By Carolyn Shadle, Ph.D.

I had the pleasure of meeting authors Cindy Adams and Suzanne Kurtz several years ago when I presented a workshop at the International Conference on Communication in Veterinary Medicine (ICCVM), which they founded and organized to advance training in communication, particularly in veterinary schools.

I knew right away that they were experienced, knowledgeable and passionate about the importance of effective communication in the veterinary profession. Adams combines a background in social work with a doctorate in veterinary epidemiology and now teaches in the Department of Veterinary Clinical and Diagnostic Sciences at the University of Calgary. Kurtz is currently the director of the Clinical Communication Programs at the College of Veterinary Medicine, Washington State University. She has spent many years collaborating and writing in healthcare communication.

With this background, these two women have written the veterinary version of Skills for Communicating with Patients.¹ Entitled Skills for Communicating in Veterinary Medicine², this book is a unique, comprehensive practical resource for learning and teaching skills for communicating in veterinary medicine.

Four things make the text particularly unique:

First, it is evidence-based. The authors cite numerous studies from their veterinary medicine research as well as from human medicine that demonstrate that the practice of medicine is inextricably linked with skills communication.

Right up front, for example, they cite studies like the 2015 McDermott, et. al. survey of 1774 veterinarians in which 98 percent agreed that communication skills were as important as  — or more important than — clinical knowledge.³

As they discuss each essential skill, they share more research. For example, when outlining the value of using open-ended questions early in the meeting with the client, they cite the research of Dysart et al (2011) that found that when the veterinarian did not solicit the client's concerns at the beginning of an interaction, the client was four times more likely to bring up concerns late in the visit resulting in the veterinarian having to extend the length of the appointment, ignore the concern, or defer it to another visit.⁴

Second, the work is structured around the sequential steps of a typical veterinary consultation.  Adams and Kurtz base their work around the Calgary-Cambridge Guides, an evidence-based, structured and practical instrument for teaching and learning clinical communication skills. Such skills have been evolving since early 1980s when the guides were originally developed for the University of Calgary (Canada) medical school.

The authors describe the communication skills needed in each phase of the typical visit:

• Initiating the Session;
• Gathering Information;
• Providing Structure to the Consultation;
• Building the Relationship;
• Explaining and Planning, and;
• Closing the Session.

Third, practical examples are included at every step.  Drs. Julie Cary, DVM, MS, DACVS-LA, and Jason B. Coe, DVM, PhD enrich the text with their practical examples and dialogues throughout the book to illustrate how veterinary team members use specific communication skills in practice.

For example, when discussing greetings and introductions when initiating the session, they suggest a couple of "scripts:"

"Good evening.  I am Dr. Tammy Anderson, [pause] the doctor on emergency duty this evening.  May I ask your name?  And this is [gesturing to patient]?"⁵

Fourth, the text includes a plethora of resources.  In addition to the inclusion of references to research, they include a rich appendix, keeping the reader from having to go a far to find important material.

For example, Appendix A includes the Calgary-Cambridge Guides: Communication Process Skills feedback format for veterinary medicine. A worksheet is provided, ready to use for teachers and learners to conceptualize and record information during a consultation and in the medical record.  It reflects recent research and current thinking about what's needed to make interactions effective. Each item in the content guide is followed by a space where learners can make notes that they will use to insert into the medical record.⁶

Appendix B provides the Historical investigation pyramids: Beef, Dairy, Equine.  Adams and Kurtz have found that veterinarians just beginning to learn history taking find additional direction to be useful.  They have, therefore, included four species-specific "pyramids" showing the details to use with the Calgary-Cambridge Content Guide. In their text, they include a typical for small animal investigations. In the appendix, they offer three species-specific pyramids.⁷

At 305 pages, this is a handbook to be referred to over the entire course of a career. It is also a textbook, a masterpiece of inspiration, research, and practical material that will do much to move forward the use of better communication with clients and colleagues.

When I told her how much I appreciated the book, Adams told me, "The goal of this book is to describe in detail what you can do at each stage in the consultation to establish effective relationships with clients to work toward the bet clinical work for patients."

I said, "You have achieved your goal."

References

1. Silverman J, Kurtz S and Draper J (2013) Skills for Communicating with Patients, 3^rd ed. Racliffe Publishing, London & New York
2. Adams, Cindy L & Kurtz, Suzanne (2016) Skills for Communicating in Veterinary Medicine, Otmoor Publishing, Oxfort & Dewpoint Publishing, New York
3. McDermott MP, Tischler V, Cobb MA, Robbe IJ, Dean RS (2015), Veterinarians-client communication skills: current state, relevance, and opportunities for improvement. JVME: 42(4):305-14.
4. Dysart LMA, Coe JB and Adams CL (2011) Analysis of solicitation of client concerns in companion animal practice. JAVMA. 238(12):1609-15.
5. Adams, Cindy L & Kurtz, Suzanne (2016), p. 48.
6. Ibid, p. 259.
7. Ibid, p. 265.