Hands up all of those vets who can perform a full and thorough skin work up in the time allocated to one consultation?
If you are anything like me, by the time you have obtained a full history, carried out a thorough clinical examination and discussed your findings with the owner, the task of squeezing all of this into a single consult is near on impossible.
Last week’s webinar topic was based around this particular challenge. Our very own ‘Webinar Vet’ founder Anthony Chadwick took off his webinar hat, put on his dermatology hat and offered us some invaluable guidance by sharing his wealth of experience gained through running a successful dermatology referral service ‘The Skin Vet’.
Firstly, Anthony wanted to stress that squeezing a dermatology consult into anything less than 15 minutes would be very challenging. It would make sense that 5 minutes should be placed aside for history taking, 5 minutes for clinical examination and 5 minutes to take samples. However if you know you have a challenging dermatology case booked in, then setting an hour aside to perform a full work up would be ideal and would also create a great impression with the client.
Another great piece of advice from Anthony was to make sure all the vets in one practice were ‘singing from the same hymn sheet’ when diagnosing and treating dermatology cases. Having written protocols in place on how to manage cases is not unreasonable.
The importance of history taking was also prioritised by Anthony and he used an example of an itchy dog which he had seen as a referral case. By asking the simple question ‘were any in-contacts affected?’ and by finding out that one of the owners had a rash, Anthony was able narrow down his possible diagnoses. This dog was eventually diagnosed with sarcoptic mange. Obtaining a full history can sometimes be time consuming but is essential, so utilising your nurses to obtain this history can prove very helpful.
A full thorough examination should always be carried out and if there is not enough time in a consult to perform this examination then it is not unreasonable to admit a case – just as you would admit a case to work up other clinical signs such as vomiting. It is also good practice to obtain samples including skin scrapes and samples for cytology – and why not use a flea comb on every case that walks through the door? If fleas are present you can actually prove it to the sometimes disbelieving owner!
The mass of information we have to give owners throughout managing a dermatology case can be overwhelming for us and for clients. Anthony suggests owner compliance can be improved considerably by always giving written information and instructions to clients and by following up cases with phone calls. Not only does this promote good medicine and client bonding, it will also generate good revenue for the practice.
Finally Anthony was keen to discuss the benefits of referral. Specialist knowledge is often sought when cases are unresolved or deteriorate, or if there is a need for specialist equipment such as intradermal skin testing. We all know these cases can be frustrating to both us and to the client and it is not unusual for a client to seek a second opinion about managing a dermatology case.
So for those tricky cases, referral to a specialist seems like a very sensible option and, in my opinion, should always be offered to clients so they can make their own educated and informed decision.
By managing our time wisely, it is possible to manage most dermatology cases in practice, but if we struggle, referral remains an option, and hopefully by following the guidance given to us by Anthony not only will our patients stop tearing their hair out, so will we.
By the Stethoscope (MRCVS)