A client is explaining her dog Crazy Doodle’s latest antics, which led to today’s visit for stitches. You nod and type detailed notes into the electronic medical record as the pet owner shares her story. You feel like a superhero of time management, efficiently using every precious minute of exam time. Unfortunately, your multitasking could lead to missed information and a loss of the client’s trust. A study of British physicians found communication consequences when they read patients’ records and listened at the same time.1 For example: Patients withheld their initial replies from physicians until eye contact was made. Patients paused midsentence when physicians looked at medical records and resumed when eye contact was regained. Physicians frequently missed or forgot information provided by a patient while they were reading the medical records. The study concluded that using records while patients are speaking is not efficient for the patient or physician.1 Patients gave information more slowly and less completely, and physicians did not hear all the information provided. Whether you use paper charts, electronic medical records or a hybrid of the two at your veterinary hospital, you could face the same communication challenges as physicians. Here are nine strategies to improve client communication while you use electronic or paper records during exams: 1. Listen without note-taking during a client’s opening remarks Just as a physician would start with “Where does it hurt?” open with broad questions that let pet owners share information and help you build trusting rapport. Make clients feel they are an important part of the information-gathering process. Don’t jump into history questions in the interest of efficiency. First, encourage clients to explain a health problem from when it started to the present.1 Say, “Start at the beginning and take me through what has been happening” or “Tell me how he has been doing since the surgery last week.” Just listen and let clients complete their opening statements without interruption. Ask clarifying questions when a client’s statement is vague or you need more details. For example, “Could you explain why you think your dog is in pain?” Periodically summarize what a client has said to confirm your understanding and to invite further information. 2. Separate listening from reading the record To signal to a client when you need to consult your notes, say, “Thank you for describing the length and severity of your dog’s seizure. Let me review when the last seizure occurred.” This tells the pet owner that you need to review information in the medical record before restarting the conversation. 3. Position computers or paper charts so clients can see you Avoid turning your back to pet owners while writing or typing. For a paper chart, use the exam table as a writing surface and face the client. For electronic records, position computers so your profile is visible to the client while you type. Nonverbal communication can have five times the effect of verbal communication on a person’s understanding of a message, compared with spoken words.2 When sharing treatment plans, medication instructions and handouts, don’t stand behind the exam table. This physical barrier blocks nonverbal communication between you and the client. Instead, position yourself shoulder to shoulder with the client on the same side of the exam table, standing about a handshake’s distance apart. Another choice is to stand at the foot of the exam table, forming L-shaped body language next to the client. Both positions allow you to read information right-side up and point to key instructions. Use a highlighter to mark details that a client will need to remember. Because position is important for nonverbal communication, mirror the client’s stance. If she is standing, you should stand. If the client is sitting and you are standing, you are in a position of dominance. You need to be on equal footing when having a conversation. If the client is seated, sit in the chair next to her. If the space will be uncomfortably close, kneel next to the client. 4. Have an assistant transcribe while you’re explaining exam findings After the technician finishes assisting the doctor with the exam, she steps over to the computer to type notes as the veterinarian shares his findings with the client and answers questions. The veterinarian can review the record and confirm that the technician accurately captured information at the end of the visit. 5. Let clients know when to pause a conversation This helps you separate client- and record-focused stages of the visit. Say, “Let me note those symptoms in your pet’s medical record. Then I’ll share treatment choices with you.” 6. Use the record as a prop Point to the screen or chart and say, “Your dog’s heartworm/tick screen was last year on Jan. 15, so the annual screening is due today.” 7. Invite clients “inside” medical records To engage pet owners, have them look with you as you share digital X-rays, lab results, dental photos, ultrasound images and other diagnostics. Offer to email images or test results, or share them in your website’s patient portals. Oftentimes, half the family may not be present for the appointment. Sharing test results and using exam report cards allows clients to accurately communicate highlights of the visit to other caretakers. 8. Share that you’re documenting agreed-upon treatment plans and follow-up During today’s exam, you diagnosed a cat’s Grade 2 dental disease. Print and review the dental treatment plan in the privacy of the exam room, where the client can comfortably ask questions about the procedure and price. When she agrees to the care, say, “Let me have you sign the treatment plan to accept care. You’ll also take home a copy today.” Then open the appointment schedule on the exam room computer and say, “Let’s choose a date for the procedure. Dr. <Name> does dental procedures on Tuesdays and Thursdays. Which choice fits your schedule?” After the client selects a day, set the admission appointment time. An appointment reminder will print on today’s receipt. 9. Write notes at the end of appointments Be diligent about recordkeeping immediately after each visit. Don’t wait until the end of the day, because you won’t remember details of 20 conversations. Consequently, you could harm patient and practice health. To help your doctors and technicians be great communicators during exams, watch my webinar on “Creating the 5-Star Experience in the Exam Room.” View the course description and enroll here. Remember, the exam room is your classroom. When you’re an effective communicator, you can increase acceptance of professional services and products, boost client satisfaction and retention, and enjoy healthy revenue from better compliance. References Adams, C. and Kurtz, S. Skills for Communicating in Veterinary Medicine. Otmoor Publishing and Dewpoint Publishing, 2017; pp. 160-162, 90-91. Gray, C. and Moffett, J. Handbook of Veterinary Communication Skills. Wiley-Blackwell. 2010; pp 7-12. Wendy S. Myers owns Communication Solutions for Veterinarians in Castle Pines, Colo. She helps teams improve client service, communication skills and compliance through consulting, seminars and monthly CE-credit webinars. You may reach her at wmyers@csvets.com or www.csvets.com. Originally published in the January 2017 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!
