Veterinarians: Find the love for your dermatology cases

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“Skin diseases are frustrating and slow to treat, [but] our clients want fast and easy,” said Darin Dell, DVM, DACVD, at the Fetch dvm360 conference in Baltimore. The disease process and client expectations are at odds with each other from the beginning, he said, and the situation is further complicated by the fact that a successful outcome in dermatology cases relies on both veterinary expertise and client compliance with at-home treatments.

Unfortunately, client frustration is often displaced onto the veterinarian, regardless of how well the veterinarian practices medicine. To maximize successful treatment and client satisfaction with dermatology cases, strong working relationships with both clients and patients are essential. In his lecture, Dr. Dell, who practices at Wheat Ridge Animal Hospital in Colorado, provided tips for building successful relationships in dermatology cases.

The client relationship

Be clear. Clear communication is at the core of building a good client relationship, Dr. Dell said. He stressed the importance of patience and repetition when talking to clients, citing the fact that most people must hear something three to seven times before they will act on that information. Thus, the veterinarian and support staff must be clear and repeat important points, especially about the diagnosis, throughout the appointment.

Get to the point. Dr. Dell has observed that less than a quarter of clients presenting to his referral hospital know what their pet's diagnosis is, while the rest feel that their veterinarian doesn't know what is going on. In reality, most referring veterinarians do know what is happening with the pet, but the client either hasn't heard or hasn't understood it. Dr. Dell encouraged veterinarians to be very direct with owners, noting that he often finds himself saying, “Your dog has a chronic condition. It is never going to go away. We are going to manage it,” multiple times during each appointment.

Put that in writing, please. Verbal communication can be enhanced by providing written discharge instructions after every appointment. This adds value to the appointment, gives the client a guide for what they are expected to do at home, and can be used by staff members to answer questions from clients after the appointment. Additionally, Dr. Dell encouraged veterinarians to make a clear road map for treatment and follow-up that can be shared with the client to manage expectations.

Teach, teach, teach. Opportunities for client education should be provided throughout their time in the hospital and at home to reinforce the key points discussed during the appointment. Dr. Dell suggests providing educational material in multiple formats as learning styles vary. He often provides educational videos for his clients to watch during their wait, he said. Written handouts are another helpful tool, and many can be downloaded for free online or obtained through local pharmaceutical representatives. (Check out dvm360's vast library of client handouts, organized by topic area, here.)

Help, please. Finally, Dr. Dell discussed the importance of making an appropriate referral and acknowledged that guidelines for referral are often lacking in veterinary school education. He encouraged practitioners to not consider referral as a defeat, but instead think of it as another way to advocate for the patient. Dr. Dell recommended referral in cases when:

• No clinical improvement has been found after the third visit, as many clients will move on to another hospital after a fourth visit without resolution or improvement. Dermatology cases are one of the most common reasons for clients to move between hospitals and seek second opinions, and Dr. Dell encouraged veterinarians to not take this personally.

• A case is complicated or there are multiple disease processes at work.

• Clients or patients have unique requirements, such as a comorbidity that makes simple dermatology treatment more difficult.

The patient relationship

The other key to building a strong client relationship relies on establishing rapport with the patient. Ultimately, if a pet enjoys coming to see you, the client will be much happier to see you as well.

Dr. Dell acknowledged that there are much stricter time constraints on general practice appointments than he experiences in a referral setting, but he encouraged veterinarians to go slow and listen to their patients' body language. Because dermatology is rarely a life-or-death situation, it is okay to skip some parts of the examination, such as taking a temperature, Dr. Dell said. The veterinarian's goal should be to see as much of the patient as possible without making the pet uncomfortable or painful.

Dr. Dell gave several tips for successful examinations in dermatology patients:

• Use treats to introduce yourself, distract pets during the examination and reward appropriate behavior. Have a variety of treats available, including some hypoallergenic ones.

• Save the uncomfortable or obvious problem area(s) for last. Dr. Dell encouraged practitioners to tell the client they want to examine these areas last to avoid missing important information that can be found elsewhere on the exam due to becoming hyper-focused on the obvious problem.

• In cases where there are no obvious problem areas, examine the paws and ears last because these are common sensitive areas for many patients.

• Don't be afraid to postpone part of the examination for the patient's benefit. When obvious discomfort or pain exists, such as in otitis externa cases, it is better to treat the pain and recheck in a few days once the patient is comfortable. Don't look at an exam as a win or lose situation, Dr. Dell said. Taking a step back and managing patient comfort with pain or anti-anxiety medications will prevent injury and avoid creating a bad association for the patient between ear handling and pain, thus making treatment more difficult for the client.

• In cases where postponement is not an option, consider a short-acting injectable sedation.

• Use medications for anxiety to help prevent damaging the relationship between the pet and either the owner or veterinarian. Dr. Dell commonly reaches for trazodone and gabapentin and sometimes asks clients to give these medications prior to at-home treatment as well as appointments. He compares the use of these drugs with sedation dentistry to help clients understand the benefit in managing the patient's anxiety.

Stronger together

While dermatology cases will always involve significant time and effort on the part of the client and veterinarian, building strong working relationships with clients and patients will enhance outcomes and client satisfaction. Clear communication with clients and careful handling of patients improve the experience for both owner and pet. Many of Dr. Dell's tips can be applied to cases beyond dermatology, especially those that require long-term management.

Dr. Kate Boatright, a 2013 graduate of the University of Pennsylvania, is an associate veterinarian in western Pennsylvania. She is actively involved in her state and local veterinary medical associations and is a former national officer of the Veterinary Business Management Association.