Worldwide medical and scientific journal for animal health professionals

Issue number 1 Communication

The smooth consultation (part 3)

Published 02/04/2020

Written by Miguel Ángel Díaz , Iván López Vásquez , Cindy Adams and Antje Blättner

Also available in Français , Deutsch , Italiano , Português and Español

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.

The smooth consultation (part 3)

Key Points

When the client is involved in making decisions, he feels committed to actively participating in the pet’s treatment.


The first step is to change your attitude from the omniscient, dictatorial “god in white coat” to the interactive “health partner”


The best partner of a client is an open veterinarian who strives to find the best solution for each pet and its owner.


If clients get special favors on demand, this client group will grow steadily


Explaining & engaging

For a successful consultation, a warm-up, a good relationship, the right questions and answers, listening and feedback are immensely important. It also matters if and how the veterinarian succeeds in explaining his findings and therapy so that the client understands and provides consent.

The “icing on the cake” is when the client is involved in making decisions because they are his and not just the veterinarian’s. This makes the client feel committed to actively participating in the pet’s treatment – both issues being the basic prerequisite for adherence and client loyalty par excellence, something that every veterinarian and every service provider wishes.

Vet practitioners who consciously work on their communication style gain even more than compliance and client loyalty (which is already a great deal), they experience significantly less stress, happier clients and a better overall atmosphere in the workplace! By actively engaging in good and clear communication they achieve the best prophylaxis (prevention) of misunderstandings and stress and the best path to a positive and good client relationship.

How does that work and what needs to be done? How do you deal positively with odd or provocative clients? Let’s first look at the building blocks of an ideal consultation where the veterinarian:

  • leads the client through the consultation like a guide;
  • makes his actions consistently transparent;
  • explains his findings in client language;
  • obtains feedback time and again on whether the client has understood him and his opinions on the recommendations;
  • helps clients make decisions, wherever possible, i.e., gives him options with clear recommendations that are discussed and decided together; and
  • asks the client about his needs:
    • in general as an introduction to the consultation (see “Questions & Answers” in the chapter “The smooth consultation” part 2)
    • to offer therapy & diagnostics so that the client does not feel overwhelmed
    • to integrate therapy as optimally as possible in the everyday life of the client and his pet

All this does sound like a lot of issues that take a lot of time, but really, it isn’t that difficult and may even be time-saving. This is because the communication style is more effective, everything runs smoother and less often queries and misunderstandings on the part of the client must be clarified after the consultation.

Strategy during consultation 

Clients look to the doctor as a leader whom they can rely on. Someone who takes them through the exam, diagnostics and therapy “journey” and helps them make the right decisions.
Figure 1. Clients look to the doctor as a leader whom they can rely on. Someone who takes them through the exam, diagnostics and therapy “journey” and helps them make the right decisions. © Manuel Fontègne

To perform an optimized communication during client visits, the first step is to change your attitude from the omniscient, dictatorial “god in white coat” to the caring, interactive “health partner” (Figure 1).

Step 2 is practice, practice, practice. Working on your communication style and strategy. As with anything that’s new, perpetual practice makes perfect.

Step 3 is about techniques and tricks to deal with more complicated situations and unusual client enquiries.

The following sections of an example dialogue demonstrate how an uncomplicated consultation with a conscious and optimized communication can work (Table 1).

 

Recap of Section 1-3 and the main communications techniques used.
Section 1 Technique Goal
Start
“We are now… OK?”
Summary of client´s wishes & feedback To be sure nothing has been missed and that Mrs. Schmidt understands what´s going to happen now and is OK with that
Physical exam
“I´ll examine….”
Guiding the client through clinical procedures and explaining them
Creating an outlook and security for the client that everything will be explained in detail
Section 2 Technique Goal
Summary & recommendation #1
I´ve now…. How does that sound?”
Explaining the first main issue – the teeth and giving a clear recommendation with a request for feedback Presenting the most important finding alone, so that Mrs. Schmidt can digest this information and give her opinion before moving on
Participation
“Oh, anesthesia…”
“I´m sorry….”
• Open-ended questions
• Empathic response
• Positive outlook (new drugs, better procedures)
To “dig” until the roots of Mrs. Schmidt´s fear of anesthesia are clear
Showing Mrs. Schmidt that her fears are taken earnestly
Calming Mrs. Schmidt
Recommendation #2
I´d like to suggest… extra safety…”
Which additional information…?
“We can do it right now or… What works best for you?”
Stating benefits
Open-ended questions
Posing 2 alternatives and asking for an opinion
Presenting the second issue (after the first one) together with benefits and checking if Mrs. Schmidt has fully understood everything
Giving Mrs. Schmidt a choice and involving her by asking for feedback
Section 3 Technique Goal
Agreements
“Ok, then…”
“Do you have any other questions for me?”
Summary of agreements
Closed question
king sure nothing was forgotten, involving Mrs. Schmidt, reinforcing her consent
Mildly directing the consultation to its end
Conclusion
“It was a pleasure…”
Saying good-bye by complimenting the client Ending the consultation with a positive note

Table 1. Recap of Section 1-3 and the main communications techniques used.

Section 1 – Start and physical examination

Including explanations of techniques used and why they are used.

  • Veterinarian: Mrs. Schmidt, we are now beginning the annual health check and vaccination for Lucky, with special attention to his ears, ok?

The vet practitioner starts the physical exam by repeating Mrs. Schmidt´s wishes and asking for feedback, if she is (still) OK with that.

  • Client: Sounds good!
  • V: I’ll examine him from nose to tail and comment on what I do and see. When I’m finished, I will give you a summary and recommendations. I will also focus on Lucky’s ears and heart, because Lucky is now 10 years old and we need to check his internal organs regularly.
  • C: Good!
  • V: The eyes look very good: clear and shiny. The nose also looks healthy. Overall, the teeth and mouth are in good condition, I see tartar, which I would like to discuss with you later.

Now the veterinarian performs a “from nose to tail” physical exam and comments on what he is doing while examining the ears, skin, abdomen, heart, etc. In addition, he highlights the findings that he will talk about in more detail later.

Section 2 – Summary, explanation, recommendation and participation

Including explanations of techniques used and why they are used.

  • V: So, I’ve examined Lucky entirely and have a complete picture. I am happy to say that Lucky is very healthy – ears and heart are also in top shape! Of course, there are also issues that we should talk about when a dog is aging: these are Lucky’s teeth. Lucky has significant tartar on the incisors and canines, and if left untreated it may cause gingivitis and heart problems. That means: I recommend you have the tartar removed within the next month. To do this, Lucky will need brief anesthesia. How does that sound to you?

The veterinarian briefly summarizes the most important findings, explains the relevance and makes a clear recommendation. In addition, he deliberately combines the recommendation with an open question to find out how Mrs. Schmidt finds his suggestion. This is important for further treatment in order to remove any barriers and / or objections and to consider the client’s needs when planning the therapy.

  • C: Oh, anesthesia... that’s dangerous, right?
  • V: What concerns do you have?
  • C: My last dog before Lucky, Cassy, needed days to properly wake up after anesthesia. It was awful. He cried for 3 days, could not get up, and was unhappy!
  • V: How long ago was that?
  • C: About 10 years...

By repeatedly following up with open questions, the situation that led to Mrs. S.’s reservations against anesthesia were clarified, and the vet practitioner´s reaction to her concerns was optimistic and empathic. Dr. V. has taken in her fears, and then painted a positive picture of the new situation, in which Lucky will have an easy time with the procedure because of modern medicine and caring supervision.

  • V: I’m sorry, that must have been a very unpleasant situation. I can reassure you, today, we have much more advanced anesthetics that make waking up a lot calmer and gentler. Lucky will stay with us until he can walk alone again and is totally fine. Does that sound better?
  • C: Much better!
  • V: Now I’d like to suggest that we test Lucky’s blood before the anesthesia and see if the blood cells and organ data are all right – that will make the anesthesia even safer. A blood test will let us know which medication works best for Lucky and are the most beneficial. Which additional information do you require? 
Presenting offers and checking for understanding and concerns, one after the other in a “chunk and check” format helps clients make informed decisions.
Figure 2. Presenting offers and checking for understanding and concerns, one after the other in a “chunk and check” format helps clients make informed decisions. © Manuel Fontègne

After Mrs. S. reacted positively to Dr. V’s explanations, Dr. V combines the second suggestion – a preoperative blood test – with the benefit of “increased safety”. Doing so now offers the advantage that important information can be better understood in small units, and the client can follow and “digest” bit by bit and not be overwhelmed by a lot of information and recommendations. This prevents the client from simply rejecting an offer because he feels everything is happening too much and too fast and that he is being forced to make a decision (Figure 2).

  • C: I understand everything now and have a better feeling. I think we will do it as soon as possible. What about the blood work?
  • V: We can do it right now or 2 days before the appointment. What works best for you?
  • C: Let’s do it now, then it’ll be all set.

Mrs. S. can decide freely and chooses the next appointment, i.e. immediately, because Dr. V. specifies 2 temporary options for the blood examination entirely without pressure.

Section 3 – Agreements and conclusion

Including explanations of techniques used and why they are used.

  • V: OK! My assistant will take blood from Lucky now and bring it to our lab. We will have the results tomorrow morning, but I suggest that you set an appointment now with my assistant to remove the tartar. She will also explain the process in detail, go through the declaration of consent with you and give you a leaflet with all the important issues. Do you have any other questions for me?
  • C: When will I receive notification of the blood test results?
  • V: My assistant will arrange a phone call with you in the next 2 days. Is that OK?
  • C: Yes, everything sounds great. Thank you, Dr. V.
  • V: It was a pleasure to look after Lucky and you. See you at the surgery appointment. And remember: If you have any questions – please contact us!

Note: The best partner of a client is an open veterinarian who strives to find the best solution for each pet and owner.

Difficult situations and interactions

In most cases, clients can be well managed with positive communication which often results in a win-win situation for pet, client and practice. Occasionally there are also clients who question our recommendations and suddenly the consultation is no longer going smoothly. The consultation gets stuck, conflicts arise and the team has to make sure that it stays cool and does not pour fuel on the fire. Reasons for differences of opinion and resulting discussions as well as conflicts between veterinarian and pet owner exist in daily practice, e.g.:

  • The client has found something on the Internet that he wants to discuss with the veterinarian and get his opinion.
  • The client is influenced by other opinion leaders: breeders, dog clubs, friends and family.
  • Veterinarians and nurses have different opinions on the same topic within the same practice.

Often as a practice team, we perceive a simple question from the client, “I read on the internet...” or “the breeder has said”, as a (mild) provocation, although the client – except for very few – did not mean to be provocative. On the contrary, it is a compliment that the client asks “his” veterinarian for advice instead of simply buying the grain-free food advertised on the Internet.

Antje Blaettner

In most cases, clients can be well managed with positive communication which often results in a win-win situation for pet, client and practice.

Antje Blaettner

We are now showing you the slightly changed ending of the dialogue between Mrs. Schmidt and Dr. V., with Dr. V. dealing with a typical client question in a sovereign and calm manner:

  • Client: Oh, before I forget. I wanted to ask if it would be better if we change Lucky’s food to a grain-free one.
  • Veterinarian: What an interesting question! What information do you have on grain-free diets?

It is important here to not to react immediately and not to enter an instructive “mini lecture” about grains or pro and con grain-free, but rather to ask an open question which reveals the background and clarifies the goal of Mrs. S´s question.

  • C: I read on the Internet that grains, especially wheat, cause many allergies and that it is better to feed without grain.
  • V: Which allergies are described on the Internet?
  • C: Itching, vomiting and diarrhea. I don’t want that. I want the best for Lucky!
  • V: And what have you noticed about Lucky so far?
  • C: Nothing. He tolerates and likes eating the diet you prescribed.
  • V: I’m really pleased to hear that, and if it changes, please come to me immediately! There is currently a lot of information on the web that makes no sense, doesn´t have a scientific basis and comes from people who just want to make profit with their own products. Which sources or studies are given on the subject of “grain-free”?

This (open) question is used to ask for sources, and to show Mrs. S. that a veterinarian relies on scientific evidence, questions sources and is willing to deal with the subject for his clients.

  • C: I didn’t read anything there, but I can give you the website, then you can have a look.
  • V: I’d be happy to do that. That’s a good idea. Just give the name of the site via phone to my receptionist, and I’ll contact you when I have information, ok?
  • C: That sounds good. I know that you understand a lot more about it. But there are so many sites on the net and I get confused.
  • V: I completely understand. And I want the best for Lucky and you too. Thank you for coming to me with the question – we will call soon.

In this dialogue, Dr. V. kept the “communication door” open and signaled that he is interested in an exchange and his clients’ issues are also his issues – a mutually satisfying and positive relationship.

Note: Each client’s question is initially (only) a simple question and deserves a friendly and clear answer.

Emotional blackmail

Between all the good and dedicated clients, there are those who put their own interests first, and are not willing to negotiate.
Figure 3. Between all the good and dedicated clients, there are those who put their own interests first, and are not willing to negotiate. © Shutterstock

Unfortunately, between all the good and dedicated clients, there are those who put their own interests first, and are not willing to negotiate (Figure 3). They try to impose their will on the practice team according to the motto “If I do not get what I want, then I’ll go somewhere else!”

For example, this can happen when:

  • clients request times for appointments outside of office hours;
  • they ask for price discounts because another vet practitioner offers them cheaper services; and
  • request the ordering of certain products not included in the range of practice.

Sometimes the client learns through contact with practice teams that he will get his way if he sticks tenaciously enough to his wishes and tries to enforce them with emotional blackmailing such as “but you don’t want to lose me as a client” or “but you are animal lovers, and I cannot afford the vaccination for 3 cats “.

If the practice team gives in, it not only encourages such clients to beg for special favors, it even causes other clients to copy that behavior, because they realize that the team can be blackmailed. Clear and simple rules help here, which should be created in the team and then applied consistently. Of course, the team should react calmly and confidently and not respond to the emotional blackmail.

If clients have questions about appointments outside of office hours, ordering specific products or other things that you cannot and will not meet, the recommendation is, that you always give a consistent and friendly response and combine it with an alternative offer:

  • Unfortunately, we cannot offer you that.
    • How do you like an appointment tomorrow at 7 or the day after tomorrow at 4?
    • I have a very good and tasty alternative to the food that you mentioned. May I briefly explain it to you?

In requests for discounts, the following procedure is recommended:

  • Client: I have three cats – what sort of discount can you give me for the vaccinations?
  • Veterinarian: I can understand that you want to save money and ask for a discount! This is quite normal when it comes to goods – but the vaccination is a medical procedure including a medication. That means I have 2 options: I can save on the vaccine itself and give each cat less of it, so the vaccine probably will not work properly. Or I save on my service and don´t perform a thorough examination on the cats before vaccination, with which I may miss a condition and the vaccine does not work. Where should I save?

Note: this procedure only shows the client that we have little leeway when it comes to medical services and medicines. In no case should it be indicated here that Dr. V. would do so!

Then he asks an open question and returns the (apparent) decision to the client.

  • C: No, I didn’t mean that. I’d like to pay for the full service, but less. It must be important to you that all animals are vaccinated!
  • V: And because you want the full service, I must do my job as a veterinarian technically correct, which means: complete and thorough examination of the pet and full dose of a well-effective vaccine. I don’t see a possibility of a discount. But if we talk about food for your 3 little ones, then I can offer you a reimbursement in the form of goods when you buy regularly at our office. How does that sound?
  • C: I will look for a cheaper practice for the vaccination, but I will come back to you for the food.
  • V: OK! Thank you for your visit and all the best for your 3 cats.

In this dialogue, the client has unmistakably exposed herself as a blackmailer and price-hacker, i.e., she is a client who cares more about low prices than quality. As a team, you should consider: How do we want to deal with such clients? Do we want to respond to their demands, retain them and thus open the door for more demands and clients who set conditions? Or do we set our own standard of quality and price and stay consistent? When we do that, we gain respectability, focus on clients who appreciate our quality, and get rid of the price-hackers and blackmailer, resulting in stress-reduction and creating a positive team spirit.

Note: If clients get special favors on demand, this client group will grow steadily!

Miguel Ángel Díaz

Miguel Ángel Díaz

Miguel received a degree in Veterinary Science in 1990. After working at several clinics he opened his own clinic in 1992 Read more

Iván López Vásquez

Iván López Vásquez

Iván comes from a family of veterinarians; his father and older brother share the same passion. He obtained his degree from the Universidad de Concepción Read more

Cindy Adams

Cindy Adams

Cindy Adams is Professor in the Department of Veterinary Clinical and Diagnostic Sciences at the University of Calgary, Veterinary Medicine, Read more

Antje Blättner

Antje Blättner

Dr. Blättner studied in Berlin and Munich and after graduating in 1988 she set up and ran her own small animal practice. Read more

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