Relationship vs. marketingship

‘If you don’t know where you are going, any road will take you there.’

                           Alice in Wonderland 

Most relationships between veterinarians and clients is initiated by a sick animal requiring medical attention. Therefore, this relationship is one of dependence, obviously differing from the typically intimate (interdependent) relationship. Thus the instigator of a relationship between veterinarians and clients is for the most part servicing a need and its reward for the veterinarian measured primarily in pecuniary terms. As unpalatable as this may sound it does not infer that veterinarians are motivated solely by profit or that this is reckoned in their therapeutic approach. However, marketing maximises the vet-client relationship for purely pecuniary gain. For many veterinarians, marketing is still a dirty word with connotations of unscientific and uncompassionate motives. However, we cannot avoid the obvious truth that without an income, a practise cannot survive and prosper. In order to tackle an economic market, sociologists make general assumptions about human nature and society as shown in Figure 1. 

 Basic Assumptions about Human Nature:

Ø         Human beings are essentially self-oriented and inclined to pursue their own interests at the expense of others

Ø         Human beings are symbolic creatures. Their environment is a symbolic mirror of their perceived reality.

Ø         The human potential to hope and aspire (emotionally, economically, socially) seems unlimited given social conditions.

 Basic Assumptions about Human Societies:

Ø         Societies present organised systems of human survival and reflect origins as well as predicted outcomes.

Ø         Human societies operate under conditions of perpetual scarcity for most resources needed by their members.

Ø         The continuous confrontations within and between societies are a necessary condition for growth and social change.

Ø         Human societies consist of inherently unequal elements. The result of dealing with this inequality is social organization by classes: the haves & have nots, the satisfied & desirous, the males & females, the majorities & minorities, the rich & poor.

Ø         Because of this inherent inequality and perpetual scarcity of resources, competition for power and material is endemic in all social systems.

Around 1950, the American psychological community bought into a new idea - operant conditioning, also known generally as behavioural psychology - B.F. Skinner being the major proponent. Skinner’s point was that there was no need to understand how the mind works, if we are able to manipulate behaviours as we want. We can modify behaviour, in fact we already do, to achieve the behaviours we desire in people. All that is necessary is to find the correct stimulus[ii]. This theory, termed operant conditioning and based on the work of the Russian psychiatrist Ivan Pavlov, predicts social behaviour in humans based on environmental stimuli. It is based on the premise that humans are exclusively the by-product of social forces, and that he becomes the type of person society wants him to become. That is, he is a social animal. The hard premise which social theory assumes is that what is not expressed does not exist. Though capitalist in origin, this theory closely emulates the sinister philosophy of dialectic materialism as proposed by Engels and Marx, which denigrates individual autonomy at the price of social cohesion. However, its permeating influences in our capitalist psyche are manifold. Social theory believes that existence shapes consciousness or that circumstances alter humans; that our inner core is not the constant, unchanging soul Christendom has ascribed for us.

Social theory makes a number of basic assumptions about people when they consider commerce and marketing. These include the notion that people who engage in economic interactions are naturally seeking to maximise profits. Sociologists also believe that most gratification among humans is obtained through using others for their advantage. Thus people who have greater access to information about social, economic, and psychological advantage consider alternative, more profitable situations. It is also believed by sociologists that people naturally calculate the best possible means to compete in rewarding situations. The same is true of punishment avoidance situations. People are perceived socially as goal-oriented in a freely competitive system and that ‘social credit’ is preferable to social indebtedness. The more deprived the individual feels in terms of an act, the more the person will assign value to it. Social exchange theory assumes that we are all in it for ourselves and that the responses evoked by people is more important than their internal situation. Garrett Hardin summarised this view in The Limits of Altruism when he wrote that public policies should be based on ‘an unwavering adherence to the cardinal rule: never ask a person to act against his own self-interest.’ If we believe these pragmatists, it’s easy to become cynical about helping others. But there is no way of assuming that increased personal wealth must be the goal people set for themselves. Fortunately, most people recognise that money is at best a means of achieving part of their happiness.

If we consider morality as being a desire to help people, and if being unable to help people we ensure that we do not harm them, then how do we determine a middle road between what is profitable for a practise and what is self-orientated over-servicing? The answer is obviously a moral one, but certainly over-servicing can include such things as: 

Ø         Over-treating - diagnosing and treating diseases which do not significantly improve quality or quantity of life (e.g. minor skin diseases, lumps, bumps, etc). It would also includes the use of excessive diagnostic/laboratory tests to confirm what is already known from clinical evidence (e.g. Xray, blood test and ultrasonography for a cat-fight abscess)

Ø         Over-prescribing - using more than the necessary medical/surgical modalities to treat a problem (e.g. treating a mild case of kennel cough with antibiotics, expectorants, mucolytics and anti-inflammatories), or using more expensive medications when cheaper ones would suffice. 

When it comes to advertising, little national uniformity exists regarding  how much and what sort of advertising is allowed. In surveys of medical, veterinary, dental and legal professions, it has been noticed that there has been a steady movement towards acceptance of advertising in some form. At present, there still remains substantial reservation towards the use of persuasive advertising. Although patients are viewed as being more demanding than in past times, practitioners still expect their relationships with patients to be long lasting. In spite of this, there is an acceptance that more competitively-based competition and thus advertising will continue. In view of the kinds of advertising that are now used by medical and veterinary practices, and of the change in attitudes that has occurred, control of advertising might cease to be a concern to the profession[iii].

According to marketing gurus, the aim of marketing is to establish, maintain and enhance relationships with customers at a profit. To do this, trust is an essential role. Past and present relations with clients is vital to maintaining trust. Distrust is inevitable when expenses are beyond those anticipated by clients. In vet practise, the initial service we provide provokes one of three responses by clients; satisfaction, dissatisfaction or a neutral response. Most new clients thus offer a veterinary practise a two-thirds chance (positive or neutral) of repeat service[iv]. The vet-client relationship once formed sustains itself through trust. It is the main ingredient for stable and durable commercial relationships[v]. Trust is established through competency and an ability to communicate care, and forms as a bond at the personal level (vet-client or nurse-client) rather than directed toward a company (practise-client)[vi]^,[vii]. Once established, respect from both parties for each other beyond their immediate service-for-money needs sustains the relationship[viii]

If we consider the relationships formed between employees in a veterinary practise and clients (i.e vet-client, nurse-client, etc), these relationships can contribute both positively and negatively to the practise success. For example, this relationship contributes to the practice’s success by fostering customer satisfaction and loyalty. However, the dark side of this is that it also increases the customer’s willingness to follow a specific vet if they leave the practise. This is minimised by fostering relations between a client and several employees instead of a single one, as well as by stimulating employee satisfaction and retention in order to continuously nurture the client-base. Employee satisfaction is thus pivotal to maximising practice success[ix]. In other words, a moral practice has high morale.

John Stuart Mill promoted what has become known as social utilitarianism which is a principle of ‘the greatest good for the greatest number of people.’ Mill stated that ‘the greatest good is promoted by allowing citizens to criticise their government, to worship as they please, to choose their own mode of life, and to think and to act as they choose.’ Simply put, social utilitarianism defines the impact of actions on the individual’s happiness. When people do not find in life sufficient enjoyment to make it valuable to them, the cause of this development is generally because people are caring for nobody but themselves. Next to selfishness, the principal cause which makes life unsatisfactory is want of mental cultivation. Mill writes: 

‘A cultivated mind - I do not mean that of a philosopher, but any mind to which the fountains of knowledge have been opened, and which has been taught, in any tolerable degree, to exercise its faculties - finds sources of inexhaustible interest in all that surrounds it. In a world in which there is so much to interest, so much to enjoy, and so much also to correct and improve, everyone who has this moderate amount of moral and intellectual requisites is capable of an existence which may be called enviable; unless such a person, through bad laws or subjection to the will of others, is denied the liberty to use the sources of happiness within his reach, he will not fail to find his enviable existence, if he escape the positive evils of life, - such as disease, indigence, and the unkindness, worthlessness, or premature loss of objects of affection.’