by Deidre Gesualdi, MS, DVM, Practice Consulting Veterinarian, Hill’s Pet Nutrition
“If you don’t stand for something, you’ll fall for anything.”
Let’s start at the very beginning. Because– as I understand it– it’s a very good place to start. So, let’s get this out of the way, and we can move on. Where do you stand on making nutritional recommendations for your patients? Either you believe in the benefits of good nutrition, or you don’t. There we have it, it’s out there now. Simple enough, right? And if you don’t believe that nutrition can have a positive impact on patient health, this isn’t written for you.
The rest of this is written for those of us that truly do believe in the benefits of good nutrition, and we just need a little help. A little help giving our inside voices a real, outside voice. A little help giving conviction to our conversations. A little help to give our patients the best, total, and complete care that we can give them. Although this is written with nutrition in mind, you may find that some of these ideas and concepts will apply as you consider some of your other recommendations, as well.
So often, I hear myself giving impassioned talks about how much I’ve learned about nutrition since joining the team at Hill’s Pet Nutrition; and, I think of how much more effectively I would use nutrition in managing patients, knowing what I know now, about what a difference great nutrition can make for a pet. These days, we are lucky enough to have a full spectrum of therapeutic nutrition to target specific conditions, and beyond that, a world of wellness nutrition at our fingertips. But, much like it is for people, all pet food is not created equal. And we have the opportunity, power, and responsibility to make a difference to the lives of both pets and pet parents.
More often than not, underutilizing nutrition in managing patients you see, really comes down to just not making those recommendations. You and I both could probably make lists, and spend a lot of time discussing, ad nauseam, the reasons why nutritional recommendations are not made- from ‘not understanding the products’ or ‘how to use nutrition the right way’, to ‘not having enough time’, etc… I feel like I’ve heard them all. And, admittedly, at times I’ve been guilty of making and using some of them myself. At the end of the day, they all just sound more and more like excuses. And, as I run over them in my mind, I can hear how sad they sound. If they were friends, I wouldn’t want to hang out with them. Because, that mindset might just be contagious and send me off to ‘Apathy Island’—a reality show you certainly don’t want to get marooned on. But this is not about ‘not making recommendations’. It’s about giving you the freedom and/ or permission and/or confidence to unleash your inner “recommendation rockstar”, and make your recommendations. So, I’m dismissing ALL of those sad excuses in one easy swoop (is it swipe left or swipe right?!). ALL of them are going bye-bye. Good-Bye. Not getting a final rose, nope, not staying one more week on ‘Apathy Island’. Because, whichever one you choose & use regularly, if you are honest with yourself, you know it’s not ‘your best’. This is important, so I want you to keep this in the top of your mind. As we move forward, I want you to ask yourself “does this feel like my best?”
Before we go any further, I need to remind you who you are. When I checked in at vet school, during orientation, one of our very first lecturers told us “by the time you graduate, you will be amongst the top 1/10th of 1% of the population in terms of education”. Wow, that had some impact! So, you are a real smarty-pants. People come to see you to help their pets. They want your advice. You practice good medicine, and you are good at what you do. People come to see you because they want to hear what you have to say. Don’t hold back on them. You are also strong. You made it through a vigorous veterinary medicine education program. You interviewed for, and were offered this job/ internship/ residency/ etc… Undoubtedly, you’ve had to deal with some other stuff in your life. So, muster up your courage and buckle in. You’ve got places to go.
You are getting new shoes today. Woo-hoo! You know how important your feet are, and who knows more than us about being on your feet all day. Naturally, you want the most comfortable, the best support you can find. Before you get too excited, these are just “virtual” new shoes. You’re going to try some new things on. They may not feel comfortable at first. But I think you are going to like them.
Think about the two following scenarios, and ask yourself each time, “does this feel like my best?”
1) A pet parent brings their dog/cat to see me for a problem. I believe that this combination of +/-pharmaceuticals, +/-treatments, and +/- nutrition will help their pet. I tell them everything that I think will help. The pet parent makes decisions based on my recommendations.
2) A pet parent brings their dog/cat to see me for a problem. I believe that this combination of +/-pharmaceuticals, +/-treatments, and +/- nutrition will help their pet. I only tell them part of what I think will help.
To frame this thought process in a different way: If we think of this situation in terms of our own care, what do you expect from your doctor? What do you want from your doctor? You kind of want to stick around for a while, so, you definitely want the best. The best options, the best treatments, the best care.
To make a recommendation, or to not make a recommendation; this is the question. Again, I have to ask you to take your simple test “which one feels like my best?” Let’s look a little more in depth at some possible outcomes. This is good for us. Science brains. We like outcomes, right? Begin with the end in mind.
Best foot forward, let’s break down making the recommendation first. This should sound something like this, “Based on what we discussed today about your pet, and knowing we both want what is best for your pet, this/ these product(s) is/are what I recommend because of these benefits…. “ This is our work, as veterinarians, to provide the best care to pets that we can; to make recommendations is an integral part of that responsibility. Remember, it is “our best” to make the recommendation, and as long as it is made, we can feel good about that. It is our responsibility to share the education and the information; ultimately, it is up to the pet parent if they want to proceed. Let’s check in: does this feel like my best?
What are the possible outcomes of telling the pet parent what you think they should feed their pet? Let’s keep this basic, and break the possible outcomes into two: the pet parent complies/ agrees with my recommendation vs. the pet parent doesn’t agree to, or comply with, my recommendation.
If the pet parent agrees, good for you! And, good for the pet parent, and mostly for the pet! Hmm… this seems easy enough. And, how does it feel- does this feel like my best? Yes, this definitely feels like my best.
So, let’s just say that the pet parent doesn’t agree or doesn’t comply with what you recommended. Ouch, right? That hurts a little, you say? It’s okay. Someone told you “No”? You can take it. Remember, you are strong. (These are new shoes, and they may not feel completely comfortable or broken in at first. Let’s give it some time to settle in). Where do we go from here?
There can be many reasons why a pet parent can’t or won’t agree to your recommendation—all of which are particular to that pet parent and not personal to you. These are pet parent-centered reasons. We are not going to spend much time here, because it is not helpful for our purposes. Once we’ve explored what is in our control, and given “our best” effort, we’ve done all we can do; there is a certain part of this equation that belongs to the pet parent. At this point, the one helpful thing you can do is to clarify. You’ll want to clarify their understanding of the problem, and restate your recommendation, being sure to include the benefits to their pet in the conversation. If you hear anything other than agreement, it’s appropriate for you to let them know that you will make a note about what you discussed should they ever want to revisit this in the future. Once again: Does this feel like my best? Yes, I think it does.
In both situations outlined above, we shared what we thought, and the pet parent made a decision, correct? Everyone should be able to feel good about this pathway; you- for sharing all of your information and recommendations; the pet parent- for all of the information which helped them make an educated decision. You were an active part of this decision process. Does this feel like my best? (I wasn’t sure about these new shoes at first, but they might be alright! They fit well & they feel good. Make me look pretty good, too).
Let’s now look at the flip side of the coin—Not making a recommendation. Oh! My old slippers… or flip-flops. Broken-in, comfortable. Hmmm… but now that I’ve been trying some new shoes on, I can feel the difference. These aren’t supportive, and I’m not standing on anything firm.
When I think of all the possible outcomes of not making a specific recommendation, they all seem to end in the same place—ultimately, with the pet parent not doing what I want them to do, and the pet not getting my best.
When I don’t make a specific recommendation, there are three potential outcomes. In potential outcome #1, the pet parent continues on the current path in the same direction; so, we can expect nothing to change, and everything to remain the same, or possibly become worse. With potential outcome #2, the pet parent continues on their own path in a different direction; we don’t know what to expect, or where things will go, because we are not involved anymore. And in potential outcome #3, the pet parent listens to someone else (not you) that is making strong recommendations; we can make up a long list of who might be gaining the ear of our valued client, and you must ask yourself, “do they know more about pet nutrition than I do?”
No matter which of the potential outcome possibilities that result out of my choice NOT to make a specific recommendation, the resulting outcome for both me and the pet parent is the same. We can really only call this a “pathway” and not a plan. Since you are not involved in the management of these ideas, we can’t really feel comfortable calling this ‘a plan’. The light bulb should be going on now… “If I don’t make a recommendation, the pet parent is definitely NOT going to do what I want them to do, because they don’t even know what I want them to do.” Hmm… it doesn’t even sound like I am part of this process. Passive. Does this feel like my best? (This shoe does not fit me well; and, it doesn’t make me look good either.)
Think of it in this way, if you saw a pet that had dental disease, and you thought they could benefit from a dental cleaning, do you recommend it or not? If you recommend it, a certain percentage of pet parents will have it done, and a certain percentage will not. If you don’t recommend it, what are the chances that the pet will have the cleaning you thought it needed– probably a pretty low to zero percent chance. Why—because the pet parent is not going to leave your exam room, and go home and think “oh, I bet I should have a dental cleaning done for my pet.” They think everything is fine, because you didn’t tell them any different.
At every office visit, in the exam room, time will come to sum up your assessment and make your recommendations to the pet parent. And what will you do? Which path will you choose? Remember, the choice is super simple when you ask yourself: which feels like you are giving your best? Keep walking in your new shoes, break them in. Soon you’ll be standing tall, and looking good. You’ve got sure footing and firm support. You have a renewed confidence, and the resolution to recommend with reckless abandon. I promise, before too long all of it will feel pretty darn good. And you’ll know, without having to ask yourself… This feels like my best.
Dr. Deidre Gesualdi earned her DVM at Virginia-Maryland Regional College of Veterinary Medicine in 2004. Following school, she worked as a small-animal private practitioner in Virginia for five years before joining the Hill’s Pet Nutrition team in 2009. Dr. Gesualdi is currently employed by Hill’s Pet Nutrition as a Professional Consulting Veterinarian, where she engages and educates veterinary teams in pet nutrition, promotes nutritional recommendations, and partners to assist practices in business growth. She works with veterinary specialists and general veterinary practices throughout New Jersey, and some areas of New York, Pennsylvania and Connecticut. In addition, she works closely with staff and students at several local Veterinary Technician colleges.