In this episode, Dr. Cari Wise introduces the concept of appointment staging, which emphasizes the importance of not feeling compelled to resolve all issues during a single veterinary visit, particularly when multiple health concerns are identified.
Dr. Wise identifies several contributing factors to this pressure. One significant factor is a prevalent misconception among veterinary professionals regarding their role. Many veterinarians operate under the belief that if they identify a problem, they are obligated to address it immediately. This mindset can lead to an overwhelming workload that exceeds what can be reasonably managed in a single appointment. Another contributing factor is the perceived expectation from clients; veterinarians often assume that clients expect all issues to be resolved during the visit. This assumption can create a sense of obligation that detracts from making informed and thoughtful decisions regarding the pet’s care.
The episode further explores the negative consequences of attempting to address multiple issues in one appointment. This approach can lead to information overload for clients, who may only retain a small fraction of what is discussed during the visit. Consequently, clients may feel overwhelmed and decline all recommendations, which can ultimately harm the pet’s health and damage the veterinarian-client relationship.
Setting realistic expectations is also crucial. If diagnostic tests are necessary, veterinarians can inform clients that results will be available in a few days, allowing time for thoughtful consideration and planning. This approach not only alleviates pressure but also enhances the client experience by providing clarity and structure.
Key takeaways:
- Addressing multiple concerns at once can lead to burnout and lower care quality.
- Slowing down, prioritizing patient comfort, and effectively communicating with clients regarding follow-ups are essential.
- Staging appointments improves case management, reduces staff stress, and enhances client experience.
- Emphasizes that quality medicine leads to financial success
- Effective time management and appointment staging can improve outcomes and satisfaction for clients and patients.
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EPISODE TRANSCRIPT
This transcript is auto-generated and may contain typos.
Hi there. I’m Dr. Cari Wise, veterinarian, certified life coach and certified quantum human design specialist. If you’re a veterinary professional looking to up level your life and your career, or maybe looking to go in an entirely new direction, then what I talk about here on the Joyful DVM podcast is absolutely for you. Let’s get started. Hello, my friends. Welcome back to the Joyful DVM podcast. In today’s episode, we’re going to be talking about appointment staging and why you don’t need to solve it all in one day.
So what I’m talking about is when you have a case that comes in that has multiple things going on, and a lot of the times those appointments are only scheduled with one problem in the subject line. So perhaps they’re coming in for an ear infection and then you go in the room. By the time you’ve completed your physical exam and gotten a history, you now suspect that this animal could have, let’s say, maybe Cushing’s disease, it’s also got a skin infection and you found a bunch of soft masses on the body.
Maybe the owner talks about how the animal has been drinking more water and urinating in the house. And now all of a sudden we’ve got all of these different things that are possibilities going on with this animal that need to be addressed. Along with that, you notice that maybe there is an eyelid mass and some really bad periodontal disease. Now you’ve got a list that’s growing of problems and potential diseases with this particular animal.
So what do you do? Many of us feel this pressure and this need to try to solve all of the things in one single appointment. And that’s just not realistic, especially when the demand for veterinary services, what it is today, we only have so much time in a day and we only have so many team members to be able to help us. So we’ve got to get better at appointment staging if we are going to preserve the quality of the medicine we practice and the experience for our clients as well as the experience for ourselves.
So to start off, let’s take a look at what drives our need to fix all of the things one visit. Well, it really starts with a personal misunderstanding of our role as veterinary professionals. Yes, we go in, we get a history, we do a physical exam, we have an assessment then and we make some recommendations. And as we’re going through that physical exam, we’re starting to create this list of differential diagnoses and we start to recognize then the diagnostic data or the test information that we’re going to need to be able to identify specifically and then address the concerns.
If we come into that with an expectation of ourselves that if we diagnose it or identify it, that we should address it or fix it right now, then notice that that is going to stack onto our workload beyond the capacity of what a single appointment has allowed. When we have these cases that have multiple things going on. So we have to come back to us and see, do we carry around a story that says that if I see it, I must fix it or address it right now?
Because many, many of us do. Because it’s linked to a second belief that if I don’t, I’m somehow not doing my job, or not doing my job well, or I’m failing. So if we slow all that down to realize that just because you identify the problem today doesn’t mean it needs to be addressed today, that starts to change the entire canter of the appointment cycles and it actually helps balance everything out.
So that need to or that pressure to address it because you found it today is one of the first things that really drives this overall behavior. Another thing that drives this behavior is this sense of obligation to a perceived expectation from the client. Now, what I mean by that is that we are going into these appointments assuming that the client will expect us to address everything that we find today.
And we don’t know that that’s true. But even if it is true, we still have the ability to adjust an expectation. When we go in with a perceived expectation to any situation, then we are going to stack on a sense of obligation to then perform a certain way. And it takes away a lot of our ability to make smart choices for the patients, for the clients, and for our staff in the moment.
So we want to just be aware of that, that we might be operating in our appointments from this idea that the client is believing that since they are there, we must address or fix all the things right now. And that just isn’t true. And even if the client does believe that, it still isn’t true. And I’m going to give you some tips about how to navigate this here in a few minutes.
The third thing that drives this need to solve everything in one day might be a pressure to produce revenue from the place that you work. So if you are feeling pressured to produce a certain amount of revenue per day, see a certain amount of. A certain amount of revenue per day. I want you to realize that when we approach any kind of case from a revenue pressure perspective, we are never doing what’s best for the client and the patient.
When you practice good medicine, the money takes care of itself. I really, really believe this, and I do not believe that we ever need to pressure a client into making a specific decision in order to meet our revenue goals. I think when we look at our job from that perspective, it really takes out the personalization of the experience, and it really starts to impact the trust building between clients and veterinary professionals.
People pick up on it when we’re just trying to get them to do stuff for money. Now, I’m not saying a lot of us approach things from that perspective, but I know that some of us do. And so I want us to take a nice deep breath and realize that it’s not the end of the world if you don’t meet your revenue goal. But more so, if you will just practice good medicine, you likely will meet and exceed your revenue goal as a natural result.
If we have this fear going into these appointments, that if you make a recommendation for somebody to come back, that they won’t come back and do the things, then I want you to recognize that maybe those choices weren’t the right choices for an owner. A client who wants to proceed with the diagnostics and treatment that we recommend isn’t really going to change their mind. If that diagnostic test and treatment starts today or tomorrow or three days from now, if that’s what they want to do for their pet, then that is going to be what they want to do for their pet.
However, a client who feels pressured to make a decision to do something that they’re not actually comfortable with doing may cave to that pressure and do it today and then become disgruntled on the other side of it, especially when those diagnostic tests don’t reveal any specific diagnoses. Now, just as a little sidebar here, I absolutely do believe that diagnostic testing that results in positive or not negative results, so that result in normal findings.
Let me put it that way. Diagnostic testing that results in normal findings is very valuable information, and it is part of our process of getting to the root of whatever the disease actually is. However, whenever we do diagnostic testing, if we’re doing it in a pressurized or rushed kind of fashion, where clients don’t understand what we’re looking for and the potential of what we may or may not find, and all we have focused on is, like, this one thing that we think it might be, and this is the test that we need to do to see if it is, then when we do that test in a pressurized setting, in a kind of a rushed setting, and then that test is normal.
Many times clients will then communicate that that was a waste of their money or that that didn’t need to be done, or that, you know, we only did it because we wanted to make some revenue, that wasn’t our motive. But that can be the way that our motive is perceived when we are very rushed and when we are feeling a lot of pressure to convince people to do stuff.
This is why it’s so important for us to slow it down so that we can educate the clients appropriately on what it is that we are recommending and then letting them make the choices. Remember, a client who declines everything that you recommend is not a reflection of you doing your job badly. Your ability to do your job and how well you do your job as a veterinarian is not dependent on what they ultimately decide because the decisions are never yours to make.
So you can’t control them. When we try to control them through pressure and through kind of like fear mentality, honestly, like a pressurized, you should do this for your dog. So through judgment, maybe is a better way of saying it, which is meaning when we try to convince people to do stuff without allowing them to make their own choices, then what the results are of whatever that we’re recommending become the way that they determine whether or not they spent their money wisely.
And if it doesn’t give them answers, and then like, then the next thing is just to do more tests or to approach things a different way. That’s when they’re already like, unease over spending their money comes out in different ways. So all of this to say in the moment, if you approach cases from the perspective that if they leave the building, that they will never come back to do the things that you recommend, let that be okay, because if they’re doing it from a pressurized perspective, it wasn’t the right fit for them anyway.
And that’s ultimately not going to create the best experience for them or for you as veterinary professionals. So this has kind of bled into the next point here, which is what happens when we try to do this, when we try to do all the things for all the different problems that we identify on a physical in one single visit. What happens when we do this? Well, we’ve already started to talk about this.
We have a negative impact on the customer service for the clients, number one. So not only are we kind of rushing through a whole bunch of different things, which is creating this information overload experience for the clients, and we already know statistically that people only retain about 10% of what is said. So if we’re throwing lots of different information about lots of different things, ear skin masses, teeth, all at one time.
And then here’s how we’re going to address this. Here’s how we’re going to address number two. Here’s how we’re going to address number three. Here’s how we’re going to address the number four. That’s just a lot of information for somebody who thought they were just coming in for an ear infection, to use our prior example. So that information overload can really cause the client to shut down, which changes the entire experience for the negative for that client.
There’s just not enough time in that appointment that was allotted to address all of those things in a way that adequately educates the client so they can make an informed decision. And when people shut down, they often just say no to everything. So we’ve actually done the opposite of what we think we are doing. Instead of helping the client and the pet, for all these things that we found wrong, the client has shut down because they’re in overload and they say they decline everything and you may never be able to help that client or pet again.
So the customer service experience really does decrease when we try to fix all the things at one time. In addition, when we do try to fix all the things at one time and we end up in a situation where the client is agreeing to do these things. Now we have often expanded that appointment beyond the time that was allotted for it. So now we start to have this cascading effect of running behind in future appointments.
So not only are we decreasing the customer experience for the client who are seeing, but we are also decreasing the customer experience for the clients who follow. And this just ends up being a stacking problem if you keep doing this over and over and over again throughout a day. So we end up with this lower quality case management, not only of the cases that we are seeing that are the ones with more complex problems and multiple problems, but also lower quality management of the more routine things that come later.
Because we are rushed and because we tend to cut corners, this leads to creating more mistakes on simple things. Because when our staff, which is our second really big problem here of what happens when we try to stack all this stuff, our staff or our professional helper resources are also strained. Right? So we don’t have more staff to take on more work. And especially these days where many of us are running short staffed, if we add on more things, then that is going to strain and really pull their workload beyond the capabilities of doing it all well.
And so we start to see mistakes. They might be simple mistakes, but they may be more complex mistakes. So forgetting to a simple mistake might be forgetting to record radiographs in a radiology log. A more complex mistake might be grabbing the wrong medication or the wrong size, or putting in the wrong directions and sending an owner home with that. So mistakes can have real consequences. So we need to remember that we don’t need to interact with these cases from this extreme pressurized situation and belief that we must fix it all now because we can, or we must address it all now because they’re here.
That actually doesn’t help anybody at all. It strains our practice resources and it negatively impacts our customer service for those clients and the clients who follow them who may not have a pet with multiple problems. So what can we do when it comes to staging appointments and managing our time and resources more effectively so we don’t end up in these situations where everybody is stressed out and strained and the experience is ultimately going downhill and the clients end up in overload?
What can we do? Well, when we identify multiple things going on with a patient, we absolutely should communicate those findings to the owner. So if we go back to one of my original example, dog came in for an ear infection, but we also found that had periodontal disease and an eyelid mass. And it looks like it’s got a skin infection. And he’s talking, they’re talking about it being maybe pupd.
So we have some concerns. Right? So we’re concerned about an ear infection. We’re concerned about maybe underlying Cushing’s or diabetes. We got some teeth that we need to deal with at some point. We’ve got this skin infection that probably could use some attention right now in addition to the ears. And so if we look at this case, we can see there are some things that this animal could benefit from us doing right now.
And then there are additional things, additional follow up that we could kind of stretch out so we don’t have to do them all, that we could get them back to do those other things? So the way that I like to approach these cases is how can I make this pet comfortable right now and what information can I attempt to get right now that isn’t going to add a lot more time, but it’s going to help as far as trying to understand how these different things might be connected.
So for this specific case, I would absolutely cayman for ears. I’m going to address the ears. So it’s going to get an ear cytology If I think it needs a mite check, it’s going to get a mite check. We’re probably going to clean the ears, we’re going to get it on some medication that’s going to happen. If it’s also all crusty and itchy and it’s got a skin thing going on, I’m probably going to treat that.
And if I need a cytology, I’m probably gonna do that. If I need a skin scrape, I’m probably gonna do that. Because I’m gonna be doing the ears anyway. That’s not gonna take that much more time for me to do those two little things. But I’m not gonna get into a huge conversation with the owner about all the other things that could be going on because I want to address the things that need to help get this animal comfortable right now.
So I’m gonna treat that. So if it’s got a pyoderma, I’m gonna treat that pyoderma, I’m gonna talk to the owner about what I suspect could be contributing to these things and about this situation with the drinking and peeing. And so I’m going to recommend that we run some blood work and get a urine sample. What I’m not going to say is that we’re going to run some blood work, get some urine and you’re going to get those results right now while you’re here.
Because even if I have the in house diagnostic capability to get all those results right this second, I don’t have the time to address all of that right now in this one single appointment. So I can give the owner the options of going ahead and starting this diagnostic testing and getting these first level diagnostics going. But then I’m going to set the expectation that I will be back in touch with them in two to three days with those results.
Now I’ve created myself some time to think about this case, to get the results back and to make a plan for this particular pet. I’m also, because it’s an ear case, I’m absolutely going to go ahead and set up that recheck appointment for, for 10 to 14 days later. Now if my client comes back and says, you know what, I don’t wanna do blood work in urine today, I’m only here for the ears.
I’m gonna say totally fine when you come back in 10 to 14 days. Let’s talk about this again because I’m concerned that these things are related. And here’s our first step on how we’re going to try to get to the bottom of all of that so that we can keep Fluffy from having more and more of these problems if it’s possible. So again, I’m just giving the owners the choice and by having that conversation of here’s the things that I think we need to do to, to get to the bottom of how these things might be related and giving them that bit of information then and saying we can address this again in 10 to 14 days, that gives them time to settle into the idea that there’s more going on with their dog than just ear infections.
That’s not a bad thing to give them time to just kind of acclimate to this new information that they didn’t have because they just thought they were coming in for an ear infection. And we walk in the room and it’s got a whole myriad of problems. Now many of us at that point would just jump into internal self judgment or not self judgment, internal judgment of the client for letting their pet get to that position.
That’s not useful, it’s not necessary, it’s not our job. Our job is to do an evaluation, to make some recommendations, so to provide education. That’s what we do. If you add judgment into your regular interpretation of the client and interaction with the client, that’s not going to help anybody. And we tend to do that when we end up in these situations where the animal has multiple things going on and we have this pressure to fix it all at one time because we feel pressured to fix it all at one time.
And so what happens is our brain offers us, like if they would have come in sooner, then we wouldn’t have to deal with all of this stuff right now and then I wouldn’t get behind and then they wouldn’t have to spend so much money and yada, yada, yada, on and on and on. And we don’t know if any of that’s true. And it’s completely a waste of our mental energy and our emotional well being to even go there because it’s irrelevant.
What’s relevant is what’s actually in front of you at this point in time. So little side tangent there for you. So just giving them the options, grabbing whatever data you can, if the owner wants to do it today is awesome. And if they don’t, 10 to 14 days later, now you’ve got the time to address it again. At the same time, if we talk about the other things there, right.
We talked about with this particular dog, this case example, periodontal disease and some soft masses. Yeah. Needle aspirates. And cytologists, if they’ve got 10 masses, maybe you want to do needle aspirates and cytologies on all of them so that we get some baseline information. Maybe they’re all going to come back as lipomas, but you don’t know. Right. So talking to the owner about they’ve got all these masses, we don’t know what they are unless we do needle aspirate and a cytology to see.
And then depending on what we find there, we may recommend removal. This is something that I would absolutely recommend that you get scheduled to evaluate and to investigate at a future appointment. If you want to do that when you come back for your ear recheck, we can absolutely create the time in that appointment to do it at that time. That’s definitely something I would recommend doing. Same thing with the teeth.
You know it’s going to need a dental at some point. You also know that likely you’re going to want to run some pre anesthetic blood work before you do the dental, so we can share that with the owner as well. The teeth are going to need to be cleaned and part of that procedure is to do some pre anesthetic blood work. The blood work that we run now may work as pre anesthetic blood work for the dental.
As long as we don’t find some other disease process, we need to stabilize first. So again, giving the owner some information on how some of these things tie together, but then not necessarily approaching all those things at one time. It’s not like you’re going to stop everything and clean the teeth right now. Right, because we know that’s an anesthetic procedure. So just notice that if, you know, like you look at the teeth and you’re not going to drop everything to do a dental right in this moment, you have that same opportunity to stage things out.
Even with things like multiple soft masses and more closely addressing skin problems. When you need more time, create more time. If the appointment as it was scheduled is not sufficient time to address the concerns, then create another appointment. It’s only through pressure and fear that we believe that, that we must do all the things in the one appointment when they are there. And like I said before, when we try to pressurize clients, pressure clients into making decisions right now, that actually decreases our ability to help them.
Because when people feel a lot of pressure, oftentimes the answer that we’re going to get is no, because they just simply haven’t had enough time to digest everything that we have told them during their visit. When we Allow ourselves this opportunity to slow the entire thing down, to stage the appointment, to separate out over multiple visits the things that need to be addressed. This is when we do the best possible job for our patients and for our clients, because this gives us time to think about the case and to educate the clients about their choices and about what we believe is going on.
There are also some pretty simple things that we can do just throughout our general day, even when we don’t have situations where the cases in front of us have multiple things going on. Some things that we can do to manage our time and our resources more effectively, especially when we’re fully booked. So some tips with that would be to get the samples and to call them with the results.
So set that expectation at the beginning, even if it’s something like needle aspirates and cytologies in house lab work, urine results. If we don’t absolutely need those results right this moment for the appointment, it is completely fine to say, we’ll give you a call in two to three days. Now, I know a lot of us like to do urine right then because it’s going to change what we’re going to send home.
Awesome. If you’ve got the capability and the time and the staff to be able to do that that way, then absolutely do it. But if it’s maybe a urinalysis as part of just a senior screening, or you’re just wondering, there could be something going on, but we don’t have a drastic problem right now. It’s not the presenting problem. If you will, then it’s okay to say, we’ll call you with those results in two to three days.
So just to kind of clarify, especially when I’m talking about urine, if the presenting problem isn’t something like inappropriate urination or pupd, you don’t necessarily need to give them the urine results while they are there. If you’ve got the time and you’ve got the staff, by all means do that. But if you don’t, it’s okay to use a staging process. Gather the samples and let them know you’ll be back in touch with those results in two to three days.
Give yourself more time than is needed to get the blood work back or the urine results back. Yes, you might have those results tomorrow, but you know what’s gonna happen tomorrow. So give yourself two to three days. That way, when you deliver that information, even if it’s early, you’re kind of over delivering. In the experience, it’s better to under promise and over deliver than to over promise and under deliver.
So don’t tell them, I’ll call you tomorrow and then have your return call be two to three days later. That’s really deteriorating the client experience. But if you tell them, I’ll have you give you a call in two to three days then, and you happen to get it back tomorrow then, and you have time, then you call them tomorrow, then that is actually a positive experience for the client.
So be realistic and set yourself up for success when it comes when for the expectations to the expectations that you’re setting with the clients. Because you are the one who gets to set the expectation. Remember that you’re the one who gets to decide how quickly things move forward. And if you’re not in an emergency medicine kind of situation, you don’t need to behave like you’re in an emergency medicine situation.
It is okay to stretch this stuff out to keep more balance for your staff, for yourself, and for the entire kind of customer journey as well. Remember, when it all comes down to it, the experience that the client has at a veterinary hospital is something that we control. And we get to control that experience by setting expectations that are realistic. Now remember, I know clients are always going to believe whatever they’re going to believe.
You’re not going to control that part. So don’t misunderstand what I just said. What I mean by that is you get to decide the cadence of how things happen at your own facility. You get to set the standard for when results come back, how you approach things that need more time to address diagnostically. And so as we set those expectations, we also then create more standardization and predictability in our workflow, so that when we do have those true emergent things that come in, and we do need to add those on, that they become the unexpected thing that we add on, not just part of the normal stuff that got added on.
When 75% of the things that got added on today’s schedule are things that we could have actually scheduled for tomorrow or for another time down the road. If you’re looking at your schedule and you’re thinking about what I’m saying, and you’re like, but, Cari, there is no time to add more into my schedule tomorrow, so I might as well do it today, then I want you to consider whether or not you’re using day admits or drop offs as part of your workflow, because that’s another way that you can address these things without creating a lot more backup in your time.
So if you have an animal, for example, that has maybe like some progressive lameness over Time. And so the next step is to do some radiographs. If they come in with a complaint of progressive lameness and you look at the animal and it’s not an acute injury, it’s not something that needs emergent radiographs, you could then bring that one in as a day admit. Let them stay for a few hours so that your staff can work in those radiographs as there’s a little bit of time, or you can schedule them for a drop off the next day for a few hours and do it that way rather than trying to stack it on right now on top of all these other appointments that are here.
And the reason that we would try to just do it right now is going to again come from a pressure, either pressure or fear. So fear that the owner is going to be mad if you say let’s do X rays later or let’s drop off or fear that if you don’t do them right now, then they’re never going to do them. And again, I want to come back to that second point.
If a client isn’t going to do them, if you don’t do them right now, then they probably didn’t ever want to do them in the first place. So just take that into consideration. And if you want to come back and say, but their schedule just wouldn’t allow it and there’s a thousand excuses of why that can’t be, then I want you to that are like client related excuses.
I want you to realize that your job is to provide the opportunity for their service. Your job is not to cater to every expectation of the client. You are willing to take radiographs, you are willing to help the patient and this is how you do it. So it’s a yes? Yes, we can absolutely take radiographs. Why don’t you leave Fluffy with us for a few hours, we’ll get those done, we’ll give you a call and then you can come back and we’ll talk about the results or that sound.
Yeah, absolutely. I recommend radiographs for Fluffy. Why don’t you get them scheduled to drop off tomorrow or the next day and we’ll get those radiographs taken and then when you come back to pick them up, we’ll be able to talk about those results. You get to set the expectation. Can you do them right now? Right now? Not right now. We can’t do them right now. We can do them later.
And some people are. You just don’t want to say no to your clients. You’re afraid of what they’re going to say if you say no. And you’re thinking that if you tell them not right now, that that means you don’t care. And that’s not the case. If you have the staff to do everything right now, wonderful, then do that. But my guess is you’re not feeling a pressure around time and you’re not having a negative compounding customer service.
If you have enough staff. That’s probably where most of us are not right now. That’s not the reality for most of us right now. So using things like these day admits or these drop offs is a great way to help balance some of that time out. And then when you know they’re coming, you could also then schedule in some time to actually do those procedures. Especially when your staff is really small, you can create that time.
And so what gets added on truly are the emergent and urgent and not the things that don’t have to be done in this moment. For those of you who are ending up saying hours past the time that you should be working because you just can’t seem to get finished with appointments, part of what you need to look at is your opportunity to stage more of your appointments, to not solve everything at one time, to utilize things like day admits and future appointments for diagnostic testing.
It’s completely fine to schedule an appointment at a future date with the sole reason of doing diagnostic testing. So scheduling a 30 minute block, because that is where your fluffy is going to come in. So you can aspirate the 10 masses and do the cytologies and either send them off to the lab or read them yourselves. Completely fine to do that. And even in that case, it may take you most of that time to get those samples and you don’t have time within your 30 minutes to look at all of them right then that’s fine.
Again, use your staging that you will call with those results in two to three days and you can set all this up on the front end. For those of you who haven’t practiced this way, this might feel really scary because you’re afraid of the. No, you’re afraid the client’s going to get frustrated if you can’t do it all at this one time like you’ve always done in the past.
But you’ve got to come back and remember that we teach people about our culture. We are the ones who set the expectations. We are the ones who set the cadence of any appointment. And it’s okay for us to change that as our entire demand for workflow and our staffing changes, because everything changes. So just because you might have always been a practice that did everything the same time when they were there doesn’t mean that you have to continue to do it that way, especially if you don’t have the staff and the time to be able to accommodate that.
Remember, part of what we’re trying to do here is to create a good experience for the clients and to give them the best information about their pets. When we are rushed, we aren’t doing that, not only with the animal that has multiple things going on, but also with the more standard cases. Because when you are feeling rushed to get through your appointments, you are cutting corners. There are things that aren’t getting done, there are conversations that are not being had.
There are situations when things are just getting treated without using your diagnostics before you do treatment. And I’m not saying the situation where a client is declining the diagnostics, saying you’re just treating based on an assumption because you don’t have time to do the diagnostics. So you’re not even offering it. This is where I’m telling you, if you practice good medicine, the money takes care of itself. Good medicine is to do your diagnostics, at least to offer them.
Let me see, I want to back that up. Good medicine is to offer the diagnostics. That doesn’t mean they’re going to say yes. So it doesn’t mean that they say no. And you just treat based on a presumptive diagnosis that that’s bad medicine. Because it’s not. Hear me? That’s not bad medicine. Treating on a presumptive diagnosis. When a client declines the diagnostic testing required to definitively diagnose, diagnose the disease, that is not bad medicine.
You need to obviously use some judgment. You’re not going to presumptively diagnose a diet or treat a diabetic with insulin. Right. Like that’s not what we’re talking about here. But let’s go back to our ear case. You have an animal that’s got evidence of otitis and we suspect it’s probably yeast, maybe bacteria, could be mites, but probably not. Little soupy ears, stinky. And you recommend an ear cytology, ear mite check, and they decline that.
Are you then just not going to get. Send the animal home with information or medication? No. Like we’re gonna go ahead probably and send something home for the ears based on the presumptive diagnosis of otitis. That’s not bad medicine because you offered. It’s always the client’s choice as to whether or not they accept or decline what you wanna be able to show is that you offered. When we get in these situations, when we are really, really rushed, we start to cut corners.
We stop offering. We just give medication that isn’t helping anybody. It’s not educating the client, it’s not practicing the best quality medicine, and it’s deteriorating the entire customer service experience. Because if we’re cutting off the diagnostics, we’re also likely cutting off the education about the diagnostics because we’re trying to get on to the next case. And so the client doesn’t understand then the full scope of what’s going on with this dog that has an ear infection.
And so when that doesn’t get better, maybe you tell them to come back for a recheck in 10 to 14 days, and they come back and they say it’s not any better. You had. Didn’t have. You didn’t prepare them for that, for that potential outcome. Right. You didn’t let them know that it’s possible that in 10 to 14 days this isn’t going to be resolved. Because maybe it looked like a chronic, ongoing.
Maybe you suspected some underlying thing like hypothyroidism or Cushing’s or something, allergies. You didn’t take any time to educate about any of that stuff on the front end, even just. It didn’t take 30 seconds to talk about some of that stuff. But if you’re feeling really rushed, you’re cutting that part out of that particular client’s experience and then setting everybody up for a frustrating experience down the road.
And that’s all likely all happened because somewhere earlier in the day there was a case or cases that were more complicated. I don’t want to say more complicated that had more things going on than was what the appointment was for. And then you felt an obligation or a pressure to address all those things at this time. And it wasn’t emergent, so it could have actually been staged. These are just things for you to think about as we’re going through the way that we interact with our veterinary clients.
The level of service that is expected is different than it was 20 years ago. People want to do more for their pets than they’ve ever wanted to do before. They’re more curious. They want to do the testing. This is a good problem to have that there is demand for our services in this way, but we can stage out the delivery of these services. Just because somebody wants to do all the things doesn’t mean we have to do all the things right now.
If your schedule can accommodate that in a way that not only provides the best experience for that client, but also the other clients who also have appointments coming up behind them. If you don’t have the staff to be able to accommodate adding on all of that stuff at one time, if you don’t have the energy, even, like, if you are also, like, mentally just cannot try to think through a complex case in the middle of all these other cases, it’s okay to slow it all down, make a plan.
And I can tell you that from having practiced this way, quite honestly, this is the way that I have always approached my cases, because I’ve often been a solo doctor, that it’s. The clients really don’t get mad about this. You know, we can spend that first visit, like, where they come in with their one concern. But I found five things. We spend most of that visit talking about all the five things and what we need to do to figure out what exactly is going on with the five things.
And then I will likely say, okay, so for today, let’s start with doing what we need to do to get Fluffy comfortable. So if they came in with something that’s making the animal uncomfortable, I’m gonna try to do something to address that. And let’s go ahead and get some labs so we can start to get some information about these other things that are going on. I put all that stuff on my treatment plan, and then when we go over that treatment plan, I’ve already seeded, like, I need to see Fluffy back in, like, 10 days.
So I’ve already seeded that before I even go over the treatment plan. And if they don’t want to do the diagnostics today, then I just say, okay, let’s readdress this in about 10 days. So when we come back and I recheck Luffy in 10 days for this thing that we’ve addressed, then consider whether or not you want to move forward with doing some diagnostics at that point. So we’re doing some blood work and some urine at that point in time, or if they said yes to that, then maybe I say, okay, great, we’ll get those results.
And if it looks like we need to take some X rays to get some additional information, when I call you with the lab results, we may set that up to be something that we do when you come back for your recheck in 10 days. And then if it does turn out that we do want to do the x rays in 10 days, then I’m planning the time ahead of time to do that.
And more often than not, I’m going to say, yep, we need to do some X rays. Why don’t we plan for that drop off just to be or that recheck to be a drop off for the day. And that way I can go ahead and recheck Fluffy, we can get those X rays. And so when you come in to pick her up, we’ll set some time aside to talk about all the things that we found.
That’s how you stage out these appointments. And it still creates a really positive customer experience because the owner leaves from that first appointment realizing, okay, there’s a lot of things going on, but we’ve got a plan for how we’re going to start getting information and it’s going to take us some time to get there, but we’ll get there. And we don’t need to create this scarcity situation where you must do it right now because if they leave, they’re never coming back.
Just settle back into knowing that the people who want to address their pet’s medical issues to the fullest extent are going to come back to do that. That you’re not going to lose an opportunity to treat a patient if you don’t do it right now. And if you do, like if a client’s like right now or never, consider maybe that client wasn’t the best fit for your practice.
Just because you can doesn’t mean you have to. My friends, we have got to slow this down so that we can continue to create a good customer experience for our clients and a good and balanced and sustainable experience for ourselves. We don’t need to be running around like chickens with their head cut off all the time. We don’t need to be practicing day in and day out from intense pressure.
There are ways to manage all of it and it starts with us shifting what we believe our responsibility is in the moment, giving ourselves permission to stage out these appointments and realizing that when we slow it down in this way, not only does that pet with a complex medical situation get better care because they get our best mental status and also the time to educate our best mental status to address the case and our the best opportunity to educate the clients about the case.
Not only do they get that, but the clients and patients who are also on the schedule that day get a better experience as well. Because we are not distracted by what happened before or trying to squeeze in the appointments that actually had scheduled time because we have now pushed everything later than it is supposed to be. So give yourself permission to slow it all down. Remember that your job is to do an exam, to make a recommendation and to follow through on what the client decides, but that you still get to decide the timing of those recommendations.
And you have the ability to set that up in a way that is actually beneficial for everybody involved. All right, my friends, things to consider this week. I hope you have a beautiful week, and I’ll see you soon. Bye for now.