Master this veterinary procedure: Client communication

A middle-aged couple presents to my clinic with an older dog to discuss therapy options for an oral tumor. The man stands across the exam room, arms folded across his chest. It's clear that he doesn't like what he's hearing. I notice his skepticism and address it directly. "It seems you may have some concerns with what I'm describing," I say. "Can I ask what your thoughts and concerns are?"

This simple question leads to the descovery that the client had a similar cancer himself and went through many of the procedures I was describing. Understanding his experiences and worries, I address in more detail how these things are different in dogs and provide more information along those lines.

By the end of the visit, the clients not only pursue multiple treatments for their pet, but the man is now standing next to me, chatting and smiling. If I had ignored the nonverbal cues and had just continued to educate about treatment options—rather than investigating, understanding, and expressing empathy for the client's concerns—I suspect the clients would have left without smiles and without treating their pet.

You've probably had similar experiences in your veterinary clinic. Talking to clients about a difficult diagnosis like cancer doesn't rank high on most veterinarians' list of favorite tasks. But the reality is that good communication allows us to practice better medicine. It bonds clients more tightly to our practice, which increases adherence to our recommendations and also benefits our bottom line.

The first step? Start thinking of client communication as a procedure. Since you speak with almost every pet owner who comes into the practice, it's actually the most common procedure you perform. And like with any procedure, you can improve your skills with practice. So stop thinking you're either a strong communicator or you're not. The following tips will help you become an expert in four key client communication skills—even if you're one of those veterinarians who prefers talking to pets rather than people.

1. WATCH WHAT THEY'RE SAYING

A large part of all communication is nonverbal—and unintentional. Your clients' unconscious body language is akin to a poker player's "tell." If you know how to read these nonverbal cues, you can tell what a client is thinking or feeling. Case in point: How do you know when someone's angry? Usually it's because that person talks louder and changes her posture, not because she says, "I'm so mad!"

Often clients' nonverbal communication actually contradicts what they're saying. And body language doesn't lie. How many times have you asked clients if they understand, only to hear a soft "yes" in response while the client makes no eye contact? Nonverbal cues like this are signs that your cliens really don't understand. Paying attention to a client's tone of voice, facial expression, and posture will allow you to clarify the situation before a critical misunderstanding occurs.

Another plus: Being aware of and reacting to nonverbal clues takes up no extra time during an appointment. In fact, it may even save you time. All you need to do is note the nonverbal cues and, perhaps, comment on them (more on this below) to help guide the discussion in a more beneficial direction.

2. WALK IN THEIR SHOES

Feeling empathy is another key part of building rapport with clients. But it's not enough to imagine what a pet owner is feeling. You must show that you empathize or the client won't know you understand. Here are three ways you can exhibit your empathy:

See clients. Pet owners want to know that you view them as individuals rather than faceless customers. So let them know you appreciate their uniqueness by commenting on something unrelated to their pet's medical concerns. For example, ask clients who wear T-shirts emblazoned with a sports logo how their team is doing.

Clients also want you to notice the emotions they're experiencing about their pet's health issues. A good way to let them know you're tuned in is to state what you see: "You seem worried," or, "You look nervous." While these statements might seem awkward or obvious, they allow clients to know that you recognize their feelings. Clients greatly appreciate these expressions. Empathetic statements end up helping you, too, because they improve the bond between you and your clients. Also, a statement as simple as, "I can see this is difficult for you," can help ground a client in the midst of a difficult discussion. Acknowledging the tough emotional situation, such as a cancer diagnosis, may allow the client to refocus on the medical conversation.

You also show empathy in nonverbal ways by using gestures and an appropriate speaking tone and rate. For example, speak more quietly and slowly in times of sadness. And hand a box of tissues to any client who begins to sniffle. It's a wonderful way to show empathy.

Hear clients. Showing clients you're listening to and understanding them is another important aspect of exhibiting empathy. To improve your empathetic listening, think of the hearing-responding process as breathing. First, listen and take in what clients are saying (inhale). Then, show appreciation and understanding of their experience (exhale). Use both verbal and nonverbal methods to illustrate your understanding. Reflective listening, discussed in tip No. 4 below, covers the verbal side. Nonverbal reactions include appropriate facial expressions, nodding, making eye contact, leaning in toward the client, and so on.

Accept clients. People inherently want to be accepted. When pet owners don't feel judged, they're more likely to be honest with you, voice their concerns, and ask questions they may have otherwise been too embarrassed to mention. Showing clients you accept them also will help them see you as supportive rather than adversarial when working through difficult problems. There are three types of statements you can make to help clients feel accepted:

1. Nonjudgmental statements. Example: "You were placed in a very difficult situation."

2. Normalizing statements. Example: "It's so common for pet owners to miss these masses until they get very large."

3. Self-disclosing statements. Example: "You're not alone—my cat has behavioral issues, too."

Intentionally making these types of statements takes a conscious effort, but doing so can significantly improve the bonds you've developed with clients.

3. GET THEM TALKING

Asking open-ended questions can help you obtain an accurate history and ensure that discussions about diagnostics and treatment options are successful. Why? Because open-ended questions encourage pet owners to tell their stories. And that's a good thing when it comes to solidifying client bonds and increasing the feeling of a partnership in veterinary care. Don't worry, your clients' stories won't necessarily be long, rambling soliloquies. With specific techniques, you can focus their answers. In fact, open-ended questions often save time during client conversations because they allow you to understand the true nature of the client's concerns. This way you're not addressing an unrelated issue.

Try not to ask closed-ended questions that begin with words such as when, is, did, who, and where. These questions often result in one-word answers. They can also make the conversation sound like an interrogation. Closed-ended questions certainly play a role in client communications, especially during emergency situations or when you need to clarify. But they're best used after you've asked open-ended questions.

Begin open-ended questions with what or how. Avoid why, because it seems to carry judgment, as in the accusatory, "Why did you do that?" Start your client visits with a broad question such as, "What's been going on?" This works even if you already know the complaint from the technician's history. If you've been told the patient is hematuric, for example, you could say something like, "So, Pippa is having blood in her urine. Can you tell me what's been going on?" This technique shows clients you're aware of their concerns and still allows them to share valuable thoughts and feelings. What's more, clients will answer in their natural vocabulary. Pay attention and, when possible, use the same words back to them in your response to improve their understanding even more.

Open-ended questions also help you avoid awkward, time-consuming conversations. If you ask a client, "Are you thinking about euthanasia?" when she wasn't, you may soon have a hysterical pet owner on your hands. Instead, when you've delivered difficult news, ask something like, "What are your thoughts about options at this point?" Also remember this rule of thumb: Ask, don't tell. When you've offered a new diagnosis, ask a client what he knows about the disease rather than jumping into a description. This not only gives you an idea of where you need to start your client education, it also shows the client you value his knowledge.

4. LISTEN AND REPEAT

Reflective listening, also called active listening, also improves your bond with clients and improves your medicine through solid communication. With reflective listening, you repeat (or reflect) what clients say or imply, thus showing interest in and understanding of their statements. By paraphrasing clients' meaning, you're both showing empathy and checking your understanding so you can correct any misconceptions they may have or give additional information as needed.

Reflective listening includes nonverbal techniques such as nods, smiles, "mm-hmms," and hand gestures. And here's a great tool to use when you're unsure of what to say next or want a pet owner to expound without your input: Verbally repeat the client's last word or phrase. For example, if a client says, "Momo has just been acting crazy," you respond with a simple, "Crazy?" The pet owner will instinctively elaborate for you. For other types of reflective statements, it's helpful to begin them with a standard stem. The classic stem is, "What I hear you saying is ... " Other stems may feel more natural—and less like a therapist. My favorites are, "So, you're saying that ... " and "It sounds like ... "

Here's a reflective statement in action: "It sounds like you're worried that Turner's quality of life is poor right now." Clients can correct you if that's not their main concern, or they might feel a sense of relief that you understand them. Another example: "So you're worried about the cost of the treatment?" This may elicit a "Yes, it seems very expensive," or maybe a "No, the cost isn't the problem. It's the time involved." This way you're able to address the client's true concern.

By actively employing all of these communication techniques in your daily interactions with clients (and even team members), difficult situations may not only be improved but also completely avoided. What's more, you'll help make clients feel they're in partnership with you in giving their pets the best care. And that's good for your medical outcomes, as well as your bottom line. Sure, employing these techniques takes concentration and effort. At first they may seem artificial and uncomfortable. But over time you'll improve your communication skills (remember, communication is a procedure) and they'll become a more natural part of your interactions with pet owners.

Dr. Laura Garrett, DACVIM (oncology), is a clinical associate professor in the Department of Veterinary Clinical Medicine at the University of Illinois at Urbana-Champaign College of Veterinary Medicine in Urbana, Ill. Send questions or comments to ve@advanstar.com or post them online at dvm360.com/comment.