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| Another pic of the brush-tail bettong at the conference...just because its a whole lot cuter than photos of people speaking behind lecterns. |
Blogging a five-day
conference turns out to be a huge challenge when you are attending it at the same time. So we’ve been a little slow –
mostly because we’ve been busy attending every possible breakfast session,
lunchtime lecture, plenary, special-interest-group dinner and mini-lecture
possible. And still we missed a few! (There were eight concurrent streams and
over 200 sessions to choose from during the week).
For me there were two
stand-out sessions in the last two days that I’d like to single out.
Martin Whiting
discussed business and veterinary clinical autonomy. He noted, particularly
with reference to the UK but it is also happening in Australia, the growth of
veterinary practice franchises or chains. There are of course big benefits of
standardising veterinary care – centralised services, bulk-buying and
cost-savings for clients, sharing of high-value, short-life products such as
blood products between practices, standardised employee training and education,
centralised after hours services, better working conditions and so forth.
But there are some very
clear disadvantages, depending on the way these are run. What happens when you are treating a patient and the
standard operating protocol dictates that you need to work it up in a
particular way and you disagree? What if bulk purchased medicines or foods are
not the optimal treatment in a particular case? Some practices incentivise vets
to sell particular products, or force veterinarians to refer to a particular
service. Many pay on a commission-basis or give bonuses for invoicing over
certain thresholds. These business practices have serious consequences for vets
and patients.
Commission-based
remuneration in health care can lead to abuse and generate distrust between the
client and clinician. Clients may be unsure if the recommendation is being made
for commercial reasons or in the best interests of their pet. Individual
veterinarians must always abide by the professional code of conduct, which
trumps private practice policy in the event of a disciplinary hearing. Dr
Whiting made some excellent observations and the presentation generated a lot
of discussion. This potential conflict between practice protocols and clinical
autonomy has huge ethical implications and is something that the profession
needs to address.
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| Dr Ilana Mendels from VetPrac won a prize for visiting the AVA's Wellness Stand. Ilana is always well coordinated but note that her glasses, lanyard and shirt are totally coordinated with the prize. Seriously, do us mere mortals stand a chance? |
Meantime when it comes to
communicating costs in veterinary care, Ontario Veterinary College’s AssociateProfessor Jason Coe had some fascinating data to share. A lot of veterinarians
feel awkward talking about money. Some perceived it made them look like they
were money-focused, some felt that their job was just to worry about the animal
and let reception discuss costs with clients. Dr Coe has done some great work.
The upshot is that upfront communication about costs improves clinical
outcomes.
When he asked how many
vets enjoyed talking to clients about money, 45 per cent disagreed and 28 per
cent strongly disagreed. That’s a pretty clear majority.
But time and again,
studies have shown that client satisfaction is increased when the client
understands the costs involved and why these are incurred.
Vets get a bit defensive.
In a study Dr Coe ran, he found that vets often justified costs in terms of
their investment in time, overheads, the skillset required etc.
What the clients wanted to
know was what the costs meant in terms of their pet. For example, this
operation will give Rusty X chance of cure or 6 months additional survival,
relieve pain and allow you to manage him without medication…etc. The
time taken, the equipment needed etc. weren’t so relevant.
Veterinarians said they
felt undervalued or guilty when talking about money which made them a bit gun
shy. But pet owners felt that a failure to discuss costs upfront could lead to
clients being over-extended financially. One point of discussion was the client
who comes in and says “costs are irrelevant”.
This actually means
different things to different people and often these clients challenge the
bill when they finally see it. So it is important to discuss costs even if the client says that costs do
not matter. Knowing what to expect does matter.
In one overseas study,
almost 50 per cent of veterinary clients left the consult room without an idea
of what costs they would be up for. In another study by Coe, Adams and Bonnett
(JAVMA 2009 234:1418-1424) of 200 veterinary consults, only 29 per cent of
visits included a discussion of costs, and 25 per cent of vets never initiated
cost discussions.
Dr Coe discussed the
different ways that veterinarians might initiate cost discussions in an
emotionally charged environment. The use of empathy ranked very highly.
Interestingly in an Australian study by McArthur and Fitzgerald AVJ
2013:91:374-380), veterinarians expressed empathy in only 41 per cent of
consults – and 73 per cent of those occasions involved directing empathy at the
animal. Which is fine – except only the empathy statements directed at the
client had any impact on client satisfaction.
Dr Coe talked about the
use of partnership statements and “I wish…” statements to express our concerns
in a way that is meaningful to clients (for further info see Hardee, Platt
& Kasper J Gen Intern Med 2005,
20:666-669). You can think empathic and helpful thoughts all you like, but if
you don’t express these to the client they won’t have an impact on client
satisfaction.
And client satisfaction is a variable that has a huge impact on
client uptake of recommendations and therefore clinical outcomes. We know why we
are making a recommendation, but as a profession we need to improve our
communication. The client wants to know why we are making this recommendation
to Phil, or Rory, or Cliff (insert favourite pet name here).
However you feel about money, Dr Coe’s data showed
overwhelmingly that upfront discussions about costs were helpful to clients,
allowed them to plan better and improved their relationship with the veterinary
team.
