Talk the good talk: The necessity of effective communication (Supported by Nestlé Purina, Pfizer Animal Health, and the Veterinary Specialty Practice Alliance)

Every discussion in an emerging partnership between specialists and primary care veterinarians eventually comes around to the necessity of effective communication. How you talk about referral with clients, what you say, how you communicate with specialists, and how specialists communicate with you is, by all accounts, critical to success for both practices.

Cindy L. Adams, PhD, MSW, is associate professor of Veterinary Medicine-Clinical Communication at the University of Calgary in Alberta, Canada. She sees communication issues from an evidentiary perspective, including evidence from studies in human medicine. The word collaboration forms the core of her advice.

The client conversation

"Shared decision making requires a collaborative discussion," she says. "The veterinarian shares his or her thinking and offers all the options respective of the client's thoughts, concerns, and experience. The strongest predictors of adherence are empathy and shared decision making."

Shared decision making is a process, Dr. Adams says. It starts early in the relationship between the primary care veterinarian and pet owner. The ability to shift perspectives and to see the problem from the pet owner's eyes takes time and effort.

Keep Talking

Start by working to understand the client's beliefs. What are the client's expectations? The conversation might go like this:

"Based on what you've told me so far, it sounds to me like you'd like to go further with some exploratory work. That's why we're talking about referring your pet to a specialist."

Having engaged the client, you can continue working through the issues. The veterinarian can involve the client more deeply with a simple, "I'm more than happy to help you think through this." Then the conversation should contain constant rechecking for engagement with a simple phrase like, "What are your concerns?" or "Do I have that right?" The goal is dialogue, not monologue.

"To a great extent," Dr. Adams says, "this is about sharing your thinking, as appropriate, once you know people are interested. What you want to do is involve them by making suggestions rather than directives. That is extremely critical." Many practitioners forget to invite clients to add their ideas throughout the process.

Dr. Adams emphasizes the necessity for creating this pattern of interaction and collaboration early on, so when the time comes to make a referral recommendation, the primary care veterinarian and the client are prepared for the conversation.

Conversing with specialists

Being left out of the loop when the patient goes to the referral clinic is one fear many primary care veterinarians harbor. But those who have honed their skills emphasize that primary care veterinarians and specialists won't let this happen.

Dr. Adams agrees. Again, she thinks the same skill set applies, but with a twist. She says practitioners subtly train clients how to be clients, but they must also train themselves to be clients of the specialists they utilize—and train specialists how to deal with them. That interface requires a straightforward conversation. She suggests something like this between the primary care veterinarian and specialist: "I have a case I'd like to discuss. Before we go any further, I need for you to know this is really important to me. I need to know how you conduct your business when you work with somebody like myself."

Here, Dr. Adams says, you are gathering information, the same way clients gather information from you. Particularly, you want to know how the specialist plans to stay in touch with you. Then you need to let the specialist know what you want out of the relationship. She suggests a statement like: "Do you mind if I share with you some of the things that matter to me?" or "I have three things that matter to me a lot. Can we talk about it?" Then, she says, "download" those three things and let them know you are sincere.

Same skills, different situations

Dr. Adams suggests all communication skills ought to come from authentic motives to be both successful and ethical. Have a genuine curiosity about the needs of those you encounter. Your interest should be authentic, and have sincere respect for the other persons.

"I invite people to see these conversations as something with a beginning, middle, and end," she says. "Think of this as a funnel. It starts with a big open inquiry early on working to arrive at common ground. That common ground might be a place where both the veterinarian and the client are satisfied. Grab onto that."

MAKING IT WORK THE ESSENTIALS OF SUCCESS

Jules J. DePorre, DVM, and Pierre A. DePorre, DVM, of the DePorre Veterinary Hospital, have been referring patients to Ned Kuehn, DVM, MS, DACVIM, of the Michigan Veterinary Specialists hospital, for 17 years. Dr. Jules DePorre thinks the key to making the referral collaboration work is excellent communication between practitioners at his hospital and the specialist's.

Dr. Kuehn encourages primary care veterinarians to visit a specialty practice in order to strengthen the relationship. He thinks veterinarians who bring clients on a tour of referral hospitals score points with clients and specialists. "It's a matter of building trust," he says. "Then the (primary care veterinarians) can know that their clients will be treated well and that they'll be apprised of problems and treatment."