4 Courses at a 5-Star Restaurant: Explanation & Planning Part 1
Mrs. Kensington just arrived for her appointment with Zipper, the family’s gray and white male cat to investigate the lump on his neck, sudden loss of appetite, and onset of lethargy.
You have examined Zipper and are compiling your findings. Now it is time to take out your communication tools to explain the diagnosis and work toward a mutually agreed upon treatment plan for Zipper.
The Attitude of the Waitstaff
Before embarking on your conversation with Mrs. Kensington, it might be helpful to review some key concepts regarding relationship building.
There are two relationship styles you can use with your clients—the first is
paternalism. Paternalism is like throwing a shot put at your client rather than trying to play catch.1 In paternalism, the focus is on the delivery of information, which is often unidirectional, large in mass and scale, and lecture-like, making it difficult for clients to receive the message.
The second relationship style is relationship-centered care (RCC). This style is like playing Frisbee—a reciprocal interaction focused on dialogue.1 The delivery of information is light and free, with small pieces delivered one at a time, followed by requesting the client’s response. The deliverer and receiver work together to adjust the message in order to stay on track. See Building the Relationship below for additional information about relationship-centered care.
How would you like to serve your client? Throw all the courses on the table at the same time (shot put) or place each course inconspicuously in front of the patron one at a time (Frisbee)?
Missed our 2-part series on building client relationships? Learn how to successfully implement relationship-centered care with your clients with this Communication Toolbox.
Dinner is Served
Imagine yourself as a gourmet chef preparing exquisite entrees at a 5-star restaurant. You labor to find the freshest ingredients, then add them in just the right amounts at the right time to ensure the dish is fit for a king or queen. Now it is time to plate the dish and present it to your hungry patron. What would it feel like to sit down to each course arranged with care with the waitstaff checking to see how you were enjoying it (Frisbee)? What would it feel like if they threw everything into a Ziploc bag, gave it a few shakes, and poured it directly on the table (shot put)? What good is it to put in the effort, time, and ingredients for a perfect meal if the presentation is rushed?
Data dumping may be your default mode in the explaining and planning part of the clinical interview. You will work with the client to build a partnership throughout the phases of initiation, gathering information, and building the relationship. Yet your tendency may be to bulldoze your way through explanation and planning, focusing on your agenda and leaving the client in the dust with an unappetizing meal in his or her lap. In this article, 2 key communication tools (see Tools of the Trade) for explaining and planning, using easily understood language and the chunk and check method, are explored.
Tools of the Trade
There are 4 key tools for explanation and planning. In this article, we cover the first 2:
2. Giving information in manageable chunks and continually checking
3. Assessing the client’s starting point*
4. Relating explanations to the client’s perspective*
*Tools 3 and 4 will be covered in the July/August issue of EVT.
Recipe for Success
Have you ever found yourself halfway through preparing a recipe when you realize you have no idea what is meant by “meuniere” or no clue how to temper the chocolate? Your clients are often in the same boat when trying to decipher their animal’s illness or treatment plans. Veterinary medicine is foreign territory to clients, so the information you share often goes over their heads.
Your fallback is to present a lot of information in a short amount of time. The “park and bark” method does not leave clients with time to absorb, respond, or participate. It’s like cramming a 4-course meal into 5 minutes and expecting room for dessert followed by a great review.
Instead, using easily understood language and the chunk and check method allows you to give appropriate and comprehensive information in a way that promotes client understanding and recall. This approach involves clients in the discussion, increasing their investment in the decision-making process and commitment to the care plan.
I’ll Have Language with a Side of Understanding
Using medical jargon often leaves clients feeling confused. Couple this with the fear of coming across as ignorant if they ask for clarification, and you have a recipe for disaster. All of us know the feeling. You know what you want to order on the menu but have no idea how to pronounce it. There are many ways to approach the situation: Some order the house salad, others hold up the menu and point, some ask how to pronounce it correctly, and a few brave souls give it a whirl. There is no telling how knowledgeable your clients may be or how they might respond when they do not understand what is being said. To avoid misunderstandings, avoid medical jargon and explain the terms you use in a way the client can easily comprehend.
“The mass you felt on Zipper’s neck is an abscess, a lump filled with pus.
Given that Zipper is a scrapper and has a history of getting into fights, I recommend that we test him for a virus that can be spread through bite wounds from cat-to-cat.
I also recommend we obtain blood work to see how serious his infection is and to check his organ function to prepare for anesthesia.”
View tips for putting these tools into practice with Role Play.
Kibbles & Bits
A second tool that ensures retention and understanding is the chunk and check method. By giving information in small pieces [chunk] and checking for understanding [check] before moving on, you elicit the client’s feedback and responses to help guide the discussion.
Let’s break it down further. Create manageable chunks of information for the client to absorb. Speak in small, easily understood phrases, presenting only 1 to 3 sentences at a time. Then check if the client understands before proceeding.
“We will need to place Zipper under anesthesia to drain the pus from the abscess. Zipper may need a temporary drain to make sure the pocket does not fill up again [pause].”
Allowing for a pause in the explanation gives the client time to chew, digest, and swallow the information before taking the next bite. Checking in with the client encourages questions and clarifications. Asking permission to continue allows you to gauge the client’s readiness to move forward with the discussion.
“What are your thoughts [eliciting the client’s perspective]?”
“Shall I continue [asking permission]?”
You can check for client understanding with open-ended questions. Involving the client in this way ensures that he or she keeps pace with you during the discussion. A client who is actively engaged in the conversation is more likely to fully understand and adhere to recommendations.1
“What questions do you have at this point [open-ended question]?”
“How would you like to proceed [open-ended question]?”
“What additional information might be helpful for you [open-ended question]?”
“What concerns do you have [eliciting the client’s perspective]?”
Everyone has specific “spiels” on various topics, and it is easy to go into default mode and deliver a mini lecture. Checking with the client enables you to customize or tailor the explanation.
Finally, check whether the client is on board with the plan of action.
“I am interested in hearing your thoughts regarding Zipper’s surgery [open-ended statement].”
“What questions do you have about the options we have discussed so far [open-ended question]?”
“What concerns do you have about caring for Zipper at home [open-ended question]?”
Keep in mind that the bite size for the client may differ from yours; you have had these discussions before but the client may be hearing this information for the first time. If the news is bad, unexpected, or stressful, you may need to provide even smaller bites with even longer pauses between servings.
How Does Everything Taste So Far?
Asking clients to restate what they heard in their own words allows you to clarify information as needed, possibly preventing the meal from being sent back to the kitchen. Exercise this skill mindfully, as it could be misinterpreted as condescending if worded incorrectly.
“I know that I just gave you a lot of information about Zipper [empathy] and I am concerned it may not have been clear. It would help me if you could tell me in your own words what we’ve decided for Zipper [partnership]. That way we can be sure we are on the same page [partnership].”
My Compliments to the Chef
Two ingredients that create an interactive approach with clients are using easily understood language and providing information in small chunks and checking for understanding. Pausing between bites allows clients to digest the information before moving on to the next course. Checking for understanding encourages the client to raise questions and concerns—giving you an idea of what information needs to be repeated, clarified or added. Combined, these tools keep you and the client on the same page, leading to heightened adherence, satisfaction, and compliments to the chef. | EVT
4 COURSES AT A 5-STAR RESTAURANT EXPLAINING & PLANNING: PART 1-Lisa Hunter, LSW, and Jane R. Shaw, DVM, PhD
1. Skills for Communicating with Patients. Silverman J, Kurtz SA, Draper J. Radcliffe Medical Press, Abingdon, UK, 2005.