THE BUSINESS OF PRACTICE


tions allow clients to fully express themselves and describe their experience, thus allowing the clinician to appreciate the whole story of the client and patient’s problem.1,2 At first glance, this may not seem desirable, because information that is unre- lated or unnecessary is potentially provided. How- ever, if only closed-ended or very focused questions are asked, valuable information from the client about what has been going on with the horse may be missed. Also, the time spent learning about the horse and client is important for relationship build- ing and rapport. Examples of open-ended ques- tions are “What has been going on with Lucy?” and “What have you noticed that has you concerned?”


Reflective Listening


Reflective listening is a way to demonstrate that the listener is paying attention, to facilitate the client sharing his or her thoughts, and to indicate com- prehension.1,2 A reflective statement is essentially paraphrasing what the client has said. This offers the client a chance to clarify or provide a correction if what was reflected was incorrect or to elaborate if there is more he or she wants to share.1 It shows clients that the veterinarian is genuinely interested in what they have to say and ensures that he or she is catching all the pertinent information being shared. This skill is particularly useful when mul- titasking during an appointment, because the client may have concerns that the veterinarian is not lis- tening if a physical exam or other procedure is being conducted when he or she is speaking. In this case, reflective listening demonstrates to the client that the veterinarian is still listening despite doing an- other task simultaneously. Reflective listening helps to form a partnership with the client and can help direct the appointment. Examples of how re- flective statements often begin are “If I heard you correctly . . .” or “It sounds like . . .”.


Pick Up and Investigate Cues


Clients often provide verbal and nonverbal cues throughout the interaction, and it is important to notice these cues and explore them with the client.1 Research has shown that doctors in primary care only respond to 21% of patient cues, while ignoring the rest. The same research also showed that when the cues are not investigated, patients brought up the same concern repeatedly; this clearly indicated that whereas the patient had not overtly stated a concern or feeling, there was an issue that needed exploration.1 Actively investigating a client’s cues by asking an open-ended question—or using a re- flective listening statement— provides an opportu- nity for the client to share his/her thoughts and feelings openly and for the veterinarian to demon- strate his or her interest in the client’s experience.1


Common Ground


In many instances, the client and the veterinarian begin the appointment with different perspectives;


276 2013  Vol. 59  AAEP PROCEEDINGS


one of the most important steps in a successful and satisfying encounter is bridging the gap between veterinarian and client and finding common ground.3 This process has three primary steps for the veteri- narian and the client: (1) developing a shared un- derstanding of the problem, (2) deciding on common goals for treatment, and (3) determining the role of each of them going forward.3 The ability to find common ground is contingent


on an effective investigation of the client’s perspec- tive having taken place. The predominant themes of this phase of the interaction are negotiation and sharing of information and feelings. Two-way com- munication is essential in this part of a client in- teraction; the veterinarian and client must listen actively to each other, respond appropriately, and express themselves in a way the other can understand.3 Clients often come into an interaction with ideas regarding the diagnosis3 or what the treatment should be on the basis of their own experience, In- ternet research, or the advice of friends. This can be challenging for veterinarians to manage if the clinical picture they see does not match the client’s ideas. The work done earlier to explore the client’s perspective can allow the veterinarian to address the discrepancies directly and tactfully. Although the veterinarian may want to simply provide infor- mation about their interpretation of the clinical pic- ture and carry on, it is important to address the client’s ideas and frame the information that the veterinarian believes is important in a way that is meaningful to the client.3 Defining the goals of the treatment is also essen-


tial.3 In some situations, clients have unrealistic ideas of what can be done, for example, making a lame horse sound or an aging horse as vital as they once were. Open discussions as well as utilizing skills to involve the client and share information about the horse’s condition can be useful methods to bridge the client’s desires and what can be accomplished.3 Finally, the roles of each party, going forward,


must be established.3 The information gained ear- lier in the appointment can help the veterinarian formulate a plan that will be appropriate for the client. It can often be tempting to make assump- tions about what the client will or will not be willing to do; the use of communication skills that promote client involvement and promote shared decision- making are valuable to ensure that the plans made are what the client truly wants. If common ground cannot be found in the key


areas described, the likelihood that the client will be satisfied and the patient will receive the care it needs is decreased. As discussed above, open- ended questions and reflective listening are impor- tant skills that aid in gaining an understanding of the client’s perspective.1 Skills that promote good two-way communication, client involvement, and


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