Building a Home to Care for Your Clients: Part 2

• Building a Home to Care for Your Clients.pdf (282.7 KB)

Chance is comfortable, thanks to the pain medications as well as his resting place—lying across Mr. McDaniel’s lap. You can hardly believe that he is the same man who walked frantically into the clinic half an hour ago with Chance limping at his side.

Because of your nonverbal communication and expressions of empathy, you gained Mr. McDaniel’s trust. Now it’s time to discuss the surgical options and postoperative care to fix Chance’s torn cruciate ligament. It might be time to pull out your cruciate lecture. Or is it possible to invite Mr. McDaniel to play an active role in decision-making, as he is the one who is going to be doing most of the work at home?

Building a Home to Care for Your Clients: Part 1
In the last issue we examined how attending to the relationship throughout a client interview acts as glue, holding the various parts of the visit together and allowing the goals of the consultation to be reached. Building the relationship enhances the accuracy and efficiency in which information is gathered, leads to client and veterinary team satisfaction, and promotes partnership and collaboration.² We explored how nonverbal communication and empathy lay the foundation and build the framework for long-term veterinarian–client relationships. This article presents tools to deepen that relationship by offering partnership and asking permission.

Building a Custom Home
Building a custom home takes planning, time, money, and teamwork. You have to work with your architect and contractor and they with you, or you may end up with a house that pleases neither of you. It is the same in the veterinarian–client relationship. With the growing expectations of clients, increasing consumer knowledge, and strong attachment between caregivers and their companion animals, clients wish to take an increasingly active role in the decision-making process. One way to accommodate this is by switching gears from a paternalistic approach toward a collaborative partnership.

This House Is Not My Home: Paternalism
Paternalism is characterized by a relationship in which the veterinary team sets the agenda and moves forward, assuming that the client’s values, ideas, and opinions mirror their own. The veterinary team takes on the role of guardian, which puts the client in a passive role. In general practice, 58% of all veterinary visits and 85% of problem visits were found to be paternalistic in nature.¹

Paternalism is like throwing a shot put at your client.² You definitely are not trying to play catch! Instead, 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.

Using a paternalistic approach is like building a custom home without your client’s input. Sure, this seems efficient and effective at the time—you don’t have to worry about their suggestions or wait for approval of your plans, so the 3-bedroom, 2-bath split-level house is built rapidly. However, if it turns out the client really needed a 4-bedroom, 2½ bath ranch, it will take time and resources to fix the discrepancies. It also is far more difficult and costly to regain clients’ understanding, commitment, and trust than to establish common ground at the beginning.

Paternalism is characterized by a relationship in which the veterinary team sets the agenda and moves forward, assuming that the client’s values, ideas, and opinions mirror their own.

Something We Can Both Live With: Relationship-Centered Care
Relationship-centered care is characterized by a balance of power between veterinarian and client. It involves negotiation between partners to come to a mutual understanding or shared vision (see “But I’m Not a Family Therapist”). As the veterinary team, you function as an advisor, which creates an active and participatory role for the client in the decision-making process. In general practice, 42% of all veterinary visits were relationship-centered, and specifically in 69% of wellness visits veterinarians used a relationship-centered approach.²

Think of relationship-centered communication as a game of Frisbee.2 Playing Frisbee is a reciprocal interaction focused on dialogue. 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 so both parties can stay on track.

Eliciting feedback allows you to assess how clients perceive the process and understand the information presented. In this manner, you are building a custom home, involving the client in each phase of construction. When the home is finished, it is a direct reflection of both your ideas and input and those of the client.

Communication Toolbox: Solving the Case by Creating a History Together

“But I’m Not a Family Therapist”
Delving into your clients’ personal lives may feel awkward because:
• It breaches personal and professional boundaries
• Counseling is not your area of expertise, veterinary medicine is
• You don’t have time for this—your time is best spent discussing the medicine
• You’re afraid of opening up a can of worms and if that happens, what to do with it

Reconsider that today’s companion animals are considered members of the family. Thus, it is important to understand and work within the family framework. Finding out more about finances, stressors, daily activities, professions, schedules, capabilities, and barriers allows you to draw up a mutual blueprint to create a successful treatment plan, one in which the client feels valued, empowered, and motivated to adhere to.

Blueprint for Success: Partnering with the Client
A key concept of relationship-centered care is creating a partnership with the client in the treatment of his or her companion animal. One tool in developing a partnership is to use inclusive language—eg, “let’s,” “we,” “together,” “our,” “us”—that reflects you are working as a team toward a mutual goal.

For example, you might say to Mr. McDaniel:

“Let’s take a moment to talk about what we can expect from Chance’s surgery.”
“We will work together on a plan to care for Chance at home.”
“How can I help you find a dog-walker to help get Chance out midday?”

Partnership is a meeting of experts. You are the expert when it comes to veterinary medicine, and the client brings his or her own set of expertise to the table (see Client Expertise). Clients represent half of the equation and without their input you may find yourself battling adherence issues, a lack of understanding, and poor satisfaction.²

Client Expertise
Partnering with the client involves expanding your data gathering to include the broader lifestyle and social aspects of the client’s life with the pet. Clients are experts on their pets’ temperament and behavior, their financial options, social support systems, experience and knowledge, and their expectations, thoughts, feelings, and fears. Discussing details such as financial resources, role of the pet’s primary caregiver, how easy or difficult it will be to implement a treatment plan, recent life changes (eg, birth or death, new job, recent move) allows you to tailor the treatment plan and promotes client adherence.

Knock First: Asking Permission
Knocking before entering the exam room is common courtesy and generally a good idea. So why do we tend to barge through closed doors when it comes to client communication? Simple: we know where we’re headed and are so eager to get there that we sometimes forget to “knock” first.

Asking permission is a gentle approach for assessing the client’s readiness to take the next step. We can use it as a tool to structure a conversation and build a relationship. By asking permission, you propose a transition to determine if a client is able and willing to move on. This simple act of respect gives clients time to ready themselves, become receptive to what you have to say, and pace the conversation along with you. It invites clients to contribute to the discussion and lets us know where they stand.

“I am wondering if we could talk some more about our surgical options for Chance.”
“Are you okay if we now discuss the risks of Chance’s surgery?”
“Can we move on and talk about how much this is all going to cost?”

A House That is Up to Code
An approach based on relationship-centered care allows you to build a long-term and sustainable client base. In partnerships, clients feel valued and are actively involved in their pets’ care, which in turns ensures that patients receive the care they need. A collaborative approach enhances accuracy of data collection, promotes adherence, and increases client satisfaction.^1-3 Asking permission ensures that you are both working off the same set of blueprints to create a common vision and leads to a finished home that both of you can feel good about.

Putting It into Practice
As the key elements of building a relationship with your clients fall into place, give yourself a quick litmus test after each appointment. You may even want to hone in on one question at a time.
1. How would you characterize the type of relationship? (Relationship: paternalism/shot put or partnership/
Frisbee?)
2. How did it appear that the client perceived the information? (Key skill: assessing the client’s nonverbal communication)
3. How did you acknowledge the client’s thoughts or feelings about their pet’s illness? (Key skill: empathy)
4. How did you involve the client in the discussion? (Key skill: partnership)
5. How did you break the conversation into pieces and invite the client to make the transition with you? (Key skill: asking permission)
6. Whose plan was it really in the end? (Relationship: paternalism or partnership)

If your answer to any of these questions indicates some “missing pieces,” it may be time to slow down and connect to build long-lasting and highly satisfying client relationships, which are at the heart of veterinary medicine and at the core of why many of us chose this profession. | EVT 

Building a Home to Care for Your Clients: Part 2
Lisa Hunter, LSW, and Jane R. Shaw, DVM, PhD
References

1. The relationship of physician medical interview style to patient satisfaction. Bertakis KD, Roter DL, Putnam SM. J Fam Pract 32:175-181, 1991.
2. Skills for Communicating with Patients. Silverman J, Kurtz SA, Draper J. Radcliffe Medical Press, Abingdon, UK, 2005.
3. Physicians’ characteristics influence patient’s adherence to medical treatments: Results from the medical outcomes study for adherence. DiMatteo MR, Sherbourne CD, Hays RD. Health Psychol 12(2): 93-102, 1993.

Suggested Reading
Veterinarian-client-patient communication patterns used during clinical appointments in companion animal practice. Shaw JR, Bonnett BN, Adams CL, Roter DL. JAVMA 228:714, 2006.