Today's Veterinary Business

FEB 2019

Today’s Veterinary Business provides information and resources designed to help veterinarians and office management improve the financial performance of their practices, allowing them to increase the level of patient care and client service.

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27 February/March 2019 • TODAYSVETERINARYBUSINESS.COM drawback is that it makes the initial cost of treatment seem higher. What is especially important, therefore, is to make the client un- derstand that you include the fol- low-up fees in the initial payment. By the Numbers To make the approach more visual — before orthopedic surgery, for example — you could create two estimates: one for the procedure and one for follow-up care such as splint changes or X-rays. Both estimates should be understood and signed by the client. Keep in mind that a doctor might not have to see the patient at every visit. Many follow-up tasks can be performed by an experi- enced nurse. These include suture removals, bandage changes, radio- graphs and ear cytology. If the patient is not improving because a team member made a mistake of some kind, then you should consider providing a free follow-up. We all get swamped and things happen. In these moments, doing the right thing and making the client happy is really important. This can alleviate serious head- aches or even a lawsuit. Examples include: • Procedures and medications that were forgotten by a team member. • The quantity of medication to give or its frequency was incorrect. • Surgical implants such as pins or screws were placed improperly. • Physical therapy exercises were poorly explained. • Complications occurred due to the care provided. Of course, the plot thickens when the complications have nothing to do with you. These might include: • The patient chewed the inci- sion open because the owner didn't keep the E-collar on (classic story). • A bandage is filthy because the patient dug a hole in the yard after the client failed to leash him (true story). • An orthopedic surgery failed because the owner thought that allowing the patient to run up and down the stairs was OK (real story). • An infection got worse be- cause the client didn't use the medication as prescribed. In some cases, offering a compli- mentary follow-up exam might make sense as a teaching opportunity for a young (or not so young) colleague. For example, you want to observe how an open wound is healing. Try these strategies to persuade cli- ents to return for a follow-up visit: • Use staples instead of skin or intradermal sutures. Then schedule a staple- removal appointment. • Schedule the next follow- up before the owner leaves the practice. • Have your nurse escort the cli- ent to the checkout desk and tell the receptionist: "Coco needs a bandage-change appointment with Dr. Smith in one week." • Use your existing reminder system, whether phone, post card, email or text message, to advise clients of their appointment. You could add a few lines on the estimate page in which the owner commits to follow your instructions to ensure a happy ending, followed by the client's signature. Without follow-up exams, you might not be providing the gold standard of care. Implementation might be challenging, but your efforts will be well worth it. The bond you build with clients and patients will strengthen. You will be able to see if your treatment protocols are working or if you should change them. Follow-up visits have no draw- backs. Progress exams are an inte- gral part of the care you provide. Dr. Phil Zeltzman owns a traveling surgery practice. He is Fear Free certified. Learn more at CHAPTER 1 Mack, a 3-year-old pit bull, fractured three metacarpals. Even though surgery was recommend- ed, the owner elected conserva- tive management using a splint. Weekly splint changes were recommended and explained. The owner did not follow the instructions and came back more than three weeks after the first splint application. When the nurses removed the splint, they found a large pressure sore on the metacarpal foot pad. Many more weeks were needed to heal the footpad. The metacarpal bones healed first, ironically. CHAPTER 2 Nola, a 7-month-old Italian greyhound, fractured her right radius and ulna after jumping off a couch. The fracture was successfully repaired using a bone plate and screws. The owner received specific instructions: strict two-month confinement on the floor. After driving Nola home after surgery, the client carefully and lovingly placed Nola on the same couch while she prepared dinner. Nola proceeded to jump off the couch and break her left radius and ulna. What do you tell a client like this? "I told you so"? Luckily, the owner did the right thing and paid for the second surgery. CHAPTER 3 Daisy, an 8-month-old Shih Tzu, and Pip, a 3-month-old Jack Russell terrier, had a femoral head ostectomy (FHO) on the same day. I had the same discussion with the clients during the consultation, performed the same surgery and provided the same physical therapy protocol (verbally, in writing and with a video). The physical therapy was demonstrated and explained during the discharge appointment. Daisy's owner followed the postop instructions to the letter. She kept Daisy confined, walked her on a leash, kept the E-collar on and performed the physical therapy. Two weeks after surgery, she was able to extend the hip 20 times three times daily. Daisy had a very nice incision and a good, pain-free range of motion. Pip, however, never wore the E-collar, barely received physical therapy, had free range of the house, constantly jumped on and off the couch, and was allowed to run freely — on three legs —in the yard with his canine pal. Two weeks after surgery, Pip had a bright red incision missing its staples, a severe limp, a painful hip and a poor range of motion. What do you tell an owner like Pip's? Pressure sore on a foot pad from poor splint management. Radius and ulna fracture after Nola jumped off a couch. HORROR STORIES

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