The otitis case that changed my business

The otitis case that changed my business

When the owner of a Lhasa apso with chronic otitis refused to bring her dog in for a recheck, I turned the problem into a new policy at my veterinary hospital.
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Sep 14, 2018

"My mom says rechecks are for suckers." (Shutterstock.com)Long ago, I had a client (we’ll call her “Ms. Madden”) who changed my entire way of treating (and charging out) cases.

Ms. Madden and her Lhasa apso came to me from another practice. I was unsuccessful at obtaining good records, but according to the client, the other vet would always treat her dog’s otitis with “antibiotic ointment” and it would go away quickly. But it always came back.

I gathered as much diagnostic information as Ms. Madden would allow, but because she was accustomed to the other vet simply peeking in her pet’s ears and sending her out the door with “antibiotics,” she wasn’t particularly open to my plan of providing a full workup.

I suspected that the other veterinarian had been handing out antibiotic and steroid combinations several times a year. Ms. Madden was under the impression that they worked great at treating the “infection.” I, on the other hand, had a hunch that the steroids would tame the inflammation, then the ears would look better and the client would stop the treatment (and the otitis would eventually rear its ugly ear again). I also feared that, because of this haphazard management, the Lhasa apso’s ears had developed an infection that had become resistant to first-line therapy choices.

Ms. Madden wouldn’t allow me to perform culture and sensitivity tests but agreed to an ear cytology. The dog’s ears were so swollen that I couldn’t visualize his eardrums. I explained to Ms. Madden that I was going to prescribe something I thought would help (because without the culture, I couldn’t know for sure). I told her that I would like to recheck the dog before finishing the medication—after the swelling had gone down some—to make sure his ears were responding to the treatment plan and to visualize his eardrums.

When she failed to show up for her recheck appointment, I called Ms. Madden personally. She told me that the ears were “fine” now and that a desire for more money was the only reason I’d dialed her number. I tried to explain, but Ms. Madden would have none of it.

I took my frustration at this recheck refusal and turned it into something productive: I changed my hospital’s policy. It’s so important to me to get that recheck (especially on ears) that I’ve now built a courtesy follow-up appointment into every sick pet exam. I get to see my patient and provide better care, and clients can’t claim I’m trying to rob them.

We explain that the recheck is a part of their charges at the first visit and that any change in medication or added products will be extra at the second visit. Sometimes the recheck is a quick “Everything looks like I wanted,” and sometimes we have to take additional measures. Regardless, both the pet and the practice win. The only thing you really lose is the complaining, and I don’t think you’ll miss it.

Kathryn Primm, DVM, the author of Tennessee Tails: Pets and Their People, owns Applebrook Animal Hospital in Ooltewah, Tennessee. She is a frequent contributor to dvm360.com and other publications, and she was the nation’s first Fear Free certified professional.