Fixed and flexible practice communication

Normally, members of Drs. Lacombe and Odetti’s staff and client base use a combination of fixed and flexible orientations in their communication with others. They do this based on their awareness of which form is likely to produce the desired results under those circumstances. For example, Dr. Lacombe often has fixed preferences regarding the best treatments for specific problems based on his long experience. If the client objects to the treatment, he is apt to feel annoyed. On the other hand, younger Dr. Odetti does not share her partner’s orientation. She recognizes that different treatment options for the same problem may be valid under certain circumstances.

Their individual orientations could create communication problems for the practice owners. However, just because they feel strongly about their personal preference does not undermine their respect for the other or the other’s approach. They also recognize that, just because they lean toward one orientation more than the other, does not mean they cannot adopt the alternate approach if they believe it will benefit their patients and clients.

For example, Dr. Lacombe considers Ms. Tanaka the ideal client because she always does whatever he tells her to do to help her animals. Moreover, Ms. Tanaka takes pride in her ability to do exactly what the veterinarian tells her to do. However, when her cocker spaniel does not respond to treatment as Dr. Lacombe expected, he does not know what bothers him more: the animal’s lackluster response to the oral medication or the slight hesitancy that replaces his client’s normal can-do spirit when she brings her dog in again. Feeling he does not know her well enough to ask if something is troubling her, he prescribes another course of the medication he believes will work the best.

Nonetheless, the case continues to bother him. Was the drug he felt so sure about no longer the best treatment for the dog’s relatively common problem? Had the dog become resistant to the drug? Had he missed something? Should he ask his client to bring the dog in for a comprehensive work-up even though he knows her finances are limited? Why did his long-time client seem uncomfortable in his presence? What had changed?

In this situation, the client and the practitioner developed a successful working relationship based on their mutual determination to do the best for the animal. The veterinarian was determined to prescribe the treatments he believed were the best for the animal based on his knowledge and experience. His client was equally determined to ensure that her animal received those treatments exactly as directed by the veterinarian.

Like Dr. Lacombe, most practitioners would consider this clinician-client relationship a match made in heaven — until something changed. In this case, the client felt so proud of her working relationship with the practitioner that she felt embarrassed to tell him that her rheumatoid arthritis increasingly made it difficult for her to medicate her dog as directed. She also felt sure the treatment regimens he prescribed for her animals were the best ones, which is what she wanted for them. And she also valued his good opinion of her and did not want to jeopardize their working relationship. But most important to her, she felt uncomfortable sharing details about her intermittent physical limitations with him.

Although working with practitioners with fixed ideas regarding the best treatment may inspire clients who prefer this degree of certainty, it can create problems if the treatment does not work for the client or the animal for some reason. Sometimes this results in the practitioner blaming the client for the treatment’s failure. Other times, the opposite occurs: the client blames the practitioner for prescribing a treatment program they could not implement as directed. Either way, the result may be a communications disaster. Some clients may feel so disenchanted with the practitioner they go to another practice. Other times, they stay in the practice but request appointments with another veterinarian in it.

Ms. Tanaka believed that she and Dr. Lacombe had reached an impasse. Unlike when they agreed on their respective roles, she no longer believed she could meet his expectations. At the same time, he sensed that his tried and true approach no longer worked for her for some reason. However, neither of them believed discussing this was professional or appropriate. Although she felt disloyal to the veterinarian, she opted to schedule her next appointment with his partner rather than move to a new practice.

Fortunately, the two veterinarians respected each other and wanted the best for the client and her animals. While Ms. Tanaka initially dreaded encountering Dr. Lacombe at the veterinary clinic, he always greeted her with a smile and a positive comment about her dog or cat. While she sometimes found Dr. Odetti’s options confusing compared to Dr. Lacombe’s black and white “This is what I want you to do” presentations, she also found the younger woman’s presence less intimidating. That, in turn, made it easier for the client to confide her concerns about her own medical condition and how this could impact her animals’ well-being. Ms. Tanaka soon realized that, while she liked Dr. Lacombe’s direct approach to what she should do relative to her animals, she preferred the options Dr. Odetti gave her when it came to dealing with her intermittent problems treating them.

Once this rapport was established, Dr. Odetti asked for the client’s permission to add a note to her animals’ records regarding her condition. Though it would mean sharing that information with the other veterinarians should she be unavailable herself, it would ensure that the client could implement any treatments prescribed for her animals. She also assured Ms. Tanaka that, although the veterinarians in the practice had different communicating styles, the animals’ health was everyone’s first priority. They all recognized that, just as their patients’ needs could change, so could their clients’.

In this pre-COVID-19 scenario, the veterinarians accept their own, their colleagues’, and their clients’ preferred communication approaches and the benefits and costs of each. They also recognize that their clients have their own orientations and tend to gravitate to practitioners who share these. At the same time though, they acknowledge that client orientations may change. When this happens, initially they may feel miffed if the client chooses another veterinarian in the practice. But they do not blame the new practitioner for the client’s choice.

In the current COVID-19 era, much has changed and continues to change on a daily basis. Practice owners, staff members, and clients all may be coping with physical or mental health-, home-, and work-related changes. Even those in areas relatively untouched by the virus may be facing economic or other losses precipitated by the pandemic.

“I used to feel comfortable formulating the best treatment for patients and expecting my clients to do their parts. Most of them did and I never gave it a second thought,” Dr. Lacombe wistfully recollects. “But now clients who previously would do whatever I asked no longer can for legitimate reasons. As a practice-owner, I understand their dilemma and know how frustrating it can be. The practice currently cannot afford the salary increases we’d planned because of decreased revenues. We had to postpone the purchase of the new equipment we planned to buy at the beginning of the year. For the first time, I daily find myself scrambling to find options that will meet everyone’s needs: family, staff members, clients. I wish I had Dr. Odetti’s skill at this!”

Meanwhile, Dr. Odetti is discovering that her own orientation has its downside, too.

“Yes, I still want to give my clients options,” she admits. “But doing that takes time and right now implementing and updating procedures designed to protect staff and client health while ensuring animal health and welfare is my top priority. I have so much going on in my head, I can’t even give my closest loved ones the attention they deserve. Sometimes I wish I had Dr. Lacombe’s ability to focus strictly on the animal’s problem, tell the client what they need to do, and send them on their way!”

Dr. Odetti also faces clients who perceive her as a sympathetic listener to whom they could pour out their problems as in the past. These were energy-vampires in the best of times. In times when family, friends, co-workers, and other clients may want her support for far more serious problems, she finds these clients bothersome.

Most practitioners have a client communication style that works for them as well as most of their clients. Experienced practitioners may have honed this skill over the years. Novice ones may adapt and change theirs based on client responses as needed. Most veterinarians also recognize that other practitioners will have different styles that some clients prefer and this is normal. However, thanks to COVID-19, all practitioners must accept that, regardless how successful their client communication orientations may be, the best ones always remain a work in progress.