Successful Exam Room Communication

1. Preparation
   Pets present with about 3 to 5 concerns -- some concerns are the pet's and others are the pet parent's. This is the stage where we review and identify as many concerns as possible. One minute of preparation saves three minutes in the exam room. Ask your technician or assistant for the bullet points from the medical history and review the record for vaccinations, fecal checks, heartworm medication and testing, flea control and the date last used, previous medical problems, weight changes, etc. Once you have identified the concerns, you can prepare what you need.
   
   As an example, on a first puppy visit, you may have the following concerns to address:
   

   House Training	Nails
   Flea Control	Spay or Neuter
   Heartworm Prevention	Fecal
   Review puppy biography

   
   You have 30 seconds to claim their trust. What will you need to keep this pet healthy for the next year? Review the record!!
   
   Write your top 5 concerns on the check-in sheet prior to entering the room. The owner's concern must be in the top 3. Bring you concerns out during the physical exam. Tell the client how concern relates to the pet's overall health.



2. Approach
   Greet the pet and pet owner when you come in the door. This will help put clients at ease. As you enter the exam room, shake hands, make eye contact and give your name slowly enough so the pet parent can hear you. Wear a white lab jacket with your name shown on your right side so they can see it as you talk with them. Go to their side of the exam table.
   
   Welcome everyone to the exam room -- pet parent, kids and the pet by name. Watch voice tone so as to not overpower the client and instruct the client how to help and how the exam will go.
   
   Remember to use key pieces of information from the history or Technician review to engage the client. For example, "I see that Petey has gained 10 pounds since we last saw him. You have done an excellent job with his recovery."
   
   Make sure the client gets to express their concerns and interest.



3. Diagnosis
   At this stage, open questions (i.e. what, when, where, etc) are vital to help you know how much the pet parent understands about their pet's needs and to help focus the pet parent on your area of concern. You should spend about 60% of the time talking at this stage.
   
   Our goal is for the client to say it was the best physical exam they ever had. During the exam, use the otoscope and ophthalmoscope. This serves several purposes. It assists with the exam and looks more professional. Also, it will train the pet for future visits and you may find something if you look.
   
   Ask an open question to clarify areas of concern you find or that are expressed by the client. For example, if the client expresses concern over a small area of hair lost, delve deeper with questions such as "How are you currently treating this area?", "How often does she get a shampoo and bath?", "What products are you using for both?" Your interest and responsiveness raises their desire to listen to you. Lifestyle questions are good.
   
   Does the client see the connection between their concern and your diagnosis? Open questions will get you there faster. Repeat their words, and clarify their questions vs. assuming.
   
   Difficult situations may need further questioning to enable you to assess the client's frame of mind about their pet's condition. One tool you can use is the BATHE technique:
   

   B	BACKGROUND "What is going on in your life?" will elicit the context of the client's visit
   A	AFFECT "How do you feel about what is going on?" allows the client to report current feelings
   T	TROUBLE "What about the situation troubles you the most?" helps the doctor and client focus on one aspect of the problem.
   H	HANDLING "How are you handling that?" gives an assessment of how the client is functioning.
   E	EMPATHY "That must be very difficult for you."

4. Recommendations
   This is the step when you take the pet parent's concerns and connect them to a product, service or program and the answers to your open questions. For example, you might ask "Do you have your pet sleep in the bed with you?" or "How do your children interact with the pet?" Then, you could tie recommendations for fecal, deworming and continuous heartworm preventative to the client's answer.
   
   Use the exam room report card to list your recommendations. Also, provide clients with a timeline for when services are to be performed. Use mind maps to simplify treatments for clients.
   
   Write it... Show it. Pictures are worth a thousand words, so never tell what you can show. People remember less than 10% of what they hear, but 90% of what they see, hear and do themselves. Some visuals that are great to use with your recommendations would include the CET pamphlet, the Hill's Atlas and other books, as well as the pets themselves. Word pictures can also be used to help the client see how treatment would improve the pet's quality of life or provide the pet parent with peace of mind.
   
   Make sure the products that you believe in and that support your recommendations are set up in the exam room for passive marketing.
   
   Make a firm diagnosis and give your recommendations with a time line. Timelines, mental pictures or real pictures, models, care plans (estimates), discharge or recheck appointments all go with recommendations. What can they expect? What will you do to follow-up with them? How long might it take?
   
   Give 1-2 options. More than two choices becomes overwhelming. What does the pet need? The owner? How will the treatment benefit each of them? Peace-of-mind? Quality of Care? Lower bills in the future? Longer Life?
   
   
5. Close and Follow-Up
   Check for charges such as ear mites, ear cytology, etc. Reaffirm the pet parent's decisions and Make sure you give them a timeline so they know when they are to return. Explain what the next steps are for them and for you.
   
   All pets need to have reminders, revisits and rechecks.
   
   Ears, skin, urine, weight gain or loss, chronic meds, eye lesions, bloodwork abnormalities - all need scheduled rechecks, reminders.
   
   First visit = Treatment. Second visit = Prevention plan.
   
   This is the lifeblood of your practice! Affirm and confirm them for bringing their pet in and for their choice of services. Show them timelines and explain what they need next. Send reminders, follow up with telephone calls. COMPLETE THE RECORD!!!!!!!!



6. The Final Thought
   Practice these steps every day, and you will see a positive shift in your Exam Room Experience and production results:
   1. Introduce yourself to the client.
   2. Be aware of your body posture as well as the client's. Their posture will tell you when you are being too direct or they are feeling overwhelmed.
   3. Remember - conflict is not personal - it is behavioral.
   4. Give recommendations with timelines and care plans (estimates).
   5. Make specific recommendations to fill pet and client needs as well as to follow the hospital protocols.
   6. Charge for your services. Clients do not expect services to be free.
   7. Charge for unscheduled pets.
   8. COMPLETE THE RECORD