Building Trust, Educating and Shifting the Veterinary Client Mindset to CareFirst with Dr. Lauren Smith and Ron Sosa

Mary Schwartz:

Hi, and welcome to Simple, Interrupted, a podcast about radical veterinary change. On this episode, we welcome Ron Sosa and Dr. Lauren Smith to discuss the importance of creating care first clients and what that looks like. Dr. Lauren Smith is the founder of Vetitude, and works to improve relationships with vet

professionals and clients. Ron Sosa has 20 years in the veterinary industry and is now the executive director for Uncharted Veterinary Conference. He's done almost every position you can think of in the hospital. You'll hear from them on shifting the client mindset to care first by utilizing education and building a foundation for trust.

Hey, Dr. Lauren and Ron, it is so great to have you all on the podcast today. Thanks for joining me. I'm excited to dive into our topic about creating care first clients today and what that looks like. But first, I'd love to hear a little bit about what each of you all have done in the industry and what you're doing now.

Dr. Lauren Smith:

Well, I'm Dr. Lauren and I am a small animal veterinarian. I graduated from Ross in 2008. I worked for about 11 years in small animal, dog and cat exclusive, GP, and then went to relief work, doing both GP and emergency relief work.

Back in probably around, it was a bit of an evolution, but around 2015 I started the Vetitude, which is a website and social media presence that is dedicated towards trying to improve the relationships between veterinary professionals and clients. And I've done a lot of writing and done some lecturing on different topics related to client communication and cultivating good relationships with clients since then.

Mary Schwartz:

So the perfect person to chat with today.

Ron Sosa:

Hey guys, I'm Ron Sosa. I am currently the executive director for Dr. [inaudible 00:01:50] and the Unchartered Veterinary Conference, but I officially hit my 20 year anniversary in the vet industry this year. I started off, you know, almost every position you can think of in the hospital. Started off as a CSR, was on a job trained vet assistant.

I moved to practice management, owned a couple of hospitals, where we had three locations. We had two pet retailers, as well as a pet resort, boarding, grooming, dog training, you have it. And then we sold that off to a corporation and I am where I landed now, with doing some consulting as well as putting on the conferences and education for business leaders within the veterinary community.

Mary Schwartz:

That's amazing. So you've interacted with a client or two yourself in your time.

Ron Sosa:

Just one or two.

Mary Schwartz:

Just one or two. Perfect. We'll call that good enough.

So I want to start out with a concept that was brought up a couple of episodes ago about a clinic's commitment to clients. And one of the folks on the episode had a person that they had worked with in the past who used to provide clients with kind of an agreement or a set of expectations from the clinic to the client and from the client to the clinic at the beginning of their relationship. So I'd love to hear a little bit more from you both about what should a clinic's commitment to a client be and what should a client expect back from a clinic?

Dr. Lauren Smith:

Yeah, I love that idea of having almost like a client code of conduct that sets up expectations and outlines what is expected of both parties. Because I think oftentimes as veterinary professionals, we wind up setting our clients up for failure by not providing them with those expectations, and then we get mad at them for not living up to expectations that we have not provided them with or let them know about.

So if we don't let clients know that they need to call 48 hours in advance for their medication and then they wait until the medication is out and then they call us, and then when we get mad because it's like, oh, your emergency is not our problem. But we didn't let them know that, and maybe at their last vet,

they were able to get medicine at the last minute. So we need to set up expectations for clients if we are going to expect them to meet those expectations. We live in this profession. It's the water that surrounds us. So things that we take for granted clients don't necessarily know about.

Mary Schwartz:

That's very true.

Ron Sosa:

I wholeheartedly agree with that. I've seen the code of conduct now, not only just in the veterinary profession. I went to the hospital and I saw that in the human hospital, where they're doing the exchange of expectations, which I think is a great idea. I think in our profession for so long, we've probably over accommodated, even if we had set rules for we'll get to refills within 24 hours. And yet we're calling that client in five minutes. Oh, your prescription's ready. So we're saying one thing and cultivating a different culture for them for expectations.

And so I think it is really important to set those boundaries on what it is you're going to provide. Somebody smart told me that we can tell our clients no by telling them what we can do instead of saying the words no. And I think that's really important, to Dr. Lauren's point, that those expectations are what they can expect from us, but also what we can expect from them, and how we communicate and how we foster the relationship further.

Mary Schwartz:

So you brought up a good word, Ron, in boundaries. So boundaries are always something that's difficult to create and difficult to enforce. What would you all say it would look like for, you've created a code of conduct, you've sent that out to your clients. How would you enforce those boundaries with compassion and kindness? What kind of conversations do those look like?

Dr. Lauren Smith:

So one thing that I think a lot of people forget about when it comes to boundaries are that boundaries are not a way of controlling what other people do. You can't control clients. Boundaries are about what you do as an individual and as a clinic. So it's not a boundary to say you can't curse at me. That's not a boundary. What a boundary is, is if you curse at me, I will not be able to continue this conversation with you, or I will end this conversation. That's a boundary.

So the first thing you need to do is decide how you are going to honor your own boundaries as an individual and as a clinic. Because you can't force clients to do that. So I think one, again, setting the expectations. There are certain things that are going to be red lines. And again, I think you should discuss that with your clinic, what is a red line boundary where if a client crosses this, there's no coming back from it. Things like threats. If someone threatens you with a lawsuit, then you're not going to be able to continue that conversation, right?

Mary Schwartz:

No.

Dr. Lauren Smith:

But otherwise, I usually use kind of a three strikes and you're out rule. The first thing I let them know is that we are not going to be able to provide you with service if you continue to treat us this way. And then the second time, I will be more specific and say, "If this behavior continues, we are going to have to terminate our relationship with you." And you want to make it about the behavior, not about the person. And then the third strike is, "We've asked you a couple of times now not to engage in this kind of behavior. Since you are unable to honor that for us and to treat us with respect, we are going to have to now terminate our relationship with you and ask you to find another veterinarian."

So you want to make it about the behavior. You want to, again, set that expectation and let them know that it's unacceptable, give them a chance to correct that behavior. And then if it continues, then you can take whatever action it is that you said that you were going to take, whether that is to terminate the relationship or something less significant, like take them off of the waiting list if they're complaining about not being able to be seen that day. Well, if you continue to insist, then we are going to remove you from the waiting list completely. If we have a cancellation, whatever the case may be, whatever that consequence is that you have determined is appropriate for that violation.

Ron Sosa:

And to that point, I would say is making sure that we have the expectation of what that boundary looks like right up from the get-go so that we're not blind sighting our clients. And so I think that's where that code of conduct we talked about earlier comes into play, where they're not shocked when we put up a

boundary of we cannot get you your prescription for 48 hours after you call it in. They're not going to be shocked, because we've set that expectation. But then we also have to act within our own boundary, and whatever that looks like, is we need to be consistent.

And I think that's the hard thing for human beings, is consistency of your actions. Because we want to be able to accommodate and we want to be able to go above and beyond for our clients, and that looks different for everyone and we just have to stay within the lines that we are drawing. And I feel like a lot of times that gets a little bit blurred because we want to be able to do better, we want to be able to do more. We care so much that we want to be able to provide better. But then when we set it culturally, we're setting something over here that isn't within our boundary and then we can't deliver that, we've now confused the expectations. So it's all about consistency

Mary Schwartz:

And that's a point that we're definitely going to talk about later in regards to building the foundations of trust for clients. Consistency is such a huge piece of that.

So I'm going to open Pandora's box a little bit here with a pretty big question. I hope you guys are ready. So in our industry we're seeing a lot more commoditization of care. So we're seeing big box retailers come in, offer low, low prices and quick, convenient care that is attractive to a lot of clients. So how can we work to convert client mindset from those that would seek out the Walmart or the Petco for their pet's care to those that understand the value of that local practitioner, and get them back through the clinic door?

Ron Sosa:

This one is a little bit of a passion project for me. The first question I ask is why are we trying to compete? Do you know what the identity of your clinic is? Are you actually in competition to a clinic opening up inside of Walmart? Because if you're not, then I'm not going to do anything different than what I'm doing in my business. I think the foundational piece to this is knowing who you are, what's the customer that you serve? What are your values? And what that alignment looks like.

Because if I am a high value, high touch clinic and my exam is $150 to walk in my door, there's no way I'm going to try and compete with a $29 office visit, or maybe a free office visit someplace opening up in Walmart. And I shouldn't compete. And so the first question I ask is, are you in a position or is this actually competition for you?

And we also have to remember, there's all levels of care for all clientele. We can't be everything to everyone, and we shouldn't be, right? And that's how these one star reviews happen, is we try to be everything to everyone. And I go right to, do your values align? Is this the right psychographics, demographics, geographics of your clinic? I can go on and on about this all day long, so I'll give Dr Lauren a chance, because I can spawn off into 20 different directions with this question. But the very first thing I say is, is this truly competition and is this something you should truly step into? And actually evaluate whether or not you should.

Dr. Lauren Smith:

Yeah, I agree with that a hundred percent. I think you need to ask yourself what are you offering that these other big box clinics are not offering, because you can't compete on the price of your pharmacy or the price of your vaccines or any of those things. Or even convenience of walk-in status necessarily or timeliness. What you can compete in, and it's going to be a long, long time before any kind of technology can overcome or any kind of commodification can overcome is the kindness and the compassion and the service that you're offering to these clients.

Even the medicine, a lot of times people come in already knowing what's wrong with their pet because they do have Dr. Google, and they're not always a hundred percent of course, but people a lot of times are getting better at knowing what's wrong with their pet before they even come in because of technology.

So what are we offering them? And this is where I think that a lot of people are making the mistake, where I feel like more and more veterinarians are trying to establish themselves as not client service or customer service people and we are just merely doctors, and that would be great because that's what we wanted to be. But that role is very hard for us to compete on, on a competitive level like that.

But when it comes to what are the things that we as veterinarians get by far the most thanks and most gratitude for, it's for euthanizing pets. Any veterinarian will tell you that. And it's not because you did such a great medical job of euthanizing that pet, it's because of how you made that client feel. And that's something that these big box clinics cannot compete with, is the way that you make the client feel.

Mary Schwartz:

Yeah, I totally agree. I think that there is a lot to be said about veterinary teams as a whole providing a compassionate client experience that doesn't exceed what they're able to do that looks like above and beyond, but provides a connection with clients. And I think that's probably the biggest differentiator versus these high volume retail practices.

So if I was a clinic or I was a practice manager in a clinic, and I said, okay, we've been trying to compete on this high volume level, everybody's really exhausted, we can't compete with prices, clients are always complaining about our prices, let's shift into this client first within our own limits kind of model, how are you going to roll that out to your clients? How are you going to say, "Hey, I know you've been coming here getting $25 rabies vaccines, but we're maybe not going to do that anymore. We're going to raise our prices, and we're going to have a different service model."

Ron Sosa:

Oh, that's such a great question. There's so much there about buy-in, but I go to what is the reason we're shifting? So is this in alignment with the business? I always talk about vision first. Are we in alignment with where the company is going? And if that's truly the line that we're going in, then we need to be prepared that a good portion of our clients are going to leave us because we have cultivated clientele who are used to us being high volume, us being the cheap guy.

And if you're going to disrupt that, then you're going to disrupt a good portion of your clientele, who are going to leave you. And you have to be able to accept that because what you're going to have to do is market to the clientele now that you want to have, to the shifting business. You're completely changing. I would say you're starting your business over from scratch. If you go from high volume, low expense, to a lower volume, high touch, high value practice, I think you're starting all over from scratch, and you're going to have to cultivate your clientele from scratch.

Dr. Lauren Smith:

Yeah, I agree with that a hundred percent. That's basically what I was going to say, is that be prepared to lose clients. Some of them may stay because you may have developed a relationship with them and they are really with you because of that relationship that you've offered them in the time that they've been there.

But a lot of them, if they're there for that reason, for the cheap and the quick, they're not going to stay. So it's all about really cultivating a new clientele, just like Ron said. You just have to prepare for that and really focus on your marketing, I think.

Ron Sosa:

Yeah, and I think our clientele have told us, they want the cheap and the quick. They want to have that option. They also want to have the low volume, high touch when they want it. And I would say it is much more common. I've seen this in specialty practice and I've now seen this further and further with almost all clientele. They have multiple veterinarians they're seeing.

They're going to go down the road to the cheap and quick veterinarian for the vaccine, but you best believe they're going to come to this other veterinarian for the ear infection because they know they want that high touch quality medicine that they're looking for. But if they don't need that, they don't need to spend $200 for a rabies vaccine, they want the quick and cheap for the rabies vaccine. And that's okay. We have to be okay with that.

Dr. Lauren Smith:

And I see that a lot as a relief vet. At the higher volume practices that I work at, you get a lot more vaccine appointments, you get a lot more spays and neuters. And at the higher volume, higher expense, I mean, the higher quality, higher expense practices, people are coming in with animals that were spayed or neutered at the spay or neuter clinic or had their vaccines at the Vetco clinic, and then they're coming to you for medical issues. So maybe start not necessarily phasing out completely, but decreasing your focus on those kinds of services and increasing your focus on the actual medical cases.

Mary Schwartz:

Yeah, that's a great point, Dr. Lauren. And I think it speaks to what you were bringing up earlier, Ron, about what kind of client does your clinic want? And understanding that it's okay to let go of things like vaccinations. Let them get those wherever they think is best for them. But having a relationship that means when their pet is sick, when they need advice, when they need help, they're coming to your clinic for those things. It's hard to let those go, though.

Ron Sosa:

Yeah. The biggest example I see of that, Mary, is the pharmacy. That's a big hot topic. We're trying to compete with online pharmacies, we're trying to compete with Chewy and Amazon and all of these other big players who can buy in bulk and get cheaper prices than our clinics can. And maybe we're in a buying group or maybe we're a corporation, we're really trying hard, but it's like what's the why behind this? Why are we holding onto our pharmacy? Our clients are telling us they don't want it from us. They are crystal clear, they want to get it elsewhere, and yet we are holding on.

I've seen clinics now charging for prescription fees, and then you only can pick it up in the clinic. And we're making it harder and harder and harder for our clients to do business with us. Which, to go back to a point you talked about a little bit earlier, Mary, it was that trust. The harder I make it for that client to do business with me, the more trust I have to gather on the other end and the more trust it takes away when I make it harder for them.

And so I think we're going to have a lot less loyal clientele when we're making it harder to do business with us. And so I have been a proponent probably for the last 15 years of get rid of the pharmacy. It is such a low margin business in a veterinary practice. When you start to actually break down numbers, it makes no sense for a veterinary hospital to hold on so tightly to a pharmacy. I can't tell you one hospital that I've ever walked into that didn't have an inventory struggle of some sort, either trying to get cost down, inventory systems not working, nobody actually does the counts, or they're always off.

Inventory takes up so much time, the margins on inventory is so little, and we are holding so tight on it. Let's focus on our services, let's focus on the customer service, and then we will cultivate loyal clientele and we'll get rid of half the headache of our pharmacy because the client wants the cheaper version of whatever we're carrying. Let them have it.

Mary Schwartz:

Yeah. And sometimes that is what they need. So I saw a story a couple days ago about a client who had come into a veterinary clinic. Their cat needed antibiotics. At the veterinary clinic, the antibiotics were over a hundred dollars, to be able to prescribe them. And so the client couldn't afford that, but of course their pet still needed the medication.

So the doctor at that clinic guided that client to get that prescription and go to Walmart for it, which off the face, you're like, oh my gosh, why would you do that? But the reality is you could never capture that revenue in the clinic anyways because the client simply can't afford it. So by doing that, they're building

trust. Now that client is going to know that that doctor's going to recommend what's best for their pet and not necessarily what's best for the clinic's bottom line.

Dr. Lauren Smith:

Yeah, it shows ... Because there are four different basic aspects to trust. It's competence, reliability, integrity, and empathy. So when you show them that, you know, so many people, we get mad because people say we're all about the money. But then there are places that do that, where they insist on you getting the medicine through them, instead of doing that.

That shows the client that you have integrity, if you're willing to ship that out. That shows them that you're not just about the money, I just want your pet to get the best care. I want them to get the medicine, even if it's not through us. That shows empathy and it shows integrity, which are really the most important parts of building that trust. And you're going to get that money back through the continued business that you get with these clients, when you have built that relationship with them.

Ron Sosa:

And I'll tell you, it's also better business. So I'll give you a prime example. I have a client coming in with a dog with an ear infection. All of us going in, myself included, when I've gone to the vet for now, not being inside a hospital, I've gone to the vet, and I'm like, I have a budget in the back of my head. And I'm going to say, oh, an ear infection to me costs 200 bucks. Whatever that looks like. I have $200 I'm going to spend at the vet for an ear infection. I get the exam, I get the cytology, I get the ear cleaning, I get an answer and a diagnosis. And I can spend $200 on our high margin services that build trust and customer service, or I can skip the cytology because I need to be able to afford the two medications I'm being sent home with, the ear cleaner and the ear medication.

Now that $200 is spent, still spending $200 in my practice, but my margins from a business perspective are much lower than what I could do with just services alone and then send them out the door with the prescriptions to buy their medication elsewhere. If they want to buy it through you, great. But the psychology of that $200 in the back of my mind is spent here.

And then when I go to the pharmacy, or let's say I'm going to Chewy, I have a different budget in my head, but now that budget might be $250, but I only wanted to spend $200 at the vet. I think that's really interesting psychology of purchasing and buying that I've investigated and looked into, and I just find that super fascinating. And to me, it supports the fact of let our pharmacy go. It's not serving us the way we believe it is.

Mary Schwartz:

Yeah, I love that too because I think that we are oftentimes so divorced from the impact that finances have on clients. Obviously every time you have to go into a room with a client, give them an estimate, you're gritting your teeth a little bit, you have a little bit of anxiety to go in there.

But I mean, when we think about finances, it's the number one cause of divorce. So why wouldn't clients bring that kind of anxiety and tension and, frankly, shame? I mean, who doesn't feel shame when somebody gives you an estimate and you can't afford it? I mean, that's embarrassing. So why not remove that from the table as much as possible so that clients can have a more comfortable and safe experience?

Dr. Lauren Smith:

And not only is there the shame and the embarrassment and the guilt, like you said, but from our perspective, oftentimes when people feel that, what do they do? They try to displace that guilt or that shame and they lash back out at us. So for our own sake, that's the thing that we hate the most, that makes us so terrified. Anything we can do to help alleviate their shame and their guilt means that much less likely that they're going to turn it back on us, which is just better for our own sanity for sure.

Mary Schwartz:

Exactly. No backlash. I know that we've talked a little bit about trust, I'd like to dive into that a little more. So the Harvard Business Review, specifically, Lauren, you talked about trust in general between people. Harvard Business Review dove into trust between business and clients and the factors around that. And the factors that they identified were positive relationships, good judgment and expertise on the business's part, and consistency on the business's part. So ... Sorry, go ahead.

Dr. Lauren Smith:

Oh, yeah. So I have done some research and lecturing on trust too. I've always learned there's four different aspects of trust, but I think they're similar when you talk about good relationships, that's that integrity and empathy, which I kind of separated into two. And then you have your reliability, which is your consistency basically, and then your competence, like you said, your ability to do things.

So I kind of split that one of client relationships into two. But yeah, that's essentially what people are evaluating. Just seems like such an enigma, like such a, what is it, right? But you actually can break it down into very specific things that people are judging you on.

Mary Schwartz:

Yeah. So when it comes to these various areas of trust, especially when it comes to good judgment and expertise, I think this is a tough one, because with Dr. Google being available, sometimes clients come in and they have a great idea of what's going on with their pet, and sometimes Dr. Google has led them down the wrong path. So how can we have those discussions, in an empathetic way of course, but in a way that makes sure that we are guiding them towards the fact that the team, the doctors at the clinic do have the final kind of judgment and expertise that this client should be looking for?

Ron Sosa:

Mary, I love that you said guided them. And I think oftentimes in the vet industry, vet professionals, this is not just veterinarians, these are technicians, this is the entire hospital. We can get judgey about what the client will or will not do. But the thing is, we are not the decision makers for the clients. We're the sages, the wisdom, the education, the knowledge that is to give them, to let the client make up their mind about what they're doing.

If we have done our job well, we will get good compliance with what we want to do. And there's going to be times where we have done the best job possible of educating our clients, and they're still not going to listen to us. And that is okay. There's different levels, people have different values, they have different life experiences that are in difference with our own.

And again, we cannot be the judgey ones. We are there to give out our knowledge and to guide and lead them, but we are not the decision makers and we're not the end all be all. And I think that's where a lot of times we go wrong. We stand in this ground of, well, we know what's best. And although that might be true in an idealistic world, it's the pet owner who makes the decision. We have to respect that.

Dr. Lauren Smith:

Definitely. And the thing that I would say is so often, like you said, we need to make sure that we take a step back from being judgmental because people don't want that and they don't want to be lectured. The last thing they want to be is lectured, and they're just going to shut down if you try to do that. So I think the most important thing that you can do is actually listen to them.

And so do you mind if I ask why you have made this decision, or why you don't want to give the heartworm medicine or whatever it is, and then let them tell you what their objections are, what their concerns are. And then validate those concerns. If they're concerned about giving heartworm preventative because they don't want those chemicals in their pet's body, you can let them know I understand that it's a totally normal fear to have, and a concern to have. And I know that you've probably done a lot of reading about what these medicine, side effects of these medications. This is why. Show them that you've already considered that.

The medicine is actually only in your pet's body for about 24 hours. It's not in your pet's body for the full month. It's not like you're giving them this medicine and they're on it all of the time. It's very low doses, it's much lower dosages than what we would have to give if we had to treat your pet. So I understand your concern, it's a totally valid concern. I appreciate that you care about your pet that way. And we have already taken that into account and this is why we're making this recommendation. So let them feel heard and let them feel seen, and let them know that you have already considered the things that they're concerned about.

Mary Schwartz:

Employ those active listening skills. So what are some ways that clinics can provide consistent experiences for clients? So from the front door, from the moment they walk in, that first impression, all the way to the technical staff handles them, to the doctor, what are some great examples that you've seen about how clinics provide those consistent experiences?

Ron Sosa:

Yeah, I think a great consistency tool is wellness plans. That tells us what we're recommending at every life stage for that pet. And those can be altered based on breed or age or however the clinic looks at that from a consistency standpoint. But I feel like that is a great tool, where I get one client who walks into a clinic ,and they might get a rabies vaccine and walk out, and they'll never get recommended anything else. And then yet they walk in, they might see another doctor, and all of a sudden you're recommending a fecal and blood work and another lifestyle vaccine, which is all great recommendations, but now there's a lack of consistency about what the offerings were.

We made the client feel as if we're after their money because all of a sudden I went in for this rabies, for year after year, every three years. I've never been recommended this before, and now I'm being recommended a thousand dollars of work. Not actually, but that's how they feel. They feel like we are now price gouging them and trying to take all their money. And so I feel like a wellness plan is one of those great tools that delivers consistent recommendations to the pets for every wellness exam. That's just one example.

Mary Schwartz:

Yeah, I love that idea.

Dr. Lauren Smith:

Yeah, I think that those standing operating procedures are important, and training of your staff is important to make sure that everyone's all on the same page and making sure that clients are hearing those recommendations multiple times. The clinics that I go to where that general wellness blood work is being recommended by the technician before I even go in, they have much higher rates of clients agreeing to it because when they hear it multiple times from multiple people, it reinforces that this is something that's important.

Mary Schwartz:

Yeah, that's a great point. On average, people have to hear something seven times before they're bought into doing it. So one of the things that I like to point out, especially with that senior blood work example, is that that should be talked about from the beginning of that animal's life. So if you're seeing them as a kitten, you're talking about hey, here are the life stages of your pet. Here's what we're going to recommend during these different life stages, and just reinforce that message.

And by the time that pet reaches age seven, guess what, you've mentioned it seven times, they know what to expect. And as we talked about earlier, that expectation is set so when they come in for that visit, they're not surprised by the recommendation. They don't feel taken aback by it. They're ready for it.

Ron Sosa:

Yeah, I would say there's also making sure that you have standards of care in your hospital. And I'm not talking about let's make cookie cutter medicine. That's not what we're after. But what we can do is start to define how do we look at kidney disease in a dog, or whatever the most common diagnoses are in your practice. What is the first recommendation of blood work? It's not the only recommendation, but at our clinic, what is our first recommendation of blood work? And let the client decide if they want to go higher or lower.

But we should have a consistency of what do we recommend first? The same thing with surgery. Are we a clinic that does pre-anesthetic blood work? And if so, we need to be consistent about making sure that it is talked about every single pre-surgical procedure. Are we a clinic that does it a week before or are we a clinic that does it the day of?

We're not, again, not doing cookie cutter medicine because that blood work might look different from one pet to another. But the consistency of the recommendation, that you need to have blood work done prior to the procedure, and when do we do it? Is it a week before or is it the day of? What does that look like?

And so I think medical standards of care are really, really important for the consistency of the client experience so that the entire team, to Dr. Lauren's point, can make the recommendation because that is exactly what the doctor's going to say, is the blood work. They may not know what panel, but they can say the doctor's going to come in and recommend blood work based on the parameters of your pets during the exam.

And then now they're already primed and ready to go for that doctor to come in and say, "Okay, we're going to do blood work and I'm going to have this, this and this." And they've already got an estimate ready to go. So I think that there's efficiency that can be had and there's consistency, and then the client doesn't feel like one veterinarian is trying to take their money while someone else is not. There's just a consistency of care.

Dr. Lauren Smith:

I really like that you had mentioned set the standard and then the client can decide if they want to go higher or lower. So many times we set minimum standards of care, and if the client can't do that one thing, then it's like all or nothing. So if we have them on carprofen, their pet is on carprofen for arthritis, and we want a full [inaudible 00:34:30] CBC every year and that's our recommendation for monitoring every six months, and they come in and they're like, "I can't afford that blood test," then do you just say, "No, you can't go on the carprofen anymore?" Or do you say, "Okay, well it's a little bit less ideal, there are some things we're going to be missing, but we can do just this abbreviated renal chemistry instead."

So making sure that while it's important to have standards of care, I think that sometimes setting that as a minimum standard of care really does our clients a disservice when it comes to continuum, like spectrum of care, and making sure that we have that available for our clients as well. So standards are important, but also we can, if that's not available to a client, have other things that we can offer them as well.

Mary Schwartz:

Yeah, I love that point. I think it's great to be able to offer those alternative solutions that are maybe less expensive, but still take in mind the care of the pet. Because obviously if you have an old arthritic dog, you're not going to say, "Don't give it carprofen anymore because I couldn't get a liver panel on it this month." I mean, that's ridiculous.

But I think on the flip side of the coin, you could easily see a client say, "Well, why wouldn't you just offer me the lesser panel to begin with?" So I think it's important to empower our teams to educate clients. I think that's probably one of the biggest issues that we see today, is that we're not educating clients as to which care is appropriate when, and as you said, Lauren, about saying, "Hey, this might not be ideal, but let's get the minimum viable blood panel we can to make sure your pet is safe."

So what can teams do? What can leaders in practices do to structure client education so that it doesn't just feel like, hey, they only offered me the more expensive thing to get my money and now they're offering me a cheaper thing to get any of my money.

Dr. Lauren Smith:

Yeah, I think it's important to talk to them, this is the recommendation we're making and these are the risks. I had, I was at I believe it was a hairdresser, of course you know how people love to when they find out you're a veterinarian, just tell ... And so I had this one person who was doing my hair and they were telling me about their cat who had some kidney thing going on. And I don't even know what it was.

And they're like, "Well, they wanted me to spend $1,500 to hospitalize the pet and we didn't do that and we just gave them these fluids under the skin and the cat was fine. And so they were just trying to rip me off." And I was like, "Well okay, that's not how that works at all." So it's important to let people know, when I have these clients who can't afford hospitalization for, say, their kidney cat, I'll be like, "Okay, that's going to give your cat the best opportunity to improve, but if that doesn't work, we can try this. But hospitalization may offer your cat an 80% chance of being stabilized. Obviously long-term prognosis is not necessarily going to be there, but the short-term prognosis, you may have an 80% chance of stabilizing your cat. Whereas if we do these fluids, it's a 50% chance."

So giving them some numbers or some kind of idea of these are the risks we're taking, it still may work out. I'm not saying that it's not going to work out, but being specific about what you're trading off and why that is, is really helpful. So people know, okay, this is why it was okay anyway, instead of just then picking the lower thing, the cat being okay, and them thinking that you were trying to rip them off.

Mary Schwartz:

Right. There's no correlation between something maybe being a 50/50 chance, which is still a pretty good chance, versus an 80% chance.

Ron Sosa:

Yeah, I agree. I think that my foundational piece is always go, what is our medical standard of care? And to Dr. Lauren's point, this is not the minimum where if you don't do this thing, we are stopping and we're not going to do anything moving forward. This is what do we offer first? And then have everyone on the team know what does that offering look like? What is that blood panel measuring? They should know the ins and outs of that blood panel so that when a client says, "I don't understand why you need this," giant like 27 panel versus the 15 panel, they can talk to, oh, well it has these extra things and this is what it measures and this is why we need it for your particular pet scenario.

And the entire team can be engaged in educational conversation so that we have that competence, as you guys spoke to earlier, for the trust, that if I look like, oh, I don't know, let me go talk to the doctor, and I have to keep coming back in and out of the exam room to educate you, there's a lack of trust that they have about what that person's going to be talking to them.

And so educating the team is like number one, but I feel like you've got to have the foundational pieces of creating what it is, the experience you're going to create for those maybe the top 10 diagnoses you see in your practice. And then start there as a foundational piece, or maybe the top three, thyroid disease, heart disease, kidney, whatever that may be in your practice, start with those, really thoroughly educate your team, because that education will start to bleed into some of the other standards that you will build into your practice. Because the blood panels are similar.

There's just a lot of education that goes in that they can be empowered to help the veterinarian not be the sole person of all the education and doing the exam and leveraging our technicians because they have told us they want to be leveraged, they want to educate our clients, they want to feel highly valued in our practices. And why not give them the tools to be able to do that? And it's a win-win for the clients, as well as the patients and the business itself.

Mary Schwartz:

Yeah, absolutely. And to your point, from the client perspective, if I have someone who has to run in and out of the room to ask the doctor every single little question, I'm going to feel a lot less comfortable when they say, "Hey, let me take your pet in the back to get vitals," than I am if I feel like that person is competent and understands what they're, they're practicing what they preach, essentially.

I also would love to call out the idea you had about going ahead and getting those top couple diagnosis codes. Easy to run a report in your practice management software, get those couple of diagnosis codes and start bite-sized, right? Don't think of it as a whole picture yet. Just take those top three, like you said, and create what the doctors would love for the recommendations to be around that. And then have team education around how to pitch those recommendations, what the key points around those recommendations are, and then pilot that, workshop it, see where the weaknesses and strengths are, and then modify it and continue adding more and more diagnoses into that.

Ron Sosa:

Yeah, I would say we did that in our practice as we started at the veterinarian level. What do you do for kidney disease and why? And tell us all the things that you would recommend in an ideal world, and then tell us where you feel uncomfortable if a client doesn't do the thing. And so that gave us the maximum, the minimum, and then it allowed us to come together as a group later on, as we took everybody's responses in, to go, this is what we thought of as a plan, as our practice. That's what my medical director did, with help for me from the business side, to try and get better pricing on the blood panels or to get better pricing on certain products.

Then we can come together and develop a first recommendation. I hate calling it standard of care, to Lauren's point, that is not my minimum, that I'm not going to do anything. This is my first recommendation. And that's what it looks like in our practice. And so I think it's really, really important to do that.

Mary Schwartz:

Great. It has been wonderful to have both of you on today. Thanks so much for joining me for this important topic, and I look forward to chatting with both of you in the future.

Ron Sosa:

Thank you so much.

Dr. Lauren Smith:

Yeah, thanks for having us.

Mary Schwartz:

I'd like to thank Ron and Lauren for being our guests on today's episode, as well as you, our listeners. We appreciate your support and hope you'll subscribe to our podcast, Simple, Interrupted on your favorite podcast app, and share it with your fellow veterinary colleagues. This has been a co-production of Evergreen Podcasts and PetDesk. Learn more about PetDesk and how we are helping clinics guide their clients to better care at petdesk.com.

A special thanks to the PetDesk team and to all of the veterinary professionals out there. Thank you for all that you do for our pets. As well as our Evergreen production team, producers Leah [inaudible 00:43:06] and [inaudible 00:43:07] and audio engineer Grace Sienna Longfellow. I'm your host, Mary Schwartz. Thanks for listening.

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