Use 'The Exam Room 6' for better medicine at your veterinary practice

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Feb 01, 2012

"I find that it is not the circumstances in which we are placed, but the spirit in which we face them, that constitutes our comfort." — Elizabeth T. King

Is "The Exam Room 6" a new Ocean's 11? No, Brad Pitt and George Clooney won't be making it into most of our exam rooms any time soon. "The Exam Room 6" is about a big job helped out by a little card.

This pocket card can serve as an aid for exam-room effectiveness. I take this little card into exam rooms with me and put it on the counter as an "eyestop" to help me stay on target.

Clients noticed improvements. I asked better questions, and I was more attentive and thorough. Certainly, we are all up to speed on exam-room etiquette: Enter the room; introduce yourself; say good morning to the client and patient.

At the end of the visit, don't forget to say goodbye and a offer a sincere thank you.

But that's not all there is to exam room duties.

Pocket full of duties

These are the six essential steps for exam room medical duties to be accomplished efficiently, succinctly, thoroughly and consistently.

So often we see a pet for a simple problem and then tend to glide over other issues. The pocket card can keep us focused.

The six steps are:

> Prep

> What

> Assess

> Plan

> Next Appointment

> Proof.

Let's review them one by one.

Step 1: Prep

Enter the exam room fully prepared after reviewing the master problem list that addresses why the pet is here today. Also, look at the laboratory data in this patient's file.

When you finally enter the room, the client will be impressed that you remembered the pet had a pancreatitis attack in 2006.

Step 2: What

"What is going on" must be ascertained. Sit and interview the client. You should focus the conversation on two issues.

First, the client has a story to tell—so a veterinarian must sit, listen and not interrupt. All that prep outside the exam room helps facilitate the discussion.

Second, look at the physical evidence. With each patient and with each visit, the same examination template is to be followed. You know that diagnoses are built on a comprehensive history and a complete physical exam. Make sure all nine of these items are addressed at every visit: weight, body score, pain score, dental score, behavior concerns, retina, tympanic membranes, heart rate and sounds and physical mobility.

Step 3: Assess

Now the heat is on. The assessment is time to make a differential list and render a prognosis. It's possible to create at least five possible diagnoses to rule out for almost any patient. But this list is as essential for the client to understand as it is for the veterinarian and veterinary team members to work with. Clients will appreciate the need for timely screening tests when the diagnosis is cloudy—and with five possible issues, the diagnosis is cloudy.

In other words, the "let's try this" mentality can get us into trouble. The prognosis is but an opinion as to the potential outcome. Clients to know this so they can make informed choices about diagnostic tests.

The ear with an established yeast infection will carry a poor prognosis when treated with generic ear drops twice a day. The prognosis becomes good when ketoconazole is added. Clients will go with the ketoconazole when faced with the reality.