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Most chronic heart conditions remain asymptomatic for months or even years. Yet, a cardiologist may diagnose a pet with advanced heart disease and give a poor long-term prognosis. This can be very confusing for the owner when the pet is still playing, eating well and maybe even running. It is important to explain the problem and the treatment to the owner in a way that is easy to understand. Clients often fail to understand the complexities of cardiac disease in their pet, and many struggle to comply with recommended treatment and follow ups. As a result, many pet patients are lost.

Elli Kalemtzaki explains how veterinary practitioners can handle five communication issues that are common with owners of pets that suffer from cardiac disease.

Question: Telling clients that their beloved pet has a serious condition like cardiac disease is difficult. The clients are often emotional and may be confused or even in denial about the long-term prognosis. What is the best way to deliver this type of bad news?

Studies in human medicine show that the way doctors manage bad-news conversations is extremely important to the patient. Your choice of words, where the discussion takes place and how empathetic you are play a very important role in how your client will receive news about the pet’s disease condition and the required treatment.

Here are some tips on how to best communicate bad news.

Avoid delivering the news over the phone. It is better to have a face-to-face conversation in a private setting.

Acknowledge the client’s emotions. A statement as simple as, “I can see this is hard for you; It can be very difficult to hear that your beloved pet suffers from heart disease,” shows that you acknowledge the client’s feelings. That can help calm the client and direct his attention to your discussion.

Be mindful of your body language and tone of voice. Give the client your full attention. Maintain eye contact and keep a calm tone of voice. Turn your body towards them and away from your computer screen or notes. A gentle touch on the arm or a pat on the back may help comfort some clients. Watch the client’s body language to detect any signs of distress. Make sure you pause and ask if the client needs a few minutes before you proceed.

Ask open-ended questions. Open-ended, non-directive questions allow the clients to express their concerns, feelings and understanding of the subject. It is better to ask, “What are your thoughts on the choices here?” rather than “Are you considering euthanasia?” Open-ended questions can also help assess the client’s knowledge and understanding of the condition. This will allow you to clarify any misconceptions and provide necessary information.

Listen actively and show the client that what they say is important to you. Use appropriate gestures and nod or shake your head. Avoid interrupting the client. When they have finished talking, demonstrate you were listening by rephrasing what the client said. This will allow you to identify and clarify any misunderstandings. For example, you can ask: “So, you are worried about the cost?” The client may reply “Yes, I am worried that I may not be able to afford the treatment”, or to the contrary, “No, I am not worried about the cost; I just don’t want my pet to suffer”.

Question: It often feels like veterinary professionals and pet owners speak different languages, which can make meaningful communication difficult. How can the veterinary healthcare team present complex, medical information in a way that resonates with owners and motivates them to comply with the doctor’s suggestions?

Veterinary practitioners need to recognize that people have different learning styles, and then provide information in a form or technique that supports those styles.

Scientists have developed numerous models to understand the different ways that people learn best. One popular theory, the VARK model, was developed in 1987 by Neil Fleming in Christchurch, New Zealand. Fleming identified four primary types of learners: visual, auditory, reading/writing, and kinesthetic.

Visual learners comprehend best when shown an image, model or graphic that demonstrates the problem or treatment. Visual learners may take photos or videos on smartphones, or they may draw a picture to understand a concept.
Auditory learners benefit the most from a lecture or discussion, and they will often recite information back to the presenter as a way of cementing it into their mind. An estimated 25% of the population are auditory learners. Therefore, if you use words alone, you may not be communicating effectively with 75% of your audience.
Reading/writing learners respond best to written information, such as handouts, leaflets or articles on your website.
Kinesthetic learners are hands-on, experiential learners who need to perform tasks before they understand them. Use interactive lessons when showing clients how to administer medications.
If you want to educate different people, you need to know how to engage each of the four different learning styles and have a variety of methods, modes and available materials.

A word of caution, though. Veterinary practitioners will often approach client education methods in the style that they prefer, even if it not the most effective method or the client’s preference. You must be flexible and adapt your communication to the different learning styles of your clients.

Question: During an exam, cardiac disease in combination with adrenergic stimulation may lead to an emergency situation, such as cardiorespiratory arrest. The pet owner may respond with fear, shock and even aggression. How can veterinary practitioners deal with these types of situations?

In human medicine, physicians are required to provide general information about a proposed diagnosis or treatment, as well as information about how the diagnostic procedures and treatment might affect the particular patient. A veterinary practitioner should disclose similar information. Clients who have been educated about the risks and benefits of proposed diagnostic tests and treatments are able to make an informed decision regarding their pet’s care.

Many clients, however, may have a limited understanding of medicine. A veterinary practitioner may find it difficult to strike a balance between too much and too little information.

Here are some tips that you can use to become more effective in helping pet owners understand risks:

• Remind pet owners that all medical interventions are associated with some risk of possible harm.
• Use plain language to make written and verbal materials more understandable.
• Clearly describe the risk in concrete terms, such as the consequences that an illness can have on a pet’s life, or that an illness or treatment plan may carry a risk of death.
• Avoid phrases such as “low risk” and “high risk”, since they are subject to very different interpretations.
• Supplement verbal explanations with numerical data.
• Consider using summary tables that include all the risks and benefits for each option.
• Use a visual aid and verbal explanations to maximize understanding.

Communication between the veterinary practitioner and the client plays a very important role in improving client satisfaction, staff satisfaction and patient safety, as well as in reducing clinical errors.

Question: After performing a cardiology examination, it is important to explain the problem and the treatment to the owner. How can we ensure client understanding without being either too simplistic or too complicated?

We already talked about adapting client education to the different learning styles. You should also be aware that the volume of information may overwhelm an already stressed client and dramatically reduce the amount of information retained. Try to use common words and phrases instead of complex medical terms and acronyms.

Try the following tips to improve communication with your clients:

Practice explaining procedures in common terms. Students in human medical fields are often encouraged to practice explaining a medical procedure, such a colonoscopy, to a family member to see if they understand.
Speak slowly and communicate only key points. Most clients will not remember more than three messages.
Read handouts with the client, highlight and circle important parts, and encourage the client to ask questions.
Ask clients to repeat instructions back to you. Remember that when you ask clients: “Do you understand?” they may be embarrassed to admit that they do not. Ask clients to put the information in their own words. If necessary, repeat your instruction using less technical terminology. It is important that you don’t embarrass the client. For example, you could say something like: “Mr. Jones, I want to make sure I explained things clearly. I would like to check how clear I was by having you tell me how you are going to give the pills to Fluffy.”
Use analogies that are easily understood and identified by the client. For example, when you are explaining congestive heart failure to a client, you may use the analogy of the heart to a mechanical pump.
Draw a picture or use a clinical atlas if clients need to visualize what you are explaining.
Create written materials using simple words, short sentences in bulleted format and lots of white space. Emphasize what the client should do and avoid unnecessary information.

Question: Clients often fail to understand the complexities of cardiac disease in their pet, and many struggle to comply with recommended treatment and follow ups. As a result, many pet patients are lost. How can we ensure that different types of owners respect our instructions?

One of the most common reasons for treatment failure of any condition is poor client compliance – and cardiac disease is no different. Clients who do not fully understand the pet’s condition cannot and should not be expected to comply.

According to the latest American Animal Hospital Association (AAHA) Compliance study, which was conducted in 2009, the most important communication practices to improve compliance are:

• Invest time in demonstrating treatment and medication techniques
• Write down all the pertinent visit information
• Make follow-up calls
• Give medication reminders

Provide information in a way that matches all four learning styles. Use posters, charts, leaflets, anatomic models and videos for client education. Explain verbally, provide hands-on demonstrations and give the clients reading material so they can continue learning at home. Follow up by phone, text and email.

It is extremely important to follow up once the pet is home.
You need to make sure that the pet is receiving the medication, and encourage and support the pet owner during the treatment. Schedule regular rechecks to ensure that the pet owner is following your instructions.

It is important to directly involve the clients in the treatment. Take a consultative approach. Don’t just tell the clients what to do; teach them and involve them. Educate clients about signs they should be aware of. Encourage them to contact you with their observations and concerns.

One of the reasons clients fail to comply is because veterinary practitioners do not address their objections or concerns. There is only one way to overcome this obstacle: Listen to your client! Find out what matters to them and what their underlying concerns are.

Ask open-ended questions, such as: ‘What concerns you about this change?’ or ‘What other questions do you have for me about this?’

Listening invites the client to relax and listen more openly. Listening is your most important communication skill and your most important persuasion tool.

To build your listening skills:
• Focus on the conversation
• Resist the urge to be distracted
• Refrain from making assumptions about the client
• Don’t interrupt
• Respond

Using the above tips can help you enhance client compliance, which is fundamental in improving patient care and client satisfaction.

About the Author
Elli Kalemtzaki, DVM, Certified Coach & NLP Practitioner

With 20 years in the veterinary industry and veterinary marketing in a region of 18 markets and extensive experience in coaching and leading workshops across Central Europe and the Middle East, Elli is passionate about helping veterinary professionals break out of the busy trap, create a more profitable veterinary practice, secure lifelong clients, and enjoy a work life balance.
Elli is a graduate of the Faculty of Veterinary Medicine of the Aristotle University of Thessaloniki in Greece and holds a postgraduate degree from the National School of Public Health in Athens, Greece. She is also a Certified Professional Coach since 2010 and a Certified Practitioner of Neuro Linguistic programming since 2012.

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