Communication resources in veterinary medicine outline the caveats of good communication and Dr. Nan Boss makes some great points in her reference.

My 3 big take-aways  from her book are:

1)     Excellent communication in the veterinary practice is a team sport – from the receptionist to the DVM to paraprofessionals

2)     Keep it simple – use plain language to describe health issues not medical jargon

3)     Provide concise written information in support of your diagnoses and treatment recommendations

We know from the 2011 State of Pet Health Report that the most common pet diseases are those that are entirely preventable.  Strong communication is vital to client compliance to veterinary recommendations for preventive care.  The Bayer Brakke study found that 59% of dog owners and 56% of cat owners would bring their pets in more often if they could prevent problems and extensive treatments later on.

For our 2012 resolutions, let’s make enhanced client communications skills a priority so that we can help even more pets get the preventive care that they deserve!

Along with being a lumpy bumpy arthritic girl, she is considered a geriatric large-breed dog and is at risk for dental tartar, ear infections, and nuclear sclerosis according to 2010 Banfield data.  These were the top three diagnoses in 2010 for this age group, and as a practicing veterinarian, I find it fascinating because my experience with my own dog is similar to what I see in practice.   But how does this information help veterinarians and why should we care?

It is important to continue oral health care in our geriatric patients.  I’ve seen more than one case in my practice that the owner perceived the dog as “too old to undergo anesthesia”.  And then once the dental procedure was done, often with multiple extractions, the owner called me later and told me how much better their pet was doing -eating, playing, and acting like a young dog again.  Full oral examinations must accompany every physical exam.  We, as veterinarians, need to look for broken teeth, worn teeth, oral masses, tooth abscesses, and general periodontal diseases.

Ear infections are another common health issue that can affect geriatric patients.  Bailey has had many in her lifetime and they have been extremely painful for her.  More than once I’ve seen her scratch her ear and then cry out in pain.  You’d think as a vet, I’d catch them sooner.  But as a busy mom, I miss things too.  This is just one of many examples of the benefits of bi-annual thorough examinations.

In addition to periodontal disease and ear infections, lenticular sclerosis commonly affects dogs over 10 years of age.  When educating clients of geriatric pets, it’s important to include discussions on ocular health. Along with detecting it during routine physical examinations, conversations can ensue on how to help their older dogs cope with declining vision.  Although it may be out of reach for many owners, surgery can be discussed, but I also recommend non-surgical, practical interventions such as not rearranging furniture on a regular basis.  My own Bailey can’t see the tennis ball sometimes and has tripped over things the kids have left on the floor, so my family has had to make adjustments to accommodate our aging dog

I was taught that age is not a disease and as veterinarians we can help our older pets maintain healthy lives during their “golden” years.  We need to help our clients prevent diseases, such as periodontal disease, that are common among aging pets, and detect problems early.  There will come a time when I have to say goodbye to Bailey, but I know that she has had the best life possible!

We have a reason to care. From 2006 through 2009, we saw a 57% increase in the number of new canine and feline patients seen at hospitals open for at least 5 years. Part of this increase, but not all, can be attributed to practice growth. Then something changed. In 2010, we saw a 21% decrease in new patients, and this downward trend is continuing. Although the decline could be blamed wholly on the economic crisis, other factors such as increased competition for services have also contributed.²

The implications of this decline for pet health are cause for concern. Fewer new visits means pets are not getting the care they need and deserve. Indeed, we have seen an increase in the prevalence of certain preventable diseases such as diabetes mellitus and roundworm in cats is increasing.³ In the current economic environment, the importance of routine preventive healthcare, something that pet owners already struggle to believe in, will surely take a perceptual hit, and the need to effectively communicate that importance is becoming direr.

But what about existing patients? Surely they are an important concern too.  Although Banfield data show an overall decrease in the total number of visits by new and existing patients from 2010 to the present, the number of visits by mature adult and geriatric cats and dogs seems to be increasing. Furthermore, the mean number of visits per month by all pets is also increasing by about 5%. This is indeed good news—it appears we’re getting better at keeping the patients we do have, and existing patients are getting more regular care.

So where should practices be placing their emphasis: on keeping existing patients or attracting new ones? I would argue that both are important in making a better world for pets. Repeat visits increase the opportunity for veterinary staff to develop trusting relationships with pets and their owners, which can be used to facilitate conversations about preventive health matters. I am much more likely to take my family doctor’s advice when I have a relationship with her than I am if I see a different physician each visit, particularly if she is familiar with my health history and my lifestyle. Initial visits open the door to ensuring all pets get consistent, compassionate life-long care. In the end, we all win.

1. Katie Burns. Reversing the decline in patient visits. JAVMA News. Sept 15, 2011. Available at: www.avma.org/onlnews/javma/sep11/110915o_pf.asp.
2. Bayer HealthCare LLC, Animal Health Division, Bayer Veterinary Care Usage Study. Available at: http://www.ncvei.org/articles/FINAL_BAYER_VETERINARY_CARE_USAGE_STUDY.pdf.
3. Banfield Pet Hospital. State of Pet Health 2011 Report, Vol. 1. Available at: http://www.banfield.com/Banfield/files/bd/bd826667-067d-41e4-994d-5ea0bd7db86d.pdf.

Wearing my practitioner hat, the first thing I did was run a fecal float, giardia ELISA, and a direct smear.  As can occur, all results were normal, necessitating empirical treatment for “run of the mill” diarrhea.  But it got me thinking about some of the questions clients ask of me in the exam room.   What are the chances that my pet has parasites?  And, if so, can my family get them?

Recently, the Banfield BARK team published the State of Pet Health 2011 Report that shows trends and rates of many of the common findings of the 2.1 million dogs cared for in Banfield hospitals during 2010.  The full version is published on the Banfield website here.  What is the prevalence of parasites found on fecal tests?  In Oregon where I live, there were 134 cases of roundworm, and 22 cases of whipworm per 10,000 fecal tests run in 2010.  Considering how many fecal tests are performed as part of the strong routine wellness care program at Banfield hospitals, this is an important finding.  (I hesitate to say significant without a confidence interval to prove it!)  Not all of these pets are symptomatic, making it just as important to run fecal tests routinely as well as only when there is a problem.  Unless prompted, it is easy to focus on what is in front of you rather than prevention.

I know that I get busy, and more often than not I am putting out fires instead of preventing them, but Toby’s diarrhea got me thinking about what my kids may have been exposed to.  He’d had a recent fecal as part of a workup for an possible GDV event so I wasn’t as worried.  But what if he picked up something in the meantime or what if he wasn’t shedding at that time.  You really never know.  Giardia is a parasite we all associate with zoonotic potential, but according to the Companion Animal Parasite Council (CAPC) website, the jury is out as to whether or not there is a true zoonotic potential.  Tapeworm and whipworm infections have been documented rarely in humans, but hookworm and roundworm are considered serious risks to human health.  But they are all important if there is potential to infect my kids!

 Back to wearing all my hats, I’m still annoyed I had to clean up my carpet, but I’m glad Toby was free of parasites and his diarrhea resolved on its own.  Turns out he had eaten a Costco-size box of oatmeal packets that was most likely was the culprit.  The bottom line is that we should be running fecal tests at least annually on our pets, and definitely whenever a problem arises!  Better safe than sorry, no matter what hat you wear.

I realize that is a sweeping statement.  I realize that between all the team members and all the pets and all the clients and all the diseases and injuries and preventative care measures, there are countless things we do, and it is unfair to say ONE thing is the most important.  It is.  Nothing else we do carries the same risks, even to healthy pets, as anesthesia does.  It is a powerful thing.  This book reflects that well.

In a survey I received when I first started as a member of the Banfield team seven years ago, one of the questions was, “What do you like best about Banfield Pet Hospital?”  My answer then and now:  our anesthesia.  (My second favorite would be a several-answer tie!)

I love that Banfield emphasizes the importance of the preanesthetic workup for every pet.  I love that our medical standards for a pet undergoing anesthesia are so high.  I love that we have such excellent protocols.  I love our emphasis on pain control.  All of this is well expressed in Anesthesia for the Pet Practitioner.  Underlying every chapter of the book is a healthy respect for the power of this important ability we have: the ability to anesthetize pets.  The book does not treat that lightly, and I think therein lies its greatest strength. 

This is the third edition of Anesthesia for the Pet Practitioner.  The second edition just came out in 2008.  The first edition came out in 2003.  It seems to be constantly changing and improving as veterinary anesthesia changes and improves.

I took twelve hours on the first day I had available when the third edition came out and read it from cover to cover.  There are a few protocol changes in this edition, and it is even more “Oh no!  I need to know this RIGHT NOW!”-friendly than the previous two editions.  I have (thankfully) not needed to use it in that capacity yet, but if an emergency situation presented, the book would be easy to use as a quick reference for emergency protocols and medications.  I have used the book in day-to-day practice, and with the color tabs and straight-forward organization, it is very user-friendly.  I recommend that every veterinary team include Anesthesia for the Pet Practitioner, Third Edition in their hospital library.

Symposium is a three or four day event filled with CE courses and general session breakouts sponsored by our vendor partners.  We have accredited courses in many areas like medicine, surgery, practice management and communication.  All of the lectures are held at the South Point Hotel and Spa.  This year we had some lectures on canine cardiology, diagnostic imaging and anesthesia monitoring.  Our practical hands-on labs are held at the Oquendo Center which is a brand-new education facility in Las Vegas.  This year we offered labs on abdominal surgery, critical care, feline and canine dentistry.  We cover the registration for our doctors we also cover their airfare and hotel while paying the doctor’s salary to attend. 

Another important part of Symposium is our doctors have a unique opportunity to network with colleagues, interact with their field leadership and celebrate the success of our veterinary practice.  They leave Symposium feeling energized and ready to go back into our hospitals to make a difference for our families and pets. 

We just finished the last Symposium for this series, and we’re already starting to plan the next series which starts this winter!

The process is simply meant to be a way to summarize and close out the previous year and to set expectations for the upcoming year.  Who doesn’t have things that happened in 2010 that they’d like to say good-bye to?  That they’d like to never happen again?  Who can’t think of some wonderful things that your associates did that you’d like to thank them for?  This process should not cause dread on your part or the part of the associate.  You both lived through the same year and experienced the same events, so in theory there shouldn’t be any surprises during your review.  You simply rehash the events of the year and set expectations for what you want to happen during 2011.

If you have been doing the hard work of keeping track of your associates’ performance and of giving them the regular and constructive feedback that they deserve, then the annual review is a walk in the park.  You simply rehash the conversations that you have had during the year and reiterate the expectations that you have set going forward for 2011. You have them written out; you go over them with the associate, you ask the associate for their feedback and then you both sign and date it.  The actual form that you use isn’t important, but if you do a web search, you will be able to find several different ones available. 

Next month, we’ll go over the important points that you should include in your performance reviews.

Animal welfare is also what helps to drive preventative medicine. It is the desire of the animal owner to provide a good quality life for their pet that causes increased visits to the veterinarian’s office for preventative medicine and hopefully the prevention or early detection of disease. Preventative medicine is the driving force behind twice yearly examinations and also the reason that we even have patients to treat into their geriatric years. Prevention is the cornerstone for vaccinations and the reason that our pets are not overrun with heartworms, fleas, ticks and the diseases that result just to mention the most obvious. In addition, through preventative medicine and routine examinations the doctor can detect early warning signs of disease that makes veterinary medicine important to those pets who are not exhibiting signs of illness to their owners. 

Prevention and treatment are what set us apart from the owner in the pet’s life. To ignore prevention would be to ignore half of the equation and to negate the very powerful role that veterinarians play in the lives of the pets and clients whom we serve. I think we could probably all agree as a profession that both welfare and prevention are both warranted in the Oath. 

The controversy may stem from the fact that not each and every veterinarian was asked their opinion. However, the AVMA represents over 80,000 members, all of whom have the opportunity to apply to serve on the AVMA Councils and Committees. However, even if you are not contributing to the decision making pool by volunteering – your voice can be heard loud and clear through the tireless efforts of the Council and Committee members. How is that? The members represent each of us who are members of the AVMA. Those members are in place to hear from us. Contract the representatives on the Councils or Committees that discuss those topics you are interested in and have your voice heard. Read JAVMA and know what is being discussed, go online and know what the Councils and Committees are doing. The decisions made by the AVMA Councils and Committees are not done lightly or without extensive research. I know this to be true because I actually was employed by the AVMA for 8.5 years while I resided in Chicago, Illinois. I have the utmost respect for the organization, the staff, and the volunteers who make up the Councils and Committees. These are unpaid volunteers who give of their limited time, energy, and resources to represent a constituency and speak on the behalf of those of us who are not able to serve for whatever reason. I know this decision was not done lightly, and just my opinion, I appreciate the fact that both the AVMA staff and Council and Committee Volunteers work tirelessly on my behalf to make sure policies and position statements are accurate and timely.

The innovation exists today in the form of the electronic medical record (EMR)!

I had the privilege recently to speak at Tufts Cummings School of Veterinary Medicine as part of a continuing education event . Program speakers addressed many attributes of the EMR: improved communication and patient outcomes, better pharmacovigilance and public health information to name a few.*

Banfield has an EMR called PetWare; other EMR systems are available for veterinary medicine with different features, interface styles and system requirements. Many of the advantages of an EMR are obvious – an electronic patient record can’t get lost in a stack of files in your treatment area. Other advantages include the time saved when trying to read your colleagues handwriting or interpreting a patient history spread across a 6-inch deep medical file.  These efficiencies are tremendous to be sure, but there are other far-reaching benefits to be gained. Only with an EMR can individual patient records be aggregated to conduct population research and provide evidence in support of clinical decision-making. Population research generates new knowledge and understanding of disease risk factors and threats to pet health. Using EMR, these insights can also be integrated and displayed at the point of care making conversations with clients more meaningful and productive. 

As a large veterinary practice network of over 760 hospitals with an EMR, Banfield has the ability to do just that. But there is no reason that the whole veterinary profession couldn’t be connected through EMR use in the same way.  Using a standard nomenclature or language, like SNOMED, primary care and referral institutions could communicate and support a continuum of patient care –benefiting pets and clients alike. Banfield is currently integrating the AAHA subset of these standard codes into PetWare so that we will be able to share medical information with systems and providers outside the Banfield practice network.

You still might be wondering how an EMR can make a difference in the daily practice of veterinary medicine. Imagine the following possibilities if you adopted the use of EMR in your clinic. As part of a pet health surveillance system, adulterated product threats are detected early and alerts generated to minimize illness and adverse events.  In customizing care to a particular pet, for example, the decision to vaccinate a dog against Lyme disease would consider population prevalence by state in addition to pet lifestyle and use of external parasite control. A client who has a pet on a weight management program could view not only the population trends in pet obesity over time but their pet’s weight loss journey through graphing of weight and body condition over time. These tools are within the reach of veterinarians today through the use of the EMR. We can transform the quality of care and the client experience beyond what can be imagined. It’s up to us to take the lead as professionals to embrace EMR – an innovation to move the standard of veterinary care forward.

*If you’re interested in obtaining the PDF to the PowerPoint slides from the Tufts Cummings School of Veterinary Medicine’s event on The Electronic Medical Record, please email the BARK team at bark@banfield.net.

This year has seen exponential growth in veterinary internet involvement.  We started out dealing with the internet “defensively,” trying to undo problems created by false information.  We quickly learned to proactively add our voices as reliable authorities on animal health issues.  We have had to deal with client feedback in a more public way than ever.  As disconcerting as that has been, we have handled it with the prompt attention and grace that we always have.

The increase in online interactions between pet parents and veterinarians has raised many ethical issues.  We can put all sorts of medical information onto the internet, but we still cannot diagnose or treat without a valid patient-client-doctor relationship firmly in place.  We have the ability to post patient pictures and cases onto the internet in full view of the world almost instantaneously.  We have shown tremendous restraint in doing that only when we have permission from our team leadership and clients.  Clients know that in this age of instant information, they can still trust us completely with their privacy and that of their pets.

Many of our veterinary journals have become accessible online.  As much as I have enjoyed the internet explosion and accompanying learning curve, I still request paper copies of my favorite journals.  I will probably be among the last of us to give that up.  Just admitting that makes me want to plant a tree.

We have always advocated humane breeding practices.  As restrictions on high-volume puppy sellers have tightened in the United States, international puppy sources have become more popular.  Our next battle may be assuring that the puppies imported into our country are shipped humanely and legally and enter the country free of contagious and zoonotic diseases.

A second report on veterinarians and suicide was published in England earlier this year.  The authors’ first report revealed that we are much more likely to commit suicide than people in the general population.  Their second report explored the reasons this may be true.  Everyone is an individual, and the sample size was relatively small, so we are not doomed.  Do keep a caring eye on your colleagues though and take good care of yourself.

Finally, the United States Congress recently proclaimed 2011 “World Veterinary Year” in honor of the 250^th anniversary of our profession.  The resolution was introduced by the two veterinarians serving in Congress and passed with support from veterinarians across the country.  2010 was quite a year to be a veterinarian.  I am excited for what is to come, next year and beyond.