Three key communications of veterinary care - Veterinary Practice
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InFocus

Three key communications of veterinary care

“A new graduate can be as up to date as they can be on the best new diagnostic tests or treatment regimes, but if they can’t communicate with a client […] then all that knowledge is just about worthless”

The three key words in veterinary medicine are communication, communication and communication. I can’t remember who said that or where I read it – which isn’t a very good start to any opinion piece, is it? – but I’m sure it’s true. A new graduate can be as up to date as they can be on the best new diagnostic tests or treatment regimes, but if they can’t communicate with a client, to empathise, advise and console them, then all that knowledge is just about worthless.

We teach communication skills, it’s true, but for just a tiny proportion of the veterinary course. Most of the course is spent cramming students full of knowledge on the basic sciences of the normal animal and the pathophysiology of all the diseases they might encounter. I wonder if it might be worth spending a proportion of the teaching time for each disease discussing how to talk to the owner about the condition their animal has. And, more than that, just chatting to the owner about their pet, the relationship they have with the animal and how the disease is affecting their animal–owner interactions.

A new graduate can be as up to date as they can be on the best new diagnostic tests or treatment regimes, but if they can’t communicate with a client, to empathise, advise and console them, then all that knowledge is just about worthless

I may well have told you about John Heath, the vet who first got me into ophthalmology. He told me that, in the vast majority of cases, any decent vet should be able to make their diagnosis within the first minute – no, less than that, within the first few seconds – of a consultation. But the owner is paying for more than a minute’s worth of your time. One needs to be able to communicate more than just to give a diagnosis, propose a treatment and extract the cash for the examination.

I enjoy leaving our students with the client for a few minutes to take a history, make a clinical examination and discuss things with the owner before I come back into the consulting room. I tell the owner that as this is a vet school, the student will ask questions and examine their pet, after which I will come back to the room. The student will then tell me what the owner has told them. At this point, I tell the owner it’s up to them to inform me whether the students have asked the relevant questions and relayed the information they’ve been given correctly, and whether there’s anything else the owner wants to tell me. Has the student been caring and compassionate? Can they rate the student on a scale of 1 to 10? No pressure, then! I grant you, I say this all with a smile on my face, and the owner knows this is to be done in a relatively light-hearted way.

In the vast majority of cases, any decent vet should be able to make their diagnosis within the first minute […] of a consultation. But the owner is paying for more than a minute’s worth of your time

The vast majority of students score highly from the owner’s perspective. But truth be told, what’s more important to me than this is whether, when I return to the consult room, the student and owner are sitting in silence, the student having finished their investigations, or whether they are having a good chat. The conversation can be about the relationship between the owner and pet, the student’s course or any other topic of conversation. Most students are in that second group, keeping up a dialogue about the animal’s life history or behaviour, how their pet’s condition is affecting the owner or even the score in the ongoing test match. That’s what I want of a soon-to-be vet, and to my mind, no lectures on client communication can instil this into a student.

If that’s the first of our three “communications” with which we started this reflection, what of the other two? The moment the client leaves the practice, that face-to-face line of communication is, of course, broken. Or at least, that’s how it used to be. Now modern technology allows that link to remain open. The dog with the melting ulcer that I have provided with a hood graft that covers the entire eye doesn’t need to come in again and again for me to check the eye until the ulcer heals and the graft lifts itself off. Instead, its owner can WhatsApp me an image of the eye every day, and I can reply, “All fine” or “Hmm, why not come back and see me?”

The moment the client leaves the practice, that face-to-face line of communication is, of course, broken. Or at least, that’s how it used to be. Now modern technology allows that link to remain open

Now, I know you’ll say that this is a bit extreme; if I had scores of such cases pinging me a picture every day, life would become unbearable. However, enabling the owners of the Chihuahua with the healing ulcer to contact me whenever they want makes them happy and allows me to see just how the dog is doing on a regular basis. The same thing could be said for the sheepdog, Jack, from a week earlier that had a haemorrhagic uveitis and glaucoma in one eye and retinal haemorrhages in the other – he turned out to have myeloma and is now on melphalan.

His lovely, ultra-worried owners texted me almost daily in the first few days after the diagnosis to tell me how things were going. He was not feeling at all well, but after consulting with our oncologists, I could reassure them that Jack was likely to turn a corner soon. He did. We ended up enucleating the glaucomatous eye, but not before reducing his globulins and normalising his clotting cascade, thus sorting him out ophthalmically and systemically. His owner has just texted, “If there was a trip advisor for vets, you’d get five stars.” Now, you can’t ask for more than that, can you?

Enabling the owners of the Chihuahua with the healing ulcer to contact me whenever they want makes them happy and allows me to see just how the dog is doing on a regular basis

And the third communication? Maybe that’s for end-of-life care. But that’s a subject in itself, so we’ll have to leave that for next month!

David Williams

Fellow and Director of Studies at St John's College, University of Cambridge

David Williams, MA, VetMB, PhD, CertVOphthal, CertWEL, FHEA, FRCVS, graduated from Cambridge in 1988 and has worked in veterinary ophthalmology at the Animal Health Trust. He gained his Certificate in Veterinary Ophthalmology before undertaking a PhD at the RVC. David now teaches at the vet school in Cambridge.


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