Communication Tightrope

800px Tightrope walking
I’ve talked before about how “medicine is the easy part” of being a veterinarian. The challenges come when working to bridge the gap between the perfect world of ideal medical care and the reality that most people live in. We have budgets, mortgages, groceries to buy, school supplies to purchase, and far more. It can be difficult to juggle finances. It’s just as difficult (if not more so) to educate clients about what we feel is the best possible care available.

It’s not unlike a high wire tightrope, stretched between my veterinary oath and a client’s home. I have to walk that line with the proper caution to make sure I safely get to the other side. In some cases, the directions I give help the client cross my way.

Ultimately, both the owner and the veterinarian want what’s best for the pet. We’re usually able to find a happy medium. I’d like to share some examples of the situations I’ve worked through. How would you respond?

First case: A 3-year-old cat comes into the hospital for a checkup because the owner saw some little worm things stuck to his backside. The cat goes outside, has never had shots, and sometimes gets in fights with other cats in the neighborhood. The owner says he only has enough money to cover the exam, a stool check, and a dewormer. What would you do as the veterinarian? Let me add a few pieces to the puzzle. This cat should have a feline leukemia and feline immunodeficiency test, distemper and rabies vaccinations, a leukemia vaccination, heartworm prevention, and flea control. He also has really nasty teeth that should be cleaned. Now what do you do as the veterinarian?

Next scenario: An owner comes in with a new puppy. She’s brought her other adult dog in only twice in the last 4 years. That dog isn’t on heartworm prevention regularly, is overdue for some vaccines, and hasn’t had a stool check in 3 years. The new puppy will need 3 visits for her puppy vaccine series, stool checks, heartworm and flea prevention, and spay surgery. The owner has a brand new leash, collar, t-shirt, and purse for carrying the dog around in. She also has “lots of chew toys at home.” Let’s make this one a little easier by saying the client has no financial constraints, so money isn’t the reason she’s behind on caring for the adult dog. As the veterinarian, how would you advise that client about caring for two dogs when the first dog didn’t even get what we would consider the bare minimum for care?

Last one: An owner that comes in once a year with his dog and keeps up on heartworm prevention and vaccines is here for the annual visit. The veterinarian identifies a small lump under the skin and really bad dental disease. The dog is otherwise healthy. The owner gets the heartworm test and prevention, allows us to update the dog’s vaccines, and purchases some flea control for the summer. However, when the veterinarian discusses a dental cleaning and mass removal, the owner refuses to plan to have these services done. “It’s too much money and he still eats, so I don’t think he’s in pain and his teeth are fine.” What would you do as the veterinarian? Would that answer change if I added more information? That tumor could be cancer, cured if we remove it now, or fatal if it’s left in for months and months. This dog could develop a heart condition, kidney damage, or liver damage because of the bad teeth. Those consequences could take up to 2 years off the dog’s lifespan.

I firmly believe that the vast majority of clients love their pets dearly. I believe that they want to do as much as they can for their pet. I believe in trying to find a happy medium whenever I can. However, I also have a responsibility to advocate for the pet’s best interests. I have to discuss the consequences of not taking action. It requires extremely careful language to tell a client that their decisions are going to kill their pet without being offensive. I’m really not trying to blow my own horn, here. There have been times when the approach I thought would be good turned out to be horrible. People communicate in different ways. They have different values, different goals, different circumstances.

I would love to hear some feedback! All comments are screened, so if you don’t want your comment posted on the blog, just type that into the comment. I won’t publish any comment that you wish to remain confidential. If you’re willing to share, let me and the other readers know what your approach would be if you were the veterinarian working those cases. I learn things from clients every day, so I’m always eager to hear what you think.

Thanks for reading!

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2 Comments

Filed under communication, practice

2 responses to “Communication Tightrope

  1. Chris

    First and foremost, as you said, you are first-last-always an advocate for each pet. Even when you meet resistance to care for any reason, it’s still your responsibility to inform each owner of the risks their pet faces as a result of the pet’s current condition. Most people view life according to their own self-interests, so use an approach that appeals to that aspect of human nature.
    ~ If money is a problem, suggest the low-cost-vaccine afternoon Pet Authority offers and stress the fact that prevention is always cheaper than treatment. If the owner is lax about wellness care, they may be snapped into reality with a dose of the whole truth. Isolate what the hesitation is for each owner, then focus on what specifically you can do to enlighten that particular person to the best interests of their pet.
    ~ Owner ignorance plays a part here. Most people don’t understand the consequences of dental disease, or that a little bump now could become life threatening later, or that a mosquito bite can be lethal eventually. Explain that, as a vet, you need to show them the whole picture, so that an informed decision can be made. Give them something to think about; they may see the light after it rolls around in their brain for a while. Either way, you’ll know you’ve done your best for each pet.
    ~ It is a tightrope. You can lead a horse to water…

  2. All very sound advice! Some of these techniques/approaches are already In use. 🙂

    My overall goal is to give people the information they need to make a decision thatched feel is right, while also making sure that the *wrong* decision isn’t made.

    Thanks for offering your thoughts!!

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