What questions to ask your patient: Guidelines for the medical team
Respect for and recognition of the important role the animal plays in the life of his caregiver must be reflected in the way the veterinarian communicates with his client and be incorporated into all aspects of care offered.
By Dr. vet.. Alexandra L. Winter, USA
The veterinarian’s ability to communicate in clear and understandable yet compassionate terms helps the pet owner to make sense of the often very complex medical information and the options available for treatment. He or she must present all necessary information and options in order to enable the client to make the best decisions for their pet, not based solely on his illness, but also his quality of life.
How the healthcare team communicates and responds to a client’s grief after the loss of a pet can in fact be a key factor in the client’s continued loyalty to the practice.
Training in such effective, helpful and empathetic communication should be incorporated as a core component of veterinary professional education.
The veterinarian should describe the diagnosis, tests and therapies in a language that the client can understand and minimize the use of clinical terminology, abbreviations, or acronyms that can be overwhelming or intimidating to the client.
Although the client’s medical knowledge may be limited, if the veterinary team explains outcomes clearly and completely, in understandable language accompanied with written hand-outs, the client can still make informed decisions and exercise control over their pet’s treatment plan.
Conversations about EOL (the end-of-life stage), death, and grief with a bereaved dog owner are never easy, especially when urgent measures have to be taken immediately. Therefore:
The veterinarian should take his time to listen and ask open-ended and empathetic questions.
Here are some open-ended and empathetic questions showing interest:
Reflective listening:
Reflective listening is a technique involving repeating what clients say or suggest, thus showing interest in their thoughts and feelings, and making sure that you have understood their concerns. By paraphrasing clients’ meaning, you show empathy and clarify their understanding.
You may start these responses with standard phrases such as “So, you’re saying that…” and “It sounds like…” Reflective listening can also be communicated non-verbally, with nods and smiles, thus acknowledging what has been heard.
If you want a pet owner to expound without your input, try repeating the client’s last word or phrase. If a client says, “Alice has just been acting crazy,” you may respond with a simple, “Crazy?” The pet owner will instinctively elaborate for you.
The following chart illustrates an integrated approach to supporting a caretaker who is experiencing a negative diagnosis or bereavement over the loss of their pet.
→ AAHA/IAAHPC End-of-Life Care Guidelines for Dogs and Cats
→ AAHA/IAAHPC End-of-Life Care Guidelines
Verbal communication
Non-verbal communication (how you deliver the message)
Non-verbal communication
Verbal communication
For example: “Whether a dog develops hip dysplasia is influenced by many things. It might be due to genetics, something in the environment, or even diet. So it’s possible that your dog may even be the only dog from his litter to have clinical signs of hip dysplasia.”
= TOO MUCH INFORMATION IN ONE CHUNK!
Close-ended questions are yes-or-no-questions. To really build a relationship with your client, you need more than a one-word answer—which means you need to ask an open-ended question. Then you can ask follow-up questions using either method, depending on what has piqued your interest. With yes-or-no questions you could cut the conversation short, leaving you with an incomplete evaluation.
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1. Relationship-building questions
These questions help the veterinarian to get to know the caretaker and get a clearer picture of the pet's general environment. These informal, open-ended questions also relax the atmosphere.
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2. Questions assessing the caretaker’s needs and concerns
These questions help find out what the caregiver is looking for. For example, does he or she want peace of mind, comfort, or a financial estimate?
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3. Questions probing the pet's needs
With these questions, you're pinpointing changes in the pet's life. What does the animal need now? These questions also help clients understand that their pet goes through different life stages.
Did the pet caretaker understand the information?
The best time to discuss the pet’s disease with the client is not necessarily when the individual has just been informed of a terminal or progressive-disease diagnosis for their furry friend. Depending on the degree of attachment between the pet and its owner, the impact of such news will often evoke a strong emotional reaction. Practitioners should anticipate this reaction, respond to it by expressing empathy, and consider setting up a follow-up appointment to discuss EOL treatment options. This gives the owner time to come to terms with the new reality and to participate more fully in the development of a realistic, mutually acceptable treatment plan.
Provide handout information to take home. This way the caretaker can prepare himself for the follow-up visit and ask appropriate questions.
The follow-up visit is then an opportunity for a two-way information exchange between the veterinarian and client. An effective approach for conducting an EOL follow-up discussion is to schedule the appointment so as to give the veterinarian and caretaker time for an uninterrupted, open-ended discussion.
The client should be invited to ask questions and should not feel rushed or pressured into making treatment decisions. Regardless of the decisions that are made, the client should never feel judged.
It is often helpful for both the veterinarian and the caretaker to have a checklist of questions to ask and issues to discuss. The following chart provides a list of issues to discuss with the caretaker when an EOL or palliative care treatment plan is developed. Such a chart could also serve as a helpful handout for the client.
Practical Issues in Implementing a Palliative or EOL Care Plan:
Issue |
Topics to Discuss with Client |
Treatment locations |
|
Individual responsibilities |
|
Client education |
|
Environmental modifications |
|
Owner safety and hygiene |
|
Periodic plan assessments |
|
Medication, nutrition, and activity review and assessment |
|
It is the veterinarian’s duty to recommend humane euthanasia to relieve the patient’s suffering when palliative care no longer meets the animal’s physical, social, or emotional needs.
However, for some pet owners, euthanasia may not be an acceptable procedure. In such cases, high-dose palliative sedation combined with adequate analgesia is an ethical alternative = supported natural death.
An ongoing empathetic dialogue with the pet owner is essential during this stage in order to adequately communicate to the caretaker what to anticipate with the dying process as well as the post-mortem duties.
The following communication guidelines will help the veterinary healthcare team to engage in ethical, collaborative EOL decision-making:
It is helpful for the bereaved pet owner to express their emotions to an empathetic listener, the medical team. Regular, empathetic communication is the hallmark of effective support of the dog owner during EOL treatment and also after a patient’s death. The veterinary healthcare team has a responsibility to see the EOL case experience through the client’s eyes and take enough time to provide non-judgmental support.
Informing dog owners about the patient’s disease and possible out-come is particularly important in end-of-life cases. The more the caregiver understands about the disease progression, the better he or she will be able to cope with their expanded EOL caregiving role. The veterinarian should advise the client about the expected trajectory of the pet’s disease. This should include a thorough discussion of diagnostic and treatment options, interventions to ensure the pet’s comfort, and a realistic prognosis.
One of the major goals is for the pet owner to have a clear understanding of all diagnostic and treatment options. Decisions on EOL care should be made only when the pet owner has achieved a clear understanding of the situation and the options.
A thorough description of each diagnostic test, treatments and therapy, including how the results will influence patient care, will allow the dog owner to make an informed choice about whether or not to authorize the recommended procedure. It will also enable the dog owner to ask the right questions.
What do clients expect from the veterinarian
Resources and further readings
→ AAHA/IAAHPC End-of-Life Care Guidelines for Dogs and Cats (PDF)
→ AAHA/IAAHPC End-of-Life Care Guidelines
→ Communication Solutions For Veterinarians, Wendy Myers
Textbook: Client Satisfaction Pays ,Dr. Carin A Smith, AAHA Press.
→ Veterinary Communication websit
→ Magazine: Veterinary Team Brief
→ Key Communication Techniques for the 7/27/2014 Veterinary Health Care Team