Courageous Conversations in Veterinary Medicine

Ease the stress of sharing bad news with these key strategies.
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vet talking to staff

Delivering bad news to staff, clients or colleagues can be dif

For most of us, bad-news conversations are something that we dread, whether we are giving or receiving the bad news. It’s human nature to dislike bad news and to want to avoid conflict. This, in itself, is part of what makes these conversations so challenging.

When you are uncomfortable with the content to be shared in a conversation, it is difficult to be a present participant and to spend the time necessary to adequately discuss the issue at hand. Unfortunately, these discussions can’t be avoided, and learning how to communicate bad news effectively can ease some of the associated stress.

We often say we need to “deliver” bad news, but the word “deliver” implies a simple transaction in which an object or piece of information is handed off from one person to another. This idea meets the most basic of criteria for a bad-news conversation, as the other party receives the required information; however, it falls well short of an effective conversation. Often, there are decisions to be made following the sharing of the difficult news, or a determination of the next steps to be taken.

Also, much of the time we would want to share the news in a compassionate and kind fashion. In order to convey the news gently, and to allow the other party to receive the news and continue to be in an emotional state to process information and make decisions, a conversation based on two-way communication and partnership is essential. I prefer to think of conversations in which difficult news is shared as “courageous conversations” rather than conversations in which bad news is delivered.

In general, the pillars of successful courageous conversations are the same, whether they are with clients or staff. However, one important consideration in any courageous conversation is the degree of responsibility you bear for the news itself. For the most part, when you are discussing difficult news with clients, you bear little responsibility for the news. You might have uncovered the problems, noticed concerning findings and offered diagnostics, but it is not your fault that their horses have colicked or suffered injuries.

When delivering bad news to staff, you might be more responsible for the decision. While there’s nothing to be done about how much responsibility you bear for the decision, it is important to recognize that, as it can impact the dynamics of the conversation.

Conversation Content

Let’s get down to the conversation itself. The first thing that you must consider is whether the content you need to share qualifies as “bad news.” There are obvious bad news conversations, such as letting an employee go or delivering news of a career-ending injury to a client. Some are more subjective; for instance, denying an employee’s time-off request or educating a client about his or her horse being overweight.

Preparation for courageous conversations cannot be done unless you have recognized that you need to have a courageous conversation! When in doubt, assume what you are going to share will be received as bad news.

Set the Stage

Investing time to effectively set the stage for your conversation will significantly improve the likelihood of having a smooth and productive conversation. There are a number of things that should be considered, with the first being timing. Sometimes there are no choices about when the conversation can occur, such as in an emergency medical situation; but often there is some choice, even if it’s just a matter of minutes.

Choose a time when there are minimal distractions and no other demands on your time or the other person’s time. The next thing to consider is the physical environment. If possible, choose a place that has a bit of breathing room and enough space for both parties to be physically comfortable; your vet truck is likely not a good choice! Also, consider whether the news is going to be delivered in person or remotely.

As equine veterinarians, we handle many things over the phone because we are on the road and it’s most convenient to do so. However, courageous conversations are best handled in person, as the ability to respond to the other person’s cues is essential. Many cues regarding emotional state are nonverbal or paraverbal (i.e., speed of speech and vocal tone), which are harder or impossible to interpret via phone.

Lastly, consider the people that are to be involved in the conversation. Weighing the emotional safety of the other person is essential. If you know that your client is close with his or her trainer or barn manager, ask whether he or she would like to include that person in the conversation. Conversely, if you are sharing bad news with an employee, it might best be delivered oneon- one, so that person don’t feel ganged up on. The adage “praise in public, criticize in private” applies here. With few exceptions, it isn’t appropriate to share bad news relating to an individual in a staff meeting.

Conversation Timing

Once you’ve laid the foundation for the conversation, it’s time to think about the interaction itself. The way in which the conversation is initiated or the other party is invited to speak to you can set the tone for the remainder of the interaction.

It can be stressful and anxiety producing to be asked to “pop by the office” or to find someone “when there’s time.” As much as possible, try to invite the person to speak with you at a time when the conversation can happen shortly thereafter. This will minimize the dread and potential buildup of anxiety on the other person’s part.

Similarly, care should be taken to share the news without unnecessary delay in the conversation for the same reason. That said, it is important to give the recipient a warning to prepare for what’s coming. A signpost statement, where an indication of what is to come is given, allows the other party to prepare for the information that is about to be shared.

Examples include: “I have some difficult news …” and “I know you were hoping ... but ... ”. I think of this part of the conversation as a road sign that indicates a sharp corner or a steep hill ahead; these phrases cause me to take extra care and tap the breaks.

What’s Not Said

Next, think about how you speak. When having a discussion about difficult subjects or sharing difficult news, it’s important to be aware of your nonverbal and paraverbal cues, as well as those of the other party.

Our words convey our conscious thoughts; we tend to spend most of our time preparing for a conversation by choosing our words carefully. However, our nonverbal and paraverbal cues convey our emotions and subconscious thoughts. Thus, if we are uncomfortable, hurried or filled with dread about the conversation, it’s likely that this will come across through our nonverbal cues even if the words we’ve chosen do not convey them.

It’s also important to attend to the other party’s nonverbal cues. If he or she pulls back and looks away, it might be time to slow the conversation or pause. If the person cries or tear up, there might be an opportunity to offer comfort and support. Being attentive to one’s nonverbal cues will allow you to guide the conversation and meet the other party’s needs without needing to overtly solicit them.

Partnership Conversations

Receiving bad news can be very isolating. It can create questions and doubts about the future, which can add fear to an already emotion-laden conversation. Thus, the idea of partnership between ourselves and the client or employee is of particular value. The nature of the situation might preclude this from being a long-term relationship, but there is value in establishing partnership for this conversation.

Partnership can be established through two-way communication when the communication occurring is responsive and appropriate, given the other’s contributions. Time is allowed for both parties to share their thoughts and ask questions, much like a rally in tennis. Using “we” statements also contributes to the formation of a strong partnership. The use of the word “we” instead of “you” subtly asserts that you are there to provide support and assistance in this circumstance.

Another useful tool is an “I wish” statement; it is an excellent way to communicate empathy and acknowledge your recognition that this is a difficult situation in a non-judgmental and partnership-oriented way. For example, “I wish that there was more we could do.”

Empathy

Empathy is an essential ingredient in a courageous conversation. Empathy involves the intellectual understanding of another’s perspective, followed by a verbal or nonverbal demonstration of that understanding. Empathy is not agreement; you can disagree with someone and still be empathetic toward him or her and the situation.

It is also not sympathy, where you experience feelings similar to the other person. This is an important differentiation, because sympathy can lead to compassion fatigue and burnout in the long run.

Empathy also necessitates an open mind and curiosity about the other’s thoughts and perspectives. This might seem unnecessary when sharing bad news, but it isn’t. Each of us is unique and reacts to situations differently and in accordance with our life experiences. When we make assumptions about how someone is going to respond, or that person’s emotions, we negate his or her individuality and risk damaging our relationship with that person.

We can learn about the other person’s thoughts and perspectives by asking check-in questions following the sharing of difficult news, such as: “How is that sitting with you?” or “What questions do you have about that?”

Check-in questions provide an opportunity for two-way communication and will allow you to respond appropriately to the person’s unique situation and the impact that the news has had on him or her.

Take-Home Message

Sharing difficult news is never easy, and courageous conversations require courage, no matter how many skills you use or how well prepared you are. Remember to take your time, set the stage effectively, establish partnership and be empathetic.