White knight syndrome: When pets are in trouble, clients need care too

Without realizing it, many veterinarians launch into "attack the problem" mode when dealing with a sick or injured patient. This is, of course, a good thing—except when "attack the problem" means "ignore the client." "Veterinarians have been trained to focus on identifying the specific problem," says Dr. Jim Kramer, co-owner of Columbus Animal Hospital in Columbus, Neb. "We're like the white knight swooping in to save the pet from the villain."

Illustration by Steve Pica

Unfortunately, when the white knight concentrates on what needs to be done to rescue the patient in distress, he or she often forgets that talking with the client is a part of the honor-bound duties as well. And that, in a nutshell, does more harm for you, the client, and the patient than you might think.

A study published recently in JAVMA* found a gap between the way veterinarians communicate with clients during wellness appointments and the way they communicate during acute-care or problem-specific appointments. Here are some of the key discrepancies (also see the Related Article "Exam-room communication: Truth in numbers" below):

> Doctors interacted verbally with a pet twice as frequently during wellness appointments as they did during problem appointments, and the emotional atmosphere of wellness appointments was generally more relaxed.

> During wellness appointments, doctors used more social talk, laughter, statements of reassurance, and compliments.

> During problem appointments, veterinarians were more hurried and anxious, and they focused most data gathering and client education on biomedical topics alone.

So what gives? And why do we care? According to Cindy Adams, MSW, PhD, one of the study authors, there are several reasons behind this discrepancy—and lots of reasons to care, including pet health, client relationships, and your bottom line.

WHY THE GAP IN CHIVALRY?

For many doctors, the thrill of the chase kicks in during problem-focused appointments, Dr. Kramer says. They get to use their investigative skills rather than just provide a set of routine vaccinations. That sense of urgency, while in many ways necessary to address the problem, puts a damper on casual conversation.

Another theory: Money is at the root of it all. Consultant and public speaker Shawn McVey, MA, MSW, believes that a problem-specific appointment raises the specter of presenting the client with a big bill—and that makes veterinarians too anxious to indulge in relationship-building conversations. "In wellness appointments, there's no conflict with the cost, and a certain friendliness arises in the absence of conflict," McVey says. "But when large sums of money are involved, as well as the potential for the death of the patient, doctors get into self-protective mode. They want to find the answer to the problem to validate their diagnoses, justifying the money they'll charge."

But Dr. Fred Metzger, DABVP, has a different explanation. "I think it's more about the fact that problem appointments take more of a doctor's time and energy, especially for relatively new graduates," he says. "Wellness exams are easier, though still vitally important, and you're not as worried that you're going to miss a life-threatening element. You're not thinking, 'I don't want to kill this poor person's dog.'"

*Shaw JR, Adams CL, Bonnett BN, et al. Veterinarian-client-patient communication during wellness appointments versus appointments related to a health problem in companion animal practice. J Am Vet Med Assoc 2008;233:1576-1586.

THE IMPACT OF A SILENT KNIGHT

No matter whether the reason for the visit is wellness-related or problem-specific, an examination should be inclusive, Dr. Kramer says. "There really aren't two kinds of exams," he says. "No matter what the patient presents with, it's my job to look at the entire patient to identify any clinical situation affecting the pet's health."

But a thorough exam doesn't stop with gathering biomedical information, Dr. Kramer says. Questions about the pet's lifestyle, behavior, and other "social" issues such as whether other pets are in the houeshold—all of which can be elicited during more casual, relaxed conversation—often yield clues into a pet's specific medical situation.

Dr. Metzger agrees. "Wellness exams are where we really need to give our efforts some gas," he says. "At Metzger Animal Hospital, we strive to make wellness exams as important as ill patient appointments because this is when you can really learn about the pet, educate the client, and show value in what you do."

For example, Dr. Metzger likes to explain all test results to clients—especially when the results are normal. Clients learn what to look for, why it's important to keep their pets healthy, and what could happen if they don't. "I think it's even more important to communicate well with clients during well-patient exams," Dr. Metzger says. "Otherwise why would they want to follow your recommendations? Show clients the value of normal results and keep them coming back."

The JAVMA study found that doctors asked few open-ended questions in most client interactions, especially during problem-specific visits. Because of this tendency, the doctors failed to elicit enough information about both patients and clients. Plus, they displayed a distinct lack of empathy. "Only 7 percent of consultations, wellness or problem-specific, contained any utterance of empathy such as 'It sounds like this is a very difficult time for you' or 'You look concerned ...,' and that was shocking," Adams says.

These communication breakdowns can make clients feel less involved in the decision-making process and, therefore, less likely to adhere to your treatment plan, she says. And that ultimately affects your bottom line, not to mention the patient's health.

A QUEST FOR IMPROVED COMMUNICATION

The final piece of this communication puzzle is realizing that, even if you lack strong client communication skills, you're not doomed (see the Related Article "Communication: A finely honed skill" below). "Communication is a learned skill, just as spaying a dog takes training and practice," Adams says. Numerous communications classes exist, and it's a smart doctor who recognizes the need and takes steps to improve his or her exam room manner.

"Only good things can come from improving the quality of conversation in the exam room," Adams says. Patients will receive better treatment; clients will feel more understood, heard, and valued; and clients will better adhere to your recommendations for treatment. And maybe, just maybe, you'll feel more comfortable in all situations—looking—and sounding—like the white knight as you honor your duty to ensure the best care for the entire animal kingdom.

Sarah Moser is a freelance writer in Overland Park, Kan. Send questions or comments to ve@advanstar.com.