Estimated reading time: 9 minutes
Yesterday I had the privilege of spending the afternoon at one of our VetBilling partner clinics. When I’m there, I have the opportunity to see how challenging it is to work with veterinary clients from all walks of life, and from a wide variety of socioeconomic backgrounds.
A situation occurred with one of their longtime clients, and I’m sure it’s a familiar scenario that plays out in veterinary hospitals all across the country, every day.
The pet owner made an appointment for her adopted beagle/terrier mix after noticing that she was rubbing her right eye and had noticeable redness and sensitivity in the area. One of the associate veterinarians examined the dog and recommended very standard diagnostics: a corneal exam, a fluorescein stain, and tonometry (checking pressure within the eye.) The client consented to all of these recommendations.
The treating veterinarian diagnosed a corneal lesion, and advised the owner that her dog would need some topical anti-inflammatory eye drops, along with some pain medication. These are standard and reasonable recommendations, and again the owner did not decline.
When the owner went to check out after her dog’s exam was completed, she had a bill of around $250. At that point, she told the client service representative that she hadn’t realized it would cost that much, and she only had $80. That left the vet team scrambling to accommodate the situation, so in-house prescriptions were changed to written prescriptions that the owner could have filled elsewhere (presumably for less money), and there was a sincere effort to negotiate a financial solution that was workable for everyone.
When the treating veterinarian heard about this, she was understandably distressed. What had she missed? The client hadn’t explicitly expressed any financial concerns during the exam. She didn’t ask how much the diagnostics or the prescriptions would cost. She didn’t say anything at all.
Until it was time to check out and pay her bill.
I spent some time talking to the vet, who was truly baffled and feeling somewhat guilty because she didn’t see this coming. Of course she didn’t! She was busy examining the dog’s eye and worrying about the extent of the inflammation. At the same time, she was listening to what seemed to be a lot of extraneous, unrelated information coming from the owner.
The Subtle (and not-so-subtle) Clues That Clients Drop
Upon discussing the whole scenario after the fact (and reminding ourselves that hindsight is 20/20), the vet and I were able to identify a few clues that could have prompted a brief, explicit discussion about the client’s finances, which might have prevented (or at least prepared the team) for the surprise “I only have $80 today” at checkout.
Before I even get into the clues that were dropped by the pet owner, let me emphasize that the vet did absolutely nothing wrong! But our discussion highlighted some key areas of learning and communication skills development that could mitigate such situations in the future.
The vet told me that while she was examining the dog, the owner talked almost non-stop about her current life situation as well as a family member struggling with an addiction…and she also casually mentioned that she had just lost her job. The mentioning of a job loss was clue #1 that this client might have financial limitations.
As the exam progressed, the vet advised the client that if her dog’s eye didn’t improve within 24-48 hours, she should seek a consult from a board-certified veterinary ophthalmologist. The client responded by saying that she couldn’t afford to see a specialist. That was clue #2.
These clues offered by the client were actually subconscious invitations to directly address financial concerns right then and there in the exam room – but these weren’t obvious and they weren’t explicit. The vet shared with me that most of her clients with cost concerns will ask her multiple times throughout an exam, “how much will this cost?”
There are probably many more clients, however, who are worried about finances but won’t ever say so directly. There are any number of reasons for this, but just a few include embarrassment or shame over their financial situation; being too proud to mention their concerns (which is related to embarrassment); and fear of being judged by an authority figure (the vet) if they are candid about their financial limitations.
None of this is meant to excuse clients and allow them to dodge responsibility. But humans are complicated, and all sorts of behavioral factors interfere with clear, candid communication – especially when it comes to money, which is fraught with psychological baggage for many people.
Listening for “Openings” to Address Financial Concerns in Client Conversations
Learning how to “listen for openings” in client conversations can help identify those who aren’t comfortable stating their financial concerns outright. But it doesn’t come naturally to most people to listen for these openings. To make matters more difficult, vets are attending to a host of issues while the pet and client are both in the room, and one’s attention can only be directed to so many things at once.
Many of us assume we are listening to others when in fact we aren’t – we are too busy thinking about our response to what is being said, or attending to other dynamics unfolding in the situation. So it is definitely a skill that must be learned, but the payoff for learning it is that we have more productive conversations and can identify potential issues before they erupt into full-blown problems.
Here are a few things you can listen for in client conversations that can clue you into financial concerns, even if the client never addresses it explicitly:
- Mentioning a recent job loss, as the client in this situation did.
- Talking about other financial setbacks: divorce, death of a spouse, eviction, a large tax bill, even the recent breakdown of a vehicle or large appliance.
- Discussing personal medical problems/treatment.
- Discussing family challenges that may have financial implications: addictions, hospitalizations, legal problems, child going to college, etc.
We all know that clients talk about all kinds of things when they are in the exam room. I’ve often remarked that it sometimes seems like their whole life story tumbles right through the door with them! That’s because most people can’t just detach from whatever is going on in their life, especially if it is causing them stress. Another reason they talk about these things in your clinic is that clients perceive their veterinarian as a “safe person” and an ally with whom they can share “off topic” matters.
It’s absolutely impossible to attend 100% to every single thing a client says while they are in the exam room – but if you can train yourself to listen for certain key openings that may flag a financial concern, taking a moment to address it then and there may be the best way to head off the “I don’t have any money” dilemma at the time of checkout.
This doesn’t have to take up lots of time, and it doesn’t need to turn into a long, involved conversation. You can simply say something like, “I noticed you mentioned that you recently lost your job. Given what we need to do with your pet today, do you have any financial concerns that you would like to talk about?”
If the client says yes, you can then ask if they’d like a written estimate for their pet’s care plan, if they’d like to discuss ways to keep costs down, or if they’d like information about your clinic’s available payment options.
This also doesn’t have to be a discussion that’s initiated by the veterinarian. Vet techs and assistants can be trained to take over these conversations, although it is likely that the veterinarian will be the first to identify client financial concerns. At that point, a tech or assistant can be directed to present an estimate to the client or discuss your clinic’s payment options.
Take-Home Message: Learn to listen for openings in exam room conversations that may point to financial limitations. Many clients won’t express such concerns directly, due to embarrassment or fear. If you hear a key opening, it takes less than 30 seconds to sensitively address it by asking if the client has financial concerns they’d like to talk about, so together you can figure out the best strategy for getting their pet appropriately treated.
Most important, be gentle with yourself if you miss these clues. It’s a learning process and it takes time. You won’t catch everything, of course, and you aren’t a mind reader (nor should you be.) But if you hear something that sounds like an opening, just ask the client directly and compassionately.
The earlier that client financial limitations are identified, the better the outcome for the pet, the owner and the clinic. You can then begin strategizing and formulating a financial plan before the client reaches the front desk to check out and says “I only have $80 today.”
What are your experiences with similar situations, and how have you handled them in your own hospital? I’d be interested to hear your feedback.
Stay tuned for our next blog post, where I will address the other side of the coin: Why (and how) pet owners should bring up financial concerns and budget constraints right away, making it easier for their veterinarian to assist them.
P.S. Why am I even talking about this? What qualifies me to talk about listening skills? Well, for one I know how hard it is to effectively listen! Before co-founding VetBilling, I worked as a pastoral counselor. During my graduate school training and internships, I had to learn how to listen, even though I thought I already knew how to do it! One of the key things I was taught by my professors and clinical supervisors was to listen for “openings” that come from the client – people often skirt around issues that are difficult and painful and won’t bring them up explicitly – but they almost always drop “clues” that are like a door cracking open just a tiny bit. It was my job as a counselor to learn to listen for and catch those tiny openings, and to get the client to open the door a little bit more by sensitively asking a probing question.
Suzanne Cannon, M.S., M.A., is the co-founder of VetBilling. She previously worked as a pastoral counselor and hospital and hospice chaplain. Suzanne has had dogs throughout her life, and has always loved and ridden horses. She finally found her way into horse ownership in midlife, and she currently has a Clydesdale/Thoroughbred cross named Chase. Suzanne is also mom to two dogs, a miniature schnauzer named Finch and an Otterhound named Scout. She lives in Westminster, Maryland.
Suzanne is available to speak at practices, conferences and seminars about this topic and many others related to client financial concerns and overcoming the cost barrier to veterinary care. Please contact her via her personal email, firstname.lastname@example.org, if you are interested in having her speak.