Everyone works out their own way of doing a rehab consult, but I thought I’d share my preferred approach. It’s a system – and I love systems because they make daily life more orderly and more enjoyable. My ideal consult affords me time to gather information, to think and to work co-operatively with my client and the referring vet.
You might find some aspects of my system helpful:
1. Get the history
We must know the patient’s medical history – get this from the referring vet. The history is important because medical conditions such as cardiovascular disease, skin conditions and even cancer can affect our treatment choices.
2. Get the radiograph or MRI report
I always like to look at the radiographs before I read the history. It gives me valuable information – and I like to see what I can discover for myself before I am told!
3. Read the client questionnaire
The client is able to give you the broadest and most detailed information about their pet. I ask them to fill in a questionnaire as they sit in the waiting room. The questionnaire asks the following questions:
- What do they wish to achieve from the consultation? This gives me the opportunity to manage expectations – which are sometimes unrealistic.
- What is their pet’s quality of life, out of 5, currently?
- What motivates their pet?
- What does the pet most enjoy doing?
- Does the pet’s condition prevent them from doing what they most enjoy?
- What supplements and medications are they taking?
The first thing I do during the consult is to observe the pet while talking to the owner. I watch their posture, how they move, how they get up and how they lie down. This gives me a general idea of the pet’s sense of well being, state of mind and areas of discomfort.
5. Evaluate lameness
I then walk the dog in a quiet area where I can do a lameness evaluation. I like them to walk away from me and back to me, while I move to both sides and watch them move. Lastly, I ask them to walk in a circle to the right and a circle to the left. This is a helpful diagnostic exercise, as some soft tissue injuries are exacerbated when the affected limb is on the outside when circling.
I then do an examination, while the dog stands on a non-slip surface in a quiet area with no distractions. I do a full orthopaedic examination and a neurological examination. Some neuro cases can present similarly to orthopaedic cases, and vice versa. I take goniometric measurements of the affected joints and the contralateral joints. I always take muscle mass measurements at the first consult, unless the pet is anxious and overwhelmed.
7. Map a treatment plan
Once I have done a full examination I mentally map my treatment plan and discuss it with the dog’s owner. It is important that he or she understands the goals and how I plan to achieve them. This way the client feels part of the process and is more likely to appreciate the improvements we see in the coming weeks.
I always explain that the plan is not cast in stone; it may vary, depending on the response. If at any stage we don’t see the expected improvements, we will re-evaluate and change the plan, or, if we suspect a complication, refer back to the referring vet. Once a client knows this, they are far more likely to accept any changes I introduce later on.
An example of a treatment plan would be two treatments per week for the first four weeks and then a re-evaluation. If the pet is progressing as expected, we will decrease the treatments to once a week for the following month, and then re-evaluate.
8. Manage expectations
I like to give my clients hope, but one needs to be careful not to create unrealistic expectations. For example, if the dog has been paralysed for four months, it’s unlikely the dog will start walking within one month of treatment. Most clients will accept this if you explain it clearly.
9. Summarise the appointment and the plan
… and give the client relevant information sheets. I like to give out information sheets on all the common conditions, and on the treatments I use. Clients are often overwhelmed with information overload during a consult, and cannot remember everything I tell them. An information sheet gives them something to ponder, and to share with others in the family, so that all are clear on the condition and its treatment.
10. Write the vet report
I always write a report for the referring vet, in which I discuss the findings and the plan, and inform him or her of when to expect further feedback.
It’s great to have a system, and to progress through these steps methodically. I find that the critical aspect in my system is clear communication; this is so often overlooked in our pressure to get things done.
My questionnaire is crystal clear; I hear expectations and correct them where they’re unrealistic right at the outset; and I try to explain the treatment plan and its nuances on day one, emphasising that it may vary as results show. When both client and I understand one another perfectly – and when the referring vet is kept in the loop – the chances are high that my client will trust me and be satisfied with my services.