How do we care for our clients? Of course, we treat their pets with compassion, and we do our best to accommodate the clients’ needs. We squeeze one more dental prophy in on the only day they could come. We stay late to see the appointment that was 30 minutes behind because we know that ear infection is pretty uncomfortable (not that you weren’t still finishing call backs anyway…). We explain their pet’s diagnosis. And explain it again. We do our best to treat clients in a way that shows them that we care about their pet.
But how do we show our clients that we are caring for them, too? Our human counterparts have focused for years on patient centered medicine. I would argue that we largely do the same thing. However, the dynamic we have in our doctor-patient relationship is necessarily filtered through the lens of our doctor-client relationship. I wondered how that could be translated. We cannot always do exactly what we want to for a patient, but perhaps we can increase our success rate by including the client more like the way a physician interacts with their patient.
In the article “Because One Shoe Doesn’t Fit All: A Repertoire of Doctor Patient Relationships” (Marie-Therese Lussier, MD MSc FCFP and Claude Richard, PhD, in Canadian Family Physician, Vol 54, August 2008), the authors note that context is a huge part of determining the way a physician should interact with a patient. For example, in an emergency situation, the physician best shows his concern and interest for the patient by getting treatments moving and resources in place, rather than conversing with the trauma victim about his goal for treatment. Life- saving expertise is required, and the physician is the “Expert -In – Charge”. We face this sort of situation as well, whether in an emergency clinic setting, or in general practice with BDLD racing back to the treatment room. While we are constrained by the need to have approval of the client to treat, we still must show that we are here to take care of things. We don’t offer multiple options. We tell them this is what needs to be done, now. We are the expert. That is how we care for the client in a scary, urgent situation. Giving too many options or too detailed information in the heat of the moment can result in delay of treatment, but also put undue strain on a client that is counting on you to know what to do to fix their baby!
Suppose the situation is still quite serious, but less emergent. How can our approach change to result in both the best care for the DKA kitty, or the stable but fractured HBC, and the best interaction with the client? Perhaps there are a couple of reasonable treatment plans for this patient. Maybe one is decidedly better (yes ma’am, please transfer your open fracture to the vet school tonight!). But you could stabilize the fracture, start antibiotics and hospitalize the pet overnight so they could drive to the specialist tomorrow. Some components are probably not option, like top notch pain relief. But in this case, there is time to talk a bit more. You are still the expert, but in this scenario, you can discuss what you think should be done, and why option A is better than option B. Then you can listen to your client’s response, and begin to account for their feelings and limitations as you determine your next steps. You have allowed them to be heard, and to have input, over a limited range of options, and have cared for them in this way. You have acted as an “Expert Guide” on the journey to heal their pet.
How about those chronic conditions? Some are more serious, other conditions less so… CHF, DM, OA, CKD. Pick your favorite part of the alphabet soup! Usually, the longer the pet has these conditions, the better the client comes to understand them (especially if we are doing our job in client education). They become better equipped to discuss options, and often there are more ways to skin the cat… oops. Bad analogy. Uh… more treatment options… yeah. In these scenarios, you can be the “Partner” to the client. I know, many of us do not like to think of relinquishing any control. And of course, you are not going to advocate for anything less that the best interest of the pet. But for these long- standing cases, there is often more than one way to get to that result. Urgency is generally not a factor here, so discussion of the condition, the vast options that might be appropriate at a given stage of disease, and the desires, beliefs, and limitations of the client (physical, financial and psychological) can come into play. Perhaps the lab willingly takes his arthritis medicine if its chewable, but the client cannot pill him due to her arthritis, so generic carprofen is out. One client may be comfortable with doing sub-Q fluids at home for her renal disease kitty. Another is a complete needle-phobe, so that’s not an option for her. You and the client can share a common goal, and work in partnership to accomplish those in a way that fits for the client. You are caring for the client in a more developed way, with much more dialog and more flexibility.
At some point, your client may be very adept at managing their pet and recognizing what variations in condition or routine are significant. You have already established the trust needed to know what this client is capable of handling on their own. For instance, the client may realize that her arthritic lab is experiencing breakthrough pain after stumbling on the hardwood floors. She knows extra pain medication is needed, and gives it to her pet, as you have previously directed, without needing calling you first. Afterwards, she calls to let you know the change she made. Or our client with the renal kitty realizes that she needs an additional day of subQ fluids each week, based on the previous discussion you have had, and her experiences with caring for her kitty over the past several months. She calls to ask you for more fluid bags and lines, explaining the situation at hand. These clients are needing you to act as a “Facilitator” in this case. They have become well versed in their pet’s condition and you know them well, also. This is the highest level of trust, and you are caring for your client by having developed such a relationship, and by allowing them the autonomy are capable of managing. These clients feel respected and trusted, and in turn respect and trust not just you, but your relationship with them.
At various points in your relationship with a client, you will care for them in different ways, based on the needs dictated by the situation. It is forever fluid, just as any good relationship is. If we are chronically an Expert- In- Charge, we run the risk of alienating, insulting, or simply failing to meet the needs of the client. In turn, if we try to ask the client for input on a scenario that is beyond their means to contribute to, we have caused them an undue burden and risked the well-being of their pet as well. By learning to interact in the various ways, being adept in our fluidity, we can do a great job of caring for our clients, and that will help us care for our patients better, too!
Written by: Dr. Kristen Arp
Dr. Arp graduated from the University of Georgia College of Veterinary Medicine in 2002. She has practiced in the Metro Atlanta area since graduation. Dr. Arp lives in Loganville, Georgia with her husband, Trey and their two children. Tempe, their chocolate lab, can regularly be seen riding in Dr. Arp’s van, always ready to help with her patients.