Frankly Speaking

In 2001, the Journal of the American Veterinary Medical Association stated, “Veterinarians’ responsibilities have expanded to include the mental health and well-being of their clients as well as their clients’ pets.”  For me, this came as no great surprise.  Having graduated from veterinary school in 1982, I’d already learned that if I wasn’t taking good care of my clients’ emotional needs, it was far more difficult to take good care of my patients’ health needs.  Admittedly, it took me a few years to catch on to this notion.  During my formative years, I recall thinking that good client communication would be a “slam dunk”.  After all, I fancied myself to be a good teacher and a nice person.  It didn’t take long for me to realize that the “medicine part” was becoming a whole lot easier than the “client part.”

Thus began my avid interest in the art and science of client communication.  I read whatever I could get my hands on (not much in the veterinary literature at that time) and attended communication workshops. I began studying my clients, trying new tactics and techniques, and asking questions of them not necessarily directly related to their dog or cat (Kleenex consumption increased exponentially).  I founded and continue to facilitate a community Client Support Group (talk about a front row seat in terms of understanding what is going on in our clients’ minds) and have enjoyed teaching client communication skills to local and national audiences.

The unfortunate fact of the matter is that few veterinary colleges provide any formal client communication training to their students- doesn’t make much sense does it?  One of the schools that doesn’t overlook this important subject is Colorado State University.  Here veterinary students receive fabulous communication training via the Argus Institute (www.argusinstitute.colostate.edu).  This organization’s stated mission is “to strengthen veterinarian-client-patient communication and support relationships between people and their companion animals.” In addition to providing formal client communication training to CSU veterinary students, the Argus Institute also makes communication training available to veterinarians.  These workshops are called FRANK (based on the notion of “frank” communication), and the emphasis is on relationship-centered care, an approach that emphasizes collaboration and shared decision-making between veterinarian and client.  Pfizer Animal Health was involved in the creation of FRANK in 2007 and continues to generously fund this program.

I just completed my first FRANK training workshop- what a fabulous experience.  I left the program feeling invigorated, renewed, and eager to apply what I had learned. The majority of the workshop time was spent in small groups within simulated exam rooms.  Professional actors played “the client,” each getting in character with their assigned emotional agendas (they were awesome and totally believable).  Everyone took turns as “the veterinarian” during these mock office visits.   The interactions were videotaped after which respectful, constructive critique was offered within the small group setting. We worked on several communication skills including delivery of empathetic statements, maintaining focus on the “common ground” (the well being of the patient), reflective listening, facilitating silent pauses (time for clients to gather their thoughts), disclosure (sharing stories of our own that might parallel what the client is emotionally experiencing), and asking open-ended questions (allows the client greater opportunity to share their stories).

A veterinarian can be a sensational surgeon or a dandy diagnostician, but such skills may wither on the vine if he or she is not a successful communicator.  More than ever before, people are becoming savvy consumers of veterinary medicine and better effective medical advocates for their pets.   My sense is that these wonderful trends will drive the awareness that client communication training for veterinarians is profoundly important.   Frankly speaking, I think it’s about time!

Wishing you and your four-legged family members a joyful and healthy holidays season.

Dr. Nancy Kay
Specialist, American College of Veterinary Internal Medicine

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller.

Order  a copy of Speaking for Spot personally signed by Dr. Kay – http://www.speakingforspot.com/purchase.html

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Listen to Dr. Kay’s interview – A Veterinarian Advises “How to Speak for Spot” on NPR’s Fresh Air with Terry Gross

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13 Responses to “Frankly Speaking”

  1. Amy Says:

    Sounds like a great program. I know a few human doctors who could use this!

  2. Kathie Says:

    I suspect the veterinary schools are no different from the (human) medical schools in not providing sufficient training to help DVMs and MDs to be skilled and compassionate in caring for their patients. I worked in the medical field for 25+ years and recall many times when our physicians referred patients for surgery or complicated treatment – warning them that the physicians were highly skilled in their field but had little or no bedside manner. Hopefully we have moved past that.

    That is one of the things I love about Speaking for Spot. It teaches us much needed skills and techniques for being great medical advocates for our pets and, just as importantly, these are the same skills that we need and can use in being great advocates for both our family members and our own healthcare. Perhaps it should have been titled: “Speaking for Spot and Yourself: Be the Advocate You and Your Dog Need to Live Happy, Healthy, Longer Lives”!

  3. Beth Says:

    A friend brought her 10 year old German Shepard to the emergency clinic (a highly regarded one, here in NJ) because she had a blood clot in her foot that burst. The vet on duty told her that anything past 10 years old is a gift – not what anyone needs to hear at such a a stressful time. (Her dog recovered and is 13 now.)

    Another friend carried her Labrador who had injured her leg into the vet’s office only to be chastised for having a lazy dog.

    My own “holistic” vet said she hated to see the dog win after I couldn’t get the muzzle on her during a house call visit. My dog had been traumatized at te previous vet’s office while wearing it.

    Sadly, I’ve kind of gotten used to insensitive vets!

    It’s also been noted that human doctors don’t receive adequate training either, especially when it comes to situations dealing with the terminally ill. Often they push for more treatment which is often invasive and has little chance for extending or improving quality of life when suggesting hospice care at end of life would truly be more compassionate.

    Thanks for this article, and for bringing awareness to this program!

  4. Laurel Says:

    Thanks for writing on this topic. The folks at the Argus Institute are indeed pioneers in the field of veterinarian-client communication. In my experience of losing several dogs over the years, the veterinarian’s attitude and communication skills can do much to ease the situation, or to make it even worse, and I have experienced both ends of the spectrum. But I will never forget the comforting words of a veterinary technician, the day I found out that my dog’s cancer had spread. “God will take care of her when you no longer can,” she said. She took a risk in saying that, not knowing my spiritual beliefs, but she said it with such conviction that I knew it came from her heart. I have thought of her words often in the years since.
    Laurel, celebrating the love of dogs at http://laurelhuntbooks.com

  5. Barbara H Says:

    Dear Nancy,
    You have always been such a good writer, and you wax eloquent on topics from descriptions of the pancreas to matters of the heart.
    I read your blogs even though I don’t have a dog, because they are so well written and speak to the human condition.
    Keep up the good work!
    Barbara, friend and owner of Gado Gado International, Santa Rosa (www.gadogadointl.com)

  6. Vikki Says:

    Coming from a business point of view here. I love the concept however, I am not so sure vets will be able to offer FRANK exams unless they charge a lot more per exam and will clients be willing to pay for the extra time? I know I would.

    I think this would be a great business tactic for a new vet to take when just starting his or her practice. This way the vet would build their rep with high customer satisfaction and attract only higher-end clients and would therefore be able to command higher prices to pay for the extra time they spend per client. Like any business or skill, specializing or being the best at what ever it is you do sets you apart.

    Vets could also offer a two tiered exam fee schedule. One for basic exam and one for FRANK exam but I think that muddies up the water too much for clients to grasp.

  7. Denie Fleck Says:

    I and my dogs have been blessed by a few veterinarians during our life who have possessed a genuine “bedside” manner for both their two- and four-legged clients, so I was delighted to read how other veterinarians are considering compassion an important component to their on-going education. As humans, we all know that they “way” you speak or deal to another can make a huge difference in how that person responds to you, so why not our pets as well. It’s also helpful for pet parents to feel their furry kids’ medical provider is in sync with their feelings and concerns. Thanks so much for sharing this info…I hope veterinarians and animal care-givers across the globe will take note.
    Denise Fleck, Pet First-Aid Instructor http://www.sunnydogink.com

  8. Helen Gruenhut Says:

    This is long, but I will make it short. On Sep 17,I had to put my Belgian Malinois to sleep. She was 14 1/2 yrs old. I think she had a stroke. I will not write all the symptoms she had that morning. She was my service dog. We were like one spirit. The morning she collapsed, it was pouring rain. She was too heavy for me to carry her. I had her outside to go to the bathroom. The only help I had was out of town. I sat with this dog, in the rain. I covered her with a tarp and waited for help.
    When I arrived at the Vet, I had the male tech to carry her in. She could not walk. The vet went over her and said, “I don’t find anything wrong with this dog. What do you want me to do.” I told him that I brought her to be euthanized. This dog was fine the day before. I did not want this dog to suffer, but to go with dignity. I could not manage her, if she could not walk. I am seventy six and live alone. She was put to sleep.
    This Vet left me, not only with great grief, but continuous guilt. I have had dogs for fifty years. I think we let some of them stay here too long, just for our sake. I loved that dog with all my heart; and it makes me cry just to write about this.
    I doubt the Vet knew the sorrow that he was setting up in my heart; but I do hope the new classes will help new Vets be more sensitive to their clients.
    Helen Gruenhut

  9. Jamie Says:

    So true Dr.Kay!

    My vet four years ago was unable to understand why I was so annoyed. Three weeks after a “complete” physical that indicated my 10 year-old Aussie was in great health, she was diagnosed with canine osteosarcoma. We put her down four weeks later. Vet could have been a little more understanding, but was unwilling to admit that she might have over looked something. Scout was dead, nothing could bring her back, all I wanted was some contrition. But, alas, it was not to be.

    Smart lady but a little lacking in the social intelligence arena. We left her practice and never looked. Is there hope at the DVM schools?

    Jamie

  10. Dr. Nancy Kay Says:

    Hi Vikki,

    Believe it or not, both in human and veterinary medicine, studies have documented that relationship style care actually requires less overall time spent in an office visit than the opposite style of communication referred to as “paternalistic care”. Although this may sound counter intuitive, it seems that the relationship building that happens up front allows subsequent communication to flow more smoothly.

    Thanks for your thoughts,
    Dr. Nancy Kay

  11. Dr. Nancy Kay Says:

    Some truly heart wrenching stories have been shared. I am grateful to those who were willing to post such comments. Reaching the end of a beloved four-legged family members life is tough enough. When folks don’t receive appropriate support from their veterinarians at this crucial time, the burden becomes even harder to bear. I’m sorry that this has happened for some of you. Please know that most veterinarians do what they do because they truly love animals and care for the people at the other end of the leash. They may not have had the appropriate kind of communication training needed to help others as much as they would like.

    Best wishes,

    Dr. Nancy Kay

  12. Dee Siat Says:

    I have raised many dogs and have been to many Vets over the years. It does amaze me at the lack of communication and sometimes even epression of compassion. I am a Certified Grief Recovery Specailist who assists people through their pet loss.

    I am amazed how little resources are made available to us Pet Parents by our Vets. In addition to communication skills I believe classes should be given on how to handle the loss of a dear pet. I don’t think most Vets understand how devastated we can be. I would like to see more Vets offer Pet Loss Classes and offer some expression of compassion.

    Thank you
    Dee Siat, CGRS, Interfaith Animal Clergy

  13. Miria Yarden, B.Sc.,MS,APDT Says:

    I work closely with one of many veterinarians who is wonderful in all ways but one. When a friend of mine brought in her cat believing that he had a tumor on his neck, he found it to be an abcess wehich he ltreated succeefully. However, he insinuated to her that she was too “freaked out” and overly emotional, imagining things to be worse than they are. She left in a depressed and guilty state.
    I asked him that if he took one of his cildren to the pediatician and was told that he was too emotional and imagined things wrong with the child, would he go back to that doctor again? Of course not, he said.
    Well, when a client brings in a beloved pet, that animal is, to many people, their child. They look to you as that “child’s” pediatrician and expect from you, besides competent medical help, emotional support and encouragement.
    He looked thoughtful for a little while and to his credit said that I was right, he never thought of himself as such and that he will never belittle a client’s emotional involvement and needs. He made good on his promise and now he treats the “parents” of his patients, not only thieir companions.
    Thank you, Dr. Kay!

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