Ideally, every client-veterinarian interaction establishes a tempo that enables both participants to comfortably exchange the maximum amount of information about the animal’s condition and its treatment in the least amount of time. “Yes, but” clients often disrupt that flow, and may generate considerable negative practitioner emotion.
Clients who open their conversation with the signature “yes, but” may seek to achieve 2 quite different results. The first group of “yes, but” clients want to correct information communicated by the veterinarian. These clients think that this will ensure the best care for the animal, but they may cause anxiety to veterinarians who perceive such questioning as criticism. For example, hoping to impress her new client, Ms Dombroski, with her friendliness, Dr. Aaronson glances down at the preliminary information provided by her front office staff, looks at the fluffy dog before her, and exclaims, “She’s adorable! I just love Pomeranians!”
“Yes, but she’s a volpino Italiano,” Ms Dombroski replies.
As mortifying as such breed-related errors may be, skilled veterinary communicators can salvage their image and the client relationship with a truthful, “I’m so sorry! I’ve honestly never heard of the breed, but I’d love to learn more. Please tell me about her.”
However, little can be done to explain the error that leads a testy client to counter, “Yes, but he’s not a female. He’s a male.” or vice versa.
Granted, practitioners could blame their front office staff for such misinformation, but that amounts to admitting to the client that these individuals might lack proper training and supervision. That, in turn, might lead clients to wonder if this deficit extends to other areas of the practice. Consequently, a simple apology is the best response, coupled with adequate staff training to ensure the collection of accurate patient information.
Professional colleagues in multi-veterinarian practices also may set each other up for legitimate “yes, but” client responses. In a common scenario, rushed clinicians jot down only the sketchiest of notes on the medical record. Some fully intend to go back and provide a more complete description when time allows. However, others may assume that, if their brief notations make sense to them, their colleagues will, or should, understand them, too.
When Dr. Aaronson pulls the record on Jeff Barrett’s heifers in response to an emergency call and refers to the animals’ pneumonia, Mr. Barretts replies, “Yes, but Dr. Ingersoll said he thought it might be an allergic reaction of some kind, too. I’m calling because he said he’d put them on a different medication if they took a turn for the worse, which they have.” Dr. Aaronson quickly scans the record and finds no mention of either her colleague’s thoughts regarding any other diagnosis or treatment.
Practitioners who have found themselves in this awkward situation mention entertaining 3 alternatives at such times: guess what the colleague had in mind and proceed based on that assumption; put the client on hold and contact the history-writer to supply the missing information; or work up the case from scratch. Practically all clinicians who have experienced this kind of client interaction mention a fourth, albeit imaginary, alternative: the slow and painful death of the colleague who put them in this position.
The second group of “yes, but” responses are those clients who use it to avoid committing to the treatment of the animal. In previous columns, the proper way to address the client’s time, financial, emotional, and physical limits that may interfere with that commitment and undermine the treatment process have been addressed. However, the “yes, buts” differ from those clients in one of two ways. Although some of them may have specific limits that preclude the animal’s treatment, they also believe that the exact nature of these limits, and any resolution thereof as it affects the animal, is none of the veterinarian’s business. Rather than come right out and say this, they will contradict or otherwise introduce stumbling blocks at every step of the communication process, hoping to lead the veterinarian to conclude that not treating the animal is a valid approach. For example, following her husband’s sudden death, Ms “money-is-no-object-when-it-comes-to-my-pets” Dombroski finds herself in dire financial straits, thanks to some foolish investment decisions her husband made. Rather than share this painful information with a veterinarian she hardly knows, she challenges every option Dr. Aaronson proposes in hopes that the veterinarian will agree that no viable approach to her pet’s problem exists. Interestingly, in the course of doing this, some of these clients even will deny the existence of the real stumbling block: “It’s not that I don’t want to spend the money on Georgio,” Ms Dombroski tells Dr. Aaronson. “I’d spend every cent I had, if I thought it would correct his problem.”
Unlike clients who have specific limits for their animal’s treatment, there are the “yes, buts” who lack a sufficient bond with the animal to sustain anything beyond the most rudimentary treatment. These clients will summon every limit they can think of in an attempt to convince the practitioner that treatment is not a viable option.
“I’ve seen skin infections like this before,” says Dr. Aaronson, “and they respond very well to medicated baths.”
“Yes, but we’re having trouble with our well,” replies Mr. Cunningham. “Barely have enough water to bathe ourselves, let alone bathe a 60-pound dog.”
“Oh,” replies Dr. Aaronson. “Well, oral medications work well, too.”
“Yes, but he hates to have his mouth messed with.”
“In that case, we could use injectables.”
“Yes, but he doesn’t like needles and neither do I.”
“We could bathe or medicate him for you here,” offers the increasingly irritated Dr. Aaronson.
“Yes, but I’m on the road a lot and couldn’t bring him in.”
“You could drop him off on your way out of town and pick him up when you return.”
“Yes, but that would be expensive.”
“We could arrange time payments.”
“Yes, but my wife would throw a fit if we took on more debt.”
Unfortunately and regardless of their underlying motivation, the more “Yes, but” clients resist doing what the veterinarian wants, the more determined some practitioners may become to treat that animal. The increasingly frustrated veterinarian may waste an incredible amount of time and energy trying to overcome the many obstacles these clients have put in place.
In a worst case scenario, the veterinarian succeeds in forcing the client to do something he or she doesn’t want to do, and the treatment process and the animal suffer the effects of any negative client emotions this elicits. When Ms Dombroski agrees to a costly treatment she cannot afford, this upsets her so much, it undermines her relationship with her pet: “Why did I ever get a dog that was susceptible to such problems!” It also negatively affects her relationship with the veterinarian: “Damn her for making me do this!” the stressed woman cries when she adds the veterinary bill to the growing pile of others on her desk. Or, the veterinarian assumes responsibility for the animal’s treatment him- or herself, naively believing that the client will be grateful for this interference. However, because these clients did not want to do anything at all, the veterinarian’s offer to do everything is the last thing they want. At that point, some clients may come up with such outrageous excuses that even the most unaware practitioner will realize that these people do not want to treat this animal: “I’m sorry,” murmurs Ms Dombroski, “but what you’re asking goes against my religion.”
Others may tell the truth in a moment of panic: “I don’t want to treat this dog. I don’t want you to treat this dog! I don’t even like this dog!” rages Mr. Cunningham.
Given the amount of time and energy these client encounters involve and the lack of benefit to the animal, it makes sense to nip the “yes, but” process in the bud. After one or two such responses, the more experienced Dr. Aaronson says to her client, “Am I correct in thinking you don’t want to treat this problem at this time?” If the client agrees, she leaves the door open for future treatment as well as positioning herself as a nonjudgmental professional sensitive to her client’s needs. Dr. Aaronson’s sensitivity might cause the client to disagree and reveal the true reason underlying the reluctance to do what the veterinarian believes must be done. Either way, both the client and the practitioner gain from this approach. And while some might argue that no animal benefits from lack of treatment, this always must be measured against the negative effects of inconsistent treatment administered by unwilling caregivers.
In the next column, we will discuss a seemingly client oxymoron: those clients who fail to properly treat their animals or even deliberately harm them specifically to keep in the practitioner’s good graces.