The biggest source of missed income originates in the exam room. Too often we fail to recognize the vital role this service plays in creating value and confidence in our services. Performing a physical examination is a part of nearly every patient interaction in a veterinary hospital. How we perform and communicate our physical examination plays a large role in our compliance with recommended diagnostic and treatment offerings. While every doctor will have his or her own style and routine, it is important that the examination be methodical, efficient and convey thoroughness and compassion to the client while keeping the pet as comfortable as possible. Step-by-step instruction of how to perform a physical examination is found in the staff training DVD "Creating the Veterinary Appointment" (2008 E³ Management Press – http://www.E3Management.com/). If we want to maximize our minimal contact with our clients and patients, we must start by focusing on improving our physical examination skills.

The entrance

I believe the ideal physical examination begins with a warm entrance and greeting of the client and patient by names. I have all of our staff greet by shaking palms and paws. We then sit down and the technician reviews the pertinent medical history she has previously obtained. The doctor then asks any additional questions and we begin the examination.

General condition, ears, eyes, and nares

The technician gently lifts the pet onto the exam table. If the pet is large, we often perform the examination on the floor where a larger dog is often more comfortable.

I start by performing a body condition scoring (BCS) and assessing the pet's general appearance. I make comments regarding the coat, stature, weight and overall state of appearance. I then move to examining the ears, eyes and nares and work my way back, articulating each part of the exam. It is very important that you explain each step and point out any abnormalities as you discover them. I start the examination with the pet facing me to gain better access to the head and neck. It is important that you have a logical examination flow that incorporates natural transition points. Transition points are opportunities to change orientation naturally so you appear coordinated and rehearsed. Without a well-thought plan of execution, your examination may appear haphazard and incomplete. Further, by training a coordinating with your staff, you avoid embarrassing gaffes such as bumping into each other or having to ask them to turn the pet back to you because you failed to complete an aspect of your examination. Whatever your desired flow, you should discuss and role-play it with your staff so that everyone is on-board and understands your methods.

I like to dim the lights as we start the exam by looking into the ears and eyes. This helps me in my examination and also reinforces the seriousness of the examination to the client. Dimming the lights is a natural transition point in that it takes the client from the previous ten or twelve minutes to talking and discussing their pet's medical history to the action of performing the examination. We then create another natural transition point when we turn the room lights on again.

I recommend detailing your findings verbally whenever a client cannot see what you're examining. This serves not only the client but the staff member assisting you as well. When your staff is involved in the examination, they can help you complete the physical examination report. While we use a video-otoscope in diseased ears and nares, for most routine examinations we use traditional otoscopes. Describe the retina, lens, conjunctiva, tympanum, nares and other pertinent structures. This reinforces to the client that you are performing a thorough and complete examination and are capable and competent. I use an ophthalmoscope followed by a halogen penlight to test pupillary light responses. After describing my findings, I use the penlight to illuminate the nares to assess patency, architecture, the presence of any discharge or other abnormalities.