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Tag: Clients

How to handle a disgruntled client
When the unexpected occurs and patients come through our emergency clinic doors, we will often face times when owners become very difficult to deal with. Understanding where they are coming from may help diffuse the situation, but not unless you have good communication skills.

It’s very a very natural response to become defensive when someone acts aggressively and when you feel threatened, but unfortunately this reaction is counterproductive.

You want to be able to treat their pet and help them, but instead your focus can shift to needing to defend yourself and calm them down.

However, the last thing you want to do is advise your client to “calm down”.

Understand the client

Being able to recognise the five stages of grief can help us understand and deal with the situation more effectively. These are:
- denial
- anger
- bargaining
- depression
- acceptance
Unfortunately, more often than not, it’s nurses and receptionists on the front line who often bear the brunt of this, and it is our job as vets to help them through this process. We need to remind ourselves not to take things personally, as these owners are upset only at the situation and circumstances, not at us.

We need to remain calm at all times and reassure the owners we are here to help them. Owners’ frustration often stems from helplessness and guilt – we all know situations involving much-loved pets can often be driven by anxiety and are highly emotive.

Other times it is because they feel their concerns have not been heard. If you suspect this, you can ask them specifically what they want from us and you’d be surprised how quickly the situation can be resolved once an understanding is reached.

Listen to the client

The Kübler-Ross model, or the five stages of grief, postulates a series of emotions experienced by those experiencing any form of personal loss. IMAGE: raywoo / Fotolia.

It is important to listen without judgement or interruption – although we all know that’s easier said than done.

Showing genuine empathy and acknowledging clients’ emotions and concerns can help you quickly build trust with owners. Even if you don’t know all the answers, let them know you are there for the same reason – you both want to help their pet.

As some of you may have experienced, the most emotional owners can often turn out to be some of a vet’s best clients.

Saying that, if you ever feel you are in danger, or that you are unsure of how to handle a situation, always consult with a more experienced colleague or speak with the vet in charge of the case.

It may be advisable to have a practised line of communication, which shows compassion and understanding but removes you from the situation, where you can get additional support or help.

I see every day our veterinary nurses wear their hearts on their sleeves, and difficult clients can sometimes really hurt them. With this in mind, it is important a nurse can have some breathing time and regroup ready for the next client.

We know nurses want nothing more than the best for the pets in their care. Each case will be different, each client will respond differently, so, like we say in emergency, you have to expect the unexpected.

One thing we do know – your veterinarian will never question a nurse’s compassion. When it comes to client communication and pet care, we will always be a team looking out for one another.
May 16, 2022
VN tips: client communication
While we know nurses join the veterinary profession for their love of animals, there is so much more to their job description. Veterinary nurses wear many hats covering so many important roles within the clinic.

As with veterinarians, client communication is a vital component of their job and can often be one of the most challenging.

Conveying compassion

Client communication is a vital component of a veterinary nurse’s job.

One thing I have learned to appreciate about nurses is their endless supply of compassion for their patients. Having the ability to convey this compassion to an owner is a sure-fire way to develop a positive relationship, which is the veterinary dream.

Admitting a beloved pet to hospital can be a stressful time for owners. They don’t understand what happens behind the scenes, they just know their pride-and-joy is disappearing into the unknown with someone they have likely never met.

Owners have a tendency to ask nurses questions they were either too shy to ask the vet, or too overwhelmed to remember to ask during their consultation, so I decided to ask the nurses at Animal Emergency Service how they reassure our clients during the admission process.

Offering reassurance

Here are some tips our nurses find useful when dealing with clients:
- Introduce yourself and let them know their pet is in exceptional hands.
- Know the pet’s name and why it is at the hospital.
- Understand the procedures their pet is undergoing while in your care.
- Let them know they are welcome to call and you will be happy to inform them how their pet is getting on while in hospital.
- Never tell them everything will be fine. You can never be sure with medical procedures, but reassure them they are in the best hands possible – their pet is being treated as if it was your own pet in hospital.
- Make them feel their pet is special. Most clients are under the impression their pet is the only patient in the hospital and is essentially the most important pet you’re dealing with that day.
Let owners know their furry friend is comfortable and relaxed in hospital, and receiving an abundance of love. Happy patients make for happy clients and if anyone can reassure an owner his or her pet is receiving the love it deserves, it’s a warm-hearted nurse – just another reason nurses are known as the hearts of our clinics.
May 9, 2022
Social media, pt 4 – content creation

Goals, targeting and platform are really important, but the most important aspect is, of course, content – what will you actually say and will your audience see it?

Generating content can be really time-consuming, but one thing I’ve learned is I tend to overthink it – a simple image or short video can really speak to people; it doesn’t always have to be profound or polished.

However, a plan needs to be in place to make it work. Think about who will create your posts – internal staff or external, and if external, how well do they know your business? Most posts should have an action you want people to take, so make it really clear if it’s a click, sign-up or watch. Plus, think about who will schedule it and who will monitor it.

Mix it up

At our hospital, we try to be consistent and post three times a week on the same days and times – although when we started, we did experiment with different days and times to see where we got the most engagement from our audience.

We find what works best is cute, informative and surgical (or gory) posts. However, no winning formula exists – expecting something to go viral is almost a guarantee it will not. The best advice is you have to mix it up, try new things and see what works best, but don’t stop experimenting and learning.

Permission to post

The most important aspect in a veterinary practice, if you are showcasing pets, is consent – always ask permission before posting. It is one of our key policies and we have a robust process, using consent forms and telephone calls, to ensure clients are happy with us telling their story.

For us, in emergency, this is essential as we deal with some of the sickest of sick pets. With this in mind, we tend to wait until they have been discharged from our care for a number of weeks and follow up with a call to see how the patient is before we consider releasing videos or case studies.

Make sure they also know the posts are for the purpose of education and prevention.

Make sure you are prepared to respond to questions and comments.

Back and forth

Always remember, too, that social media is a two-way street. When you open yourself up on social media, be prepared for questions, comments and reviews that come your way.

Set aside time – and have a policy in place – for answering and responding. This is especially true for the negative ones, which, inevitably, despite best intentions, every practice will get.

Done well, and with the right time, team and money invested, social media in the veterinary industry is a brilliant way to showcase the fascinating, inspiring, sometimes strange and utterly rewarding work we do each and every day.

April 27, 2022
Social media, pt3 – choosing the right platform
Understanding which social media platform will work for your practice really depends on your key audience and the type of content you want to share.

Loads of social media platforms exist and I sometimes find I’ve just got the hang of one, only to be encouraged to try a new one. It’s easy to get caught up in the next big thing, but considering we also need to do our demanding jobs, it is important we get it right and don’t waste our time.

Each channel is different, so should be used in different ways. My advice is keep it simple and master a few channels, rather than doing most of them.

Choosing and using the right platform

To help find the best social media platform for you, start by asking yourself these four simple questions:

Why?

It is important to ask what the overall motivation is. Each platform has its preferred type of audience and style; therefore, look at what you want to achieve and go with the platform that can offer the best return.

Do you want to increase traffic to your website, increase search engine optimisation (SEO), create a community with clients, or reach new people? Once you know your social media goals, the platform you should be using will become obvious.

Also, give each platform time. They take time to grow – especially organically.

Which?

“Facebook is by far the largest social media platform and is great for reaching the pet and veterinary communities,” says Gerardo.

Research each platform to identify which one offers the biggest audience reach, how easy is it to reach them and what style – photos, text, video or blogs, for example – works best.

Facebook is by far the largest and great for reaching the pet and veterinary communities. Plus, content remains on there – like a mini website – for years. Other channels such as Instagram, Google+ and Twitter have a quicker and more visual approach, but content gets old very quick. Google+ and Twitter are also good for improving SEO, so they are worth considering for your strategy.

LinkedIn is tailored more to business-to-business, Tumblr for blogging and Reddit as a discussion forum. If you want to engage with a younger demographic then Snapchat and Instagram are best, while Pinterest has more female users.

We have found it is better to focus on a couple of platforms with equal benefits on engaging with our audience, reaching local pet owners, and increasing web traffic and enquiries.

When?

Think about when you will be posting. Look at each platform to see when people are online – before work? After work? At lunch?

If you find your audience is online outside of work hours then, to take the stress out of it, go for platforms with a simple scheduling tool, such as Facebook, so you can schedule posts in advance – saving you having to think about things each day.

Only commit to what you can – a post every day may sound good, but in reality, it may be a stretch too far. Do two or three posts a week to begin with and alternate days on each channel. That way, you will have content live on most days of the week.

Also, it is important to think about how many users will have access to each platform, how will you monitor who is responsible for what, and who will be responding to comments and messages.

How?

Focus your time. It is worth investing a little time to understand what the platform can really offer – if you can, watch tutorials, read blogs or ask an expert.

With Facebook, once I really looked at what it could do versus what we were doing, I found we were not taking advantage of its full potential.

Most social platforms are constantly updating and evolving what they offer, so keep up to date and make sure you get the most out of them.

Also, if you find one platform isn’t working out, don’t be afraid to close the account.
- Next week, we will be looking at the all-important content and how to get it right.
April 25, 2022
Social media – getting your practice online
For the next month, I want to move away from the clinical and medical aspects, and focus on some other demands and challenges part of everyday veterinary life. So, over the next four weeks, I will look at the main considerations when planning social media campaigns for your veterinary practice.

As a director of a number of emergency animal hospitals, it is also part of my role to produce content, develop a strategy and oversee our social media presence.

Of course, I am not solely responsible. I am lucky to have a great team surrounding me, which is crucial in making social media work in your practice – it has to be a team effort with everyone understanding, and sticking to, the agreed rules, strategy and objectives.

If I am honest, I was unsure about our hospitals – and me, personally – venturing out on social media; however, after a couple of years, it had proved both rewarding and essential in raising awareness of our work and profession, and in connecting with our clients and pet-loving public.

In this four-part series, I will look at four key aspects in making social media work for your practice. The first aspect is goals, or motivation for getting your practice online socially.

Goals and objectives

Firstly, the whole practice must agree and commit to a set of shared goals and objectives, and all be on the same page when it comes to what they want to achieve and how to go about it.

Without a plan or strategy in place, no direction, teamwork or accountability exists. Plus, it is hard to know you have been successful, if the practice hasn’t agreed what successful means to them.

Secondly, for the most part – although it is nice to get a little fame and recognition – the main motivation for any vet practice when sharing what they do socially is that it comes from a place of training and education. We all want to educate pet owners in preventive measures and help them keep their pets safe and healthy.

I also find in the veterinary industry, misinformation and misconceptions can exist about the work vets actually do, so this is our chance to show and educate people what it is really like behind the scenes, by showing real life stories and cases – even the tough ones. This has been a favourite aspect of mine – I love being able to share what we do behind the scenes, and the reaction has been incredible.

Thirdly, in a veterinary practice, social media offers a unique opportunity to strengthen and enhance the client bond, and be a constant source of accurate and important pet health information. Being able to have that two-way street with our clients is also essential for us to continually improve and learn.

Public awareness

Emergency practices don’t have clients as such; they only need us when their pet is in a critical state. So, what we want is for the public to know our name, what we do and, most importantly, where we are in case, one day, they need us.

Social media has been integral in allowing us to reach and engage with people before they actually need us.
- Next week, Gerardo will be looking at targeting and its importance in creating return on investment on your social media efforts.
April 11, 2022
‘Long COVID’ within the veterinary industry

Despite that all COVID-19 restrictions are due to be removed as early as the end of the month, the long-term impacts of this pandemic have yet to ease and will likely be sending ripples through many professions for the foreseeable future.

The virus has already left lasting changes to the landscape of the veterinary industry – not only in how it operates, but in how new professionals are taught from the ground up. Long gone are the days of packed-out waiting rooms and lecture theatres.

The more things change

Even with restrictions out of the way, it’s thought that measures put in place over the past two years to reduce viral transmission in our practices may remain the “new normal”, with clients asked to wait outside until necessary, and often with only a single owner asked to come in with their pet at any one time.

Several vet schools now operate under the banner of “blended learning”, whereby the curriculum is taught in a mixture of face-to-face content, live and online lectures, alongside pre-recorded, virtually accessible resources.

In the face of recurrent industrial action – coupled with the rising, desperate demand for new veterinary professionals – online teaching may offer a convenient, long-term solution.

Fallen behind

As with all change, there are pros and cons, although one area I think is yet to be fully addressed is the issue of EMS backlogs.

There are current backlogs in the NHS, the postal system and in many other major industries throughout the country, and I don’t believe the veterinary student training system has escaped unaffected.

Car park consults may remain the “new normal” for some practices. Image © Eva / Adobe Stock

Exaggerating social inequity

For a good 12 to 18 months, many practices – especially small independents – were forced to shut their doors to both pre-clinical and clinical placements – and although EMS requirements were lowered for all year groups due to graduate by 2023, every succeeding year must complete the formerly required 26 weeks.

This has led to an overwhelmingly large number of students competing for a progressively smaller number of placement opportunities.

This makes it particularly difficult for students who lack their own transport, or the funds to travel far from their university or hometown, meaning there may be growing social inequity in the variety and quality of experience vet students are able to obtain.

Better the devil you know

Not only this, but large veterinary conglomerates may have the infrastructure to accommodate larger numbers of students, and new graduates may want to “stick with what they know” and, therefore, be less likely to consider signing contracts with smaller, independent practices.

There is also the argument that, with the rise of online teaching and decrease in student-lecturer contact, work experience has never been such a valuable tool in supplementing a student’s learning.

With the demand for placements higher than ever before, and veterinary practices sometimes two or three times busier than before the pandemic, the financial cost of EMS for some students has never been greater.

Essential experiences

Confidence, satisfaction and a balanced education behind all new graduates serves the interest of both individual professionals, and the profession as a whole.

In my opinion, there has never been a greater need for a review of the need for higher education funding for veterinary students, to allow every student access to a large variety of work experience and the opportunity to see what different avenues are available to them after graduation.

February 16, 2022
Euthanasia (part 2): caring for the patient

Last month we discussed the importance of caring for clients during the process of euthanising their much-loved pet. This month, we focus on your patient.

The goals of euthanasia are always to make it as painless, fearless and stress-free as possible for the patient.

Pain relief

Most patients presented for euthanasia are either suffering from chronic, terminal or traumatic disease.

The first thing I like to do is ensure the patient’s pain is managed. This usually means providing opioid pain relief. Methadone is my opioid of choice. Butorphanol provides minimal pain relief, but is excellent for mild sedation.

Next, if your patient is in shock, you need to try to alleviate some of it through IV fluid resuscitation. This is important as poor circulation will slow the process when you administer the euthanasia solution.

Calm and stress-free

One of the most important goals in the euthanasia process is to have the patient as calm and stress-free as possible.

If the patient is stressed or anxious, some sedation may be required. Diazepam or acepromazine are good choices, depending on the condition of the patient, of course, and, together with the opioid you have administered already for pain relief, will help calm the patient. Try to avoid using medetomidine as a sedative in all but the most fractious of patients, as it causes peripheral vasoconstriction that will make IV catheter placement difficult.

The aim of sedation is to relax your patient as much as possible without rendering them unresponsive to owners when it is time to say goodbye. This can be tricky as every patient responds differently to sedation, so you must make a point of warning owners the sedation may make their pets very sleepy.

IV catheter

Where possible, I avoid performing euthanasia without first placing an IV catheter. It makes the delivery of the euthanasia so much smoother. Including an extension to the administration line also allows you to stand a little away from the patient and their owners to give them a little privacy while you administer the euthanasia solution.

Once your patient is sedated and an IV catheter placed, I set up comfortable bedding in the room where I will perform the euthanasia and bring the patient to the room. The amount of euthanasia solution I have with me always exceeds how much I think I will need; the last thing I want is to have to leave the owner and patient to get more euthanasia solution.

Once I have administered the euthanasia solution, I check the heart and once that stops completely, I then tell the owners their pet’s heart has stopped, which they understand as their pet has passed.

Performing euthanasias is the one of the hardest parts of our job, but also a privilege we hold as vets, so I hope my tips will help make the process easier for you, your client and, most importantly, your patient.

February 8, 2022
Euthanasia (part 1): caring for the client
Euthanasia is a big part of our work as veterinarians. Working in an emergency setting, it is something I have to face on every shift.

It doesn’t get any easier no matter how many times I have to do it, but I have fine-tuned my approach over the years so each euthanasia process runs as smoothly as possible, with minimal additional stress to both patient and client.

This month, I will talk about taking care of your client.

Communication is key

Euthanasia is a big part of our work as veterinarians.

The most important aspect of taking care of your client in this difficult time is to make sure you really focus on communicating clearly, effectively and, most importantly, with sincere empathy.

First, I listen to their concerns, and why they have made the difficult decision to euthanise their pet.

Quality of life decisions can be a very grey area, and sometimes what you think may be manageable as a veterinarian can be a huge quality of life concern for a pet owner.

A prime example is osteoarthritis in older dogs. You may assess them as being clinically well except for some difficulty walking, but the client sees their pet every day and notices the struggles they go through.

Euthanasia is a difficult conclusion for them to come to and, in most instances, I will defer to the client when it comes to assessing the quality of life of their pet.

Quality assessment

One way I help clients assess their pet’s quality of life is by asking them about a few aspects of it, including:
- Can your pet do the things that make them happy?
- Do they spend more days sad, depressed and ill compared to the number of days they are bright, happy and eating?
- Is your pet in pain? Is this pain manageable?
Confirmation

Once a client has expressed they want to euthanise their pet, I always try to confirm three things:
1. That they have actually decided to euthanise their pet. I frame the question like: “So, my understanding from our conversation is that you have made the decision to euthanise Fluffy today?” Sometimes, when you ask this question, the client reveals they have not actually come to that decision yet, which means you will need to backtrack a little and guide them through the decision process again.
2. Whether they would like to be present for the euthanasia.
3. How they would like us to handle the after care.
I also always try to manage all documentation and finances before the euthanasia so the clients will be in a position to leave immediately after the procedure, meaning they can begin to grieve rather than have to do paperwork. The only exception to this is when the patient is in a critical condition, meaning euthanasia cannot wait.

Explaining the process

Try not to perform the euthanasia in your consult room or in the main treatment areas – if you have a private room for euthanasias, that is the most ideal. This is important especially if the client comes back in the future with another pet or a new pet. They often find it difficult to walk into your consult room and be reminded of the euthanasia of their beloved pet.

I like to give clients some time to spend alone with their pet to say their goodbyes in private. When I come back into the room, I start by explaining the process of the euthanasia, covering the following things every single time:
- Euthanasia is an overdose of an anaesthetic agent
- The process is quick – 10 to 20 seconds
- It is completely painless
- The pet doesn’t close their eyes afterwards
- The pet can have a couple deep breaths and muscle tremors
- The pet can release their bowels and bladder (especially important to warn of this if the clients want to hold their pet)
- Lastly, if their pet came into the hospital in shock and obtunded, where I have fluid resuscitated them, meaning they are now more bright and alert, I warn the clients that despite their pet looking better, the underlying disease remains the same.
Once the euthanasia is performed, I again ask if the client wants to spend a little more time in private with their pet. Finally, when the client leaves, they typically will say “thank you”.

Whatever you do, do not say something like “my pleasure” or “you’re welcome” like you would for a vaccination consult – this is a natural response, but would be a terrible faux pas. I simply say “I’m very sorry for your loss. Take care for now and let us know if we can help in any way”.

Next month, I will talk about taking care of your patient throughout the euthanasia process.
- Gerardo Poli is the author of The MiniVet Guide to Companion Animal Medicine – now available in the UK.
February 1, 2022
When emotions run high
Vets have to handle a variety of difficult situations, from delivering bad news to addressing financial difficulties. But when it comes to tackling client grief, awkwardness or anger, it’s a bit like that old children’s book, We’re Going on a Bear Hunt – we can’t go over, under or around it – we’ve got to go through it!

I recently had a three-hour communications practical, during which my fellow students and I were tossed into a randomly selected clinical scenario designed to help us deal with uncomfortable areas of future practice. These included such topics as:
- discussing the needs for euthanasia
- apologising for clinical mistakes
- reasoning with angry farmers when their herds came back TB-positive
Role play

We’re Going on a Bear Hunt, written by Michael Rosen and illustrated by Helen Oxenbury, is available from Amazon.co.uk and other booksellers.

All scenarios were conducted with real actors portraying the clients – and although we’d been given a list of topics to revise if we wanted – any revision turned out to be next to useless as the exercise was less about what you knew, and more about how you dealt with people.

Personally, I find this type of practical as rewarding – if not more so – than our clinical skills work. We have countless opportunities to practise suturing, spaying and catheterising in the labs at school, and in final-year rotations, but dealing with the raw side of client communications is the one thing we never actually get to experience until we’re suddenly in the driver’s seat.

It’s completely understandable – nobody wants a student present at their most vulnerable moments. If my own pet was being put down, I’d want the comfort of an experienced vet doing the job and walking me through it from start to finish.

Learning experiences

That’s why I think communication practicals are so incredibly useful, and it’s a real shame that I’ve only had three in my course so far. It can be difficult to learn from and build upon experiences spaced years apart from one another, and I feel incredibly sorry for the year before me (while I was intercalating) who had to do their scenarios over Zoom.

One of the most valuable lessons that these practicals have taught me, is not to be afraid of emotion.

It can be difficult – especially when a very valid defence mechanism for many medical professionals is to distance yourself from it at all costs – but there are moments when all is required of you is simply to be there, to listen and understand.

Just be there

There’s no textbook in the world that can teach you that. When a client (or an actor pretending to be a client) is crying in front of you, you want to fix their grief because fixing things is, quite literally, your profession.

Your instinct is to talk and fill the silence, but instead, you need to wait for them to process the moment and then be there to answer their questions.

Some things you can’t fix and you can’t work around – you just have to go through them.
January 19, 2022
Temporary catheters in obstructed FLUTDs: buying time with a blocked cat
Obstructive feline lower urinary tract disease (FLUTD) is a common presentation in both general practice and emergency settings.

Every clinician has his or her own approach to treating and managing a cat with obstructive FLUTD signs. Working in an emergency setting, once I have confirmed an obstructed bladder via palpation, I focus on trying to relieve the obstruction as quickly as possible.

The first step is obtaining consent from the client to administer pain relief (an opioid IV or IM), place an IV catheter, collect blood for biochemistry, electrolyte and blood gas analysis, and temporarily relieve the obstruction.

At our hospital, we achieve temporary relief of the obstruction generally within 15 minutes of patient arrival.

Process

Obstructive feline lower urinary tract disease is a common presentation in general practice.

We do this in three steps:
1. Assess the tip of the penis, occasionally a crystal/mucus plug is all that is blocking the penis.
2. If this is not the case, I pass a pre-lubricated 22g IV catheter tip (without the stylet) into the penis with a 10ml syringe, containing 0.9% NaCl, connected for hydropropulsion. In the vast majority of cases, this helps to dislodge the urethral blockage enough to enable some urine to pass (urination suggests active urination by the cat).
3. Once urine is flowing, I pass a 12cm or 14cm rigid catheter, tape it to the tail and leave it in place to allow constant drainage.
If the 22g IV catheter does not relieve the obstruction, I would use a rigid catheter and progressively advance it up the urethra while hydropropulsing with the saline the entire time. Once unblocked, then I will tape it to the tail as aforementioned.

Quick Tip: Once you have the catheter in the tip of the penis, pull the prepuce straight out to straighten the penis and thus the penile urethra. Otherwise, the bend in the penile urethra may hinder the passage of the catheter.

Benefits

The benefits I see of placing a temporary urinary catheter include:
- immediate relief to the patient and reduces their stress levels
- provides a sample for urinalysis
- allows you time to run through the diagnostic and treatment plan in more detail with clients
- buys you time to stabilise the patient for their anaesthetic later to place a closed system indwelling urinary catheter and then bladder lavage
Quite often, your patient would present unwell enough that you should have no issues (resistance to) passing this temporary urinary catheter, provided you have given pain relief on presentation.

In fractious patients, I usually forgo the temporary catheter and focus on stabilising the patient. The aim is to have them stable as soon as possible for sedation or a general anaesthesia to place a longer indwelling urinary catheter.
November 1, 2021