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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Questions & answers
Certainly, there are many questions a veterinarian can and will need to ask the client to collect a case history, but given the limited time available to each client, these questions should be well-considered – the quality of the question determines the quality of the answer. That means: think first about what do I want to know and why? Then formulate the appropriate question!
With the right types of questions you can:
gain valuable information about the pet’s illness;
reveal the client’s needs;
find out the client’s opinions and attitude;
gently lead clients to a decision.
We must not forget that the client is, on the one hand, a layman, but, on the other hand, he can find a lot of information on all sorts of subjects on the Internet – including the subject of animal health.
This means that clients are often “pre-informed” and come with a self-diagnosis or they present their “internet findings” and would like to discuss them with us. Nevertheless, the client needs our guidance and clear recommendations in order to work with us as a partner to design the best care for their animal.
Basically, there are several types of questions that are well suited for the consultation and can be used for a variety of purposes (Table 1).
Question type & examples
Not suitable for...
So-called “why-questions”, which start with what, which and how:
• What brings you in today?
• What exactly did you notice about your dog?
• How did you give the food?
• What is your opinion on this issue...?
• Which other questions do you have?
• Inquiring about client needs and information on symptoms
• In-depth questions to clarify symptoms
• Inquiring about viewpoints and opinions
• Obtaining feedback
• Promoting decisions
• In case of lack of time, because the answers are much longer than with closed questions
Closed questions are questions that are answered with yes or no:
• Shall we take an x-ray now?
• Is the next appointment tomorrow at 3 o'clock ok for you?
• May I give you a 3 kg bag of pet food?
• Promoting decisions: yes or no?
• Guiding a client who talks a lot or when time is running out
• Requesting opinions
• Inquiring about information
Alternative questions are questions that give the dialogue partner two possible answers:
• Should we perform Plan A with x-ray and blood test or Plan B with x-ray only?
• Would you like to come in at 3 or 5 tomorrow?
• Can I give you a small or a large bag of pet food?
• Promoting decisions: this or that?
• Leading the client to a decision where he does not think about whether he wants something at all, but which alternative to take
• Guiding a client who talks too much
• Requesting opinions
• Inquiring about information
Table 1. Types of questions well suited for a consultation.
The art of dialogue is to ask the right question at the right time inquiring about the reason for the consultation, as well as the client’s desires and needs, while at the same time not giving the client the feeling of being in an interrogation. How question techniques – together with active listening – can be implemented in dialogue, is shown in the next example dialogue.
Note: the quality of the question determines the quality of the answer!
Listening & understanding
Not only asking the right questions, but also the manner of listening, active clarification and feedback are important to connect with the client in order to really understand him, make suitable offers and win him as a partner. The partnership between veterinarian, practice team and clients is important because it is the basis of a successful business relationship! If the veterinarian alone decides diagnosis and therapy, the treatment itself is probably not worse, but the pet owner is merely the doctor’s assistant and not a genuine partner.
For a high level of compliance and client loyalty, however, it is essential that the veterinarian views the client as partner and aims to achieve goals (therapy, diagnostics, etc.) together with him.
This means that the vet practitioner should:
ask open questions:
if he wants to get information and opinions;
if he wants to inquire about the client’s needs and wants;
if he wants to clarify something that is not 100% clear;
if he wants feedback.
ask closed and alternative questions:
if he wants to facilitate decisions;
if he wants to filter out a client trend (Plan A or Plan B?);
if the client talks so much that concentrated and focused work is made difficult or time runs out.
The following example dialogue shows how the following techniques like asking questions, listening, understanding, clarifying and feedback can be implemented in everyday practice:
Veterinarian:Mrs. Schmidt, what brings you and Lucky in today?
Client: Lucky needs to be vaccinated and I wonder if I should have him neutered.
V:I understand: Lucky will get his annual health check with vaccines. Then you need advice on neutering. Is there anything else I can do?
C:Yes, please pay special attention to his ears during the health check, Lucky had an ear infection last year.
V:All right, I have noted that. Mrs. S., can you tell me about your thoughts on neutering Lucky?
Dr. V. asks this question to clarify why Mrs. S. is considering neutering her pet. This information is important in order to respond appropriately to the situation. Moreover, the statement “if I should have him neutered” is anything but clear, i.e., what exactly Mrs. S. means remains initially in the dark. Simply going over it and delivering standard advice ignores the client’s needs and wastes time.
C:I read that this helps when male dogs are restless, but I was told that animals get fat after neutering.
V:Please explain in more detail how Lucky is restless.
C:Well, if there’s a female dog in heat in the area where we go for a walk, he doesn’t obey at all, runs away and once we get back home, he lays at the door and whines all the time.
V:Ok, and how does he behave if there isn’t a female dog in heat around?
C:Then he is the best behaved and most relaxed dog in the world.
V:It looks like you would both benefit from neutering Lucky. Here´s my suggestion: There is a preparation that is implanted under the dog´s skin and inhibits male hormones. If I implant it, then we’ll have about 4 months to see if Lucky will be calmer around bitches in heat. How does that sound?
C:That’s a great idea – let’s do it! And then we can still operate him in the end?
V:Sure, that´s always possible, but then we’ll know if neutering is the right solution. I suggest that we do the health check, vaccination and the ear examination today, and make a new appointment for the anti-hormone implant. Does that work for you?
C:That’s great. Let’s do that.
In this dialogue, the veterinarian deliberately asks open questions until he is sure that he has enough information to offer a solution that suits the client’s needs and the present situation. He also listens carefully to what Mrs. Schmidt says and clarifies what exactly “restless” means by digging deeper with open questions. This is immensely important, because behind the initial symptoms described by Mrs. Schmidt there could also be a cardiological or internist issue. By asking questions, listening and giving feedback “How does that sound? / How does it work for you?”, the dialogue takes a good and mutually clear, open and satisfying direction (Figure 1).
Note: It is important to ask questions and actively listen until all facts are crystal clear.