What is the most important part of the physical exam? In vet school, I remember good-natured debates between cardiologists, neurologists, and immunologists as to which organ ranked highest in terms of an animal’s health. Always cordial, our sparring professors acknowledged the importance of a holistic approach but quickly reminded us we really should focus on their chosen body system if we wanted to prioritize correctly. Even the ophthalmologists, in love with eyes as they were, had to concede most animals could live without them. Most of us loved getting into the weeds on these body systems, and we had our favorites (neuro nerds versus cardio nerds—who reigns supreme?). However, one specialist was nearly completely written off. During his lectures, the stadium seating was mostly empty, our lack of respect for his chosen discipline painfully on display. He had an unbelievably difficult message to convey to a group of eager young animal nerds: we should learn to talk to people. What an unappealing idea. Humans were our least favorite species. We were in vet school precisely to avoid those destructive and cruel bipedal primates, not to get deeper into their minds. Besides, what good was it to learn this when we had biochemistry midterms to cram for? Say what you will about the Krebs cycle, but at least it seemed important to animal physiology. Pharmacology lectures may have been painful, but they were far better attended than communication ones. Deep down, we knew something really important was happening in those complex biochemical pathways. Something in there that would help us help animals. We were there for knowledge, not to practice public speaking, which is completely understandable. We spend thousands of hours and hundreds of thousands of dollars earning the privilege to practice nonhuman medicine. We are not really “people” people. Would we not rather get better at ausculting, palpating, performing surgery? Is that not what we were there for? Plus, my class’ apathy toward human interaction was not unique. Even administrators did not make it a priority. Communication makes up less than 1 percent of the required curriculum in many veterinary schools. In a 2015 study, two-thirds of practicing vets said they were not prepared for real world communication when they left school.1 There are harsh wake-up calls, and then there is hitting the floor of a busy veterinary clinic as a new grad: primary patient responsibility, angry and upset clients without a supervising clinician to back you up, and a rotating cast of support staff frustrated with the daily toils of veterinary practice. You are not in Kansas anymore. Very quickly, veterinarians learn speaking to people may take up most of their professional day. The same group of experienced veterinarians who said they did not feel prepared for communication in school were quick to recognize its value: 98 percent said it was equally or more important than all other clinical knowledge.1 The wild thing is, we still do not usually prioritize it as a discipline. Rarely do I hear colleagues discussing the technicalities of communication the way they might excitedly share news about a new monoclonal antibody or stem cell therapy. What gives? If I told you talking to people mattered more for your proficiency as a clinician than any other clinical skill, why would you not level up your game? Many vets think they can just pick it up on the fly. We have a lot to deal with, and developing interpersonal skills seems like so many other “urgent” demands we don’t have time for. Maybe we avoid this topic for the same reason we entered veterinary medicine in the first place: we would prefer to avoid people. If I told you that getting a root canal once a week would make you a better veterinarian, you probably would not rush to your dentist. However, if you are struggling with at-home compliance, staff retention, rude or abusive clients, or the quality of life of some of your patients, I promise you communication skills are worth building. Also, it is not just my opinion, it is an evidence-based recommendation. Courtesy Dr. Greg Bishop, www.sasquatchpaw.com In 2020, an integrated review (a high-tier analysis that uses qualitative and quantitative studies) compared 48 peer-reviewed articles on veterinary clinical communication. They found a strong correlation between the quality of veterinary-client interactions and animal health.2 The ability of veterinarians to align pet owners with their treatment recommendations depended on their communication skill level. There it is; if you want to help animals more, improve your speaking skills. You may think you are already an adept speaker. Your flea allergy dermatitis lecture is down to a tight five minutes, and you always say “wart” instead of “cutaneous mass consistent in appearance with a sebaceous adenoma.” You’ve got have a knack with sweet little old ladies, but how is at-home compliance going across the board? Is your staff happy? Gotten any online reviews lately? Any nasty ones? Do you enjoy working with most of your clients? It is no secret our profession struggles with mental health. We have atrocious burnout, depression, and suicide statistics, which I will not belabor here. The point is, improving your communication skills really can help. It is not a panacea (you cannot convince a bleeding vessel to clot during a spay), but for the emotional sake of everyone in the veterinary clinic, it is by far the most important skill you could invest in yourself as a clinician. The good news is we are in an explosion of science on improving the quality of clinical communication. Led by scientists, such as Jason Coe, DVM, PhD, and Cindy Adams, we are in a veritable golden age of veterinary communication research, with dozens of new papers each year compared to the handful we had just a few decades ago. It is not just strategies like active listening and mindfulness, either. This rich field is yielding new technological devices, such as “paralanguage,” “kinesics,” and “metacommunication.”2 If all of this sounds like a broccoli-flavored dental floss salesman just knocked on your door at 2 a.m., please remember the old days are long gone. We are no longer in an era of unquestioning public trust. We are outgunned by the pet food industry, which boasts an annual U.S. spending of $64 billion (compared to our $38 billion in the veterinary pet market).3 Clients are now questioning the motives of their veterinarians,4 instead seeking the input of the more “trustworthy” cashier at the local boutique pet store. Old-school paternalism is a losing game.5 You may feel perfectly skilled in dealing with angry clients, delivering bad news, managing expectations, and getting fully informed consent on risks, prognoses, and costs of the (no doubt high-quality) medical care you provide. However, if there is any part of you that thinks it would be nice to experience more gratitude from your clients, I highly suggest taking a look into sharpening your communication skills. There are many resources out there, from textbooks6 to international conferences,7 but a good, evidence-based starting point to keep it simple, honest, and kind.2 If you were not get taught much about communication in school (or you skipped those lectures to cram for a biochemistry midterm), you are not alone. Even those who have been out for a while have substantial knowledge gaps. Remember those 98 percent of practicing vets who said communication was equal to or greater than all other clinical knowledge? Only 40 percent of them said they would be interested in furthering their communication training.1 I get it. We are under a lot of pressure, and there is very little time, and building communication skills sounds about as much fun as extracting root tips from a diabetic Yorkie. However, maybe, if you have read this far, you are willing to admit communication does have an impact on your patients’ health outcomes. If nothing else, the quality of your communication with a particular pet’s owner might be worth paying attention to, even if it means you recognize how poor the health of that interaction is. Is it crazy to note that in your medical record, just as you would document the animal’s heart rate and body condition score? I don’t think so, and I hope we as a profession continue to make inroads in this all-too-important aspect of veterinary medicine. As animals become more and more important to people’s emotional lives, we will bear a larger and larger psychological burden as we compete with the pet food and product industry in the growing maelstrom of misleading information. The one way we can hope to keep the profession relevant (and uphold our oath to improve animal health) is by learning to navigate that information landscape. In other words, communication. Greg Bishop, DVM, is a small animal veterinarian and a part-time veterinary technology instructor in Portland, Ore. Dr. Bishop also creates the monthly cartoon series, “The Lighter Side.” The author’s opinions do not necessarily reflect those of Veterinary Practice News. References McDermott MP, Tischler VA, Cobb MA, Robbé IJ, Dean RS. Veterinarian–client communication skills: current state, relevance, and opportunities for improvement. Journal of veterinary medical education. 2015 Dec;42(4):305-14. Pun JK. An integrated review of the role of communication in veterinary clinical practice. BMC veterinary research. 2020 Dec;16:1-4. American Pet Products Association. (2024). Industry Trends and Statistics: U.S. Pet Industry Expenditures. Retrieved from https://americanpetproducts.org/industry-trends-and-stats. Janke N, Coe JB, Bernardo TM, Dewey CE, Stone EA. Pet owners’ and veterinarians’ perceptions of information exchange and clinical decision-making in companion animal practice. PLoS One. 2021 Feb 1;16(2):e0245632. Bard AM, Main DC, Haase AM, Whay HR, Roe EJ, Reyher KK. The future of veterinary communication: Partnership or persuasion? A qualitative investigation of veterinary communication in the pursuit of client behaviour change. PloS one. 2017 Mar 3;12(3):e0171380. Adams CL, Kurtz SM, Bayly W, Mülling C, Suchman A. Skills for communicating in veterinary medicine. Oxford, UK:: Otmoor Publishing; 2017 Feb 11. International Conference on Communication in Veterinary Medicine. (n.d.). ICCVM. Retrieved November 14, 2024, from https://www.iccvm.ca/
