Every discussion in an emerging partnership between specialists and primary care veterinarians eventually comes around to
the necessity of effective communication. How you talk about referral with clients, what you say, how you communicate with
specialists, and how specialists communicate with you is, by all accounts, critical to success for both practices.
Cindy L. Adams, PhD, MSW, is associate professor of Veterinary Medicine-Clinical Communication at the University of Calgary
in Alberta, Canada. She sees communication issues from an evidentiary perspective, including evidence from studies in human
medicine. The word collaboration forms the core of her advice.
The client conversation
"Shared decision making requires a collaborative discussion," she says. "The veterinarian shares his or her thinking and offers
all the options respective of the client's thoughts, concerns, and experience. The strongest predictors of adherence are empathy
and shared decision making." 
Keep Talking
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Shared decision making is a process, Dr. Adams says. It starts early in the relationship between the primary care veterinarian
and pet owner. The ability to shift perspectives and to see the problem from the pet owner's eyes takes time and effort.
Start by working to understand the client's beliefs. What are the client's expectations? The conversation might go like this:
"Based on what you've told me so far, it sounds to me like you'd like to go further with some exploratory work. That's why
we're talking about referring your pet to a specialist."
Having engaged the client, you can continue working through the issues. The veterinarian can involve the client more deeply
with a simple, "I'm more than happy to help you think through this." Then the conversation should contain constant rechecking for engagement with a simple phrase like, "What are your concerns?" or "Do I have that right?" The goal is dialogue, not monologue.
"To a great extent," Dr. Adams says, "this is about sharing your thinking, as appropriate, once you know people are interested.
What you want to do is involve them by making suggestions rather than directives. That is extremely critical." Many practitioners
forget to invite clients to add their ideas throughout the process.
Dr. Adams emphasizes the necessity for creating this pattern of interaction and collaboration early on, so when the time comes
to make a referral recommendation, the primary care veterinarian and the client are prepared for the conversation.
Conversing with specialists
Being left out of the loop when the patient goes to the referral clinic is one fear many primary care veterinarians harbor.
But those who have honed their skills emphasize that primary care veterinarians and specialists won't let this happen.
Dr. Adams agrees. Again, she thinks the same skill set applies, but with a twist. She says practitioners subtly train
clients how to be clients, but they must also train themselves to be clients of the specialists they utilize—and train specialists
how to deal with them. That interface requires a straightforward conversation. She suggests something like this between the
primary care veterinarian and specialist: "I have a case I'd like to discuss. Before we go any further, I need for you to know this is really important to me. I need
to know how you conduct your business when you work with somebody like myself."
Here, Dr. Adams says, you are gathering information, the same way clients gather information from you. Particularly, you want
to know how the specialist plans to stay in touch with you. Then you need to let the specialist know what you want out of
the relationship. She suggests a statement like: "Do you mind if I share with you some of the things that matter to me?" or "I have three things that matter to me a lot. Can
we talk about it?" Then, she says, "download" those three things and let them know you are sincere.
