ABSTRACT: There has been limited formal teaching of the process of consulting, for veterinary nurses. This article covers the processes required to convert 'the art of consulting' into a structured format.

Veterinary nurses often undertake the role of‘clinic nurse’ with little or no training on the delivery of a consultation. This, coupled with the requirement of the new nursing award, necessitate that both students and qualified veterinary nurses receive training in these very important skills.

Although there are several frameworks for consulting in medical education, none had been developed specifically for veterinary use. The Cambridge-Calgary consulting model has been adapted by the National Unit for the Advancement of Veterinary Communication Skills (NUVACS) as the most relevant framework for the veterinary profession (Figure 1).

Figure 1: Adapted Cambridge-Calgary model of veterinary consultation skills

1.   Preparation

Any equipment required for the consultation should be prepared in advance, the consulting room needs to be clean, and the nurse should be familiar with the clinical history of the patient, in particular any relevant details (Figure 2). iMake a note of the animal’s name, sex and age, and use these when talking about the patient. Your appearance is also highly important as it governs the client’s perception of you (Figure 3).

Figure 2: Ensure that the consulting room is clean and tidy

Figure 3: Personal appearance is important, note the clean uniform, tidy hair and name badge

2.   Initiating the Consultation

Whether or not the consult is regarding the previous clinical history of the animal, if you mention or ask how the pet has been since the incident, the client will feel that you care about their pet.

The consultation should also be started by confirming the name of the client, when calling them through from the waiting area. Always introduce yourself, and confirm the nature of the appointment at the outset. Clients often make an appointment for one cat, and then bring the other one instead, as they could not locate or catch the initial one!

If there is a delay, keep the waiting clients updated as they don’t like to be kept waiting – not acknowledging increased waiting times will lead to frustration on the client’s part, which will make your job worse once you do see them.

Spend a few minutes becoming acquainted with the patient. Dogs should be patted and spoken to and cats interacted with, prior to removal from their basket. Use of the pet’s name is vital. If cats are unwilling to leave their baskets, then remove the top, if possible, and then either examine them in the bottom half of their basket, or lift them out on their blanket onto the consulting table. This stage is very important for creating rapport with the client and their pet. Remember to use the client’s name too, and consider whether it is appropriate to shake hands. But most importantly involve the pet.

In order to create good rapport, nurses should empathise with the owners; indeed empathy is an essential trait for all the practice team – not just the VN that they see during the nurse consultations. In the majority of cases, the pet is an integral family member, and this special bond needs to be respected.

When children are brought into the consulting room, involving them can prove to be useful (Figure 4). Getting them to weigh the pet, or to read off the weight, are good examples of this, especially in weight loss clinics as it helps compliance with the children feeding the pet. Colouring books and pencils are useful for distracting children – and remember to put their completed pictures on the wall in your consulting room.

Figure 4: Puppies are often bought for children and. therefore, inclusion of children in the consultation process is important

3.   Information gathering

Background information will be gleaned from the clinical history, but additional information can also be obtained through carefully focussed questioning. Many clients are more than happy to offer information whether it is relevant or not.

Some need specific questioning in order to retrieve the required information.

The use of ‘open’ and ‘closed’ questions should be utilised, as different types of answers can be gained. Questioning also helps provide information regarding the clients expectations and specific concerns. If conducted appropriately, this part of the process allows you to demonstrate your professionalism and knowledge, whilst helping to build rapport with the client.

Questions also help to give you time to think and time to focus. Use communication cues – such as nodding your head – to demonstrate interest in what the client is saying. Listen to what the client is saying, and, in some cases, repeat back to the client what they are saying in order to confirm details (Table 1).

This is a very important stage of the consultation, and one that is often overlooked or not completed to the full. In many situations, when the consultation has finished, the client often adds, “… and another thing”! This can be pre-empted by focused questioning of the client at the outset.

In some cases the client may have a very long list of queries or tasks. Prioritise the most important ones for the patient – by negotiation with the client if necessary – as they may have a different perspective to you as a veterinary professional.

For example, you may decide that the dramatic weight loss and polydipsia are the most important factors to be considered; whereas the client may be more worried about overlong nails or an increase in vocalisation for no apparent reason. If this situation is experienced, then the client should understand why you feel that these clinical factors need to be prioritised over the clipping of the patient’s nails.

In situations where the client has a long list of non-emergency questions or procedures, it is important to hold a dialogue at the outset as to which things are to be completed first; and then a subsequent appointment can be made in order to complete the outstanding requirements. Reasons for suggesting more than one appointment may include: insufficient time
to correctly cover all the items, too much information for the client to retain in one appointment, the pet becoming stressed – for example if its coat is matted – or to aid in compliance.

4. Physical Examination

When initiating the physical examination, it is important to be aware of the clinical history of the animal. If the animal is known to have a tender abdomen, or arthritic joints, care must be taken not to exacerbate any discomfort. With larger dogs, or those that don’t like being on the consulting table, the physical examination can be conducted on the floor.

Whilst performing the clinical examination, it is important to talk through with the client what you are doing and looking for. Work systematically from the head backwards – having a set routine will help to ensure that things are not missed out.

Start by looking at the symmetry of the head and jaw. This is important when animals are presented with dental disease, because lumps or bumps on the mandible or maxilla can be an indicator of tooth root problems. Any nasal discharge should be noted, along with its colour and whether it is lateral or bilateral. When examining the eyes, the size of the pupils and their symmetry should be noted. The conjunctiva surrounding the eye should be examined too, in order to check for infection, and any discharge. Ears should be checked for discharge, wax, dirt and smell.

Examination of the mouth will depend on the co-operation of the animal being examined. If it is known to be difficult to handle, in some circumstances asking the owner to lift the animal’s lip up so that you can look at the teeth can be appropriate, provided that you are confident that this will not put the owner at risk of being bitten. If any disease is present, then it should be noted and graded (Table 2).

When palpating the animal’s neck and shoulders, the lymph nodes should be checked and, if palpable, this needs to be noted and referred to the veterinary surgeon. The condition of the coat and skin should be accessed and checked for parasites. The range of movement in limbs should be assessed; and careful questioning about mobility should be instigated with cat owners because most arthritic changes are put down to old age rather than reduced mobility in this species.

Examination should also include measuring and assessing the heart and respiratory rate. Finally, the overall condition of the animal should be noted, including body condition score (BCS), muscle condition score (MCS) and body weight.

5.   Explanation and Planning

Once all the information has been gathered and the animal examined, your initial findings need to be explained to the owner and conveyed to the veterinary surgeon as appropriate. If your consultation is primarily aimed at dealing with issues such as weight reduction or care of the geriatric patient, veterinary intervention may not be required. It will be your responsibility as a veterinary nurse to plan and explain the next steps in such a way as to ensure that the information is conveyed in a form that the owner understands. This can be oral or written, and in some cases educational DVDs can be utilised. Some points will need to be reiterated, and a useful tip is to do so in a different form.

When planning the next step the owner must agree with the decisions that are being made and be able to comply with the instructions given. If these steps are not complied with, the risk of non-compliance increases dramatically.

There are three elements involved in the implementation of care: the veterinary professional, the client and the pet. All parties need to be in agreement in order to make a plan work. The owner may agree to administration of oral medication on a daily basis, but the pet may resist this, thereby resulting in non-compliance.

Breaking down the information into ‘digestible’ chunks can be helpful for the owner. During lengthy consultations, it can be useful to ask the owner if he or she wants to take notes – have a pen and paper ready in order to allow them to do so. Asking the client to identify any challenges associated with the implementation of the proposed plan at home is important too as it not only identifies potential pitfalls, but also encourages the client to feel a degree of ownership of the process.

6.   Closing the Consultation

When closing the consultation the aim is to summarise the decisions that have been agreed, and to arrange future appointments, as necessary. It is important to confirm that the owner is happy with any agreed protocols, such as medications that have been dispensed or diets recommended (Table 3).

Also ensure that the client is provided with contact details. These may be either telephone or e-mail, indeed both are recommended; and don’t forget to reinforce your name by either writing it on any documentation provided or giving a card with your details. Whilst primarily considered a tool of ‘the business person’, business cards can be produced very cheaply for all clinical staff and are appreciated by clients. 


Nicola Ackerman BSc(Hons)RVN CertSAN A1 V1 C-SQP MBVNA

Nicola works as senior medical nurse at The Veterinary Hospital Group and has been one of the emergency night nurses since 2005. She is a graduate of Hartpury College with an Honours Degree in Equine Science, specialising in animal nutrition; and qualified as a VN in 2002. She has subsequently gained a post graduation Certificate in Small and Exotic Animal Nutrition.

She is also the Head Assessor in practice for a team of four other assessors, and is currently studying for the internal verifiers award [V1|. Nicola was part of the BVNA Council for four years and held posts of Treasurer and Executive Editor of the VNJ during this time.

Nicola is part of the Pet Obesity Taskforce and has written a book on animal nutrition for veterinary nurses and technicians.

To cite this article use either

DOI: 10.1111/].2045-0648.2011.00097.x or Veterinary Nursing Journal Vol 26 pp 368-371.

• VOL 26 • October 2011 • Veterinary Nursing Journal