The Team Approach
From initial patient presentation to long-term management, the pet owner interacts with every veterinary health care team member. Embracing a team-based approach can help establish clients’ trust, promote communication and compliance, and improve overall patient care and quality of life.
Receptionists and client-service coordinators are often the first interaction the pet owner will have with the veterinary practice. Developing communication resources and telephone triage skills will help the nonclinical staff determine appropriate scheduling for ill patients and those requiring ongoing monitoring with timed testing or even potentially life-threatening situations.
The patient history that is obtained by the credentialed veterinary technician or veterinary assistant plays an essential role in veterinary case management for endocrinopathies. The patient history focuses on the pet’s health from the point of view of the pet owner, which is invaluable as this information cannot be wholly determined by physical examination and diagnostic test results alone. An accurate history is helpful in determining the duration and severity of clinical signs, developing a problem list or prioritizing differentials, and monitoring a patient’s response to therapeutic interventions. For example, knowing the likelihood of toxin exposure may help the veterinarian assess a patient in a hypoadrenocortical crisis, when the possibility of an acute kidney injury may confound the diagnosis.
Communication tips on how to take a quality patient history:
- Encourage the use of a pet owner questionnaire.
- Standardized history taking may promote continuity of care and monitoring of trends.
- Templates can be tailored for different situations—wellness, sick visits, ongoing monitoring for chronic diseases, etc.
- Address clients in a clear and courteous manner.
- Speak respectfully and avoid using medical jargon or slang.
- Start with open-ended questions.
- Establish the presenting complaint and pet owner’s concerns with questions such as, “Can you describe to me what happened?” or “What brings you in today?”
- Endeavor not to interrupt the pet owner, as valuable information may be missed.
- After identifying the presenting complaint, progress to more focused closed-ended questions to clarify the situation, such as, “How long has this been happening?” or “How often does this occur?”
- Allow for pauses.
- Let the client gather their thoughts. Try not to rush them to fill the silence.
- Practice positive nonverbal communication. Use open body postures, direct eye contact, and head nodding.
- Engage in reflective listening.
- After the client finishes talking, reflect on what was heard and ask if the situation has been understood correctly. For example, “Annabelle vomited five times since yesterday; is that correct?”
- Express empathy.
- When talking to pet owners, the veterinary health care team should be able to understand the owner’s situation and be able to communicate that to them. For example, “I know you care for Simon, and I understand this can be overwhelming.”
In addition to acquiring a patient history from the owner regarding the presenting complaint, one must also inquire about the general status of the pet (including diet) and past pertinent medical history and obtain an accurate medication history. When asking about medications, one must be clear to specifically ask about preventives, over-the-counter medications, supplements or nutraceuticals, and any topical medications. Owners often only think of oral prescription medications and may not think to divulge important information, such as the use of topical exogenous corticosteroid products.
Clear communication with the pet owner and the veterinary team facilitates ongoing care and monitoring. Without proper communication and established protocols, scheduling something as simple as an ACTHST can be problematic if the owner, client-service coordinator, credentialed veterinary technician, or veterinary assistant does not know when an ACTHST should begin after trilostane administration. Additionally, one must remember that dose adjustments are not made in a diagnostic vacuum. Clinical signs and physical examination are equally important factors in successful ongoing patient management.
As these patients visit the veterinary practice more frequently for monitoring, prioritizing patient comfort and reducing stress will go a long way in building the veterinary health care team’s relationship with the pet and their owner. Not only will low-stress visits reinforce pet owner compliance for timely follow-up, but they will also encourage more reliable diagnostic results as stress can influence many endocrine-related diagnostics. For example, using devices such as butterfly catheters for ACTHST and LDDST to facilitate both obtaining a baseline sample and administering the appropriate medication with a single venipuncture has the benefit of reducing stress and minimizing discomfort and vessel trauma when compared with repeated venipuncture events.
Another example of prioritizing patient comfort to support consistent diagnostic values to monitor trends is blood pressure measurement. The 2018 ACVIM Consensus Statement: Guidelines for the Identification, Evaluation, and Management of Systemic Hypertension in Dogs and Cats includes a helpful protocol for accurate blood pressure measurement in small animal patients.87
Regardless of the endocrinopathy, the veterinary health care team is instrumental in educating the pet owner. For successful management, the client should have a basic understanding of the disease, the clinical signs, adverse events, long-term goals, and recommendations regarding treatment and ongoing care.