ABSTRACT: A good consultation requires both clinical and communication skills. Communication is not only part of good practice and essential to the provision of good pet health care and customer service, but it also increases job satisfaction and is better for business. Avoiding communication problems means there are fewer complaints and less time wasting and stress for all concerned.

Whilst VNs are exceedingly capable and competent from the academic and practical viewpoint, some find conducting appointments quite challenging until they have had the opportunity to develop their own individual style through personal experience. Self-confidence is vital.

Don’t be intimidated by clients. Remember they value your opinion and lack the special training that you have received.

This article covers the essential communication components which structure a professional veterinary consultation via a simple step-by-step process, providing a framework which can be applied to a wide range of appointments in a consistent, structured and quantifiable way.

Communication

Communication is the act of conveying and receiving information, ideas or feelings. Effective communication is a two-way process, just like the transmitter and receiver for a radio. We sometimes have to work harder communicating with certain types of people and have to tune into their ‘wavelength’

Communication is a skill we learn from birth which entails more than just words

–   it also involves all the special senses and a lot of ‘body language’ (non-verbal communication). As veterinary nurses, we should remember that the correct use of posture, eye contact, touch and tone of voice are important in reassuring pets as well as owners.

Professional relationship

Pets are part of the family. They play a therapeutic, emotional and social role. The pet-owner bond is gaining strength and clients need to view you as calm and dependable, someone they can trust to help keep their pet happy and healthy (Figure 1).

Figure 1: Pets are part of the family

During the consultation, you need to build a rapport with both pet and owner

–   be enthusiastic, interested, positive, gentle, friendly and caring. Find a way of complimenting the pet, no matter what you really think about it. Try to keep a sense of humour and let your personality shine through. Clients need to believe you understand their perspective and empathise with them. Quite simply, put yourself ‘in their shoes’!

Remember to trust the owner’s instinct. If he or she thinks there’s something wrong, treat it seriously as they know their pet best. Veterinary work is, in many ways, analogous to human paediatrics. Pets can’t tell us what’s wrong, we can’t rationalise with them and we have to consider the owners’ concerns and expectations. Similarly, a doctor needs to consider the parents’ opinions during a child’s appointment and use a different approach from that required with adult patients.

Easy steps

You are responsible for guiding the client and the pet from start to finish of their consultation, just as a navigator helps a driver to reach his or her destination safely and quickly. It is your role to follow a sequence and attend to time. Don’t be afraid to state the obvious, so that the distinct component parts of the consultation are evident to the owner. And remember to speak clearly.

Tell clients what you are going to do, tell them that you are doing it, and tell them what you’ve done. Try to be concise and keep things simple to avoid confusion. At the end of each stage, summarise to check client understanding before moving on further, a technique referred to as ‘chunk and check’

1.   Preparation and planning

Ensure you have prepared well so your appearance is professional and that your consultation room and equipment are ready. Familiarise yourself with the case background information and note any particular issues relevant to the scheduled appointment.

2.   Welcome

Greet your patient and its owner in a friendly and courteous manner and make them both comfortable. Introduce yourself, including your professional qualifications or role.

3.   Collecting information

Ask clients to tell you what they are worried about and let them see that you are listening attentively. You need to understand the problem both from the veterinary and owner viewpoint. Use carefully phrased questions to collect together information.

Closed questions are those which require a simple ‘yes’ or ‘no’ answer; for example, “Do you give tit bits?”

Open questions usually begin with ‘how’, ‘which’, ‘where’, ‘what’, ‘who’, ‘why’ or ‘when’ and will require a fuller answer; for example, “How often do the claws usually need clipping?” It helps if you say the pet’s name and repeat the owners’ expressions. Ask if there is anything else that the client wishes to discuss, as sometimes people are shy or afraid and hold back something important (Figure 2).

Figure 2: Sometimes people are shy or afraid and hold back something important

“Let’s see if we can find out what’s happening and sort things out. I can see you are worried but you’re not alone. We’re here to help and give you peace of mind.”

4.   Patient assessment

Explain that you would like to conduct an assessment of their pet and check you have their permission to proceed. This signals to owners that you are moving on to the next step.

It is important to reassure the patient as you complete your evaluation and also to communicate what you are doing verbally so the process is overt, understood and remembered by the owner – at the same time recording the information in your notes.

5.   Summary and decision making

Organise this information in your own mind before giving your interpretation of the situation. Above all, do no harm; and if you are unsure how best to proceed, offer to seek the opinion of a colleague and contact the client personally within a specified time-frame with a response. Otherwise, use your professional judgement to summarise in order of priority.

Avoid dramatic or inflammatory vocabulary which makes owners more emotional. Choose euphemisms carefully to reduce anxiety, such that owners can think logically but still grasp the serious point you are making. Use ‘jargon-free’ expressions, which are easily understood, and provide options which, regardless of owner philosophy or budget, make it possible to plan an agreed way forward.

Try to allow time for the information to sink in and gauge the owner r
esponse before going further. Provide the opportunity for discussion and negotiation and explain alternatives in terms of their rationale, for example, “If a Buster collar is worn for just a few days, there is less risk of wound interference or licking which means that it will heal faster.”

Remember not to ‘judge the book by its cover’ and assume that because someone looks wealthy that they have money to spend and are willing to do so, or vice versa. Avoid being judgmental or making clients feel guilty if they decline your recommendation. Try to be flexible, supportive and encouraging. Repetition is an essential tool for effective communication. If the client finishes your sentences or repeats your words it suggests he or she clearly understood and agree with what you said.

6.   Closure

Once a plan is agreed, it is best illustrated through the use of visual aids, practical demonstrations or written instructions that keep both client and patient involved in the consultation and improve compliance. The World Health Organisation defines compliance as the extent to which a person’s behaviour corresponds with the agreed recommendation with their healthcare provider. Improved compliance results in better veterinary care and alleviation of pain and suffering.

So, at this point, describe the worst case scenario and what to watch out for by way of complications. This ‘safety net’ helps to manage client expectation. It is far better to ‘under promise’ and ‘over deliver’. A final summary helps you to check you haven’t missed anything, confirm the client has understood and has nothing further to ask before they go through to reception to book their follow-up appointment.

It is worth reflecting at this point and evaluating your ‘performance’. Ask colleagues to give you client feedback if possible. Be self-critical as it helps to know which techniques work well and which ones require improvement.

7.   Review

At follow-up appointments, your encouragement and support is essential to good compliance. Reviews provide the opportunity to reinforce your recommendations, check your patient’s progress, verify client satisfaction and make adjustments to the management plan as necessary.

Conclusion

Most of this article is just plain common sense for those who are born as naturally good communicators; but, for those who wish to develop and practice their inter-personal skills or have had little communication skill training, it may help provide some tips to consider in the evolution of their own consultations, when designing practice protocols, or for student training.

Further reading

O'KANE, J. (2001) The Pressures of the First Job In Practice July 2001. RADFORD, A., STOCKLEY, P., SPENCER, C. et al, Development, Teaching and Evaluation of a Consultation Structure Model for use in Veterinary Education by JVME 33 (1) 2006 AAVMC p 38-44.

SILVERMAN, J., KURTZ, S., DRAPER, J., (1998) Skills for Communicating with Patients Radcliffe Medical Press, Oxford

As previously mentioned, pulmonary thromboembolism development is a real possibility in these patients and it is life-threatening. The patient needs to be monitored closely for sudden or severe respiratory distress, as this is the main clinical symptom. In some cases it may be necessary to perform a lung perfusion scan to detect areas of hypoperfusion indicative of the presence of a thromboembolism.

The VN must support the patient’s actual problem by providing it with strict cage rest, oxygen therapy, anticoagulants and thrombolytic agents under the direction of the vet. The major potential problem to then bear in mind when administering anticoagulants and thrombolytic medications is the possibility of haemorrhage, so the VN should monitor the patient’s PCV every two hours, and prepare a blood transfusion in case it is needed.

The VN must not neglect the standard post-op care checks either and requirements including correcting hypothermia, routine wound checks (remember the increased chance of dehiscence) and good nutrition!

Main complications associated with adrenalectomy

•   Haemorrhage

•   Fluid and electrolyte disturbances

•   Pancreatitis

•   Wound infection

•   Delayed wound healing

•   Thromboembolism

Homecare advice and support

It is most certainly the responsibility of the VN to make sure owners are aware of their job in the life-long management of their pets at home. This should be done by discussing the medications they need to administer and how to administer them, the clinical symptoms associated with a deterioration in the animal’s condition, and making sure they come back in for regular check-ups either with the VN or the vet.

It would be advisable to write an information leaflet to be given out to the owners, which details the relevant facts about their pet’s condition, the surgery that has been performed, why life-long medication is required, what the clinical symptoms of deterioration are and why they are significant, and then also a section that specifically relates to their animal and what you have asked them to do at home.

Remember each animal and case is unique, and you should create a homecare plan for the owners according to the patient’s needs – maybe a daily checklist for them or simple chart or diary for them to complete and bring with them at each visit.

Further reading

HOTSTON MOORE, A. (ed) (1999) BSAVA Manual of Advanced Veterinary Nursing. BSAVA, Gloucester

MARTIN, C. and MASTERS, J. (2006) Textbook of Surgical Nursing. Oxford, Elsevier

MOONEY, C. T. and PETERSON, M. E. (2004) BSAVA Manual of Canine and Feline Endocrinology. BSAVA Gloucester.

WELCH FOSSUM, T. et al., (2002) Small Animal Surgery 2nd Edition. St Louis. Mosby

Author

Clare Spencer BVetMed MRCVS

Clare Spencer graduated as a veterinary surgeon from the RVC London in 1984. She is especially interested in medicine, nutrition, client care and treating pets as part of the family. Clare has practised in the UK and France and currently works part-time in practice and part-time as a nutritional technical adviser but, wherever she works, she knows she can't do her job properly without the support of a good nursing team.

• VOL 25 • No4 • April 2010 • Veterinary Nursing Journal