Why invest in communication (part 2)

Myths about communication

During the past dozen years, interest in communication in veterinary medicine has really taken off among veterinarians, team members, educators, researchers and students. But beware! Mistaken perceptions by some people in the veterinary profession regarding communication continue to undermine effectiveness not only in challenging situations but also in everyday practice. We communicate all the time so why should we bother reading and taking classes about communication, especially when we have so many other more important things to learn about? Does this sound familiar? This article gets at why and how social talk is unlike clinical communication. In order to practice evidence-based medicine in the 21^st Century, we need to look carefully at what the research says regarding the role of communication in achieving economic viability and significant outcomes of care in veterinary medicine. In addition, we need to begin to dispel the myths about communication that may be holding us back from achieving a professional level of communication competence. The following aims to arm readers with the necessary rationale and scientific backdrop to lead their practice forward with success.

To begin, let’s get a handle on how we think about communication because the way we think about it has a significant impact on what we do with communication every day in practice. Some common myths about communication sound like this:

Myth 1

“Communication is an optional add-on, an extra and there is no science to prove that it’s important. All I have to do is have someone who’s good at communication and then I don’t have to worry about it.”

Myth 1: The truth is, communication is a core clinical skill and there’s considerable science behind it 1. Research into communication in veterinary medicine spans the last 17 years and it points very strongly to the relationship between communication and client compliance, client and veterinarian satisfaction, reduced risk of complaints and patient health outcomes. Knowledge, communication skills, self-awareness, physical examination skills and medical problem solving are inextricably linked – you cannot have one without the other 2. Effective communication skills are essential for all interactions ranging from routine wellness exams to problem visits to end of life decision-making and euthanasia. There are not a new set of communication skills for every issue rather we need to sharpen the intentionality of our use of skills depending on the urgency, episode and context in order to work toward the outcomes that we are after, including the client’s perspective. It’s essential that we ensure that staff members get communication training and mentorship while they are on the job. Effective communication is the responsibility of all members of the practice team. Communication skills are not an optional extra in veterinary medicine – without appropriate communication skills, all our knowledge and intellectual efforts can be wasted (Figure 1).

Myth 2

“Communication is a personality trait, either you have it or you don’t.”

Myth 2: The truth is, communication is NOT a personality trait. It can be taught and it can be learned just like any other clinical skill 3. Communication in veterinary medicine is a professional skill that needs to be developed to a professional level. Communication is a series of learned skills rather than just a matter of personality. Personality may well provide a head start but we can all learn from wherever our individual starting point may be. The key to learning a complicated skill, be it a sport or communicating with clients, team members, specialists, is to break down the skills into their component parts. We often hear, for example, “She’s good with the clients” or “He has a really nice style, he handled that angry client so well” without quite identifying what he did, thereby making it difficult to emulate. We need to identify the actual skills that have been used, practice the individual components and then put them back together again. Because of its inherent complexity there is no ceiling in achievement. We can always learn more.

Five elements are necessary to master any skill set:

• Detailed and clearly defined skills to be learned

• Being observed or observing communication skills in action

• Well-intentioned detailed feedback of what is working and what would make the communication better

• Practice and rehearsal of skills in various contexts

• Small group (practice team) or one-to-one teaching and learning format (Figure 2)

The most comprehensive, applicable and utilized model for communicating in veterinary medicine is the Calgary-Cambridge Communication Process Guide. This model includes 58 highly evidence-based communication process skills plus another 15 process skills related specifically to giving information to clients and making plans for follow-up. The guides are the backbone of communication teaching and learning in education, continuing education and practice (Figure 3) 1. The checklist (available for download at the end of the article) can be used as a starting point for identifying skills that are already being used in the practice and areas for growth.

Myth 3

“I’ve had lots of experience and I’ve been talking most of my life. My experience is enough.”

Myth 3: The truth is, experience can be a poor teacher. Unfortunately, communication skills do not necessarily improve with time and experience. We know that without communication training and mentorship, veterinary professionals tend to adopt a particular style of interacting with clients that can be detrimental to important outcomes including accuracy, efficiency and supportiveness. While experience may be an excellent reinforcement of habits it tends not to discern between good and bad habits. We use the same methods over and over again without careful examination of their effectiveness in the work that we are doing and what we are trying to achieve. The goal is to adapt to each and every client and situation using the skills that are the most effective in terms of achieving the outcomes that you and the client are after.

Myth 4

“All of this focus on communication takes too long to be practical. If I start communicating more it will take too long. My appointment will run overtime.”

Myth 4: The truth is, once learned, the use of effective communication skills takes less time than a more traditional appointment (Figure 4). Communication researchers in veterinary medicine report that on average more traditional appointments that are characterized as being highly biomedical in nature take 11.98 minutes. Appointments that are characterized as being more relationship-centered in addition to addressing the biomedical aspects of the patient take 10.43 minutes 4. You might be asking yourself “how can that be?” Further research found that interrupting clients and not allowing them to complete their story and the reasons for being at the practice resulted in concerns coming up late in the appointment. This was reported as having an impact on the length of the appointment and quite possibly the accuracy of the diagnosis due to late arising information provided by the client 5. Clients also reported higher satisfaction when an appointment was relationship-centered 6. Like any other complicated clinical skill, when we are first learning to use skills that are less familiar to us, it takes longer until we master the skills and can put them into practice without so much focus. Think about how long it took to do your first spay compared to the time that it takes a seasoned vet practitioner.

There have been enormous advances in the field of communication skills teaching and learning over the last 20 years.

• Communication programs have become a part of mainstream education at all levels of training at many schools.

• High stakes summative assessment of communication has become an established component of many undergraduate curricula at some schools.

• There have been an increasing number of courses and workshops for veterinarians and staff regarding communication for practice success.

• The science in favor of the importance of communication for practice success is far too compelling to refute. The practice of excellent veterinary medicine is inextricably linked with skilled communication – you cannot have one without the other 7.

Download the checklist in PDF format