Consultation Style: Are You Following Best Practices?

Veterinary schools have shifted consult emphasis toward a client-communication model (ie, Calgary-Cambridge model). In this study, 48 private practice consultation video recordings were reviewed for content and timing and then coded to create structural consult models. There were 3 appointment types; new appointment or presentation, recheck, and routine. Appointments largely involved dogs and cats (66%), female owners (71%), and female veterinarians (60%). Mean appointment length was 11.45 minutes (range, 4–28 minutes), with problem and recheck appointments requiring 14 and 13 minutes, respectively. Most appointments took an iterative approach that led to 71% exceeding necessary history-taking. An increase in time budgeting is needed, so that the client has informed consent and cost estimate. In addition, history and physical examination were often interwoven as the patient’s history was developed. Although veterinarians adapt to iterative methods of consultation, it is not clear that this improves appointment outcomes related to client perception and appropriate diagnoses.

Commentary: This study evaluated how closely appointments adhere to the client-communication consult model taught to students. Similar to a previous study of consults, general practitioners overlap portions of history-taking and physical examination to create a flow to the appointment that does not follow a standard template. Although these consults frequently ran several minutes longer than the time allotted, the study design could not evaluate clinical outcomes of this approach. It did, however, note that some appointments involved nonpertinent discussion and others were punctuated by veterinarian absence; in these cases, client-communication strategies might have been beneficial. When considering the components of appointments, it is extremely cost-effective to record or film the team and perform self-evaluations of appointments. Examination styles are highly personal, but good communication has similar underpinnings, regardless of how one practices.—Ewan Wolff, DVM, PhD

SOURCE: The structure of the small animal consultation. Everitt S, Pilnick A, Waring J, Cobb M. J Small Anim Pract 54:453-458, 2013.