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How will you tell her?


It's never easy to be the bearer of bad tidings. But you can ease the hurt clients feel with a sensitive approach. Here's what you need to know to break bad news gently.

Sparky, a seemingly healthy patient scheduled to go home, is lying cool and lifeless in a pool of her own secretions. This chilling discovery melts your cheerful demeanor—and your prospect for a happy, productive morning. Once a source of reciprocal joy and hope, this pet has become an instrument of misery. And guess who's giving Sparky's owner the bad news?

Mr. Pit takes up familiar residence in your stomach. You'll be distracted until the conversation is behind you, but you dread its awkward, painful onset. So how will you deliver the message? The look-em-in-the-eye, tell-it-to-em-straight approach may look good in Westerns. But in real life, it might send an unsuspecting pet owner into an emotional free fall.

My brother tells of a friend who, after returning from vacation, took his small children to retrieve their dog that was boarded at their veterinary practice. The veterinarian dis­appeared to the back of the practice and returned carrying the lifeless body of their pet that had died unexpectedly. While the doctor delivered the necessary information, it was an abrupt and painful way to share it—especially for the children.

Whether you're telling clients the groomer inadvertently trimmed their pet's fur too short, describing a mis­understanding about appointment times, explaining the doctor they want to see is unavailable, or giving biopsy results with a dire prognosis, the same thoughtful communication ideas apply.

1. Set the stage

When you prepare clients for alternative outcomes, they're less likely to feel shocked or betrayed by bad results. So when clients ask, "You won't let my pet die, will you?" my answer's always the same: "I can't guarantee I'll live through the procedure." Although we often laugh together at the prospect of my dying while performing surgery on their pet, it's a statement of fact that puts the situation in perspective.

Do not let bad news wreck your day

Then I tell them about our impressive patient-monitoring capabilities and record of success. But I remind them we're dealing with natural systems, so we don't have total control. Every year, people die from tonsillectomies and trips to the grocery store.

When it's necessary to deliver bad news, allow your clients time to embrace and digest the facts. Start the conversation by saying something serious occurred. They'll start to realize the scope of the problem by your tone and demeanor, which will prepare them for the details you'll provide.

2. Recognize the opportunity

Where there's crisis, there's oppor­tunity. Some of the most loyal clients have experienced a pet-related problem or challenge. When you express your concern and a desire to make amends, you can bond them more tightly to your practice than if nothing bad ever happened. And, you can show how much you care and what you're willing to do to rectify the situation.

3. Control the venue

If you can, give bad news face-to-face. E-mails and letters can be heartfelt, but they're one-dimensional and easily misunderstood. The absence of body language and voice inflections can lend different meanings to words than you intended. Rather, use written communication for follow-up once you've reached an understanding.

Consider designating an area for tough discussions that's pleasant, clean, and quiet. Use soft lighting and com­fortable furnishings and avoid or eliminate visual distractions, such as clutter or a highly-trafficked coat rack, or audio distractions, such as barking dogs or talking people.

4. Make a connection

Successful communication occurs when both parties emotionally connect. So when you deliver bad news, connecting with the client is key. What makes a successful connection? It differs greatly with age, gender, familiarity, occupation, and many other factors. You'd obviously approach a 6-year-old child differently from a 36-year-old attorney, but there are universal pathways, including body language, facial expressions, and vocal tones.

My physician is the best communicator I know. He has scores of patients and many life challenges. But during our meetings, I feel I'm his only concern. He dresses in clean, professional—but not overly formal— attire and positions his chair to remove any physical barriers between us. From beginning to end, he gives me his complete attention. He maintains an open body posture, never crossing his arms or legs. He doesn't fumble with equipment or read medical charts while I'm speaking. He speaks clearly in warm vocal tones and smiles. He's calm, confident, decisive, and caring.

As it turns out, I've learned a lot from my doctor. I'm a tall man and know many of our clients are taken aback by my size, especially if I burst into the exam room. Their eyes widen as they trail toward the ceiling, searching for the uppermost limit of my body. So before I enter a room to deliver important news, a team member leaves a chair for me, and the most diminutive client towers over me. I use body language, facial expressions, and vocal tones to establish a connection. To demonstrate I listened and understood, I repeated their responses. Some say parroting back is passé, but I disagree. It's easy, effective, and surprisingly powerful.

5. Let people see inside

Clients expect veterinarians and team members to care deeply about animals and the people connected to them—and that's what they want to see. So let your guard down, open up, and show them your personal, animal-loving side.

While the discussion shouldn't focus on you, some heartfelt self-disclosure can reassure clients you understand their feelings and relate to their pain. Sometimes, I feel it's helpful and appropriate to mention my mother's losing battle with breast cancer or my father's fatal car accident or share the loss of one of my pets. And I often discuss other recent similar medical cases to show clients they're not alone.

6. Use humor

Humor is highly personal—and risky. Failed humorous attempts can seem callous or inappropriate. But successful attempts can defuse otherwise difficult situations and bring sunshine into a dark world. You've just told a client her beloved pet has renal failure or metastatic cancer. Consider reminding the client how the dog stole toilet paper from her bathroom, knocked over the Christmas tree, or buried her spouse's slippers in the yard. Or mention something funny the pet did at your practice. Perhaps the patient's eyesight is failing and you reassure the owner blind animals often compensate well and it's not like her dog's a jet pilot. Clients often appreciate levity and laughter, and it changes the climate from enduring a problem to extending a worthwhile life. It shifts the focus from negative—the expense and the pet's pain—to positive—the value and joy of life.

What is the risk?

7. Use touch

Body parts we generally regard as safe to touch, such as shoulders or arms, still come with risk. So if you're worried clients might misunderstand your intentions, see that they don't. For the most part, people can sense intent. In interpersonal communication, both parties work to answer, "How does the other person really feel about this? Does the owner truly want the best care for her pet or is she acting out of guilt? Does the team member actually care or is she reciting a script?" Touch can powerfully reassure beyond words. But if there's any chance for misunderstanding, ask first before you touch. I often say, "Can I give you a hug?" I've never been turned down.

Discussing loss

Grief is the spontaneous response to loss, and it's a process we don't control. When you're delivering bad news about a potential loss, remember logic can't out-reason emotions. Use phrases that acknowledge and validate the client's feelings. To a crying pet owner, you might say, "I'd expect you to cry at a time like this." Avoid statements like, "Don't feel bad." This doesn't change clients' feelings and belittles them as if they could wish their emotions away.

When words of comfort aren't enough, offer structure. Explaining their options patiently may give clients a sense that life is not out of control.

Ultimately, you can only help clients if they let you, so create an environment that fosters their trust. When threatened with bad news, clients may feel angry, confused, frightened, disbelieving, or otherwise not themselves, and they may be difficult to handle. Help them endure the crisis by offering an extra dose of patience, empathy, and kindness.

Jim Kramer, DVM, CVPM

Jim Kramer, DVM, CVPM, is a partner at Columbus Animal Hospital in Columbus, Neb. Please send questions or comments to firstline@advanstar.com

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