Dear Second Opinion,
I recently had a new consultation for a dog with suspected atopic dermatitis. As I reviewed the various diagnostics, treatment options, and lifestyle changes to manage this condition, the client developed a glazed-over look in their eyes. I continued presenting the information, but I could tell they had stopped paying attention and were not absorbing what I was saying.
This seems to happen frequently, especially with new consultations. Clients often appear overwhelmed and even flustered when I begin to discuss their pet’s disease process and review available diagnostic and treatment plans. Providing thorough recommendations without inundating clients with too much information can be challenging. I strive to maintain an excellent quality of care for my patients, and I believe this is best achieved by actively involving clients in their pets’ diagnostic and treatment plans; however, I’m struggling to help clients understand my recommendations and decision-making process without being overburdened.
My biggest fear is that I’m ultimately doing a disservice to my patient if I am too brief in my explanations or don’t spend enough time discussing recommendations. At the same time, if the client is unable to retain and process the information I am providing, does it even matter how thorough I am?
Dear Conflicted Communicator,
You are correct. There is often a lot of information to give clients, most of whom have very little understanding of disease processes. So, how do you toe the line between critical communication and too much information?
Understanding Client Stress & Motivation
Many clients come in with a preset level of either stress or apathy that can interfere with their ability to focus and learn and often manifests as overwhelm, low motivation, or high resistance.
Overwhelm: Clients feeling overwhelmed may need an entire day to process what they are told. Others may cope by tuning you out and scrolling on their phone.
Low motivation: Clients with low motivation are less likely to be engaged, making compliance and adherence unlikely.
High resistance: Resistance is common and normal when information contradicts what the client believes to be true. Human brains often react with fear to the unknown.
There are also those clients that simply don’t want a lot of information. These clients want you to understand and fix the problem, and they are happy to receive minimal amounts of information as long as you can prevent or fix the issue. I call these going to the mechanic clients. They typically want to know what is wrong in 5 words or less, how much it is going to cost, and how long it will take to fix the problem.
During an appointment, I usually start with basic information and offer more if the client expresses a desire to learn.
If you have to convey a large amount of information, consider the following.
Prep the client beforehand. For example, I have a lot of information to share with you, so get ready!
Split information into chunks. Share only absolutely critical information that day, and save the rest for future conversations—either remotely (eg, via video call, email) or in person at follow-up appointments. Be strategic about what you share and when.
Use handouts. Empathize with the client about the amount of information. I prefer to read the handout to the client and highlight important information as we go through it. Alternatively, you can ask the client to read the handout and follow up with them in a day or so.
In addition to handouts, provide links to videos that increase learning. This also saves you from having to talk so much.
Clarify and create interest using metaphors, which help draw parallels between difficult medical concepts and ideas with which the client is already familiar. Metaphors create a bridge that can help the client conceptualize what you are discussing and allow you to concisely explain something that would regularly take multiple paragraphs to explain. Thinking of creative ways to explain complex medical subjects can be a fun exercise.
For example, clients rarely understand the importance and entirety of strict cage rest. Typically, once the dog is feeling better, the client will let them out of the cage early for various reasons, usually resulting in the dog ending up back in the clinic with acute pain. Instead of saying strict cage rest, clients can be told to put their dog in dog jail. This usually makes the client laugh, and they pay closer attention, asking what dog jail is. Explain that their dog needs to be in dog jail for the next 2 weeks, only released while on a leash to urinate/defecate. At the recheck, ask, How did dog jail go?.
It will likely require trial and error, but you can test these ideas on clients and see what works best for you in getting and keeping client attention when it is most needed.
Sarah Wooten, DVM, CVJ