Master delivering bad news to veterinary clients

Delivering great news to clients at the veterinary clinic is a pleasant experience. The results show the chemotherapy was effective, so you are eager to inform the pet parent their beloved animal is cancer-free. Being the bearer of bad news is not always as easy. The tumors have returned more aggressively after treatment, and now you must face an already emotionally stricken client.

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To help navigate these difficult conversations, Rachel Venable, DVM, MS, DACVIM (Oncology), founder of Pet Cancer Care Consulting in Scottsdale, Arizona, led a lecture at the Directions in Veterinary Medicine conference in Nashville, Tennessee on elements that can lead to successful communication with clients.¹

Nonverbal communication

There is much that is said…in what is not said at all. Research has found that in certain circumstances, 55% of communication is body language, 38% is tone of voice, and just 7% is the actual words spoken.^2,3

Subtle changes to your body language can have big impacts. For example, Venable shared that setting up the exam room so you can be at direct eye level and make eye contact with clients can foster trust. She suggested using stools that can be moved around and adjusted to where the pet owner is sitting. This can express to them that you are on their level and not trying to be authoritative by standing over them or being seen as subservient if sitting below them. If pet owners are sitting on the floor, Venable recommends sitting with them, if possible. “And if I can't sit on the floor, like when I was super pregnant, so then I would comment on it and say, ‘Hey, I'd love to sit on the floor with you, but I just can't.’ Even though they didn’t think about it, the fact that you mentioned it, then they feel a little bit better about why you’re not.”

Like how teenagers are often told by their parents, “It’s not what you said, it’s your tone,” Venable explained this can apply to nonverbal communication in veterinary medicine as well. It’s important to be mindful of this and have a compassionate tone when delivering bad news to clients. “There’s a lot of things, understandably, you're stressed about, but how are you showing that to the outside world?” said Venable.

Active listening

Doctors are often notorious for being perceived as bad listeners, Venable told attendees. She cited research found in Skills for Communicating with Patients in which clients were allowed to complete their opening statements to doctors without interruption and it took them less than 60 seconds and no longer than 150 seconds.⁴ This demonstrated that if clients are just given time to reach their main point, you can reveal their true concerns and what their goals are to avoid problems down the line.

It also is apparent when someone isn’t listening, and this can make clients frustrated. Venable noted that thinking about what you are going to say next while a pet owner is speaking doesn’t count as listening either. Going back to body language, Venable said, “A thing you can do to show someone you're listening, is…nodding your head, maybe saying something like, ‘Go on,’ and echoing.” Echoing is essentially paraphrasing what the client is saying to ensure you understand their needs while also displaying to them you’re listening.

Giving pet parents your undivided attention shows your listening as well. Don’t be on your cellphone and if you are required to type records, inform the client that you are writing notes on their pet’s case. “Usually, as long as they know you're typing [about their pet], and it's not like the case before or something else, then people are totally fine with it,” Venable said. “What I recommend is while you're typing now and then, look over at them, do head nods, that kind of thing.”

Empathy

Venable stressed that there is a difference between empathy and sympathy. “Empathy is trying to understand and appreciate what someone is going through. This doesn't mean that you had to have gone through the same situation,” she explained. “Sympathy is where you're almost in a sense, looking down at someone, not necessarily trying to be rude or bad. But it can be taken as maybe more sense of pity, or you feel sorry for them.”

She advises to practice empathy as much as you can in the veterinary clinic because sympathy can cause issues, such as trying to find the silver lining in a bad situation. “Because we want to make things better. That's one of the reasons we're in the medical profession,” Venable said. “But sometimes, especially when things are bad when someone's trying to tell you something, if you try to make it seem better, then it seems degrading, right?”

Stay away from using phrases such as “at least,” Venable recommended. If a dog is diagnosed with diabetes, don’t say, “At least it’s not cancer,” as this pet parent now must help their dog manage this life-long disease and it can be hard on them. Another no-go is the word “I understand.” This can also upset pet owners as you aren’t experiencing the same thing as them and it isn’t your pet.

Rather, to show empathy, use statements that link you as the doctor to them as the client. Certain phrases to use can include, “I can appreciate how difficult this is for you,” or, “I'm so sorry your pet is going through this.” Then, let the clients cry or do what is necessary to feel their emotions. “That’s something that I've learned when people are in the moment of something bad, don't necessarily try to fix it,” Venable said. “They just need to feel that emotion and just kind of process it themselves.”

Benefits of improving your communication skills

According to Venable, when you improve your communication, you improve your life. Because communication is inextricably rooted in all we do as humans, fine-tuning these skills will help you grow in and outside the clinic. It promotes client compliance and satisfaction while reducing miscommunication and misunderstandings. “And because the conversations go better,” Venable added. “You have less personal burnout, right? Less stress, less anxiety.” Enhance your nonverbal communication, active listening, and empathy skills, and watch the relationships in your personal life flourish as well.

References

1. Venable R. How to improve your communication skills and learn to give bad news. Presented at: Directions in Veterinary Medicine; Nashville, Tennessee; September 15-16, 2023.
2. Mehrabian A, Wiener M. Decoding of inconsistent communications. J Pers Soc Psychol. 1967;6(1):109-14. doi: 10.1037/h0024532
3. Mehrabian A, Ferris SR. Inference of attitudes from nonverbal communication in two channels. J Consult Psychol. 1967;31(3):248-52. doi: 10.1037/h0024648
4. Silverman, J, Kurtz, S and Draper, J.Skills for Communicating with Patients. 3rd ed.CRC Press; 2013.