Getting things right in the consult room - Veterinary Practice
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Getting things right in the consult room

IF taking a nuts and bolts approach
to your client interactions is a
difficult issue for you, then perhaps
you would feel happier turning the
page. For anyone on the path of
process review, it starts with phone
calls and booking appointments,
but the final destination of all client
head-to-heads is the consult room.

Fixing your consulting process may
be the last part of the puzzle in making
your business sustainable, according to
OnSwitch founder Alison Lambert.
Speaking at the London Vet Show, she
championed the brave few willing to
record what happens inside the
consulting room and urged the rest to
follow suit.

Consulting may be an art but it is
also a process that can be measured.
“It is the core of a veterinary
professional’s life,” she said. “It is the
most important critical customer
interaction after the first phone call and
you must measure what is happening.
It is far too important for you to leave
it to chance.

“You must acknowledge that
people can be better at consulting. To
improve you have to commit to observing those consults by being in
the room or filming them.”

Filming interactions is a rising trend,
enabled by inexpensive camera
technology and hard drive recording.
Observational training itself is nothing
new. “Everything the nurses do in
training is observed,” said Alison. “As
an assessor you constantly review what
the nurse team is doing. Vets do not
and that is a gap in reviewing
professional performance.”

Medics have largely ironed out
inconsistencies in consultation practice
using evidence from large-scale studies.
Alison’s examples included observations
of 21,000 diabetics whose doctors were
rated on empathy and communication
skills. High empathy and
communication doctors had diabetic
patients with fewer complications.

In a study of women with breast
cancer, those who received talking
therapy weekly with their health
professional survived around 15
months longer than those who saw an
oncologist on an ad hoc basis.

“Improve your communication if
for no other reason than it gives better
outcomes,” said Alison.

Veterinary and human
medical consults have
more similarities than
differences. At least one
half of the equation – the
owner – is identical. “The
problem we have is that
there are few data points in
this sector,” said Alison.
“Client communication is a
critical skill. It is taught in
medical schools across the
world. There is a structure,
a process and it has a direct
impact, robustly evidenced.”

When vets are pushed for time it
can feel like the robust pledge to ensure
animal welfare at all times has become a
touch jaded. “Remember: those 10 to
15 minutes are not about getting as
much money as possible: it is about
giving your professional opinion,
solving problems, and it is your sole
endeavour to do that.”

Financial legwork

Appropriately charged medicine equals
good business. Practice pricing strategy
should do the financial legwork. “One
in four cat and dog consultations
requires an intervention such as surgery,
imaging or diagnostics,” said Alison.
“That is good medicine and good
recommendation practice.”

One study of vet client interactions
on adherence to dental and surgery
recommendations (citation below)
showed that the odds of a client
following a clear recommendation were
seven times greater than if a vague
suggestion was made. “If we have clear,
professional, evidenced
recommendations and a course of
action, the owner will always say yes or
no,” said Alison.

Buy the doctor’s handbook on the
Calgary-Cambridge consultation model,
she urged. Ignore the fact that the book
is for doctors: it is money well spent.
“Let’s use it, it works,” she said. “Their
evidence is constantly updated along
with new technologies. Imagine if we
all followed the same process and said
this is what we do as vets. It is about
our professional reputation with the

Seven steps

There are seven steps to success in the
OnSwitch consult room. First is
preparation. Whatever you were doing
previously, leave that task behind; be
focused and arrive early; have your kit
in the room, any equipment at the
ready and vaccines close to hand.

“Don’t walk into the consult room
at 9am when the consult is due,” said
Alison. “The reason you run late is
because you start late.”

establish owner
rapport. Make an
effort to talk directly
to the owner and
establish eye contact.
Once that is done
you should define the
agenda by asking
open questions about
the animal such as
“Tell me what the
problem is…” or “What have you
noticed about…?”

Follow that up with number four:
the obvious pet examination. “Nurses
are much better at doing an obvious
physical examination,” chided Alison,
yet this is what the owner is paying for.
After that, make your recommendation
based on the evidence of your findings.

“Check and signpost” is number
six. “The owner may not wish to
proceed for whatever reason,” said
Alison. “You have given your best
recommendation and must let them
judge.” Finally, in closing the consult,
make sure you book the next

The idea and process is simple:
communications skills can be taught,
but it takes self-reflection. “There is
nothing like the pain of doing a staged
consult and getting feedback,” she said.
“Until you feel pain you do not learn.”

Reviewing the consultation process
feels intrusive but there is far less pain
in peer-review than financial misery.
“I’m tired of hearing ‘the internet is
killing my business’ or ‘the corporates
are killing my business’,” Alison stated.
“Do you know who is doing that? The
people in your consult room. Commit
to good medicine. Measure it, train it,
review it, commit to it.”


Kanji, N., Coe, J. B., Adams, C. L. and
Shaw, J. R. (2012) Effect of
veterinarian-client-patient interactions
on client adherence to dentistry and
surgery recommendations in
companion-animal practice. J Am Vet
Med Assoc
240 (4): 427-436.

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