Think about it for a minute. You’ve been told by your veterinarian that your beloved dog has a complex, potentially fatal disorder with which you are uncertain how to proceed.
This is a gut check for the entire family – and totally unexpected. You’re feeling blindsided and suddenly find yourself quickly looking for direction down a pathway hopefully toward full recovery.
Suddenly you are testing your veterinarian’s – primary care or specialist – mettle through a corridor of tension and passion.
For years, you have served as Fido’s CEO, meaning the dog’s health and welfare have always been a top priority. Devastated and confused, you’re searching for a full explanation of the disease and all of your options.
Chances are this scenario began with your primary-care veterinarian, who is referring you to a specialist in the area.
Questions! You have a boatload of them ranging from quality of life to long-term prognosis and costs of this potential slippery slope of care.
Rest assured, you’re not the lone one concerned about the translation of your dog’s ailment and all attendant issues. Your veterinarians are, too.
Dr. Saundra Willis, a Mukilteo small-animal internal-medicine consultant for a veterinary diagnostic laboratory, addressed attendees at the American College of Veterinary Internal Medicine last month in Indianapolis on “Communicating Difficult Diagnostic Testing and Medical Cases to Pet Owners.”
She said, “Complicated disease and diagnostic testing can be challenging and frustrating for pet owners, especially when they don’t understand the value of testing. They will often decline an option that is not understood. This is particularly true if the veterinarian has not clearly and concisely outlined what he/she thinks the problem or problems might be, the potential disease(s) causing the problem(s) and the diagnostic tests needed to be run.”
Many are concerned about the overload of tests, she noted. The most direct way to achieve lasting relief is by attempting to initially diagnose the disease so that treatment can be definitive and not simply empirical, she said. “Diagnosing disease also makes financial sense. Money is not wasted on treatments for diseases the pet does not have.”
Willis places a high priority on client communication. With internet and friends’ information readily available but often misleading, owners must be able to rely on their veterinarian for accurate advice.
After nearly two decades in diagnostic laboratory work consulting with small-animal veterinarians, she is sensitive to client concern regarding the rising costs of veterinary medicine and the perception that these expenses are solely attributed to the business of veterinary practice and salaries. “The truth is,” she continued, “veterinary medicine has advanced and we have many more diagnostic and treatment options to offer the owner for his/her pet, although we still have the proverbial shot and pill in our medicine bag for those who want minimal care. It is all about quality of life.
“It is not always about running every test under the sun,” she continued. “We must have a reason to conduct every test and a plan for using the results. Often the results help us in the next step, whether diagnostic or therapeutic. Sometimes testing simply provides peace of mind. For instance, a diagnosis of cancer when the owner is not considering chemotherapy but needed to know why his/her pet was ill. If you are uncertain what you would do with the results of any test, don’t run it. Most owners have financial restrictions and we need to work within their budget.”
From the outset of each case, communication and teamwork are critical in pulling the various strands together. “We can be the most intelligent, skilled veterinarian in the community,” she argued, “but if we cannot communicate, educate and empathize with our clients, we will not succeed. People learn differently. Some learn visually, others more auditory. While diagramming a diagnostic work-up on a white board might work well for the visual learner, others might get a better grasp by talking about the diagnostic tests and hearing the options.”
She told the veterinarians that they needed to make their best recommendation and pause. “If we encourage a dialogue, we may learn where we need to communicate more information and get a better grasp of clients’ misconceptions and limitations, financially and otherwise.”
While the bulk of Willis’s audience was seasoned professionals, communication is drawing an emphasis to varying degrees in veterinary schools throughout North America, too. Washington State University’s College of Veterinary Medicine Clinical Communication Program focuses on several populations.
Washington State University’s College of Veterinary Medicine Clinical Communication Program offers two required courses on the importance of interaction with pet owners. The center has an exam room with a one-way glass, observation area for the students to confer with pet owners while being monitored by a staff member.
“Our coaches are a variety of faculty (often specialists who teach and work in the Teaching Hospital) and general practitioners who receive extensive training in the content and process of communication training,” said Julie Cary, program director.
“We also work with our specialists in training to augment the communication between clients, general practitioners, technicians and technician students. We are gearing up to do more continuing education for practicing veterinarians,” she added. An eight-credit, continuing-education technician communication workshop is scheduled Aug. 1 in Pullman.
Communication skills cannot be taught with classroom work, Cary acknowledged. “You can raise awareness of the importance or value of those skills, but to change behavior you need to engage in practice, feedback from peers, well-trained coaches, reflection and repeated practice.”
The school’s devoted a center with exam rooms, one–way glass, observation rooms, video and audio-recording capabilities is designed to train this skill set with the same level of rigor required to teach surgical and physical-examination skills.
Cary said the curriculum in the eight-year program is constantly evolving and moving to meet the needs of those involved. The two-semester course is offered the spring of the second year and fall of the third year. To help ensure students are actively engaged, it is divided into small groups of four or five enrollees facilitated by one of two veterinary coaches.
The course is designed, Cary concluded, to ensure that interaction is not simply sending a message, rather is aimed at enhancing learners’ ability to communicate effectively in veterinary medical contexts – more accurately, efficiently and supportively – with both colleagues and clients.
