You are a veterinarian. You are in it to help, but do your patients know that? I bet a lot of them mistake your good intentions for an attack, and I doubt you enjoy their reaction: bites, scratches, kicks, growls, and hisses. Aggression, motivated by fear, can turn your childhood dream of being a professional puppy cuddler into a nightmare. However, we do not blame pets (or at least we should not). It is easy for most of us to sympathize with animals. We understand they are in a scary place, and many of our patients still think they need to defend themselves.1 We do not judge fear-aggressive behaviors as inappropriate, although we might blame their owners for not recognizing them. Would it not be amazing if our patients just cooperated, though? Medicine is hard enough without physical danger. We have overbooked schedules, Monopoly money, student debt loads, and increasing anxiety in pet owners leaching into pets.2 Imagine if the animals just trusted us. It is a lovely idea, but a long way off. Who knows, maybe we will get so good with pet sound boards3 that we can explain we are trying to help. They might start coming in on their own, and we could do away with the owners altogether! Okay, now we are in very tempting territory. Negative veterinarian-client relations contribute to the abysmal mental health that many of us suffer, but I do not think we can be rid of this irksome component of the veterinarian-client-patient relationship (VCPR) just yet. In fact, I would argue that people, not animals, are the ones we should try to persuade. Humans are the one species where words have the ability to change the trust dynamic and have the potential to transform difficult situations into optimized veterinary medicine. Think about it: If the animals cooperated instead of attacking, your life would be better, no? However, you do not blame a pandemic puppy for being a basket case, do you? You blame the owner for not properly socializing “Bananas!” which, if they had just listened to your advice in the first place, none of this would have happened! It is not your fault they did not listen to you, but it is not their fault either, or at least, that’s not a healthy way to think about it. Humans are just as much animals as any pet, albeit with a different set of fear-aggressive behaviors (checking phones during appointments, passive-aggressive jokes about charges, and nasty online reviews). However, unlike dogs and cats and whatever else you see, the magically wonderful thing about people is that you can talk to them. I know, I know. You think talking to people is the worst part of your job, but it is not (that’s forgetting a face shield while flushing an anal gland abscess). Come on, most of your job is actually talking. It is a necessary and inseparable part of it. You need to collect a good history, explain assessments, make recommendations, and get informed consent to execute all the other fancy medical skills you paid so much for. Without good communication, it is all for naught. Understand that good communication–even perfect communication–can defuse tense situations, make delivering bad news easier, and improve your staff’s, clients’, and your mood.4 As long as you are stuck in a job requiring humans in the loop, it does not hurt to figure out how to cooperate with these finicky primates. If you believe speaking well will make you a more effective vet (not to mention happier), the next step is to understand what helps with that. The simple answer is to be simple, honest, and kind. In other words, be trustworthy. Because we are all nerds here, let’s break it down into individual components. Emotional awareness First and foremost, you need to know what this pet means to its owner. The pet services industry is growing by billions of dollars annually,5 driven by younger generations for whom pets might be just as important as people. On the other hand, some folks have a more “traditional” relationship with their animals (finding out where they sleep–bed, floor, barn–is a pretty good trick to figure this out quickly.) You need to know how your client feels about their pet because that helps you understand their reaction to what you are recommending. I would not strongly recommend an MRI and CSF tap for a semi-feral tomcat covered in fleas that presents for anisocoria. There is an old saying in veterinary medicine: “You can’t care more than the owners do,” but I also believe you cannot care less. Committing either error might make your client feel like you do not really understand their goals, and this will start to erode their trust. It is true they came to you for help, but if you only give them unpalatable options, they may react defensively in all the insidious, covert ways that humans do (I know a colleague who was labeled a “fascist” for recommending flea prevention; true story). Constantly keep the pet-client relationship in mind as you consider your advice. Clear communication Also, keep it simple, and I mean, extremely simple, because people are—how do I say this nicely?—not as smart as you. This is not to be judgmental, but they would not know what a phalange is. You do because you spent four years or more of your life in a dark cave poring over Miller and Evan’s Anatomy of the Dog. Not everyone knows this stuff. We use a lot of normal human words in medical speak (“impacted,” “expressed”), but they do not mean the same thing to normal humans. We ought to think about them as different languages. Carefully translate your thoughts into comprehensible packets of information. That means matching your speech, tone, and body language to your clients. If your client’s facial expression reads like they are getting a lecture on the Krebs cycle, you probably need to simplify or “dumb it down” to borrow an expression. Otherwise, you risk them leaving the appointment confused and disoriented, which is not a great way to build trust in a relationship. Want a trick? Type your notes and ask ChatGPT (or the large language model of your choice) to translate them into simpler terms. It only takes a few seconds. People do not seem to bat an eye at using translation apps for foreign languages, so why not use technology to improve your communication with non-medical people? Professional competence A huge component of trust-building is having the appearance of trustworthiness.6 You do not always have to feel confident, but you should definitely look confident. I have been in this business for more than a decade, and although I often feel like I have no idea what I’m doing, I try to hide my imposter syndrome from clients. An exam room is not the best place to explore your personal struggles. Fake it till you make it, stare at your degree in the mirror every morning, and practice your daily affirmations (“Veratrum californicum on day 14 of sheep gestation leads to cyclopism, I got this!”). Whatever you need to do to feel like you belong here. Keep this ever-present; you are the most knowledgeable person in the room (and do not let yourself or anyone else forget it). Even if a client is bold enough to say outright, “I don’t think you know what you’re doing,” ignore this and give them a paternalistic smile that says, “Yeah, but I know more than you do, so keep your adorable ignorance to yourself from now on please,” and move on with the appointment. This is the only point where I think throwing in a little jargon is appropriate. Dropping the word “oclacitinib” into casual conversation is a great way to demonstrate competence. Conclusion There are a lot of other strategies that not only build trust with your clients but maintain the quality of your medical practice. Being honest about costs, procedures, and outcomes is crucial. Involving clients in decision-making helps balance everybody’s preferences and optimizes patient healthcare and the experience for both your veterinary team and the clients.7,8 It is probably true that client communication is getting more difficult as the paternalistic model of veterinary medicine dies out and Dr. Google creeps ever further into pet owners’ lives. Remember, we cannot be successful without our clients. What good is performing the perfect TPLO surgery if the client does not follow postoperative care instructions well? For better or worse, we are stuck with our clients as equal partners in animal health. Remembering the critical role communication plays in veterinary medicine will align you with your clients, making everyone better off. Client-centered care, relationship-centered care, collaborative medicine, whatever you want to call it, think of it as teamwork and get ready to team up. This might feel like having a blind desert tortoise as a doubles tennis partner, but consider this: using this approach can increase client compliance up to seven times,7 improve appointment efficiency,6,8 and increase both client and veterinarian satisfaction with visits.6,8,9 In a profession struggling with mental health and a world struggling with eroding trust in experts, it does not look like there are many alternatives to improving communication on an individual level. Trust is the foundation of cooperation. These strategies are a way to ask for the trust of your clients subtly. Fearful animals need clear signals that we are here to help, not harm; and pet owners are very often fearful animals. They do not want a fight. We should remember that animals do not bring themselves in; people need to decide to seek the services of professionals. They want our help. If we can give them a little more grace, patience, and understanding, all while displaying our honesty and competence, we can tap into medicine’s most invaluable commodity: trust. 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 Edwards PT, Hazel SJ, Browne M, Serpell JA, McArthur ML, Smith BP. Investigating risk factors that predict a dog’s fear during veterinary consultations. PLoS One. 2019 Jul 22;14(7):e0215416. Stellato AC, Flint HE, Dewey CE, Widowski TM, Niel L. Risk-factors associated with veterinary-related fear and aggression in owned domestic dogs. Applied Animal Behaviour Science. 2021 Aug 1;241:105374. Bastos AP, Evenson A, Wood PM, Houghton ZN, Naranjo L, Smith GE, Cairo-Evans A, Korpos L, Terwilliger J, Raghunath S, Paul C. How do soundboard-trained dogs respond to human button presses? An investigation into word comprehension. PLoS One. 2024 Aug 28;19(8):e0307189. Pun JK. An integrated review of the role of communication in veterinary clinical practice. BMC veterinary research. 2020 Dec; 16:1-4. Morgan Stanley. Pet Care Industry Outlook: Growth Expected Through 2030 [Internet]. New York: Morgan Stanley; 2021 [cited 2024 Dec 16]. https://www.morganstanley.com/ideas/pet-care-industry-outlook-2030. Shaw JR, Adams CL, Bonnett BN, Larson S, Roter DL. Veterinarian satisfaction with companion animal visits. Journal of the American Veterinary Medical Association. 2012 Apr 1;240(7):832-41. Kanji N, Coe JB, Adams CL, Shaw JR. Effect of veterinarian-client-patient interactions on client adherence to dentistry and surgery recommendations in companion-animal practice. Journal of the American Veterinary Medical Association. 2012 Feb 15;240(4):427-36. Dysart LM, Coe JB, Adams CL. Analysis of solicitation of client concerns in companion animal practice. Journal of the American Veterinary Medical Association. 2011 Jun 15;238(12):1609-15. Hughes K, Rhind SM, Mossop L, Cobb K, Morley E, Kerrin M, Morton C, Cake M. ‘Care about my animal, know your stuff and take me seriously’: United Kingdom and Australian clients’ views on the capabilities most important in their veterinarians. Veterinary Record. 2018 Nov;183(17):534-.
