To increase owner compliance, I generally follow these guidelines. First, I ask the client directly if they think they can
perform the task or tasks that I recommend. Do you think its realistic that a mother of three at home can bathe a Golden Retriever
every three days? Allowing the owner to feel more comfortable with what he or she realistically can do is very important and
puts the owner's mind at ease. Alternative treatments or changes in frequency of treatments can be recommended, thus enhancing
compliance. Why prescribe an antibiotic that is administered two times or three times daily when you can prescribe a once-daily
alternative for a client who works long hours? Why prescribe a capsule to a stubborn, aggressive Lhasa Apso when you can prescribe
a pill that can be crushed or a suspension mixed into food? Why recommend a home-cooked diet for a working mother or father?
Novel commercially-available pet food should be adequate for an elimination diet. Successful outcome still can be expected
in many cases, even when certain frequently performed treatments, such as shampoo therapy, ear cleaning, etc., are performed
less frequently. Second, I frequently request a recheck examination in one week to two weeks after initial presentation in
animals that are severely effected by disease or were placed on a food trial. Many things can go wrong during the initial
stages of a treatment, so this is the best time to catch these problems early and change them. Weight loss and lack of interest
in the diet during dietary changes are major concerns, and these can be addressed during this recheck examination. Demonstration
of certain difficult tasks, such as instilling otic medications, ophthalmic medications or ear cleaning, clearly will enhance
owner compliance and treatment success. I try to educate the client as much as possible by explaining the disease in detail
and follow up with client-education handouts.
Finally, I have found a dry-erase board placed in the examination room to be an invaluable tool to illustrate confusing diseases
or treatment plans.
We all know about the economics of our field of medicine, and this can directly interfere with our ability to practice properly.
Here are some tips to help you and your clients deal with the rising healthcare costs for their pets. First, I tell all my
clients to purchase pet insurance; it's that simple. I believe it actually is worthwhile, especially with severe, catastrophic
illness or injury.
Third, for the more-expensive off-label medications (especially drugs that are not available in your practice), I have
found the warehouse-type prescription pharmacies to be the least expensive. For example, modified cyclosporine 25 mg size,
30 count, is $36, but it costs $79 at the local pharmacy located in the Bay Area. This can be a substantial savings if the
pet remains on this drug for life. Finally, referral to a board-certified veterinary dermatologist can save the owner money
in the long term. Cases that are very frustrating, severe in nature or chronic and relapsing might be managed better with
a specialist. We might be better equipped to deal with these cases, and our specialized expertise and knowledge of newer,
safer and more-effective therapies can provide a reasonable and economically feasible treatment plan for those difficult cases.
Editor's note: This story is the second in a two-part series. Check out DVM Newsmagazine's October issue for the first six cases in Derm's Dirty Dozen.