Posted on July 18, 2011
Does Your Veterinarian Hear Your Concerns?
Until a few years ago it was darned near impossible to find much in the way of useful research about communication between veterinarians and their clients. Nowadays, several wonderful studies are surfacing. It’s about time I say, and the results have been fascinating! The newest communication study appears in the June 15, 2011 issue of the Journal of the American Veterinary Medical Association and is titled, “Analysis of solicitation of client concerns in companion animal practice.”
The purpose of this study was to determine what percentage of veterinarians evaluated effectively solicited their clients’ concerns at the beginning of the office visit. When veterinarians did solicit concerns, the client’s responses were referred to as their “opening statement”. What we know from research pertaining to human physicians is that only 23% to 28% of patients are allowed to complete their opening statements. On average, they are interrupted by their physicians within 12 to 23 seconds. Research has also documented that physicians often mistakenly assume that the first or only concern expressed by their patient is the main concern or only concern.
In addition to learning how many veterinarians effectively solicit client concerns, this study also determined if there is a difference in the way clients respond to open-ended versus closed-ended solicitations. Open-ended questions such as “What brings you in today?” cannot readily be answered by a simple “yes” or “no”. Rather, they require more expansive, thoughtful responses. Closed-ended questions such as, “Has Peanut been vomiting?” can readily be answered by “yes” or “no” and may entice a client to focus on what they perceive the veterinarian thinks is important rather than what they are truly concerned about.
Here’s what this study’s researchers learned by reviewing 334 videotaped veterinarian-client office visits:
– Solicitations for client concerns were made in only 37% of the office visits.
– Of the office visits that included solicitations, 76% of the queries were open-ended and 24% were closed-ended.
– In response to open-ended solicitations 76% of clients expressed one or more concerns. In response to closed-ended solicitations, 40% of clients expressed one or more concerns.
– Clients spoke more than twice as long in response to an open-ended solicitation compared to a closed-ended solicitation.
– Clients’ opening statements in response to the solicitation were interrupted by the veterinarian 55% of the time, on average after only 11 seconds!
– Following an interruption, clients returned to and completed their response only 28% of the time.
– Appointments in which the veterinarian did not solicit client concerns at the beginning the office visit were significantly more likely to have concerns raised at the end of the office visit.
– Open-ended solicitations were more likely to occur during “well pet visits” than visits initiated because of a medical issue.
Are you surprised by these results? I’m a bit surprised by the numbers and, admittedly, as a veterinarian, I’m feeling a bit of professional embarrassment. This study underscores the fact that veterinarians could be doing a much better job soliciting and listening to their clients’ concerns. By learning from studies such as these, there is so much potential for greater success, not only in terms of doing a better job for our patients (gaining an accurate assessment of all concerns is certainly in the best interest of the patient), but also in terms of our clients. Actively listening to their concerns without interruption conveys empathy and what person worried about their best buddy’s health couldn’t use a good dose of that?
As a consumer of veterinary medicine, what is the take home message for you? I hope this data will prompt you to be persistent in expressing all of your concerns to your veterinarian at the beginning of the office visit. And, if interrupted, do your best to return to your original train of thought!
What is the take-home message for veterinarians? It is clear that we could and should be doing a much better job consistently asking open-ended questions at the beginning of office visits and then actively listening, without interruption to hear what our clients have to say. Perhaps before entering the exam room we might remind ourselves of the saying I’ve always loved, “Don’t just do something, stand there!”
Best wishes for good health,
Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook
Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.
I can’t say that I am surprised or appalled at these statistics. Vets are very much like general practitioner doctors. They want to get to the point, and get you out the door and paid for as quickly as possible. There are a select few who genuinely care about your concerns and will listen to exactly what you have to say in regards to your pet. Unfortunately they are very few and far between. Taking your furry loved one to a new vet can be a scary process, but it will pay off in the end to find one that actually cares as well as listens.
Thanks for the great article,
-Jen @http://jenleeblair.wordpress.com/
I hope it is ok to respond twice. I wanted to say why I left my last vet to come to this new and wonderful vet.
My old kitty with megacolon had been seen many times by this vet (I mean the one I switched from). I ran out of his laxative, which was only available by prescription.
He would NOT call it in. I was recovering from a knee replacement, and there were blizzard warnings, but I had to have an office call with my kitty before I could get the prescription.
This was the last straw, as it were, and rather typical. Even though I did Rescue and have two kitties and five dogs, so they saw me a LOT, they always wanted an office call before filling a prescription.
Again I speak to my wonderful vet, Dr. Radcliffe.
My concerns are queried twice, once at the desk as I am checking in, and then, when the vet sees me, repeated back to make sure I have been understood correctly, something like, “So, little Tina is having diarrhea again, right?”
Not only is the vet good at this, and obviously loves his work and my pets, but ALL the office staff are concerned and helpful.
I never leave feeling that I have not communicated my concerns. I love them all. I drive two hours to get there, but it is worth it.
To be fair: client often has been queried twice prior to engaging
the vet:
First the screening telePhone call often the most onerous as it requires description of symptoms to non- medical staff:
next , to the tech who writes on the chart
the nature of the visit. By the time owner gets to the doc,
Hopefully she or he has consolidated the chat into a succinct report
So they can get on with solutions. Not as cozy but perhaps more
productive!
I had an experience just yesterday that brings home your point. One of my horses was having a stress issue that had vague and non specific symptoms. The first time he was seen by the vet, my daughter took him and I told her what I had observed. The initial diagnosis was allergies. I did not think this was a correct diagnosis and continued to watch for more symptoms. More observation on my part and another trip to the vet and the diagnosis was inability to urinate! He was one relieved fellow after having his bladder drained! His urine will be sent to the lab for close scrutiny and I hope an answer will be forth coming.
The vet and I kept bouncing ideas off of each other and we were able to tackle my horses’ problem together.
I think as more animal owners/lovers realize that they can understand their pet’s body language and subtle signals better than anyone else, the more they will speak up for their pet to their vet.
Tight schedules are the downfall for more than just the vet field. All medical related fields are seeing how this is affecting their patient relationships.
And we, as lay folks, need to respect their tight schedules by not repeating our questions and keeping “chatting” to a minimum!
Thanks for your interesting comments and letting us vent!!!
Jackie Jurasek
Bravo! Again, Nancy you choose to blog outside the box and am pleased that you continue to speak openly and honestly about veterinarian/client relationships and responsibilities. I will forward this post to my email list in the hopes it offers some more timid client to speak up on their dogs behalf.
Just recently I was asked to come and help out w/ a stray picked up by a client and went to see this dog in the hospital. I was struck by this vet’s complete and utter defensiveness at any questions I had about the dog. I did not get a word in edgewise and when I did, I was cut off w/in seconds. To read this study days after this occurred is actually quite alarming to me. It’s amazing folks put up w/ this kind of behavior.
Thank you again for the courage to speak to the white elephant!
~jill
Dear Dr. Nancy, no, it doesn’t surprise me at all, sorry. We dealt with many veterinarians and I hear many stories, no, it doesn’t surprise me at all. If anything, the statistics are better than what I would have thought.
One thing that I believe is a good idea is to write stuff down. Make a check-list of the concerns before going in and make sure each item gets addressed. While listening isn’t an issue with our great vet we eventually found, it’s also a question of memory. If it is written down, you know you won’t forget.
Our vet always opens the visit with things such as “What can we do for Jasmine today?”, or lately, “What are we doing today?” That is largely because I discuss most things with him via emails first. So the answer might be “We are going to check her front left foot because is seems to have an infection, we’re going to vaccinate for Lepto and run titers for dap”.
Of course things can always be discussed before hand, then the opening starts with description of the issue as observed, his physical exam and possibly labs. Sometimes the issue is obvious and visit results in diagnosis and treatment. (e.g. the food indeed is infected, with this and this, here is what we should do). If the issue is more complex more email discussions and/or diagnostic tests precede a course of action.
This doesn’t surpise me at all or disappoint me. It seems to hold true with most doctors. I am ok with that because I know they are left brain thinkers.
That’s what makes them so good at medicine.
Now it’s true that better listening skills might lead to better diagnostic skills but it’s a tough call.
Many pet owners are not assertive enough in a vet’s office, so everyone could do a bit better.
While I like my vet to be able to communicate on at least a basic level, I’d prefer they focus on medicine.
Maybe an intermediate is required. Someone more right brained to gather case history?
Very interesting article as always. I wonder did they study the difference between female and male comunication?
This is a big concern of mine. I try to bring a list of things I want to ask about to vet visits because once the vet starts in on their exam or follow up questions on the first issue on my list, the only way my other items are going to be looked at is if I interrupt to bring them up. I hate to keep talking when the vet is doing an exam because I don’t want to distract him/her.
I try to start my “opening statement” by saying I have a few issues if that’s the case. Maybe it would better to say I have four things I need to ask about and list them all. But there’s something wrong when I feel like I need a strategy to get my concerns heard.
I have an older whippet, a new veterinarian, due to a recent move, and reduced income. I now make the most of any office visit by preparing a list of questions and concerns in descending order of importance. On my first visit I took out the list as the doctor came into the room, and pleasantly told her that I’d brought a few concerns to discuss. She was pleased ( and a little relieved?) that we could “problem solve” the list. Like all doctors, vets are problem solvers. I want to help by being as clear as possible.
Great piece, Dr. Kay – thanks.
I found the data to be a little alarming and embarrassing, too. I hope I do a better job with my clients and patients!
It is so easy, with several patients waiting to be seen and a fully booked schedule to fall into the trap of rushing pet owners to the point, or not being able to fully hear their concerns. We veterinarians need to be able to give them the time they desire to get their concerns across and be heard.
The conversation can be helped by a bit of prep work on the part of the pet owner as well – having written questions, avoiding repeat questions and focusing on the most important concerns can make sure that everyone’s time is used wisely and all questions get answered.
Sincere thanks for a thought-provoking piece!
I drive an hour to get to my favorite vets. One of the reasons I go there is that they ALWAYS listen to everything I have to say and then will try to piece together a solution to the problem from all of the different things I tell them. I love them.
I think the research suggests that there is an attitude on some veterinarians’ parts that the pet parent’s experiences and views do not have much value to them as a doctor. It takes a bit of time for non medical folks to get their communication across. When a veterinarian takes the time to listen AND draw out the pet parent’s then they, as the doctor, have critical information to help them diagnose more accurately and to help prevent future problems for the pet. As it is with all things in life, communication is at the root of success or at the root of failure.
Active listening is a skill that does not seem to be taught in higher education. It is a valuable skill, which I use each and every time I interact with people in stores that I service.
Vet’s are no different than any other professional whom are skilled in the profession they have chosen.
The practice of veterinary medicine is ever evolving and changing, but some vets are grounded in the practice of the past, or are beholden to the pharmaceutical companies as there is profit in meds, for all occasions, instead of correcting the root cause.
The average consumer and pet person is not skilled in asking questions or at times even understanding the problems, so they rely on the vet.
\What is the take-home message for veterinarians? \
Listen, change and adapt.