Cancer is the easy part! Techniques to help with difficult clients (Proceedings)


Cancer is the easy part! Techniques to help with difficult clients (Proceedings)

Apr 01, 2010

Speaking with pet owners is something veterinarians do constantly; as such, it is the most common "procedure" performed in veterinary medicine. Yet very few veterinarians receive any guidance in this critical area during veterinary school or after. Does communication matter? Studies in human medicine have shown that the consumer perception of health care quality is highly dependent on the quality of interactions with doctor. Also, the consumer satisfaction levels impact the clinical outcomes (people who liked their doctors did better!). Distressingly, one out of five patients reported a problem communicating with their doctor on most recent visit. Other studies have shown that effective physician-patient communication has been correlated with at least five health outcomes including diagnostic accuracy, improved health status (BP, blood glucose, stress levels, pain management, etc.), improved adherence rates, better patient and physician satisfaction, and decreased malpractice risk.

Good communication allows one to practice better medicine. Improved assessments & diagnosis will occur from acquiring accurate information, understanding the client's concerns and thoughts, actively involving the client in the treatment process, and enhancing the generation of solutions. Improved adherence to your recommendations will occur from better understanding of your client (beliefs, motivation, etc) and empowering the client to be part of treatment team. This will lead to increased preventative care and improved animal health and welfare. Estimates from human medicine on adherence showed that 50% of patients could not recall instructions. Of those that did, only 70% followed them. Veterinarians overestimate adherence, with one study showing average adherence of only 50% for 3 areas:

Client satisfaction/retention is increased with good communication. The client feels respected and valued; this will lead to increased referrals and decreased liability. Practice management improves with improved ability to communicate and manage, improved relationships with colleagues, increased job satisfaction and decreased burnout.

One survey showed that out of a multitude of factors pet owners desire in their veterinarian, the top factor was that the vet be a good listener and communicator, next was being kind and gentle, then respectful and informative, and fourth was reputation for high quality care. Price was selected as #9!

For these multitudes of reasons, communication matters. As such a critical part of the therapeutic success of a veterinarian's efforts, communication is an essential component of the veterinarian's role. It is the vet's responsibility, and it cannot be delegated. Thinking of communication as a procedure will help to understand its importance and place emphasis on the fact that good communication CAN be learned. Like any procedure, mastery requires practice and experience. Too often the ability to talk to people effectively is considered an inherent skill – you either have it or you don't. However, many studies in the field of human medicine have shown that the skills involved in communication are able to be defined and, indeed, learned. There are several constructs upon which to outline and describe techniques in communication. This talk will focus on the four core communication skills.

 • Non-verbals

 • Empathy

 • Open-ended questions

 • Reflective listening

Non-verbal communication

Roughly 80% of all communication between individuals is nonverbal and generally unintentional. Thus, information that cannot be hidden is being exchanged at all times – both from the client to the clinician, and vice versa. The nonverbal aspects of communication are like a poker player's "tell" – they give away what a client may be thinking or feeling, possibly contrary to what they are saying verbally.

 • Involuntary nonverbal communication more accurately reflects a person's feelings.

 • The nonverbal channel is the primary mode of communications of emotions.

 • In mixed messages, when verbal and nonverbal communications disagree, the nonverbal channel sends the truer message.

 • A common experience is asking a client if they understand, and the client hesitantly says "Yes", often without meeting the clinician's eyes. The non-verbals clearly say the client does NOT understand, and paying attention to that fact and trying to clarify things at that time will often save misunderstanding and upset in the future.

 • Nonverbal clues are also extremely useful in communication as they take up no extra time during an interaction. They are going on constantly, and one needs to only consciously note them (and perhaps comment on them, see below) to help guide the discussion in a beneficial manner.