BUSINESS
The Tyranny of Choice in
The Exam Room
Dr Dave Nicol BVMS Cert Mgmt
I read a comment on a social media thread that
gave me reason to write about the tyranny of
choice. Here’s what was posted, “Clients are more
questioning of the profession these days, more able
to price-compare and the reticence about discussing
money is long-gone. Our practice ethos is to involve the
client with the range of treatment options for their pet…”
Which is management speak for “we offer our clients
choice”. Which sounds like a great thing to do, but I
respectfully disagree with and have seen more than
enough evidence from the exam room that this ap-
proach is hurting your patients, your clinical develop-
ment, and your veterinary practice.
Since when was third best good?
Offering choice is, in theory, good and inclusive. But in
reality, it is being poorly executed. Frequently, vets are
not offering choice in such a way that all options are
fully discussed and clearly understood well enough to
allow a truly informed decision.
The tyranny of choice
Before we go further (and the angry comments flow)
let me state that I am a fan of having choices in gen-
eral. I like to be able to choose my mode of transport
to work. I like to be able to choose what to write and
when. I like to be able to choose who I vote for. There
are many people on planet earth who don’t have the
luxury of such choices. So choice, or rather freedom
of choice, is fantastic.
But when it comes to a complex topic like veterinary
medicine choice is, at best, a double-edged sword.
There, of course, are some that disagree. In fact,
many of you reading this will be practice owners who
are self-selecting as the more gifted communicators.
But I’m willing to bet you have staff. And the group
that is most let down by the philosophy of offering
choice are your assistant veterinarians.
So let’s begin with three exam room realities which
act as the backdrop to this post.
1. Many veterinary hospitals operate with 10-20
minute veterinary appointments, which are often
running late.
2. Few vets are trained communicators and fewer
still are naturally gifted at this skill.
3. People (in this case pet owners) do not generally
grasp complex subjects in a short single sitting.
This, in my opinion, is completely understandable. To
aim for such an outcome is setting you and your pa-
tient up for failure. The notion that we can success-
fully describe a complex clinical situation and the ac-
tions required to deal with it in such a way that a client
could possibly make the choice unaided in less than
20 minutes is a very sick joke.
The bad taste punch line is that a shocking number
of animals leave our exam rooms with clear clinical
needs poorly addressed or not addressed at all.
This goes a long way to explaining why is the uptake
of simple, inexpensive yet highly effective treatment
options like preventative dental cleanings are so poor
when the disease prevalence is so high.
What is happening in our time-crunched world is that
we are offering two or three options with little in the
way of useful qualification for each. An d that inevitably
leads the client to make a decision on what they un-
derstand best – price.
If the price for option A is £2000, option B is £1000
and option C a mere £500, then, in the absence of a
persuasive (clear, understood and compelling) reason
to choose A or B, the client is probably going to opt
for C. But how many clinical situations (come to think
of it any situations) are best resolved by the third best
option?
Issue 05 | OCTOBER 2017 | 5