The Double Edged Sword of Choice in Veterinary Practice

Nowadays, more than ever before, the consumer has the power of choice. Rightly, consumer experience is valued and reviews alone have the potential to make or break a business. In pursuit of the best value and service, the consumer is less concerned with loyalty to a company, and more concerned about comparison. This ‘power of choice’ has done wonders for client satisfaction, the accountability and standards of businesses. However, we’ve also noticed that new veterinarians in the Thrive network have some anxieties surrounding contemporary consumerist culture, and how this could alter communication with clients.

“Everyone is more questioning these days, more able to price-compare amongst a plethora of options and less concerned about sharing how much money they have spent. How can I live up to clients’ expectations in a ‘comparison culture’?”

The solution could be to offer clients choice in your interactions with them. Giving them only one recommendation for their dog’s steadily declining dental health – say, tooth extraction – could tempt them into looking elsewhere. In this case, another practice (and/or vet) may give the option of temporary solutions before a final tooth extraction is required.

The purist sales people out there will always advocate that choice should be offered, as will the veterinary associations – under the guise of informed consent. 

In theory, or in the perfect world, providing choice to your clients sounds like a wonderful thing to do. However, in practice/reality this strategy looks highly risky and could have damaging effects on both patient and practice outcomes. 

What are these potentially damaging implications and how can you avoid them? Read on for more.

Choice: The Double Edged Sword

As humans we all tend to like to have choices. We like to be able to choose the colour of our cars. What news outlets we read. Where to go on vacation. There are many people on planet earth who don’t have the luxury of choice. So ‘choice’ is fantastic.

In the veterinary field choice can also be a useful tool, and it sounds great in any practice brochure or website. Provided you are a skillful communicator with plenty of time and have an intelligent, trusting client in front of you, choice is just dandy. But let’s be realistic.

1. Many surgeries operate with 10-15 minute appointments, often running late. How can you offer all the options within this limited time-frame?

2. How many vets are truly gifted communicators able to convey complicated messages in simple to understand ways?

3. How many clients, intelligent or not, “get” what it is we are trying to say?

Since when did ‘third best’ = ‘good’?

The mantra of choice is in theory good. But in practice there is more than a passing suspicion that it’s being abused.  In practice observations reveal that frequently, we vets are not offering choice in the pure way management types talk about. That’s the type of choice made when the options are fully and clearly understood well enough to allow a truly informed decision. The type of choice that comes from research and comparison sites.

If veterinary clients were making well informed choices, how come the uptake of basic treatment options like descaling a mouth with progressive periodontal disease is so poor?

Instead, what is happening is that we are offering two or three options with little in the way of useful qualification for each, or an explanation that the client will truly understand.

Let us say option A costs $2000, option B $1000 and option C a mere $500. In the absence of an overwhelmingly persuasive reason to choose A or B, the client is at risk  of opting for C. In the absence of accessible information, cost (the variable best understood) comes to the fore.

But how many clinical situations (come to think of it, any situations) are best resolved by the second or third best options?

Consider the example. The vet finds dental disease (a progressive condition which needs treatment) in a dog. Next, she offers the client three choices.

1. Undergo a relatively expensive descaling procedure to correct the problem.

2. Try a course of antibiotics.

3. Review things in three months because they aren’t really bad just yet.

What the client really hears is: this can wait. They will either opt for option 2 or short circuit straight to option 3. Here, choice translates to lack of assertiveness and dilutes any sense of urgency. The client may be thinking: ‘if option 1 really needed doing then wouldn’t the vet just tell me clearly to get on with it?’

As this recommendation isn’t clearly made, the client assumes that things are OK, and will opt for the easy/cheap/safe option of reviewing things in the future. We all know ‘the future’ means ‘next vaccination’, if they bother to come in for that at all.

You can probably see where this is going. Choice can often provide the client an illusion of security, resulting in inaction whilst their pet’s health declines – an ominous snowball effect.

Choice as Abdication of Responsibility

Some (typically those short on confidence – new graduates are a good example) use choice to make the client decide, and thus move the responsibility of decision-making from vet to pet owner. How many times do you see “client declined X-rays”, defensively written on the clinical notes? In reality, the client probably chose a different option based on a poor understanding of the situation because they weren’t given enough guidance. ‘Client declined’ and ‘client didn’t choose because of overwhelm’ are not the same thing.

The vomiting dog that might have a life threatening intestinal obstruction, but might also just be gastritis, is a good example. The options:

1. Admit for bloods and an x-ray.

2. Admit for observations.

3. Medicate and review in 12hrs (tomorrow morning usually).

If the vet really thinks there’s a foreign body then there is only one ‘optimal’ choice. But I’ve heard vets give all three options together with little guidance. Guess which one wins more than it should when no clear direction is given? If you guessed cheap, you guessed correctly.

An Alternative Viewpoint on Choice

An alternative  viewpoint, one that was developed after viewing hundreds of veterinary consultations in which the best option for the patient was not the one selected., is to focus on better describing the “best” option for that pet and family in that moment.  

In other words to train vets to clearly think through the choices in their head, then select the one they feel is in the best interest of the pet’s health at that time, and to make that recommendation on it’s own. This alongside the use of  clear and persuasive language such as, “what we need to do here is…”. It’s proactive and motivating, with no mixed signals to confuse clients.

Now, if after some discussion the client does not want to follow this option then the vet should respect that and offer a next best alternative. And so on and so forth until the final plan is fully agreed and understood.

Most of the time, however, this won’t be necessary because the vet has made a clear initial recommendation and explained why this is the optimum way forward.

And a further note, Plan A need not be the “Gold Care” option but the best option available to any pet given their unique set of circumstances. One size does not fit all.

Choice and the Risk of Career Damage Authorities 

“But the medical associations say we must offer options” you howl. Yes they do, and we’re not advocating reducing those options, merely presenting them in a way that makes it clear which option you believe (in your professional, highly trained mind) is in their pet’s best interest.

That’s not limiting choice, but reframing it. In doing so you avoid the biggest risk for all vets when discussing clinical plans, the risk of overwhelming and confusing your client. 

 Communication Skills Are Key

Vets are honest, hard working, committed to their patients and thoroughly altruistic. All of which are awesome characteristics to be admired, fostered and protected. But they are not a naturally gifted group  when it comes to communicating and persuading clients to take the right action on behalf of their pets.    

Another issue is our ongoing and deeply uncomfortable relationship with pricing. Many, many vets remain apologists for their pricing rather than advocates for their service. 

Choice offered against this backdrop is open to misuse by vets and misinterpretation by clients. The result is that many animals are not receiving the best care possible at the time they need it. This happens to impact not just the patient, but your bottom line.

You may think you are offering choice in the best way possible, to keep the client happy. But is choice working for or against the pets in your practice? And how are you measuring it? If you found this article useful, you could benefit from viewing our free webinar: 4 Steps to a Happy and Successful Career as a Veterinarian. Beyond the illusion of choice, this webinar will detail further mistakes to avoid in order to become a happy and successful vet. 

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