Talking to clients about nutrition (Proceedings)


Talking to clients about nutrition (Proceedings)

Our ability to communicate with clients determines our success as clinicians and caregivers. This is because client adherence to our recommendations depends in part on the relationship we share. In medicine, as in life, improved interpersonal interactions between caregiver and patient lead to increased commitment and satisfaction for all concerned. Since we cannot not communicate, every aspect of our communication affects our relationship with clients. The importance of the quality of our interactions contains elements of both verbal and nonverbal interactions between the caregiver and patient (Figure 1). Verbal elements include what we say and how we say it. What we say needs to be calibrated to the ability of the client to understand our language. The use of technical jargon, while a useful shorthand between colleagues, can lead to misunderstanding and confusion for clients. How we say what we say also is important. Our cadence, tone of voice and volume all communicate our empathy and concern for the client.

Effective nutritional advice depends on obtaining an accurate diet history and successful compliance with recommendations by the pet owner. Effective communication requires us to:
     • Determine the emotional state of the owner;
     • Evaluate the owner's knowledge and understanding of the situation;
     • Ask open-ended questions;
     • Actively listen to client responses;
     • Accurately interpret verbal cues such as silence;
     • Accurately interpret non-verbal cues from the client's body language;
     • Provide clear, unambiguous instructions.
We try to determine the emotional state of the owner first because it determines their ability to provide information and understand instructions. Clients who are frightened, worried, or angry may not be able to think clearly, and first may need to be calmed and comforted. This often happens when the owner brings an animal in on an emergency basis, or with a chronic problem that hasn't been resolved.

We need to learn who we are talking to because the person who actually feeds the pet can provide the most accurate information on exactly what is being fed, how much and how often. We can only obtain partial or incomplete information when the primary caretaker of the pet is not present; when this happens we recommend sending home a comprehensive diet history form that the primary caretaker can complete and telephone, mail or FAX it back as soon as possible.

Once we decide the client is ready and able to provide a history, one should try to ask open-ended questions. Open-ended questions are those that do not result in a yes or no answer. They invite the client to describe what happens to their individual pet in their unique environment. Although using open-ended questions may require more time, it allows the client to provide information by "painting a picture" we might not otherwise be able to see. Asking open-ended questions also avoids the temptation for the client to provide answers they think we may want to hear.

What should we do when our clients remain silent in the examination room? How do we interpret silence as a [verbal] clue? In an effort to prevent long periods of silence, some of us continue talking, thinking that the client hasn't quite grasped our explanation or intention, while others of us abruptly cut the interview short and make a hasty exit. Silence on the part of the client could mean one of three things: they understand what we are saying and they are waiting for us to continue; they do not understand what we've said (and are hesitant to ask any questions); they [simply] require a bit of time to process the information we've just shared and/or formulate their question. It's imperative that we allow clients the necessary time to think before reacting to information their next decision will be based on. Along the same line, how should we interpret one- and two-word responses, such as "okay", "I see", or "I get it"? These types of verbal cues may or may not indicate that the client is following what we're saying and is in agreement with us. For some clients, these phrases represent a non-commitment, and are said just to keep up their end of the interview, while many clinicians and technicians interpret these responses to mean the client understands and will comply.