Monday, March 1, 2010

Monday, 2/1/2010 - Client communication and Flash

Vet Tip of the Day: Client Communication

Using Flash as an example, we've been discussing some of the principles of lameness evaluation used by veterinarians to make safe and accurate diagnoses for their equine patients.  There is a final element in this process that is critical not only to lameness exams but to every other facet of equine veterinary practice as well.  This element is client communication, and it is the subject of today's Vet Tip of the Day. 

For me, the most important goal when communicating with a client is to explain their horse's condition in the clearest terms possible.  Most of us have strong emotional ties to our horses.  At the same time, we know that our horses have an economic value, and that the cost of veterinary care can rapidly escalate.  When our horses are sick or injured, we immediately are concerned for their welfare while simultaneously wondering about associated costs.  Although we are uncomfortable facing it, for almost everyone there is a necessary balance between love and money where our animals are concerned.

As a veterinarian, I feel that the best service I can give my clients is to provide them with straightforward, understandable language describing their horse's injury, the prognosis for recovery, the treatment options and their associated costs. With a clear understanding of the facts surrounding their horse's problem, I believe my clients are best equipped to make informed decisions that are within their means and in their horse's best interest. 

Flash belongs to a very involved owner who has been breeding and showing performance horses for years.  Mary loves her horses, but is aware of the reality of economics when it comes to their maintenance.  Emotions can quickly cloud the picture when these two factors come into conflict.  She has a demanding job and juggles a heavy schedule to make time for her animals.  Many of my appointments with Flash take place without Mary being present.  It is very important to her that I contact her promptly after seeing Flash.  She expects a complete and definitive description of whatever has gone on with her horse so that she can stay on top of developments and make appropriate decisions as needed.  I appreciate these qualities because they reflect her concern for her animals and allow us to have an open, productive relationship.

Fulfilling such expectations is pretty easy when you are dealing with something like a simple skin laceration of the face.  All I have to do is remember to give clear instructions to the trainer and make the phone call to Mary as I leave the barn,  assuring her that Flash will be fine and I'll be out in 14 days to remove the sutures. With a lameness such as the one we are currently working through, it is more challenging.  I don't want Mary to worry unnecessarily, but it is important to convey my concern that the cause of Flash's lameness may be quite serious.  I am doing this based on my years of experience and my knowledge of anatomy and physiology but without a definitive diagnosis to offer Mary.

In this situation, because I cannot clearly define the problem, I explain the various possible causes of Flash's lameness to Mary without overwhelming and confusing her, and then focus on laying out a specific, structured plan explaining how we will go about narrowing down these possibilities.  This plan has a time line, it addresses Flash's care during that time, and it identifies specifically how I plan to go from "I don't know exactly what's wrong" to "OK, Mary, this is the problem."  Bringing in the opinions of outside experts, in this case ACVS board certified surgeons, to consult, is not only appropriate but, in my opinion, recommended, in this situation.

By approaching a challenging case with such an approach, I believe that the animal's best interest is protected, and I have the best chance of maintaining the trust I have established with my client and thereby minimizing her stress while we get to the bottom of Flash's problem.  As long as Mary is confident that her horse is safe and a time line has been defined, she can exercise her patience and allow me to continue down the path to figuring out Flash's lameness.

Tomorrow we will look at Flash's second set of x-rays and discuss his second lameness examination and the ongoing mystery, including the opinions of the outside experts.
Enjoy.

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