Effective Communication in Veterinary Practice
Effective Communication in Veterinary Practice
Communication
Communication is essentially the sending and receiving of messages. 93% of communication
is non-verbal, of this 55% is body language and 38% is tone of voice. So we can see the
meaning of the actual words, only 7%, is hugely influenced by non-verbal factors.
How good we are at communication is also linked to self-esteem and individual style. You
can learn communication skills in the same manner as other clinical skills – with practice.
The Veterinary Defence Society (VDS) reports that 80% of claims against veterinary surgeons
contain an element of an element of communication breakdown.
Non-verbal
Facial expressionPosture
Hand gestures
Proxemics (personal space)
Haptics (touch)
Appearance
Paralanguage (hmmm, uh huh, pitch)
We need to be consciously aware that our faces are communicating, the look on your face
can give away how you really feel. Standing with your arms crossed is quite a defensive or
protective stance, it’s not very open, better to have arms loose by your sides. Positioning
yourself behind the consultation table creates a barrier to communication, better to be at
the short edge of the table, this encourages open communication. Lots of people are very
animated with their gestures but this can sometimes be distracting, try to limit this and only
use to emphasize vital information.
Proxemics is the distance between you and another person. Too close and this can make
people feel uncomfortable and intimidated, too far and you appear disinterested.
Haptics concerns touch, knowing when to touch, or not, a client can be difficult to figure
out. If in doubt don’t do it. Some people are very tactile and will do this automatically.
Placing your hand on a client’s upper arm is deemed the safest form of touch.
Appearance is important, we are all guilty of judging a book by its cover. Presenting yourself
in a professional manner, clean and tidy will encourage good communications with clients.
Paralanguage is the little add-ons we do to encourage someone to keep talking, i.e. hhmm,
uh huh. It also refers to the rate and tone of your speech.
Body posture
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Open and closed body posture can give you clues to how a person is feeling, this can often
to be contradictory to what they are saying. Open would be a person with relax open arms,
often animated hand actions and open palms. Legs will be loose and not crossed, they will
face the speaker with the head up, looking around, nodding encouragingly, and leaning
slightly forward.
Closed would be someone with folded arms, like they are hugging themselves, legs crossed,
slightly turned away from speaker, head will be down or looking away and they will be
leaning back.
SOLER
Sit squarely in relation to the client or owner, maintain an open position, lean slightly
forward, maintain appropriate eye contact and relax.
Verbal communication
The pitch, tone, speed, and volume help to convey the meaning of our words. The way we
use words, word choice and syntax (sentence formation) can also imply meaning. The
sounds, or paralanguage we use modifies meaning and conveys emotion. For example: A
woman without her man is nothing or A woman: without her, man is nothing. Or it’s raining
isn’t it, as a statement, or It’s raining isn’t it? As a question.
One way communication
The written word, brochures, flyers, adverts, emails, letters, text messages, etc. The most
important thing to remember is that is must be unambiguous, not open to interpretation.
Proofreading, checking for grammar, spelling and meaning is imperative when displaying
information for public consumption. Ill written brochures or leaflets will make the practice
look unprofessional.
The authoritative statement is one which does not invite a response from the recipient. This
type of communication is best used in situations when there is very little time for group
decision making or in an emergency where someone needs to lead. However, this
authoritarian style of communication can be seen as bossy, dictatorial or controlling if not
done well. A good authoritative leader will be able to communicate without being perceived
as dictatorial.
you are not able to listen effectively. This leads to both parties getting frustrated and
dissatisfied. What could you do to change the outcome of this situation?
More recently video conferencing, essentially phone conversation with video footage, with
the use of programmes like Skype can be useful as you are able to observe body language
although with some time delay. Email is like a slow motion version of the phone
conversation, it is used more and more these days especially in business. However, the tone
of the message can be misconstrued and can take longer to rectify incorrect interpretations.
As with one way communication it is imperative to review spelling, grammar, punctuation
and meaning when sending professional email communications.
Collaborative
In the workplace this could be in person or remote team meetings and video conference
calls. Depending on the platform there could be collaborative communication via social
media networks, i.e. vet nurse chatter where a nurse asks for help with a case and others
reply. Collaborative communication needs teamwork to be successful.
For any of these to be successful there needs to be a shared goal, clear objectives and no
unnecessary emails or meetings – these just disrupt work time. The use of team chat
systems is encouraged to get quick answers rather than email. Personally I find this just
another thing I have to monitor and I actually don’t check the lecturer team chat often as I
find it a distraction but I agree it can answer questions quickly if used appropriately.
Share documents in order to work collaboratively, store in a shared drive which can
accessed and edited by anyone in the team.
Avoid collaborative communication via emails as this can take up work time and can create
situations where important details get lost in an email chain of multiple recipients.
Models of Communication
There are many models of communication to work with, it is a subject that has been studied
for hundreds of years. Various models have been developed over the years, all with their
own advantages and disadvantages, i.e. the continuous loop model, Berlo’s model
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communication, and the veterinary consultation model has been developed from the
Calgary-Cambridge Observation Guide for medical interviews.
Preparation Room and Personal
Room: privacy, no interruptions, no calls, door signs, diary code.
Safety and comfort, closed doors and windows, chair for client, clean and tidy.
Personal, knowledge, read the history, referral letter, test results etc.
Mentally, clear your mind, put your ‘brain in neutral’, approach each consultation fresh even
if the last thing you did was particularly stressful or emotional. Leave all of that behind you.
Appearance, make sure you are clean and tidy, de-hair yourself, change top if contaminated.
Always have a professional manner and remember your facial expression.
Initiating the consultation
Introduce yourself especially if this is the first meeting, state what you do in the practice.
“Hello, I’m Kerry one of the ICU nurses and I’ve been looking after Barney”.
You could say hello to the pet, or at least make reference to them. Small talk, puts everyone
at ease, make a comment about the weather, ask how they are today, did they get parked
ok etc. This is obviously situation dependent, it wouldn’t be appropriate during at
euthanasia or in an emergency. Although, in my experience going back to clients later in an
emergency consultation and having some small talk can put them at ease and calm them
down. Ask open questions, you will get more information than asking closed questions.
Gathering information
Open questions will get more information, this allows the client to say what the problem is.
For example, “How has been Barney since we last saw him?”
Closed questions generate yes or no answers, use these for the specifics. You’ll use a mixer
of open and closed questions when speaking to clients. For example, “Is there someone to
look after Barney when you’re on holiday?” Try not to use leading questions or questions
where it sounds like there is a right and wrong answer. Also if you say we in a question it
makes you and the client sound united and will strengthen the client bond.
Listen, you must pay attention, do not interrupt. Active listening, such as, nodding, uh huh,
murmuring noises will encourage the client to carry on speaking and it shows you are paying
attention.
Explanation & Planning (giving information)
The aim is to give the client information in order to make an informed decision and increase
client compliance with treatment plans. This involves giving small pieces of information at a
time and ask if the client has any questions. This is termed “chunking and checking”. Asking
if they understand is not best, as often they will just say yes, it’s better to ask if they have
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anything they want to ask. If you provide written material alongside the verbal information
it is more easily retained. Avoid use of veterinary terminology or at least explain what it
means. Also avoid colloquial terms like “knock him out” or “fixed”, it’s best to say the actual
term in these cases, so anaesthetise or neutered. Often clients will ask what you would do if
it was your pet. This is a difficult one, as we can’t be seen to be influencing their decision.
The best response is to say “it would be a difficult decision for me too” or “I know from my
own experience how hard it is, but I just thought of what was best for my pet”.
Closing the interview
Give a summary of the consult, ask them if they want to discuss anything else, state what
the plan is, i.e. treatment plan, surgery or next visit. Arrange the next appointment, if no
appointment needed agree who is phoning with an update, you or client and state the day
this will happen. Phoning clients asking for updates really strengthens the client practice
bond, they love it. You also get to know if the treatment is working and can ensure patient
welfare.
Behaviours
Avoidance, sometimes used to evade confrontation
Refusal to recognise the problem
Side stepping situation, methods of avoidance can be very elaborate
Displayed in many ways – refusing to get test, not answering phone
Submissive
Behaviour often shown in not wanting to say “NO”
Not wanting to draw attention to yourself
An inner belief you are not as good as others
Wanting to appear polite and helpful in an excessive way
Wanting to avoid a scene
Different cultures and religions view animals differently in the Islamic faith view dogs are
viewed as unclean and would not be allowed in the home. Jewish clients may not be able to
attend appointments on the Sabbath day, a Saturday. In a number of Asian cultures, neither
hello nor goodbye is frequently used. South East Asia – opinions rarely expressed to avoid
upsetting the other person.
Culture and religion will influence the strength of the human- animal bond. What role does
the patient play in the client’s life? Is it a working dog, companion, breeding animal, or
assistance dog? There is an emotional, psychological and physical component to the human
animal bond. We need to be aware of the relationship in order to provide the most
appropriate care for the animal and service for the client. Part of our role is to promote the
health and well-being of both parties and to reduce the impact of treatment plans on both
client and patient. Treatment plans may need to be adjusted depending on the human
animal relationship, this could be due to a cultural, religious, financial or animal role reason.
It is important not to judge clients decisions.
Distance – Latin cultures stand closer than those of us in the UK and many Asian countries
Touch – Many European countries are very tactile, kissing hello and goodbye, whereas many
Asian countries casual touch is very uncommon. Men and women do not touch in public,
something to bear in mind when thinking about comforting a client with touch. In some
cultures the head is sacred and touching a person on the head would be very offensive, feet
are also considered dirty and to point at someone with your feet or touch with your feet
would classed as rude.
Eye contact – In most Western countries making eye contact is acceptable, however, in the
East avoiding eye contact or only one person making eye contact is acceptable.
Voice – We are louder in the West than our Eastern cousins, speaking softly is a sign of
respect especially when addressing a person of higher authority.
Age
When communicating with clients of different ages you will need to alter your style. With
young people, you may need to go into greater detail to explain fully the problem or
procedure, but do not use jargon, use simple language, visual aids, like pictures and
diagrams can be useful.
With older people who may have hearing loss or poor memory recall it is important to speak
slowly, use short straightforward sentences, and avoid noisy and reverberating
environments. Make sure to speak to them face on, use strong verbal cues, keep it simple,
give them key points to remember, write it down and be patient. Perhaps having a family
member or friend that can help them or come with them next time would be useful. Follow
up calls to make them feel supported and not all can be very helpful for all concerned.
Grief
Communicating with clients who have lost a pet or face losing them can be difficult. Think of
how you felt when you lost a loved one and how did communicate with others at the time?
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It is important to be aware of the stages of grief, denial, re-explain the situation, and have
written material to hand as this can be useful. They may have misplaced feelings of anger,
they may be angry at you/VS for giving the news. Do not respond to the anger with anger,
verbally acknowledge their feelings, and be empathetic.
Bargaining, a client may ask you to try everything you can in order to give them more time
with their pet, clarification can help alongside showing empathy to their feelings, or you can
give them one more day with their pet by providing supportive treatment, fluids, analgesics
etc. Depression, they may be withdrawn and quiet, do not talk for the sake of talking, ask if
they have any questions, give them time alone, the grief and sadness can be overwhelming
at this time. Acceptance, they are sad but will react normally and interact with others. This is
a good stage to discuss after death procedures, cremation etc.
They may not experience all the stages or in the order listed. You need to be empathetic and
sympathetic, say how sorry you are, you know how awful it is. Be supportive but not over
bearing. Giving information or leaflets on pet bereavement is helpful and non-pushy. If you
have a bereavement clinic make them aware of the service.
Sensory impairment
With hearing impaired clients remember to speak to them face to face, use a steady pace,
give written instructions or information leaflets, visual aids, use nonverbal cues, facial
expressions, body language to highlight important points. Relax, they will appreciate you
being normal with them.
For blind clients please introduce yourself, ask if help is needed, speak naturally and clearly,
they’re blind not deaf! Continue to use body language. This will affect the tone of your voice
and give a lot of extra information to the person who is vision impaired. Use everyday
language. Use accurate and specific language when giving directions. For example, "the door
is on your left", rather than "the door is over there". Avoid situations where there is
competing noise, schedule appointments at quieter times of the day. Letting them feel
things may help with explanations.
Artifactual Communication
This is basically how we present ourselves to the world. It includes the use of personal
adornments such as clothing, jewellery, make up, hairstyles, beards, the possessions we
own and display to others. For example the latest gadgets, iPhone, designer handbags, and
type of car we have. Environment refers to our home, location, size of home and
decoration. These can be seen by some to show our status in the world. The colour of your
clothing, the artifacts you choose to adorn yourself, your possessions as well as the
environment you are in at the time all potentially influence how others perceive you either
We are all guilty of judging people by how they look, the tracksuit wearing, tattoo adorned
man with a staffi, we think rough, scary or common. Or where someone lives, in posh part of
town therefore we think snob. Don’t judge a book by its cover! Be open and welcoming to
whom ever comes into the practice, take away the adornments and everyone is just a client
with a pet.
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powerless, stuck and resentful, and respond by expressing their feelings by subtly
undermining the object (real or imagined) of their resentments – even if this ends up
sabotaging themselves. The expression "Cut off your nose to spite your face" is a perfect
description of passive-aggressive behaviour. They will lack self-esteem and feel of lack of
control over themselves and their surroundings.
kept to a minimum. Placing signs on the door is helpful. Making staff aware is good practice
too. They can be respectful of what is happening. The process itself can exclude the owners
as you might need to restrain the animal, raise the vein. Place IV catheter, use extension set,
animal may need sedation, allow owner to hold.
Some clients may wish to have a lock of hair, you can offer this if they do not mention it.
More popular these days is getting a paw print, there are kits available, clay, you can press
the paw into it and inscribe a name, and they just need to be put in the oven for a short
time. If you don’t have kits, you can use an ink pad and paper. Coffins are great for
presenting the body, you can lay blankets in the coffin and one on top, and they just look
like they are sleeping then.
Maintaining professional relationships with clients
It is important to be open and honest, respectful, trustworthy, show empathy and maintain
confidentiality. Make a fuss of their pet, provide appropriate unbiased advice and be clean
and tidy. Form a partnership relationship where you are in it together to care for their pet,
this involves shared decision making this gives the client a sense of control and a feeling of
togetherness. Follow up calls and reminder systems will strengthen the client practice bond.
Do not ever speak poorly about colleagues or your employer in front of them or even allude
to a problem. Remember boundaries, this is a grey area, personally I wouldn’t form a
friendship outside of work with a client and there are no rules against it but be cautious if
you do. Care with social media, no revealing case details or slagging off your work. And
remember to smile.
Supporting clients in decision making
You must be open and honest about the prognosis and treatment options, provide
appropriate advice, creating a partnership and shared decision making relationship will help
the client feel supported and not alone in the care of their pet. Give them time to think,
alone, clarification using literature and visual aids may be useful. Check they understand and
ask if they have any questions.
Supporting bereaved clients
Sending sympathy cards is good practice, the owner feels they and their pet was valued and
meant something to you/your practice. Giving them a call a few days later to see how they
are doing is thoughtful and again makes them feel supported and valued. Best to do this
before calling to say the ashes are back. If they are returned to the practice, this is also a
sensitive time. When you call them you should give them an appointment/arrange a quiet
time for collection, this reduces stress of other clients seeing them, and you may want to
use the quiet room. It’s an awkward moment handing a box or casket over, but as long as
you are mindful of the situation, kind and sympathetic, saying again how sorry you are and
to take care can ease the situation for all parties. Giving information or leaflets on pet
bereavement is helpful and non-pushy. If you have a bereavement clinic make them aware
of the service.
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Supporting colleagues
We all get stressed at work from time to time, we are overworked, have a lot of
responsibility, understaffing issues, patient loss and client complaints will affect us all at
some point. Sometimes factors in our personal life can make the stress at work difficult to
cope with. If you notice a stressed colleague, try to talk to them over a cuppa, offer help –
what can you do to lighten the load? Make them take a break for 5 minutes. Where
appropriate team meetings should be held to discuss any issues, there should be an agenda,
a set time and a plan of action. All meetings should use SMART objectives for outcomes.
Reflecting on difficult cases as a team can help process the event and make improvements
for future cases. It is not about placing blame. If you are truly concerned, speak to line
manager to make them aware of the situation. Provide them with details of professional
support, such as Veterinary Benevolent Fund (VBF), Vet life website, the Samaritans and the
BVNA.
Telephone communication
Answer within 3-4 rings, if you don’t you’ll start off on the wrong foot. Include the practice
name and your name, “Hello small animal hospital, Kerry speaking, how can I help you?” Be
polite and sincere, use enthusiastic, natural, and attentive tone. Speak clearly, enunciate
and use simple words and phrases. Use tone, pitch, humour, and silence to emphasize
points, remember to take notes – owner name, pet name, address, phone number,
problem. Ask them open and closed questions. Ascertain the seriousness of the problem,
and then prioritise appointment. Be aware of your practice protocol, know how to transfer
calls put calls on hold. Be able to give clear directions to the practice. Finally close by asking,
“Is there anything else I can help you with?” And “Have a good day goodbye.”
E-Communication: Email
Valuable communication tool as a standalone form and in addition to face to face / phone to
reiterate points / instructions or follow up with clients. However, the meaning may be open
to interpretation. It requires clarity, correct spelling, grammar and punctuation so it the
meaning is unambiguous. Quick to do and it is important to reply promptly where possible.
Social media
Behave responsibly and professionally when posting on your own social media and when
commenting on other sites / posts. Be respectful of & protect the privacy of others – GDPR.
We are always representing the profession, COPD. Would comment if it was not on social
media? Be proactive in removing content which could be viewed as unprofessional – don’t
post it in the first place. Be aware that innocent references to social activities could be
assumed as taking place during working hours & could be misinterpreted or used as the
basis for a complaint. Maintain and protect client confidentiality by not disclosing
information about a client or a client’s animal which could identify them on social media
unless the client gives explicit consent. Make sure to always comply with employers or
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college / organisation’s internet or social media policy or risk the consequences, which could
be detrimental to your career.
It is our job to promote the health and well-being of both parties, to reduce the impact of
treatment plans on both parties. We should not to judge owner decisions but make it a
shared decision process. For example, with the Muslim culture it is not permitted to keep
dogs in the house, so we might need to offer different a treatment plan or to hospitalise the
dog. In Judaism it the use of porcine insulin is prohibited so we would offer synthetic insulin.
A client may not be insured and be unable to afford treatment offered so we can offer
payment plans, cheaper treatment or referral to a charity organisation, or start Crowd
funding.
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Don’t assume that if it is a family pet they will want to do everything possible to save / cure
their pet. Don’t assume that the owner of a working dog will not spend money on their
animal. If treating an assistance dog you may need to delay treatment until owner can make
alternative arrangements and get other support in place. It will have a huge effect on their
life. Don't judge owners on breed of dog / appearance, don’t make assumptions on what
they might want to do. Offer a range of treatments for all clients regardless of appearance.