Helping your veterinary clients feel heard and understood improves communication and relationships, and resolves conflicts.
The veterinary setting has always been a prime area for communication challenges. While it’s tempting to focus on the cute puppies and kittens coming in for their first vaccinations,
the reality is that veterinary teams are often faced with intense conversations with clients about difficult medical treatment decisions, financial considerations, and the need for euthanasia.
The pandemic has compounded these issues. Like many businesses, veterinary clinics have found themselves swimming in a sea of uncertainty among community shutdowns, changing regulations, and staffing shortages. At the same time, according to the American Society for the Prevention of Cruelty to Animals (ASPCA), more than 23 million U.S. households have adopted pets during the pandemic, leading to higher demand for veterinary services. Now, in year three of the pandemic, clinic schedules remain packed and both staff and clients are experiencing high levels of stress, making the need for clear
communication more important than ever.
WHAT’S HAPPENING IN THE BRAIN
While it is tempting to focus only on what is coming out of our mouths when we talk about communication, we first need to understand what is going on in the brain. Dr. Dan Siegel
has a great way of talking about how the brain works in high-stress situations.
It’s called “The Hand Model of the Brain” (Siegel, D. “Minding the Brain”. https://www.psychalive.org/minding-the-brain-by-daniel-siegel-m-d-2/).
Hold up your hand, palm facing out. Tuck in your thumb towards your palm, and
then bring down the remaining fingers to cover your thumb. Now you have a general model of your brain! Your fingers represent the front of your brain which is an area called the prefrontal cortex, while your thumb and wrist represent the interior parts of the brain such as the limbic system and brain stem.
The prefrontal cortex allows us to think critically, make logical decisions, and have emotional regulation, while the limbic system and brain stem have more to do with emotions and instinctual responses. This is important because it turns out that the
prefrontal cortex is sensitive, and when it gets overwhelmed, it does what Dr. Siegel calls “flips its lid” (quickly straighten out your fingers), giving over control to our more emotional
and instinctual impulses. In some situations, this is critical for survival. If you find yourself being physically attacked, you don’t want to ponder the most logical solution, you want to save yourself as quickly as possible! However, when the stressor is a challenging or difficult conversation, “flipping our lid” is more likely to lead to emotional outbursts, or not being able to speak at all, rather than effective communication.
To keep our “lids” where we need them to be, we must first take care of ourselves. While it seems like everyone is touting the benefits of self-care, taking time for oneself can feel like an additional burden when our schedules are already so full. Maintaining healthy eating habits can help us keep our cool. While the advertisers of Snickers didn’t have it exactly right — you are still you when you are hungry — you probably aren’t performing at your best. Hunger can lead to low blood sugar, which can cause fatigue, sleepiness, difficulty concentrating, and poor coordination. It can also lead to a release of cortisol and adrenaline, which can contribute to feeling “hangry” (hungry + angry) when faced with stressors or irritations. While it may feel like you don’t have the time or energy to plan ahead, making time for healthy meals and snacks throughout the day can help keep your mood stable and your energy up.
Similar issues arise with a lack of restful sleep. In addition to being associated with potentially serious medical conditions, like high blood pressure, heart disease, and stroke, being sleep-deprived can also contribute to feelings of irritability, problems with memory, an inability to concentrate, and a depressed mood. It’s obvious that if you’re tired, irritable, and having trouble focusing on the situation at hand, your ability to communicate will be impaired. Turning off screens at least an hour before bed, listening to a calming podcast or music, or reading a book, are some things you can add to your routine to help lead you to better sleep. If you have concerns about the amount or quality of your sleep, please consult your medical provider.
By maintaining a healthy body and brain, we’re better preparing ourselves to cope with challenging communication scenarios.
SETTING BOUNDARIES
Healthy communication includes maintaining healthy boundaries. While we have no control over what anyone else will say or do, we do have some control over what we will tolerate from others. In the veterinary setting, establishing boundaries about time and behavior are common needs.
For clients who call or show up at the veterinary hospital excessively, setting a
boundary may look like establishing specific times when the veterinarian will call to discuss the animal’s progress, or blocks of time when the client can visit with their animal. For example: “Mrs. Jones, Dr. Smith will call you sometime between 2 pm and 4 pm to talk to you for up to 30 minutes about how your dog is doing.” If the client calls outside the appointed time, unless it’s an emergency, have staff take a message and tell the client that their concern will be addressed during the scheduled call. If you are not able to keep that appointment, be sure someone contacts the client to let them know. Boundaries of this nature can be negotiated — maybe the client would rather have two shorter calls rather than one long one — but the important thing is that a boundary is set, and the needs of the client and clinic are balanced.
Many veterinary clinics have had experiences with clients becoming verbally abusive towards the staff. Verbal abuse can consist of yelling, cursing, calling people names, or even threatening them. Acknowledge what the person is feeling and set a boundary: “Mr. Jones, I can tell you’re angry, but I am not going to let you talk to me that way. If you wish to continue this conversation, I need you
to lower your voice.” If the client will not do so, it is appropriate to ask them to leave. The conversation can be picked up at a different time, or other resources may be offered.
NONVERBAL COMMUNICATION
Communication goes beyond the words you use. A significant portion of our communication is nonverbal, although there’s some disagreement about the exact percentage.
Tone of voice: The entire meaning of a sentence can change based on the tone of voice and inflection you use. For example, can you remember when you were a child and an adult called out your name? Could you tell when you were about to get in trouble? Of course you could! There was something about the way the adult said your name that
let you know there was a problem. Make sure your tone of voice matches whatever message you’re trying to convey to the other person. If we want people to remain
calm, we need to speak calmly, which means regulating the tone and volume of our voices and the speed of our speech.
Facial expressions: We also receive a great deal of information from the facial expressions of the person we are talking to. This has presented a challenge during the pandemic, since we need to wear masks that cover the nose and mouth when we’re in public places. Not only is it a hindrance for those who rely on reading lips to help them determine what people are saying, but we’re now limited to the upper portion of the face, which provides more subtle expressive cues. Many people lack awareness of their facial expressions when they’re talking. Particularly over a mask, those slightly bent eyebrows or furrowed forehead may now be interpreted as anger or grumpiness when people can’t see your mouth. Do you know what your face does when you speak? Stand in front of a mirror and pretend you’re having a conversation. Does your facial expression correspond with the message you are trying to convey? It may feel silly, but an awareness of your facial expressions is the first step to being able to adjust them if needed.
Body language: In addition to tone of voice and facial expressions, we also communicate a great deal with our body language, particularly through gestures and posture. While
gestures can be helpful to convey information — location, size, or emphasis — when we’re in a stressful conversation or conflict, we want to keep our gestures calming and neutral.
Avoid sudden, large movements and keep your hands near the mid-portion of your body. Your posture can also be interpreted in a variety of ways. While it may simply be comfortable to you, having your arms crossed may give the impression that you are defensive or closed-off.
Standing with your hands on your hips can be seen as being scolding or stubborn. Particularly in times of conflict, aim to keep an open posture. Keeping your hands either at mid-waist or down at your sides conveys that you are relaxed and open to listening.
BEING HEARD AND UNDERSTOOD
When we communicate with one another, we want to feel as though our message has been heard and understood. Use active listening skills to help make that happen.
1. Paying attention: Show you’re paying attention by making eye contact, and occasionally nodding your head when appropriate. Don’t interrupt, and pause before answering. Often, we start planning our response before the person has even stopped talking. Listen to understand, not to respond.
2. Reflecting: Repeat back what you heard the person say. For example, if a client is debating treatment options because they have concerns about cost and their animal’s
quality of life, you might say something like, “I’m hearing that you’re worried about how much this treatment will cost, and you’re not sure your dog will be able to do the things he loves to do, like go for walks in the park. Is that right?” By reflecting what the client said, you’re showing that you heard them, and also giving them the opportunity to confirm that you have it right, or to correct you if it is not what they meant. For example, “Yes, I am worried about how I will pay for this, but I’m more worried about how much pain my pet will be in.”
3. Clarifying: If you’re not sure what the other person in the conversation is saying, use clarifying questions or statements such as, “Let me make sure I understood correctly. Are you saying that you’re worried about your dog’s quality of life?”; “Tell me more about that”; or “Can you explain that a little more?” Not only do these open-ended questions help you get more information, but they also show you’re interested and paying attention to what the person is saying.
HOW YOU’RE SAYING IT
Just as it’s hard for you to communicate when you’ve “flipped your lid”, this is also true for your clients. If they are stressed, scared, or angry, it is going to be harder for them to focus and understand what you’re saying.
Keep your language simple. Medical terminology can be confusing for a layperson on a normal day; during a crisis, it may be overwhelming. Remember, stress is contagious so make an effort to speak slowly and calmly.
Stress affects focus and memory. Give clients written materials that reinforce what you’ve told them, so they can review the material later or schedule a follow-up call to go over it again and ask any questions.
Ask clients to reflect back to you what you said. “I want to make sure I explained this clearly. Can you tell me how many times a day you will need to give this medicine?”
It takes time and effort to connect with people, but helping them feel heard
and understood is the first step to resolving conflicts and improving professional-client relationships. By communicating clearly, we can create a better work environment and
better outcomes for animals.
AUTHOR PROFILE
Dr. Bethanie Poe has been involved with the University of Tennessee Veterinary Social Work program for over a decade, first as a graduate student when she helped develop the Veterinary Social Work Certificate Program, and now as an instructor. Dr. Poe is currently the Middle Tennessee Coordinator for UT’s Human-Animal Bond in Tennessee (H.A.B.I.T) program, where she strives to make animal assisted interventions available to victims of crime.
