Communication with Pet Parents is Important – In Life and In Death

by | Nov 30, 2011

Education about medical treatments is just as important as education about death care processes

Here´s the article that Dr. Marty Becker shared – in its entirety:

Sticks and Stones May Break Your Bones, But Words Can Cost Your License
By James F. Wilson, DVM, JD; Christina Moore, DVM candidate 2012; Erich Roush, DVM candidate 2013
November 15, 2011

A 10-year-old Yorkie died unexpectedly after receiving the third mitotane (Lysodren, drugs.com/pro/lysodren.html) tablet you dispensed to treat her Cushing´s disease. You know that either you or your room technician told the client about the possible risks and complications of this treatment because “someone always does.”

Now you are being investigated by the state veterinary medical board, your license is at stake, and Ms. Loveherpet is threatening a lawsuit for $100,000 in damages for emotional distress for the loss of her best friend “Gigi.”

Even worse, she´s threatening to trash your practice by starting a website to determine how many other pets you have “killed.” You couldn´t sleep last night because all you could think about were the 14 years of your life you´ve spent building a practice that is now at risk because of a simple breakdown in communication.

According to Laura Downes, executive director of the Maryland State Board of Veterinary Medicine, unprofessional conduct lawsuits often boil down to charges of negligence or issues with communication. She says, “It is not uncommon for investigations to indicate that the standards of medical care have been met but documentation of the communications by the veterinary team was inadequate. If the pet´s condition deteriorates or the pet dies while under veterinary care, clients often assume that substandard care was provided. Excellent communication at the beginning and throughout treatment can assuage misunderstandings later should the pet not respond favorably to treatment.” Complaints from clients can result in hefty fines, mandatory continuing education, and even license suspension.

Facing the Facts
Many veterinarians will face situations like this at some point in their careers. Downes estimates that 75% to 80% of client complaints to state boards are the result of breakdowns in communication. Poor listening skills are cited in a large percentage of medical negligence cases as one of the main reasons why individuals take legal action against health care professionals.1

One of the main issues in these cases stems from obtaining educated owner consents. Without discussing diseases in lay person´s terms and documenting communications in patients´ records, clients can easily come back and say, “I didn´t realize this procedure required so many follow-up visits and care or had so many possible adverse effects, or I never would have agreed to it.” For this reason, the use of clear communications as well as written, signed consent forms that educate clients about the course of treatment and risks associated with various procedures helps minimize communication errors and omissions.

See the Informed Consent Form

What´s worse is that these facts may not change any time soon. Only 6 of the 26 veterinary schools researched for this article list a specific communications course in their curriculum, either as a required class or an elective.2 Some schools, like Washington State, Wisconsin, and Minnesota, require multiple courses that are specifically focused on communications throughout the 4-year program.2 Many others have some coverage of this important skill scattered throughout the curriculum.2 Still, the community of veterinary schools as a whole is not doing enough to provide veterinary students with sufficient client communications training.3,4

Common Mistakes
Typical communication mistakes veterinarians make include the following:

1. Assuming that other team members provide accurate and relevant information to clients without providing them with detailed scripts, question lists, educational consent forms, and/or operational instructions to use for key client interactions.
2. Assuming that clients understand what is being explained just because they are nodding along or saying “yes” or “uh-huh.”
3. Using closed and/or leading questions that suggest certain answers without allowing clients to expand on them.1 While closed questions make it easier to control the discussion, they can make clients feel intimidated or threatened; open-ended questions allow clients to describe their experiences, feelings, and understanding of the subject under discussion.1
4. Assuming that clients do not have the resources or are not willing to pay for what´s best for the patient and failing to explain why that course is the best option.5
5. Failing to use legal consent forms and discuss the issues they contain.6

Communication Strategy
There are many things you can do to ensure that you or your associates never face state board complaints, investigations, and/or disciplinary actions as a result of simple communication errors.

Use the term “medical care plan” instead of “estimate” to focus on courses of action for patient care. This semantically different term emphasizes the diagnostic and treatment part of the plan and diminishes the focus on money.

When possible, stand side-by-side with clients as you educate them, using “show and tell” models, images, or handouts. Encourage them to stop you for clarification and ask questions as you are explaining procedures or as they read the consent forms they are signing. When clients hesitate to sign consents, say, “Please be sure to tell me about any concerns you may have.” The side-by-side posture decreases the image that you are using confrontational communication techniques and, instead, illustrates rapport-building communication.

As much as is practicable, document all forms of communication in the medical record, including in-person educational discussions, phone conversations, and emails. Recording modestly detailed notes during and after these conversations allows you to refer back to them later, when time has faded your accurate recall of events. Detailed records ensure that you and your staff look and are “smart”; incomplete records make all of you appear careless. Remember that documenting courses of action that were recommended and deferred or refused is just as important as documenting the risks and adverse effects of procedures that may have been accepted.

Learn to use personality assessments such as Myers-Briggs (myersbriggs.org) or DISC (discprofile.com) to help staff understand their communication styles. Practice communicating with clients and staff who have different personality types to better understand how to be more effective.

Do your best to assure that someone on your team can speak Spanish or at least communicate in this language using medical terminology. According to the 2009 U.S. Census Bureau, 12% of the population is Spanish-speaking-and that number is only expected to increase.7 Keep an English/Spanish medical dictionary in your clinic and hang posters in or around the exam rooms with translations for common phrases and terms used in veterinary exams. Don´t let language be a barrier between you and your clients!

Invest in books that teach communication skills. Handbook of Veterinary Communication Skills by Carol Gray and Jenny Moffett, Getting Past No by William Ury, and Legal Consents for Veterinary Practices, ed 4, by James F. Wilson are good resources.

Communication regarding medical subject matter is a skill that is developed over a lifetime of effort and experience. You can educate yourself and your team regarding the most common mistakes and how to avoid them. Fundamentally, if we communicate well, then our clients will be happier, our patients will get well quicker, and we will all enjoy our jobs more.1 | EVT

References

1. Handbook of Veterinary Communication Skills. Gray C, Moffet J.-Ames, IA: Blackwell Publishing, 2010; pp 15-26.
2. Research performed by Christina Moore referencing web-based course content for all U.S. veterinary school curricula, 2011.
3. The KPMG study: The current and future market for veterinarians and veterinary medical services in the United States. Brown J, Silverman J. JAVMA 2:161-183. 1999.
4. NAVMEC Report, final draft. aavmc.org/veterinary-educators/navmec.aspx.
5. Law and Ethics of the Veterinary Profession. Wilson JF, et al-Yardley, PA: Priority Press, 1989, p 112.
6. Legal Consents for Veterinary Practices, 4th ed. Wilson JF-Yardley, PA: Priority Press, 2006, pp 4-7.
7. Language spoken at home: 2005-2009 American community survey. U.S. Census Bureau; factfinder.census.gov.

How much is too much to spend on a pet funeral?

by | Jul 19, 2011

Make it be about what the pet parent wants and needs!
“How much is too much to spend on your pet´s funeral?”
Ah, yes, another article picked up by my Google Alert about pet funerals. Actually it was a blog that was exploring the question “How much is too much to spend on your pet´s funeral?”
I personally find these types of conversations absolutely astounding! In fact, almost uncomfortably embarrassing! After all, who on earth would think that it would be appropriate to tell another person what´s acceptable to spend on ANYTHING?
Furthermore, being a veteran of the funeral industry, it was never, ever in any of my training to learn how to guide a family on what´s acceptable to spend on their loved one´s final service. I never heard “If you loved Mom enough, you´d buy this casket” or “ that type of casket doesn´t really show how much you loved your husband, does it?” Rather it was about a service and the memorialization pieces that provided the most VALUE to the family in creating this final tribute. The VALUE of the services and memorialization pieces, right? There was nothing in this process that equated the amount of love to the amount of money spent. Quite the contrary – our goal was to provide a service where the value of the service delivered far outweighed any amount of money spent!
Furthermore, I have never heard people having a conversation about when to stop providing medical care to someone because of the expense of the care.
But, I find it almost amusing that people are forthright with these opinions when it comes to pets. For those that aren´t pet parents, there are opinions on what´s “acceptable” to spend on health care, on daily care, and ultimately on the final arrangements for the pet. And, the only time that scrutiny comes into play is when it´s “too much.” Whatever that number is – based on each person´s own opinion!
62% of our society has a pet. And, as a pet parent, I, as well as other pet parents, take pride in being a responsible pet parent. It´s what we sign up for when we take one of these furry creatures into our homes. It´s an option that we have that we knowingly and willingly commit to when we accept this role.
But, it´s a role that for the 38% of our population leaves us open to shame and criticism. When all we want to do is celebrate these little creatures when they are alive – and pay tribute to them when they die.
In a way that´s right for us! And, let me be the one to determine what´s the right amount to pay for this type of honor! It´s what I WANT to do!

Remembering Ebony

by | Feb 1, 2011

Creating an experience of “saying good-bye” for Ebony´s family

Typical of my work, I found myself on a plane yet again, on my way to Scottsdale, Arizona, to address a group of funeral professionals on the topic of pet loss services. Such an honor to share my story and passion with others!

As I sat down, as I´ve done countless times, I struck up a conversation with my seatmate. As there was a couple of dogs on the plane that I had made over as they made their way onto the aircraft, it was clear that I was a dog lover. My seatmate noticed that and admitted that he, too, was an animal lover. By then, I knew his name was Ross and that he was headed to Scottsdale as well for work.

As our conversation proceeded, he asked if I had pets. I beamed as I shared photos of my precious little fur-kids. Then I asked him if he did. He said he had but his beloved lab, Ebony, had died almost 4 years ago. I knew that he lived in my city so I told him what I did and that I too had lost a beloved almost 8 years ago. Then I asked him who had helped him with the loss of Ebony. Interestingly enough, it was my little pet funeral home. And, he remembered it was Jessica who´d been there when he brought Ebony to us.

By this point, he´d turned his head and began to talk to the back of the seat in front of him. While it was in a manner of relaying his story to me it was also in a manner of giving him a chance to remember. He remembered what my pet funeral home looked like. He remembered the casket Jessica helped him get Ebony in to. He recalled how he has the urn and her paw print and fur clipping in his office, where he can talk to her still.
He especially remembered the room where he got to spend some time with Ebony. His final time with her, this girl that he´d brought home 17 years ago, as a fresh little puppy. His first born. His love. He recalled to me how grateful he was for that experience of spending a few minutes with her, just the two of them, as he´d given everyone else their time at home. This was his time to say I love you. His time to say how much he´d miss her. His time to tell her that she truly was “the best dog ever.” By now, the tears were showing as he was taken back to this time, almost four years ago, but yet it seemed like yesterday.

As we landed in Scottsdale, we disembarked. He gave me a hug and said “Thank you for starting that business.”
Yes, it´s an honor to share my story and my passion. However, the biggest honor is to hear these stories.

Rest in peace, Ebony. Rest in peace.

At the holidays, help them remember,…

by | Dec 13, 2010

The holidays are hard,… how are you helping your families?

The holidays are upon us,.. and for those of us that are facing the first holiday season without a beloved pet, this beautiful season is also laced with sadness.  I´m one of those pet parents,… My precious Golden Retriever, Mike the Dog, died a few months ago and I am facing one of those “firsts.”  Our first holiday without Mike the Dog – the first holiday where I don´t get to buy the big special bone that he liked, or the box of treats that were special for “Big Dogs.”  Yes, one of those highly charged and emotional events in the “year of firsts.”
As a pet loss professional, this is a perfect time of year to be a companion to families that are wanting an outlet to “remember” their special pet at this time of year.  A time when they are remembering and want to pay tribute to this life that was shared.  It´s the perfect time of year as a companion to:

Host a holiday ceremony to honor the pets
Provide a holiday ornament for families – have them come by your Pet Memorial Center to retrieve their ornament and share in a cup of hot tea with you.
Provide an opportunity for families to come by your Pet Memorial Center to light a candle in honor of their pet.
Have an open house for families – to come and support others that have experienced the loss of their pets too.
Send a card to families – to let them know you are thinking of them at this time if they need some extra support.

Be a companion to your families during the holidays.  Families WANT to honor their pets – give them the outlet to do this.

 

I WANT to say Good-Bye

by | Nov 16, 2010

Pet Parents want the oppotunity to say good-bye,..

As a grieving pet parent, we WANT that opportunity to say good-bye to our precious deceased pet. But, I digress – do I truly WANT that? No, because what I really want is to have my pet back. But, do I now NEED this opportunity to just not have my pet taken away from me – and give me one more time to be with my precious pet? One more time to say all of those “I love you´s” and to kiss that beautiful head? One more time to relieve all of those special times that we spent together? One more time to relieve that day you came home to live? YES! Please know – a pet parent wants to have this opportunity to “do one more thing” for my beloved pet.
As a pet care professional, it´s imperative that you are willing and capable of guiding a pet parent in what their options are to honor and pay tribute to their deceased pet. And, while you may be met with resistance, please know it´s resistance in the fact that I still want my pet here – and to do what is being recommended to me is the LAST thing that I want to do.
However, this very well may be the BEST thing that you can do for me. For me, the grieving heart who “doesn´t know what I don´t know” needs someone to guide me – to walk with me. With all of the thousands of families that I have worked with – seeing their pet “one more time” has clearly been deemed the “best thing that I could´ve done.”
Are you giving your families that opportunity? They do want it, trust me.