Building a Home to Care for Your Clients: Part 1

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“Today has been a good day,” you think to yourself. Things are running according to schedule. The surgery patients are recovering well and so far your appointments have been pretty straightforward.

You even got to sit down to enjoy your lunch. Not bad considering the owner of the clinic, Dr. Wilcox, is on vacation. You sigh and lean back in your chair. That’s when you see Mr. McDaniel walk through the door with his dog, Chance, who seems to be limping along. Mr. McDaniel is adamant that only Dr. Wilcox see Chance. It’s time to pull out your communication toolbox and begin skillfully building the relationship with Mr. McDaniel, and fast.

Building the Framework of Relationship
All of the tools covered in the Communication Toolbox articles contribute to building the relationship. Attending to relationship throughout the interview acts as the glue, holding the various parts of the visit together, and is in itself a tool to achieve the goals of the consultation. Building the relationship enhances the accuracy and efficiency in which information is gathered, leads to client and veterinary satisfaction, and promotes partnership and collaboration.^1,2

Think of building the relationship as the frame of a house that provides structure, support, and stability. In this way, the house (your relationship with the client) can endure the high winds, snowstorms, and torrential rains that veterinarian–client relationships sometimes experience. In this article we examine the communication tools used to build the framework and lay the foundation for long-term client relationships, which is more important than ever before. The tools presented in Part 1 of this article are displaying and picking up on nonverbal behaviors and expressing empathy.

Nonverbal Nuts, Bolts, and Nails
We’ve all heard the expression “actions speak louder than words.” Our nonverbal behaviors are the nuts, bolts, and nails that hold the relationship together. Researchers estimate that nonverbal cues make up as much as 80% of communication.³ These behaviors include eye contact, facial expressions, posture, body positioning and movement, and vocal cues such as rate, volume, and tone (see Types of Nonverbal Communication, below). Nonverbal communication is fluid and lingers long after we’ve delivered our verbal message.

The first key lesson is that our nonverbal messages overshadow our words when there is verbal and nonverbal incongruence.

For example, you might say to Mr. McDaniel, “I can assure you that although I am not Dr. Wilcox, I will do my very best to help you and Chance during this difficult time [partnership].” Yet, if your voice is shaky and barely audible, your arms are crossed defensively across your chest, and you haven’t looked Mr. McDaniel in the eye once—he is going to think he’s putting the life of his best friend in the hands of a young, scared, less than confident veterinarian who doesn’t have the courage to address him directly.

Types of Nonverbal Communication

Posture: Sitting, standing, arms relaxed (open and inviting), arms crossed (closed off)
Proximity: Space and positioning between yourself and the client
Touch: Handshake, pat on the shoulder
Body movements: Hand and arm gestures, nodding, fidgeting, foot and leg movements
Facial expressions: Smile, frown, raised eyebrows, tears, flushing
Eye contact: Gaze, staring, connection
Vocal cues: Pitch, rate, volume, rhythm, silence, pause, intonation
Use of time: Rushed, slow to respond, early, late, on time
Physical presence: Ethnicity, gender, body shape, clothing, grooming
Environment: Location, furniture placement, lighting, temperature, colors, odors

On the flip side, if you make the same statement while looking the client in the eye, standing straight with an open posture, and using a confident tone and volume, your verbal message of competence will be taken seriously. Nonverbal communication enables our verbal messages to be delivered with accuracy and authenticity. But nonverbal behaviors also tend to tell the truth and can “leak” our underlying feelings. It is critical to keep this in mind when feeling apprehensive, triggered, or judgmental toward a client.

Just as clients pick up on our nonverbal communication, it is equally important that veterinarians pick up vital information and create openings for conversation by cueing in on client nonverbal behaviors as well. This will allow you to check if your assumptions are correct and acknowledge the client’s feelings.

For example, even though Mr. McDaniel says he is disappointed that you are treating Chance, he also is visibly shaking and has tears pooling in his eyes. By picking up on these cues, you can address his feelings by stating, “I know you are disappointed that Dr. Wilcox is not here to treat Chance [empathy]. I see that you are very worried about how we are going to fix his leg since the doctor who knows him is not available [empathy]. Tell me how I can work with you and Chance to ease your concerns [partnership].” Checking in allows the client to further discuss his concerns, feelings, and beliefs, which in turn provides you with key insights in how to best work with both the client and the patient.

The key lessons in nonverbal communication are to match your behaviors to those of your client, strive for congruence between your verbal and nonverbal messages, and pick up on client cues, which can foster nonverbal rapport and build a strong connection with your client.

Laying the Foundation with Empathy
By picking up on nonverbal cues, you successfully unearthed Mr. McDaniel’s thoughts, feelings, and concerns about Chance’s medical care. Great, but now what do you do? The next step in building the relationship involves laying the foundation through empathy. Empathy involves seeing and appreciating the situation from the client’s perspective. It requires you to take yourself out of the equation and put yourself in the client’s shoes, setting aside your experiences and viewpoints and remaining open to the client’s thoughts and feelings.

When you express empathy in response to a client’s concern, belief, idea, or feeling, common ground, as well as a shared understanding of the client’s experience, is established. An empathetic response involves accepting what the client says without judgment while acknowledging the client’s feelings and beliefs.

Empathy can be expressed in a myriad of ways:

1. Name or acknowledge the client’s thoughts and feelings:

“It’s terrible timing that Chance is hurt when Dr. Wilcox is on vacation [empathy]. I know how much you trust
Dr. Wilcox and I hope that I can fill his very big shoes [partnership].”

2. Legitimize or normalize the client’s thoughts and feelings:

“What is making this even more stressful is having an unfamiliar veterinarian perform surgery on Chance [empathy].”

3. Be fully present—use attentive silence and appropriate nonverbal signals such as small nods to encourage the client to share or process their thoughts and emotions.

4. Show appreciation for the client’s contribution:

“Thank you for sharing that with me. It’s helpful to know what concerns you have, so we can work through them together [partnership].”

An impactful empathy statement is tailored to the trials and tribulations of the client and attempts to characterize his or her experience. As a result, the statement “I understand” in itself is far from empathetic and could produce a reactive response from the client, such as “How can you possibly understand?” You can strengthen “I understand” by finishing the statement with what exactly you understand. “I understand that Chance chased a fox, returned limping, and you are afraid that he may have broken something [empathy].”

Tools of the Trade: Good Starts to Empathetic Statements

“I appreciate that…”
“I see that…”
“I sense that…”
“I understand that…”

Go Ahead and Take the Risk
It can seem a bit risky or awkward to check in on a client’s feelings, so you may initially resist tackling the inherent emotions in opening your heart to your clients. Take the risk, as it is likely that you will be handsomely rewarded. Why are you so fearful? (See What is Holding You Back From Expressing Empathy?) The answer to these fears lies in one word—trust. Build trust with clients by expressing empathy, trust that your compassion will be enough, and trust yourself to accept emotional gifts from your clients.

What is Holding You Back From Expressing Empathy?

You may fear:

Releasing your own emotions by sensing the emotions of others
Triggering emotions in your clients that you cannot handle
Breaching personal and professional boundaries
Making mistakes: “What if I interpret their feelings incorrectly?”
Losing control: “What if I open up a can of worms?”

The House That Relationship Built
A strong relational foundation is built on empathy and the frame is held together by the nuts, bolts, and nails of nonverbal communication. Building a strong and long-term client relationship is at the heart of veterinary practice and is at the core of why many of us chose this profession.

Learn how to practice the concept of expressing empathy with your team

Read "Building a Home to Care for Your Clients: Part 2" the next article in the Communication Toolbox series.

For additional articles and training materials, see the Communication Toolbox series. This is the fifth article in the series.

Building a Home to Care for Your Clients: Part 1
Lisa Hunter, LSW, and Jane R. Shaw, DVM, PhD

References

1. Shaw JR, Barley GE, Hill AE, Larson S, Roter DR. An Intervention Study: Communication skills education onsite in a veterinary practice. Pat Educ and Couns 80: 227-344, 2010.
2. Shaw JR, Adams CL, Bonnett BN. What can veterinarians learn from studies of physician-patient communication about veterinarian-client-patient communication? JAVMA 224:5; 676-684, 2004.
3. Kurtz SM, Silverman J, Draper J. Teaching and learning communication skills in medicine. Arbingdon (UK): Redcliffe Medical Press, 2005.