Specific Strategies for Successfully Marketing Preventive and Therapeutic Ear Care

Believe In Its Importance. Understand that preventing and resolving ear prob­lems is very important to the pain-free life of the pet.

Educate Yourself. As in all other facets of our veterinary education, we must first understand both normal and abnormal conditions, including disease processes of the ear.

It is also important for the veterinarian to keep abreast of the numerous products now available for both preventive care and therapeutics for the ear. The formulary contained in the appendix of this book lists many drugs, along with specific ingre­dients. The chapter on ototoxicity has a helpful guide to ingredients contained in products that may potentially cause additional problems if used in pets compromised with a ruptured tympanum. It is crucial to understand not only what products are available but also their uses and contraindications. Many of today’s pet owners are better educated than ever before—and sadly, with the help of the Internet, may be better versed in particular products than the veterinarian who has not taken the time to study each product introduced to this profession.

Educate the Staff. Clients relate better and therefore talk more openly with your staff members than to the veterinarians in the practice.

Staff must understand the importance of not making a telephone diagnosis or examination table-side diagnosis until appropriate confirmation diagnostics are performed, so that all recommendations are made based on confirmed and docu­mented diagnoses. It is very difficult for any veterinarian or other staff member to overcome wrong information that has been provided by an uneducated staff member without destroying some credibility of the practice as a whole. Every staff member must fully appreciate the power of each interaction with the client and the potential consequences of giving out wrong information. Every staff member interaction with the client has a positive or negative effect on every client decision.

Seeing is believing and one of the best staff education tools. Teaching staff members what a normal horizontal and vertical canal looks like allows them to know what is abnormal. The use of videoscopes such as the MedRX Video Vetscope (MedRx, Inc., Largo, Florida) allows the veterinarian to teach many staff members at the same time, by generating a visual image on a video monitor that all can watch. The educated staff is far more capable of selling clients on the need for thorough ear examinations when clients call with questions about a problem, as well as when medical history indicates the possibility of aural pathology.

It is impossible for anyone to market successfully anything he or she does not understand. All educational tools available should be used to teach both staff and clients about ear care.

Equip Yourself. Much of the instrumentation needed for ear disease diagnostics and therapeutics is already present in the typical veterinary clinic. Client perception of overall medical competence is influenced by the equipment seen and used in the examination room. Otoscopes must be in every examination room, ready for use, if one expects to gain 100% compliance in thorough examination of each and every ear, each and every time. Battery-operated otoscopes provide portability but also are prone to become inoperable due to low battery charge. Wall-mounted transformers (Welch-Allyn) eliminate the embarrassment of dead batteries—and the resulting perception of incompetence. These units typically also have a much brighter light, allowing better visualization.

Particular attention should be paid to sanitation and cleanliness of the otoscope specula so they are always ready for use when a new patient enters the room. A new, innovative specula-cleaning device is available, consisting of a brush within a stain­less cylinder, which can be filled with disinfectant. Having the cleaner instrument on the counter in every room maximizes time efficiency and guarantees specula are kept clean. A cheap alternative would be to place a small bristle brush used for cleaning test tubes in each examination room—or having two sets of specula in each room so the soiled one can be removed from the room during the cleaning process before the next client is called in. Staff should also be educated on the possibility of spreading infectious organisms from one pet to another when using an uncleaned specula, even though it may not appear dirty.

The expense of new equipment is relatively unimportant relative to the immedi­ate cash flow that can be generated from the use of such medical instrumentation.

New video otoscopes now available not only allow the practitioner to do a better job with diagnostics but also educate the client at the same time and treat more thor­oughly and effectively. Adequate visualization, a clear view of the inner lining of canine and feline ear canals and tympani, can be very difficult owing to the limits of standard diagnostic otoscopy instruments. Showing clients, staff, students, and other practitioners ear canal abnormalities through a standard otoscope can be awkward, even using the “teaching otoscope” heads that are available.

The video otoscope employs new technology to expose the hidden world of ear pathology. Because the instrument is attached to a miniature video camera and video display, otic examinations can be visualized in real time on a video monitor. A color video printer allows “before and after” pictures of ear canal conditions that can be shown to the client later. The photographs generated can provide pathologic infor­mation in a way that is perceived much more seriously by the client; the client is more willing to request needed procedures because it has now become a much more informed (educated) decision.

Failure to look is much more often the problem in clinic income than is a lack of knowledge. It should become standard protocol that every ear of every anesthesized pet in the clinic for any procedure, related to ear disease or not, be examined using the videoscope; doing so often results in the discovery of many additional medical problems in the ear that would otherwise go unnoticed until they became much more severe.

“Before and after” pictures can also be kept on file to use in educating other clients about ear disease and the reason for appropriate preventive ear hygiene. These pictures can also be added to the reminders sent out to the client for various procedure updates.

Adapters allow other hospital instruments to generate video images for both the practitioner and client. Such instruments as microscopes, rigid endoscopes, and flexible endoscopes can be enhanced via the videoscope.

Although many practices have purchased videoscopes, most greatly underuse them. Why? They are not convenient to use. For that reason, I have installed a new videoscope system called Vet Dock (MedRx, Inc., Largo, Florida) that is economi­cal enough to be placed in all examination rooms. This has allowed videoscope visu­alization of all ears during every examination to become habitual. The client is able to visualize the ear examination at the same time as the veterinarian does. Involvement breeds interest, and interest generates additional requests for appropriate services.

Look for Problems. The foundation of a successful wellness program includes both a thorough medical history and comprehensive physical examination of the patient, with the goal of catching signs of potential disease before it becomes clini­cally evident. Time is required for thoroughness. Staff delegation is an important tool in optimizing the time available for the veterinarian to concentrate and perform these nose-to-tail examinations.

Educate the Client. People do not buy what they do not understand. A lack of client education reduces the choices by the client to a matter of price. Because a large amount of ear disease lies deep in the ear, the pet owner may not even perceive a problem. The old adage “show and tell to sell” is still true. As mentioned, every client is a unique individual having different “hot buttons” and different desires. The particular “hot button” (stimulus triggering the client to take action) may be visual, auditory, tactile, or olfactory. Clients learn in different ways. It is crucial that the practitioner take the time not only to be thorough in the examination but also to discover the “hot button” of each client to determine what is the most important to them. Clients want to know: What is wrong? Can we solve it? Will it hurt? How long will it take? How much will it cost?

Never assume the client is aware of all the services/products the pet needs or you can provide! Increasing the client’s perception of all abnormalities may be accomplished by the following:

• Show the problem to the client via the standard otoscope, teaching otoscope, or video otoscope. Reddened, inflamed ears are quite easy to understand when they are observed.

• Have the client smell the odor.

• Have the client feel the swollen or bony ear canals.

• Explain to the client that the resistance by the pet to having the ears examined or whining during manipulation or insertion of the otoscope specula indicates that the ear is painful. Use the analogy of how painful human ear infections may be.

Other visual aids that are available and should be used include the following:

• Diagrams of the ear’s anatomy. These should be framed to enhance the profes­sional image and placed on the wall of each examination room close to the exam­ination table so they can be referred to when discussing ear disease.

• Wall posters of photographs of dog and cat ear disease conditions

• Loose-leaf notebooks in each examination room showing pictures of ear disease and therapeutic/surgical procedures

• Brochures from product suppliers

• Ear models

• Personalized handouts on clinic letterhead, including a diagram of the ear, so that the area of the problem can be identified. It should be standard policy that no client ever leaves the examination room without a handout detailing the specific condi­tions diagnosed. Handouts become miniature billboards marketing both the prac­tice as a whole and the specific problem being explained.

Visual aids are good, but the most important educational tool is staff and veteri­narian interaction with the client! Staff training in ear disease conditions, therapy, and prevention is essential. After appropriate staff members are properly trained, much of the client education time can be delegated to them. Everyone must under­stand the “hows” and “whys” of ear disease. Staff must comprehend that the number- one reason for chronic otitis is lack of client compliance, which is most commonly a result of a lack of perceived importance to the long-term quality of life of the pet. To market ear recommendations most effectively, relate otitis to the following:

• Otitis hurts! It can be very painful, as is often evident from the swelling and redness. Many pets with painful ear infections may show behavioral changes such as aggression from the pain. Compare it with human ear infections.

• Otitis stinks! A stinky pet may well not remain inside the house for long. Pets relegated to the backyard most often no longer get the best care.

• Otitis includes infection! Any infection can be a “seed” for infection elsewhere in the body. Infection can rupture the eardrum and even move on to the nervous system. The inner ear is a direct route to the brain!

• Otitis can cause loss of hearing!

Successful client education requires an environment conducive to learning. Client anxiety limits concentration. Do you think it is fun to put a pet in the car and come to the veterinary hospital? Do we make it easy for them to do business with us? Think of all the barriers we throw up to the client, making it inconvenient for them. Waiting time is the number-one de-marketing problem in almost all practices. Today’s client does not have time to wait. Today, instant service takes too long! When we feel hassled, we are not in the best state for listening attentively. Minimizing client anxi­ety allows the client to concentrate more on what you are saying and showing. Such things as striving to see appointments on time and minimizing confusion in the reception area can improve client relations. Offering to assist the client with the pet both on arrival and when paying says a lot about the value the practice places on its clientele.

Methods for entertaining children, such as a TV showing pet movies and quiet toys, can be quite useful in distracting them so they do not distract the parents.

Anxiety can also occur from a perception that the pet is being hurt during the examination or treatment. The best way to show you care is to be gentle. Sedatives are greatly underused in veterinary medicine and result in poor examinations and missed diagnoses. Any resistance to a thorough examination should result in sedation of the pet.

Clients must also be educated about the many products available that have the potential for enhancing the ear’s resistance to infection. These products should be evaluated by the veterinarian, who should make appropriate recommendations to the client, including the facts and benefits of the particular product. Recommendations should be provided in the form of “the pet needs—” rather than merely “I recom­mend—

Most treatment failures are a result of poor client compliance with prescribed home-care therapy. Successful outcomes require that the client understand both the importance of following the treatment protocol and how to do it. Written home-care instructions should always be provided after discussion in the examination room. Using treatment regimens that clients can actually do and that fit their lifestyles are the cornerstones of successful treatment. Proper administration should always be demonstrated and then observed as the client attempts to mimic your demonstration. If the client cannot perform it satisfactorily, it would be appropriate either to hospi­talize the pet or have it brought to the clinic daily for treatment. Remember that you will be judged by your results. If the problem does not resolve, even though it may be due to the client’s lack of appropriate treatment, you will be blamed. That’s not fair—but that is reality! After a few days of appropriate treatment, ideally, the pet will feel more comfortable and the pain reduced so the owner can take over treat­ment. It is crucial that the practitioner understand the importance of resolving the pain as quickly as possible so the pet will accept treatment readily. Everyone should praise the client’s efforts. Everyone loves compliments and being made to feel important. Compliance with home-care recommendations should always be assessed during telephone progress checks.

Make Your Services Convenient! Convenience rules the world today. The astute practitioner offers such services as pet drop-off and late pickup. Treatment proce­dures such as topical medication application should be initiated during the initial visit to better ensure client compliance. All needed services should be scheduled for a time most convenient for the client—which in most cases is the initial time of pre­sentation for the problem or routine examination. The veterinary practice demonstrates respect for the client’s time when appointments are behind schedule by offering an opportunity to leave the pet at the clinic for a few hours while complete diagnostic evaluation and therapeutic procedures are performed. The client will appreciate the explanation that it would be more convenient for them to have all work performed now that the pet is already there. Staff should be trained to schedule a specific dismissal appointment time to minimize client waiting, frustration, and anxiety.

Price for Your Market! There are two types of fools: those who charge too much and those who do not charge enough! Fee schedules vary tremendously due to practice philosophy, locale, and financial status of the typical client in the practice. Different clinics attract different types of clients. The key to success is being sure that the level of service exceeds the fees charged.

Pricing is no longer based on what it costs to provide a service but rather what the client perceives the service is worth. My rule of thumb is that the fee for any service should be a minimum of five times the hard costs of materials. In other words, drugs and materials needed to provide the service should be no more than 20% of the total fee.

The major cause of relapsing otitis is failure to recheck and treat long enough. A line item on a client’s bill entitled “otitis recheck package” may be established to include the medical progress examination, sedation, ear swab and staining, and flushing. This is preferable to listing all services at a standard fee and then provid­ing a discount. Discounting merely hints to the client that the veterinary practice’s services are overpriced. Bundling these services into one line-item fee enables the practice to set an appropriate fee for the group of services, which may allow a lower total fee than if the fees are individually itemized and are perceived as too much by the client. It is always better to adjust fees to an acceptable level and still provide “best care” whenever possible. When procedures start to be deleted because of client resistance to the total fee, quality medicine begins to suffer quickly. This group of bundled services may then be lumped into one total fee and the package given a separate treatment computer number. The total fee is the same as it would have been with some discount given at the bottom of the invoice, but this strategy avoids the flavor of being merely another retail outlet. It is important to look at long-term prac­tice revenues rather than short-term gratification. The key is to keep pets healthy and coming back for years to come.

The fee charged for individual components of ear problems must be based on client perception of the importance and difficulty of each service. Some of the line items include examination, cytology, cultures, cleaning, flushing, biopsy, sedation, corticosteroid injections, antibiotic injections, and medications dispensed, including pain management. The practice manager must look at the total as well as the indi­vidual line-item fees and make a determination as to what is acceptable to the client to maintain a high level of compliance with recommendations.

Fees must always be related to value. Clients should always leave with tangible evidence of the intangible services provided. Examples would be client handouts, pet examination report cards, pictures of the individual pet’s problem, and brochures. If clients are to return, they must perceive the services as worth the fees charged. Unfortunately, clients constantly reevaluate everything they encounter while visiting the clinic, and the sum total of these evaluations determines the overall practice’s image of competence and compassion—and it continues to improve or decline on every new encounter.

Remind Clients! Clients hate making hasty decisions. Spending money causes the same stages as the death of a family member: anger, denial, grief, acceptance. Even a pet’s chronic renal failure may be an acute diagnosis to the client—which requires time for mental adjustment. Some tips for better compliance include the following:

• Go slowly. Give the client time to weigh the potential disadvantages of not accepting the recommendations.

• Give the client a reason to act promptly, such as better chance of complete resolution.

• Show the client how the pet will benefit, such as pain resolution.

• Show the client how he or she will personally benefit (healthier pet, lower future costs).

• Detail the consequences of noncompliance with the recommendations.

Today’s client has an absolute right to be demanding. It is important that all staff members understand that every client must always be given the opportunity to provide the best care available for their beloved family member. Sometimes financial constraints do not allow all pets to receive this highest level of care. We must, however, always be thankful that every client and pet encounter gives us an opportunity to recom­mend the best course of treatment. Clients unable to accept this “best care” level should not be made to feel bad but rather given options for treatment. In my own practice, the first option is to finance the difference in “best care” and “OK” care. If the client can pay at least a significant portion of the total fee, it may be wise to consider financial arrangements. Financing will always be more profitable than discounting. The sad fact is that we all discount every day by not charging what our human-care counterparts do for anything we do! Veterinarians should make medical decisions, not financial decisions. Clients do not pay us to be financial counselors. Whenever we do not offer the best, we are prejudging the value of the particular pet to the client—and we do not have the right to do that.

Computer searches of the practice’s client base can produce lists of patients with past otitis problems that can be targeted for marketing efforts. Even offering compli­mentary rechecks of this client base can result in significant findings of additional pathology, allowing the recommendation of additional services and products. The real key is simply finding a way to get these pets presented for examination—which is then followed by thorough medical history-taking and comprehensive physical examinations, with the goal being to discover every potential medical problem with every pet every time it is presented. After the problems are found, a commitment to assertive marketing is essential to help pets live the longest, highest-quality life possible.

Follow Up! It is surprising how many veterinarians are willing to allow a client to spend large sums of money on ear diagnostics and therapy but then rely on the client’s impression of the response to treatment. A phone call to the client to check on the pet’s progress in 24 to 48 hours impresses the client by reflecting a caring attitude and stressing the importance the doctor places on complete resolution of the problem.

Clients respond better when they are treated nicely from the start and are made to feel that they are an important part of their pet’s future well-being. Scheduling and charging for follow-up examinations and diagnostic testing greatly enhance the client bonding rate to the practice, build client trust, and ensure administration of appropriate therapy. Staff should always schedule the recheck appointment and ensure that needed reminders are entered into the computer before the client leaves the clinic. The veterinarian should also consider sending reminder notes to clients for proce­dures recommended that were not accepted at the time of the initial diagnosis and recommendation. Patients with severe wax accumulation in the ear canals should receive a reminder for rechecking and ear flushing at an appropriate interval. All pets receiving long-term medications should receive periodic rechecks.

Become Creative! The practice wishing to improve or grow the practice should consider the following strategies:

• Plan a staff meeting to discuss ear care and ask staff for ways to improve compliance.

• Write an article for a local newspaper on proper ear care.

• Position the clinic as an ear care clinic.

• Place messages on the outside marquee reader board to generate questions about ear care.

• Develop relationships with local groomers and other pet care professionals to increase the number of referrals for ear disease.

Why is client compliance with ear care recommendations so low?

• They do not perceive the significance of catching problems early and treating them to get complete resolution.

• They do not realize that the normal ear anatomy predisposes pets to external ear disease.

• Clients often do not recognize the early, subtle signs of pain from ear disease.

• Clients have financial issues. Sufficient money is most likely not the problem but rather the client’s priorities in spending discretionary funds. Your goal is to raise that priority through client education.

• Fear of anesthesia. Clients do not understand the advances in anesthesia safety of the past few years. Everyone must be careful not to create unnecessary anxiety by overemphasizing the “risks” of anesthesia required for appropriate treatment. Clients must definitely be informed of the inherent risks of all anesthetic events and appropriate consent documentation completed, but they should also perceive that the risk of anesthesia is much less than the damage an untreated ear infection can cause. Consider using the term sedation rather than anesthesia, when deep surgical planes of anesthesia are not needed. Emphasize all the precautions, such as vital-sign monitoring, that are performed to make the procedure as safe as humanly possible.

• Owner forgetfulness of the recommendation. It pays to develop a system of consis­tent reminders for needed procedures.

Marketing ear care is one of the most professional services a veterinary practice can offer. Clients perceive the veterinarian as the pet health care professional. We must not disappoint them. More ear disease is missed because we don’t look than because we don’t know. We must look for it consistently and thoroughly in every pet presented for examination. Current estimates are that 15% to 20% of all canine patients and 4% to 6% of all feline patients presented have some type of ear abnor­mality. A little quick arithmetic reveals that the income potential for marketing ear care is not insignificant:

Typical client base: 2500 canine patients + 1000 feline patients = 3500 patients 10% to 20% of canine patients with ear disease = 250 to 500 patients 4% to 6% of feline patients with ear disease = 40 to 60 patients

Total possible patients = 290 to 560

Minimum services needed and suggested fees to perform thorough ear

examinations:

Office visit and physical examination $35

Ear swab and cytologic evaluation $22

Sedation and reversal $35

Ear flushing and suction $28

Total $120

NOTE: The potential income from examination and minimal treatment only is $37,700 (290 patients) to $72,800 (560 patients).

Add fees for any other treatments, drugs, additional testing, surgical procedures, follow-up visits, and so on, and the income stream continues to increase substantially.

There is probably sufficient ear pathology in our current patient base to keep a veterinarian busy full time. The real question is whether practitioners are willing to dedicate themselves to examinations thorough enough to find all the problems pres­ent and then have the time needed to educate the client so that every recommendation is borne out by an educated decision by the client. Assertive marketing is nothing more than providing all the facts and benefits of the recommendations in such a way that the clients desire to accept those recommendations. Assertive marketing requires persistence, consistency, passion, and credibility. Veterinarians who maintain the trust of their clients see a high level of compliance in the acceptance of recommen­dations. That is all there is to successfully marketing high-quality ear care in the veterinary practice.

It is the veterinarian’s professional, ethical, and moral duty to recommend every­thing the pet needs. Never assume that the client is aware of all the services the pet needs or you can provide. Good medicine is great business!