Clients might seek a second, third, and fourth opinion until someone tells them their dog’s comminuted tibia fracture will heal without surgery.Photo courtesy Phil Zeltzman You chose the correct workup. You determined the proper diagnosis. You laid out the treatment plan. Yet, your client declined to move forward. How could they do that to you? Of course, the decision is rarely personal. And despite what we often tell ourselves, it’s not necessarily because of the cost. One of the (ever-so-few!) frustrations of our profession is when a client opts to forgo treatment even though you believe in your soul moving forward is the right thing to do. Let’s go over 10 common reasons clients decline treatment and what you can do to avoid that. Money Finances often dictate what people do, and pet care is no different. Most clients aren’t aware of the average annual cost to care for a healthy dog or cat, let alone when a pet needs medical, surgical, or dental treatment. One way to help avoid this sticker shock is to discuss pet insurance early on, say during a puppy or kitten visit. As long as the client chooses the right insurer and the right plan, and as long as the company doesn’t find a sneaky way to decline coverage, pet insurance saves lives. Presentation (1) You’ve just handed a treatment plan to a client for a surgical procedure. Their eyes immediately go to the bottom right of the page, honing in on the grand total. They completely skip over what is included in the treatment plan. Then they look back up at you a little paler and mumble, “Let me think about it.” Did you take the time to thoroughly explain what was included? Or did you—or your team member (nurse, assistant, receptionist)—just hand them the paperwork and wait for their decision? Clients rarely pay for things that don’t seem worthwhile. They cannot see value in a line item unless they know what it’s for, why it’s been recommended, and how it will help their pet. Taking the time to explain the process step-by-step helps them visualize the procedure and understand that every part is integral to their pet’s care. Lack of buy-in can also come from your staff. Clients often ask a trusted team member privately what they think about the proposed treatment. How they respond can make a dramatic difference regarding the clients’ decision. Lack of information Simply telling clients their pets need a surgical or dental procedure isn’t enough. It is critical they understand the reasons for the recommendation, as well as the benefits and risks of the treatment options. Granted, some clients may require hearing or reading more information than others. They need to appreciate not only why you are recommending the procedure, but what it means for their pet’s health. What is the typical outcome? What is the success rate? That said, don’t give them too many options, as it might lead to analysis paralysis and an absence of a decision. Always offer the best option for this particular patient, regardless of what you think the client can afford. If you can clearly demonstrate the value in your recommendation, the client is much more likely to elect a service or procedure. This is no different than when you go to the spa, pay for an upgrade, or buy organic. It’s all about value. Presentation (2) Buddy, the Labrador, presented with a six-month history of lameness on the right hind leg. The exam reveals a full drawer sign, muscle atrophy, and obvious pain upon manipulation of the stifle. There is no question the patient has a complete tear of the anterior cruciate ligament (ACL). Compare these three presentations: “Yeah, you might want to consider getting this ACL taken care of at some point.” (This is an actual quote from a seasoned colleague). “If these pills and a bit of rest don’t help, let’s discuss other options.” “Buddy needs a TPLO. This is the only way he’s going to be comfortable and functional again.” The way the doctor positions the treatment plan is instrumental in the client’s decision. If your presentation is wishy-washy, the client will always follow the path of least resistance, as well as the least expensive route. However, if you are confident in your diagnosis and your recommendation, patients will most likely receive the treatment they need and deserve. “It’s just a dog” Despite our core belief, some clients simply do not view pets as family members. No matter your efforts, they may never view your recommendations as worthwhile because they will not spend that much on a barn cat or a yard dog. It never hurts to try, though. Educate them as you would any other client. You never know when you might turn someone around and get them to do what is best for their pet. Fear Fear of the unknown. Fear of side effects. Fear of complications. Fear of anesthesia. Fear of surgery. Fear of death. Fear of what the breeder, Dr. Google, or the neighbor said. If your client is not made aware of the possible complications in an objective manner, their imagination is free to roam. The best way to fight fear is education. Be honest about the pros and the cons of any proposed recommendation. Never brush off a client’s concern. Quantify the risks—don’t sugarcoat them. Provide them with information, facts, statistics, personal experiences, and success stories of patients you’ve treated. Walk them through what is actually going to happen to their pet, step-by-step. Let them know how often you’ve performed the procedure and how safe it is. Show them their pet is truly in the best hands. And demonstrate that not providing treatment will cause more long-term harm than the recommended procedure. Trust Trust is the currency of veterinary medicine. A client is far less likely to agree to treatment if they don’t trust you. Would you do everything your car mechanic recommends if you didn’t trust him? What about your physician? Your hairdresser? In addition to trusting you, clients need to trust your team. No matter how introverted you are, it is critical to build rapport, one client at a time. Prove to them you genuinely have their pet’s best interest at heart. A client willing to trust is a client willing to treat. Time Some clients won’t commit to a treatment recommendation simply because of the time involved. Examples include: walking their dog three times a day to help with weight loss; coming back to your practice for weekly splint changes for eight weeks after fracture repair; or doing physical therapy until a joint feels better. It’s part of our job to explain the long-term benefits outweigh the short-term commitment. Second opinions Second opinions can be a blessing or a curse. Sometimes the words, “Let me get a second opinion,” is code for, “I will go see every veterinarian in town until I hear what I want to hear.” This is probably a client you should be happy to lose to your “competition.” Other times, the second opinion confirms what you told the client, who will feel reassured you spoke the truth and they will come back for you to treat their pet. Animal cruelty Some clients are convinced that confining for two months or using an E-collar for two weeks is cruel, degrading, and psychologically damaging to their pet… that either option causes more harm than allowing their pet to live the rest of their life without receiving the proper treatment. No matter how much you explain to them that confinement and an E-collar are necessary for proper healing, they simply cannot accept it. In these situations, you will need to decide whether you are willing to work with a client who will not follow your recommendations. Ultimately, our job is not to convince a client to do the right thing—we are not in the arm-twisting business. All we can do is educate them objectively, be their pet’s best advocate, show the value in what we have to offer, and let them decide for themselves. If they choose to decline your recommendation, it’s on them. Don’t take it personally. You will have done your part and should feel good you did the right thing. If they accept your recommendation, you can feel even better that you lived by our oath. Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified, is a board-certified veterinary surgeon and serial entrepreneur whose traveling surgery practice takes him all over Eastern Pennsylvania and Western New Jersey. You can visit his website at DrPhilZeltzman.com. He also is cofounder of Veterinary Financial Summit, an online community and conference dedicated to personal and practice finance (vetfinancialsummit.com). Kat Christman, a certified veterinary technician in Effort, Pa., contributed to this article.
