Client Relations And Access To Care Including The Importance Of Utilization Of Telemedicine In Veterinary Medicine

Host: Hello everyone, welcome to the veterinary business podcast, your ultimate resource for developing a successful veterinary practice and career. I am Narayan Arul Rajah, the founder of the veterinary business podcast and one of the co-hosts. On this podcast, we bring you insights and expertise from industry leading doctors, experts and taught leaders. We cover a wide range of topics, including practice management, marketing strategies, leadership development, HR best practices, and much more. Whether you are a practicing veterinarian, a practice owner, a practice manager, or a student studying to be a veterinarian, this podcast is tailored to help you navigate the challenges and opportunities the business of veterinary medicine. Every lesson of this podcast is to welcome to visit the website veterinarybusinessinstitute.com for additional resources, tools, and support to support your growth. And remember, you can also subscribe to our podcast on iTunes,

Host: Google Play, Spotify, and other popular podcast platforms. Today, I'm excited to talk to Dr. Sheryl Good, Chief Veterinary Officer at the Bridge Club. Our topic is client retention and access to care. And we are going to be talking about the utilization of telemedicine in veterinary medicine. Let's jump in. Before we get started, Dr. Good, why don't you take a minute to tell us a bit about yourself. Who are you? How did you get into veterinary medicine? Tell us your story. I don't know if we have enough time for all of that, but I'll try. So I am a small animal practitioner in Michigan in the United States. And I've had a 35-year career so far and I say so far because I have just recently retired from my day job, if you will, as the Chief Veterinary Officer, Chief Veterinarian at the practice that I used to own that I built. I had sold it a couple of years ago, but I got started in veterinary medicine. As a young child just loving animals, saying I always

Host: wanted to be an animal doctor. It's the same story for so many of us who love animals and who got into this career. But I went to school at Michigan State University and became a small animal practitioner in Michigan in Dearborn, Michigan. Worked for someone else for about seven years and then decided that I would like to own my own practice and treat my team a little bit better than my boss had treated all of us. I was very much of the thought that if you have a happy, healthy team that is going to pass on to the clients to make our clients happy and healthy and just helps the whole atmosphere of the practice and how you are able to take care of your patients. So I was able to build my own practice. I purchased a practice back in 1995 and then by 2003 we outgrew our tiny little building and we were able to build a larger building and move in in 2003. And then like I said, I am recently retired from that practice. But of course, very involved with the

Host: veterinary industry in many different ways, committees, boards and with the global committee too because I'm on a wasabi board, the world's small animal bed association. Thank you. I have two follow up questions on your background. I mean I'm kind of starting to move into your phase in the sense my kids are growing up, my youngest is about to go to college. So my wife and I, you know, we are like, what do we do with our lives? Because all this time we saw ourselves as like caregivers, like my mom was living with us until like a couple of months ago and and of course our kids. Now all that is changing and the kids don't need us anymore. So how did you make that transition as you went through life? You know, like, well, you know, as a mom or, you know, family, how did you kind of navigate that? So I remember, you know, thinking to myself, you know, when I was young, you know, I'm gonna, I didn't even need to have thoughts of marriage and children. Of course,

Host: I knew that probably would have happened, but my whole thought was, I'm a veterinarian. I'm going to be a veterinarian and that's all I'm going to do right. But of course, I got married, I have three children and so as I was practicing, I still made my children and my husband and my family, you know, a big part of my life and made sure that, you know, I was paying attention to them. Hopefully, as much as I was paying attention to my patients and my clients, of course, as they grew older, I don't feel that they didn't need me anymore just in a different way, right? Because, of course, you, when the children are living with you, you know, they really depend on you a hundred percent, but then as they move on and go to, you know, college or fine jobs, they, they still depend on you to be that, to be that back up, to be that listening ear. So yes, you're not as focused on their day to day, right? But you're still a parent. And, you know, now, you know, I also, my mom didn't

Host: live with us, but she had cancer to the last couple of years of her life. She passed two years ago. And it was really at that time when I said, you know, I, I really feel I need to step back from the day to day private practice life. I need to spend even more time with my family. And in the meantime, my children were getting married and now each kid has a kid, so my grandma. So I wanted to spend more time with the family, but never did I want to stop being active in the veterinary industry, because that is my passion. So I wanted to be able to, you know, give back, if you will, by helping with animal welfare and, you know, have a big passion for helping, you know, our clients to be able to, you know, get care for the animals and in any way possible. And of course, one of my huge passions now, and in the past several years, has been telemedicine and I'm on the veterinary virtual care association board, which was one of the founding members

Host: of that particular board to, you know, help our veterinarians and our veterinary technicians really understand that that can, you know, help practice and help our clients. That's brilliant. Thank you. So what I'm hearing you say is, you really took some time to think about what's important to you in that stage of your life. And then, of course, the answer was, you know, being having more time for kids, grandkids, family, and then of course, going back to what you're passionate about as a little girl, you know, helping animals, but hopefully doing it in a way that's very impactful. Not necessarily just as a practice owner, but in a much larger role, like as a leader, as an influencer, as a, you know, a person who's kind of charting the path in terms of like new ideas and new ways of doing things like telemedicine, for example. Do you think about your time in any way? Like, do you say, I'm going to give so much of my time here? Oh, is it just fluid? It's just,

Host: you know, like, these other things I care about and then you just, yeah, for me, everything's pretty fluid. I've never been one to structure, you know, my time in that way. I always, and some people maybe thought that I was doing too much at once, but it just always seemed to work. I just, you know, I'm just available for whatever needs needs to happen. How do you give time to yourself, like self-care, but it's, you know, exercise, eating healthy, traveling, just taking a break, is that something you plan for and like put into your calendar or you tend to ignore that? No, actually, I used to not plan for it, but, um, no, I'm a big foodie if you will. I love food. I love drink. I love getting together with friends and family in that way, and I'm a, I love travel. My parents instilled this love of travel in me since I was a young child. They took us all over the United States. They took us sometimes overseas. And I do have relatives all over the

Host: world, so relatives and now friends being in the global veterinary part of the global veterinary community. I have so many friends all over the world. So that's one of the things I'm really excited about in, in my, yes, I'm your retirement, if you will, is doing more travel. And of course, with traveling, you do sort of have to plan for that, right? It's not something that you could, I guess I could do it for the moment now that I, I'm retired, but I also have a commitment to one of my grandchildren that I've maybe said her twice a week. So then I have to plan if I want to just drop in. Yeah, that's awesome. Thank you for that. Let's just jump into the topic, which is client relations and access to care. Of course, we're going to touch on telemedicine in the context of that. What do you feel is one of the most difficult issues plaguing pet owners today? Well, you just said it access to care. You know, at this time, and it's not just, you know, I'm in the United

Host: States. So, you know, so many of my, you know, colleagues and team members, it's hard because there is, there seems to be a shortage. There is a shortage of veterinarians in practice. There's a shortage of veterinary technicians in practice in the US, but, but I'm also hearing the same all around the world. I heard from a veterinarian in Australia. They don't have enough veterinarians. I heard of it from a veterinarian in London, same thing. So, that's one thing. So, we don't have enough, we don't have enough bodies. You know, good bodies in the field to be able to take care of all of the pets. And since COVID, the number of pets in households has, you know, probably. Yeah. Yeah. So, that's a problem. And because of that, you know, the biggest problem in my mind is access to care. You know, how do our clients, how do people find the way to get care for their animals? You know, the right now, I, my, the practice that I was, you know,

Host: working at that used to be my practice. We were booking out for a normal routine appointments about three or four weeks. You know, I'm no longer practicing there. So, they went from three to two doctors. And I'm sure they're booking out even farther for routine appointments. You know, they have a few emergency slots available. It's a day practice done in emergency practice. But it's so difficult to be able to get all of the patients in when you need to see them, you know, hands on. Right. You're very creative. So, let me just throw a kind of a real situation. Actually, so we, we on Merlin, he's a shelter. He's 10 years old. And there's been three or four times where something lying on the floor eats it. And then my daughter's got nuts and they take them to the emergency. And it's a really, really painful process. Usually, a waiting three for hours, waiting in the car. They want to even let you in. They'll call you

Host: within the car outside. So, that's one case. And then he had some kind of a health issue where he was there was some bleeding in his nose. And nobody could find out for like three, four times you enter three for veterinarians. And finally, they ran a bunch of tests and told us, he has cushions disease. And now, I guess, he's getting medications for certain things for pressure and cushions disease. It's really tough. I mean, not tough, but it's not very inconvenient. It's very, like, you know, you're just stressful. Like, this whole experience as a pet owner. So, how do you think some of your ideas could help? Like, in those two examples or two situations that I just share? I mean, for example, you know, tell me medicine, for example. Yeah. So, I think that telemedicine any type of, you know, teletriage, telehealth. Those, those things are so important because, you know, in your case, where, you know, say your baby picked something out before, you know,

Host: and you want to just go rush to have the baby seen. Well, or any other circumstance, you could, you know, either phone a telemedicine, you know, company, teletriage company, or if your veterinarian had, and, you know, a telemedicine app, which is what we, you know, at my practice, we had a telemedicine app, where you could text, you know, and, and, you know, say, this is the problem. You know, is this something I need to worry about, and then you could engage, whether you're engaging with, you know, veterinary technician, or you're engaging with someone else in the practice or someone else in the company who, you know, can guide you through all the questions that you have and put your mind at ease, either yes, you should go to the ER and wait those three or four hours, or no, here's some things you might be able to do, and if that doesn't help, then, you know, you would need to go and do an in-person visit.

Host: Yeah, I think you absolutely right. I think he was not even a baby anymore. He was like a big dog, but still my kids were going nuts because I guess they didn't know like it's just the unknown. Once one time he hit a door, so they were afraid that's going to balloon inside, and maybe it was a real problem, but then he would eat two grapes, three, you know, certain things that he's not supposed to, and the kids with the toys are going to die, I mean, and then they're so fond of him, so they drop everything, and so I guess it's nice to, I agree, that makes ton of sense, like having somebody to talk to, somebody on most stuff. I mean, right now we just rely on Google, but nobody trusts Google even though Google says, you know, no big deal. Yeah, you have to be careful when you're Googling, because you know, if you're getting an accurate portrayal of the problem, right, and it could make you even more

Host: nervous for us, right? Thank you. Usually they'll be like, oh, except for these situations, oops, we don't know what that is. Yeah, and I, you know, just one example for me, and this was not, you know, on the other side, you know, the veterinarian of veterinary technician should be able to be paid for their expertise, right? They shouldn't just, you know, you shouldn't be able to just call willy-nilly and be able, because they're so busy, right, and get answered, but just one example, I have just a friend of mine, and I'm totally, you know, happy to answer calls or text. They, they called because they were just so frantic, they're, their dog ate some chocolate, and, you know, they just didn't know, you know, is this something I have to go to the emergency for, right? And so I was just very quickly able to do a calculation with this very large, very large dog who ate a very tiny bit of, you know, and thankfully, not baker's chocolate,

Host: because that's, you know, high in high in chocolate, the theory of roaming, but that, you know, a very large dog ate a very tiny bit of chocolate, so I was able to let them know this shouldn't be a problem. You don't have to go to the emergency. The baby may get an upset tummy, might vomit, might have a little diarrhea, but it's not going to be a severe issue, so you can just, you know, watch them. So in those kinds of situations, it's good to be able to, you know, certainly, be able to call, you know, either your, or text, you know, at your own vet, who may have a tell a medicine, you know, part of their practice, or a tell a medicine company. And these kind of questions could be answered by a tech, right? You don't need a bit of anything like you don't need a veterinary to answer that question for sure. And that's, it's very important, another, another great way for maybe some of the technicians or inventorians to be able to

Host: to practice would be in these kinds of situations. If maybe you want to be a stay at home mom or a stay at home dad, but you still want to practice, you know, veterinary medicine, either as a veterinary technician or a veterinary, you could, you know, do this type of work without having to go into the hospital. And I'm not saying that, you know, I'm certainly not saying that there isn't a need for hands on, because of course you can't diagnose so many things without being able to lay your hands on the patient to be able to, you know, you blood tests and your tests and all of those kinds of things and take x-rays. So, you know, there is a need that is the gold standard for diagnosing many, many things, but, you know, you could send a picture of, oh my gosh, my dog has a lump. What is this? And it turns out to be a tick. That could be a picture, right? You could send a picture and you don't have to bring it up, you're ped in for something like that.

Host: I mean, from my perspective, the poor hours, the $400 for non-nissue, I bet even the telemedicine is 100 bucks. It's still worth it. I mean, you know what I mean? It's priceless just because the amount of time and everything else you go through. The second example I shared with you, which is he was, he was, you know, something that blood was coming out of his face and then, like, we had to go to multiple doctors to figure out what was going on. And these regular doctors, they were not especially, so they didn't know what was going on. So they would just, I don't want to say waste a lot of time, but we were just spinning our wheels and there's no guidance. How would you solve that problem? Do you see that happening a lot with, like, most practices, or is it maybe ours as a unique case and maybe it's not true? Yeah, there are, you know, medicine is not an exact science and the presentation of bleeding from the nose, pushing disease wouldn't be the first thing

Host: that I thought of either, right? So there's a lot of things that run through a veterinarian's mind when they're presented with an animal that's bleeding from the nose. So, you know, certainly taking that baby to you, to the, to a day practice, you know, like what mine was the first, first veterinary and if you will, to do a really good exam, a thorough exam, you know, do blood work to make sure that the dog doesn't have a bleeding problem. And then from there, at least in, in my hands, if I'm not able to make a diagnosis, then I do refer to a specialist. So, and a specialist, in this case would be like an internal medicine specialist that they may have to do more in-depth testing, they may even have to do, you know, scope, you know, where they have to scope, the nose or do a CT of the nose to find out why we're bleeding. One, I mean, you know, cushions disease is usually diagnosed by a blood test. But it's a special kind of a test, right?

Host: Usually, nobody would think of running that test. Well, if, you know, I would have thought about running a cushions test if they're showing symptoms like, you know, drinking a lot, peeing a lot, panting a lot, losing hair in certain areas, getting a big pot belly. Those are the common signs. But if, you know, when we do, we take blood pressures, if the blood pressure was elevated, that could give us an idea, oh, that we have bleeding from the nose and the blood pressure is elevated, it could be cushions. We better check that. So that's, we do check for cushions disease in our practice. But, you know, again, bleeding from the nose is, is a, not a common sign. So it may not be, you know, the first that may not have thought of that, and they would have had to send you a specialist. And the big part of this is also educating the, the, the, the, the parents, right, the pet parents or the, because a lot of times we had no idea

Host: what's going on, doctors typically don't explain what, why they're doing what they're doing. So we're just, you're like, you feel even more lost. I mean, even when you rush that dog, because he had chocolate, just because you don't know what you don't know. And then you really have to plant relations is, is so important because your clients are those pet parents, right? They, they care for them like they're their children. And so you have to be able to have a good rapport and be able to communicate with them in a way that they understand. And that's really, at least when I was in school, they didn't teach us how to be able to communicate to build those relationships. So I feel, you know, at least in my case, I'm a people person. And I'm very hopeful that I was able, I feel that I was able to create those relationships by communicating with my, my clients in a way that they, they could calm themselves and really listen to what I had to say,

Host: because you can't just throw big words at people. You know, they're not going to understand all the big words. You have to be able to explain them in such a way that they'll understand. And if you have a client who's very anxious and very upset about what's happening with their patient, maybe it's going to get through to them. So, and you can, if you're really looking at them, you know, you know, you know that they're not getting it. But to be able to then follow up with them, you know, the next day or the day after to, you know, see how they're doing, see, you know, how, you know, if you've made a recommendation for giving medication, see how they're doing with that, because if they aren't able to give medication, then that pet is going to get better. And then they're going to go somewhere else because the pet didn't get better. But that's also something a veterinary technician could do, the follow-ups, right? And veterinary technicians are great at

Host: talking with clients. You know, some clients will talk to the vet texts even more than the veterinary veterinarians themselves. Thank you. So, you talked about access to care, we talked about education, we talked about, you know, telemedicine, they're all kind of, you know, part of that, right? So, how can the veterinary community help? Well, I think we just need to be open to providing more of these things for our clients and recommending more of these things, like telemedicine, teleatriage. And, you know, maybe I have a friend who is a traveling technician, you know, and she'll go into people's homes and help them with treatments and that kind of thing. So, just, I guess, opening up our minds to other possibilities to be able to help our clients you know, a lot of people can't come into the clinic, you know, at certain times either they can't drive or they're sick. Are they live too far away or the dog is too mean or the cat gets crazy.

Host: You know, and it's difficult for them to come into the clinic. So, there's a lot of different ways in which telemedicine, teleatriage, telehealth can help in that way. I think that's one of the biggest help to access to care. Thank you. You talked about telemedicine a lot. And, we, you give some specific examples of how we could help, for example, triage, right? Like, you can triage a lot of non-nergy and situations that could be handled without a visit to the doctor. You talked about possibly follow-ups. So, perhaps, you could use telemedicine for those follow-ups. The tech could follow-up and make sure things are going well. It doesn't have to be a doctor and doesn't have to be a visit. It could be maybe a check-in, right? A lot of this could be done through text, through phone calls, any other ideas to use telemedicine to improve client relations? You know, you could actually kind of dabble in this a little bit. The veterinarian or the veterinary

Host: team could actually host, in this goes along with education, host, you know, Zoom calls. To educate clients about how to clean ears and put in ear medication, how to trim nails, how to, you know, even talk about behavior, right? Because behavior is behavior issues is a very large part of concerns for our clients and for the patients. So, using, using, not necessarily telemedicine, but a teleplatform, if you will, to be able to educate our clients. But with telemedicine, you know, in, in my hands, I was able to relieve some of the appointment burden on my practice by taking on some of those calls that came in as telemedicine appointments. So, for an example, my pet has this rash. I'm really concerned about it. They won't stop itching. I want to bring them in right now. What can I do? You know, we can turn that into a telemedicine appointment where, you know, we guide them to our, because we used an app, you know, a telemedicine

Host: app is a platform. We guide them there. They request a console. And then in between seeing in-person appointments, I was able to, you know, take on quite a few telemedicine appointments, because I'm texting back and forth, you know, and they send me pictures of the issue. I talk about, you know, how is the baby doing generally. And then I key in on the issue. And then I can, you know, tell them all the different things that could be going on. Maybe we have fleas, maybe we have an allergy to something. Maybe we have a cut, you know, that's causing this. And then, you know, as a veterinarian, if this is my patient, anyways, at least in Michigan right now, we can't establish a veterinary, plant, patient relationship over telemedicine, but that's another story that would take too long to talk about. But the, you know, this is my patient. So, I can recommend medication, explain how it works. And then have them come into my practice and pick

Host: some up and get the baby started on something that helped with itching, something that helped with the, with the rash. And then say, okay, we can either follow up here in a few weeks, or we can schedule you an in-person exam in a few weeks to follow up. And that makes a lot of sense. And then we can talk about laws and everything else, but perhaps let's not get in touch with it. How can telemedicine improve wellness and well-being? In my opinion, you know, I was able to do telemedicine wherever I was, right? So, I didn't restrict taking calls to the time of day when my, you know, when the business was open, I would take telemedicine calls, you know, if, you know, I could be sitting at the hairdresser place, you know, getting my hair done. And I can answer my phone, you know, because I can text. If I'm sitting there, getting my hair dried, and I'm texting back and forth with a client, easing their, you know, mind about what's happening. It's just to me

Host: that was a way it made me feel good, helping my client, and then they were able to get me on a Saturday when they wouldn't have been able to get me any other time. But you, but you can, you know, a lot of people I think, you know, you shouldn't be available all the time. Of course not. I wouldn't, you know, if, if I was going to be busy doing something, then no, I would not answer a call. But you can set your schedule, right? If you, it, for the, for the vet tech and the vet who, you know, need, you know, want to be taking appointments, you know, off hours from the routine, 13 hours of the day, and because they want to, you know, be able to take care of their kids, but maybe they want to see patients, you know, tell medicine patients from like 7 in the evening until 11 in the evening. You know, then they can set their own schedule. So I think that that improves wellness because it, they can have family time, and then they can have, you know, when they need it,

Host: right? Not the nine, they wouldn't have to work the normal nine to five. They could be with their family, especially with little children. Thank you so much, Dr. Good. I really enjoyed this conversation about client relations and access to care. Of course, the importance of telemedicine's in veterinary medicine. I really appreciated our conversation. Of course, I appreciate you as a human being and for, and for what you do for to the profession. I also want to take a minute to thank all listeners. We appreciate each and every one of you. We cannot do what we do without you. If you like our podcast, please share it with your colleagues and friends on social media. Also, please don't forget to review a little review press on your favorite podcast platform. Could be iTunes, could be Google Play. Your reviews will help other doctors and practice on as binders. Until next time, keep striving for excellence and making a positive impact

Host: in the lives of your patients and their parents. We appreciate all of you an amazing week ahead. Thank you.