2.4.2 Empathy
Empathy is the ability to understand a client's emotions and feelings, and to reflect them back to them in a supportive way. It is an essential communication skill for the clinician to learn and utilize. The good news is that the skills required to come across as trustworthy and empathic can be learned and improved by practice.
2.4.3 Logic
Logic encompasses the actual words we use and the explanations we give of diseases and treatments, which are consciously assimilated by the client. In the Internet age, clients can be incredibly well educated about their pet's clinical signs and disease. If a client is seeking information from Google (where unprofessional opinions abound), try instead to direct them to Google Scholar for more objective, scientific information.
Figure 2.4 Diplomas in the waiting room.
Figure 2.5 Array of thank‐you pictures.
We must strive to educate the client. Indeed, this has been shown to increase levels of satisfaction and compliance (Lue et al. 2008). During the consultation process, use whiteboards, a pen and paper, or digital tools (tablets) to explain disease processes, and show the show client dental radiographs, slideshows, or pictures. Provide a scrapbook in the waiting area and collect client testimonials. Have a “dental pet of the month” on a display board. Produce professional leaflets explaining dental diseases for clients to take away and read. Ensure your website is up to date and contains useful information and videos (“How to Brush my Dog's/Cat's Teeth”). Ensure that your own skills and knowledge meet current recommended standards (Holmstrom et al. 2013). This is best achieved through a combination of theory and practical CPD courses. The whole team must voice the same message (see Chapter 4).
Logic allows a client to validate their gut‐feelings gained from the unconscious messages of trust and empathy.
2.5 Communication Skills
Communication should be thought of as a clinical skill essential to clinical competence – one that can be learned and improved (Beck et al. 2002; Shaw et al. 2004; Shaw 2006; Kanji et al. 2012). Communication skills are significantly associated with outcomes of patient care, including patient health, patient and physician satisfaction, and malpractice risk (Shaw 2006). There are three principal types:
Content Skills: The content of questions and information given.
Process Skills: Verbal (words chosen) and nonverbal communication, including vocal indicators (speech tone and pace, rhythm, inflections, sounds used to convey understanding [uh‐huh, ahh, mm], volume, laughing, yawning, etc.), facial expressions, eye contact, posture, touch (beware of intense cultural differences), gestures (pointing), body movement (foot or finger tapping), smell, and appearance.
Perceptual Skills: Cognitive (problem solving) and relationship (personal awareness and awareness of others) skills.
Shaw (2006) identified four core communication skills that highly effective practitioners should possess: nonverbal communication, open‐ended questioning, reflective listening, and displays of empathy.
2.5.1 Nonverbal Communication
Nonverbal and verbal communication should complement one another. If their messages are contradictory, the receiver (client) will instinctively trust the nonverbal signs as the true message (Mehrabian 1981). For instance, a veterinarian might say that a pet needs dental treatment because of signs of advanced periodontal disease, but if they are shifting in their seat and not maintaining eye contact with the client, this will not be a credible recommendation.
Miscommunication is much more likely to occur when nonverbal communication is lacking (e.g., emails and telephone calls).
Increase sensitivity to clients' nonverbal cues. Reflecting them back to the client in a supportive way can help display empathy (e.g., “I can see that you are concerned about the safety of a general anesthetic for Monty, so may I explain how we reduce the risks?”). Empathy is a positive predictor of consultation outcomes, including client satisfaction and compliance (Beck et al. 2002).
Increase awareness of your own nonverbal cues, which can include eye contact, gaze, body posture, orientation toward client, gesturing, and nodding.
Sincere smiling and appropriate eye contact can enhance your communication and display of empathy. Smiling reduces stress, increases positivity, and is infectious – when clients smile back, they feel more positive themselves. Eye contact can indicate attention and sincerity, but inappropriate gazing may come across as being aggressive and can negatively impact the physician–patient interaction (Beck et al. 2002) (Figure 2.6).
2.5.2 Open‐Ended Questioning
Open‐ended questions allow the client to elaborate and impart as much relevant information as possible. They start with words such as “What…?”, “How…?”, and “Tell me…” (e.g., “How has Misty been since I last saw you?). Closed questions, on the other hand, demand a one‐word answer (“Is Fluffy vomiting?”). Both styles are useful during the consultation process, but starting with an open question allows the client to voice all of their perceived problems and concerns, allowing them to feel fully heard. If the clinician can listen effectively (and not interrupt), they can reflect this back to the client, again showing empathy. Closed questions can be used later in the process to gain further details and clarification.
2.5.3 Reflective Listening
Effective listening is an essential skill that practitioners must learn. A good listener seeks to understand before being understood. It is important that you and the client agree that what you understand is a true representation of what the client was saying. Listening is very different from hearing. It can be challenging because our brains move much faster than we talk, thinking ahead and formulating diagnostic and treatment plans. Beckman and Frankel found in 1984 that in 69% of medical consultations, the patient was interrupted within 18 seconds of speaking to a doctor. When this happens, the patient loses their flow of thought, may repeat things that they have already said, and may go on to omit essential information.
Figure 2.6 Nonverbal communication: (a) smile versus (b) non‐smile.
Reflective listening returns back to the client both the words and the emotions that they themselves have conveyed. It shows that they have been heard and understood, and allows them to correct, clarify, or add additional details. It can be achieved via paraphrasing and summarizing:
1 Paraphrasing is restating the content and emotion of the client's message in your own words: “It must have been very distressing for you to see Milo paw at his face so aggressively.”
2 Summarizing presents to the client what you have understood so far: “So, Coco seems to be going off dry food, but is still keen on wet food. Her breath smells, but she seems well in herself. Is there anything else?”