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The human side of veterinary medicine
Talking to clients

One of the oddities of veterinary life is that some practitioners who are amiable and verbal, even charming, in a social setting find difficulty and discomfort in talking to clients.  Why this peculiarity occurs has been the subject of much speculation and analysis.

A $75/hour psychiatrist might be of great value in analysing the problem, but this is not the only type of remedy available.  There are alternative therapies that offer the possibility of effective relief in less time and, because they are largely self-help techniques, they are less costly.

A trace of insight

According to psychologists, there is a hidden but perfectly reasonable cause for this seemingly anomalous condition.  A person may be comfortable in the company of peers (a social context), but may tend to be self-conscious in the presence of authority.  In severe cases, the self-consciousness may deteriorate into lowered self-confidence, a vital personality flaw in any practitioner.

But can the client be viewed as an authority figure?  Don’t clients on the contrary, tend to look on the doctor as the authority?  Strangely, the answer to both questions is yes.  In contemporary practice both doctor and client may see the other as influential and commanding, though in different ways.  How is it possible for such reciprocal attitudes to coexist?

The client, of course, generally respects the doctor.  Nevertheless, for the duration of the visit the doctor is the employee of the client.  Many of us recognise this aspect of the client/doctor relationship only vaguely or unconsciously, yet it has a profound effect on office behaviour.  As an employee, then, the doctor must perform satisfactorily (i.e., cure the patient) and, at the same time, be courteous and respectful to the boss (the client).  No wonder some veterinarians feel ill at ease across the table from a new and possibly demanding client.

The antidota

To begin with, every veterinarian understands client entitlements: continued civility to both patient and owner; the most effective patient treatment available; undiminished quality of care to the conclusion of the patient’s illness; no illusory promises or predictions; plus all the rest of the decent and human aspects of the client/doctor relationship.  These are inherent and unarguable practitioner obligations to clients.  They must not be confused, however, with a practitioner conferring on clients powers and authority they do not deserve.

Most veterinarians, it is true, do not suffer from verbal indisposition most of the time, but most of us do experience trouble talking with clients some of the time.  Eliminating these annoyances, or minimising them, can only increase the pleasure and satisfaction of practice.

When we feel uneasy while talking to a client, regardless of whether the subject matter is pleasant or unpleasant, we may be unconsciously feeling like the child in a parent/child exchange.  This is more likely to happen if we perceive (rightly or wrongly) the owner to be older, stronger, wiser, more experienced, more educated, richer, or more relaxed than we.  In other words, we sometimes tend to feel childlike in the presence of a person we unconsciously see as a parent or parent surrogate.

There is a simple antidote for this kind of mental poison.  The client, it is true, is our employer and has hired us to perform a specific professional task for which we are well prepared: but this client, though truly an authority figure, does not require our fear and trembling.  How can we work effectively in such a state?  We don’t have to.  The antidote is the fundamental realisation that the client needs us – desperately!

This is where we must stop thinking of our own concerns and feelings of inadequacy and concentrate on what the client and the patient need.  There is nothing worse psychologically than preoccupation with one’s self, especially if aimed at our weaker and more vulnerable elements.  The client seeks the doctor’s strengths:  do we respond from weakness?  One of the principal rules of practice is to fill the client’s needs.  Nowhere, not even at the bottom of the rule list, do we find any mention of filling the doctor’s needs.

The moment the ugly solipsism ‘I feel uncertain talking to this client’ creeps into our mind, we must chase it with two basic questions: ‘What is this client’s need right now?’ and ‘How can I satisfy it?’  This is really an exercise in reality testing.  Our own fears of inadequacy are probably not based in reality, but the client’s needs surely are.  Given this logic, which need must be addressed?  There is no choice; the client and patient must be served.

Communication techniques

All this analytic material may sound logical and believable, but the pragmatist inside every veterinarian still cries, ‘Yes, but how do I accomplish these mental gymnastics?  My heart may truly yearn to be everything the client wishes, expects, and deserves, but my head keeps reminding me of the patient’s ambiguous blood values and those mysterious unexplainable shadows on its radiographs.  So how can I not equivocate, when I’m uncertain about the diagnosis in my own mind?  And yet, I want to be truthful to the client.  Is it possible to resolve such a clinical dilemma?’

Certainly.  It is not only possible but imperative that we be both candid with the client and comfortable with ourselves, even during the most distressing owner/doctor conversations.  To the degree that if we fail in this effort, we will have failed our client.

Most of us, however, do have the right motives.  We want to relate well, keep the client’s attention, and communicate warmly and accurately, but our talk machine may not be running as smoothly as we might wish.  It may need a little tuning up.  Maybe it starts well enough, but at a critical moment, it may hesitate, pause, and threaten to stall.  This tends to lower our credibility in the client’s mind.  Because we wish to be more convincing, not less, it can only help to examine some of the techniques developed to improve the quality of professional conversations.  We must not confuse these established methods, however, with the flattering ‘say-something-nice-to-the-client’ school of a mindless Dr Feelgood.

One standard, but unhelpful piece of advice is to tape yourself, then listen and hear how horrible you sound.  A much better audience and critic is a sincere and trusted friend or colleague.

My own experience confirms this claim.  For many years, the field representative of a giant pharmaceutical company had been lavishing free goods on me.  Often it was so bountiful as to be embarrassing.  I frequently inquired about his company’s liberal give-away policy, but he never addressed my question.  Finally, after much prodding, he replied, ‘You’re the only one I give this much stuff to.  But you deserve it.  I try out all my new sales pitches on you. You listen, you point out the strengths and the weaknesses, and then I fine-tune the presentation.  That system has never failed to make a hit with my sales manager and with my customers.  So I thank you with all the free goods I can.’  No wonder we got along so well.  We filled each other’s needs.

The following techniques have the same purpose.  If some seem artificial at first, don’t be deterred.  Like driving a different car, a new system becomes easier as you use it.  Also, if you try to keep doing all the recommended dos, you’ll have no time to be tempted by so many of the attractive don’ts, such as ‘don’t ridicule the client,’ ‘don’t gossip,’ and ‘don’t offend.’

Stimulate client participation

By making comments and questions open-ended, you will stimulate client participation.  This is much more than keeping the ball in play.  It can be a veritable wellspring of data, a source of information not available in any other way.  Remarks such as ‘Can you think of any reason why…...?’ or ‘In your opinion, what could have……?’ or ‘How do you explain……?’ may lengthen the office visit somewhat, but the knowledge gained is well worth the additional time. 

In fact, voluntary client contributions often answer specific diagnostic questions that the brightest clinicians sometimes wouldn’t think of asking.  For instance, ‘Yes I remember now that we had to leave him alone in the yard all afternoon.  We had to go down to the bank and see why they had reduced our credit rating practically to nothing, and that’s when he must have chewed the fence posts and swallowed the rocks.’  An extra dividend is the pleasure the owner gets from having had the doctor’s undivided attention for those few moments. Expect these people to tell their friends, ‘Our veterinarian listens.  We like that.’

Stick to the point

The more important the clinical issue, the more important it is to stay with it.  Rambling, gossip, and other diversions may lower your own anxiety, but will only exacerbate the clients.  What most owners want to hear are the two bottom lines: prognosis and economics.  Get to them as quickly as possible, with logic and with empathy, and then stay with them.  As a result, prompter client consent will leave you tingling with success, with no room for anxiety.

Filter constantly

Many of the news media have shown us all too often how to poke fun at our elders, condescend to women and children, and denigrate people of different races and religions.  It is easy to fall into the conversational mode of unthinkingly repeating these canards.  I know, because I’ve done it too many times myself.  Even as the ‘harmless’ words were rolling off my tongue, I’d have given a week’s pay to be able to snatch them back.  A better filtration system would have kept many a client on my roster.  It will do the same for any practitioner who devotes himself or herself to developing one.

Skip the ‘I’ and the ‘We’

The client’s main interest is in the patient.  Your achievements and skills carry very little weight, and your show-and-tell monologues about your modern decor and updated equipment are boring.  Worst of all, about the last thing any client wants to hear is how safe your new anaesthetic machine is.  In fact, the thought of their treasured pet unconscious on the veterinarian’s table is enough to terrify most owners.  They can’t consider your great survival rate; all they can think of is the 1 in 10,000 animals that did not wake up.  If you absolutely must use a first-person pronoun, let it be the plural, so as to include the staff, and use it in those contexts as ‘We care about…….,’ which projects an idea the client is sure  to find more interesting.

Tact, tact, and more tact

Even criticism, when needed, can be delivered tactfully and sympathetically.  ‘It’s too bad you put mange lotion on your cat,’ we say quietly, ‘ but I don’t think she licked off enough to hurt her badly.  Besides,’ we add with conviction, ‘you had no way of knowing your neighbour was misinforming you.’  The opposite, or adversarial, type of criticism is known as ‘fogging.’  It consists of substituting a false issue (the doctor’s tactless attempt at dominance) for the truly important one (helping the patient).  A typical example is the vulgar and unthinking exclamation ‘What? You soaked the poor cat with poison?  How could you?’  I have always wondered why everyone of us would cringe at hearing a colleague make such a gaffe, but could turn right around and do the same thing ourselves.

Listening: The quintessential clinical art

It is safe to say that practitioners desire to please their clients, but it is equally safe to admit that not enough of us have devoted ourselves to acquiring the interpersonal skills needed to do so.  All clients are consumers of veterinary services, and virtually all consumers of any product like salespeople who listen.  They enjoy buying from someone who clearly has a sincere interest in their wishes, needs and hopes.  In veterinary medicine, this interest centers chiefly on the patient, but it is the client who recognises and understands it value.  Though we may not relish the designation of salesperson, the plain truth is that we are retailers of a sort.  Denying it cannot change this aspect of the doctor/client relationship.  Learning the art of listening, however, and using it properly, will immeasurably enhance our practice competence without sacrificing profit, honour, or ethics.  Furthermore, it will render the bond between doctor and client even firmer.  To begin, however, the best counsel experts give is to stop thinking of the client as a captive audience who eagerly awaits your tales of medical/surgical heroics.  It is better by far to listen and to find out what the client has in mind.