We spend the vast majority of our days interacting with our clients. For this reason alone, it behooves us to devote energy to ensuring these relationships are rewarding.
If given a choice, I’d say we all prefer working with individuals who leave us feeling respected and appreciated. Building strong relationships with clients is protective against burnout, compassion fatigue and many of the smaller daily stresses and strains of practice.
In veterinary medicine, three different types of approaches to client relationships are discussed: veterinarian- centered, client-centered (or consumerist) and relationship-centered. These mirror human physician-patient relationships and other provider-recipient relationships.
Veterinarian-centered care is akin to paternalistic relationships, where the provider has the power in the relationship and the receiver (or client, in our case) has very little power. This type of relationship was common 50 years ago in medicine. The doctor was seen as all-knowing, and the patient had blind trust in him or her to provide care.
As our society has changed, in part due to ease of information access, both client-centered and relationship-centered care have become more common.
Client-centered relationships are those in which the client has the majority of the power. Those situations can occur when clients are price shopping, or when they request/demand a certain procedure be done without full consultation with or support from the veterinarian.
Lastly is the relationship-centered model. This is the one being taught to veterinary and medical students alike, because it promotes shared power and shared responsibility. The veterinarian’s role is to be the expert and to work with the client to determine the best course of treatment for the animal. The veterinarian makes recommendations, but ultimately, the client makes the decisions that he or she believes are best for the situation and his or her animal’s health.
A 2015 focus group study explored equine clients’ expectations of veterinarians and equine veterinarians’ perceptions of clients’ expectations.1 The results of this study support the paradigm shift seen in human and companion animal medicine from paternalistic care to a partnership model. The study included caretakers from all different types of equine industries—including racing, backyard and performance—and it was found that the commonalities between them far outnumbered the differences.
Clients placed a heavy emphasis on the quality of their relationships with their veterinarians.1 I think this is intuitive for many equine veterinarians, and several veterinarians in this study who described their clients as friends back it up.
What makes the relationship good? Clients discussing this described the knowledge that their veterinarians have of them, their horses and their unique situations as a key piece.1 Further, clients described this knowledge as impacting the care their horses received, because it contributed to the veterinarians’ recommendations.
Clients also said that communication can be used to build and strengthen the relationship.
Another key piece was respect, meaning a willingness to take into account the other person in the interaction. Caretakers also noted how their relationships with their horses contributed to the care they wanted their horses to receive, and that it was important the veterinarian recognize that.1
Earlier focus group research in companion animal medicine regarding clients’ expectations and veterinarians’ perceptions of clients’ expectations supports the work done in equine practice.2,3 Clients’ expectations included being provided choices, two-way communication and education. Each of these expectations is comprised of a number of smaller components.3
In two-way communication, the client feels that the veterinarian listens to and respects him or her, employs easy-to-understand language and provides proper care. The provision of choices pertains to diagnostic or treatment plans; clients wanted to be informed about the risks and benefits, the costs and the prognoses for the options presented.
Education relates to how veterinarians provide information to the client. One clear desire of clients was that the information relate to their pets specifically. By contrast, veterinarians stated they more often provided information about what was involved with services or what justified the cost of the services.2, 3
Awareness of clients’ expectations can arm us with the information we need to meet them. In turn, when clients’ expectations are met, it sets a foundation for a strong working relationship and decreased conflict.
Client Adherence
Building on the client expectation research, a study investigated how client adherence to recommendations was influenced by veterinarian-client communication. 4 It was found that when veterinarians made clear recommendations (e.g., “I recommend that …”) compared to ambiguous recommendations (e.g., “You could do one of the following three things”), clients were seven times more likely to follow the recommendations. 4
Also, clients who adhered to the recommendation were more likely to be satisfied with their appointments. Further, the degree to which the appointments were relationship-centered was associated with client satisfaction.4 This is backed up by a separate study that found that clients were more satisfied with visits that were classified as relationship-centered compared to veterinarian-centered.3
Communication Is Key
Recognizing the value of using a relationship- centered approach is the first step toward using it in everyday practice. It’s important to recognize the difference between how we view ourselves and the way in which we communicate, and the way our clients experience it.
A 2006 companion animal study found that only 7% of appointments contained an empathy statement.5 This is a very low value, particularly given the importance of demonstrating empathy in building relationships and supporting the client.
In my experience, veterinarians are very empathetic individuals; I believe there is a disconnect between intention and execution. Veterinarians are fixers by nature, and they often feel that the best way to help clients through difficult or anxious times is by telling them how it can be solved. This is a key component of the interaction. We share that there are options and how they can support the health of their pets.
First, we must realize that there is value in saying or doing something that demonstrates to the clients that we have heard their concerns, and we have heard what they are telling us. This is empathy— when we learn about the clients’ experiences and we say or do something that indicates that we have an understanding of what those are.
To be effectively empathetic, we must first hear from the clients. For instance, if we arrive at a client’s farm to deal with a colic, and the first thing we say is “I know it’s stressful and scary,” that is not likely to be an effective empathy statement. Instead, if we ask the client “How are you doing?”, wait to hear the response and then say “I hear you; it’s scary knowing they are in pain and not knowing how to help,” we are more likely to have contributed positively to the client’s well-being and the relationship between us.
Asking the Right Questions
Both the equine and companion animal research speak about the veterinarian knowing the client or asking the right questions. In some ways, this can sound a bit like a trick. How does one know what the “right” question is?
One way to determine which questions to ask is to use open-ended questions. When we use open-ended questions, we are casting a wide net, allowing clients to provide us with the information that they see as relevant and important. This is in contrast to closed-ended questions, which is more like fishing with a rod and lure—if you don’t choose the correct bait, you might not catch the kind of fish you wanted (or any fish at all).
Open-ended questions or inquiries require a thoughtful response and cannot be answered with a “yes” or “no.” This much is familiar to many people. It can be difficult to transition from asking closed-ended to open-ended questions, and it can require practice. In general, think of using the words “what,” “how,” “tell me,” “describe” and “explain.” They are all good stems for open-ended questions or inquiry.
Body Language Counts
Lastly, the ways in which our body language and non-verbal cues impact all of our interactions are of critical importance. You’ve likely heard that non-verbal communication is important, and heard a statistic that it accounts for about 80% of the communication we are relaying or perceiving. What might come as a surprise is the difference in the types of messages that are conveyed verbally and non-verbally.
We send our conscious messages through verbal communication, while we send our unconscious messages through non-verbal communication. Further, if our verbal and non-verbal messages are inconsistent, it is our non-verbal messages that are perceived by the other. This is of great importance.
Many of us think that we cover our irritation well, and we might be able to control some of our non-verbal cues. However, it is unlikely that we can mask them all of the time, or that we are able to mask all of the non-verbal signs of irritation. It is for this reason that using the “correct” words when engaging with clients is not enough. We must also believe and strive to form strong relationships, validate our clients and understand their perspectives. If we don’t, then our efforts are wasted, because our faces, bodies and voices will give us away.
References
1. Best, C. Exploring interpersonal relationships in equine veterinary practice. PhD Thesis, Department of Population Medicine, University of Guelph, Guelph, ON, Canada, 2015.
2. Coe, J.B.; Adams, C.L.; Bonnett, B.N. A focus group study of veterinarians’ and pet owners’ perceptions of the monetary aspects of veterinary care. J Am Vet Med Assoc 2007;231(10):1510-18.
3. Coe, J.B.; Adams, C.L.; Bonnett, B.N. A focus group study of veterinarians’ and pet owners’ perceptions of veterinarian- client communication in companion animal practice. J Am Vet Med Assoc 2008;233(7):1072-80.
4. Kanji, N.; Coe, J.B.; Adams, C.L., et al. Effect of veterinarian-client-patient interactions on client adherence to dentistry and surgery recommendations in companion-animal practice. J Am Vet Med Assoc 2012;240(4):427-436.
5. Shaw, J.R.; Adams, C.L.; Bonnett, B.N., et al. Use of the Roter interaction system to analyze veterinarian-client- patient communication in companion animal practice. J Am Vet Med Assoc 2004;225(2), 222-9.
