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Effective communication strategies in an emergency setting

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Dr. Kerri Nelson is an emergency veterinarian and medical director at Veterinary Emergency Group and will be opening their new hospital in Denver this summer. She is currently pursuing certification to become a Pet Loss Grief Recovery Specialist through the American Institute of Health Care Professionals, and is passionate about helping owners through the process of losing a beloved companion. Outside of work, she is an avid marathoner, equestrian, and skier. She recently started blogging about her experiences with burnout, grief, and compassion fatigue.

We set the owner up with a bean bag and Netflix for the night.

We have all been there: its 2 a.m. on a Saturday morning, you have a cat rushed into the hospital who is laterally recumbent, bradycardic, hypothermic, and dry as a raisin. You know from the second you look at this animal it will require multiple days of intensive care in order to save their life—if it can even be saved. Your team works efficiently to place an IV catheter, draw blood work, and provide heat support. You start to explain to the owner how serious this is, discussing differential diagnoses and a treatment plan. Before you know it, everything is turned around on you: “My cat was fine 2 days ago. Now you’re saying it will cost $5000 to fix him? And you don’t even know if he will live? If you cared about animals, you would be doing this for free.” And so on.

We have to accept the fact that there are some people in this world who will always react with this kind of anger, no matter how much we try to placate them. However, I have found these kinds of conversations can often be avoided simply by utilizing certain phrases and finding different communication strategies when owners are placed in these stressful situations.

1. Make a good first impression.

Owners should be greeted immediately upon arrival into the hospital. This goes without saying. Inevitably, the next thing you want to ask them is, “How are you?” This is a mistake I see many new veterinarians and support staff make. If an owner is in the emergency room in the middle of the night with a pet who isn’t doing well, chances are they aren’t great. So instead of saying this, I will introduce myself, ask the owner and the pet’s name, and then simply say something along the lines of, “How can we help you with Fluffy?” or “What brings you in today?”

2. Try to fill the silence.

For most of us, it only takes a couple minutes to perform a physical examination. For an owner, those few minutes may feel like an eternity. They are wondering what you’re finding as you’re looking over their pet, listening to their heart and feeling their abdomen. Even if what you find is normal, tell them that. The silence can be excruciating. So I like to fill the silence by saying things like, “His heart sounds good, no murmurs or arrhythmias. But he does look a little dehydrated.”

If you find something abnormal, like petechiation on the gums or an open wound, be sure to show this to the owner. Simply telling them without making them feel involved and letting them see the abnormalities for themselves is ineffective, and can sometimes result in disbelief on their part.

3. Pay attention to your body language.

If you talk with your arms crossed or turn your back to the client, this conveys the wrong message. Any time you can put yourself on the same level as someone, do so. Sit on a chair next to them, sit on the ground, do whatever you have to do to make the situation more comfortable and relaxing.

3. Be confident in your recommendations.

Choosing your words appropriately goes a long way when it comes to getting an owner to agree to your diagnostic and treatment plan. If you feel that blood work is necessary, state this clearly. When you say, “Maybe we should run some blood work” versus “I recommend we do blood work,” this conveys instills confidence that you feel a certain diagnostic is necessary.

Be specific about why you recommend a certain diagnostic. For instance, if you recommend radiographs in a vomiting dog, you might tell them you want to rule out a foreign body to make sure further intervention, such as endoscopy or surgery isn’t warranted. It is important to prepare owners for negative diagnostics, as it sometimes a point of contention when they spend money on diagnostics but “don’t have a definitive answer.” You may not have a definitive answer when that dog’s abdominal radiographs are unremarkable, but you can reassure an owner there is no obstruction, and that alone is of tremendous value.

5. Emphasize your common goal.

We want animals to get better and if they cannot be treated, we all want to make sure they aren’t suffering. When an owner is upset, whether they react with anger, anxiety, or anguish, simply reassuring them you both have the same end goal will greatly help to mollify the situation. Saying, “I share your concerns” or “Alleviating Fluffy’s pain is our main goal,” will help unite you, and allow you to work cohesively with the owner to make the best plan for your patient.

6. Be realistic and honest.

You’re not going to get a cat out of kidney failure in 24 hours. You’re not going to fix a DKA in one day. It is imperative to prepare owners not only for the length of hospital stay expected at the initial onset of an illness, but also to prepare them for the long-term. For instance, if you diagnose diabetes, they need to understand that having a diabetic animal is a huge lifestyle change. They need to understand insulin administration will become part of their daily routine, and there will be a significant number of follow-up appointments after the patient leaves the hospital.

It is always fair to say, “Let’s get through the first 24 hours and re-evaluate afterward, but realistically, kidney failure will not be fixed in just one day.” Sometimes I will make an owner a 24 hour estimate with the idea that 24 hours is our decision point. If the animal is improving, we will continue treatment. If the animal is not improving, worsening, or overtly suffering, then at that time we may consider humane euthanasia.

Owners always appreciate you being honest about what you would do if you were in their situation. And you may not always have the answer to that question, which is okay. Sometimes all you can do is give them all the prognostic information possible, be straightforward with them if you feel the animal is truly suffering, and if they still cannot make a decision, then it is the time to implement the “give it 24 hours and re-evaluate” strategy.

One of the most important phrases I say in the emergency room when I know a patient is terminal and suffering is to tell an owner, “Many people ask if it’s too soon to consider euthanasia, but more often than not, people tell me they wish they hadn’t waited so long. It is a gift to be able to alleviate their pain before it becomes too much to handle.”

At the end of the day, client communication can be one of the most trying parts of our job. However, it can also be one of the most rewarding parts of our job. Nearly any situation can be mollified when you shift the focus toward the well-being of your patient, and approach every conversation with honesty and solicitude.

“At the end of the day people won’t remember what you said or what you did, but they will remember how you made them feel.” – Maya Angelou

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