Category Archives: In the exam room

FRANK Communication training

A dream of mine came true today: I attended the first day of the Pfizer FRANK Communication workshop!

A little background about FRANK: it’s a veterinarian-client communication workshop designed to help practicing veterinarians and their staff communicate better and more effectively with their clients and team members. I first learned about it when our Pfizer Technical Services veterinarian, Dr. Joe Holzhauer, presented several “pieces” of the workshop at our hospital a few years ago. Ever since then I knew I wanted to take the full workshop, taught by Dr. Jane Shaw and colleagues, based in Fort Collins, Colorado, at the Colorado State University Veterinary Teaching Hospital.

It’s a 1.5 day workshop, and today was Day 1. Somehow, I missed the advance reading assignment, so I was worried I would feel behind. Fortunately, the Frank presentation Dr. Holzhauer had brought to our hospital had prepared me well, and I’m interested enough in this stuff that I had already read one book (Exam Room Communication for Veterinarians by Dr. Jon Klingborg) and started another (Skills for Communicating with Patients by Silverman, Kurtz & Draper) on the subject of communicating effectively with clients.

We spent the first part of the morning learning some of the science behind improved communication skills. Not surprisingly, veterinarians who take the time to listen to their clients’ concerns can enjoy better compliance with their recommendations and achieve better patient care. The clients have an increased sense of satisfaction and have a better understanding of the recommendations being made. Studies in human medicine show that improved communication from the doctor yield improved clinical outcomes and decreases complaints and malpractice litigation.

We also discussed two main approaches to communication: the “shot-put” method and the “Frisbee” approach. As you can imagine, “shot-put” is one-way and can be overwhelming to clients due to the amount of information being dumped on the client. With the “Frisbee” approach, you have a two-way dialog with the client, listening to their needs and concerns, and shaping your recommendations to fit the situation. There has been a paradigm shift in veterinary medicine, getting away from the veterinarian-centered conversation (“I’m the doctor and I know best”) and moving towards “relationship-centered” communication where the dialogue is guided by feedback from the client. An important distinction to make: we do not practice consumerism, where the client says, “This is what I want,” and is not willing to have a back-and-forth dialogue.

In the afternoon, we practiced the communication skills we learned about in what was basically a wet lab setting! CSU has these exam rooms designed for the sole purpose of improving communication skills. A group of students can sit on one side of a one-way mirror, with headphones on, and listen to the conversation occurring in the exam room on the other side of the wall. Wow, how cool is that? There were six people in our group, and we each took turns interacting with a professional actor who portrayed a client in a pre-determined scenario. After our allotted time of 15 minutes, we all discussed how the interview went (what went well, what would be even better).  I have no doubt that we all learned a ton from this!

An added benefit was when Dr. Shaw stopped by our room for a visit. Dr. Shaw is like the guru/goddess of veterinary communication training. Someone asked what are we supposed to do when a client with a sick parvo puppy gets mad at us because she doesn’t have the money to pay for treatment? She skillfully took on the role of an angry client, and I watched one of the members of our group struggle with what to say to her as she got angrier and angrier. Then we paused, discussed what could be done differently, and tried again. I watched with amazement as one of our group members skillfully employed empathy statements and long pauses to let the owner vent her frustrations. Eventually the anger gave way to just sadness, and seeing this transition—although it was really just acting—gave me confidence and peace of mind in knowing that it’s ok to just agree with a client about the sucky situation and just let them talk. You can’t make a bad situation not suck, but you can be there as a human being and listen to them.  Sad, but touching. And instead of making the client angry that you didn’t help them, they will remember your compassion (and hopefully not write nasty reviews about you on Google!).

Tomorrow, we will do more communication lab work. The actors were fantastic, and the scenarios forced us to not worry so much about the medical/technical side of things so much as focus our attention on our communication skills.

I’m already looking forward to bringing these skills back to work with me, as I know I will be able to employ them immediately!!

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Communicating clearly: “Let’s see if he has a bladder”

A recent post on A Vet’s Guide to Life, Proper Communication, discussed some important points when it comes to communicating with pet owners. The post started with an email from a vet tech (and vet student hopeful–good luck!) who shared her observations about doctor-client communication. She cited specific examples of conversation snippets that might sound odd or be misinterpreted by a lay person (which most pet owners are, with some exceptions of course).

Here’s one example she used: “Once, she [the veterinarian] told someone with a puppy who was leaking urine that she wanted to ultrasound him in back to ‘see if he had a bladder’–meaning check to see if his bladder was full–so we could get a urine sample. The owner blinked her eyes and said, ‘is it possible that he might not have a bladder?’ to which the doctor replied, ‘sure, especially if he just urinated.'”

This observation illustrates a couple important points:

  1. The veterinarian is oblivious to the fact that her nonchalant explanation, while it makes perfect sense to her, can easily be misinterpreted by someone who interprets a more literal meaning.
  2. The perspective of the vet tech watching this conversation take place is removed enough from the situation to catch this potential problem and identify it as such.

I like learning from these kinds of alternative, fly-on-the-wall perspectives. I think it takes the perspective of someone removed enough from the situation to catch these potential communication gaps. I’m an advocate for video recording exam room etiquette so as to analyze your body language and communication style, but would the vet, if she watched a video of this exchange, even detect that her choice of words could be confusing? I think most vets who are comfortable with their communication style would not notice the lack of understanding on the part of the owner.

I applaud the vet tech who made this observation (and others mentioned in the original post). I think the truly great vets are ones who not only understand the complexities of veterinary medicine, but can communicate complex issues in a way that non-medical pet owners can understand. This is something I struggle with every day, and one of the reasons I started this blog.

For vets interested in expanding their ability to communicate effectively, consider enrolling in the PfizerFrank Communication Training. I haven’t done the actual 2-day workshop at Colorado State University, but we’ve had some in-clinic Frank training which has been very illuminating and helpful.

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Filed under About this blog, In the exam room

Exam room videos for exotics

Veterinarians and vet students with an interest in exotics will be thrilled, as I was, to discover the YouTube channel for Dr. Laurie Hess. Dr. Hess is a board-certified bird specialist and exotic animal veterinarian and owner of the Veterinary Center for Birds & Exotics in Bedford Hills, NY, an all-bird/exotic animal hospital. Through this YouTube channel, you can watch Dr. Hess as she:

The videos are short (less than 10 minutes each) but do a great job of capturing the exam room atmosphere, and they demonstrate handling and examination of the particular individual species featured.

Which was your favorite video? (I know mine was the hummingbird!!)

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New guinea pig wellness exam

**Dear Learning Vet readers: I removed the video because I don’t have proper permissions from the client and no longer have a way to contact them. So sorry! You can still read over the transcript below to get an idea of what I covered. Thanks for your understanding!  –TLV **

In this video (removed), I examine a newly-adopted, young guinea pig. The very enthusiastic (and adorable) girl in the video brought Sugar in for her first exam to make sure she’s starting off on the right foot with her very first pet. Here are some thoughts/observations to take note of:

– When I examine smaller mammals, such as guinea pigs, rabbits and chinchillas, I prefer to lay a towel for the pet to sit on. They really don’t like the slippery surface of the exam table and can hurt themselves if they try too much to scramble away.

– Notice my “sign-posting”–this is a communication tool which means I tell people what I’m doing before or while I’m doing it. “What I’m going to do today is…”

– For the exam, I wrap the guinea pig snugly in a towel, also known as the “burrito technique”.

– I usually have a technician in the room with me for dogs and cats, but not always with exotics. Still, I need a little help holding her still, so I ask for the girl’s assistance.

– I start my exam with the mouth. I use an otoscope with a large head and a magnifying lens, which helps me examine the teeth. If there’s too much green stuff/food in the mouth, I use cotton-tipped applicators to swab it all out. It’s sooo important to see those teeth! I want to observe even/smooth molar wear.

– The owner has lots of questions and stories, so I struggled a little bit with staying “on track”, which means I’m more likely to miss something, since I’m not following my usual routine.

– I like holding guinea pigs and rabbits in the “C position” for nail trims. They usually hold more still this way.

– After the exam, I spend time talking about diet and husbandry.

– Diet discussion takes place 7:53-11:35

– Vitamin C discussion at 12:30

– Cage setup discussion approximately 14:25

– Talking about types of health problems guinea pigs can have: 16:30

– Video concludes before I dismissed the patient. I think it’s important to let owners know “what’s next”, even for wellness visits, so I told them I recommend a wellness exam every 6 months.

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Filed under Exotics, In the exam room