We’ve all been stumped in the exam room, unsure of what recommendation to make to a client or in need of a colleague’s opinion.
Recently, I needed to advise a client on tapering a dose of an anti-seizure medication (zonisamide). I knew how to taper phenobarbital (very slowly) but was not certain the same was required of zonisamide. When I stepped out of the room, I told the client I was consulting the veterinary neurology specialists on VIN to better advise her on how quickly or slowly to taper the dosage. As a result, the client was more confident in my recommendation.
Veterinarians frequently need to step away from the examination room in situations like mine, or for a variety of other reasons: to find more details about a specific topic or drug online, take a phone call, respond to another team member’s question, or even to take a moment to regroup.While all of these are adequate reasons for stepping away from the exam room, admitting that you need to confirm information can be difficult for many veterinarians. Many of our clients have done their own online research on their pet’s problem before arriving for the appointment and may bring their own diagnosis and treatment suggestions to the exam room. In a small 2017 study, 40% of veterinarians felt that internet information had a negative impact on pet health.1 It’s up to us to provide the medical guidance specific to each pet’s situation—and that’s something Dr. Google can’t provide. However, this can all add pressure on us—it may feel like we need to know everything, all the time. That just isn’t practical.It takes finesse to maintain a client’s confidence in your abilities while gracefully exiting the exam room—it’s a skill I wish I’d honed earlier in my career.
I surveyed my veterinary friends to compile this list of tips and tricks to escape the exam room.
1. Acknowledge
Even with Dr. Google’s rise in popularity, know-it-all clients still shouldn’t put pressure on us to come up with an answer on the spot. It’s okay to acknowledge the client’s desire for a quick response, before explaining that you would like to understand the full context of the case.Once you have acknowledged both the client’s and your own need for more information, one option is to exit the room to check patient records.Depending on your access to patient records in the exam room, you may need to leave to review the record in more detail:
“I just need a few minutes to go to the treatment/office area computer and review Ace’s complete history and make sure there’s nothing that would change my plan for us today.”
Another option is to shift the examination to an area away from the owner (using good judgment and making sure to keep the examination as fear-free as possible for the patient). Explain to the client that you would like assistance from another veterinary team member:
“Let me take Bruno to the treatment area where I have better lighting and a technician to assist me.”
“Let me take Cookie to the treatment area where there are non-slip floor mats so he’s more comfortable while I manipulate his hips and knees.”
Although it may feel as though clients expect an immediate response, pet owners will appreciate an acknowledgement that you need to gather more information.
2. Body Language
Watch your body language and posture. How you say that you don’t know something can actually inspire confidence in an owner.
“I’d really like to give you the most current advice on how to dose this medication. I’ll be right back after consulting the pharmacy reference.”
During these kinds of discussions, I am often seated in the exam room, facing my client. When a question arises that I cannot answer without going to look something up, I tend to use body language like placing my hands in my lap and responding, “Hmm, I’m not sure I know that off the top of my head.”
Showing vulnerability when you don’t know every detail on a topic while asserting that you will do everything you can to find out lets the owner know you’re working with them for the common goal of helping their pet.
3. Collaborate
Ask another veterinarian! Of all the tips for exiting the exam room my colleagues offered, this by far was the favorite.
In the multi-doctor hospital where I practice, I find that clients appreciate that I am going to consult one of the other veterinarians, often someone they have seen before and also trust.
When you exit the room to consult another veterinarian, whether in person or over the phone, be confident in emphasizing that, as a team, you are doing everything you can to help the pet.
“I’m confident that Darcy has a foreign body obstruction, but I’d like to get Dr. Smith’s opinion as well before we move forward.”
Collaborating and getting an additional opinion from your colleagues even gives you the opportunity to tell your client they are “getting two for the price of one!”
4. Dig Into Data
You’ve already acknowledged the need for more information about the patient, but you may also need more information about a diagnosis or treatment. Explain to the client that you want to offer the most up to date research on a topic before excusing yourself from the exam room.
“I need to double-check the dosage for Eliot and see what options are available for this medication.”
“Let me find a copy of our anatomy chart so you can see what Fargo’s knee joint should look like.”
“Gertie’s dermatosis is an unusual case. I’m going to check a veterinary database online for the most recent dermatology case studies.”
Finding materials to share with your client is a great opportunity to exit the room while bolstering your client’s confidence.
5. If All Else Fails…
Sometimes, something a client says might just plain throw you off. When you need to get out of there ASAP, try these:
“Excuse me, I need a drink of water.”
“Sorry, I hear the front desk calling my name!”
“Let me step out of the room to grab a better stethoscope/otoscope.”
What are your tips for escaping the exam room?