A Guide to Oral Communication in Veterinary Medicine

Good communication skills provide better clinical outcomes and help avoid minor as well as major mistakes. Approximately 60-80% of negligence claims against vets are related to poor communication, with new graduates especially vulnerable. Communication skills are a growing part of the curriculum in veterinary schools, recognising how fundamental clear communication is to good practice. A Guide to Oral Communication in Veterinary Medicine covers why communication skills are important, the structure of typical communications and suggested approaches, veterinary specific communication pathways, and sample scripts between vet and client. Scenarios covered include everyday communication, dealing with challenging situations, different species, different settings, and communication within the veterinary team. The aim is to instill confidence and competence, build professionalism, and avoid problems. Most current teaching is based on a toolbox approach developed from the human medicine model. However, there is no set standard for teaching methodology, which is why this is primarily a book for students, but also includes a section for educators to provide guidance in this nascent subject.
Half Title
Title Page
Copyright Page
Contents
About the Author
Preface
Dedication
Acknowledgments
About the companion website
List of Acronyms
PART I CLINICAL COMMUNICATION AS AN INTEGRAL PART OF THE VETERINARY PROFESSION
CHAPTER 1 WHAT DO OUR CLIENTS UNDERSTAND? THE EVOLUTION OF THE DOCTOR–PATIENT RELATIONSHIP, PATIEN
1.1 The Development of Medical Paternalism
1.2 The Limitations of Medical Paternalism
1.3 The Evolution of Relationship–Centered Care
1.4 The Modernization of Medicine Drives Relationship–Centered Care
1.5 The Concept of Health Literacy
1.6 How Do Health Literacy and Relationship–Centered Care Apply to Veterinary Medicine?
CHAPTER 2 HOW CAN WE HELP OUR CLIENTS TO UNDERSTAND? THE EMERGENCE OF CLINICAL COMMUNICATION AS A TE
2.1 Connectivity and the Provider–Patient Relationship
2.2 Past Assumptions about Relationship-Centered Care
2.3 Challenging Past Assumptions
2.4 The Kalamazoo Consensus Statement and Relationship-Centered Care
2.5 The Changing Face of Medical Education
2.6 The Changing Face of Veterinary Education
2.7 Communication as a Teachable Skill
2.8 Present-Day Challenges Associated with Teaching Communication
2.9 The Future of Communication Training in Veterinary Curricula
CHAPTER 3 HOW CAN WE STRUCTURE THE CONSULTATION FROM THE VANTAGE POINT OF CLINICAL COMMUNICATION? TH
3.1 The Shift from Medical Paternalism to Relationship-Centered Care
3.2 Relationship-Centered Care in Veterinary Medicine
3.3 The Development of Consultation Models
3.4 The Calgary–Cambridge Model
3.5 The Revised Calgary–Cambridge Model for Veterinary Patients
3.6 Limitations of Consultation Models
PART II DEFINING ORAL COMMUNICATION SKILLS AS THEY RELATE TO THE VETERINARY CONSULTATION
CHAPTER 4 FIRST IMPRESSIONS
4.1 Our Journey through Healthcare as Consumers
4.2 The Veterinary Client’s Experience
4.3 Starting the Client’s Journey off on the Right Foot
4.4 Prep Work May Seem Silly, But …
4.5 Greeting the Client: What the Veterinary Team Can Learn from Human Healthcare
4.6 Greeting the Veterinary Client: Finding Common Ground
4.7 Attending to the Client’s Comfort
4.8 Acknowledging and Attending to the Patient
CHAPTER 5 DEFINING ENTRY-LEVEL COMMUNICATION SKILLS: REFLECTIVE LISTENING
5.1 Introduction to Reflective Listening
5.2 Clinical Conversations, Defined
5.3 Why Should Healthcare Providers Listen?
5.4 Why Is Effective Listening such a Difficult Task?
5.5 Active or Reflective Listening, Defined
5.6 Active Listening Requires Preparation
5.7 Active Listening in Veterinary Practice
5.8 Examples of Active Listening Statements in Veterinary Consultations
CHAPTER 6 DEFINING ENTRY-LEVEL COMMUNICATION SKILLS: EMPATHY
6.1 Cognitive Empathy
6.2 Missed Opportunities for Empathetic Displays in Healthcare
6.3 Emotional Empathy
6.4 The Impact of Empathy on Case Outcomes
6.5 Empathy versus Sympathy
6.6 The Human–Animal Bond Creates Opportunities for Empathy in Veterinary Practice
6.7 The Dangers of Making Assumptions about Client Emotions
6.8 When Might Clients Become Emotional?
6.9 The Challenges Associated with Empathetic Displays in Clinical Practice
6.10 Displaying Empathy through Actions in Clinical Practice
6.11 Displaying Empathy through Words in Clinical Practice
6.12 The Potential Dangers of Empathy in Clinical Practice: the Client’s Perspective
6.13 The Potential Dangers of Empathy in Clinical Practice: the Clinician’s Perspective
6.14 The Decline of Empathy?
CHAPTER 7 DEFINING ENTRY-LEVEL COMMUNICATION SKILLS: NONVERBAL CUES
7.1 The History of Nonverbal Cues in Clinical Conversations
7.2 The Importance of Nonverbal Cues in Clinical Conversations
7.3 What Contributes to Accuracy in Judgment Making Based upon Fleeting Observations?
7.4 What Are Nonverbal Cues?
7.5 Kinesics
7.6 Proxemics
7.7 Paralanguage
7.8 Autonomic Shifts
7.9 Revisiting the Impact of Nonverbal Cues on Clinical Conversations
7.10 When Words and Nonverbal Cues Do Not Align: How to Handle Mixed Messages
7.11 Nonverbal Skills Development
CHAPTER 8 DEFINING ENTRY-LEVEL COMMUNICATION SKILLS: OPEN-ENDED QUESTIONS AND STATEMENTS
8.1 The Comprehensive Patient History
8.2 Why is it Critical to Elicit the Patient’s Concerns? The Human Medical Perspective
8.3 Why is it Critical to Elicit the Client’s Concerns? The Veterinary Perspective
8.4 Noncompliance in Healthcare
8.5 The Art of Listening and the Dangers of Interrupting during History Taking
8.6 The Art of History Taking: Introducing Two Styles of Questioning
8.7 Closed-Ended Questions, Defined
8.8 The Open-Ended Question or Statement
8.9 Is there a Place for Both Open- and Closed-Ended Questions?
8.10 Client Preferences for Open-Ended Questions Based upon Species
CHAPTER 9 DEFINING SUPPLEMENTAL COMMUNICATION SKILLS: REDUCING MEDICAL JARGON
9.1 Defining Medical Jargon
9.2 The Limitations of Medical Jargon: the Provider’s Perspective
9.3 The Limitations of Medical Jargon: the Patient’s Perspective
9.4 Easy-to-Understand Language Implies Transparency
9.5 Implications for the Veterinary Medical Profession
9.6 Strategies for Overcoming the Use of Medical Jargon
CHAPTER 10 ENHANCING RELATIONSHIP-CENTERED CARE THROUGH PARTNERSHIP
10.1 The Shift towards Partnership
10.2 Are Veterinary Clients Experts?
10.3 Setting the Stage for Relationship-Centered Care
10.4 Establishing Partnership with the Client
CHAPTER 11 ELICITING THE CLIENT’S PERSPECTIVE TO ENHANCE RELATIONSHIP-CENTERED CARE
11.1 Phrases that Effectively Elicit the Client’s Perspective
11.2 Softening These Phrases
11.3 What Happens When We Do Not Use This Skill
11.4 Revisiting the Same Scenario and Eliciting the Client’s Perspective
11.5 Eliciting the Client’s Perspective Also Helps Clients Open Up about Treatment Preferences
CHAPTER 12 ASKING PERMISSION TO ENHANCE RELATIONSHIP-CENTERED CARE
12.1 Incorporating Permission Statements into Clinical Scenarios
12.2 What if the Client Doesn’t Say “Yes”?
12.3 Alternative Phrasing of “May I?”
12.4 Other Clinical Scenarios that Benefit from Asking Permission
12.5 The Clinical Importance of Asking for Permission among Dog and Cat Owners
CHAPTER 13 ENHANCING RELATIONSHIP-CENTERED CARE BY ASSESSING THE CLIENT’S KNOWLEDGE
13.1 What Happens When We Do Not Assess the Client’s Knowledge?
13.2 Revisiting the Same Scenario to Assess our Client’s Knowledge
13.3 Other Reasons to Assess our Client’s Knowledge
13.4 Assessing Knowledge Is Respectful
CHAPTER 14 MAPPING OUT THE CLINICAL CONSULTATION: SIGNPOSTING
14.1 Defining the Consultation Map
14.2 Using Signposting to Outline Differentials
14.3 Using Signposting to Discuss Treatment Plans
14.4 Using Signposting to Rein in a Chatty Client
14.5 Using Signposting to Preface Actions, Such as Reviewing the Medical Record
14.6 Using Mapping Statements as Caution Signs, So-Called “Warning Shots”
CHAPTER 15 COMMUNICATION SKILLS THAT FACILITATE CLIENT COMPREHENSION: SUMMARIZING AND CHECKING IN WI
15.1 Summarizing
15.2 Internal Summaries, Defined
15.3 End-of-Consultation Summaries
15.4 “Chunk and Check”
CHAPTER 16 COMMUNICATION SKILLS THAT FACILITATE COMPLIANCE: CONTRACTING FOR NEXT STEPS
16.1 Defining “Contracting for Next Steps”
16.2 Examples of Contracting for Next Steps in Clinical Practice
16.3 Contracting for Next Steps Tells the Client What to Expect
16.4 Contracting for Next Steps Reinforces Our Role in Patient Care
16.5 Modifying How Contracting for Next Steps Is Phrased
16.6 Be Prepared for the Client to Say “No” to the Initial Plan
CHAPTER 17 AGENDA-SETTING AND THE FINAL “CHECK-IN”
17.1 The Value of Agenda-Setting
17.2 The Final Check-In as a Relationship Builder
17.3 Pairing the Final Check-In with Appropriate Nonverbal Cues
17.4 What If the Client Does Not Stop Talking?
CHAPTER 18 DEFINING TWO NEW SKILLS THAT COMPANION-ANIMAL CLIENTS VALUE: COMPASSIONATE TRANSPARENCY A
18.1 What Is Transparency in Healthcare?
18.2 Barriers to Transparency in Healthcare
18.3 Transparency in Veterinary Medicine through Words
18.4 Transparency in Veterinary Medicine through Actions
18.5 Veterinary Clinical Scenarios that Involve Transparency
18.6 Example of a Situation that Would Have Benefited from Transparency
18.7 Unconditional Positive Regard in Healthcare
18.8 Unconditional Positive Regard in Veterinary Medicine
18.9 Veterinary Clinical Scenarios that Involve Unconditional Positive Regard
PART III APPLYING COMMUNICATION SKILLS TO EVERYDAY CONVERSATIONS IN CLINICAL PRACTICE
CHAPTER 19 USING COMMUNICATION SKILLS TO INITIATE THE CONSULTATION
19.1 Preparing for the Visit
19.2 Developing Rapport
19.3 Identifying the Presenting Complaint
CHAPTER 20 USING COMMUNICATION SKILLS TO GATHER DATA: HISTORY TAKING
20.1 Taking a Complete History at a Wellness Appointment
20.2 Taking a Complete History at a Sick Visit
CHAPTER 21 USING COMMUNICATION SKILLS TO GATHER DATA: EXPLAINING AND PLANNING
21.1 Explaining Physical Examination Findings in an Apparently Healthy Patient
21.2 Explaining Physical Examination Findings in an Ill Patient
21.3 Forward Planning
21.4 Planning Next Steps in an Apparently Healthy Patient
21.5 Planning Next Steps in an Ill Patient
PART IV TESTING YOUR UNDERSTANDING OF ORAL COMMUNICATION SKILLS IN VETERINARY MEDICINE
CHAPTER 22 END-OF-CHAPTER READING COMPREHENSION QUESTIONS
CHAPTER 23 WORKBOOK-STYLE EXERCISES
Exercise 23.1 – Defining Communication Skills I
Exercise 23.2 – Defining Communication Skills II
Exercise 23.3 – Examples of Communication Skills in Use I
Exercise 23.4 – Examples of Communication Skills in Use II
Exercise 23.5 – Open- vs Closed-Ended Questions I
Exercise 23.6 – Open- vs Closed-Ended Questions II
Exercise 23.7 – Converting Closed-Ended Questions into Open-Ended Questions
Exercise 23.8 – Converting Open-Ended Questions into Closed-Ended Questions
Exercise 23.9 – Reflective Listening I
Exercise 23.10 – Reflective Listening II
Exercise 23.11 – Empathy I
Exercise 23.12 – Empathy II
Exercise 23.13 – Nonverbal Cues
Exercise 23.14 – Barriers to Communication
Exercise 23.15 – Reducing Barriers to Communication
Exercise 23.16 – Body Language and Communication I
Exercise 23.17 – Body Language and Communication II
Exercise 23.18 – Medical Jargon I
Exercise 23.19 – Medical Jargon II
Exercise 23.20 – Medical Jargon III
Exercise 23.21 – Medical Jargon IV
Exercise 23.22 – Medical Jargon V
Exercise 23.23 – Medical Jargon VI
Exercise 23.24 – Partnership
Exercise 23.25 – Eliciting the Client’s Perspective
Exercise 23.26 – Assessing the Client’s Knowledge
Exercise 23.27 – Signposting I
Exercise 23.28 – Signposting II
Exercise 23.29 – Signposting and Transparency
Exercise 23.30 – Putting It All Together
CHAPTER 24 ANSWER KEY TO WORKBOOK-STYLE EXERCISES
CHAPTER 25 CLINICAL VIGNETTES FOR ROLE PLAY
Scenario 25.1: Greeting the Client at a Wellness Visit I
Scenario 25.2: Greeting the Client at a Wellness Visit II
Scenario 25.3: Greeting the Returning Client I
Scenario 25.4: Greeting the Returning Client II
Scenario 25.5: Taking a Clinical History at the Wellness Visit – Feline
Scenario 25.6: Taking a Clinical History at the Wellness Visit – Canine
Scenario 25.7: Taking a Clinical History at a Sick Visit – Feline I
Scenario 25.8: Taking a Clinical History at a Sick Visit – Feline II
Scenario 25.9: Taking a Clinical History at a Sick Visit – Canine I
Scenario 25.10: Taking a Clinical History at a Sick Visit – Canine II
Scenario 25.11: Explaining Physical Examination Findings – Feline I
Scenario 25.12: Explaining Physical Examination Findings – Feline II
Scenario 25.13: Explaining Physical Examination Findings – Canine I
Scenario 25.14: Explaining Physical Examination Findings – Canine II
Scenario 25.15: Explaining Radiographs I
Scenario 25.16: Explaining Radiographs II
Scenario 25.17: Explaining Radiographs III
Scenario 25.18: Explaining Radiographs IV
Scenario 25.19: Explaining Bloodwork I
Scenario 25.20: Explaining Bloodwork II
Index