Simple changes can aid in achieving higher compliance for programs. The approach you take with clients can influence the outcome of whether or not they follow your recommendations

July 1, 2003

Article

Dr. Linda Randall explores how the veterinary team can have a direct influence on whether or not a client will except a recommendation.

You go to your physician and she tells you that you are healthy. Although you already suspected as much, you are pleased to have her confirm it. She then goes on to tell you she has several suggestions for you. All of these, she says with a warm smile, will help you live a longer, better life, free from worry about your health.

Doctor's orders

First, she recommends that you receive a vaccination. No, she hasn't seen any cases of this disease, but it is in neighboring areas, and if you contract this disease you will get very sick and may even die. You may have a vaccination reaction that could cause you to miss work for a few days and may necessitate a hospital visit if it becomes serious, but very few people have a reaction. She proceeds to tell you about several other health problems that you can prevent with oral medications and a skin cream. She leaves the room and you sit, in your fashionably printed paper gown and contemplate your heretofore easy-going life of health. Who knew? The nurse comes in to ask if you have any questions. She assures you that all of this will fit in with your lifestyle and will soon become a habit. You have to squirt one bitter tasting liquid in your mouth daily (and, yes, swallow it after letting it rest on your tongue for five seconds), come back tomorrow for a panel of blood tests, return in three weeks for a vaccination booster for this disease you have never heard of, and you have to start buying a special food that has the right assortment of nutraceuticals for people over the age of 37. You are delighted by only one thing: She tells you that eating one chocolate bar a week will prevent one of the diseases. Oh boy, you think, I love chocolate!

How do you feel as you leave your doctor's office? You originally may have felt proud of yourself for staying in such good shape. You work hard to be healthy, and you were happy to receive recognition for your good deeds. You thought you knew about most of the significant diseases you could contract in your area of the country and perhaps were dismayed to find there were some new ones you didn't know about. With the recent buzz about vaccination reactions (smallpox vaccines were a topic of discussion at work) the vaccine you just received is a worry to you. But, hey, that chocolate bar thing, that sounds too good to be true. You can do that. Although you promise yourself you will try to do the other recommended preventions, all you actually end up doing is enjoying a guilt-free chocolate bar every Friday evening.

Getting on board

It is a fact that most people do not follow up on their doctor's recommendations, whether for themselves or their pets. As the above scenario suggests, there are many reasons for this. They include emotions, knowledge (if you feel stupid for not knowing something, you are much less likely to be compliant), ease of administration, number of new things you have to incorporate into your already busy life, taste and general feeling of satisfaction (if you love chocolate, you will eat your chocolate bar and wish you had been instructed to eat one every day. If you dislike chocolate, you won't eat the bar, and will resent the fact that your favorite food, Pop-Tarts, wasn't the recommendation.)

Compliance Checklist

So it should come as no surprise that many of our clients do not follow our recommendations for preventive therapeutics or diagnostics for their pets. Most of our clients probably try to follow our recommendations for heartworm prevention, vaccinations and nutrition but start fading in compliance as time goes on. You know how it is: You are on a diet and are losing weight. One day you eat a piece of cake that you know you shouldn't. You still lose weight. So the next week you eat cake and ice cream and maybe you still lose weight. This process continues until you start gaining weight. The lag time between continued weight loss and the start of weight gain is the place that you decide that you can get away with non-compliance. It is this space that we need to address with our clients.

n No one likes to be told they are wrong. Don't make your clients feel as if they made a mistake. They usually know they were advised to do something different than what they actually did. Instead, spend time finding out what would encourage each client to follow your recommendations. As in the first scenario, if you don't understand or have never heard of a disease, you're much less likely to perceive it as a threat that requires your vigilance and your money. In these cases, face the fact that you may not be successful in convincing a client that his or her pet needs a particular vaccine or preventive. Instead, ensure that you have adequately provided information to the client in both verbal and written form without overwhelming them. It may only be when a friend's dog develops heartworm, or contracts Lyme disease that the problem will become real enough to him or her to follow your recommendations. At this point, you want the client to not only remember that you suggested the preventive or the vaccination, but also to feel comfortable coming back to you for not only these, but for other treatments or to ask questions. If your client believes you will criticize them or think they are stupid for not following your suggestions, he or she will not return.

n Make it easy for a client to follow your recommendations. That sticker that goes on the calendar to remind an owner to give the monthly heartworm preventive was a good idea, but the pill or topical still needs to be administered. Give the client some options: would it be simpler for them to come in every six months for a heartworm injection? Apply a topical? Give a flavored tablet? Do they want you to send them one pill every month? (Remember that the online pharmacies will do this for them. Perhaps it is something for your hospital to offer, too.) If you find that someone is not successful in following the plan the two of you have formulated, gently try to find out why. It could be that the person who brings the pet in is not actually the person the family considers the owner. This is commonly true if the pet is a hunting dog or belongs to the children. The spouse that hunts or a child may be the one expected to provide the homecare compliance, not the person to whom you have been talking.

n Ensure that they understand the value of the service. Although we all recognize that it is less expensive to prevent than to treat, the reality is that if we don't have the funds now, we often feel that tomorrow will just have to take care of itself. What can you do to help in this situation? The solution will be different for each hospital and client, but the important thing to remember is that an answer can usually be found. The first thing to do is to explain the benefits of compliance. It takes a lot of practice to be able to do this without preaching or sounding like a used car salesman. The practice is worth it, though. Some veterinarians, especially new ones, have become accomplished at this by taking a course on salesmanship or communication skills. The Dale Carnegie course is well recognized for its success in helping professionals learn how to dialogue with clients/customers and colleagues. Local colleges often have excellent courses, too. If you don't have the compliance record you want, consider that it may be partly your presentation and start to acquire improved communication skills!

n You must believe in what you are saying and your staff has to, as well. It is amazing to me to see how quickly a client will agree to purchase a product I have recommended because I have used it successfully with my own pets. The difference is merely that if I use it, I love it. This confidence translates into my demeanor and verbal tone. This attitude is contagious and the client can't help but think they, too, should be using the product. Of course, to forestall buyer's remorse, it is wonderful when your staff supports your recommendation by reassuring the client that they made the right decision. They, too, have to trust the product so that they can absolutely exude enthusiasm to the client. This also translates to the price you charge for products and services. You have to sincerely believe that you and your team deserve your salaries and that your clients deserve a nice facility staffed with educated, caring people. If you truly trust that you are charging fairly, you won't show any signs of apology when you recommend treatments, diagnostics or pharmaceuticals to your clients. Your clients are then more likely to perceive the recommendations as worth the price and are, in turn, more likely to accept them.

Compliance is something we will always have to monitor because it doesn't come easy to any of us. It is wise to be keenly aware of your own compliance dilemmas, as well as that of your staff. Doing so will make you additionally aware of just how difficult this issue is and how easy it is to relax your standards. It may also encourage you to be more gentle and compassionate when working with a client's less than stellar compliance performance.