Practitioner-client communication: When goals conflict

Listen to just about any group of private practitioners talking during breaks at scientific meetings and you'll quickly discover that 2 concerns dominate the conversation. First and because of their training, they share any interesting or troubling medical or surgical cases, how they approached them, and any results. Sometimes they do this to seek additional input from their colleagues; at other times, they (graciously, of course) boast about their triumphs.

Regardless whether they seek information or contribute it, the conversation flows easily because they all share the same professional language instilled in them during their veterinary education. They may engage in spirited discussions about the merits of a particular drug or surgical procedure, but even the most recent graduate or aged practitioner can participate.

Compare this with what happens when the conversation turns to “people problems.” Rather than boasting about their successes or presenting challenges to which their colleagues eagerly offer solutions, they vent their feelings. Dr. Alpha rants about the client who calls him every other day “to talk about nothing,” while Dr. Beta rages about the one who always questions her bill. Complaints abound about noncompliant clients:

“I don't understand why my clients won't do what I tell them,” grumbles Dr. Green.

“Don't they want their animals to get better?” adds a frustrated Dr. Brown.

Invariably, someone in the group recites the litany that private practitioners have been reciting for years: “I love working with animals. It's the people who drive me crazy!”

In spite of the fact that if practitioners are sued, it is more likely because of poor communication skills than medical or surgical ones. However, when such client communication problems arise, most practitioners can't rely for help on any relevant training they received during their veterinary education, simply because it wasn't there. The authors of most veterinary medical and surgical texts assume that all animals are well behaved and that all owners possess sufficient bonds with their animals and faith in their veterinarians to ensure 100% compliance with any veterinary requests. Further adding to the problem, even as the greater sophistication of veterinary science and technology demands greater skills in client communication, we're told that there is no time to teach such a “soft” subject, because there is so much new science and technology to cover. When communication is addressed, rather than exploring that associated with the nitty-gritty of daily practice, the focus is often on talking to the media or in other formal settings. No one questions the value of public speaking skills, but such encounters comprise a relatively small percentage of private practice communication. What practitioners really need is the ability to communicate effectively in an intimate, yet professional and meaningful, way to people of diverse backgrounds under a wide range of sometimes highly emotional circumstances.

In this series, some of the elements that come into play in private veterinary practice and may enhance or undermine quality practitioner-client-patient interactions will be explored, beginning with one of the most shocking lessons new graduates learn very quickly: All the medical knowledge in the world won't save them — or their jobs — if they can't communicate well with clients. Unfortunately, many times their employers can't tell them how to rectify this problem, because they've had to master this skill by trial and error themselves over the years. This lack of guidance can lead to well-meaning but bizarre attempts by panicky new graduates to communicate more effectively. For example, one employer overheard his new associate laboriously spelling out “ovariohysterectomy” to a bemused client, because she had been taught that the word “spay” was unprofessional. Rather than use a word that a client would understand, this new practitioner opted to take up valuable time in teaching her client the “correct” term. When her employer challenged this approach, she replied, “But I thought you wanted me to communicate better with clients!”

Experienced practitioners all know that most clients find the use of professional jargon irritating and condescending, and that clinicians who routinely use multisyllabic medical terminology alienate all but the most polite or desperate for veterinary care. However, the critical issue isn't so much the exact words we use, but our point of view. Let's consider a common practice situation to see how this works.

Ms. Danier is awakened in the middle of the night by the sound of her 10-year-old poodle, Biscuit, coughing. She tells him to hush, but the cough recurs. The next morning, she takes her pet to Dr. Lopez for an examination.

When Dr. Lopez sees Biscuit's name and “coughing” on his schedule, that single word triggers a cascade of medical considerations that begins with a list of possible differential diagnoses. He then goes on to ponder the best diagnostic tests and possible treatments, and even checks a journal article for the most recent canine cough-related information. In short and thanks to his training, when Dr. Lopez opens the door of the examination room and greets Ms. Danier, his goal is to discover the cause of Biscuit's cough.

However, what thoughts are running through Ms. Danier's mind during this same interval? First and foremost, she feels worried that, whatever is wrong with her beloved pet, she might not be able to cope with it. Second, she feels guilty that she yelled at the dog when his coughing awakened her from a sound sleep. Third, she feels sorry for the timid animal who becomes very anxious in strange surroundings and now sits trembling on her lap. Because she sees the cough as the cause of all these negative effects on herself, her pet, and their relationship, does it come as any surprise that her goal is to stop that cough as soon as possible?

It doesn't require a degree in communications to recognize that if Dr. Lopez focuses on fulfilling his own goal without first addressing his client's, his chance of establishing a quality relationship with her ranks on a par with the survival rate of that proverbial snowball in hell.

“But how can Dr. Lopez prescribe something to stop the cough, if he doesn't know what's causing it? That would be malpractice!” The trained problem- rather than patient- and client-oriented medical mind, immediately zeros in on the medical aspect of the problem.

That's true, but we're not talking about stopping the cough. We're talking about addressing the owner's desire to stop it. What concerned owner wouldn't want to do that? And, in fact, this reality is so obvious to many clients when they leave their animals for a work-up that it never dawns on them that their veterinarian doesn't share it. This leads to nightmare scenarios, such as the one that occurs when Ms. Danier calls Dr. Lopez later that day to inquire about her dog. Dr. Lopez rattles off the list of diagnostic procedures that he conducted on Biscuit, noting that some samples were sent to outside laboratories for processing and that he would have those results by the end of the week. Because he didn't tell her what he planned to do and what this would mean both to her dog and her, before he hospitalized Biscuit, Ms. Danier naturally has no idea of what he's talking about. Even if she does, she immediately zeros in on her primary concern, the reason she brought Biscuit to see Dr. Lopez in the first place.

“Is he still coughing?” she asks.

In that instant, the cost of not addressing his client's concerns first hits Dr. Lopez like a truckload of cement dog statues. Like all other practitioners who have found themselves in this wretched position, he must now tell his client that he did not do what she expected him to do and why he did not do this. He or someone else must also tell her that she is expected to pay for all these services. At best, Dr. Lopez will have a semiplacated client who pays her bill and follows his recommendations for treatment. At worst, his client will be furious, refuse to pay her bill, and bitterly complain to Dr. Lopez's employer and every pet owner in the community about his uncaring treatment of her and her dog. Meanwhile, Dr. Lopez will feel frustrated and angry because in his mind he did everything by the (veterinary text) book.

The moral of this story? Enter every client interaction with the idea of first answering the question, “What does this problem mean to this client and this animal?” and then seeking the answer to the question, “What does this problem mean to me?” Granted, addressing client needs and expectations up-front might seem like a waste of valuable time to busy practitioners; however, compared with what it takes to clean up the fall-out of a communication melt-down after the fact, it's a time-saving bargain no practitioner can afford to pass up.