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Are Annual Exams Really Necessary?

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Last year, in a much-discussed New York Times article titled “Let’s (Not) Get Physicals,” a physician reporter named Elisabeth Rosenthal argued that annual physical examinations for human patients are pointless. She cited a Canadian government task force recommendation to abandon annual physical examinations because they are “nonspecific,” “inefficient” and “potentially harmful” (in that they may lead to unnecessary tests). The task force said examinations should be replaced with intermittent screening tests for age- and risk-specific conditions (mammograms, Pap tests, etc.). Dr. Rosenthal argued that this logic is sound in the United States as well.

 

White Labradors

 

Scrutiny of annual physical examinations for people does not come as a surprise. Health care costs are soaring, and research consistently shows annual physicals don’t save lives. Most treatment is started because a patient feels sick and comes to the doctor — not because of findings in a routine examination.

 

So, do these human-side rumblings mean that we should re-evaluate the annual or biannual examinations that veterinarians recommend for pets? Are those trips to the vet with seemingly happy, healthy pets really worth the stress and effort for all involved? I’ve asked myself those questions repeatedly. Here are the key points I always return to.

 

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[tweetthis]Are annual exams necessary? [/tweetthis]

 

Originally Published: Vetstreet.com – April 25, 2013  [Republished on Yahoo.com]

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Veterinarian Confession: “I Don’t Brush My Dog’s Teeth”

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Mrs. Griffith sighed as she gently separated her youngest daughter and oldest Labrador Retriever. She stepped between them and over a discarded pacifier to look me directly in the eye. “Really?” she asked. “Do you brush your dog’s teeth every day?”

It was a moment of truth. She didn’t ask me what I recommend. She asked me what I do.

The best thing for her dog’s dental health is a daily tooth brushing with pet-safe enzymatic toothpaste. Unfortunately, the problem with my being a real person — one with a working spouse, young children, two jobs and a few hobbies — is that what I know to be “the best thing” and what I actually do at home are occasionally not the same. Mrs. Griffith had a lot on her plate at home, too, and when she asked me for honesty, my credibility was on the line. I wasn’t going to lie to her, and I’m not going to lie to you either.

I know exactly how dental disease affects pets. I know that the dental tartar you see slowly building up on your pet’s teeth is about 80 percent bacteria and that it damages the gums, the bone beneath and the ligaments that hold teeth in place. This bacteria can gain access to the blood stream and infect vital organs like the heart, lungs and kidneys. I also know that advanced dental disease hurts; it makes pets feel sick. Daily brushing is the best deterrent.

But like 95 percent of pet owners, I don’t regularly brush my dog’s teeth, even though I know it’s the best thing for his health. Still, that doesn’t mean dental health isn’t on my mind. Here’s what I do instead:

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Originally Published by Vetstreet.com.

Survival Guide to Appointment Pile-Ups

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Originally published: Exceptional Veterinary Team, May 16, 2012

 

It was 11:15 am and my waiting room contained my 10:20 appointment (who had just shown up), my 11:20 wellness examination, an emergency “squinting dog,” and a woman desperate to talk with me about whether I thought her sister’s dog might have Cushing’s disease.

If you’ve ever worked a Saturday in veterinary medicine, you know the feeling—almost as if all the local pets and owners have secretly staged a flash mob performance for that very moment. The slammed schedule is an unavoidable reality in every clinic.

Prolonged client wait time is one of the top reasons clients change veterinarians, and it inversely correlates with veterinarian income.1 This means that the longer clients wait, the less likely they are to return—and the lower their veterinarian’s personal income tends to be. Obviously, the ability to juggle patients (and their owners) is vital to success.

Fortunately, there are steps that lead to better performance when working-up multiple cases simultaneously. Here are 5 tips for more effective movement between exam rooms and decreased wait time without sacrificing quality.

1. Abandon Multitasking

Often, it feels like the quickest way to get things done is to work on two things at once. For example, it is tempting to have a technician review the signalment for the next case while writing in the preceding patient’s chart. However, science tells us that if you need to accomplish multiple things within a short span of time, it’s better to focus on the component tasks sequentially than to do so simultaneously.

When it comes to paying attention, the brain simply doesn’t multitask. Attempting to take in two sources of information at once means that pieces of both are ignored.2 In addition, studies have shown that people who are interrupted take about 50% longer to finish a task and make up to 50% more errors.3,4

True, some of us are more adept at toggling between tasks than others, and moving between familiar tasks is certainly easier.2 Ultimately, however, multitasking is not a shortcut. Discard it and embrace the “one at a time” approach to catch up faster.

2. Structure Your Appointments

Keeping the intricacies of multiple cases and conversations straight in your mind is tricky. Apparently, so is remembering complex food and drink orders for a dozen restaurant patrons. In a 2008 Behavioural Neurologyarticle, Buenos Aires traditional waiters who had memorized all orders shared an interesting technique for keeping information from multiple sources straight. They thought of patrons’ orders in terms of courses, with each meal having a defined and well-known structure (ie, drinks, then appetizers, then salads, etc). Once the meal pattern was defined and memorized, the waiters could organize information quickly and easily by using the courses as an informational scaffold.5

In the same way, you can structure appointments into segments by mentally compartmentalizing case information (see Creating a Mental “Menu” below). This allows you to move between examination rooms and address segments of different cases sequentially—and more effectively.

3. Fill in the Gaps

Good veterinarians are also good technicians. This doesn’t mean veterinarians should take on technician tasks all the time, but doctors should not be shy about jumping in to help when technical work is required to move backed-up appointments forward. At the same time, don’t micromanage your staff and let them utilize all of their skills to assist you.

4. Don’t Forget the Drop-off Option

As the saying goes, “When you’re up to your neck in alligators, it’s hard to remember you came to drain the swamp.” Look for opportunities to suggest that a client could leave a pet for a few hours. The owner may prefer to relax at home or get a bite to eat instead of waiting. By offering to turn a scheduled appointment into a drop-off, it is possible to turn a complex appointment into a flexible one—while also preventing client irritation.

5. Exercise Regularly

Exercise is highly beneficial to your ability to successfully juggle cases, and not just because it gives you the stamina to dash between exam rooms all day. People who exercise regularly can expect to have greater long-term memory, problem-solving abilities, and attention spans, as well as decreased anxiety. They also show greater capacities for improvising based on previously learned information, thinking abstractly, and reasoning quickly.3,6 All these skills increase effectiveness when faced with different problems (and pet owners) in rapid succession. Even a small amount of exercise will help reap mental rewards: 30 minutes of aerobic exercise 2 to 3 times per week has worked in laboratory studies. Mental benefits appear in as little as 4 months.3,7

Creating a Mental “Menu”

A typical appointment can be organized into 4 menu “courses”:

Interview. Patient history, signalment, body weight, and temperature are recorded. This section can be carried out by trained technicians using a standardized hospital protocol. Veterinarians do not need to be present.

Physical examination. The veterinarian reviews the history and continues the interview while conducting (and explaining) the physical examination.

Diagnostics and treatment. Once the physical examination is concluded, treatments (eg, ear cleanings, bandaging, medication, etc) and/or diagnostics are performed. While the veterinarian may be needed for diagnostic interpretation, many diagnostic and treatment procedures can be carried out by technicians. Doctors are thus able to move to another case during this phase.

Results, summary, and discharge instructions. Following diagnostic and treatment steps, the owner must be updated and given clear instructions. Be sure to summarize all diagnostics, findings, and treatments performed to ensure client understanding and compliance going forward. This is an excellent way to emphasize the value of the services you performed. At this time, your portion of the appointment is concluded or further diagnostics or treatments are undertaken (return to Diagnostics and treatment).

You could simply let long waits become a habit at your practice. You could also keep staff members late to handle backed-up appointments. However, since labor costs are the greatest expense most clinics incur and clients exhibit a clear trend for switching veterinarians when waits become too long, it seems unwise to ignore the costs of that pattern. Practicing ways to work up multiple cases more efficiently saves not only your sanity but also your business. And a healthy business means more healthy patients. | EVT

So I’m a Doctor… Now What?

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Nineteen months ago, I started my first job as a veterinarian. It’s a position where I split time between a large general practice, an emergency hospital and a one doctor start-up practice. This is the time I’d thought I’d unleash all of the great ideas I had in veterinary school about how things should be done in private practice.

As you can imagine, that’s not exactly how it turned out.

After I graduated from veterinary school, I amassed a modest amount of medical knowledge, endless enthusiasm and a desire to use my soft skills and business acumen to be immediately successful. I hit the ground running and unleashed cutting-edge management techniques on the unwary support staff. I printed off checklists, called for meetings and wrote almost weekly proposals to my bosses (a project known to my employers as “the Roark Report”).

Overall, this approach was almost a complete flop. While I was quite possibly the most prolific proposal writer ever produced by an accredited veterinary program, my ideas consistently fell flat. When they didn’t fall flat, they ticked people off. It was certainly not the entrepreneurial explosion that I had hoped for.

Without abandoning my commitment to the soft skills and my deep passion for the business side of our profession, I was forced to step back and look closely at what other doctors were doing successfully. It was my great fortune to be surrounded by a lot of successful general practitioners who had widely varying styles and approaches. I set out to adapt my strengths and interests to the techniques that they were using effectively. In the end, three specific themes seemed to correlate very strongly with success. The more I focused on these areas, the greater my happiness and productivity became. We’ll start with the most important:

1. Communication

I have always viewed myself as good communicator, but I made a mistake early on in this vital area. I explained things well to clients, but tried to be the person that I thought my clients wanted me to be: extra polite, almost overly sensitive and always extremely tactful. Because of this approach, I don’t think my clients saw me as genuine, and it hurt my chances at building trust.

A few months into my career, a pair of very difficult clients helped me realize that if I do my best to educate and advocate for what’s best for the pet, it’s up to the clients to decide if they like me or not. I can’t be all things to all people, so I decided I might as well just be myself and be comfortable with it.

This epiphany, probably more than anything else, made me happier in practice. I still explain those medical conditions, but my explanations come with a southern drawl and colorful candor. Amazingly, I seem a lot more popular these days than I ever did when I was trying to come across as “Dr. Perfect.”

Clients have real relationships with me now and because of the trust these clients put in me, I am more confident, more relaxed, and I don’t feel the need to “sell myself” for the first five minutes of every visit. I can focus more of my time and effort on educating the clients and providing the best treatment for the pet. I’ve also found that strong relationships and good communication mean better compliance, and that opens the door to offering great medicine. (Note: I believe that great medicine results in a healthy patient, a happy client, a feeling of satisfaction and the ability to make student loan payments.)

2. Efficiency

In my experience, a focus on communication has been critical to building the tiny client base that I currently enjoy. Sacrificing quality time with the client and patient to stay on schedule is obviously not a good idea. However, running behind all the time has proven to be a poor choice too. The answer is to balance these two evils. I learned how my hospital works, and how I should work within it.

Every hospital has a different system for providing medical care. For example, at the emergency hospital where I spend half my time, there are often a dozen technicians and assistants working in and around our treatment room. The most efficient way to get a dog taken care of here is to get him/her out of the exam room and into the treatment room where the technicians can go to work like a NASCAR pit crew.

At the one-doctor practice where I spend the rest of my time, the only people in the hospital are myself and a technician… And she comes into the exam room with me. If we take a pet from the exam room into the treatment room, we are the only two people there. We had to walk 30 extra feet, and now we have a second area to clean up. Providing services in the examination room makes significantly more sense.

These two hospitals showcase radically different, equally effective, systems for providing care. To be successful in either one, you have to gain an understanding of the system and build a strategy for working efficiently within that system. The development of this stratagem ultimately allowed me to maintain my relationships with clients, stay on schedule, keep better records, make management happy and live a (slightly) lower-stress lifestyle in the workplace.

3. Complete Care

Since my first day in practice, I wrestled with the desire to increase my ACT (average client transaction) while protecting my integrity and the trusting relationships that I have built with my clients. How do I offer our full range of services without looking (and feeling) like a used-car salesman?

When I started my job, I noticed that my boss never talked about ACT. He talked about “completeness of care.” It was probably six months before I understood why this was his focus.

Complete care is all about doing a good physical examination and work up, and then educating clients on what you found, your judgment on the best course of action and why. I feel like, if that is my approach, then I am being entirely honest with clients. It also lets your clients choose their own course of action. The client and I are a team in the care of this pet. When the client makes informed decisions, then I am building this trusting relationship, practicing great medicine and going home feeling satisfied. My ACT benefits from this approach too.

I definitely did not come out of veterinary school at the top of my game, and I really had no idea how to put my interests and skills to work for me in private practice. I know I made as many mistakes as anyone (maybe more – enthusiasm can be dangerous that way), but I have since settled into a personally, professionally and financially rewarding career thanks largely to a focus on communication, efficiency and complete care. If my experience can help even a single associate veterinarian or new graduate be happier and more productive, then this column will be worth the effort (and far more valuable than any edition of “The Roark Report”).

Dr. Roark is an associate veterinarian in Leesburg, Va.