Part of that defensiveness stems from the unspoken and unpleasant connotations that veterinarians associate with pet owners and the word compliance: "I told you what to do. You chose to ignore me, and now look where we are. I guess you don't care what's best for your pet."
In their book Skills for Communicating with Patients, the authors, Jonathan Silverman, Suzanne Kurtz, and Juliet Draper, present alternatives to the unfriendly terms compliance and noncompliance and introduce instead the terms concordance, implying understanding and agreement, and adherence, implying consistent follow-through. I suggest that veterinarians adopt these terms in their thinking and professional dialogues about their recommendations to clients and their clients' abilities to follow through.
Nevertheless, whether we call it compliance or concordance and adherence, all of us, veterinarians and pet owners, need to realize that we have a virtually identical concern: doing what is best for pets to the best of our ability. And we must do this in a time of economic difficulty and fragmentation wherein veterinary care, services, and products are available from a number of competing sources such as low-cost, not-for-profit, mobile, and emergency care clinics; human or online pharmacies; and pet stores and big-box and online retailers.
To veterinarians, it often seems as if we are giving recommendations or prescribing treatments that would benefit pets—but "the clients just don't listen." Unfortunately, pet owners often feel as if they are given confusing and sometimes conflicting recommendations and are left asking themselves, "What am I supposed to do?" The vital step veterinarians often skip is communication, which is different from simply talking or giving pedantic directions.
I have often caught myself saying, "I care about your pet as much as you do," because I believe that most pet owners who seek veterinary services care deeply. However, pet owners often do not understand the issues at hand, and frequently their ability to provide care is affectd by concerns veterinarians are not aware of. I have come to realize I should have been saying, "I care as much as I think you care." Veterinarians frequently make judgments about clients' commitments without knowing what factors may be behind their decisions. At the same time, we may not always convey the reasoning behind our recommendations.
Most failure by pet owners to follow veterinary recommendations is not willful defiance or even indifference. Failure occurs as a result of a lack of clarity from veterinarians, a lack of understanding by clients, and a lack of joint commitment to achieving the best healthcare outcome.
So what is the solution?
1. FORM A CONSENSUS RECOMMENDATION
The first step toward concordance is forming a consensus recommendation and having all doctors and staff members repeat that recommendation regularly. Frequently, the doctors in a practice have not agreed on wellness care recommendations, and the technicians may ultimately deliver discordant messages about pet healthcare. The greatest barrier to client acceptance of a recommendation is the confusion brought about by inconsistent recommendations. We cannot expect clients to understand and accept inconsistent recommendations.
Some practices I have visited routinely stock all available parasite preventives, all available nonsteroidal anti-inflammatory products, and three or four virtually identical antibiotics. Why? Because stocking inventory is easier than reaching a consensus recommendation.
If a client requests a particular parasite control product, it is either because he or she been guided by an advertisement or because we introduced a new product that we believe is superior but we did not take the time to convert the client. Pet owners generally won't recognize that chemical compositions are often very similar or even identical. The product they request may very well be identical to the one we dispense. We just need to explain it to them.
Tell your clients why you support certain products. Brand recognition is important, but not as important as professional advocacy. The positive influence of professional advocacy on consumer purchasing decisions is why advertisements make statements such as "this product is preferred by nine out of 10 dentists."
2. BE SIMPLE AND DIRECT, AND MAKE YOUR BEST RECOMMENDATION
In their book Made to Stick: Why Some Ideas Survive and Others Die, the authors, Chip and Dan Heath, stress that using technical jargon is a barrier to communication with people not in the know. Clients may not say, "I don't understand that term," but if you listen with your eyes, you may see their posture change or their brows furrow when you say, "polycythemia rubra vera," or "thoracolumbar." These terms are appropriate when talking to colleagues or writing medical records, but when communicating with clients, saying "too many red blood cells" or "middle of the back"is clearer.
Even when numerous preventive measures or diagnostic or treatment options are available, there is still generally one agreed upon best option—and that is what you should recommend. While clients want to be involved in medical decisions, they are rarely prepared to appreciate differences among the options presented. So if veterinarians offer multiple options, we must make it clear that the options are not interchangeable. A fractured pelvis might best be resolved by using plate fixation. Perhaps, an external fixation device would also be appropriate. But you need to explain to clients the benefits and disadvantages of each option.
All options might be presented but not on equal footing. The preferred option should be presented as clearly superior. Then comes the hard part—be quiet and let the client speak. There may be a long and awkward silence, but stick it out. Either clients will accept your recommendation and you will have achieved concordance, or they will ask for another option and you start over again. So make your best recommendation and give the client a chance to say, "yes."
3. MAKE IT PERSONAL
Avoid statements such as, "Studies have shown that this situation responds best to this recommendation 53% of the time." Instead, personalize the recommendation and say, "While no one can predict what will happen in any case, I am comfortable that this recommendation gives Scout the best chance for a full recovery." Broad recommendations are great, but Mrs. Jones is concerned about one thing: What is the best thing you can offer to keep her pet healthy, happy, and comfortable? So personalize your recommendations to make it clear you think they are in her pet's best interest.
4. SAY IT YOURSELF
"I will have the technician discuss parasite prevention with you" may be more than what many veterinarians are doing, but it sends a signal to clients that the discussion is not worth your time. If a recommendation is worth making, it is worth the time to make it, explain it, and advocate for it. Certainly, team members play a key role in clarifying the recommendation and in helping facilitate adherence to the recommendation through reminders and inquiries. Most important, team members can facilitate client adherence to your recommendations by walking the talk and honestly reporting that they follow your recommendations.
Consider statements such as "Mrs. Jones, I know how important Scout is to you, and I want to be sure we do all we can to protect her from serious diseases that can shorten her life and some that can potentially cause diseases in your children. Heartworm preventives are effective and have the added advantage of preventing internal worms that can cause disease in people. I strongly recommend that we start Scout on a monthly product that will help you and me keep her healthy. Do you have any questions I can answer? Can I count on you to stick to this plan with our help?"
This one-time discussion explains what you advocate and why you feel so strongly about it. You are acknowledging possible concerns and offering your support.
5. COMMUNICATE WITH CLIENTS REGULARLY
One thing veterinarians have over Internet pharmacies and web-based resources is a relationship with clients, so it is important that we foster these relationships by communicating with clients regularly. In today's practices, it is not uncommon to have 25% to 30% of office visits unscheduled. Why not use those lulls to call clients and just say, "Howdy." Seek other opportunities to reach out, such as surprising clients with a chat in the waiting room. An offer of a cup of coffee or juice or a cookie is always welcome.
Websites are great, but when did you last update yours? Clients are likely to be linked into social media, such as Facebook, Foursquare, and Twitter. Chances are you have someone on your staff who would be great at handling social media contacts and tweets to keep your message in front of your clients.
6. BE VALUABLE
All of us are consumers and are influenced by our own circumstances—busy schedules, conflicting responsibilities, finances. We all look for convenience and value and shop based on price. I bet you shop at big-box stores. We all seek convenience and price, but not at the expense of value.
To compete with Internet pharmacies and web-based resources, veterinarians must emphasize value and relationships and provide better service experiences. Look at online review sites to see what people are saying about your clinic. Clients are increasingly making decisions based on consumer review sites. Consumer publications are advising pet owners to look beyond the veterinary hospital for products and services in order to save money. Consider hosting a focus group to learn what your clients think and where they are shopping for your services when they look elsewhere.
We must stop treating our professional services and knowledge as a commodity. Surveys have shown that while clients are concerned about price, they want to know they are receiving value. Veterinarians must compete on price with relationships, knowledge, and value.
7. RESPECT THE CLIENT'S DECISION
It has been said that medical decisions should be made by addressing three concerns: What is best for the outcome of the disease or injury? What is best for the patient's quality of life? And what is best for the pet owners and their family?
We do not know the details of clients' circumstances. All we can do is provide clear and direct information and treatment options and then give clients permission to decide. We then must respect their decisions.
We veterinarians need to take the leadership role when it comes to achieving concordance with and adherence to our guidelines. We need to build consensus in our practice teams, but we also need to be the primary communicators of clear, direct, and personalized recommendations with adequate follow-up. Then we can feel confident that our clients will be able to make well-informed decisions.