Reality checks – Today’s veterinary affairs

Reality checks

With chronic ear disease, follow-up care is essential for success. Learn how to improve compliance, strengthen the human-animal bond, and make your patients feel like they are themselves.

An animal with ear disease may crack when someone tries to touch its head. Or the smell emanating from his ears could drive family members away.

When Kathryn Primm, DVM, CVPM, called to find out why her client’s dog missed a follow-up appointment after two weeks of ear infection treatment, she got a response that changed her practice permanently. “The client said her dog’s ears were okay, she didn’t need a new check, and we were just trying to get some extra cash.”

Needless to say, Dr Primm, owner of Applebrook Animal Hospital in Ooltewah, Tennessee, was frustrated that he could not complete the case. The patient’s ears were so swollen that she could not see the eardrum and she strongly suspected that the infection was resistant to first-line treatments.

Dr Primm decided that if she couldn’t help this patient, she would help others. Now every sick animal, including patients with otitis, receives a new courtesy check.

“I decided to put my money where my mouth is,” Dr. Primm said. “I think it reinforces the idea that we’re not just trying to take money out of our customers; we really care whether the animal is feeling better or not. “

Why re-checks are so important

As Dr Primm’s story illustrates, cases of ear infections can be frustrating for clients, vets and even veterinary dermatologists, said Melissa Hall, DVM, DACVD, of the Animal Dermatology Clinic in Tustin, in California.

“When it comes to ear infections, you have to deal with the infection itself, but you also have to pursue a quest to find the underlying trigger,” Dr. Hall said. “And unless you identify that underlying trigger, it will come back right away.”

The initial appointment is usually to bring the infection under control, treat the swelling and manage the pain, Dr. Hall said. For some simple cases involving only the outer ear, this is enough. But many patients need more extensive and continuous care, which means the second appointment can be even more important as it sets the stage for the entire plan.

“This new check is a great time to say, ‘OK, let’s start talking about potential triggers. Does your dog sting and lick its paws? Does this ear infection seem to appear around the same time each year? Have we had ear infections since we were a puppy? Said Dr Hall.

Answers to these types of questions help Dr. Hall determine if something like an environmental allergy or a food allergy is behind the ear disease.

Another common problem with cases of ear infections is that, as in Dr. Primm’s case, the ear canal is so swollen and painful that the vet cannot use an otoscope to view the tympanic membrane. A follow-up appointment is necessary to see if it has ruptured and if the middle and inner ear are affected. Also possible? The animal may not be at all better.

“One of the most important things I do with every ear sheath is, if there is any debris, pus, or exudate in that ear, I dab it and do an otic cytology,” Dr Hall said. “It’s even more important during the rechecking. Maybe you were super focused on all these bacteria that you saw on day one and then on the recheck you dab them and now there’s a ton of yeast. The skin is still red, the ear is still swollen, the animal is still stinging and shaking its head, but now you have a completely different beast.

Re-verification is therefore essential for many reasons:

  • To make sure the treatment is working.
  • To understand why this is not working.
  • To determine if deeper ear structures are affected.
  • At a minimum, to ensure that a simple infection is well controlled before it progresses and becomes more complex.

All of this means that communication with the client is at the heart of effective ear infection management.

Manage expectations

When pet owners arrive hoping for a quick fix, Dr. Primm must tell them bluntly: ear infections are rarely a one-size-fits-all solution.

“It’s about managing expectations,” she says. “If you warn them that it’s likely to come back and we’re together to get it under control and manage it for the long term, they’re less likely to think you’re right after the money. And they’re also less likely to think you’re incompetent. “

Dr. Primm often sees cases of ear infections from other practices, and these clients say the other vet “never got to cure him,” she says. “If that other vet had said, ‘No one can fix it, it’s going to be a lifelong problem,’ they would probably still have this client.”

Dr Hall agreed. “Unfortunately, a lot of our clients treat veterinary medicine like they treat human medicine,” she says. “They just want me to give their pet an injection or a pill to improve it. But when we talk a lot about any type of chronic ear problem, there is no easy solution. So we absolutely have to set expectations, discuss long-term management and develop a plan together. If we are able to put a plan in place early on, knowing that there is a good chance that the problem will return, then the owner will not be so upset when he does.

A step-by-step approach

Of course, many GPs in busy practices don’t have 45 minutes to an hour to discuss all of these issues in one appointment. Which brings us back to the follow-up appointments.

“It takes a while to get all the education done and really get to know this owner and this animal,” Dr. Hall said. “You might not have that time on the first date. But when re-checking or re-checking later, you have a little more time. Maybe this time we will talk about that aspect, next time we will focus on that one. It breaks it up so you don’t run completely behind your whole day just because you have an ear case. “

In fact, ear infections are an opportunity to showcase your expertise as a veterinarian. For example, when Dr. Primm suspects that a seasonal allergy is the cause of her patient’s ear problems, she tells the client, “You will probably see me next year. Don’t be surprised if it reappears. “Then she sets up a follow-up reminder in her practice management software to contact the client a few weeks before that date the following year.

“I said, ‘Hey, do you remember me? I think we are going to see an ear problem. And when they do, they think I’m a genius, ”Dr. Primm said. “It’s not that I’m psychic; it’s just that I’m experienced. It also makes people feel special because you remember them and care about them.

Strengthen the bond

As Dr Primm, Dr Hall and other savvy veterinarians have discovered, ear infections can be an opportunity for veterinary practice rather than a source of frustration. First of all, helping patients in dire need is inherently rewarding, and this is the reason most veterinary professionals got into the business in the first place.

“I had a lot of ear infections when I was growing up, and I remember the headaches and pain when I was little,” Dr. Hall said. “But our pets can’t say, ‘Wow, I’ve had a headache for a week and a half now.’ I can understand why they are grumpy. I have seen ear infections cause so much pain that it is difficult for them to chew.

Otitis can also endanger the relationship between an animal and its family. An animal with ear disease may crack when someone tries to touch its head. Or the smell emanating from his ears could drive family members away. The animal could develop vestibular syndrome and begin to fall on its side, horrifying owners enough to raise the specter of euthanasia. If the vet can come up with a plan to help the problems go away – even if it means referral to a specialist, surgery, or both – that practitioner becomes a hero of the family, a savior of the human-animal bond.

“I was able to go through the most difficult times of my life because I was able to hug my dog ​​and cat every now and then,” said Dr. Hall. “Anytime they’re uncomfortable, it hurts me. So I think we need to look at the ear cases and say to customers, “Yeah, that’s frustrating. But we’ll go through it together. ”

Additionally, enlisting the pet owner as a vital part of the team can be incredibly empowering for the client.

“I am trying to create a path to involve the owner,” said Dr Hall. “No one knows an animal better than its owner. You can say, “ Yes, I ask you to do a bunch of little things, but those little things can contribute to a much better quality of life for your pet. You will have a more loving animal, you will be more connected, you won’t have that smell, and you won’t have to grind their teeth every time they shake their heads or scratch their ears. ”

Dr Primm said that with her courtesy rechecks for ear infections, the value she gains in bonding with clients and caring for patients far outweighs any loss of income from medical progress reviews. .

“Having them in my exam room, seeing our posters asking them to rate us online, and creating a positive feeling that we really care about their animal, it just increases our chances of communicating with that client. I think that’s totally an advantage, ”she said.

Ultimately, whether it’s with ear issues or any other condition for which rechecks are essential, “It all depends on that connection,” Dr. Hall said.

Kristi Fender is a freelance writer and writer in Shawnee, Kansas, with a long history of animal health and veterinary medicine coverage.

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