Issue 1 - May 2020

The C-factor: vet skills in communication

Other articles from the same issue

Why invest in communication (part 1)

Why invest in communication (part 1)

In the US, there are 3 times more suicides in the veterinary profession than in the average population and the ratio is even worse for women. That is why it is so important to look at how certain communication techniques can prevent this phenomenon. Let’s begin this chapter with a clinical case involving Maria.

Why invest in communication (part 2)

Why invest in communication (part 2)

Working as a vet practitioner clearly put us at risk of “compassion fatigue”, a very tricky and devastating disease. The authors of this issue of Veterinary Focus are convinced that effective communication can prevent burnout. Unfortunately, there are numerous myths about communication, which we will clear up in this section. 

Why invest in communication (part 3)

Why invest in communication (part 3)

We are convinced that good communication with the pet owners and with the staff can contribute to a balanced life and help prevent burnout and other psychological disorders. This is an unexpected but very true reason to improve communication skills. This section explains the many benefits of effective communication.

Why invest in communication (part 4)

Why invest in communication (part 4)

Let’s quickly remind ourselves of the science behind communication and look at what neuroscience has to say on the subject.

Why invest in communication (part 5)

Why invest in communication (part 5)

“Know thyself”, Socrates said. In this last section, we look at "triggers" which cause us to behave in certain ways, and how to address them.

Communication is a clinical skill (part 1)

Communication is a clinical skill (part 1)

The communication skills that follow are essential for the development of a collaborative veterinarian-client partnership, staff member-client partnership, staff member-staff member relationship. These skills constitute the core of clinical communication skills that can lead to more common ground, enhanced relationships and coordination of care, reduced conflicts and complaints. Let’s begin by looking at non-verbal communication. 

Communication is a clinical skill (part 2)

Communication is a clinical skill (part 2)

One of the key skills in building relationships with others is the use of empathy. Empathy is referred to as the essential building block for extending compassion. That said, of all the skills used in a consultation, empathy is the one most often thought by learners to be a matter of personality trait rather than skill. Certainly one of the first steps in communicating empathy is the internal drive to truly want to understand the client’s perspective along with relevant communication skills to relay this knowingness. Although some of us are more naturally empathetic, skills necessary for empathy can be learned.

Communication is a clinical skill (part 3)

Communication is a clinical skill (part 3)

Asking owners open-ended questions, especially at the beginning of a consultation, is extremely important to improve not just communication in general, but also to ensure the veterinary practitioner takes the animal’s history effectively.

Communication is a clinical skill (part 4)

Communication is a clinical skill (part 4)

As well as listening it is important to actively encourage the client to continue telling their story. Any behavior that has the effect of inviting clients to say more about the area they are talking about is a facilitative technique. At the beginning of the consultation our objective is to obtain as wide as possible an understanding of the patient’s problem or needs and the client’s agenda before exploring any one problem or issue in greater detail. As we discussed earlier, open-ended questions enable us to encourage the client to tell his story before we drill down into more detail.

Communication is a clinical skill (part 5)

Communication is a clinical skill (part 5)

Inclusion of the communication skills in every day practice requires us to move beyond what we do anyway to a higher level of intention in the way that we interact with clients and one another. These more effective consultations and interactions also lead to improved outcomes of care including: improved client, vet practitioner, staff member satisfaction, increased understanding and recall by clients, increased adherence and practice success. Let’s turn our attention to two useful techniques for communicating during consultations: the “shot-put” approach and the “Frisbee” approach. 

The smooth consultation (part 1)

The smooth consultation (part 1)

Vet practitioners frequently concentrate on the pet and forget about the owner… Client centricity requires some preparation and training. The consultation should follow a process where conditions are created to have a positive interaction with the pet owner, starting with a warm-up and using the communication skills explained in the chapter “Communication is a clinical skill”. In this first section, we look at warm-ups and how to establish a good relationship with owners.

The smooth consultation (part 2)

The smooth consultation (part 2)

This section provides some specific examples of different types of questions (open-ended, closed) to ask owners during consultations, as well as additional advice and practical examples to help you improve your listening skills.

The smooth consultation (part 3)

The smooth consultation (part 3)

This last section focuses on the importance of teaching. It also explains how the perfect consultation should be structured, outlining three different stages. Lastly, we look at difficult situations veterinary practitioners may find themselves in, as well as the best way to deal with emotional blackmail.

Everyday challenges

This chapter will cover some difficult situations that a vet practitioner can face. With the influence of “Dr. Google”, pet owners have more and more objections: they challenge what the vet says and does… this can lead to conflicted situations. Finally, many veterinarians are uncomfortable talking about money. Suggestions for how to talk about money are proposed in this section of the Focus.

Conflict: gaining the client’s trust

A) Introduction

Did you know that studies show that one of the most effective ways to create loyal clients is by providing them a satisfactory response to a complaint?1

However, we know it’s easier said than done. Our primitive brain has been trained by millions of years of evolution to respond automatically to anything that could be perceived as “threatening”, and its two immediate responses — fight-or-flight — don’t exactly help resolve our clients’ complaints. Everyone eventually makes a mistake, sooner or later. Our professional career largely depends on us being able to develop skills to manage complaints and restore damaged emotional connections and trust with our clients.

1 25% of positive encounters started as service failures ( 1 )

B) Where do complaints come from?

Our clients rarely have enough scientific knowledge to judge our clinical performance. Most complaints do not come from missing excellence at work, but from things like those shown in Table 1 below ( 2 ).

Most frequent kinds of complaints.
Being cold or distant
Sketchy or undecipherable explanations, incomprehensible technical language
Not fulfilling promises (punctuality, returning phone calls, etc.)
Not listening, interrupting
Arrogance
Disrespect
Seeming uninterested
False expectations
Negative surprises (bills that do not reflect the initial price, much worse health result than promised, etc.)
Table 1.

C) The five-step method for effectively handling complaints

The good thing about having a method is that you can follow it to restore your clients’ trust, and teach it to other members of your team so they are prepared when things go wrong.

Step 1. Stay calm and get them to say “exactly”

One of the most frequent errors is letting our amygdala take control and fire signals, for instance, making us act defensively when there are complaints or look for excuses, interrupt or counter-attack. To avoid this we must calmly focus on the client, listen in order to understand, not judging, asking questions to clarify and avoid misunderstandings, asking permission to take notes if necessary, summarizing what we have understood in our own words, and finally asking if that was the root of the conflict in order to get the client to say “exactly”.

If we get the client to say “Exactly, that’s why I’m complaining” we will have taken a giant step towards solving the problem.

Veterinarian: Mrs. Gomez, if I have understood, what you’re upset about is having to wait an hour for your appointment. Not only have we misused your time, but nobody told you that you would have to wait for so long or why.

Client: Exactly, it’s not just the waiting, it’s the feeling that my time isn’t being respected.

Step 2. Ask what happened

Sometimes a client goes too far in their interpretation of what happened. For instance, they could come back with “blah, blah, blah...it’s clear to me that you don’t care that we’ve been here waiting for an hour in the waiting room”.

In that case, once the client has calmed down and has said “Exactly” we can begin to question their assumption. But be careful, because this is a very risky step. One false move could create more tension than there was originally. You should think carefully about whether taking this step is worth it.

V: Mrs. Gomez, I understand that we could have given you that impression and I am very sorry. I assure you that we do care very much about our clients and that our mistake is not because of a lack of interest.

Step 3. Put the complaint into a category

Avoid the question “Whose fault?” and instead ask “What did we do bad?”.

Although the line between one type and the other is sometime blurry, in general complaints can be classified into three types (Figure 1) ( 3 ):

Figure 1. Generally speaking, complaints enter one of three categories.
© Manuel Fontègne

1. Task complaint: something wasn´t well done. For example, a bandage was poorly applied, fell off and the owner had to come back to the clinic to have it replaced.

2. Protocol complaint: it´s about some step of the process. For example, the surgeon forgot to phone the client after his pet surgery as he had agreed to do.

3. Behavior: It´s about the impact on people of the way we act. For example, the receptionist was cold, unfriendly and didn´t inform him about the delay in the appointment

Don´t make it personal, remember:

• Was something done wrong, for instance giving back a dog with blood and urine stains after a hospitalization?

• Was it a protocol error, for instance not calling a client after an operation?

• Perhaps it was a problem caused by inappropriate behavior, for instance a veterinarian who was impatient and unfriendly during an office visit?

In the case of Mrs. Gomez, perhaps the error was with the appointments system (too many appointments in too little time), the veterinarian (office visits running too long and building up delays), the receptionist or assistants (they didn’t keep the client informed about the delay, how long it would be and why it was happening nor did they give them options).

Iván López Vásquez“Many of our most loyal clients are a result of having known how to restore their trust through a well-resolved complaint.”Iván López Vásquez

Understanding the type of complaint is essential not only to providing a satisfactory response, but to making it an opportunity for learning and improvement. When you receive a complaint, ask yourself if it is due to something that was done wrong, a bad protocol or inappropriate behavior. Be thankful that you have the opportunity to discover and improve it.

Step 4. Apologize sincerely

You have listened calmly to your client, you have got them to calm down and feel understood, and you now understand the source of the problem. It’s time to say:

I’m sorry Mr./Mrs. Gomez.

I or we take full responsibility.

I or we understand how you feel because of having to wait for so long, unexpectedly, and the lack of consideration of not being informed or given options.

Can I ask if I or we can do anything to resolve/minimize the impact of what happened?

Although many veterinarians think that this last question is very risky, in the authors’ experience there are very few cases where the client has put an extortionary or disproportionate proposal on the table. If that were the case, it would have to be negotiated. And if the client doesn’t know or doesn’t dare propose a solution, we have to make sure we propose one that will satisfy the client. Remember, many of the most loyal clients are a result of having known how to restore their trust through a well-resolved complaint.

C: Nothing can give me back the time I’ve lost, I’m afraid nothing can be done at this point.

V: Mrs. Gomez, it’s true, and I wish I could go back in time and fix it. Unfortunately, I can’t, but with all due respect I’d like to suggest something: next time you come to the clinic we will let the doctor know, check that nothing unexpected has shown up and make sure everything is set up for your appointment. Is this Ok for you?

Step 5. Put the previous step into action immediately

Whatever you promised to do, do it right away. Trust can only be restored through actions and not kind words or good intentions. We are not what we say we are, but what we do.

V: Mrs. Gomez, I’d like to fix this myself with reception so that you don’t have to explain yourself any further. Does that sound good to you?

D) Conclusion

Unfortunately, there´s no 100% guarantee of adequately solving every complaint. But if we manage to do it, not only will we restore the emotional connection and trust with our clients, but they may even recommend us.

Managing objections

A) Imagine

Figure 2. Even if complaints are upsetting, they are a good opportunity to clarify information, build trust and strengthen the communication to reach an agreement.
© Shutterstock

You have worked hard to explore your patient’s health issue, to explain the symptoms, the different possible diagnoses and the best options to follow. You have been clear in your recommendations, and you have been sure to use good verbal and body language. Suddenly, BOOM!, the client unexpectedly complains, asks for you to explain further why certain tests are needed, seems uncomfortable with the price, and drags their feet, saying they have to think about it.

Your amygdala activates! Your heart races, your jaw tenses up, your smile turns into a serious expression and it feels as if your blood was going to boil. You are upset, but you should be thankful. An objection is not a complaint or a rejection (although its emotional impact feels similar to us), it is an opportunity to clarify information, build trust and strengthen the communication to reach an agreement (Figure 2) ( 4 ).

B) Two kinds of objections

Based on what we already know about neuroscience, we can distinguish two types of objections. Those that come from messages we have sent unconsciously and put our client’s primitive brain in high alert mode. For instance, a weak handshake, not maintaining eye contact, speaking with lots of “ummm... errrr...” while touching our neck and clearing our throat.

As a result, the client has perceived something that makes them trust us less. They are no longer listening to our reasoning, no matter how convincing we are, because their amygdala is telling them to flee. And to do so, they politely say things like “I need to think about it”, “Maybe later”, “Send me all the information in an email and I’ll let you know”

The other kind of objection is more rational. For instance: “I am not in a good place financially right now, it’s not the best time”, “This price is very expensive for me”, “I’d like a second opinion before I decide”.

C) Ranking the most frequent objection in your practice

In Table 2 below, you can see a list of objections often heard in clinics everywhere.

List of objections often heard in clinics.
“I must think about it.”
“I have to talk about it at home.”
“I don’t have the money right now.”
“Give me the information to look over.”
“It seems like a lot of money to not have any guarantees.”
“They did that to my friend’s cat and it didn’t go well.”
“Last time they told me one price and I ended up paying much more.”
“If he's going to have to suffer, I prefer to put him down.”
Table 2.

If you stop to think about it, you’ll see that in most cases we don’t see more than 10 kinds of objections. We recommend that you make your own table of objections with your team and organize them in order of more to less frequent.

Then construct a response to each of the most frequent objections.

Admitting an objection, while uncomfortable, may be what we need to get a “Yes” from our clients. Ignoring an objection will not make it disappear, in fact the opposite usually happens. Over time it becomes the source of misunderstandings, false expectations and complaints. Taking an objection as a complaint or even as a personal attack unnecessary heightens tension.

So, what should we do?

D) The five-key method for handling objections

Key 1: Back up your client

Do you remember that the amygdala has much more influence on our decisions than our cortex? The first step consists of calming down our primitive brain. It is essential to start by saying “Yes”. Trying to force the client to change their mind will only make them push back even more, get exasperated and become hostile. The idea is to acknowledge their point of view, respect it, and only then give your own opinion.

For instance:

“Yes, I understand the pressure of needing an operation at a difficult time financially.”

“I perfectly understand how difficult is to decide when there isn’t a 100% guarantee...”

Key 2: Get them to say “Yes” as many times as you can, get them to say “exactly!”

Now it’s time to ask questions and listen actively. Ask lots of questions to clarify things and to get them saying “Yes”, like “Yes, that’s what I mean”, “Yes, exactly”, “That’s right, yes”.

For instance:

V: “If I have understood, you are scared of anesthesia, right?”

C: “That’s right”.

V: “And you’re also worried about the cost of the procedure, because it has caught you at a bad time, right?”

C: “Exactly.”

V: “Is there anything else you could be worried about that we haven’t discussed?”

C: “Not right now, those issues are what worries me most.”

Key 3: Be consistent

The goal now is to remind the client why they are at the clinic — their fears, their needs, the threats and opportunities — and to connect these with the “Yes” responses they have given. An inexorable law of influence says that once an opinion has been expressed, human beings feel the need to act in accordance with it.

For instance:

V: “If I have understood, you don’t want Layka to suffer unnecessarily. She is part of the family, and so much so that you’re worried about the impact that it could have on your young son if Layka wasn’t well. If you decide to do something, you want the best guarantees that she won’t suffer, that she’s receiving excellent care and will recover as soon as possible. How would you feel if we were able to solve this while minimizing the economic impact?”

C: “Much better!”

Key 4: Offer alternatives, minimizing any risks and inconveniences detected

It’s time to respond by offering alternatives that meet the needs previously expressed by the client. Use the table we made with the most frequent objections and respond to each one with the help of another table to look for solutions, like the one shown below (Table 3).

Ideas for offering alternatives Write your example here
Tell a story  
Present an important fact  
Share a client testimonial  
Show a video of a similar case  
Be clear about the risks of doing nothing  
Table 3.

For instance:

V: “That is why it is so important to do pre-anesthesia tests and the electrocardiogram. They let us find any hidden risks beforehand. And hospitalization, even though it raises the cost, is essential to make sure that Layka is not experiencing pain after surgery. We have done this procedure hundreds of time, with a success rate of over 80%. In terms of it being a bad time financially, would it help you decide if you knew you could pay for the procedure in up to 12 months installments? We have a financing system that is very helpful in these situations.”

Key 5: Confirm that you have been successful and ask more questions

At this point you must encourage action.

V: “So we would be giving Layka and her family the best treatment and making it more affordable. Do you think we should get started? Every minute counts.”

E) Examples

 “It is very difficult to keep his weight down. My husband feeds him chips and table food.

 1– Yes, keeping his weight down is difficult and I understand your husbands wants the best for Max, – 2– as we all do. Don´t we? 3– We want max´s liver and heart to work better and that´s the reason I recommend this diet, it´s the best option. 4– Would it be helpful if I could share some information about the impact of chips on obesity and how it hurts the liver and heart of dogs with you? 5– Do you think it could help your husband to become more aware of the situation and understand the impact of Max´s nutrition in his quality and expectancy of life?

 “What are you doing!!? The other doctor that I used to see didn’t do it that way!”

 1– Sorry, you seem surprised I´m doing it in a different way the other doctor did it. 2– I understand it may alarm you –3– as you want the best for Layka, but be sure that´s also what I want. 4– Please, let me explain why I´m doing it in this way and ask you if there´s something you need to clarify… 5– is it Ok for you?

 “But I was expecting Dr. Dubois today, where is he?”

 1– I know you were expecting him. I´m sorry he cannot be here, I´m afraid something unexpected showed up and he had to leave. 2– Dr. Dubois really knows “Book” well, doesn´t he? 3– We all want the best for “Book”. 4– If it´s OK for you, I´ll examine “Book” , share my findings with you and then mutually discuss what´s the best thing to do, of course keeping Dr. Dubois up-to-date… 5– OK?

F) Conclusion

To summarize, the best way to tackle objections is to understand that they are natural and to see them as a great opportunity to build trust with our clients and methodically address them. Although we feel uncomfortable at first, the more we practice the more convincing we will be in refuting the most frequent objections.

Money talk

A) The challenge of talking about money

Figure 3. Veterinarians generally feel uncomfortable talking about prices and/or fees, but they should be the one who starts the conversation.
© Shutterstock

When a client decides to happily pay the price for the services provided to them, that moment is the “result” of good communication and interaction with them because they perceive that the knowledge and services received are worth the price that is charged.

Talking about prices and/or fees is “part of the conversation in veterinary medicine”, yet veterinarians generally feel uncomfortable talking about it, because: “We are doctors ... and we don’t want to mix medicine with money”, “We decided that it’s not our responsibility” (and we prefer to leave it to other members of our team), or clearly “We don’t feel able or have the skills to do so”. Meanwhile, clients expect the veterinarian to be the one to start the conversation about the prices of veterinary treatments (Figure 3), but this often does not happen. Other clients interpret the veterinarian mentioning prices during the visit as them “worrying more about money than about the well-being of their pet”, even becoming suspicious of their recommendations ( 5 ).

This is certainly a challenge, so here are some tips that could make the difference.

B) Generate value in the services provided by pointing to excellence

Clients should feel that veterinary fees (what they pay) are less than the value of excellence they perceive to have received (Figure 4). This ensures that the “money” conversation will flow in the interaction, and will cause less discomfort for the veterinarian.

Figure 4. Clients should feel that veterinary fees are less than the value of excellence they receive at the practice.
© Manuel Fontègne

How is value added?

1. Communication should “focus on the relationship” and avoid the “expert” model

There must be “agreement and cooperation” before medical procedures begin, as this improves the satisfaction of everyone involved. Be careful with your body language and appearance, as clients form quick perceptions from the moment they enter your office.

2. Identify your clients’ expectations, feelings, ideas and doubts:

Try asking questions like:

What are your expectations in terms of Moby’s recovery?

What options would you be willing to consider for Eva’s treatment?

What do you think would be the best plan of action for Cookie?

Are there other questions you’d like me to answer?

If you integrate this information about your clients with the patient’s clinical history and the findings of your clinical exploration, you will know what to say and how to say it ( 6 ).

3. Reduce your client’s uncertainty

Try to make sure your client understands the situation, their pet’s condition and the reasons behind your recommendations; give them “chunks” of information and frequently “confirm that they understand what is being said”. Try not to confuse them with lots of information all at once or use too much technical language ( 6 ).

Miguel Ángel Díaz“There must be “agreement and cooperation” before medical procedures begin, as this improves the satisfaction of everyone involved.”Miguel Ángel Díaz

Stay alert to the client’s verbal and non-verbal clues... Maintaining eye contact is essential to pick up every nuance of their reactions. If you feel that clients are not following you, ask open questions like:

• What do you think about the surgery we’ve just discussed?

• What are your thoughts about the treatment plan I have proposed?

C) Accept that talking about money in veterinary clinics is part of the conversation

Accept that when a client asks about prices, it is a normal stage in a decision-making process regarding a purchase, and that you must provide a response to their concern at that time. It’s better for you to answer with an “estimated price range” instead of detailed prices for services.

When to respond? Ideally, once you have most of the information about the patient (clinical history and clinical exploration), and you have detected the client’s expectations and other medical doubts. Talking about the “detailed” prices for surgeries, hospital stays and other items can be left to your receptionist or to your nurse.

If the client does not ask about prices, tell them... They must know the cost implications of the procedures being recommended at all times. This will ensure that the bill for the services is not a “surprise” for the client or even for us. This is what happens when a procedure is carried out and then you find out that the client cannot or does not want to pay for it. Also remember that “acceptance” is not “an agreement”: your client may “accept” that his cat needs a scan, but “agreeing to have it done and to pay for it” is very different ( 5 ).

If you have to initiate the conversation about money, be direct, explicit and don’t apologize for your fees. Present your suggestions calmly and wait for the client’s reaction:

V:“I am suggesting the best medical treatment I know for King’s condition. Let me know if the price is an obstacle and we can explore less costly options (7).

D) Teach your team that the price of the services in your clinic “is what the services are worth”

Your team doesn’t necessarily have to feel that “your prices are high or a problem”, but they could unconsciously be non-verbally communicating their feeling of discomfort or mistrust with the prices charged to clients. Your team must internalize that they work at a “veterinary services company” that has expenses and needs profitableness.

Work through the following exercises with your team:

1. Many veterinarians don’t know about “the expenses” charged for their services.

Ask them if they know the total costs of keeping the clinic open for a full month, paying all the salaries, covering all the company expenses and without seeing any clients that month...after, you need to share your calculations with them, surely it will change how they see things. Remember that this exercise is for your team; don’t use it with your clients because it’s better to focus on creating value when interacting with them.

2. Practice a professional response to the client complaint: “your services are very expensive”:

Calmly and empathetically, taking care of your body language, try something like:

“I hear what you’re saying, and I’m sure there are less expensive services. However, these are the prices at our clinic.”

“I hear your concern about price, and yet we want to give Fluffy what she needs to get well. I would recommend the first two tests to get a baseline...”

E) Remember that clients value the benefits of services and not just their characteristics

Veterinarians often focus on explaining the reasons behind their prices, in terms of the time invested or the features of the services provided. Example:

 “For Magoo’s surgery we have an operating room with technological equipment and an anesthesiologist who works with the surgeon.

This tells the owner very little, because they are just the features of the service. What they want to hear are the benefits that they and/or their pet will receive as a result and/or the benefits for their relationship with their pet (current or future).

Veterinary doctors must learn to talk about the features of the service “along with” its benefits. For instance:

 “For Magoo’s surgery we have an operating room with technological equipment and an anesthesiologist who works with the surgeon (features)… so that we can monitor him during the entire surgery, minimizing the anesthetic and surgical risks (benefits).

Saying no with a smile

A) Introduction

• A client asks for an office visit but arrives late to the appointment, just when the clinic is closing.

• After a long treatment, a client asks for an unwarranted discount.

• A client is always criticizing a colleague from another clinic.

Every day we face situations where we have to say NO to our clients. And yet we find it difficult to do so, because of things like:

• We don’t want to lose the client and harm the clinic.

• We don’t want to harm the relationship.

• We are afraid of their reaction.

• We feel guilty.

For many of us, the best solution to this dilemma is:

Concede: saying yes when you really want to say no.

Attack: not knowing how to say no or not saying it the right way.

Avoid: keeping quiet and not saying anything.

But it doesn’t have to be that way. We humans are naturally more good-natured than selfish. Showing empathy when dealing with others helps us build healthier relationships. However, in the professional world with our clients, sometimes being too empathetic (thinking more about “you” than about “me”) makes “saying no” more difficult for us when we really need to, because we do not want to seem selfish, distant or cold.

There is a three-step method that can help you say no with a smile, which consists of saying yes before and after the no ( 8 ).

YES! – NO – YES?

B) Step one: Yes!

This consists of saying yes internally to your values, to what is important for you.

Don’t jump the gun; first pause and think:

• Are there any triggers affecting me right now?

• What are my options?

• I want to say no, I have a right to do so, but could I pay an excessive price for it?

• Have I listened to and understood the other side?

C) Step two: No!

This is a very delicate step because nobody likes to feel rejected. The secret to success is to not make it personal, to not judge, to stick to the facts and use descriptive language.

To facilitate the no, it can be very useful to appeal to shared interests (like your interest in the health of the pet) and/or standards (like respect, family time, etc.).

Here are several ways to start your no:

• “No, thank you, _______________”

• “We have a policy that _____________”

• “I have a prior commitment _______”

• “It’s not possible right now, ___________”

• “I prefer to refuse your request rather than do it poorly __________”

D) Step three: Yes?

When one door closes another opens! Try to offer a solution, a third alternative that takes the interests of both sides into account.

This is when you must be careful to manage how the other person’s reactions affect you. Remember not to concede or attack, and to stay true to yourself.

Compare these responses:

“Mr. Segre, there’s nothing we can do. You arrived just when we’re closing and are demanding we look at Layka’s limp, a limp that started seven days ago! All right, bring Layka into the office, but we can’t be doing this, blah, blah...”. Mr. Segre gets his way, and the veterinarian angrily concedes.

“Mr. Segre, you said that the limp began a week ago and has gotten gradually worse, but otherwise Layka is eating, drinking and doing her business normally. Mr. Segre, my family is waiting for me and I intend to eat dinner with them and see children before they go to bed. I’m afraid I can’t see you at this hour of day because it would mean finishing work very late and your situation is not an emergency. What I suggest is that we find a solution together, a day and a time that works for both of us, so I can give Layka my full attention and give both Layka and my family the time they deserve.”

Which one would you choose?

The second is a good example of the concept of “assertiveness”, which is the ability to express your point of view and respect that of others, without being aggressive or demeaning. Assertiveness and empathy are elements that must be in balance when we communicate.

Figure 5. Assertiveness is the mindset necessary for a win-win situation.

In Figure 5 above we can see where “assertiveness” falls between “thinking about myself” and “thinking about you”.

In our example, along with worrying about “how we say things”, we must also consider how much of what we say (words) are focused on “thinking about myself” or “thinking about you”.

When “saying no” is hard for me and I think more about Mr. Segre than about my family commitment, I concede and fall into the I lose–You win box. Doing this often is not good because it gradually eats away at our personal well-being and job satisfaction, as we do not feel in control of our time or able to do anything to change it. This can lead to “learned helplessness”, approaching burnout.

E) Setting limits

Setting limits is part of effective communication: limits on roles and responsibilities, physical limits, time limits, limits on priorities, on what we talk about, etc. are all welcome in an interaction and we should not be scared to express them.

The YES! – NO – YES? method is a great tool for setting limits and reaching a I Win–You Win solution, because it allows us to show “assertiveness”, making it clear that what is said strikes a very useful balance between “thinking about myself” and “thinking about you” (my client).

If I decide to be stricter with my principles and stop conceding to the demands of clients like Mr. Segre, I also need to be careful. Otherwise I could easily fall into the “I Win–You lose” box, if what I’m saying is more focused on my interests and values (thinking about myself) and less on yours (thinking about you).

In cases when you feel you should make an exception despite the personal sacrifice required, and you decide to concede and lend a hand, we suggest the following: remind yourself to let your client know that the effort being made to see them then is “an exception and not a rule”, in order to teach yourself and them about the limits so that next time you can say “No” with a smile.

 “A ‘No’ uttered from the deepest conviction is better than a ‘Yes’ merely uttered to please, or worse, to avoid trouble”. Mahatma Gandhi

Conclusion

Most of us dislike conflict. To avoid them or manage them successfully, it is necessary to follow different steps. For instance, managing objections requires 5 steps. To improve in this area, it is interesting to list the most frequent objections you are facing in your clinic and to brainstorm with your peers for better consistency.

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