In 1998 I realized that I wasn't using the annual visit properly. I could foresee the implications of changing vaccine protocols, and I realized I was depriving my patients and my practice by not having a more complete annual visit protocol in place. So I developed a seven-step annual visit to emphasize prevention.1
Dr. Gary D. Norsworthy
The results have profoundly changed my practice. Today, clients better understand that their annual visits are wellness exams, not just vaccination visits. Our patients are healthier because we offer more services, and our practice generates more income because we're offering more of the services pets need.
A program for all practices
I launched my annual wellness program in a canine-feline practice, and I've continued to use it in my feline-only practice. Here is my seven-point plan for an effective wellness exam:
Step 1:Take the patient's history. A receptionist ushers the client into the exam room and asks the client to complete a history form (Figure 1). Key questions help us assess the pet's risks (indoor vs. outdoor pets, boarding pets, and pets that attend cat or dog shows) and signs of disease. We designed the forms so that problematic answers align in the left column. This lets me scan the list quickly and recognize points I need to discuss with the client.
The form also includes space for the client's relevant comments. A bonus: We ask clients whether their contact information has changed in the last year, so we get their most current contact information when we collect the history.
Step 2: Screen with an electrocardiogram (ECG). The technician, with the client's help, records a lead II ECG using a portable ECG machine that is easy to use and offers a quick printout. While the ECG is printing, the technician makes initial entries in the exam-room computer, recording the cat's weight, a list of vaccines needed, diet, current medications, and any issues the client raises.
Step 3: Examine the pet. I perform a thorough examination, beginning with the oral cavity and progressing caudally to the tip of the cat's tail. I speak my findings so the client knows what I see and so the technician can make entries into the objective portion of the problem oriented medical record (SOAP) on my exam-room computer. Because the exam is a critical step in finding early disease, it's important to take a systematic approach so you don't skip body parts.
Figure 1. History Form
Step 4:Perform necessary lab testing. This step depends on the pet's species, age, and whether it lives indoors or outdoors, as well as the client's desires and the practitioner's capabilities. For some cats, we don't perform any tests. For others, especially senior cats, we recommend a blood panel, urinalysis, and blood pressure determination.
Step 5: Offer specific health recommendations. Make your recommendations both verbally and in writing. We use a preprinted annual exam report (Figure 2) or a computer-generated form. Common recommendations include dental cleaning, mass removal, dietary changes, and necessary followup visits to monitor certain conditions. We tape a strip of the lead II ECG to the bottom of this form. Often the client will take the document home to show his or her spouse, other family members, and even other cat owners.