Give Clients Something to Talk About

Medical lawsuits might be a declining trend if communications were strengthened between practitioner and client, says Thomas E. Harris, Ph.D., veterinary consultant and professor at the University of Alabama.

Table 1

Citing several studies, Harris, a consultant on enhancing communication skills, says many typical M.D. lawsuits "have very little to do with malpractice."

The lesson for practitioners, veterinarians included: "It's always the ones who communicate poorly who get sued."

Harris, who teaches organizational communication at the University of Alabama, says physicians and veterinarians should understand that most malpractice cases would not be pursued if the client believed the physician communicated reasonably well.

"But if the physician does not (communicate well), the meaning they extract from the doctor is 'they don't care.' "

Harris takes the adage "say what you mean, mean what you say" far beyond the legal arena.

Not from Webster

He holds a fairly unorthodox, un-Webster's-like viewpoint on communication: "it is the attempt of human beings to create and maintain meaning in their lives.

"In our technically oriented society, we tend to focus on the transfer of information," he says. "In fact, communication has never been about that. The reason we communicate - the only reason really - is to somehow make sense of what is actually a pretty confusing world.

"The misorientation of why we communicate explains why so many people with science or engineering degrees focus on the technical aspect rather than on the meaning aspect," says Harris, who has 30 years of consulting experience with small businesses, including veterinary practices, as well as corporations. "In doing so, there is guaranteed misunderstanding."

Back to school

"Nowhere in any pre-med, veterinary or engineering curriculum does it say how to work with people," says Harris. "It's all about technical perfection, which hardly is a negative. But what is missing there is the audience - who happens to be your client or the people you work with."

A study of writing, speaking and reading curriculum in veterinary colleges published in the Journal of Technical Writing and Communication (Vol. 30(2) 105-123, 2000) backs up Harris' claims. It indicates that while 27 veterinary schools do provide writing, speaking and reading tasks in nearly every veterinary medical course, very little emphasis is given to prerequisite speaking courses.

The study attributes deans of the veterinary schools as saying that their communication courses accord with the communication tasks expected to be performed by practicing veterinarians. However, study investigators noted that veterinary medical curricula tended to focus on academic or clinical communication rather than what is required to operate a veterinary practice.

Adds Dr. Nan Boss, practicing veterinarian in Wisconsin and author of "Educating Your Clients from A to Z: What to Say and How to Say It," don't wait for schools to cover the communication ground.

"Educate yourself on communication. There are plenty of books and classes on communication skills," she says.

"When I was a new graduate, I was not very good at communicating with clients, nor with the people I was working with. My first boss out of school was kind enough to point out to me that I stunk at it," and recommended that she take a communications course.

Veterinarians are "very backward" in communications, says Boss, regarding themselves as medical people. "They do not take the time to learn about business topics."

She says veterinarians tend to "isolate themselves" by only reading veterinary journals and attending veterinary seminars.

But you don't always have to attend the latest seminar for tips. Sometimes effective communications techniques blossom from noticing the "little things" first.

Internal communications

Boss, self-proclaimed introvert, vows next time she won't forget to ask her colleagues about their vacations.

A silly issue? Boss, who prefers not to air her private life in the workplace, thought so, until another associate expressed her hurt feelings over Boss' "lack of concern."

Although Boss can laugh about the matter now, she says, "part of what I've had to learn as a boss and leader is that I cannot treat everybody the same. That I have to plan and prepare ... how I'm going to interact with people depending on what they're likely to feel and how they're going to respond."

Sometimes methods of communication require an understanding of how we communicate for starters.

Understanding meaning

Harris shares three modes of how humans express meaning when communicating:

• Language

• Listening

• Nonverbal signals

"But when you're talking to someone who is outside your realm of expertise, making it clear to him or her is more important than it being clear to you," Harris explains.

Secondly, don't forget to listen to your clients. Sounds simple, but still, most people, including veterinarians, listen with 25 percent effectiveness, says Harris.

"They're looking for a quick diagnosis so they can figure things out. The problem with that is that unless you are remarkably on target - a true cruise missile with the way you listen - you won't get it."

Third, watch for nonverbal signals-and understand the meaning they convey. For example, if a veterinarian does not maintain eye contact with a client because he is trying to multitask, he may be sending a message that he doesn't care.

Another popular misnomer is that if people cross their arms, they are defensive.

"Absolutely untrue. People cross their arms because it is comfortable. The irony of it is, the meaning of crossed arms makes us look defensive. My advice to a veterinarian would be although you shouldn't let it bother you if you're talking with your arms crossed, know that you come across as being judgmental.

Style, generation differences

Harris names the four styles of communicators:

• Analytic - very good with data, but lacks decision-making skills.

• Driver - Sticks to the task and makes decisions quickly, but can be brutal in the process, because they're very good at it.

• Expressive - Very good at getting along with people, but undisciplined and manipulative because they can talk people into things.

• Amiable-Wonderful as colleagues, but they don't stand up for things.

• The veterans or WWII generation: very rule-oriented. Believe in doing a job right. Will work long hours.

• Baby boomers: very oriented toward solving problems, success. Will work long hours.

• Generation X: little attention span, but could be quite good workers if you're willing to adapt to their style.

• Generation Y: Watched mom and dad work too many hours. Most aren't interested in working more than 40 hours.

Applying the styles

Respect the age difference between 50-something veterinarians and 28-year old associates for example, says Marilyn Moats Kennedy, an internationally-acclaimed communications consultant. The communication styles are light-years apart.

"The 50-something veterinarian is a pre-boomer or boomer. That person is going to be doing vocal riffs: 'Hi, how are you. So glad to see you.' They are going to be stopped dead by the fact that these 28-year olds are so extraordinarily direct.

"'Did you have trouble getting here?' 'No.' 'Did you have trouble finding a place to park?' 'No.' They don't chat," says Kennedy, whose clientele includes the AVMA, AAHA and various equine veterinarians.

In her opinion, younger people, especially those under 30, are direct, factual and they don't "spin."

The well-established veterinarian needs to respond by assisting the younger associates with tips on how to communicate with pet owners of different ages and backgrounds, says Kennedy.

"Prepping people is most important for eliminating misunderstandings and communications problems, because I don't have a doubt that these 20something veterinarians are state of the art, enthused and dedicated.

"Because they've been hanging out with their contemporaries and professors, I just think they don't have a clue that Mrs. Brown is going to kick them in the knee unless she is treated with proper majesty."

Since younger veterinarians may withhold details unless requested, Kennedy suggests asking the client upfront.

"It never hurts to ask anybody, how much information do you want," she says. "Do you want every last detail, or do you want me to just hit the high points? It's your call."

Don't patronize

Also, veterinarians should be careful not to patronize.

"Just because I'm old and have a cat does not mean that you can patronize me. I am pretty scientific and can find things out if I want them. If I ask a question, don't reassure me; answer my question. 'Does my cat have a problem?' 'Oh don't worry about it, it's no big deal.' Listen you a_____, I want the scientific words for that."

All-encompassing strategies

To Boss, communication strategies in the office should be simple: "Be honest with your clients and don't surprise them. The same goes for employees: be honest with your employees. Tell them what you think their strengths and weaknesses are."

Don't wait until the job review to unload a list of problems you have been accumulating over the past year. "People should be given the chance to know what you're thinking and what you think they need to improve on throughout the year," she says.

"Whether you're dealing with a client or an employee, the first thing you should communicate to that person is that you care about them, their pet," she says.

Payoffs

"People notice when you become more effective in communication," says Harris. "Because slowly but surely their comfort level goes up. Communication is meant as a collaborative effort to reach a common solution."

"Why is communications important to the veterinary profession? Because animals don't talk," says Kennedy. "It's the people you have to be concerned about."

The bottom line is to build your business, she says.

"When evaluating your practice, the question that should be branded in your mind: how do we give the best service not just to the animals but make the client, the pet owner, understand that the animal got the best service and that they should come back to us?" asks Kennedy.

"One size does not fit all," she says. "You can vary your communication styles just like you speak a different language to people who don't speak English."

"Internal communications ebbs and flows. People don't need training in communication - they need mentors," Kennedy says.