What veterinary clients really want, too?

In an article titled “What Patients Really Want” posted on Medscape (1), last year, medical student Monica Kidd describes her experience when she participated in a radio show in which listeners were invited to call in with advice for young doctors. Unlike most of us, 6 years of prior radio experience freed the future physician from the fear that her voice might tremble or crack on air. But as a medical student, just 2 wk from her last final exams, she was far more concerned that she would become the target of a vitriolic public tirade aimed at her chosen profession. And perhaps rightly so.

As it turned out, Ms. Kidd had been trained in a Canadian hospital that has been embroiled in controversy for several years. It began when a pathology sample from a woman with breast cancer that tested negative for its hormone receptor status later was found to be positive. When other samples were retested in-house, similar erroneous results were discovered. When more than 1000 tests were then sent to another facility for retesting, a 3rd of those were determined to be false negatives. In human terms, each false negative represented a woman with breast cancer who might have benefitted from anti-hormone therapy during that period, but who was not offered it based on the original pathology test results.

If the story stopped here, most veterinarians would feel immense compassion for the young doctor-to-be facing that microphone. However, the story gets worse, and it involves the same stupid and cowardly error those from all walks of life and in all professions have made time and time again: cover-up. Instead of admitting the mistake immediately, hospital officials failed to inform the public about the problem. Needless to say, and as always, the public was outraged when both the initial problem and the cover-up were revealed.

Such was the nature of the community’s emotional environment when the interviewer opened the microphones and invited listeners to call in with advice for Ms. Kidd and her colleague.

Although it is highly unlikely that a situation of this magnitude would arise in a private veterinary practice, only the most inexperienced or naïve practitioner would say, “That’s the kind of thing that could never happen to a veterinarian.” But as veterinarians rely more on tests for the diagnosis of more diseases in more animals, the need for those skilled in performing those tests and correctly recording and interpreting the results of those tests grows. And even though we all admit that a learning curve accompanies the mastering of both a test’s technology and the accurate interpretation of its results, inherent in this is the awareness that mistakes almost surely will occur. With luck, those performing the tests and interpreting the results in-house will learn quickly, and errors will be few and quickly recognized when the results of the physical examination and history do not mesh with those test results.

What makes the content of this article pertinent for practitioners, however, is not that it describes the communication techniques Ms. Kidd used successfully to soothe a barrage of angry callers; quite the contrary. What compelled her to write the article was the realization that the callers’ advice made a valuable contribution to her medical education. Even better, what those people shared is relevant to all veterinarians, too. In the article, Ms Kidd lists the following advice for physicians offered by those who called in:

“Speak common words.

Stay put. Commit to your patients.

Make time for the unexpected.

Be kind. Know that everyone is hurting.

Know how to take a fishhook out of someone’s finger.

Make eye contact.

Encourage questions. Answer them.

Practice your powers of observation.

Take care of yourself.”

Is there any item on that list that does not apply to new veterinary graduates and many established ones, too? Some might even argue that the list is more relevant to busy veterinarians than physicians. Consider recent graduate, Becky Snyder. After having to prove her mastery of medical terminology and jargon for 4 years, she chafes at the idea of not being able to impress her clients with her command of it.

“It’s only because the practice owner constantly reminds me to use everyday language that I do,” she states. “And I admit that sometimes I resent that I have to do it. Plus it’s also hard work.”

And how does Dr. Snyder feel about staying put so that her clients can get to know her as a person and benefit from the increased rapport and trust created?

“I can appreciate where they’re coming from because I feel the same way about the professionals I deal with. But I want to keep my options open for a while,” she adds. Canada’s a big country and I’d like to see more of it while I’m young.”

How about the advice to make time for the unexpected? Surely every veterinarian knows that the unexpected is so common that it would be foolish not to expect it. Even so, some still fill every minute of the day based on time-is-money thinking, only to alienate clients and perhaps even provide less than optimum patient care when the unexpected occurs. Other times, new graduates, or those new to the practice, may underestimate how much time it will take to accomplish certain tasks until they familiarize themselves with the workings of a particular animal hospital. Meanwhile some employers might not give newcomers enough time, thereby setting the latter up to shortchange patients and clients when the unexpected occurs.

It is also a given that all veterinarians are kind, so advice regarding this is unnecessary, right? Theoretically and philosophically, yes, but when a lack of time and experience collide, kindness can go out the window. When that occurs, Dr. Snyder’s desire to get the job done as quickly as possible might cause her to forget how much her patient and client may be hurting, either physically or emotionally.

“I know the animal is in pain and that the owner is upset, but I don’t have time to worry about that when I have a waiting room full of clients who need to be seen,” she defends her position.

On the other hand, if the veterinarian does not find some way to communicate kindness, she may discover that fewer and fewer clients desire her services.

Regarding fishhooks: if you do not know how to remove one, learn, because chances are you are going to have to if you remain in private practice, and you may have to remove more of them than the average physician. It is a simple procedure and a great practice builder when done in a kindly manner.

It would seem that establishing eye contact and encouraging client questions that are duly answered are such obvious practitioner qualities that there is no need to mention them. However, the number of clients who complain about their veterinarian’s unwillingness to do one, or both, suggests these 2 pieces of advice should remain on the veterinarian’s list, too.

“But I want to focus on my attention on the animal,” protests Dr. Synder. “Isn’t that what clients expect me to do?”

Yes, but they do not expect or want her to focus all of her attention there. For one thing, her failure to establish eye contact communicates a lack of confidence, although some may see it as evidence of dishonesty. Either way, doing this is detrimental to a quality clinician-client relationship. Once eye contact is established, her clients’ compliance will depend on Dr. Snyder’s ability to encourage their questions and provide meaningful answers.

Do veterinarians need to be reminded to practice their powers of observation? Absolutely. Another recurrent client complaint is that the veterinarian barely looks at the animal before rattling off a list of tests that need to be done, or before making a diagnosis and prescribing a treatment. Other times clinicians become so focused on the problem for which the animal was presented that they become blind to anything not directly related to it. Nor can practitioners forget to extend those constantly enhanced powers of observation to the client as well as the veterinary staff to ensure quality animal care.

Take care of yourself. Although clinicians who come to work injured or ill might think of themselves as dedicated, most clients would prefer that they stayed home or, better, did whatever was necessary to remain healthy. Admittedly some of their reasons may be purely self-serving: “I truly felt sorry that Dr. Snyder was so sick when she came out to check my gelding,” said one of her clients. “But I also felt like I wasn’t getting my money’s worth. And to be honest, I wasn’t too keen on catching that nasty cold she had, either.”

So what do veterinary clients really want? To paraphrase Ms. Kidd’s conclusion about physicians, they just want us to be decent human beings.