Getting things right in the consult room

01 February 2014, at 12:00am

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 public.”

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.” 

Secondly, 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 appointment.

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.