"My colleagues are miscommunicating with my clients..."
Hi Dr. Ruby:
Recently I have had a couple of situations where a colleague has seen a client that I would typically see (ie I was away on holidays or conference etc.) and as a result, there have been some sticky situations which have developed that I would like your advice on.
An example was a dog that came in for lameness for 3 days. My colleague examined the dog and recommended knee x-rays based on the location of the lameness and clinical signs. X-rays were performed and a drawer sign was elicited leading to a diagnosis of a cruciate tear. The owners were then recommended to have surgery. The dog was given pain medication and the owners declined surgery. I felt that everything that was done by my colleague was completely appropriate and I would have done the same as well.
A few days later, a receptionist called to see how the dog was doing. The wife said that the dog was back to normal and was very upset that all of these "unnecessary" x-rays were done on her "normal" dog and she questioned the validity of my colleague’s recommendation for surgery and implied that she was motivated out of money and not the well-being of her dog. The client said that "Dr. W would have never done such unnecessary tests," which is basically not true. I am very thorough with my workups so I think this statement is based on our level of trust. My colleague let me know of this and she was understandably upset by the accusation. I reassured her that she did the right thing.
So now I am not sure what to do. I am thinking that I should call the client myself and see how things are going. My hope is that she will open up and I can try to do some damage control. I could offer to examine the dog myself for free and go over the x-rays with the client. However, if she does not take the bait, then I guess I will bring it up myself. (ie “So Mrs. X, I heard that you were disappointed with your last visit. I would like you to be happy and I wonder if there are some knowledge gaps in what is going on with your pet. Perhaps I can clear them up.")
A similar situation developed with another client but with a different colleague. Similar circumstances where a client felt that she had x-rays that were done that the owner consented to at the time but afterward did not feel was appropriate. Again the workup was appropriate in this situation...The thing that I found from talking with the client was she did not feel she was kept abreast of what was developing. I spoke to the client and smoothed things over; however, I had to refund some her money to save the relationship.
My frustration stems from how can I prevent this? I do not want to be cleaning up other people's messes and I want the clients to trust my staff as well. Perhaps my colleagues need communication training?
Any other suggestions would be greatly appreciated.
Dr. W, DVM
Dear Doctor:
I'm so glad you asked about this issue as it gets to the very heart of what we’re trying to convey at EVT. It's often not “what you do” as a doctor with your clients, but “how you do it” that will impact the client's perceptions of care. Of course, it is a given that veterinarians will all do very thorough and appropriate workups and treatment, as these are the foundation of excellent medical care. So why is it that 2 veterinarians can do the same workup, and recommend the same treatment or test, and clients will feel taken advantage of by one, and well cared for by another? It is all in the delivery, geared towards individual clients' needs and expectations. This is the “art” of medicine rather than the “science.” Great doctors will attend to both, as they realize that helping the client understand and concur with treatment is as important as prescribing the right treatment. If this is not attended to, clients will feel frustrated at best and cheated at worst. Since they make all the decisions regarding their pets’ care and caregivers, their commitment to both the doctor and the recommendation is imperative.
Are the other colleagues in your practice new veterinarians or recent hires? If so, it takes time for clients to become accustomed to and to trust new practitioners. If this is the case, you can be the “bridge” between your new colleagues and your clients by making sure you stress your faith in your colleagues. You could do this through a flier in the waiting room, or even a card mailed to your clients. In the cases where the initial trust seemed shaken, as in the cases you shared, it would be entirely appropriate for you to call the clients and make sure they know you stand behind your colleagues’ recommendations. You could also, however, attempt to figure out what made the clients feel less than pleased with the care they got. Of course you will want to solicit this information without, in any way, condemning your colleagues. For instance, you could say something like; “Mrs. Mullen, this is Dr. W. I understand that you and Chloe were in recently and you weren't pleased with your visit. Your satisfaction and Chloe's care is very important to us. Could you tell me what happened from your vantage point?" Note all that you are doing here is soliciting Mrs. Mullen’s “perception.”
Listen carefully to what she conveys, and validate her concerns. For instance; "I see. So you felt as though you didn’t really understand the reasons for the x-rays to begin with and when Chloe got better so quickly, you thought perhaps they hadn’t been necessary. Is that the case?" If she answers in the affirmative, you can then go on to assure her you believe this was exactly the care that Chloe should have gotten and why. You can help her understand that although the new doctor may not have fully helped her understand the need for the x-rays, you fully support the decision made, given the medical documentation. Assure her the right treatment was suggested and that you would have done the exact same thing. In this way, you help her see both that you care about her experience, support your colleague AND agree with the care provided in your absence. This step will put out the immediate “fire.”
Next, it will be important to address the issue with your colleagues so that this doesn't become a common occurrence.
Your colleagues may be great doctors medically, but these complaints appear to indicate that they need some work in honing their clinical communication skills. This is not an unusual problem with medical professionals. Many doctors have put a great deal of effort into learning to practice great medicine, but have not done specific training in how to help their clients understand or accept this good care. Since you have written this letter, I suspect you have learned to develop good rapport with your clients. In this case, you can be a positive mentor for your colleagues. Although it will take some time to help them improve their skill level, it will be one of the best investments in your practice that you can make.
I would suggest a couple of things:
First of all, a colleague of mine, Dr. Suzanne Kurtz, has written a wonderful book for physicians that we have adapted to using in the training of veterinary students. It is called “Skills for Communicating with Patients” and it is a wonderful resource. It can be ordered online, in paperback. Buy each colleague a copy, and have weekly meetings where you all read through a chapter and discuss how you might apply the skills to clients you've seen over the week. This would be a great refresher for more experienced clinicians, and provide solid training for new docs. As a matter of fact, you may find you enjoy putting a name to skills you have been practicing somewhat unconsciously!
Additionally, have your colleagues take turns “shadowing” you for a half a day while you see clients. Perhaps this could be done on their days off to decrease production loss. The purpose of the shadowing experience is for them to view not the medicine you do, but how you help your clients understand and accept the treatment or recommendations that you make during visits. This will help reinforce the skills they read about in the training manual. You could share lunch time together at the end of this session and “dissect” the communications aspects of the visits, to ensure they recognized how you worked with each client.
I've worked with many doctors who make the assumption that “they are who they are” and that as long as they provide appropriate medical care, it is up to their clients to accommodate to their style. Unfortunately, this belief results in many clients going elsewhere for veterinary treatment and care. Clinical communication is a skill that needs to be learned and practiced just like any other medical skill. It can be learned and it can be taught. The book I've recommended is a great starting point.
Your diagnosis of the need for communication training was right on! I wish you the best as you seek to help your colleagues learn how to better gain the trust and commitment of their clients through better communication. Please let me know how it goes!
Warm Regards,
Dr. Ruby
P.S. You may find these articles recently run in EVT to be helpful for staff trainings and discussions, too:
1. Connecting with Clients
2. Delivering Bad News: A Crucial Conversation
3. Room Enough for All of Us
4. Nonverbal Communication
5. Partnering with Clients: The Dance of Rapport
