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Yeah, it’s true. When we’re faced with truly obnoxious clients we vets do what all professionals do but almost never deign to admit: We sometimes pad the bill (well, sort of).

I’m surely immersing myself in scalding water on this one but honesty’s what you come to Dolittler for, right? So soak it up, because this post’s going to tell you why sugar beats vinegar every time.

Today’s client sounded sweet over the phone, but I’ve known her long enough to remain unswayed by this. This owner almost never arrives personally, preferring to send the housekeeper (who happens to be afraid of her charge) while she keeps her pedicure appointments. What’s far worse however is that Fido always arrives in distress long past his original illness date.

Like most vets, I detest the concept of fighting fires when earlier detection of disease would have driven most responsible pet owners to seek professional help sooner.

It’s this series of irresponsible events that drives me to keep a closer tally of every miniscule cost this pet imposes on our practice in our efforts to get him well. No catheterization attempt goes unnumbered, no bag of fluids goes untallied and no pill goes unaccounted for.

That’s the reality of veterinary practice and I’m sure it applies to my accountant, lawyer, masseuse (if I had one) and barmaid, too. Being nice, communicating well and showing you care by doing your part is the key to getting treated well when it comes to getting your bill.

“Not fair!” you may well cry, but these are life’s truths in any service business. Ask any professional you know well and the honesty may well pour forth in torrents you never imagined.

For most of us there are policies and pricings which we may adhere to assiduously. Then there are exceptions which may well apply to any number of our compliant and caring clients.

If your pet arrives in obviously profound distress due clearly to your disregard for her condition, you can bet you’ll get taken to task by our standard pricing policies. Show your concern and your evident care and you’re more likely to catch a break on any number of itemized details.

I’m not promising you’ll save a bundle, but your attitude counts for perhaps 10% of your bill in most standard vet settings.

Now, this may sound unreasonable and I’ll be the first to confess that it is. Humans will be humans.

Every responsible pet owner should know that unseen discounts are far more common in veterinary medicine than you might expect. We’re not really padding the bill when it comes to the losers; we’re charging YOU less because we love you.

Comments
As a professional, albeit in a completely different area, I can say this is totally true. Another truism: when we've shaved hours and costs off an invoice, and yet people still complain? No future shaving of costs will occur. Being kind to the people that are busting their tails for you goes a long way.
# Posted By Creature of Habit | 2/26/08 8:46 AM
I couldnt agree more. I have been in service indudsties all my life and thats trhe price someone pays for being stupid
# Posted By james | 2/26/08 10:06 AM
Our office refers to no-freebie invoices as the PITA tax ;)
# Posted By AdoptedAPBTs | 2/26/08 10:36 AM
One time, years ago (no names to protect the guilty and it wasn't pet-writing anyway), I agreed to bail out a desperate editor who had had another writer bail on a piece right deadline. So I helped out said editor, who turned out to be such an incredibly demanding and unreasonable twit that it wasn't worth the fairly decent amount she'd offered to pay me to get her out of the jam. (The check didn't come formonth after, by the way.)

After the assignment, she waxed on about how wonderful the piece was, how great I was to work with and how grateful she was for me stepping in at the last minute to help. "Thank you very much!" I said out loud, and to myself I muttered, "Never again!"

Instead of saying "no" next time, though, I cited what (I thought) was an eye-poppingly astonishing fee the next time she came calling (also on deadline). Figured that was a polite way to say, "No, thank you."

Alas, see agreed to the fee without negotiating, and I had to write for her again. Again, she was difficult to work with, and again, the check was a long time coming.

These days, I merely say to her (very, very sweetly and politely): "I'm so sorry, but I'm too busy." (Actually, she of course doesn't ask anymore, since I don't write pieces in her subject area.)

There isn't money enough in the world (well, within reason) to work with some people!
# Posted By Gina Spadafori | 2/26/08 11:35 AM
Forgive typos above. Writing while listening to a conference call ... ack!
# Posted By Gina Spadafori | 2/26/08 11:37 AM
I really don't understand why people aren't nicer to people in service positions. They're HELPING you, for Pete's sake! And how good their service is will depend directly on how nice you are to them, even if they try otherwise they're only human.
# Posted By zandperl | 2/26/08 11:58 AM
My vet gives me a 10% "preferred client" discount on services (not products). It's automatically applied by the computer to my bill. I have a great relationship with my vet and his staff, but the discount is a tangible acknowledgment that they like having me as a client, which is appreciated.
# Posted By Mary | 2/26/08 2:30 PM
I don't see how anyone can say it isn't fair... after all, how WE behave (as clients/consumers, in this case) toward others is one of the very, very few things in this life that we truly have control over. I think this is true everywhere - if the client makes the choice to be snotty or unreasonable when dealing with the vet and the staff, that's his/her decision and it seems eminently fair that he/she pay a premium for it!
Oh, and speaking of staff... the clients who terrorize the front office staff but are sweet to the vet aren't fooling anyone!
At least at the vet's office, all that happens is they have to pay more - no one is spitting in the soup, so to speak! :-)
Another great article, Dr. P!
# Posted By Barb | 2/26/08 2:55 PM
once i had the privilege of deciding how much to add to the bill of a client who kept sending us his sweet little sheltie to be sewn back together after his other (aggressive devil of a) dog tore her apart. it had to be the third time she'd had to go through extensive wound treatment since he wouldn't separate them (or euthanize the terror) and we thought that maybe a ridiculously high bill would bring him to his senses.

we love the vets that help us out too! mine is mailing me ear meds stat because my poor girl has her first ear infection (yeast on the gram stain), they don't have time to see me today, and a snow storm is hitting now and i'd hate to get in an accident making the hour trip to see them.
# Posted By Sarah | 2/26/08 4:06 PM
"Instead of saying "no" next time, though, I cited what (I thought) was an eye-poppingly astonishing fee the next time she came calling (also on deadline). Figured that was a polite way to say, "No, thank you."

Alas, see agreed to the fee without negotiating, and I had to write for her again."

Evidence that you had under-priced your services the first time--and probably the second time, Gina. I hope you've corrected that since.:)

There is one local bakery where I never pay full price for what I buy, and may walk out with extra goodies if the owner or his daughter happen to be on the counter. I really don't buy very much, but I've been buying it every week for years, since they had a much smaller shop. I bring friends, i pick up orders for friends who don't live close enough to get there easily, at holidays I tell them, I can't go where I'm going without bringing some of their pastries.

They love me, and all I've ever done is be a small but regular customer, and be polite, and tell othe people I like them.
# Posted By Lis | 2/26/08 5:50 PM
Whatever happened to treating others the way you would like to be treated? I couldn't sleep at night thinking I upped someone's bill just because they bugged me.

I am in the service business, and I would never think to treat my clients differently, no matter how they treat me. It's just not right...I will be honest, truthful, and tell them what I think - about them, our relationship and their business. I won't hide anything and 'secretly' up their bill if they are difficult or I don't agree with them; nor would I 'secretly' give a discount to a 'fun' client. On a rare occasion if it gets just too bad of a situation, I tell them I'm not the right fit for them and go on. But I am always honest and always forthright.

Besides, it's not very good for your business.
# Posted By Anonymous | 2/26/08 7:45 PM
Not FAIR!! No, it IS fair. It's fair because I think my vet sugarcoats our bills too. Me and my boyfriend are always friendly and never miss an appointment, pay on time, and bring our animals in under any distress. We even took in a litter of baby rats too see how they were all doing.

That's how it should be, if you have someone with a bad attitude I'd charge as much as I could.
# Posted By ashleigh | 2/26/08 8:35 PM
Anon - reread Dr. K's last line - there's a difference between charging rude people more and charging nice people less.
It works this way at my hospital too. We have little control over the prices for particular items or services - those are set and are out of our hands. We DO have control over whether or not we charge for them. For example, a nail trim is priced at around $12. I trim nails as a courtesy on puppies/kittens and for pets of regular clients, no charge, because it's not that big of a deal and it doesn't take much of my time (and for well-behaved pets, I think $12 is just a little excessive). Treat me like crap during the visit, though, and if you request a nail trim, bam! it's on your invoice. The price of radiographs at my clinic is composed of film exposures, processing/handling fees, pet restraint/positioning, etc. (which are part of the price of any clinic, just not necessarily itemized). I tend to remove some of those smaller fees for good clients (although everyone has to pay for films exposed). Again, act like a jerk to me before the doctor comes in and they are all staying on your invoice (and at my hospital, the techs are the ones who finalize your invoice, so be nice!). It basically comes out to discounts on our time rather than cost of supplies or materials used for nice clients, and I feel great about that. Although some people think we are high-priced, I think most of our prices are fair compensation for raw cost and our time/expertise (although there are exceptions - I think our meds are marked up too high), and I don't have a problem backing them up. But it's nice to be able to offer a small, unofficial discount to clients who appreciate us and our time, take great care of their pets, or just make me smile. :)
# Posted By anna | 2/26/08 9:27 PM
Also, difficult or just plain crappy clients tend to take up more of your time, either directly by how much you have to listen to them b*tch or indirectly by how much extra time you spend trying to make their pets well (due to non-compliance, lack of care, postponed treatment, etc.). When you get down to it, you pay your vet mostly for his/her time and expertise - in those cases, you've doubly earned the right (that you already had) to FULLY charge for your services and not blink twice about not wanting to minimize their invoice w/your own goodwill!
# Posted By anna | 2/26/08 9:35 PM
Re:

"every miniscule cost this pet imposes on our practice in our efforts to get him well"

Well, I don't think it's the PET that's imposing.

You may be "mad" at the client, but remember -- the animal is your patient, not her. Be careful not to transfer that resentment.

As for "liking" or "not liking" clients and how that effects pricing and care -- I recently heard a very interesting piece on NPR. It was a doctor, talking about how he had misdiagnosed a patient, and he later realized it is because when she complained about her symptoms, she annoyed him. He didn't like her. Therefore, he couldn't be objective, and she's lucky she didn't die. It bodes well for him that he is honest enough to look at that.

When you find yourself thinking that way about a client, it is time to check yourself for the kind of insular thinking that is the pitfall of clinicians. In your case, the one who suffers wouldn't be the one who's earned your annoyance, it would be an innocent animal instead.
# Posted By Stefani | 2/26/08 10:29 PM
That's a great point, Stefani. But I can't imagine treating an innocent animal differently! If anything, I see the techs fawn over our more neglected patients. They take pride in making their stay comfortable, knowing they probably never get such direct attention. But I definitely hear what you're saying.
# Posted By Dr. Patty Khuly | 2/27/08 9:56 AM
Anon- there's an ocean of difference between "upping" the bill for an rude client, and shaving or discounting a bill for 'favorite' clients. I don't think any of us implied the former- only the latter. Taking measures to keep favorite clients happy is what we are mostly talking about here.

Stefani, I heard the same NPR piece. I think you're maybe going the apples/oranges route. The NPR doctor was speaking of his own ego and how this woman's behavior grated on him in the exam room, his inability to sit through her list of symptoms and his snap diagnosis followed by his unwillingness to review his own diagnosis. This affected how he treated his patient medically speaking, not how he billed them. Versus Dr.K's post which is dealing with someone who shows up late to appointments, haggles over bills, sends personal staff to the Vet appointments, treats front desk staff poorly or shows up with a neglected animal. To me, this is apples and oranges. Though both equally interesting.
# Posted By Creature of Habit | 2/27/08 12:49 PM
I read the intended point; it is human nature to treat responsible people differently versus negligent owners that seem not to care a whit about their pet's comfort or well-being. I would notice this at my groomer-friend's shop, matted and horrid dogs, that were only brought in twice a year!

Stefani, brings up a good point of not letting a bias develop that would end up harmful, and hopefully, this is exceedingly rare. Although, I can't help but wonder sometimes, if the vet scam I experienced was aided by my 'known' long- standing willingness to provide care above and beyond the average---simply because of how I value my pets and my history of prompt payment. (yes, I have no children, but I'm sure not a "well-to-do" individual)

The clinic I currently am a client at, also leaves final billing to the front desk. If an obvious charge is "missing" , I feel it necessary to 'speak up'
#1 I don't want a simple mistake to cost someone a demotion or loss of employment #2 I haven't the slightest idea how the employee Vet is paid (hourly, percentage, etc.) #3 the business has to run and the practice-owner-vet is not the one giving the discount. But I appreciate their occasional offer, they are very kind & courteous.
# Posted By Barbara A. Albright | 2/28/08 10:49 PM
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