The client is getting nowhere in her explanations as Joanne looks over her glasses at the reception room full of clients waiting for Dr. Gordon-some have appointments, others have dropped in to see if Dr. Gordon has a spare moment for a "few questions." Mrs. Powell, who has an appointment, waits patiently with her cat "Nellie" safely hidden in a cat carrier. She silently frets as the morning scene continues to unfold before her.
Dr. Gordon is behind as usual because he is friendly to everyone and wants to keep up with all the news that the clients are only too happy to impart.
As Joanne tries to move Mrs. Johnson to some sort of action Junior Smith enters the clinic with three intact male Beagles for vaccinations and nail trims. The three Beagles claw the linoleum and lunge in all directions on their leashes as Junior tries to talk to Joanne about another two Beagles still left in the truck. Junior Smith is oblivious as the Beagles investigate Mrs. Powell's cat carrier and one by one urinate through the slits onto the unsuspecting "Nellie" contained within.
Presidential press conference
Just then, Dr. Gordon emerges. His appearance stimulated several people to talk to him at once concerning every conceivable malady known to veterinary medicine.
As the scene unfolds it vaguely resembles a presidential press conference. Dr. Gordon briefly holds court and finally moves back into another exam room. Unnoticed, Mrs. Powell discreetly slips back out the front door with her dripping cargo and bumps into Malcolm Smith, a drug rep from Acme Smackmee Company. Mr. Smith calmly walks into the melee, smiles at Joanne, and walks directly to the back to talk to the doctor. As Joanne watches the drug rep walk by, Mrs. Johnson suddenly hangs up. Just then Susan Lewis walks boldly and directly through the front door, past the crates and clients, and to the front desk where she plants a stare directly at Joanne. She is upset and wants to talk to Dr. Gordon ASAP. Mrs. Lewis has been a fairly good client over the years but has a tendency to let her animals go until a crisis develops. She is highly emotional and Joanne and Kelly, the kennel girl, have taken special care to comfort her during her pet's illnesses. Joanne once even drove her home when it was apparent she could not drive due to the emotional stress.
Mrs. Lewis has always taken great pains to call the doctor by his first name and has welcomed the attention Joanne and Kelly have given her over the years. Sometimes she has exaggerated her pet's problems in order to continue to attract attention to herself and her situations.
A few weeks ago, in a panic, Mrs. Lewis had brought "John Boy," her German Shepherd, in with a gastric torsion during the noon hour. Dr. Gordon dropped everything to work on John Boy over the next 18 hours. John Boy died the next morning in spite of the colossal efforts of everyone involved.
Mrs. Lewis was very emotional over the phone and couldn't bear to come in with her husband to pick up the body. Because the death of a patient is a sensitive time for everyone, hospital policy has been to send a bill and a sympathy card at a later time.
Unfortunately, a pattern has developed with Mrs. Lewis. When she does manage to "compose" herself, she often calls to complain about her bill. It seems that Mrs. Lewis feels that since she has had such a good relationship with the doctor and that she has been coming in for so many years she should qualify for a "frequent flyer" type of pricing arrangement. Even though several hundred people in the practice have spent more money than Mrs. Lewis over the years, she has half jokingly remarked to various clients that she has paid for about 50 percent of the hospital by now. Today Mrs. Lewis is not in a joking mood.
Joanne walks to the back and finds Dr. Gordon finishing up a prescription for "Jessie" Jones, an aging English Setter with arthritis. Malcolm Smith is bending his ear about the new arthritis "cure" available through Acme Smackmee at huge introductory savings. Dr. Gordon listens as Joanne states that Mrs. Lewis would like to speak with him now. Dr. Gordon grunts and continues to talk to Malcolm.
Joanne trots back to the front and now sees four people at the counter including Mrs. Johnson with her cat, Barney. Three apparently unclaimed children have appeared in the vicinity of the over-the-counter display. Just then Dr. Gordon calls on the intercom to ask Joanne for assistance in the back with a toenail trim.
She has several options at this point:
* A. Call 911
* B. Call for an emergency drop shipment of chocolate.
* C. Try to compose herself and manage as best she can.
* D. Videotape the proceedings for Animal Planet.
Although the answer is C, composing oneself in this circus atmosphere will be challenging.
Is this a busy hospital?
Of course this hospital is busy-but is it productive or even professional? As far I can tell, no business has yet to be transacted, yet this hospital is extremely busy. This is a hospital out of control, and the doctor seems to be enjoying himself. If this is a typical day at Elsewhere Animal Hospital, then financial and professional success will be elusive for Dr. Gordon.
Out of control
The issue for this hospital is not that it is busy, but that it is out of control.
In fact, the inmates are running the prison. Dr. Gordon obviously relishes the idea that his opinion is in great demand and that he runs a friendly and open veterinary clinic. He has, however, let the clients (and the drug rep) run the entire production, and he is merely a puppet in his own puppet show. Many of his clients have, in fact, become parasites of the practice.
Mrs. Johnson-the time parasite
Most receptionists get calls from this type of client on a daily basis.
They are sometimes lonely people who just want to talk about themselves and their pet's medical conditions.
Many times they want only free advice. These clients are, by definition, 'breaking into line' ahead of good paying clients who are waiting to talk to the doctor and who have made legitimate appointments. Often this person has a knack of asking leading questions that guarantee that you will continue to talk to them ad nauseam. If you have only one person answering the phone up front, you will inevitably have this type of client slowing down or bring the flow of veterinary medicine in your hospital to a standstill. This cannot be tolerated.
* Solution: Next to hiring people just to answer phone lines, there is only one approach for these clients. They must be encouraged to make an appointment to see the doctor within the first few minutes, or you must ask them gently, but firmly, for a time within the next 24 hours that you can call them back. This now puts the client at some inconvenience because they are now being asked to call back at a time that is convenient to the receptionist and not the client. In most cases they will terminate the conversation quickly and efficiently.
Additionally, receptionists and other staff should avoid lengthy explanations. This should be left to the doctor in an exam room. If a concise answer to a query cannot be given, the receptionist must either excuse him or herself or quickly offer an open appointment slot to the caller. There should be no middle ground for the caller to seize upon to ask additional questions.
Junior Jones 'bad neighbor,' inflation parasite
Junior is proud of his Beagles. Even if this type of client should call ahead and bring three of his dogs in for shots, he may bring in the whole kennel in to save him 'some time' and trips to the vet. This type of client also will bring an extra dog or cat along "for the ride" and suddenly ask if he can work this extra pet in at the same time.
Most vets are only too glad to have the extra business but often find that managing a whole bunch of animals in an exam room is logarithmically more difficult than handling one at a time. Veterinarians often will take more than an hour for such a visit that originally had a 15-minute appointment slot. A lot of these clients bring no one along to help them corral the dogs. Often this kind of chaotic visit creates a lot of missed charges.
Junior and his dogs are also "bad neighbors." Junior secretly enjoys the 'scrappy' nature of his Beagles. Testosterone is a badge of honor. Any damage to other clients' property or hospital property just goes along with the program of "havin' dogs." Junior is the kind of dog owner whose pets originate many of the wounded pets brought in by responsible owners.
* Solution: These clients need to be told that they will need to make another appointment for the other dogs or that the doctor will try to fit the client in around other clients. Try to have no more than two dogs in an exam room at any one time. Watch carefully for missed charges.
Malcolm Smith special privilege parasite
Drug representatives work very hard for a living and deserve our time and attention. However, no drug representative should be able to short circuit the flow of paying clients that have taken their precious time away from their homes or work to bring their pet to the doctor.
* Solution: All reps should be told to make appointments with the doctor just like everyone else. Most already do.
Susan Smith-financial parasite
Susan is a manipulator. This kind of client has many permutations and combinations. It is common for clients to fancy themselves as special "friends of the hospital" and excellent animal caretakers.
Often these clients have blind spots when it comes to the care that they are actually providing for their pets. Although it is always appropriate to give clients estimates of services, there are situations in all hospitals that make this difficult or impossible. Emergency situations that end in the death of a pet create very little opportunity for appropriate financial discussions. Clients whose caretaking behaviors lend them to crisis medicine will always make it difficult for veterinarians if they also try to control what they are willing to pay for services after the fact.
* Solution: Manipulator clients must be identified. Once identified the staff must be careful not to be sucked in by enabling behaviors that are green lights for the client. These clients should leave deposits for all hospitalizations regardless of how many visits they have made to the hospital. The doctor should be firm and not discount fees. If a dispute does occur the doctor should hold the line. Most of these clients will become better clients in the long run if they are made to 'toe the line' to be on an equitable basis with other clients.
There is no pride in having a busy hospital if most of the activity is aimless and unproductive.
Clients are just human and will approach their responsibilities to the veterinary hospital based solely on their own misconceptions and often misguided needs. For veterinarians this will lead to chaotic work environment. Veterinary hospitals, like all institutions, need some form of appointment and client flow structure. This is in the best interest of the clients and their pets. A number of clients, if given the chance, will parasitize the time and financial resources of our practices. Some of these clients may not even be aware that their behaviors actually create a negative environment for every business that they enter or interact with.
It is therefore up to us to control the reception room environment. Without it we have no hope to control three of our most precious commodities: our time, our financial resources and good clients like Mrs. Powell who will leave for other hospitals with reasonable appointment and reception room structures.