In 1999, this concept was expanded beyond traditional uses (high competition, depressed areas, etc.........now it is more often linked with the reduced vaccination frequency we are seeing from extended DOI vaccines (there is not solid titer protection data in current research to support the stopping of immunization protection). So, as FYI, the Preferred Client program, Recovered Patient and Recovered Client programs are explained in detail in the Signature Series Monograph, Client Relations Zone Operations, available from VIN Press and at the web site: (http://www.drtomcat.com/). It is supported well by the Blackwell Publishing text, Veterinary Healthcare: Options in Delivery. Here are the basic components of the program:

 Life Cycle Consultation - a semi-annual event (www.npwm.com) with the doctor to "qualify" for the "preferred client" status (but each pet is separately qualified). This is not designed as a vaccination event, but rather a bonding session with the client. Urine Screening or blood chemistry screens are an important component of wellness surveillance, balanced against appropriate age, breed, sex and patient conditions. The doctor discusses family influences, travel exposure risks, and healthcare concerns during the consultation (the use of petMap or Carddell blood pressure screening, as well as the hand-held Heska/PAM/Biolog-type lead-II rhythm cardiac screen, in younger adult animals, should lead to better base line data in older animals).

 For twelve months, minus one day, after the semi-annual life-cycle consultation, the patient has "qualified" for the balance of the wellness program (many small, economical, fast-in-fast-out, visits), including but not limited to:

 Immunization review with outpatient nurse without a doctor's consultation, and when administered, charged at "competitive rates", as compared to the media published rates of the community.

 Courtesy dental hygiene checks with the outpatient nurse. This allows early detection of the redness of the gums (pain) and provides an economical access to the dental teeth cleaning which usually reduces the bad breath in companion animals.

 Parasite prevention and control counseling with skilled nurse, and if blood or stool samples are required, they are collected and tested at usual practice rates, with the results always called back to client; this is done without a doctor's consultation unless results are positive.

 Nutritional advisor for dietary needs, again without a doctor's consultation, but with monthly check-ins with the nurse.

 Behavior management, including in-facility source for accessories like scat mats for cats and head collars for dogs, after the physiological and medical concerns are eliminated by an outpatient consultation.

 The client is always asked if they want a "doctor's consultation" instead of the nursing appointment, which is, "often preferred if they have doctor questions or have not visited with the doctor in the past few months...... but as a "preferred client", it is now their option, not a practice requirement!"

 For twelve months, minus one day, after the semi-annual life-cycle consultation, the client has "qualified" for the communication outreach program, including but not limited to:

 Periodical newsletters describing the new programs and emerging trends in animal wellness and healthcare delivery.

 Health Alerts for specific conditions emerging within the general area or animal population of the community.

 Specific status reports concerning each animal in the family, their protection level, and special programs which may be accessed.

 Priority access for doctor's consultations, and nursing "hot line" support for the continuing care of the pet.

 Walk-in privileges whenever the situation is deemed appropriate by the preferred client - no appointment required, unless a specific time or specific doctor is desired by the client.

 If there is concurrent boarding and/or grooming, preferred clients will be notified of advanced registration privileges during busy holidays.

Consultant's Observations

 The fact of life is simple; multiple smaller cost visits will cause greater annual value per animal.

 Over 50 percent of all nursing visits will sell something additional.

 Over 23 percent of all boarding or grooming guests need some form of immediate healthcare.

 Smaller tickets reduce ticket shock, make the practice seem more competitive, and better fits the tight discretionary spending habits during times of uncertainty or economic stress.

 This program must be tailored to the practice, and includes a major effort in extending the veterinarian's impact by utilizing the paraprofessional staff. In light of this, an on-going in-service training program is required to augment the 90-day orientation training plan.

 Over 75% of the clients will opt for a doctor's consultation at full price, but it is their option and they deserve to be seen on time and by the doctor they requested (if any) - never offer a doctor or ask which doctor - if they have a preference, they will tell you!

Consultation versus Examination

For years we have called the doctor's patient diagnostic exam and client consultation, the sharing of knowledge and skills, by one term: "examination". We were comfortable with this misnomer, even to the extent of hiding the professional effort inside a "vaccination fee", that is until the superstore down the street said an "exam" is included with all vaccinations. Panic was a common response, but clarity in services rendered, and itemized listing within the practice billing was not.

Then the retrospective vaccine panic hit the profession. Some people believed that the vaccinations were "dangerous", and in pursuit of research dollars, published antidotal information not substantiated by the traditionally severe drug evaluation criteria. Again, panic was a common response, but clarity in services rendered, and itemized listing within the practice billing was not, but this time, more practices started looking for an alternative to burying everything inside the vaccination fee. The clarity of practice billing was not the goal, just what could they advertise to "beat the competition" and media blitz.

Please stop the insanity. Look at what your practice is doing, and start quantifying what your quality of care stands for in the community. Look at a current application of reality and "truth" in performance:

 An animal deserves a semi-annual life cycle consultation with the doctor (one dog year is equal to about five to seven people years, and that is long enough for any living entity to wait for a wellness evaluation!).

 A nurses "wellness" asymmetry examination is done at every entry into the hospital, but the doctor's diagnostic examination is done only when your pet is sick or with the semi-annual life cycle consultation. This is a critical step in maintaining your pet in a well state, due to the other factors that will be discussed even when your pet appears healthy (as discussed below):

 The consultation will offer discussions about the immunization and protection programs available, as well as when your pet needs to access those services (it will likely be at a time separate from the consultation, so the cost of the semi-annual life cycle consultation will seldom be additive, unless the client requests immediate care be rendered).

 Screening programs for better breath (dentistry), internal body system changes (blood chemistry), and even surveillance of the aging process (radiology and electrocardiograms), will be discussed, and scheduled on an as needed basis.

 Families that hike with their pet, or take them on vacation, or those that just live near the fields and woods, may need additional protection; that is also discussed and planned during the doctor's consultation.

 Fleas and ticks, as well as some internal parasites, can be deterred from attacking your pet. These alternatives will be discussed during the consultation, and options will be provided for the client's consideration.

As you can see, most of the consultation elements above require: 1) participative listening, 2) assessment of internal, external, or environmental dangers, and 3) subsequent client communications. If your practice spends the time to listen to clients, healthcare access is increased in most A and B clients, and often even in the C clients. If the practice tries to do all of the above with only doctors, you cannot afford the effort. If you use an outpatient nursing program concurrent with high density scheduling, as discussed in the 1998 Blackwell Publishing text, Building The Successful Veterinary Practice: Programs & Procedures (Volume 2), the clients will begin to equate veterinary healthcare with other healthcare delivery models. Human outpatient clinics use 3 to 5 examination rooms per doctor and dentists use 4 to 8 chairs per doctor. Clients will start to understand that "technicians" are really nurses, with exceptional skills and knowledge about companion animals, and generally, with far abilities and capabilities than most of their human medicine counterparts.

So, undifferentiated examination by habit, or clarity in quality with the consultation; the choice is yours today. With failure to change, you will either lose the option or become an "old timer"; neither role will attract the quality client to your practice. Slow death is painful........and for the want of a horseshoe nail, the war was lost!