Posts Tagged ‘relationship centered care’

Reasonable Expectations Part II: Access to “The Back” of the Hospital

September 4, 2010

This is the second part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets.  Part one can be found at www.speakingforspot.com/blog

Care to tag along next time your pet is whisked to “the back” of the veterinary clinic for an injection, a diagnostic test, or a nail trim? Perhaps you are curious about what actually goes on “back” there. Maybe you believe that your best buddy will feel more secure if you are present.  Whatever the reason, know that  if you desire to go where your pet goes and see what your pet sees, this is a perfectly reasonable expectation in most circumstances.   Your request might be denied if: 

-Your pet is better behaved without you there (all vets have experienced aggressive patients in the exam room who become gentle as lambs when separated from their humans).

-There is something going on that is private (for example, a grieving client) or too graphic for you to see (trust your vet on this one).

-Your dog or cat will be in an area of the hospital that is off limits to humans. For example, in my hospital, in order to avoid radiation exposure, no one other than the patient is allowed in the room where X-rays are taken.  Gentle sand bags are used for restraint along with mild sedation if needed.

– The staff is aware that you have a lot to say and no one will be able to get anything done because they will be too busy responding to your questions. 

Admittedly, some vets simply don’t like having clients tag along.  If your doc falls into this camp, some patient persuading on your part may be necessary.  Provide reassurances that you will be on your best behavior and remind him or her that large animal vets do practically all of their work in front of their clients.  I happen to love when my clients wish to accompany me into the bowels of the hospital.  In fact, I find myself inviting them to follow more often than they think to ask.  I prefer they get a first hand look at what I am doing and seeing, rather than simply listening to my after-the-fact verbal description.  Admittedly, I’m proud of my facility and feel great when clients see our bustling staff, content patients in clean, comfy cages, and state of the art diagnostic and patient monitoring equipment. 

Before my clients step foot beyond the exam room, I gently coach them on the art of being unobtrusive- avoiding instructing nurses on how to restrain their pet and asking a bazillion questions while I am performing a procedure.  I always reserve the right to send clients back to the exam room if I perceive that their anxiety level is becoming contagious, and I describe in advance what they will be seeing.  This deters some, which is a good thing- nothing like a fainting or vomiting client to get the day off to an exciting start! 

Have you ever accompanied your dog or cat to “the back” of the hospital?  Was it a good experience for you?  How about for your pet?

Now, here’s wishing you and your four-legged family members abundant good health!

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Website: http://www.speakingforspot.com
Become a Fan of Speaking for Spot on Facebook

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.

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Reasonable Expectations

August 28, 2010

Never before, during my almost 30 years as a veterinarian, have I encountered such rapid and profound changes in client expectations. We’ve entered what I like to refer to as “The Age of the Empowered Client”. I’d love to believe that this is a result of so many people reading my book, Speaking for Spot. Alas, I must give credit where credit is due- namely, the worldwide web. Discuss a symptom with my clients and I’m no longer surprised when they pull out their printed list of the diseases Dr. Google feels might be responsible. Render a diagnosis and my client can surf the net to quickly find a plethora of others who have “been there, done that” and are willing to provide advice about how best to navigate any possible medical minefield.

Do I believe these changes in client expectations are a good thing? You betcha! As I convey in Speaking for Spot, my belief is that every animal needs an empowered, adept medical advocate by its side. Of course I want veterinarians to remain essential members of the health care team, but I love it when those at the other end of the leash (or monkey-wrenching their backs schlepping cat carriers) become the team captains!

Over the next several weeks I will write about several previously uncommon client expectations that are now becoming mainstream. They are reasonable expectations in that they ultimately serve what clients and veterinarians hold as common ground- namely, the best interest of the patient. Remember, change is not for everyone- not all veterinarians necessarily “embrace” these changing expectations. Some gentle patience and persistence on your part may be needed. If you find your vet isn’t willing to budge, for your pets’ sake, I encourage you to find a new teammate.

I’m going to describe my favorite client expectation first because, once this expectation is fulfilled, satisfaction of most others will naturally follow. So here we go.  It is perfectly reasonable for you to expect “relationship centered care” from your veterinarian. This is a style of communication in which your vet holds your opinions and feelings in high regard and enough time is allowed during the office visit to hear them. He or she recognizes the unique role your pet plays in your life and is a willing source of empathy and support. Rather than telling you what to do, vets who practice relationship centered care discuss the pros and cons of all options before making a recommendation. They believe in collaborative decision making. Compare this to “paternalistic care” in which the vet maintains an emotional distance and recommends only what they believe is best without consideration of the patient’s or client’s unique situation. There are no significant opportunities for discussion or collaboration.

Relationship centered care is not for everyone- some people truly prefer to be told what to do (certainly the way I feel when my car is in need of repair!). However, if you desire relationship centered care from your vet (or for that matter your own physician), please know that this is a completely reasonable expectation. How do you find a veterinarian who employs this style of communication? At the risk of tooting my own horn, the chapter called “Finding Dr. Wonderful and Your Mutt’s Mayo Clinic” in Speaking for Spot will tell you everything you need to know to fulfill this expectation.

Do you work with a vet who provides relationship centered care? What do you like about his or her communication style?

Now, here’s wishing you and your four-legged best friend abundant good health!

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Website: http://www.speakingforspot.com
Become a Fan of Speaking for Spot on Facebook

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.

Everybody’s Gone Surfin’ (Part Two)

December 26, 2009

I happen to enjoy hearing about what my clients are learning online.  I sometimes come away with valuable new information, and I’m invariably amused by some of the extraordinary things they tell me- who knew that hip dysplasia is caused by global warming!  Surf to your heart’s content, but be forewarned, not all veterinarians feel as I do.  Some have a hard time not “rolling their eyes” or quickly interrupting the moment the conversation turns to Internet research.  Who can blame them- they’ve grown weary of spending valuable office visit or telephone time talking their clients out of crazy cyberspace notions and reining them in from online wild goose chases.  How unfortunate this is.  Nowadays, people rapidly and reflexively reach for their keyboards to learn more about their pet’s symptoms or disease diagnosis online.  It’s only natural (and in their pet’s best interest) that they will want to discuss what they’ve learned with their veterinarian.

Is there an effective way to communicate with your vet about your online research that is neither irritating to her nor intimidating for you?  I truly believe it is possible, but it involves some work and planning on your part!  Listed below are some secrets for success- things you can do to converse about your Internet research in a manner that is comfortable for you and your vet and, most importantly, beneficial for your pet’s health.

-I may be preaching to the choir, but I cannot overemphasize the importance of working with a vet who is happy and willing to participate in two-way, collaborative dialogue with you. Your opinions, feelings, and questions are held in high regard and enough time is allowed during the office visit to hear them. A veterinarian who practices this “relationship centered” style of communication is far more likely to want to hear about your online research than the veterinarian who practices “paternalistic care” (far more interested in telling you what to do than hearing about your thoughts, questions, or concerns).  Remember, when it comes to veterinarian/client communication styles, you have a choice. It’s up to you to make the right choice!

-Let your vet know that you appreciate her willingness and patience in helping you understand how best to utilize what you’ve learned online.

-Ask your veterinarian for her Web site recommendations- those that have already been “vetted”.  This is a collaborative approach that lets her know you intend to spend some time learning more, plus a respectful recognition of the fact that she is the one who has spent her career learning about your dog’s health issues. 

-Wait for the appropriate time during the office visit to discuss what you’ve learned on line.  Allow your veterinarian to ask questions of you and examine your precious poopsie rather than “tackling” her with questions and discussion about your Internet research questions the moment she sets foot in the exam room.

-Be brief and “to the point” with your questions.  Remember, most office visits are scheduled for 15 to 20 minutes, max. 

-Let your veterinarian know that you’ve learned how to be a discriminating surfer!  You know how to differentiate between valuable online resources and “cyber-fluff”. You ignore anecdotal vignettes and Web sites trying to sell their products in favor of credible information provided by veterinary college Web sites and forums that are hosted by well-educated moderators who provide cited research references that support their recommendations.  If you need a little refresher course on how to be a “selective surfer,” I encourage you to read Part One of this article (http://speakingforspot.com/blog/?p=654).

-When you begin conversation about your Internet research, I encourage you to choose your wording wisely.  Communicate in a respectful fashion that invites conversation as opposed to  “telling” your vet what you want to do. Most veterinarians don’t like being told what to do by their clients, and who can blame them?  After all, we expect veterinarians to provide a collaborative approach- it’s only fair that they expect the same from their clients.  Consider the following conversation starters about Internet research:

Approach one:  “I’m wondering what you think about mixing some canned pumpkin in with Sophie’s food.  I’ve been doing some Internet research about diarrhea and this suggestion seems to comes up frequently.”

Approach two:  “I’ve been doing some online research and learned about the benefits of canned pumpkin.  I want to begin mixing this in with Sophie’s food.”

Approach three:  “I’d like to give Sophie some canned pumpkin for her diarrhea.  A moderator from an online forum suggested I do this.”

Approach four:  “I’ve been following an online forum about canine diarrhea. One of the moderators suggested I consider adding canned pumpkin to Sophie’s diet.  How do you feel about this?”

Which of these approaches sound like invitations for discussion? Which are more likely to be a “turnoff” for your veterinarian? If you’ve selected approaches one and four as successful ways for broaching the topic of Internet research with your vet, well done!  Give your dog a hug and yourself a pat on the back!

In the Internet, we have an extraordinary tool at our fingertips. I encourage you to be critical when choosing which Web sites you intend to take seriously and which ones you wish to visit for a good chuckle.  Approach conversations with your vet about your Internet research thoughtfully and tactfully. These strategies are bound to create a win-win-win situation- for you, your veterinarian and your beloved best buddy! 

Wishing you and your four-legged family members abundant good health,

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. 

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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