Long-term Management of Clients with Pets with Chronic Allergies: Part 1
Karen A. Moriello, DVM, DACVD, University of Wisconsin–Madison
Part 1: Always Plan for the Extra Time These Patients Need
This really happened! “Dr. Moriello, we have been seeing each other for so long I remember when Sadie, you, and I did not have gray hair!”
The relationship with clients with long-term patients is a lot like relationships with long-time neighbors walking across the lawn to chat―you are happy to see them, or you immediately start planning your escape. Even with good communications, clients whose pets have a chronic allergy need special management and lots of time for explanations and education about the patient’s condition. Use these strategies to manage long-term patients and clients:
1. Empathy
Clients are appreciative when the veterinary team sincerely recognizes the extra time and expense it takes to care for patients with allergies. Train team members to empathize with these clients and to remember that even little things, such as helping them carry large bags of special dog food to their car, mean a lot.
2. Clients with allergy pets need longer appointments
The “work” with these clients and patients is a “front-end load.” When a patient has a fracture, for example, the client’s contribution to a diagnosis may only take 15 to 20 minutes and then the work load is on the veterinary team. The reverse is true with dermatology clients, where the work required is face-to-face.
To provide the best care for patients with allergies, your team should schedule no less than 30-45 minutes per visit and communicate any adjustment in appointment times and fees. With a few exceptions, extra time with clients is the single most important diagnostic advantage veterinary dermatologists have over primary-care doctors, whose new clients often say that they wished their veterinarian had spent more time explaining what was wrong with their pet, so use this advantage.
It is important for the veterinarian to explain the need for longer appointment times for several reasons: clients know well in advance that they should allow extra time in their schedules; reception team members know to reserve the extra time, so the appointment schedule is not affected; and appointments can be avoided during the practice’s busy times, such as the middle of Saturday mornings, which makes the visit less stressful for everyone.
3. Have a strategy for patients with acute flares or relapses
Except for drug reactions or allergic reactions to immunotherapy, allergy patients seldom experience emergencies. Flares can happen overnight or gradually develop over several weeks and then suddenly reach an “itch breaking point.” In such urgent cases, the extra time that chronic allergy patients generally need may not be possible and they then should be scheduled into any open appointment as soon as possible, the immediate issue handled, and, if necessary, a longer appointment scheduled in the next few days.
4. These patients need “special” records
Even though allergy patients are seen regularly, it can be difficult to remember all the details of their cases. However, the client expects that you do remember, which is easily done by keeping detailed, accurate, up-to-date medical records that include recommendations, prescriptions, treatment plans, and next steps.
Unless the practice uses electronic medical records, keep 3 separate record sheets at the front of the file:
1. A visit summary sheet that lists the date, diagnosis, and key comments, which provides an invaluable, quickly available chronological history of the case.
2. A summary of diagnostic tests and their results, because it is important to easily and rapidly find the results and dates of core diagnostic tests (eg, skin scrapings), expensive diagnostic tests (eg, allergy testing), or tests that may need to be repeated (eg, thyroid function, food trials).
3. A summary of drugs and their doses and the patient’s response. These mini-summaries allow every veterinary team member to refresh his or her memory quickly before examining these patients and can be invaluable when a client is frustrated about the disease and feels no progress has been made.
5. Keep patients’ photographs in their medical record
Clients see the patients daily and may not appreciate how much their pet has improved between practice visits. Photos will help document improvement, relapses, or unusual findings. Photos will also be helpful if a team member needs to examine the patient for the first time, because he or she can see the patient’s condition at the last visit.