Making the case for involving the team when it comes to diagnostics and long-term treatment of dermatology-related issues.

If veterinary practices are determined to provide exceptional relationship-centered service and care before, during, and after diagnostic workups, the first step may be simply recognizing that the old way of communicating with clients needs to change.

“We used to think it was just the veterinarian dictating directions to the pet owner, and the pet owner subserviently taking that information and trying to be compliant with it,” said Natalie Marks, DVM, CVJ, of Chicago, Illinois-based Blum Animal Hospital. “While unfortunately, I think it’s still done in some practices that way, we know that hasn’t been a successful way to manage cases in general, but very specifically with dermatology.”

Most dermatology and allergy patients are chronic, life-long management patients. “We can’t cure environmental allergies,” Marks said. In order to have the best medical outcomes for patients, Marks said the best way to tackle these cases is by having all veterinary practice team members in the hospital give the same messaging. She also recommended the client be considered part of the care team.

Indeed, clients need to have an equal seat at the table, Marks said, “because they’re the ones reporting on improvement or regression. They’re the ones who are going to accept or decline what therapies you try based off of what they’re comfortable with. Then they’re the ones responsible for the long-term care at home. So they’re an incredibly vital part of the team. That’s sort of a new concept in our world. It used to be very one-directional in the way we delivered care.”

Part of the team

Marks believes strongly in a team-based approach to dermatology. She gave a presentation at this year’s VMX on the subject, “The Allergic Dog: Diagnostic Success.” All team members can contribute to patient and practice success, Marks said, if they understand each stakeholder’s role in the process. It starts with the pet owner, but the owner is one of five team members when it comes to the care of the pet. The others are:

The receptionist, or Client Service Representative (CSR)
The veterinarian technician or nurse
The veterinarian
The practice manager

“All of those people have to believe in the mission that you’re talking about for allergies, or clients will get mixed messaging and we know that’s not successful,” said Marks.

While the veterinarian’s role may be defined and understood in a veterinary practice, Marks explained more details related to the other roles within the veterinary practice.

Receptionist

The receptionist will be involved in almost all aspects of the veterinary visit other than the diagnostics part. Marks said she recommends veterinary teams start the training with the receptionists. “One of the biggest issues in dermatology is that a lot of practices are leaving opportunities on the phone,” she said. “A client may call and say ‘my dog has been itching for two days’ and out of habit we have either minimized that concern or given them an over-the-counter ‘solution’ to try, from antihistamines to bathing to fatty acids to herbal supplements – none of which are essential,” Marks said. “It devalues the need for that pet to come in, and it also diminishes the trust in the practice when we tell the owner to go somewhere else for a solution.”

The reception team is also important for the patient intake, getting the client the right directions so they can properly relay the pet’s health history, and other necessary information. The reception team will also be the ones reinforcing the veterinarian’s recommendations at checkout and will be fielding calls and questions over the phone from clients for the long-term care following the exam.

Technician

The technician is involved in the diagnostic treatment and reinforcement of the care plan. A fairly new concept in dermatology is to have the veterinarian and technician working side by side in the exam room, Marks said. In this way, the veterinarian can discuss the treatment protocol with the client while the technician does the diagnostic work, which could involve cultures, cytologies, etc. This does a couple of things for the client, Marks said. “It shows them the value for the test,” she said. “It allows them to see what areas on their pet we are concerned about so they can help do that monitoring at home.”

It also shows that the technician is a vital part of the care team. “A lot of times a client will only talk to the veterinarian, or ask the technician but then ask the veterinarian again. This shows a very equal playing field. It’s not only helpful to the client but incredibly helpful to the technician to feel an empowered part of the practice.”

Practice manager

The practice manager’s role is not as defined as some of the other team members, but it’s very important in regards to the overall messaging of the practice, Marks said. “We need to make sure all our team members are trained to know that for us, an itchy dog is a concern. An uncomfortable dog, a worried client, needs to come in.”

Practice managers can reinforce the training so there is a unified message within the practice. It reduces client complaints and gives clear direction on the mission of the practice. “And the more consistent and compliant our clients are going to be, the more trust they have in the practice, the more clients will be referred, the more they will trust in the recommendations for dental care or preventative health. It’s a business builder as well.”

Shift in thinking

A team-based approach to dermatology is a shift in thinking from the way most practices have operated for decades, Marks said. But it aligns well with the new pet care model that’s attractive to today’s new pet owner – namely millennials. “Millennials want an experience,” Marks said. “They don’t want to be told what to do. They don’t want to hear from a veterinarian that it’s ‘my way or the highway.’ They want to be actively involved. They want your recommendations. They want to know their pet matters and is being given individual attention. They want to see the value of the care.”

Marks said the team-based approach to dermatology could be a blueprint for a team approach to other categories, such as endocrine disease or arthritis. “If you implement a team approach, not only will you have a client who feels more educated and actively part of the care team, but you have an empowered vet team, which is also a huge challenge right now in mental wellness and an ongoing concern in the profession. So I think it’s a win-win on both sides.”

Do’s and Don’ts of implementing a team-based approach

Don’t give out over-the-counter advice. If a dog or cat parent calls up and says their dog is itchy, the verbiage from the veterinary practice should be: “I’m so glad you called, your dog or cat is uncomfortable and we know you want the best care for them. Let’s get an exam scheduled.” Veterinary practices should stop the habit of over-the-counter advice, Marks said. Think of it as a slogan: “If it’s skin, it needs to come in.”

Do institute a process. Marks recommended veterinary teams implement, pause, assess, quantify, and then start over. Veterinary practices doing a team-based approach should have team meetings once a month in order to gauge feedback from team members and problem solve any issues that may arise. For instance, with the new verbiage, the reception team may now be getting two new appointments a week. But does the veterinary practice have the staff and time for those appointments? Everybody needs to be on board and evaluate the pros and cons of the implementation, then reassess and understand how it affects the entire workflow of the practice, Marks said. “You figure out together how to make solutions out of those challenges, and then move on to the next step.”

Photo credits: istockphoto.com/andresr, istockphoto.com/Sviatlana Barchan

Animal Dermatology: A Team Approach