Thursday, July 21, 2011

Does Your Veterinarian Hear Your Concerns?

This topic is very close to home for me and I have written a number of posts on the subject. I have to admit that the numbers don't surprise me at all; if anything they are better than I would have thought. 

Dr. Nancy Kay, DVM, a respected veterinarian and author of Speaking for Spot (yes, that's the book I keep nagging you about - have you read it yet?) kindly agreed to have her post re-published here.

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Puppies waiting for Vet

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!”

Editor's note: One thing that's always worked well for me, whether for the reasons above or simply for the sake of bad memory, is writing things down before the visit. If you come in with a comprehensive list, it will keep you on track. Don't leave the office until every item on the list had been addressed.

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Dr. Kay  is the fortunate recipient of the 2011 Bustad Companion Animal Veterinarian of the Year Award- presented by the AVMA to the veterinarian who promotes and exemplifies the human animal bond!

DR. NANCY KAY wanted to become a veterinarian for just about as long as she can remember. Her veterinary degree is from Cornell College of Veterinary Medicine, and she completed her residency training in small animal internal medicine at the University of California—Davis Veterinary School.

Dr. Kay is a board certified specialist in the American College of Veterinary Internal Medicine and published in several professional journals and textbooks. She lectures professionally to regional and national audiences, and one of her favorite lecture topics is communication between veterinarians and their clients.   Since the release of her book,
Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life, Dr. Kay has lectured extensively and written numerous magazine articles on the topic of medical advocacy.  She was a featured guest on the popular National Public Radio show, Fresh Air with Terry Gross.

Dr. Kay is a staff internist at VCA Animal Care Center, a 24-hour emergency/specialty care center in Rohnert Park, California. As a way of providing emotional support for people with sick four-legged family members, Dr. Kay founded and helps facilitate the VCA Animal Care Center Client Support Group.  She also facilitates client communication rounds for VCA Animal Care Center employees.

Dr. Kay was selected by the American Animal Hospital Association to receive the 2009 Hill’s Animal Welfare and Humane Ethics Award.  This award is given annually to a veterinarian or nonveterinarian who has advanced animal welfare through extraordinary service or by furthering humane principles, education, and understanding.  The Dog Writers Association of America selected Dr. Kay for two awards.  The first was the 2009 Eukanuba Canine Health Award recognizing
Speaking for Spot as the publication that best promotes the health and well being of dogs. The second award was for the Best Blog of 2009 (www.speakingforspot.com/blog).

Dr. Kay’s personal life revolves around her husband (also a veterinarian), her three children (none of whom aspire to be veterinarians) and their menagerie of four-legged family members. When she’s not writing, she spends her spare moments in the garden or riding along the beach atop her favorite horse. Dr. Kay and her family reside in Sebastopol, California.


Become a fan of Speaking for Spot on Facebook.

Articles by Dr. Kay:
Even The Best Veterinarian Can Make A Mistake
Reasonable Expectations: The Ability to Discuss Your Internet Research With Your Vet
Finding Dr. Wonderful And Your Mutt's Mayo Clinic: Getting Started
A Different Way to Spay
Making Tough Medical Decisions For Your Dog: Lily's Story

Related articles:
Veterinarians Are People First
Emailing With Your Vet And The Miracle Of Web-based Medical Records
A Word On Second Opinions
Finding Dr. Wonderful And Your Mutt's Mayo Clinic: Getting Started
Making Tough Medical Decisions For Your Dog
It's Your Dog's Health
Does Your Vet Listen To You?
Help! My Dog Is Purple!
Veterinary Drive-Thru: Coming Soon To A Veterinary Hospital Near You!

9 comments

  1. In one of our first vet visits with Viva, we were welcomed by our vet who was happily talking how nice she thinks Kenzo was - our other dog. But she was looking at Viva, not Kenzo, and I also had not told her what I wanted her to look at. The "conversation" continued while she was unwrapping syringes and finding small bottles with fluids to inject. When I finally could get in a word and asked what she was doing, she finally listened and asked: "Is Kenzo not coming for his vaccinations?".

    ReplyDelete
  2. That would actually by quite funny if it wasn't sad.

    When daughter brought her Chi in for rabies vaccine, the vet just gave her Lepto also, without saying anything at all. She got a horrible reaction and almost died.

    Not the first time I heard of a vet just doing things.

    No vet should ever just do things without at least commenting on what their doing. Every action should be discussed first. For some reason that idea is lost on many of them.

    ReplyDelete
  3. Hi Y'all,

    Great article.

    I always take a list of things I want to ask about when I go to the doctor but fail to do that when taking Hawk to the vet. However, both his vets have been good about asking generally about our concerns and then if I've noticed anything more specific.

    The best vet at soliciting info is the new young vet who took over the mountain practice.

    Y'all come by now,
    BrownDog's Human

    ReplyDelete
  4. Hi Hawk's Human. Our vet is awesome too. Still doesn't mean that we are not able to forget something! BOL

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  5. Unfortunately, I have seen a lot of this lately, but very fortunately for my Dog Dylan; not at my veterinarian's office. It may be my nature to be heard too, but I do believe my vets have listened to my complete concerns, prior to even getting in the car on more than one occasion. They have helped save my dog's life as a result. They listen to all of my descriptions of behavior and symptoms in telephone consultations and in visits. Their ability to listen allowed me to influence the treatment undertaken and to make the decisions, informed as I should be. I feel very fortunate, but it was the result of effort many years earlier to find a vet compatible with my views. I know my vets believe in similar things and treatment philosophies, and when things have really mattered. They have been great!

    I know others who battle AIHA/IMHA are not so lucky. There are many people I have spoken to in the last 5 months that have been searching for a veterinarian who will help them and not give up on their dog. Everyone needs a vet who will listen and want to hear everything we have to say, since they must know what is important, before they can diagnose anything accurately. They need to be able to work with others too when the situation requires it or dogs will simply not get the best care possible, which is what they deserve.

    I know that Autoimmune Hemolytic Anemia is very often misdiagnosed and dogs end up very sick as a result. If veterinarians did listen to everything the guardian had to say, these dogs would not get into critically ill situations as often.

    We are experts on our dog's behavior. We make ALL the decisions.

    Misdiagnosis would have killed my dog. I am very fortunate to have a great vet who does listen very carefully and truly respects my opinion.

    Richard Ford
    @mybullseyeview

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  6. Yes, that was very fortunate for Dylan! Jasmine wasn't so lucky in the past. She now does have an awesome vet also (well, a crew of vets actually)

    You story is a proof of how important these things are.

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  7. Yes, it seems great vets often hang out together. Mine does go away to learn and stay on top of things, so it is critical that the others in the office be of similar mind and capability. I am lucky that way too, I know them all at the Mosquito Creek clinic and they have all helped Dylan and my other dogs. I can trust each of them to listen to me and help me make the decisions and I did so while treating Dylan.

    It certainly helps when things get serious and critical, to be able to trust your veterinarian and I certainly recommend to find the best before your dog becomes critically, or seriously ill when it will most certainly matter.

    And I more than appreciate you posting facts that back up my point. Great article and valuable info for every dog owner.

    ReplyDelete
  8. Ours are actually all different clinics and specializations, but two of them are close friends.

    ReplyDelete
  9. Excellent Post! I just noticed this change a few minutes ago and made a short post about it. I will include your post in it. I have two dog name jojo and mosa German Shepherd Breed I create a blog to know more about dog world.

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    ReplyDelete

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