Eliminate the fear of dermatology

Take the fear out of dermatology
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You need to bring the patient to the clinic, perform diagnostic tests in a non-threatening manner, define client expectations, and schedule follow-ups.

Emergency clinics are often inundated with dermatology patients who have not been seen by a specialist in small animals or whose follow-ups have not been followed.

When I was in vet school, dermatology was one of my least favorite subjects. We didn’t have a lot of good options for an itchy dog ​​other than allergy shots and steroids. Many of my cases have ended with pet owners frustrated with the many side effects of the medications they have seen in the home. During my early days as a veterinarian, I had a similar experience.

Today, however, we have seen incredible progress in reducing itching in allergic dogs and giving them a much better quality of life. Not only has dermatology become medically rewarding, it is also a tremendous opportunity for practices to develop a profit center by pursuing appropriate diagnoses and therapies in a way that reduces fear, anxiety and stress in our patients. .

According to a Zoetis study, more than 20 million American homes have at least one dog with itching and in 2019, more than 7.5 million dogs were diagnosed with it. Also, the top four reasons pet owners bring their dogs for a vet visit are allergies, ear infections, lumps or bumps, and skin infections. Most of these conditions can create hair loss, redness, discomfort, and itching, the sign most often responsible for a phone call or appointment with a client.

All of this looks very promising for veterinary practices looking for ways to grow and expand their medicine and business. Skin scrapes, skin and ear cytology, and other tests are often done several times a year, but if a practice inadvertently creates fear, anxiety, or stress in a patient on these visits, not only the animal will become more difficult to work with, but the client may become upset and avoid future testing. The result is a vicious downward spiral in which the patient does not receive the necessary veterinary care. Emergency clinics are often inundated with dermatology patients who have not been seen by a small animal doctor or whose follow-ups have been ignored.

No quick fix

How can we do better? The first step begins with the customer’s phone call. We can train our customer service representatives to stop distributing the “phone solution”. This happens when a client calls about an itchy dog ​​and asks for advice, then the team member, instead of acknowledging the patient’s needs and making an appointment, dismisses the urgency of the request. situation and offers a generally unsuccessful home trial. strategy. While many on the team believe customers want free, over-the-counter answers to resolve an itch, this couldn’t be further from the truth. In most cases, the dog continues to itch, the problem worsens, the client becomes dissatisfied and may leave the practice, and the clinic feels the financial impact.

One example is the common advice to give an antihistamine to reduce itching. We know that only 1 in 4 dogs show some relief from an itchiness (often due to drowsiness) after being given an antihistamine. This means that at least 3 in 4 dogs that are itchy and have been given an antihistamine will fail treatment and get no benefit. Instead of recommending this ineffective strategy, encourage your team to reinforce the client’s concerns and make an appointment for a skin checkup and workup.

Consider bundled care plans

When the patient presents for an exam, you should have an established protocol and team message on the importance of resolving an allergic itch to support the animal’s quality of life. When the team universally believe that an itchy dog ​​is an uncomfortable dog, then strongly recommend the appropriate tests and current treatment options, like the new technology behind Janus kinase inhibitors and monoclonal antibodies, the client sees clarity. and feels justified in investing in the meeting. In addition, the messaging ensures complete dermatological checkups on itchy patients if the customer approves it.

I encourage veterinary surgeries to offer a dermatology package. Combining all necessary hospital diagnostic tests into one package makes it easier for customers to pay a testing fee and reminds young associates what a full diagnostic dermatology panel looks like.

While testing is essential to developing a successful treatment plan, it is just as important to protect the emotional health of the patient. It starts with trying to keep the patient in the same exam room and limit the movement of team members. The team should have dermatology kits already assembled that contain everything needed for diagnostic testing: flea comb, blade # 10, spatula, mineral oil, blades, coverslip, and clear tape.

Sampling and communication

Dermatologists recommend starting with the less invasive test first (cytology) and leaving the most invasive (scratching skin) last, especially when sensitive areas like the face are involved. In sensitive areas, the team can replace broken skin with hair removal or adhesive strips to minimize discomfort. Additionally, try to keep a dog’s ear canal relaxed when getting cytology and avoid scratching the side of the canal.

Finally, develop a checklist for each exam room. Make a member of the team responsible for setting up the room and ensure that tools such as pheromone diffusers, treats, and even slow-feeding lick mats are available to help distract the patient during sampling some samples.

Once the diagnoses are made, the client is updated and treatments are prescribed, the next check-up or examination should be booked in advance. Many practice management experts believe that “the cash register is the bridge to the next registration”. Specifically, the veterinarian should emphasize to the client that the hospital is committed to ensuring the long-term comfort of the patient and that the owner of the animal is a key member of the team.

Remember to set expectations as well. The client should be informed that flare-ups in allergic and itchy dogs are very possible for weeks or months. In addition, the veterinary team should record in the medical record which emotional tools work best, such as treatment preferences, patient placement on the floor or table, and best handling practices.

I encourage you to evaluate your dermatological message, especially with regards to itching reduction. Eliminate the phone problem, become efficient in skin diagnostics, protect the patient’s emotional health, and schedule the next appointment before the patient leaves.

A team approach will create a more comfortable patient and a happier pet owner, leading to better customer retention and loyalty, return visits and referrals.

Intrepid columnist Dr Natalie Marks is co-owner of Blum Animal Hospital in Chicago. She is Fear Free certified.

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