Improving Your Equine Practice by Enhancing the Veterinary-Client-Patient Relationship

Historically, healthcare providers (physicians, veterinarians, dentists) have been viewed as wise and authoritative figures whose recommendations or advice was rarely questioned. Today, consumers view themselves as more informed and empowered and expect a collaborative dialogue and an active role in healthcare-related decision-making. It is important for equine practitioners to develop empathic communication skills and the ability to convey the benefit and value of clinical recommendations. A commitment to enhance the veterinary-client-patient relationship is essential for today’s practice success.

1. Introduction

The purpose of this paper is to provide the background and framework for a series of equine case study presentations. The case studies will demonstrate the importance of a strong veterinary-clientpatient relationship (VCPR) and provide examples of various communication techniques that have proven successful. Utilization of the strategies presented is intended to improve clinical case outcomes by increasing the likelihood of caregiver compliance and decreasing the likelihood for miscommunication. The cases will also present creative examples of written and electronic communication modalities that can be utilized with absentee owners.

Key Points

The recent recession has affected virtually all segments of our economy, including the veterinary profession. However, multiple sources have reported decreases in patient visits at small-animal practices for several years preceding the economic downturn, which suggests that other factors are also contributing to this trend.^{1– 4}  During a period of time when the pet population continued to increase, veterinary visits decreased concurrently with the reported increase of some preventable diseases.5 Concern as to whether the nation’s pets were receiving adequate preventive care prompted the formation of the Partnership for Preventive Pet Healthcare. Established in July 2011, the Partnership is led by the American Veterinary Medical Association (AVMA) and the American Animal Hospital Association (AAHA) and comprises more than 20 veterinary associations and animal health companies with a goal to improve the overall health of pets. A priority focus of the Partnership is to assist small-animal practitioners to enhance communication skills that are essential to improving the VCPR.

The Bayer Veterinary Care Usage Study was designed to investigate this downward trend in veterinary visits and identify potential actions that small-animal practitioners could take to reverse the trend.⁶ The study identified at least three factors with potential relevance to equine practice. Significant use of the Internet prior to or instead of veterinary consultation, a lack of understanding of the need for routine care, and the increasing cost of veterinary services were identified by pet owners as reasons they did not go to a veterinarian. Additionally, approximately half of the pet owners surveyed said they would take their pet to a veterinarian more often if they really believed their pets needed to be examined routinely, and more than 40% reported that their veterinarian did not always communicate in language they could understand. Pet owners do not always understand the value of a preventive care or wellness visit, nor are they appreciating the critical role the veterinarian plays in the overall health of their pet. While challenging, this information also indicates an opportunity for increased use of veterinary services if veterinarians can more effectively communicate the value of the care they provide and the contribution that they can make to the long-term health of those pets. The Partnership for Preventive Pet Healthcare is developing tools that can help veterinary healthcare teams and clients bridge that communication gap and enhance the VCPR.

Equine industry data as well as anecdotal information from American Association of Equine Practitioners (AAEP) member veterinarians has indicated a similar decline of horse-owner utilization of veterinary services. As a component of its 3-year strategic plan, the AAEP will be working to develop and implement programs and services that will help its members address these issues and better equip them to serve horse owners. To fulfill the AAEP mission of protecting the health and welfare of the horse, doing everything possible to develop trusting, long-term client relationships is in the best interest of horses, owners, and veterinarians.

Using the physical exam as the foundation on which to build the VCPR has proven to be as successful in veterinary medicine as it is in growing the doctor-patient relationship in human medicine. It is important to adopt empathic communication skills during the physical exam that emphasize building a rapport and being diligent to responding to core client concerns even if the clinician believes those concerns to be misplaced. Specific phraseology can help connect with the client such as, reflection: “I can see that you are . . . ”; legitimation: “I can understand why you feel . . . ”; support: “I want to help . . . ”; partnership: “Let’s work together . . . ”; and respect: “You are doing great . . . ”⁷ A recent report evaluating client adherence to dental and surgical recommendations in companion animal practice concluded that veterinarian use of a relationship-centered care approach, characterized as a collaborative partnership between a veterinarian and a client with provisions of clear recommendations and effective communication of the rationale, was positively associated with adherence.⁸ The findings of the AAHA Compliance Study drew similar conclusions and also emphasized the need for follow-up communications with pet owners.⁹

It is also important to explain to the client why the clinical recommendation is necessary and especially how it benefits the patient. Horse owners are usually less interested in the “science” of the treatment versus understanding how the therapeutic recommendation will help their horse. Equine practitioners are often faced with communicating the value and benefit of their recommendations through trainers or other caregivers, which increases the complexity and challenge. The effective use of written and electronic communication techniques has been shown to be effective in these situations and will be discussed in detail during the case presentations. Such techniques are an even greater asset in conveying value to and nurturing the VCPR with the absentee owner.

Extensive work has been done in human medicine evaluating the impact that the “medical interview” associated with the physical exam has on client satisfaction and clinical outcomes.¹⁰ Both empirical studies and expert opinion have concluded that the interview is integral to the positive outcomes of medical care. It has also been reported many patients are less concerned with how much their physicians know than with how much they care.¹¹ The importance of eliciting the client’s perspective and demonstrating empathy is extremely important when building the relationship bond essential to an effective VCPR.⁷  [...]