Visual diagnostics aid client communication

I'm lucky to have grandparents becoming nonagenarians. But with that longevity comes a lot of hospital visits. I like to accompany my grandparents on these visits to support them and understand what tests are being done and why. Frankly, I'm often less than impressed. It can take days for a radiograph result to come back, weeks for blood work, and sometimes a month for an MRI analysis. Even more surprising is how the information is presented: "The blood work looks good" or "There's an area I'm concerned about on the X-ray." The doctors never show any visuals—no radiograph, no ultrasound image, not even a printout of blood work.

W. Andrew Rollo

This lack of visuals doesn't seem to bother my grandmother—her primary goal is to be taken care of and feel better. But the presentation of the diagnostics doesn't sit well with me. For all the money and expertise spent on this medical care, there should be a better "sell" at the end.

Here's the problem: At the end of my grandmother's hospital stay, she doesn't hand over a credit card. Insurance covers most of the costs; anything charged to her will be billed months later. This is why medical doctors aren't trained to show the value in the diagnostics they run. If they were in charge of marketing for Coca-Cola, we'd all be drinking Tab right now.

In veterinary medicine we don't have the privilege of running tests with no questions asked. An owner who will incur a $1,000 veterinary bill needs to know why every test is being run and the value in the information gained. We are a "pay when service is rendered" industry, and—as much as we may resist it—sometimes that means we have to put on our salesman hat (see "5 Sales Tips"). Here's how to justify tests by showing and explaining the visuals.

5 sales tips that won't make you gag

Laboratory test results

When my personal physician orders blood work, he usually tells me that if there's a problem, he'll call, otherwise I shouldn't worry. At my veterinary hospital, that approach wouldn't fly with pet owners. We require blood work for all surgical procedures. That means routine surgeries, such as a spay, may be more expensive than the veterinary clinic down the street. To help owners understand the value of blood work, we give them a printout of their pet's CBC and serum chemistry profile the morning they bring their pet in. We also attach a sheet with one to two sentences explaining the medical significance of BUN or ALT values.

Some owners don't care about the blood work, or they're just in a hurry to get to work. But many others are interested when they learn that the printout shows that Otis is healthy. I admit that I get tired of explaining to owners that a slight increase in mean corpuscular volume in a healthy 6-month-old dog with no anemia is no big deal—but I do it anyway. After all, the credit card handover is moments away.

Radiographs

Radiographs have been a visual diagnostic tool for a long time. Many exam rooms incorporate a viewing box so you can bring the information right to the client. Sometimes the point is easy to convey; clients can see a rock or necklace lodged in the intestines without too much trouble.

Other findings can be harder to explain, such as a bronchointerstitial lung pattern. Depending on the client, sometimes it's necessary to be technical; other times it's best to be as simple as possible. I don't know how many times I've found myself pointing to the lungs on a chest radiograph and saying, "Black is good."

The hardest part is finding time to show the owner the radiographs. A common problem I face is taking radiographs in the middle of the day and calling an owner with the results. She comes in to pick up her pet two hours later; unfortunately, I have seven appointments waiting. It'd be easy to skip showing the owner the radiographs to save time, but that client is about to pay several hundred dollars for her pet's care. She deserves to see exactly what I was looking at, even though I've already explained it to her over the phone. So I make time to discuss the images with that client, which may mean a bit longer wait for the other clients, but in the end it's worth the scheduling challenges.

Microscopic images

There's no better way to let a client know that his pet has sarcoptic mange than to show him a picture of the mite under a microscope slide. Many new microscopes even come with an attached screen and camera. Kids love to look at mites, and when we show pet owners a picture of a roundworm egg, we let them know we're looking out for their health along with their pet's.

A microscopic picture can also be a nice way to discuss your findings from fine needle aspirates. A lipoma is boring enough for us to look at, let alone the pet owner—still, it can be useful to show an owner a mast cell when you explain why you want to surgically remove that bump that popped up on the pet's thigh a month ago.

Ultrasound

Many people are familiar with ultrasound from human medicine—that's how they got their first peek at Junior. And because of the high cost of ultrasonography, it's especially important for owners to see what they're paying for with this diagnostic procedure. I show clients printed pictures of their pet's organ, although if they ask I sometimes let them view the actual procedure.

When I explain an ultrasound picture I tell owners, "We have black, white, and many shades of gray to interpret." Many clients find the images boring—it's much harder to see a normal pancreas than the familiar shape of a human fetus. While the information I'm giving isn't as exciting as experiencing a child's heartbeat for the first time, clients need to see the liver mass to justify their pet going to surgery. They need to see the bladder stone to help them realize why antibiotics will not solve the problem of the pet urinating in the house. If owners are paying $200 for an abdominal ultrasound, it's important that they see what their pet's liver and spleen look like, even if they're healthy and normal.

Foreign bodies

The last example of show and tell is up to you: whether you display the shredded sock or plastic toy that's been in the pet's intestines for the past week, or the two identical struvite stones that if properly marketed could be sold as earrings. I decide whether to share these things depending on whether I think the owner can stomach it.

In the end, the most important visual is you. Pet care costs have a way of adding up, and they have to be paid out of pocket. For this reason it's important that you, as the doctor, offer plenty of face time: during the initial exam, after a procedure, and throughout the pet's care. The last thing you want before the wallet comes out is for your client to feel like she got the brushoff from the guy who racked up the bill.

Dr. W. Andrew Rollo is a Veterinary Economics Editorial Advisory Board member and an associate at Gibraltar Veterinary Hospital in Gibraltar, Mich. Send questions or comments to ve@advanstar.com