28 Feb 2025
The veterinary professions are uniquely positioned as trusted touch points in the pet care journey. Getting clients to follow treatment recommendations remains a familiar challenge, however, and it helps to have a strategy in place to get your messages home, says Thom Jenkins…
As a veterinary professional, how many times after lifting up the lip of an adult dog or cat have you found yourself making a dental recommendation? How successful are your patient advocacy efforts when you do so?
In 2023, Banfield reported that 73% of dogs and 64% of cats were diagnosed with dental disease1. And yet, with dentistry accounting for only 7% of clinic revenue2, nothing like this proportion of patients benefit from dental treatment.
With countless demands competing for pet owners’ time and attention, it’s not only our dental recommendations that can seem to go unnoticed. In deciding how to allocate their limited bandwidth, pet owners pass through the same two stages of decision making that we all do: concordance and adherence.
The first step when offered a recommendation is deciding whether we agree with it. This process, known as concordance, involves an interplay of psychosocial factors that guide decision making. When evaluating a recommendation, unconsciously or otherwise, we apply heuristics to determine whether we agree.
One key factor is trust in the person delivering the recommendation. Do we like them? Do we respect their authority or expertise? As Robert B. Cialdini illustrates in his book Influence3, this personal connection is often foundational to accepting advice.
However, trust extends beyond the individual to include their affiliation with broader institutions or systems, such as the veterinary practice where the recommendation is made. Veterinary clinics have long held a position of trust as the highest-quality touch point in the pet care journey. Preserving and strengthening this is vital to the success of our patient advocacy efforts.
Another important factor is social proof, or the influence of observing others’ behaviours, in part as indicators of their beliefs. When we see people we identify with – whether peers, family members, role models or influencers – endorsing a recommendation, we are more likely to concord with it.
As veterinary professionals, we have innumerable examples of positive outcomes. With appropriate permissions, these can be showcased throughout the clinic and amplified through communication channels, including automated follow ups and social media. Social proof validates a recommendation through the collective actions of others, providing reassurance that a recommendation is both reasonable and effective.
Closely related to social proof are cultural and social norms, which represent the deeper, more ingrained expectations within our communities or societies.
Unlike the situational influence of social proof, cultural norms reflect the overarching values that shape what is deemed appropriate or acceptable. A recommendation that aligns with these norms feels natural and legitimate, while one that challenges them may provoke scepticism or resistance.
Drawing on my experience working with veterinary professionals from thousands of clinics across six continents, and serving clinics in 14 countries through PetsApp, I can attest that cultural and social norms vary not only between countries, but also within individual client bases.
While this may seem intuitively obvious to some, being mindful of the different starting points from which your recommendation will be received greatly improves the likelihood of achieving concordance. This is tied to the role of personal beliefs and values in decision making. We instinctively evaluate how a recommendation fits with our worldview; if it resonates, we are more likely to agree; if it creates cognitive dissonance, or discomfort from conflicting beliefs, we may reject it outright.
Finally, clarity and emotional resonance play pivotal roles in achieving concordance. A recommendation that is communicated clearly and succinctly is easier to evaluate and accept. Ironically, while time constraints in veterinary consultations make succinct communication even more critical, the pressure of these constraints can sometimes lead to less clarity, as we try to convey too much in too little time. Emotional responses – such as relief, hope, fear or anxiety – also strongly influence decision making, tipping the balance toward or away from concordance.
Expanding decision making touch points beyond the exam room, both before and after the consultation, can help ensure recommendations are as clear as we intend them to be and less influenced by heightened emotions. Be sure to select a tool that allows personalisation of these automated touch points to further enhance emotional resonance.
Concordance is the first step on the path to ensuring our advocacy efforts benefit our patients, but it is just the first step. Alone, it is not enough. Having agreed that something is the right thing to do, we must also act on it. This is where adherence comes in.
As I know all too well, it is possible to concord with a recommendation without adhering to it. I fully concord with the view that regular exercise is important for health and well-being, and yet…
As a business owner and father of four, I can manufacture all kinds of excuses for the gulf between intent and action. However, Goethe would remind me that: “It is not enough to know, we must also apply; not enough to will, we must also do.”
It is in bridging the gap between knowing and applying (or willing and doing, if you prefer) that we can help drive adherence.
You may be more familiar with the term “compliance” in this context. However, colleagues in human medicine have moved away from this term. It is seen as too dictatorial, sometimes bypassing the concordance step outlined previously, evoking: “We are Borg; resistance is futile; you must comply.” (Non-Trekkie readers are missing out, though they may or may not concord).
Adherence, in contrast to compliance, is framed as a more “positive, proactive behaviour”4.
Adherence, the act of following through on a recommendation after agreeing with it (concordance), hinges on managing effort and sustaining motivation, as follows.
In many cases, the simpler and more accessible a recommendation is, the less effort is required – at least in theory. Clear instructions, actionable steps, and readily available resources reduce the burden of adherence. This aligns with Nir Eyal’s insights in Hooked5, where he emphasises the importance of simplifying processes and using triggers to lower the activation energy required for action.
I believe myself to be pretty good at tableting cats; however, this belief has been shaken to its core by my own cat, Addy. I dread to think how many cat owners I have put in a similarly difficult situation by prescribing pills with no indication of how to give them.
This again can be mitigated, at least in part, by associating an automatic follow-up with any sales of medication providing a video guide to the owner on how to give it.
Time constraints, affordability and physical inconvenience can make adherence infeasible.
Offering payment plans, self-serve appointment booking, asynchronous communication and remote follow-up options are just some ways clinics have sought to reduce friction.
Establishing adherence as part of a routine lowers the cognitive and physical effort required over time. To paraphrase Samuel Johnson: “The chains of habit are too light to be felt until they are too strong to be broken.”
There is a risk that disruptions to veterinary workflows during the pandemic led to a certain laxity in recommendations to which we previously advised strict adherence. This may have disrupted habits we once thought too strong to be broken (societal trends around vaccine scepticism don’t help on the concordance side of the equation, either). However, there are opportunities to be found in reforming these habits using customer relationship management tools to move beyond reactive reminders, incorporating proactive health care nudges, alerts and cues.
Most clinicians have a bucket of items they believe would help the majority of the patients they serve. This may include: regular health examinations, tailored parasite control, dental care, vaccinations, blood, urine and faecal screening, and so forth.
Many clinics bundle these items into a wellness plan, which allows them to lock in pet owner adherence with that bucket of items, while allowing the owner to budget over the course of the year while potentially unlocking some savings. There can be concordance elements at play in terms of factors such as social proof here, too. Moreover, the existence of a defined list of items helps provide education and reinforcement for both the pet owner and the veterinary team.
Highlighting clear and meaningful rewards sustains motivation. Immediate benefits, such as relief of clinical signs, and long-term rewards, such as achieving health goals for their pet, are powerful drivers of adherence.
To this end, in our recommendations and follow-up nudges to pet owners, we can go beyond the what and when to include the why and how.
Avoidance of negative outcomes
Fear of risks or undesirable consequences, such as worsening health or greater future financial costs, can drive adherence when framed constructively.
As Daniel Kahneman explains in Thinking, Fast and Slow6, loss aversion – a key component of prospect theory – is often a more powerful motivator than the possibility of gains.
Knowing that someone else is monitoring progress fosters a sense of responsibility and strengthens motivation.
As Angela Duckworth points out in Grit7: “Enthusiasm is common. Endurance is rare.” Regular follow-ups, whether digital or in person, can reinforce the commitment to adhere; for example, asking an owner to asynchronously share regular photos of a potentially frustrating skin case progression is not just about tracking improvement, but also about maintaining the owner’s engagement as you collaborate toward a positive outcome for the patient.
Not every pet owner will be in a position to offer up prospective adherence as described in the wellness plan approach. This does not need to mean leaving them behind.
We can reward adherence as it occurs. The same list of unambiguously beneficial products and services can be used to create a loyalty plan to reward adherence as it occurs, encouraging further steps along the pet health care journey.
Under this system, adherence to the complete list of items would unlock particular rewards similar to those offered under the wellness plan (yes, the two approaches can be offered in parallel). This gamification, with the accrual of pet care points, can be done automatically through integration with the clinic’s PMS based on total spend or, as I would suggest, consumption of particular items.
It is worth noting that sometimes you can have concordance and compliance with a recommendation, and yet the patient still does not benefit; for example, I have seen many a dog’s lip lifted, followed by something along the following lines of: “We should maybe start to think about considering to contemplate perhaps potentially doing a dental for Ziggy.”
Here, the owner agrees and does exactly what is recommended: they start to think about considering… well, you get the idea. But Ziggy doesn’t get the dental.
This happens when the strength of the recommendation does not match the strength of the clinical judgement. The owner hears hesitancy, not urgency, and so the action remains abstract rather
than concrete.
Many of the techniques I’ve outlined (for example, automated follow-ups and timely nudges) can work here, too, helping to align the recommendation with the clinical intent. A follow-up reminder might nudge Ziggy’s owner with a clear and direct message: “Dr Smith recommends scheduling Ziggy’s dental treatment to address their oral health needs.”
By automating this step, the recommendation remains top of mind and actionable. In this way, these tools don’t just guide pet owners toward concordance and adherence; they ensure the strength of clinical judgement is reflected in the clarity, consistency, and urgency of the recommendations the pet owner ultimately receives.
To review, achieving concordance is the first step in effective patient advocacy, but without adherence, even the best clinical judgement may fail to deliver results. By understanding the psychosocial drivers of decision making, we can better align our recommendations with pet owners’ motivations and capabilities.
Automated follow ups, habit-forming tools, and clear, confident communication transform good intentions into meaningful outcomes for our patients.
The veterinary professions are uniquely positioned as trusted touch points in the pet care journey. By embracing these strategies, we can strengthen that trust, improve the clarity and, where appropriate, the urgency of our recommendations, and ultimately enhance the lives of the pets for which we care.
Let’s ensure that recommendations, like Ziggy’s dental treatment, don’t just remain good ideas, but translate into the proactive care our patients deserve.
