Lend me an ear

You've heard it time and time again: Veterinarians need to have good people skills for clinical success. You've heard it, but are you listening?

Table 1 How good of a listener are you?

The ability to listen actively to clients, colleagues and staff is a fundamental element for clinical success. Students are so engrossed in learning the technical skills of their chosen profession that interpersonal skills sometimes are viewed as the bedside manner that will develop miraculously when needed. The fact is that interpersonal skills need to be practiced and developed alongside medical and surgical skills.

More and more veterinarians are recognizing the critical nature of these skills in working with colleagues, staff and clients. Practitioners often emphasize the importance of good people skills for an associate's success and ultimately his or her own. Hiring practitioners look for candidates that are not only technically competent, but who possess good communication and interpersonal skills. You do not need to go far to hear a colleague lament about a new associate's difficulty in dealing with clients. If these situations escalate, then the effects are seen in the bottom line of the practice with negative consequences for all parties involved.

Clients might perceive that the veterinarian discounts his or her input if the veterinarian is not a good listener. As a result, information that can assist in an accurate diagnosis might go unspoken. When a conversation is tense or emotional, it is even more important to listen first, acknowledge and continue to probe for understanding. The better you listen and make your client feel like his or her input is valid and appreciated, the greater chance he or she will do you the same for you. If you open the door for a client to listen to you and ask for clarification if necessary, then the ensuing rapport might yield better veterinary-client relations, as well as better compliance.

A friend once shared his mother's advice with me: "The good Lord gave you two ears and one mouth for a reason—you should listen twice as much as you speak."

Basic listening skills

By listening, then acknowledging what you have heard, you have given the client the satisfaction of knowing his or her message has been received and understood. Acknowledgement does not infer agreement but does open the door to a deeper understanding of why the client has brought his or her animal to you. An environment is created that allows you to provide better quality medical care along with a positive interpersonal experience.

Listening begins with paying attention. Listen patiently to what your clients have to say even though you might believe it is wrong or irrelevant. Indicate simple acceptance, not necessarily agreement, by nodding or injecting the occasional, "hmmm" or "I see."

Active listening skills

• Eye contact—Be attentive non-verbally.

• Ask questions to clarify—Reflect/paraphrase.

• Avoid interruptions.

Ask questions

Explore your clients' concerns through questions. There are two broad classes of questions: closed questions, which ask for a specific response, and open questions, which invite the client to select what to talk about.

Closed questions give the veterinarian control while the client passively gives information. Open questions give control to the client and often elicit much more useful information in the long run. Closed questions are useful for clarification and can shorten the time spent in the exam room, but overuse of this type of question can result in not getting all the information you need and is not conducive to revealing your clients' real concerns.

"Why" questions should be avoided because they put the client in a defensive position. Open questions build on the discussion. A series of questions is used to uncover a web of related factors, thoughts and feelings that are made up of a description of the problem itself and the person's perception of it. Questions are most effective when they are direct, simple and strategic.

Closed-ended questions

• How old is Felix? Are there other animals at home?

Open-ended questions

• Can you describe your concerns about Felix's health to me?

• I'm not clear on what you mean by ...

• Can you say more about that?

• The part that is still unclear to me is ...

• Can you give me an example?

Paraphrasing content is another important component of listening skills. When the client touches a point you want to know more about, simply restate the observation. For instance, if they remark, "Felix has been eating an awful lot recently." You can probe by asking, "Felix has been eating more than usual?" With this encouragement the client probably will expand on his or her previous statement.

Try to simply understand without judgement. Paraphrasing communicates to the client that you are listening and value his or her input. This technique also gives the client the opportunity to accept or reject your understanding of what was said and modify his or her statements.

Look and listen for total message

Seek to understand the emotion the client is expressing as well as the intellectual content. To carry the two ears and one mouth analogy a step further, you could add, "The good Lord also gave you two eyes—look while you are listening" for non-verbal messages.

Listen for what is not said; evasions of pertinent points or perhaps eager agreement might be signals that you have touched upon a point the client wishes to ignore or not to be true.

Avoid building communication barriers

In our attempts to be helpful, we sometimes inadvertently set up barriers that can end the conversation. The client suddenly wonders if he or she can trust the veterinarian, or that the veterinarian is not accepting or approving of what is being said.

Several ways in which a listener communicates unacceptance:

• Ordering, commanding or directing;

• Lecturing;

• Warning or threatening;

• Interrogating or cross-examining.

Other barriers include those that imply judgment or shame:

• Criticizing or judging;

• Blaming.

Summarizing the content that a client has shared can help the client see the scope of his or her concerns and how your treatment addresses those concerns. Once you have listened and understood, then you can move into describing your next steps.

Dr. Corine Farewell earned her DVM from Cornell University's College of Veterinary Medicine in 1989. In 1999, she created the Career Services Office at the College of Veterinary Medicine. In this role she co-taught practice management and served as a faculty member on the campus-wide Entrepreneurship and Personal Enterprise Program. Concurrently, she pursued her MBA at the Johnson Graduate School of Management and since 2001, she has been a part of the Cornell Center for Technology, Enterprise & Commercialization.