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Good ways to break bad news

Article

They're the situations you dread.

They're the situations you dread. Counseling a teary-eyed, indecisive client on whether euthanasia is the right choice for an ailing pet. Explaining to an overweight client that his or her pet is obese and needs exercise. Convincing a client that an aging cat or dog has a few good years yet, even if the furry friend doesn't play much and can't get up and down stairs anymore. Now, don't feel bad if these conversations are hard for you. That's normal, say communications experts and the veterinarians we talked to. But these sources all agree that you can learn to face them more effectively. Consider this a quick class in communication and human behavior. And take these nuggets of wisdom and turn them into exam-room excellence today.

The bottom line

Pet obesity

What not to do: Own the problem without the owner

What to do: Clients need to be your partners, says Dr. Brent Cook. If they won't acknowledge the risks of pet obesity—joint pain, heart disease—you'll get nowhere by nagging. More than anyone else, the owner is responsible for increasing a pet's exercise or decreasing caloric intake. "Most people don't come in looking for help with their pet's weight, or they've heard it before and haven't changed their habits," he says. So your first step is to help the client recognize the problem. Dr. Cook or an assistant uses handouts that show cats and dogs with different body condition scores. Clients circle the body condition category they think their pet falls into. "Until they really recognize the problem, they don't want to do anything," he says.

What not to do: Tackle weight without your team

What to do: Send a team message to support owners who need to get their pets' weight down, says Dr. Cook. His receptionists are trained to notice when pets are carrying extra pounds and mention it to clients: "Wow, has Fluffy put on some weight?" When pets are weighed, veterinary assistants say, "You know, last year Fluffy weighed 32 pounds. Now she's 46 pounds. Were you aware of that?" Dr. Cook says this all sets the stage in the client's mind: "Wow, this must be a really big problem." When he then sees the client, Dr. Cook explains why obesity is a health risk and asks if the client would like to set up a weight-loss program for the pet.

What not to do: Make a pet's obesity personal

What to do: You may feel uncomfortable talking about a pet's obesity with a visibly overweight client. Just keep it focused on the pet, and no one will be offended. "We don't talk to clients about themselves," Dr. Cook says. "If overweight owners happen to get more exercise walking their dogs, all the better. But don't bring their weight into the conversation."

Dr. Brent Cook, co-owner of Kingsbrook Animal Hospital in Frederick, Md.

Euthanasia

What not to do: Push the client

What to do: Learn where a client is coming from. You may think euthanasia is the right choice for this patient. You may think it's the wrong choice. Either way, you have to find out how the owner feels about euthanasia at that moment. Dr. Cindy Adams, PhD, MSW, focuses on doctor communication and says collaborative decision-making, in which the doctor's goals and the client's goals are mutually negotiated, is the best way to handle sensitive situations. "One size does not fit all when it comes to clients' values," Dr. Adams says.

What not to do: Start without a plan

What to do: Take time and plan ahead. Clients making life-or-death choices about a loved pet need guidance. "Create a structure for a clinical consultation about euthanasia," Dr. Adams says. "And explain the order of the appointment from the start." Also, don't rush the decision. In some cases, euthanasia consultations can take a full day of intensive testing, thoughtful discussion, and careful procedures. "These conversations are fraught with emotion," she says. "Take more time to do them right."

What not to do: Fear conflict

What to do: Dr. Adams says that while it's normal to avoid conflict, we often hurt ourselves by ducking the hard stuff. In fact, conflict is often healthy. It's normal to disagree with a client about what to do about a pet near the end of its life. But don't stop with the disagreement. "You can tell the client, 'We're in conflict. We disagree. We've got to work through this. I'm committed to working through this with you,'" Dr. Adams says. Then continue to tackle the issues. The main goal: Clients have to trust that you have their well-being and the well-being of their pet in mind.

Dr. Cindy Adams, PhD, MSW, associate professor at the University of Calgary

Long-term conditions

What not to do: Render judgment based just on your exam

What to do: An elderly dog that gets a burst of adrenaline at your office may be lethargic most of the time at home. "Sometimes a client thinks the pet is having a really hard time, but it looks fine to you," Dr. Richard Jacobson says. "But they're seeing it 365 days a year." Ask clients probing questions about the pet's health and try to find out whether a client is worried about nothing or seeing something you aren't. For example, if a patient thinks his or her dog's seizures are becoming more frequent, find out how frequent. Did they used to occur once every few months, and now they're occurring once every few weeks? Ask a client to keep a diary of when seizures happen to document things you don't see in the exam room.

What not to do: Judge clients on squeamishness

What to do: A dog may need a regular insulin shot. A cat may need subcutaneous fluids once a day. An elderly pet may become incontinent. These may be issues you or another pet owner could cope with, but your client just can't stomach injecting his or her pet with needles, or can't keep picking up dog poop all over the house. "It's about quality of life for the pet," Dr. Jacobson says. "If someone emotionally or physically can't handle that pet's care, that pet's quality of life suffers. I won't make that client feel guilty about it." Dr. Jacobson imagines what things might have happened in a client's life to make care of a sick or elderly animal too painful: emotional trauma, a recent death in the family, nursing the fatally ill, or just uneasiness about bodily fluids. If a client wants to euthanize a sick pet, Dr. Jacobson won't make it worse for clients. "I'd rather be a little uncomfortable with the decision to euthanize and live with that than have that client walk around with the guilt," he says.

Dr. Richard Jacobson, co-owner of Farmingville Animal Hospital in Long Island, N.Y.

It's not always what you say; it's how you say it

One particular phrase or communication style isn't going to work for everybody. Even so, Veterinary Economics Editorial Advisory Board member Dr. Jim Kramer, CVPM, a partner at Columbus Animal Hospital in Columbus, Neb., says you can still use some general principles when communicating with clients on difficult topics. He says he made a clear communication change when his clientele changed from no-nonsense farmers to companion animal owners—he learned to express sympathy. Practice his advice and see whether you can help clients cope in hard situations.

• Set the scene. Designate a clean, uncluttered, quiet, and pleasant room in the hospital with soft lighting to talk over euthanasia cases. Take away any distractions or barriers that would separate you from the client, such as desks and counters.

• Validate clients' feelings. Sometimes an owner needs you as much as your patient does, especially if the owner is struggling with the decision to euthanize. Dr. Kramer offers this example of what to say: "We know you care deeply about your friend. I know you'd never do anything to willingly cause him pain. And he was well-cared for all his life . You stuck by him through a great deal of difficulty. He was lucky to end up in a home like yours and to have someone who cared so deeply about him." Clients can't wish away their feelings, Dr. Kramer says. You need to let them know it's OK to feel sadness or frustration.

• Don't be afraid to remember the happier days in a moment of grief. With gentle humor, Dr. Kramer helps sorrowful owners look at the positive side by considering all they've done for the pet instead of focusing only on the difficult decision to euthanize. "We need to remind ourselves of all the joy that brought us to this point," he says.

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