I WASN’T AT BSAVA CONGRESS TO HEAR Chris Packham’s keynote speech to delegates, but I did read a report on it in one of the veterinary magazines. There was nothing remarkable or sensational in the report, rather it came across that Mr Packham had expressed some views on how vets could improve their communication with clients and by so doing, improve client satisfaction along the way. What’s not to like about some free advice that might help to keep clients happier? Imagine then my surprise when a couple of weeks later I read some of the reaction to this speech. There were few positive voices to be heard. Clearly he had irked a large proportion of those present, many of whom appeared to feel offended by some of the things he suggested. Are we as a profession really that good at what we do that any criticism seems totally unjustified? Or so sensitive to criticism that we simply can’t cope with it? Clearly there are ways and means of providing constructive criticism that are more acceptable than others and a direct approach can often come over as blunt and insensitive. However, Mr Packham’s autism (he has been diagnosed with Asperger’s Syndrome) is well known, and anyone who has experience of autism will know that “sugar-coating the pill” is not something that comes easily to people on “the spectrum”. This was brought home to me many years ago in the communal changing room at the local swimming pool when my oldest son (also on the spectrum and then eight years old) pointed at a fellow bather and said in a loud voice, “He’s a fat man!” Let’s then make allowances for Mr Packham’s delivery, swallow our indignation, and think rationally about what he was saying. Urging us not to treat clients like idiots is clearly a good place to start. Sure, there are plenty of idiots out there, but there are also plenty of people who aren’t. And in truth there’s no need to treat anyone like an idiot; tailoring what we say to a person can be gauged from their reaction to what we’ve already said and by the questions they ask us – providing of course we give them the opportunity to ask questions and actively encourage them to do so. It is only by asking questions that most people can build up a sense of understanding in their own minds of what is going on. Realistically though, how often do we genuinely ask clients, “Do you have any questions?”? I suspect for many (most?) of us, not very often. I also think Mr Packham is completely right when he suggests that we should talk through x-rays and the results of blood tests with pet owners rather than simply saying they are “negative”. Negative for what? It doesn’t make any sense. Surely if an owner has paid for an x-ray, we owe it to them to show them the picture and point out that there is no visible evidence of a fracture or a foreign body or whatever, or hand them a print-out of the blood results and explain that all the parameters tested are in the normal range which helps to rule out x, y or z. That shouldn’t take a lot of time and if we then ask the client if they have any questions or if there’s anything they don’t understand, we can get a realistic idea of whether they have a good grasp or not on what is, or isn’t, wrong with their pet.
This issue of communication has been brought home to me in the starkest of ways by my experiences of the medical profession over the last few months. My aforementioned autistic son, now grown up, has developed a serious bowel problem that is probably going to require some major surgery. We have seen five consultant colorectal surgeons over this time frame and all, without exception, have been appalling communicators. From being evasive in terms of avoiding speaking to me, to lacking any sort of empathy for my son or the rest of the family, they have ticked all the wrong boxes in spades. None of them has offered to show me any of the radiographs and talk me through what they show. None of them has offered to show me blood test results or even explain why they are taking them and what they are looking for. None of them has sat down in a quiet room and talked through with me what the possible aetiologies of the problem might be, the possible solutions and the possible outcomes. And they’ve certainly never asked if I have any questions and take on a look of painful resignation when I start to ask them. Indeed, one surgeon – who had seen my son for all of five minutes and had never spoken to me about the history – managed to spare the time during the ward round to say, “It’s just a case of chopping out the sigmoid flexure – it’s a useless piece of anatomy anyway, blah blah blah blah.” No explanation of why, complications, alternatives, anything. Even as a vet I felt completely sidelined; how is anybody with no basic understanding of medical matters supposed to navigate their way through that? Following on from this experience I have told numerous friends that if I ran a vet practice like this I would be out of business within a week because clients would simply go down the road to the next practice where the vet would make time to speak to them. And surely this is all Chris Packham was saying, albeit in his rather blunt style. We have a duty and indeed a moral responsibility to communicate well with our clients and to make sure that we are involving them in the decisions relating to the treatment of their pets as far as is possible. Yes, some people are more capable than others of understanding what is going on and some are more willing than others to be actively involved in the decision-making process. But it is up to us to find that out through careful explanation, careful listening, and by offering the client the opportunity to ask questions of us and then to answer those questions as honestly and accurately as possible. This is the gist of what Mr Packham was saying and surely most of us would agree that we should all be trying to do that to the best of our ability. We should probably all take the time to genuinely reflect on whether we always come across to our clients like that or merely think that we do.