of the disease process: a fractured maxillary fourth premolar causing facial swelling despite having been painful for a number of months/years; halitosis becoming unbearable for the owner; advanced periodontitis leading to pathologic jaw fracture.
2.2 Compliance
In order to provide a proactive approach to oral and dental care in pets, we must take action before the disease process starts. To achieve this, our clients must be compliant with our recommendations. Compliance essentially describes the act of agreeing to and obeying a certain proposal. Medically, it can be thought of as the extent to which a patient’s behaviors coincide with medical advice (e.g. taking medication, making lifestyle or dietary changes) (Evangelista 1999). Veterinary compliance describes the percentage of pets receiving a treatment, screening, or procedure in line with current accepted veterinary healthcare advice (AAHA 2003, 2009). Adherence describes the extent to which clients administer prescribed medications at the correct dose for the correct time, completing the course and refilling any long‐term prescription (AAHA 2009). In veterinary dentistry, we would like to see both compliance and adherence at various times: booking a pet in for assessment and treatment under general anesthesia after we have made a recommendation; giving medications for treatment; performing preventative home care; possibly making dietary changes; and attending re‐call appointments/treatments.
The traditional concept of compliance, however, may be described as being paternalistic: the health professional gives the patient/client instructions that they must follow, and can label the patient/client as noncompliant when there may be many reasons why they are not complying. The side‐effects of a particular drug might be too unbearable for the patient, so they do not complete the course of drug. By definition, they are noncompliant. An elderly patient with arthritis might not be able to remove the lid of a tablet container in order to take their medication. Therefore, again, they are noncompliant.
Relationship‐centered care is a new concept in healthcare, which emphasizes the bond between client and veterinarian and between client and pet, and involves a negotiation of outcomes, allowing the client to voice concerns while ultimately recognizing the position that the pet plays within the client's family (Shaw 2006) (Figure 2.2). This shared approach to decision‐making may be termed concordance.
In an American Animal Hospital Association (AAHA) study into compliance in 2003, practice teams felt that simply giving information about a service was enough for clients to accept their advice and follow through. Estimations of compliance levels were higher than actual values (54% vs. 35%). If the client was noncompliant, it was the client's failure, and was probably due to the anticipated cost. Clients’ perspectives were very different, however. Cost was not seen as a barrier to compliance, but rather the failure to make a recommendation or the failure to explain the importance of the recommended treatment. In addition, had a follow‐up call or reminder occurred, clients claimed they would have been far more likely to follow the advice.
In 2006, a task force consisting of health industry providers, healthcare professionals, and associations gathered to assess companion animal practice growth amidst industry struggles. The research focused on the effect of the bond between client and pet and client and veterinarian in terms of the care that the pet received (Lue et al. 2008). It was shown that the greater the bond between client and pet, the higher the level of care expected, regardless of cost. In addition, clients with strong bonds with their pets visited the veterinarian more often and were more likely to seek preventive healthcare.
Owners were likely to display stronger bonds to dogs than to cats, resulting in more frequent clinic visits for dogs (Figure 2.3). Cat owners, however, were likely to be better educated and more researched about their pet's disease. In multi‐pet households, dogs were more likely to be taken to the veterinarian than cats. It is important to acknowledge and not judge these client–pet bonds. The veterinarian should enquire about other pets in the household and make recommendations for examination of any cats.
The bond between client and veterinarian is positively affected by good communication, interaction with the pet, and ability to educate. Clients who feel their veterinarian communicates well are more likely to follow their recommendations. This includes thorough explanations and recommendations, which increase the client perception that the veterinarian is recommending something that their pet needs. Cost was not cited as a barrier to following a recommendation in the AAHA study. The things that contributed to poor compliance instead included confusion, misunderstanding, and uncertainty. Clients may not have felt that there was a need for treatment, or were not made aware of the value of performing a procedure.
Figure 2.2 Client–pet and client–veterinarian bonds.
Figure 2.3 Example of a human–dog bond, with humanization efforts.
The effect of veterinarian–client–pet interactions on adherence to a dentistry recommendation has also been studied (Kanji et al. 2012). This research assessed whether relationship‐centered care and client satisfaction were positively associated with client adherence. Overall, the odds of a client adhering to a clear rather than an ambiguous recommendation were seven times greater. Adhering clients were shown to be significantly more satisfied following an interaction. The emotional tones used by the veterinarian also had an impact. Sympathetic and empathic tones were more likely to result in adherence than hurried, angry, nervous, or dominant tones.
2.3 To Sell Is Human
In Daniel H. Pink's To Sell Is Human (2012), he argues that we are all intrinsically designed to be sellers. That is, we are hardwired to motivate or persuade someone to take action. He describes how one in nine people in the United States work in sales. The other eight, however, work in a non‐sales selling. As a medical profession, we are involved in non‐sales selling every day, whether of vaccines, a worming protocol, a diet food, a pre‐anesthetic blood test, dental treatment under anesthesia, or tooth extraction. We need to persuade people to take action based on our recommendations.
Rather than selling the client something that they or their pet does not need, we can instead use evidence‐based veterinary medicine to guide us toward such recommendations (Schmidt 2007).
2.4 Making Persuasive Recommendations
Persuasion is the act of inducing someone to do something via reasoning: motivating them to take action. This could be going on a dinner date, attending a conference, or buying (and reading) a new veterinary dentistry textbook. Persuasion relies on a sense of trust, a display of empathy, and a logical argument (Borg 2010).
2.4.1 Trust
Trust in the medical profession has been widely studied (Hall et al. 2002). It may be displayed as trust in the profession or trust in a particular clinician. The latter involves confidence in their competence and belief in their honesty. Displaying professional qualifications and thank‐you cards in waiting and consulting areas can help to strengthen a client’s feelings of trust (Figures 2.4 and 2.5). However, the decision on whether or not to trust someone is based very much on gut feelings.