Communication Toolbox: The Art of Initiation
Want to improve client compliance, reduce complaints, and increase your professional fulfillment? EVT’s new series will help you build a “toolbox” packed with clinical communication skills.
Bring your toolbox with you to rock your wellness visits, compassionately navigate end-of-life conversations, and calm those anxious clients. This month, our experts give you the tools you need to successfully start an exam and establish rapport with clients!
Inside, learn the art of INITIATION ►
• Open-Ended Questioning
• Nonverbal Behaviors
• Active Listening
You Had Me at Hello:
Navigating the Art of Initiation
It is 4:30 pm on Friday after what has been a very long and stressful week. You’ve had to euthanize one of your favorite patients and still have to call two clients with unfortunate test results before the end of the day. Furthermore, Mr. Dolohov and his dog Francis are here for their first appointment—a new pet exam. How can you make this interaction fresh and present your best self, despite these challenges?
As the saying goes, you don’t get a second chance at a first impression. Take the time to mentally prepare yourself for the next appointment. Put aside all other things on your to-do list, take a deep breath, and shift your focus to the task at hand. Making Mr. Dolohov and Francis the center of your attention before entering the room will help you be fully present for both client and pet and will set the tone for the initial exam. If you’re able to get off to a good start, this interaction will also lay the foundation for a successful long-term relationship.
As you enter the room, introduce yourself and clarify your role. A warm welcome, greeting, handshake, and introduction help establish initial rapport. Start by informing the client about your role in the pet’s care. Remove any ambiguity by helping the client understand the role of everybody in the practice through clear introductions. Check in with the client for the correct name pronunciation and gender of the pet as you demonstrate interest in both pet and client. This step helps involve the client in the interview process and begins to build a collaborative dialogue. For instance:
Hello Mr. Dolohov, I’m Lindsey [introduction], a veterinary technician working with Dr. Hill today [role clarification]. Oh, is this Francis? What a beautiful boy [demonstrates interest]! If it’s alright with you, I’d like to gather some health information about Francis to prepare Dr. Hill for your visit today [asking permission].
Hello Mr. Dolohov, is that right [confirms name pronunciation]? I’m Dr. Hill, but you can call me Amber if you’d like [introduction], and it’s my pleasure to take care of you and your boy Francis today [confirms gender]. I see that Francis is a little nervous. If it’s okay with you, I would like to sit on the floor and make friends with Francis while we talk [asking permission].
How to Open an Exam
1. Prepare mentally
2. Introduce yourself and clarify your role
3. Identify the client’s agenda using:
• Open-ended questions (How? What? Tell me?)
• Nonverbal behaviors (Nodding, eye contact, facial expressions, sitting down)
• Active listening (I see…, Go on…)
• Summarizing (Repeat back, check for understanding1)
Building Your Toolbox of Skills
This series will provide you with communication skills proven successful in navigating diverse clinical scenarios. Unlike scripts, which require specific phrasing for every situation, skills can be carried with you at all times to a myriad of circumstances. Your skills toolbox is something that you can rely on to help guide your most routine and challenging practice interactions—including complex end-of-life conversations, medical errors, and financial discussions.
The Communication Toolbox is based on the framework of the Calgary-Cambridge Guide.1 Each issue, we’ll teach you a new exam step and add evidence-based skills to your toolbox!
Identify the Client’s Agenda
Soliciting your client’s complete problem list early is critical to optimizing visit time and is best accomplished by asking open-ended questions. Questioning in this way allows you to set a plan for the rest of the visit by ensuring you fully understand your client’s expectations. An open-ended question is designed to draw out a full response from the client rather than a brief one and usually begins with some variation of how, what, or tell me. Try phrases like:
What brings you and Francis in today?
What other concerns do you have about Francis?
Anything else you would like to discuss?
While it may seem redundant or formulaic to ask numerous questions, you may be surprised by what you find. Clients often bring a laundry list of issues or topics they would like to discuss with their veterinary team. Ensuring that you explore this list and meld it with your agenda sets the structure for the remainder of the appointment and increases client satisfaction.
Paying attention to your nonverbal behaviors (eg, maintaining eye contact, sitting at the client’s level, using attentive facial expressions, head nodding) and resisting the urge to interrupt will also encourage the client to fully disclose concerns. Using minimal encouragers, such as “I see” and “go on,” during the interview demonstrates you are actively listening and are interested in hearing more.
Summarizing is a tool used to deliberately check with the client to make sure you have discovered the client’s full agenda. For instance:
It sounds like you want to discuss vaccinations and nutrition today. In particular, you are concerned that Francis may be overweight and you would like us to trim his nails [summary]. Am I missing anything [check for understanding]?
Initiating the interview well and establishing initial rapport lay the groundwork for the rest of the visit and can build a successful long-term relationship.
Having the right communication tools and knowing how and when to use them appropriately comes with practice. The best approach is setting specific, achievable goals and taking an active role in your learning. Learn about goal setting using the SMART model. | EVT
See Aids & Resources for references and suggested reading.