Skills for Communicating in Veterinary Medicine
by Cindy L Adams and Suzanne Kurtz
Forewords by: Warwick Bayly BVSc MS PhD Dip ACVIM and Christoph K.W. Mulling Prof. Dr. med. vet. and Dr. Anthony L. Suchman MD MA
"Long requested and finally here - the first ever veterinary medicine version of the bestselling Skills for Communicating with Patients."
Improve clinical outcomes through better communication with clients and colleagues. This handbook is the first to offer comprehensive, evidence-based communication guidance for veterinarians at all stages of learning and across all specialties. Gain a detailed understanding of what you can do at each stage of the consultation to establish effective relationships with clients to get the best possible clinical work done in a way that is satisfying for them and uplifting for you.
Finally! Drs. Kurtz and Adams have created a much-needed, comprehensive, clear and concise, evidence-based guide for all of us working in the veterinary field— Michael T. Cavanaugh, DVM, DABVP - CEO American Animal Hospital Association
Published January 2017
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ISBN 978 191 030 3122 (print)
ISBN 978 191 030 3139 (ebook)
Warwick Bayly BVSc MS PhD Dip ACVIM
Given the widespread recognition of the importance of communication in daily lives, from a retrospective perspective it is surprising that it has taken so long for a book of this kind to be published. Effective communication is acknowledged as being essential to success in corporate organizations, business transactions, personal relationships, politics, and team-based sporting competitions to give just a few examples of situations in which short-and long-term outcomes are heavily influenced by the quality of communication. How often do we hear that the hallmark of a great leader is her or his skill as a highly effective communicator? Therefore, in hindsight it is chastening to realize that it has taken the veterinary profession as a whole so long to accept that, along with discipline-based knowledge and well-developed physical procedural skills and problem solving abilities, the possession of effective communication skills is the fourth essential requirement for the practice of high quality medicine.
There is no place on the veterinary health care team where excellent communication skills are not essential. They are integral to building any good practice. Unfortunately, not only did it take our profession too long to acknowledge this, but it also had to accept that these skills could be taught. The caliber of an individual’s communication abilities was not dependent on what was learned as a child from parents and other family members while sitting around the dinner table. As the contents of this book thoroughly demonstrate, effective medical communication is a cognitive skill that can be taught and must be regularly practiced in order to develop proficiency; just like any other veterinary skill.
I met Cindy Adams and Suzanne Kurtz at the 1st International Conference on Communication in Veterinary Medicine (ICCVM) in Ontario in 2004. Cindy was a faculty member at the Ontario Veterinary College, University of Guelph, and Suzanne was a member of the faculty in the Faculty of Medicine at the University of Calgary. The timing was perfect. For the previous couple of years some of the leadership group at Washington State University’s College of Veterinary Medicine had been discussing the importance of so-called “non-technical” skills in the successful delivery of veterinary services, and whether it was possible to incorporate the teaching of these skills into an already overcrowded veterinary curriculum. There had also been healthy debate regarding the advisability of such a consideration and the lack of specific evidence supporting the contention that medical communication should be regarded as an essential cognitive skill and/or that it could be effectively taught. Attending that ICCVM and meeting Cindy and Suzanne convinced me and others that we in veterinary medicine had to commit to improving the communication skills of our new graduates and that there was emerging evidence to support such a move. Furthermore, it was apparent that, no matter how full the curriculum appeared to be, provision had to be made to teach clinical communication to veterinary students in a practice-like setting. Also, it had to be classified as a core course and woven into the overall fabric of the whole curriculum to the extent possible. It could not be put into a box like the “-ologies” and treated as a heavily didactic course that was assigned a semester in which it was to be “taught”. Finally, we could not have just anyone teach it. It quickly became apparent that experience did not make one an effective teacher of communication. Specific methods for teaching communication had to be developed and documented and they then had to be engaged, evaluated and further refined along evidence-based lines if veterinary schools were ever to effectively teach clinical communications.
Since that time in 2004, Suzanne has joined the veterinary faculty at Washington State University while continuing to work closely with Cindy, who is now on the veterinary faculty at the University of Calgary and the rest, as they say, is history. The body of evidence indicating that clinical communication is a teachable and learnable skill has grown substantially and curricula have been developed and improved. Recognition of the importance of teaching clinical communication to future veterinarians and helping existing ones improve their competencies is now recognized globally. So it seems logical, as another sign of the natural progression of these developments, that Drs Adams and Kurtz have now written Skills for Communicating in Veterinary Medicine. It is the first book to address this specific subject from such a heavily evidence-based and conceptual point of view and it is only fitting that they, as members of a very small core group that was there at the beginning of this emergent process, should be the ones to have authored it.
This book is not just for veterinary students. There is a growing recognition that even the most experienced of veterinary practitioners can benefit from periodic objective evaluations of their effectiveness as clinical communicators. Individuals are always changing, even if they don’t know it. Change in style and manner of communication is frequently unnoticed by the communicator and these changes are not always for the best, which is why this book is not just for future veterinarians. There is much in it that practitioners can utilize on a recurring basis. As such it should be regarded by everyone on the veterinary health delivery team as a text that is as valuable as any discipline-based one. Every practice should have at least one copy.
Christoph K.W. Mulling Prof. Dr. med. vet.
What one does not understand one owns not [Goethe].
The unique, evidence-based Skills for Communicating in Veterinary Medicine opens the gate in one sentence for understanding communication and developing ownership of this essential veterinary skill. Without a trace of a doubt, communication is an essential clinical skill without which excellent veterinary medicine is virtually impossible. “If you can’t communicate it doesn’t matter what you know” - this phrase clearly highlights the great importance of communication not exclusively but in particular in our profession. We have strong evidence for the significance and indispensibility of communication in veterinary medicine. Communication is a clinical and beyond that a practical core competence and a foundational part of modern evidence-based veterinary medicine.
In this context Skills for Communicating in Veterinary Medicine is a long expected and urgently needed book for the veterinary profession and the global community of veterinarians in whatever field or context they may work. It is authored by two leading authorities in veterinary and medical communication, Cindy Adams and Suzanne Kurtz. I had the privilege of working with Cindy Adams for three years setting up and integrating communication into the curriculum at the University of Calgary, Faculty of Veterinary Medicine. And on several occasions I had the pleasure of meeting with Suzanne Kurtz to exchange thoughts and ideas around clinical communication. The high level of professionalism, knowledge and extensive experience, the dedication and passion of the authors for the topic, is present and tangible in every single paragraph throughout the book.
This book employs a highly evidence-based approach for enhancing communication skills in veterinary medicine. This book is practical, truly comprehensive and certainly applicable across contexts in veterinary medicine as well as within the veterinary community across the globe. It is based on and constituted around the Calgary–Cambridge Guides, an evidence-based, structured and practical instrument for teaching and learning communication skills in medicine. The Guides are well established and widely used in medical and veterinary curricula. A cornucopia of practical examples illustrates the knowledge, techniques and theories covered in the different chapters.
Communication is key for a successful professional – and private – life. This is particularly true in veterinary medicine. As our patients cannot communicate verbally we rely, often critically, on successful communication with their owners. As a matter of fact we cannot deliver quality veterinary diagnoses and treatments without skilled communication. Clinical communication is highly technical. In order to develop these skills profound technical knowledge, guided and coached training, and continuous practice are essential. Skills for Communicating in Veterinary Medicine provides the foundations, detailed technical knowledge and guidance for the initiation of this process in the novice as well as the guidance and advanced knowledge for ongoing lifelong development and improvement of communication skills no matter whether we teach, work in practice or at a University.
Clinical communication deserves and requires great attention by the global veterinary community. This handbook is an extremely rich, comprehensive resource for all veterinarians and a standard reference for teaching and learning veterinary medical communication. Beyond this it will spark enthusiasm, infecting everyone who has an interest in learning or improving his or her communication skills. And once infected, with the help of this book, you will develop a deep dedication to communication and the desire to continuously improve your skills. This book will become a deeply appreciated companion you will never want to be without.
Communication is key for a successful and sustainable relationship between the veterinarian and the client and beyond that for the quality of the veterinary medicine applied to the patient. Communication is a core clinical competence essential for high quality veterinary medicine in any country. This is equally true for human medicine. In the era of globalization and the concept of One World, One Health, One Medicine, it is important to emphasize that this book integrates the human and veterinary literature throughout.
As stated earlier this book is a long needed and awaited resource for the veterinary profession, not only in North America but also in Europe and across the world. We need advocates around the world to become the voice for the uptake of clinical communication. I would like to congratulate Cindy and Suzanne on this outstanding masterpiece, this unique, comprehensive and very practical resource for learning and teaching skills for communicating in veterinary medicine. This is a new standard, a reference for learners, teachers, students and coaches, and all veterinarians no matter what they do or where they work. With the help of this work we can understand and ultimately own communication.
Skills for Communicating in Veterinary Medicine is applicable across the variety of veterinary contexts and across the globe. It will also facilitate integration of communication between medicine and veterinary medicine and substantially contribute to developing and continuously improving communication skills in One Medicine. Skills for Communicating in Veterinary Medicine is poised to change how future generations of veterinarians will communicate with their peers and clients. I am confident that this book will make a difference in our profession. May the story of Skills for Communicating in Veterinary Medicine be a successful one and may this book make a difference to our medicine and our profession.
Dr. Anthony L. Suchman MD MA
My wife and I love our veterinarian. He cares for Lulu (our aging and increasingly frail cockapoo) and for us with skill and compassion. He listens in a way that leaves us feeling understood and respected; he explores symptoms and conducts examinations carefully; he explains treatments and prepares us to be partners in care; and he organizes his office visits efficiently. In short, he does everything described in this book. And it works really well.
Throughout all of health care there is a growing awareness that relationships matter, that what used to be dismissed as touchy-feely or soft is absolutely critical to achieving good clinical outcomes, keeping care safe, reducing waste and maximizing efficiency, giving clients or patients a satisfying experience, and – now more urgently important than ever – maintaining the health and well-being of the healthcare workforce.
Just as interest in healthcare relationships is crescendoing, along comes Skills for Communicating in Veterinary Medicine. This book is truly a tour de force. It describes and synthesizes the evidence that relationships matter – an important achievement in its own right, establishing a strong foundation for further scholarship in this area. But it goes much farther, and in a very practical clinical direction. It provides detailed guidance – also evidence-based – on what you can do or say in each moment to establish effective relationships with clients to get the clinical work done in a way that is satisfying for them and uplifting for you.
While the book is structured around the sequential steps of a typical clinical encounter, the methods for listening, inquiring, negotiating, planning and organizing apply at all levels of veterinary care. They can improve teamwork in an office practice as veterinarians, technicians and front office staff collaborate to provide successful and satisfying episodes of patient care and reduce daily wear and tear in the office. They can help executives and managers in a multi-group practice or a veterinary college to take a relational approach to management, fostering a culture of engagement and co-creation, autonomy support and peer accountability. Again, more motivation and meaning at work, less burnout and turnover. And at the highest level of organization, One Health requires the capacity for multi-stakeholder perspective taking and outstanding collaboration skills as people work together across institutions, disciplines and paradigms. This, too, rests on the fundamental communication skills described in the pages that follow.
I want to appreciate the authors, Cindy Adams and Suzanne Kurtz, for their achievement in bringing this landmark book into being. And I want to appreciate you, the reader, for taking relationships seriously and seeking to strengthen this core capacity in yourself. I wish you every success in your studies and your work; the wisdom in this book will give you a huge head start.
Chapter 1 Defining what to teach and learn about communication in veterinary medicine
- More effective consultations
- Improved outcomes
- A collaborative partnership
- Underlying rationale for communication training
How do we decide what to teach and learn about communication skills in veterinary medicine?
- First principles of effective communication
- Goals of communication in veterinary medicine
- Types of communication skills
- The Calgary–Cambridge Guides: evidence-based skills that make a difference
- Relating specific issues to core communication skills
- The research and theoretical basis that validates the inclusion of each individual skill
Chapter 2 Initiating the session
Problems in communication
What to teach and learn about initiating: the evidence for the skills
- Establishing initial rapport
- Identifying the reason(s) for the consultation
Chapter 3 Gathering information
Problems in communication
The content of information gathering in veterinary visits
- The more traditional veterinary medical history
- An integrated clinical method
The process skills of information gathering
- Exploration of patient’s problems and client’s concerns/issues
- Additional skills for understanding the client’s perspective
Putting the skills of information gathering together
- The continuum of open to closed questioning techniques
- The more complete versus more focused history
The effect of clinical reasoning on the process of gathering information
- How do the different clinical reasoning approaches influence the process of information gathering?
- What is the relationship between clinical reasoning, clinical communication and medical problem solving?
Chapter 4 Providing structure to the interview
What to teach and learn about providing structure: the evidence for the skills
- Making organization overt
- Attending to flow
Chapter 5 Building the relationship
Problems in building the relationship
What to teach and learn about building the relationship: the evidence for the skills
- Using appropriate nonverbal communication
- Developing rapport
- Involving the client
Chapter 6 Explanation and planning
Problems in clinical communication
The content of explanation and planning
The process skills of explanation and planning
What to teach and learn about explanation and planning: the underlying concepts and evidence for the skills
- Providing the correct amount and type of information
- Aiding accurate recall and understanding
- Achieving a shared understanding: incorporating the client’s perspective
- Planning: shared decision making
- Options in explanation and planning
Summary: explanation and planning is an interactive process
Chapter 7 Closing the session
The process skills for closing the session
What to teach and learn about endings: the evidence for the skills
- What actually happens in the closing section of the interview?
- What behaviors earlier in the visit prevent new problems arising during closure?
- What communication skills can we recommend in the earlier sections of the consultation that will aid efficient and satisfactory closure of the session?
- What behaviors during closure are associated with inefficient endings?
- Descriptions of the skills for closing the session
Appendix A: Calgary–Cambridge Guides: Communication Process Skills in feedback format
Appendix B: Historical investigation pyramids: Beef, Dairy, Equine
Appendix C: Tasks and checkpoints mentioned in other guides
Michael T. Cavanaugh, DVM, DABVP - CEO American Animal Hospital Association:
Finally! Drs. Kurtz and Adams have created a much-needed, comprehensive, clear and concise, evidence-based guide for all of us working in the veterinary field. No matter what stage in your career, whether you are a student, educator, practitioner, manager or other practice team member, you will find this book extremely useful. Skills for Communicating in Veterinary Medicine has the potential to move the practice of veterinary medical communication forward by twenty years if enough of us read it and sharpen our communication skills. We are all experts in communication just as we are all excellent drivers. Remember that just because we’ve been communicating all of our lives, it doesn’t mean we’ve been doing it right, and it doesn’t mean we can’t improve our skills! Another beautiful thing about improving our communication skills is we can use them in our personal relationships as well. This book is a wonderful gift being handed to the veterinary profession! Please take advantage of it!
Peter Conlon, BSC(AGR), MSC, DVM, PHD, MED, Professor and Associate Dean, Students, Director, Hill’s Pet “Nutrition Primary Healthcare Centre, Ontario Veterinary College, University of Guelph, Canada:
This comprehensive and highly readable book will be valued by all who teach, learn, and use communication skills and knowledge in veterinary medicine. Our clients and patients will be better served by those who have benefited from the authors’ thorough and thoughtful approach to the discipline.
Jolanda Jansen, PHD, MSC, St Anna Advies, Nijmegen, the Netherlands, communication and behavioral change specialist in animal health and in the agricultural and veterinary industry, author of Communication in Practice, The Vet’s Manual on Clienthusiasm:
Congratulations on this great achievement. I have never ever read such a thorough overview of all literature available on communication skills. In my opinion, the book:
* is essential knowledge for every veterinarian and vet-to-be, to keep animals healthy, large and small
* makes the difference between an average vet, and an excellent vet
* has real life examples of typical conversations with clients and how to improve them
* shows that even communication science in veterinary practice can be evidence based
* teaches the best way to perform a client-oriented consultation
* improves the perceived emotional quality of the veterinary profession
* applying these techniques does help to prevent miscommunication and accompanying consequences like lawsuits
* as a vet, to keep animals healthy, the animal species you need to know most about is the human being
* offers a very thorough analysis of communication skills needed for an effective consultation
* provides an extensive review on veterinary consultation skills
* is a must read, oh no, a must apply, for every vet and vet-to-be
* supplies a missing piece in veterinary education
* fulfills a need of many working in the veterinary industry
* adds value to the veterinary profession, and helps animal owners to see that added value
Kathleen A. Bonvicini, MPH, EDD, Chief Executive Officer, Institute for Healthcare Communication, New Haven, CT, USA:
This is the first textbook which provides a comprehensive overview of the science demonstrating that ‘communication matters’ in all branches and specialties of veterinary medicine. The authors clarify the research evidence and weave countless practice examples showing the connection between communication practices and quality client and patient care outcomes. This text will serve as a reassuring go-to for veterinary students, residents and seasoned veterinarians who want to strive for professional and rewarding relationships with clients, patients, and veterinary teams.
About the contributors
Julie Cary and Jason B. Coe
Julie Cary DVM, MS, DACVS-LA, Director, Clinical Communication Program and Clinical Simulation Center, Washington State University, College of Veterinary Medicine, USA
Jason B. Coe DVM, PhD, Associate Professor, Department of Population Medicine, Ontario Veterinary College, University of Guelph, Canada