Common dental frustrations and how to overcome them – part three

1. Common dental frustrations and how to overcome them: Animals in the early stages of disease Rachel Perry BSc, BVM&S, MANZCVS, Dipl.EVDC, MRCVS European Veterinary Specialist EBVS®, Dentistry RCVS Specialist, Veterinary Dentistry

2. Does this sound familiar? • During a vaccination consultation you notice the pet has halitosis and the gingivae generally appear inflamed. • There are mild/moderate dental deposits (plaque and calculus) • You suggest that treatment will be needed “before the next booster”

3. “He needs a dental in 6 months time” • Many vets think they are making a strong recommendation when advising treatment at some time point in the future • Instead, this gives the opposite signal implying treatment isn’t needed • If there’s disease, treatment is required

4. What is compliance? • Doing what someone demands or asks • Co-operation or obedience Hey, I sat because I wanted to. Not because you told me to.

5. What is medical compliance? • A patient follows medical advice • Taking medication, making lifestyle or dietary changes Non-compliance costs the USA $100 billion every year

6. What is veterinary compliance? • The percentage of pets receiving a treatment, or procedure in line with current accepted veterinary healthcare recommendations

7. Traditional concept of compliance • Very paternalistic • Patient/client is not involved in decision making • Patient/client cannot voice concerns • May be many reasons why patient/client is non-compliant “I feel sick all the time on these tablets”

8. Paternalistic care • Traditional veterinary medical practice • Vet dominates the encounter • Vet sets agenda and pace • Content biomedical • Client voice diminished

9. Relationship-centred care • Professional & patient/client discussion • Negotiation to achieve an outcome acceptable to both people • Better outcome

10. Relationship-centered care • Acknowledge the role the pet plays in the family life • Find out what the client wants and expects • Find out what the client is worried about

11. Relationship-centered care Significantly associated with increased levels of compliance. A better term for this is therefore ‘concordance’

12. Making a recommendation • A cross-sectional study of veterinarian-client-patient interactions was performed • Overall, 30% clients adhered to a dental treatment recommendation Kanji et al. Effect of veterinarian-client-patient interactions on client adherence to dentistry and surgery recommendations in companion-animal practice J Am Vet Med Assoc2012;240:427–436

13. Making a recommendation • The odds of adhering to a clear recommendation were 7 times greater than an ambiguous recommendation • And the client was subsequently more satisfied with the interaction! Kanji et al. Effect of veterinarian-client-patient interactions on client adherence to dentistry and surgery recommendations in companion-animal practice J Am Vet Med Assoc2012;240:427–436

14. Adherence also more likely with • Empathic and sympathetic tones • No hurried/rushed tones! Kanji et al. Effect of veterinarian-client-patient interactions on client adherence to dentistry and surgery recommendations in companion-animal practice J Am Vet Med Assoc2012;240:427–436

15. Adherence also more likely with • Longer consultation time (18 minutes) • 5-10 minutes might not be enough Kanji et al. Effect of veterinarian-client-patient interactions on client adherence to dentistry and surgery recommendations in companion-animal practice J Am Vet Med Assoc2012;240:427–436

16. This study highlights- • Client satisfaction contributes to client adherence • Relationship-centred care contributes to client satisfaction Kanji et al. Effect of veterinarian-client-patient interactions on client adherence to dentistry and surgery recommendations in companion-animal practice J Am Vet Med Assoc2012;240:427–436

17. Client satisfaction is achieved by • Meeting client expectations • Communicating clearly and effectively • Building a strong relationship with the client and pet • Including the client in the decision-making process • “Do you have any questions or concerns?” Kanji et al. Effect of veterinarian-client-patient interactions on client adherence to dentistry and surgery recommendations in companion-animal practice J Am Vet Med Assoc2012;240:427–436

18. Establish practice guidelines • All vets in the practice should be making recommendations at the same time-point in the disease process • One vet cannot say “he needs a dental” and another say “it’ll be fine until next year” • All nurses must have the same message • All receptionists must have the same message

19. Summary • Convincing clients to take action when their pet is in in the early stages of periodontal disease is not easy. • Achieve action by establishing practice guidelines on when to recommend intervention, not delaying intervention ("in 6 months time..") and making a strong recommendation which involves the client in the decision masking process.