When nice wont suffice: Dos and donts of relationship-centered care

Relationship-centered care contrasts with the more traditional, paternalistic approach in both human and veterinary medicine. (Cheryl Casey/stock.adobe.com)In veterinary medicine, relationship-centered care (RCC) is a clinical philosophy that recognizes the impact of the relationship between veterinarian and client on healthcare experiences and outcomes. With roots in human healthcare, RCC is based on four principles:

1. Everyone is an individual and should be treated as such.

2. Emotion and affect (the display of emotion) are important aspects of communication.

3. Relationships are a two-way street with reciprocal influence.

4. Maintaining genuine relationships with care providers is necessary for good health.

Veterinarians who engage in RCC make healthcare decisions with their clients, not for them, taking into account the client's perspectives and knowledge to build a trusting bond that facilitates excellent care. Fundamental to RCC are effective communication, empathy, respect and trust.

The healthcare professional is often seen as a paternalistic figure who dominates the office visit, telling the client what to do and expecting compliance with minimal explanation. Relationship-centered care contrasts with that in both human and veterinary medicine.

Taking a deeper dive into RCC

A recent study from the Department of Veterinary Medicine at the Free University of Berlin explored the essential components of RCC. In general, they noted, relationship-centered veterinary visits can be characterized as “medically functional, informative, responsive, facilitative and participatory.”

The study involved a nationwide cross-sectional quantitative survey of German pet owners that solicited participants' opinions about the veterinarian's communication during their most recent office visit. Surveys were completed in late 2016. Anyone who owned at least one companion animal and visited a veterinary practice within the previous two years was eligible to participate.

A total of 1,270 surveys, completed by largely female (88.4 percent) pet owners whose median age was 38, were included in the analysis. The largest proportion of study participants (55.6 percent) owned small companion animals; 7.6 percent owned horses, and 36.9 percent owned both small animals and horses.

More tips on soft skills

Dive into sample conversations for talking about anesthetic risk and overweight pets with Dr. Ryane Englar, who helps teach veterinary students soft skills at Kansas State University College of Veterinary Medicine. What can you learn (or pat yourself on the back for doing already) from Dr. Englar's techniques to draw into your own exam room visits?

• 10 tips for talking to veterinary clients about anesthetic risk

• Chewing the fat about fat with clients

Client loyalty is vital to the success of veterinary practices. And while people can be fickle in what they consider to be high-quality service, it's clear from the results of this study which factors rise to the top when it comes to loyalty. Data were analyzed using exploratory factor analysis and structural equation modeling to determine which RCC factors were most important to pet owners.

The primary factors underlying what pet owners consider high-quality veterinary care-and thus the factors most likely to generate client loyalty-were 1) empathic communication, 2) partnership-building and 3) meeting the pet owner's need for further information and for alternative treatment options.

Keep in mind that not all pet owners want to share in the decision-making process with their pet's veterinarian. In fact, only 74.2% of participants in this study supported the principles of shared decision-making; 14.6% preferred a paternalistic model in which the veterinarian makes all the decisions, and 11.3% preferred to make the decisions themselves after being given relevant information by the veterinarian.

We've compiled some tips for cultivating loyalty in your practice among clients who prefer RCC …

Empathic communication

Empathic communication was most closely related to the veterinarian's effort to assuage clients' fears and listen to their opinions and ideas. Pet owners prefer when their veterinarian communicates in a nonjudgmental way, speaking in understandable terms and at a pace that allows clients to fully understand what they are being told.

• Do listen to clients attentively and with interest.

• Do try to put clients at ease by treating them with friendliness and respect.

Don't ignore clients' worries and fears; address them with frankness and sincerity.

• Do see each client and each patient as an individual with individual needs.

• Do provide sufficient time for clients to ask questions and consider information given to them.

• Don't ignore clients' worries and fears; address them with frankness and sincerity.

• Don't use medical jargon when speaking with clients.

• Don't use disrespectful words or body language.

Partnership-building

Pet owners want “intelligible information about the causes and effects of a pet's illness and about possible therapeutic measures,” the investigators noted, and they want it delivered in multiple formats.

• Do explain the pros and cons of diagnostic and therapeutic options.

• Do explain the results of diagnostic tests.

• Do encourage clients to describe concerns about the pet's health in detail.

Outline all anticipated client costs before proceeding.

• Do ask clear, straightforward questions about the pet's clinical signs.

• Do solicit input from clients about potential causes of their pets' health concerns.

• Do weigh the client's options as a team.

• Do outline all anticipated client costs before proceeding.

• Don't assume the client can implement home care strategies adequately.

• Don't assume a client can't or won't pay for recommended testing or treatments.

Fulfilling the pet owner's need for information and alternatives

Study results suggest that partnership-centered and empathic communication lowered pet owners' desire to go outside the veterinary practice for further information (from, say, Dr. Google) or to consult alternative healthcare providers (e.g., homeopaths).

• Do ask clients how much information they would like to receive.

• Do ask what the client already knows about the pet's condition.

Don't make the client feel rushed (even if you are!).

• Do be open to discussing alternative treatment methods, if requested by the client.

• Do provide a detailed medication plan, if applicable, including discussion of possible adverse effects.

• Don't withhold information from clients.

• Don't make clients feel foolish (there are no stupid questions).   

Study limitations

Because the survey invitation was focused largely on social media users, the authors acknowledged that not all pet owner types were represented equally. Nevertheless, the authors hope that their results prompt further investigation into how the interpersonal skills of veterinarians can help prompt loyalty to veterinary practices.