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 Leadership in the Exam Room

By C. Lee Tyner, DVM and Patrick T. Malone CSE 

One of the continuing challenges of our profession is gaining commitment from our customers to comply with our prescribed protocols. Non-compliance by the pet owners has been and continues to be a significant barrier to pet wellness at many practices across the U.S.

We believe there are actions that both you and your technicians can take that will dramatically improve compliance in your clinics. We would like to share our observations and recommendations with you and then you can decide if they will help your practice and ultimately positively impact pet wellness.

Initially it is critical that we understand our customer’s point of view. Many veterinary professionals equate non-compliance with apathy. Nothing could be further from the truth. If a pet owner is showing up at your clinic, they are not apathetic. So if it’s not apathy, why are they not complying with your instructions? We believe non-compliant customers fall into they following four categories.

Complainers – “It’s too difficult to remember the monthly heartworm preventative. Getting Fluffy back in every 6 weeks is a hassle. That costs too much. I can’t get him to take the pills.”

Avoiders – “I’m not sure I can get her here every 6 weeks. I’m afraid he’ll have a reaction. I’m worried that we won’t be able to follow that regimen. My breeder told me not to do that.”

Stoppers – “I won’t do that. Wrong. That’s a bad idea. That doesn’t work.  I’m opposed to all those shots.”

Skeptics – “I read where that causes cancer. How can you be sure that will work? I saw on the internet that doesn’t help. That’s fine in theory but what about my case.”

Our jobs would be so much easier it our customers would be as clear and as up front with us as these words seem to indicate. In reality when we communicate with each other face to face, the words that we choose to use only make up 7 – 10% of our total communication. The bulk of our communication is in the “music” that we send along with the words.

Our “music” is in our voice – the tone, the speed, the inflection. It is also in our physical presence – our body language. So our first recommendation is stop paying so much attention to what your customers are saying. Instead, focus your attention on how they say it. When you focus on the HOW then the WHAT becomes much clearer. Here are just some of the clues that will help you gauge your customer’s music and more accurately assess their point of view.

Complainers – sighing, whining, apologetic, low energy, downcast eyes, pained, tired, etc.

Avoiders – indecisive, unsure, hesitant, withdrawn, shy, changes the subject, short attention span, postpones, appeases, etc.

Stoppers – ruthless, intolerant, biting, sarcastic, controlling, interrupts, raises voice, righteous, etc.

Skeptics – argumentative, doubt, aggressive, direct, forceful, debates, argues, testing, unbelieving, denial, etc.

Once you have correctly assessed their point of view it is necessary to build rapport. That means respecting their momentary point of view to cause a connection with you and the opportunity for you to introduce higher more motivated points of view. Imagine being at the same point of view your customer has at that exact moment towards your recommendation. Then, by using your own words and music, demonstrate that you are looking at the recommendation from the same point of view. Not agreeing with their point of view, but simply respecting what your recommendation “looks like” or “sounds like’ from their perspective.

There are four general rules that may help you acknowledge points of view with which you don’t agree:

  1. Give the customer 100% Attention that proves you care. Simply suspend all other activities at that moment including the examination of the animal and even your own point of view for the moment.
  2. Give the customer a Response that proves you heard what they said. Simply respond with enough energy to show them that their message made an impact on you
  3. Give the customer Understanding by summarizing their point of view or asking a relevant question.
  4. Give the customer Respect by proving you take them seriously through the attitudinal awareness in your words and tone of voice.

Actually if you only remember to do #4 the other three will happen as a natural consequence of your Respect.

Once rapport has been established you can proceed with business by following the appropriate strategy for each of our non-compliant customers.

Complainers – Acknowledge to the customer that “It sounds like a problem so what might help is to”…Gradually reveal solutions which will help their problem. Reminder cards for follow up visits. Extended heartworm preventatives in place of monthly. Extended payment plans. A liquid replacement or pills crushed and mixed with food.

Avoiders – Acknowledge that there could be a slight risk of reaction but the vaccine is designed to avoid the larger risks of lyme or lepto. Have your tech help the customer develop a regimen that avoids missing a dose or a treatment. Set a follow up phone call to avoid missing an appointment. Anything that helps your customer avoid the perceived risks is an appropriate action strategy.

Stoppers – Immediately acknowledge with responses like “Got it. Let’s stop here. Sounds like a real problem.” Then focus your attention on probing questions like, “What’s wrong? What’s your breeder’s objection to that? Help me understand the objection. What’s the resistance to vaccines?” In most cases when you discover the reason behind their stop (the internet, their breeder, a neighbor, a friend), you will find the appropriate strategy in the good science you are able to share with then and remove their point of resistance.

Skeptics – While they tend to be the most aggressive, skeptics almost always just need the appropriate proof to dissolve their challenge. That might sound like: “There is some antidotal data on injection site sarcomas but the incidence of exposure to leptosprosis among field trial dogs far outweighs that slight risk.” Or: “I’ve seen those claims on the internet myself but I’ve used ProHeart 6 since it was first introduced and have never had an adverse event. As a matter of fact I use it on my own dog because I believe the risk of heartworm is much more likely than an adverse event.”

We believe the key to reducing non-compliance lies in the leadership we display in the exam room. Good leadership starts with good communication skills, effective listening, sincere acknowledging and then effectively positioning our recommendations in a way that they make sense to our customers regardless of their point of view.  We believe this will work in your practice. Try it and find out for yourself.

C. Lee Tyner DVM is a Professor and the Associate Director of Clinical Services at the College of Veterinary Sciences at Mississippi State University. He can be reached at tyner@cvm.msstate.edu

Patrick T. Malone CSE is a Senior Partner with The PAR Group, an international training and consulting firm headquartered in Atlanta, Georgia and the co-author of Cracking the Code to Leadership. He may be reached at Patrick.malone@thepargroup.com

The PAR Group of Atlanta, Ga. relationship with the College of Veterinary Sciences at Mississippi State University was facilitated through the efforts of Ft. Dodge Animal Health. PAR helps organizations build on their successes by developing and enhancing the business skills of communication, customer service, leadership and sales. In that capacity, PAR has had a long term relationship with FDAH and it’s distributors.

Dr. Tyner became familiar with PAR through that relationship and recommended it’s introduction to the senior staff at MSU in the fall of 2003. The PAR communication and customer service skills have now been expanded to include the CVM faculty and staff as well as being introduced to second year students. Annual reinforcement sessions further imbed the methodology through the CVM.

PAR skills are especially suited to the veterinary profession because they focus on:

  • Interpersonal skills versus strategy
  • Individual strengths, not weaknesses
  • Relationships, not transactions 

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