Spring 2019

Mastering the Art of Communication

Before heading into clinics and hospitals, veterinary students practice having difficult conversations with clients.

By Kimberly Thurler

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Illustration: Roberto Cigna

The veterinary appointment got off to an awkward start. The doctor originally expected to be consulting on a Holstein cow that was off its feed. But a last-minute switch meant she instead had an in-office appointment with Mrs. Olsen, whose 12-year-old cat Queenie had been diagnosed with thyroid disease.

Having quickly reviewed Queenie’s file, the young veterinarian explained the various ways they might treat Queenie—radioiodine treatment, surgery, oral medication, diet—but Mrs. Olsen expressed no preferences. “There are just so many options,” the client said, furrowing her brow and sighing.

“Time out,” called a clear voice. It was Cummings School Medical Director Virginia Rentko, who was facilitating a communications training session in which four D.V.M. students were meeting with clients played by Cummings School employees (in the role of Mrs. Olsen was web developer Teresa Loftin). “Mrs. Olsen just isn’t giving us a lot of information,” Rentko said. “How do you think we can get to the bottom of her concerns?”

Student doctor Abby Illingsworth, V20—and three classmates who were observing—agreed that the veterinarian needed more information. Rentko advised Illingsworth to directly ask Mrs. Olsen about her concerns. “But try questions that can’t be answered with a yes or no,” Rentko said. “For example, instead of asking if she has concerns, say, ‘What are your concerns?’”

Open-ended questions revealed that Mrs. Olsen was worried about the cost of treatment and her demanding work schedule. With Illingsworth’s guidance, she decided that a combination of prescription food and pills made the most sense for her and Queenie. As the consultation ended, Illingsworth got high marks for effectively summarizing her understanding of her client’s decisions and for her empathy throughout the appointment.

Until they sat down in Rentko’s office, the students didn’t know that what had been billed as a small-group activity would involve role play with actor clients. Each student doctor received brief information about their randomly assigned case; then it was up to them to meet with their client.

A poster on the wall listed the core communications skills previously studied in class: open-ended questions, reflective listening, empathy, and nonverbal communication. Each role-play case had at least one non-medical element—such as Mrs. Olsen’s financial and work stresses—that these techniques should uncover.

During each student’s role play, their classmates provided written and verbal feedback on one particular skill, while coach Rentko took notes on a nine-point communications checklist. The session, which came just a month before students were to begin seeing patients and meeting with owners under the watchful eye of clinical faculty, was “very nerve-wracking, but very beneficial,” Illingsworth said. “The pet can’t tell you what’s wrong so you have to get every bit of information you can out of the owner.”

Communications skills have always been essential for veterinarians, but the importance of formal training has become more widely recognized in the last 15 years. Research in human and veterinary medicine shows that better communication leads to more accurate diagnoses, improved follow-through by clients, and better outcomes for patients. It also helps veterinarians. “Developing these skills through practice builds a more resilient doctor, who is better equipped to handle unexpected and difficult situations,” Rentko said. “This reduces stress and compassion fatigue, which are increasingly recognized as problems among veterinarians.”

Cummings School includes elements of communications skills throughout the D.V.M. curriculum, and students put their classroom learning to the test in role-play sessions in the fall and spring semesters of their third year. “When you’re talking in class, even about difficult subjects like euthanasia, the discussion is still entirely hypothetical,” said Derek Standlee, V20. “It’s very different with someone sitting in front of you, when you have to work it out on your own terms in real time and there’s not necessarily one correct answer.” During the students’ 15 months of clinical rotations, they will be video-recorded working with real clients (who have given permission) and later evaluated by their faculty supervisors.

“I tell my students that communications is as important as the medicine and sometimes more important,” said Clinical Assistant Professor Annie Wayne, J05, V11, an emergency and critical care veterinarian in the Henry and Lois Foster Hospital for Small Animals. “You need to earn your clients’ trust. Then, if they have to make a hard decision, they will feel you are their partner.”

Illustration: Shutterstock

1. Be a good historian. The right diagnosis and treatment plan depend on your veterinarian having a full picture of your pet’s medical history. Jotting down key points in advance can help you tell a clear, complete story.

2. Discuss your pet’s current medications at your appointment. Bringing all the bottles and boxes to your appointment is an easy way to make sure your veterinarian knows exactly what prescriptions and over-the-counter products you are using with your pet.

3. Share what’s most important to you. You may be eager to explore the most advanced treatment options available. Your top priority may be avoiding stress or discomfort for your pet. You may need to take into account financial or scheduling constraints. Making your priorities clear enables your veterinarian to partner with you in making the right decisions for you and your animals.

4. Ask questions and get clarity. Don’t leave the appointment until you’re comfortable that you understand the diagnosis, next steps, at-home care, likely outcomes, and costs.

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Mastering the Art of Communication

Before heading into clinics and hospitals, veterinary students practice having difficult conversations with clients.