ONE of the greatest myths about
communication skills is that “you’ve
either got it or you ain’t”.
Communicating effectively with your
clients is like any clinical subject – it
involves learning and
practising a series of
discrete skills.
If you qualified 10
or more years ago, the
chances are that you
had limited training in
this area at university.
The vast majority of
vets learned
communication skills
from watching and
listening to others, or
from getting “thrown
in the deep end” with
clients.
However, we now know from
communication research that experience
alone can be a poor teacher.1 We are just
as likely to pick up bad communication
habits as we are good ones. And, since
vets normally consult alone with clients,
there are few chances to get honest
feedback on the success of our
communication style from peers.
Most of what we now know about
client communication is evidence-based
and it has changed the way we look at
the consultation. One of the
fundamental shifts is seen in the move
away from “paternalistic” medicine
towards “relationship-centred” care.
Behind the communication jargon, this simply means a change from the
traditional “doctor-knows-best”
approach to one where the client has a
greater voice in decision making. In fact,
it’s very likely that you
already practise
relationship-
centredness without
realising it.
If, for example, you
spend any amount of
time listening to your
clients and taking their
ideas on board, that’s
relationship-centred
care. This style of
communication is
associated with myriad
of benefits: decreased
litigation, increased client satisfaction,
increased vet satisfaction and better animal health outcomes2.
A major goal in relationship-centred medicine is for the vet to guide clients
to a place where they can make an
informed decision about their animal’s
care. The vet can do this by building a
rapport with the clients, and
encouraging them to open up with their
ideas and concerns about their animal
and its presenting complaint(s).
Non-verbal cues
Building rapport with the client is
largely carried out through body
language or “non-verbal cues”.
Examples of these are using an “open”
body posture, i.e. uncrossed arms and
legs, and making sure that there are no
barriers between the two of you.
The consulting room table, for
example, can be a subconscious
disruption to communication. If the
layout of the room allows it, it can be
helpful to come around from behind
the table to talk to the client. Similarly, turning your
back on the
client as you type
notes on a
computer can
disrupt rapport.
Non-verbal
cues can also be
used to show
that you are
listening.
Nodding and
making eye
contact when the
client is speaking
are common
examples.
Opening the
consultation is also an opportunity to show relationship-
centred care. An open-ended question is
recommended: “So, how can we help
Harry today?” The client is then allowed
to respond.
Both vets and doctors are inclined
to interrupt a speaking client within
seconds. By holding back and allowing
clients to speak, “the golden minute”,
we improve the chances of getting to
the bottom of why they are really here.
There’s always the worry that once
clients start talking that they won’t stop!
However, the research shows that most
clients’ opening statements come to a
natural end within a minute or so.2
Summarise
After the client has spoken, the vet can
summarise what has been said and then
make a check: “OK, so Harry is here
for his vaccination and you would also
like me to check his ears for mites. Is
there anything else that’s worrying you?”
Once a vet has taken a history,
performed a physical exam, and
organised his or her thoughts, there is a
large amount of information to get
across to the client. The best way to do
this is by keeping it short and simple.
Short sentences with checks are better
than delivering the information in one
long speech.
This excellent communication
technique is known as “chunking and
checking”. For example:
Vet: “Lucky is dehydrated and I can feel
something unusual in the abdomen. To
treat him would involve hospitalisation
and a drip. To find out more about
what’s going on would involve tests.
Have I explained that OK?”
Client: “OK, yes.”
Vet: “The tests would involve blood
tests and an x-ray of his abdomen. We
would do them today and I can get you
information on how much they are
likely to cost. How does that sound so
far?’
It’s important at this stage to find
out what the client is thinking in these
cases. In the above example some
clients may be worried about the cost
whilst others are concerned about
having their cat hospitalised. Yet another
client may be considering mentioning
euthanasia.
A relationship-centred vet asks the
client about his or her take on the
situation: “What are you thinking now?”
or “What else can I tell you that would
help with the decision?” In this way the
vet shares the information – and the
power in moving forward – with the
client.
As mentioned earlier, it’s likely that
you already incorporate relationship-
centred techniques into your own
consultation style. The trick is, as with
any clinical skill, to keep expanding this
repertoire and practise at every
opportunity.
References
- Kurtz et al. (2006) Teaching and learning
communication skills in medicine, Radcliffe
Publishing, Oxon. - Gray and Moffett (2010) Handbook of
Veterinary Communication Skills. Wiley-
Blackwell, Oxford.
