Contemporary veterinary practitioners live in a far more technology-driven era than their predecessors. Computerized records-keeping systems once only found in large teaching facilities now may exist in even the smallest private practice. One benefit of such systems is that they permit data-mining, the extraction of isolated facts pertaining to multiple patients that may provide helpful insight regarding certain disease processes. For example, Dr. Rabinowitz may suspect that she and her associate are seeing more dogs from a particular housing development with a specific disease or parasite. Or maybe she senses that animals of a particular breed from a particular source may be more prone to a certain problem than those purchased elsewhere. Thanks to her computerized records-keeping system, she can search her patient records with relative ease and isolate any cases that would prove or disprove her suspicions. Similarly and like many practitioners, she has gleaned useful knowledge from retrospective studies published in professional journals that use more sophisticated versions of this same process.
When the capacity for this kind of data processing exists, it makes sense to collect information from clients in a manner that maximizes this potential. In general, that means collecting the same kinds of information from all clients and patients in the same order. To facilitate this process, any information often is recorded using a specific protocol that may include checklists, yes/no responses or those in which the practitioner circles the most descriptive of several options offered.
But although Dr. Rabinowitz greatly values her system’s ability to streamline data collection and processing in her practice, she does worry about how doing this may affect her younger associate’s ability to communicate with clients in a meaningful way.
“It’s difficult to articulate my concern without sounding anti-technology,” she confesses. “But I’m not at all as one look around this practice makes clear. However I am concerned that my associate, Dr. Whitaker, can do a wonderful job completing our standard form but sometimes seems to have so little sense of the many unique factors that may impact the successful diagnosis and treatment of a particular animal. If it’s not on the form, it’s as if it doesn’t exist.”
Within the practitioner’s comments lie the seeds for a breakdown in communication not only between her and her associate, but also between both clinicians and their clients. And like so many communications problems this one begins with two different orientations, each of which its supporter perceives as optimal.
On the one hand, we have Dr. Rubinowitz who by virtue of her veterinary training believes that a comprehensive history for a particular patient cannot be expressed adequately in some variation on the one-size-fits-all theme. She belongs to the era during which the collective data related to a particular patient, his/her current and past environments, experiences and any other information that may be relevant was referred to as anamnesis. If that word looks vaguely familiar, it is because it is the opposite of amnesia. Whereas amnesia refers to a loss of memory, anamnesis refers to the ability to recall past information. In the medical professions, it refers to the collection of such information from the patient and the client.
On the other hand, we have Dr. Whitaker whose educational experience has been shaped by computer technology for as long as he can remember. In his mind completing the form to the best of his ability is the equivalent to getting a good history. If the form does not cover it or he cannot condense it to brief comment, he considers it extraneous information.
In addition to their different philosophies regarding what constitutes quality information collection creating communications problems for the two veterinarians, it also may create comparable problems for their clients. Not surprisingly, each veterinarian feels so convinced that his or her approach represents the most valid one that they also assume that approach best meets their clients’ needs. But is this assumption necessarily correct?
For example, some clients prefer what they think of as the veterinary drill. They like the predictability of being asked the same questions and being given the same options regarding the answers every time they visit the clinic.
“Because I know Dr. Whitaker always asks the same questions, I can focus on those areas of my animal’s health and behavior before my appointment and provide that information for him,” a client explains why she prefers this approach. “I think that helps him, plus it shortens the amount of time the appointment takes. That’s important to me because I have to take time off work to take the dog to the vet’s.”
Needless to say, these same clients may find Dr. Rabinowitz’s more specific fact-finding approach time-consuming and tedious: “All I want is to get my cat in, vaccinated, out and home again as fast as possible before she goes psycho on me. I don’t want to report on every little detail of her life!”
At the other end of spectrum are clients who find the younger practitioner’s approach disconcerting at best and insulting at worst.
“Half the time Dr. Whitaker doesn’t even look at me,” complains a member of the latter contingent. “Just keeps his head down marking things off his list. It makes me feel like my animal and I are on some kind of assembly line. Dr. Rabinowitz is so much more interested in us.”
Once the two practitioners ascertain that their clients may or may not share their individual approaches to information gathering, they then turn their attention to determining whether their preferred orientation has any negative impact on the medical care received by the animal. Obviously if one form routinely led to erroneous diagnoses and/or treatments, then it would make sense to adopt the other. However, such is not the case. Drs. Rabinowitz and Whitaker have comparable success rates.
At this point practice owner and associate might decide to agree to disagree. But because they share a common desire to provide the best service to their patients and clients, they take their evaluation one step further: They examine those cases that did not turn out to their satisfaction to see what, if any, role their respective information collection styles may have played in the outcome. When they do this, they discover that Dr. Rabinowitz’s approach was more likely to create problems in acute situations where immediate action was necessary and desired by the client. Conversely, Dr. Whitaker’s approach was more likely to create problems in chronic cases that required client involvement and compliance over an extended period of time.
“That was hardly a surprise once we thought about it,” admits Dr. Whitaker. “We’d just never made the connection before.”
Once the clinicians did think about it though, they realized that a need for both styles of information-gathering existed in their practice. Then the question became whether they should each expand their communications skills to include the alternate approach, or divide their case load so that each veterinarian handled only those cases that best suited his or her style.
“In the end, we opted for a sort of hybrid combination of the two,” explained Dr. Rabinowitz. “Because we realized that there would be times when we would be manning the practice alone, we decided we each needed to master the other’s approach. The fact that it was equally difficult for us to do this turned out to be a good thing because it kept either of us from feeling put upon. I also discovered that learning to think more like Dr. Whitaker made those crisis situations that needed more action and less talk less stressful for me.”
“In addition to doing that, we also decided to share the communications load on those cases where both orientations would benefit the patient and the client,” continued Dr. Whitaker. “For example, even though my style is more efficient for dealing with emergencies right now, I really value Dr. Rabinowitz’s skill at collecting those little details from distraught owners that may mean the difference between short-and long-term success. I now can do it if I have to, but I don’t enjoy it the way she does. So when it’s possible, I call her in to handle that part of the case the same way I would any other specialist. The end is a win-win situation for us, the client, and the animal.”
From this we can see that what began as a communications problem that might have resulted in the deterioration of the relationship between the practice owner and her associate evolved into ssomething quite different. Instead of seeing their respective approaches as right to the other’s wrong, they framed the issue in terms of if and how their orientations affected the quality of care they offered their patients and clients. By doing so, they transformed what could have become a power struggle between employer and employee into a solution, the benefits of which outweighed the cost of any changes necessary to implement it.
Footnotes
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