diseases. She also serves as co-director of the National Center for Veterinary Parasitology. She is president-elect of the Companion Animal Parasite Council and past-president of the American Association of Veterinary Parasitologists. She has served on several journal editorial boards and has authored more than 100 publications on veterinary and human parasites.

Ms. Mullins joined Dr. Ernie Ward's staff at Seaside Animal Care in Calabash, N.C. in 2006. Under Dr. Ward's tutelage, she excelled in her studies and became known for her communication skills, eventually becoming the practice's staff training coordinator. Combining her passion for education, communication, and behavior, she now serves as the lead trainer and supervisor of Seaside's sister facility, Doggone Healthy. Ms. Mullins also serves as an editorial advisor and contributor for Firstline magazine. She has also spoken at several events at CVC conventions with Dr. Ward.

Dr. Vande Linde is a veterinary practice consultant and communications expert. She has experience in private practice, teaching at various veterinary and technician schools and conferences, consulting on practice management issues, and serving on management teams at a variety of corporations. She provides interactive training programs, strategic planning, and marketing programs and services. Her focus is on excellent preventive care and good communication between pet owners and veterinarians.

REFERENCES

1. American Animal Hospital Association. AAHA State of the Industry: Close-Up Look at 2010 Purchasing Behavior, 2011.

2. Mather T. University of Rhode Island. Personal communication, 2013.

3. Jobe DA, Lovrich SD, Nelson JA, et al. Borrelia burgdorferi in Ixodes scapularis ticks, Chicago area. Emerg Infect Dis 2006;12:1039-1041.