Real time care-a veterinary rock opera! (Proceedings)

Diagnose your Laboratory

Do you grumble every month when the reference laboratory bill arrives? Do you clench your teeth when opening the in-clinic reagent invoice? If not, then you probably aren't utilizing laboratory diagnostics to their full potential. Evaluate your yearly income categories and rank them accordingly like medications, laboratory, vaccines, surgery, radiology, diets, etc. Calculate the ratio of income derived from laboratory diagnostics versus vaccine income. Practices emphasizing laboratory diagnostics have ratios of 1.5:1 or higher. Are laboratory diagnostics fulfilling your practices medical and financial potentials?

Missed opportunities?

If your laboratory diagnostics to vaccine ratio is less than 1.5:1 consider a diagnostic work-up for your diagnostic work-ups. Are you missing diagnostic opportunities? Are you performing complete laboratory profiles? Are you maximizing the advantages of in-house diagnostics? Are you taking full advantage of your reference laboratory? Are you utilizing the benefits of combining the benefits of in-clinic testing with outside lab testing?

Do you discriminate against your clients?

Are you missing diagnostic opportunities? Pre-judging clients can seriously impact your practice's reputation and financial health. Chances are your best clients don't wear three-piece suits and drive luxury cars. Right? Our clients expect and our patients deserve complete diagnostic work-ups. Frequently, patients are presented in supposedly diseased states yet appear healthier than we do! Don't clients present their pets for "not being themselves" or "ain't doin' right"? Are these patient's truly sick or are the owners over-reacting?

At our hospital a sick patient is defined as sick if the client thinks the patient is sick until we prove otherwise. Don't clients frequently say the pet looks a lot better in your office than at home? Don't they sometimes apologize for wasting your time? Who should determine if a patient is sick in the first place? The client who observes the patient everyday in the pet's natural environment under normal behavioral conditions or the veterinarian who evaluates the pet for 15 minutes in an unfamiliar environment with strange smells, sights, and sounds? Shouldn't both of you make the decision together using information provided from both parties? Missing diagnostic opportunities negatively impacts your patient's medically and your practice financially. Work them up!

Do you have all the pieces?

Diagnostic tests are puzzle pieces; you need all the pieces to correctly solve the puzzle. Missing puzzle pieces results in an incomplete picture or worse yet, the wrong picture. Complete blood profiling usually includes the puzzle pieces hematology, biochemical profiling, electrolyte analysis and complete urinalysis. Thyroid, cortisol, bile acids and other secondary tests (puzzle pieces) are usually requested based on findings from the initial laboratory profile. Medical problems may be misdiagnosed if complete profiles are not performed. Incomplete blood tests are analogous to a radiographic diagnosis made by one view-a dangerous way to diagnose. Incomplete profiling may lead to several potentially life-threatening situations. Patients with serious health problems may be diagnosed as healthy because too few tests were performed. Another potentially serious situation exists when diseases with similar lab abnormalities overlap leading the clinician to the incorrect diagnosis and treatment. Get all the pieces and correctly solve the puzzle!

Are you maximizing your in-house laboratory)?

In-house testing has revolutionized the practice of veterinary medicine. In-clinic testing now includes many capabilities including hematology, biochemical profiling, electrolyte analysis, endocrine assays and blood gas testing among others. In-house testing improves patient management by permitting clinicians to diagnose many diseases and treat immediately.

Benefits of in-house testing include better emergency service, better medicine, and better time management; improved client communications, more convenient preanesthetic testing and adds value by providing immediate results

In-house testing assists the veterinarian to diagnose problems in the emergency setting when outside laboratory services are unavailable. Your in-hospital lab can provide stat results to help narrow the list of differential diagnoses. Some patients simply cannot wait-next day diagnosis of acute renal failure may be too late!

In-house laboratories help clinicians practice better medicine by providing veterinarians with needed information to diagnose before treatment. Immediate laboratory results allow the doctor to treat the patient based on medical information today not tomorrow.

Get off the phone and deliver the broken car part!

Do you enjoy talking on the phone? In-clinic testing allows better time management for doctors and clients. Immediate results permits the discussion of laboratory results before the client leaves the hospital thereby eliminating the dreaded next day phone call. Do clients really have a clue when you phone them and waste eight minutes to report lab tests they don't understand?

Improved client communication is a major advantage of in-house testing. Imagine performing laboratory work during the same office call thereby allowing you to actually remember the client's name and that Honey is a male dog. Receiving results during the same office call allows the doctor to ask more case specific historical questions or re-investigate the physical exam. Perhaps you'll consider other diagnostics such as radiology or ultrasound based on your immediate laboratory findings.

Immediate results build immediate value. I always want the broken car part when I pick up my Jeep from the mechanic even though I know nothing about automobiles. I want to visualize where my money went. In- house laboratory reports allow you to educate clients about what you have done to diagnose their pet's condition. Always copy results for clients and write notes on the printout for clients to take home and educate other family members. One of the most important non-medical advantages of immediate tests are results are available before clients pay the bill not a day later. This becomes a huge customer service advantage-give clients their broken car part!