Although effective communication is important in all interactions with clients, it is essential during emergencies. Heightened emotions raise the stakes in meeting client expectations. Veterinarians are required to remain calm and focused in these stressful situations, as well as provide medical care for the patient, often in surroundings that are chaotic, uncomfortable or dangerous.Communication roles are tricky when emotions are at their peak. Normally kind clients can be snappy and irritable. Others will dissolve into tears and be unable to help very effectively, if at all. Sometimes clients, particularly men, have decided to “take charge” and direct the action. The veterinarian, in order to help the horse effectively, must have flexible leadership and be able to communicate calmly in whatever way the situation requires.
Clients typically have no way to assess the clinical and technical skills of their horses’ doctors. Consequently, they often judge their veterinarians’ competency on their effectiveness at communicating. Satisfaction and trust suffer when veterinarians fail to give clients enough time to explain their concerns fully, give understandable answers to questions that clients have, or offer as much information as clients need or want. It’s also important to fully involve the clients in any decisions.
It is sometimes said that human pediatrics practice is similar to veterinary medicine since the patient cannot communicate his complaint, but must rely on his parent or guardian to act as his advocate. A study by Maisels et al. in 2005 reported that improved communication with families significantly increased their satisfaction with the care of their hospitalized children. The families of children admitted to a general pediatric service were randomly assigned to receive a daily visit from a facilitator whose purpose was to respond to any questions the family might have and, if necessary, to explain results of laboratory tests. Control families received routine care with no additional visits from a patient communication coordinator. There was a highly significant (p <= .005) improvement in parent satisfaction with the care delivered to the families assigned the communicator/facilitator.
In the veterinary field, many studies have supported the essential nature of communication skills in achieving success in practice. The ability to communicate effectively can be thought of as a component of emotional intelligence. Our level of emotional intelligence is not innate, but is largely learned, and it continues to develop as we go through life and learn from our experiences. After learning about ways to communicate more effectively, an excellent method of practicing these skills is through role playing.
Veterinarians might want to role-play tough communication situations with their staffs. These sessions can be beneficial both for the staff members who will be receiving the panicked client’s first phone call and the veterinarians who attend emergencies. With repetition, the entire team will be much more comfortable working through challenging situations. It is important to note that most of us have practiced ineffective communication skills for so many years that new habits are awkward and feel unnatural at first. However, this passes in a short time, and the benefits are frequently very rewarding.
The four key elements of good communication are non-verbal communication, open-ended inquiry, reflective listening and empathy.
Non-verbal communication is powerful; it forms up to 90% of received communication! Because of this, it is important to be aware of what you are signaling to your clients beyond your words.
Non-verbal communication can also be called body language; it includes the tone of your voice, your facial expressions, eye contact, head movements, gestures and body postures. When we communicate different messages through verbal and nonverbal means, people intuitively believe our non-verbal messages. This means that if your body language reports that you are incredibly stressed and afraid, even as your voice says, “I know exactly what to do,” the client will not be reassured.
The way you listen, look, move and react tells the other person whether or not you care, whether you’re being truthful and how well you’re listening. When your nonverbal signals match up with the words you’re saying, that increases trust, clarity and rapport. When the non-verbal signals don’t match your words, they generate tension, mistrust and confusion.
Controlling the conversation during an emergency is critical. Non-verbal signals are used a great deal in requesting, offering and managing control of who is speaking. Tone of voice is of great value in defusing the emotional responses of clients and others. Sometimes it is necessary to interrupt the flow of the client’s words by touching his or her arm, turning away to the patient, or speaking louder or faster to retain control. Other times it is more successful to talk slowly, calmly and deliberately to lower the height of emotions. Speaking softly can sometimes defuse anger. Pausing or stopping while speaking can be an effective way to allow or request the client to interject questions or voice concerns.
Open-Ended Questions and Reflective Listening
In an emergency, gathering information in a timely and efficient way is important. Open-ended inquiry is a well-known technique for gathering information, and it has been shown to allow the client to shape the content of information and provide the information with timely delivery.
Reflective listening enhances the ability to accurately understand the owner’s concerns and how best to address them. Reflective listening and using open-ended questions are two techniques that are very effective in establishing efficient, connected communication throughout the stress of an emergency.
Asking open-ended questions allows the client to tell the story of the emergency without the veterinarian shaping the content. When gathering information, the best questions begin with “Tell me…”, “What…”, “How…” or “Describe for me…”.
“Why” questions are generally less effective because they can cause defensiveness. Examples of good questions would be “Tell me: When was the last time you saw Frosty acting normal?”, “What made you concerned about Skye tonight?” and “How do you think Popcorn got hurt?”
By contrast, the question “Why did you feed Dolly the chickens’ cracked corn yesterday?” might create a defensive attitude. He or she might withhold information or begin to feel blamed for the situation.
Reflective listening is simply repeating the message you are hearing from the client in your own words to insure that your understanding is correct. This step is critical to receiving accurate information.
For example, you might reply “I heard you say that Blaze had no interest in eating tonight, either his grain or his hay. Is that right?” Sometimes the response is “Oh, no! He ate his hay just fine; it was just his grain he didn’t want.”
Or with a trauma case, you might say “So you saw Ghost with his leg stuck in the bucket; then afterward, he was very lame.” And the reply could be “Oh, no, Doc, I didn’t actually see him caught in the bucket, but that must be what happened, because the bucket was torn off the fence, and now Ghost is lame.” Without echoing back the information you hear, the actual facts might not be communicated accurately.
Empathy is an important component of effective communication. Empathy is defined as having an understanding and awareness of others’ feelings, needs and concerns. It is, in essence, seeing the situation through the client’s eyes.
Veterinarians encounter many situations that elicit strong emotions, both personally and in their clients. Having the skill to acknowledge these emotions in an empathetic way can be very helpful in enhancing communication.
Statements of empathy communicate an understanding of the emotional aspects of the situation. Examples include “I can see how much you care about Twinkle. This must be very hard. Have you had him a long time?”, “After losing her mother to colic last year, I understand that you must be feeling terribly worried that Baby is colicky tonight” and “You have cared so diligently and well for Buddy. You did everything you could to make him comfortable.”
Empathy statements are non-judgmental (“You did the best you could to help him”) and help to normalize the situation (“No one could have predicted that he would try to jump that ravine”).
Sometimes empathy takes the form of self-disclosure: “I understand your hesitation…when my old horse colicked last year, I struggled terribly deciding whether to euthanize him or take him in for surgery.”
A simple, non-verbal expression of concern and compassion like a hug or pat on the arm can be empathy at its finest.
When you arrive at an emergency, you must quickly assess the situation. When you drive into the scene, assess your surroundings. Note whether people are scurrying around yelling, or whether someone runs to your window before you turn the engine off. These clues will speak to the level of emotion and the gravity of the situation. Your emotional intelligence is now critical in deciding what kind of communication approach will be needed. Remember that our clients judge us on our communication skills, and in turn, our patients’ health depends on those skills. Assess the situation, take a deep breath and be ready to be a leader when you step out of your truck.