The Double Edged Sword Of Choice In Veterinary Practice
14 years ago
4392 views
Posted
13th August, 2010 12h00
Over on the
Vetpol.co.uk community site a thread posting got The Hamster Wheel Department of Thought all fired up. The post went along the lines of this…
“…everyone is more questioning of the professions these days, more able to price-compare and the reticence about discussing money is long-gone. Our practice ethos is to involve the client with the range of treatment options for their pet…”
Which is management speak for, ‘we offer our clients choice’. Which in theory is a wonderful thing to do. But in practice can have a damaging outcome for both pets and business if not done well.
Choice – the double edged sword
Before we go further (and the hate-mail rolls in) let me state that I am a fan of choice. I like to be able to choose the colour of my car. I like to be able to choose what to write on this blog and when. There are many people of planet earth who don’t have the luxury of choice. So ‘choice’ is fantastic.
In the veterinary field choice can also be a useful tool, and it sounds great in the practice brochure. Provided you are a skillful communicator with plenty of time and have an intelligent, trusting client in front of you, choice is just dandy. But let’s be realistic.
1. Many surgeries operate with ten minute appointments, often running late.
2. How many vets are truly gifted or trained communicators or sales people?
3. How many clients, intelligent or not, “get” what it is we are trying to say?
Since when was third best good?
The mantra of choice is in theory good. But in practice I have a suspicion that it is being abused. I suspect that frequently we vets are not offering choice in the pure way management types talk about. That’s the type of choice made when the options are fully and clearly understood well enough to allow a truly informed decision.
If it were then why is the uptake of basic treatment options like de-scaling a mouth with progressive periodontal disease so poor?
Instead, what is happening is that we are offering two or three options with little in the way of useful qualification for each. And that will inevitably lead the client to make a decision on what they understand best – price.
If option A cost £2000, option B £1000 and option C a mere £500. Then, in the absence of an overwhelmingly persuasive reason to choose A or B, I’m going to opt for C.
But how many clinical situations (come to think of it any situations) are best resolved by the third best option?
Consider the example. The vet finds dental disease (a progressive condition which needs treatment) in a dog. Next she offers the client three choices.
1. Undergo a relatively expensive de-scaling procedure to correct the problem.
2. Try a course if antibiotics.
3. Review things in three months because they aren’t really bad just yet.
As a client what I’m hearing is that things can wait. Because if it really needed doing then wouldn’t the vet just tell me clearly to get on with it?
As this recommendation isn’t clearly made, I assume that things are OK and since that’s the case I’ll go for the easy/cheap/safe option of reviewing things in the future. Which we all know means next vaccination. If I bother to come in for that…
Choice as abdication of responsibility
Some (typically those short on confidence – new graduates are a good example) use choice to make the client decide, and hence move the responsibility for decision making from vet to owner. How many times do you see “client declined X-rays”, defensively written on the clinical notes. When in reality the client chose a different option based on a poor understanding of the situation because they weren’t given enough guidance. ‘Client declined’ and ‘client didn’t choose’ are not the same thing.
The vomiting dog that might have a life threatening intestinal obstruction, but might also just be gastritis, is a good example. The options:
1. Admit for bloods and an x-ray
2. Admit for observations
3. Medicate and review in 12hrs (tomorrow morning usually)
If the vet really thinks there’s a foreign body then there is only one “optimal” choice. But I’ve heard all three given together regularly with little guidance and guess which one wins out when no clear direction is given? You got it – the cheap one (that also places the animal at risk).
An alternative viewpoint on choice
My viewpoint on choice changed slightly after seeing so many consults where the best option for the pet was not the one selected.
Nowadays I train vets to clearly think through the choices in their head, then select the one they feel is in the best interests of the pet’s health at that time and make that recommendation on it’s own. I recommend using persuasive language like “what we need to do here is…” it’s proactive and motivating and you’re not giving mixed signals that confuse clients.
If, after some discussion, the client does not want to follow this option then I respect that and offer plan B. And so on and so forth until what we do is agreed and understood.
Most of the time however this isn’t necessary because I’ve made a clear initial recommendation and explained why this is the optimum way forward.
Choice and the Royal College
“But the college says we must offer options” you howl. Yes they do, and I’m not advocating reducing those options, merely presenting them in a way that makes it clear which option I believe (in my professional, highly trained vet mind) is in their pet’s best interest.
That’s not limiting choice, merely reframing it to help client understanding. Trust me, no one is going to leave my consult room without a plan that suits.
Dave’s Tuppence-worth
Vets are not a naturally gifted bunch when it comes to communicating and selling procedures. They are honest, hard working, committed to their patients and thoroughly altruistic. All of which are awesome characteristics to be admired, fostered and protected.
Unfortunately, in spite of what people may believe from the Medivet madness, vets are also chronically uncomfortable with price.
Choice offered against this backdrop is open to misuse by vets and misinterpretation by clients. The result is that many animals are not receiving the best care possible at the time they need it. Which happens to impact not just on them, but also on your bottom line as well.
You may think your vets are offering choice and you’re probably right. But is choice working for or against the pets in your practice? And how are you measuring it?
More from
59 minutes ago