Sept. 4, 2019

#13: Communication: It's NOT a soft skill! Prof. Cindy Adams

#13: Communication: It's NOT a soft skill! Prof. Cindy Adams
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Season 1

Most vets would agree that excellent communication skills are one of the most important tools that we need to develop for a happy veterinary career, and it's a topic that we've always wanted to feature here, so we were thrilled when one of the leading minds in veterinary communication training agreed to join us on the Vet Vault. Cindy Adams is a Professor in the Department of Veterinary Clinical and Diagnostic Sciences at the University of Calgary, where she teaches in the Clinical Communication and Professional Skills programs. She works to improve communication practices in veterinary medicine and education. Professor Adams has developed evidence-based communication curricula and methods for teaching, learning and evaluating communication skills across North America, UK, and Australia. Today her work forms the basis for communications skills training in many leading vet schools. Her co-authored book: 'Skills for Communicating in Veterinary Medicine,' was released in 2016 and has earned widespread recognition in veterinary medical practice and education around the globe. In this episode Cindy tells us why we really need to increase our efforts in improving our communication skills, how to rapidly gain client trust, and how to set yourself up for the perfect consult.  I guarantee you that this is not just for new grads: it doesn’t matter where you are in your vet career - you are bound to learn something new here.  We talk about agenda setting, listening, perceptual skills and how to have those difficult conversations about money, and Cindy answers a few burning listener questions about tricky communication situations.  Make sure to check out the show notes for the resources that Cindy mentions in the episode. There’s some very useful information on talking about money, discussing medical errors and how to run internal training programs for better communication.

Good evening.Ladies and gentlemen, this is Gerardo Poli. and this sorry one of the best bits of advice I've ever received was to find good mentors and to learn from them trusted people who have already done what you're trying to do.
Now.I've been fortunate throughout my career to have some fantastic mentors to help guide me, but I realized that they'd be hard to find and also hard to commit the time to 1.This is why we've gathered some of the best Minds from the veterinary world and squeeze them for their wisdom so that you Not to learn the hard way with the help of our guests.
We flipped the veterinary profession on its back and explore its soft underbelly to find the tips tools and inspiration that you'll need to build the career that you've always wanted.I'm Gerardo Poli.I'm Hubert him strapped and this is the vent valve.Most vets have been in the profession for some time think they have some pretty solid communication skills.
What do you think of it?I'd say so yeah, I've certainly learned a few things over the last couple of years.Well, I don't know that's where I think you're wrong apparently most vets don't do or that well when it comes to the kind of communication that our clients really want from us.Did you know that according to a study done the average time?
It takes for a vet to interrupt the conversation.There is a Geo.You saying yeah.Well, no you drop it or Z.We're listening.So that's two things.But that this is exactly the reason why we contacted Professor Sydney Adams to give us some insights on communication done.
The right way.Cindy Adams is a professor in the department of Veterinary clinical and diagnostic Sciences at the University of Calgary.We see teachers in the clinical communication and professional skills programs.She works to improve communication practices in Any medicine and education, dr.
Adams has developed evidence based communication curricula and methods for teaching learning and evaluating communication skills across North America the UK and Australia her work forms, the basis for communication skills taught in many vet schools around the globe.
Her co-authored book skills for communicating in veterinary medicine was released in 2016 and has earned widespread recognition in the Veterinary Medical practice and education around the Cindy is also popular speaker at conferences around the world and we are thrilled to have her with us on the vet bold in this episode said it tells us why we all need to increase our efforts in improving our communication skills how to rapidly gain client trust and how to set yourself up for the perfect consult and I guarantee you that this is not just for new graduates.
It doesn't matter where you are in your vet Korea.You're bound to learn something new here.We talked about agenda-setting listening perceptual skills and how to have difficult conversations about money and Cindy also answers a few burning questions.Our listeners have about tricky communication situations.
And when you're done listening check out the show notes for the resources at Cindy mentions in the episode.There's some very useful stuff about talking about money talking about medical errors and how to run training programs for better communication.Now get your listening ears on and enjoy Professor Cindy Adams and one more thing.
If you enjoyed this podcast and you feel that you've gained something from it, then please tell a few of your friends about it.In fact, don't just tell them for the link to them and then ask them a week later if they've listened to it yet.And if they say no and make them put their headphones in the ear and sit there with them to make sure they listen and then tell them to give us a five star review on iTunes.
He's good evening Sunday and welcome to the podcast.Good evening.Thank you.Thanks for having me.Thanks for making the time to chat to us.I just wanted to clarify so so I get it and so that the listeners all know.So you teach communication skills to Veterinary students at set the curriculum and communication for several universities in is it globally or just in the states and in Canada?
Yeah, so it's globally I've just come back from Latin America working with schools there to try to set a communication program in place.This is Calgary's I could it's a bit of a model I guess in some ways for things that are pretty decent about what it takes to have a program.
So we have a lot of visitors come here as well and get training.So if I'm not out teaching in different places and people come here for training.Okay, that's interesting.It's amazing.How how long is You've been doing this for with regards to the participating or leading the the communication side of veterinary medicine at Calgary.
Yeah, and so, you know it even started before that.I started I'm a graduate of the Ontario Veterinary College and had a huge interest my first careers in social work.I think some of you know, I practice those who work for 17 years.And in that time every context they worked in jails women's shelters Etc had animals inherent so them and so I had this huge interest in there was this lovely scholarship at the Ontario Veterinary College.
I got it and I got to go do my studies there and then try to integrate human and animal health and well-being vis-à-vis communication program.So I started that program in 2000 at ovc the Ontario Veterinary College and I got brought to Calgary and 2006 to try to build the to build a program here and Albert has a relatively wealthy Province.
And so the the big draw for me was actually having money.That I could build a good program.So I've been doing it since 2006.Yeah, and then you said at the talk I heard you had you said your daughter is also a recent graduate with that that career.
Yeah, so can you my daughter?She's working up North so that would be about nine hours from Calgary.She's a mixed animal dog.And what's fascinating about Camille star.She talks to me once a week or so or sometimes every night depending on how the day goes but amazing things have happened for her.
She's obviously been immersed in communication.She gives a Calgary So she had the depth of teaching here, but she's like the top three salesperson in the practice of 12 doctors and she's you know, I mean, I don't mean it to be about money.But what I mean it to be is that her skills have certainly contributed to her ability to work with clients and affect Patients health outcomes and get adherence.
So this stuff really works.So that's this types of stories that she tells me.She's also able to retrieve money from clients for which have been you know, Clients of the practice for years, but I really don't pay their bills.And so Camille has also been very successful in getting some money in the bank for the practice owner.
So again, she attributes that so communication.So does she actually listened to your advice or is she like most kids?I know I know my kids will listen to anybody other than me, but if I try to teach them something they mad and their dad doesn't know what he's talking about.Well, it sounds like years younger than what I mean.
She's 30 and she's you know, she's old enough to know.No, she's pretty pretty convinced.So let me shoot.We problem solve a lot of things, you know medical errors what happens when that happens?What about the people that don't pay money?So she puts in she put stuff into practice.
Yeah.It's a teaching of communication skills to students and I think it's come a long way and I qualified almost 20 years ago now and my in my Veterinary course that begged South Africa our communication Training was one Friday afternoon for about two hours and and there was a sort of an unspoken rule anything that was scheduled for a Friday afternoon.
Normally meant it's not going to be an exam.So don't worry about it.You kind of come here you want to know so everybody would sit there playing the weekend instead of really listening.I think the only the only thing I remember from our communication training was and and it's probably not the worst place in the world the guy who taught I said every client who comes in the door.
Has something written on his forehead that spells.Please make me feel important, which is not happy.It's a good place to start but that's literally what I remember from communication.Do you find do you find something that they still to some degree of perception that communication communication skills are so nice to have thing but but not essential in that it's when one of the soft skills, so to speak rather than one of the more important technical skills.
Do you still find that?Well, I certainly found that when I started it was a beast.I mean it was it was really tough goal.Now, it's so much a part of our culture.I think North America wide it's a big part of the culture when I travel elsewhere like I mention it's not necessarily so I mean I it takes me back a good 15 20 years where you've got a lot of naysayers your people that don't don't believe in it.
You've got a few key people like yourselves who get it.Amidst a lot of folks that go no way you're not taking time.Anatomy you're not taking it from Clint pass.I mean, I'm situated.I'm doing schedules right now.I have a very substantive course, it's 1/3 of the curriculum.
So a lot of my colleagues have had to surrender time in tart to teach more efficiently so that we can you know address the communication.So the students are bought in and the number one the third most highly ranked feature of our graduates are the communication skills.
So our hosts are doctors that are receiving them are they're seeing every huge difference because they're getting graduates from other colleges in in Canada.Well, that's incredible a third of the curriculum.Yeah.Do you do get feedback from practice then it's interesting.
So if you guys have a very strong communication program do is there any information to show that your graduates do better in terms of just in stems of This faction and less mental health issues or find practice easier and if in the first few years, is there any feedback in that regard?
It's a great question.It's a piece of research that we'd like to do.We need to follow them out into graduation.We get like we're now going out to the practices and we're a pretty desperate Province A Lot Like Us parts of Australia that I visited where we have a distributed model.
So on our fourth year the students don't have a teaching hospital.They go out into the practices.And we're now out there flying around and doing workshops with these hoes practitioners it take our students that haven't necessarily had the communication training and there are starting to comment that they're noticing, you know, our students have obviously things to work on but but they're noticing that they're different and they will put them in front of really challenging conversations challenging clients and our students are pretty steady.
So that's what they're telling us, but we need we need to do that research we need Fold them out in practice now and find out if they're holding the skills and what impact it's having its over Sydney has to well from from from sample of one which is myself if I just think of how much easier life became after 5 or 10 years of practice where you start just figuring it out for yourself and learning communication skills of your own bed.
Suddenly work just becomes a lot less stressful and a lot more fun.Yeah, but if you fantastic research to see ya, yeah.It would be it's a great group project.We need to do that.I am over the last maybe last year.
I've did quite a lot of reading and also attended several workshops throughout for workshops on consultation skills and dealing with clients and difficult clients and things like that and actually read your book.I read the book The and I must have been there are some sections in there there little bit dry.
Well, yeah, but there is The research in there like it references so many human and Veterinary at so much human and Veterinary literature and there's some some key aspects there that really changed the way that I view the consultation process.
We used the Calgary Cambridge style at University.We were taught that firstly and so the kind of flow makes sense and that always was the kind of of cour backbone of our consultation Styles, but even just the the one big thing which was really building Partnerships and mutually agreed agendas and confirming with them and not in like it in the whole concept that the their concerns they talk about aren't necessarily in order of importance.
That was a really big one for me which is like, oh wow, they could say five things that were concerned.In them but then was up for you.It's up to you to determine which one was most important and through questioning and clarifying and developing reach the agreed agendas and things and developing Partnerships.
So there's a couple key things and it just blew my mind that the person who was there may not necessarily actually be talking in a key sort of a concise and coherent manner that the most important thing was the first thing they said was there any kind of piece of research there that really blew your mind or it was a big lollipop.
Women for yourself when you would when you were developing this program.Well, your point is very very valid and that's quite often clients will come in and they will Vale concerns in the order of in terms of safety how safe they feel with us.
And so they might you know tread lightly to see how we react to see how we grab hold of things.And so that's why this you know, I talk a little bit about in the book about the Frisbee versus the shotput model, right?Like it's really this iterative process of you.Checking back and forth, you know mrs.
Smith, you know, he came in first and you mentioned that he needs to have his nails trimmed the also mentioned.Oh, he's having trouble getting up and down the stairs and he's eating a little bit less than normal.I just want to you know, ask the best questions about all those things, but I'm really going to start with one in particular because it's really caught my attention.
Would that be okay with you?So it's it's that kind of back and forth even though they've identified he needs a nail trim, but you're thinking oh dear trouble going down the stairs.It's golden retriever little bit overweight.It's that type of thing.So it's really about this revisiting re sorting reprioritizing screaming.
You know, that variable that you see in the Calgary Cambridge guide of once you've got the agenda doesn't mean it's necessarily done.It's that one more volley of just asking, you know, you've mentioned this this and this what else what other what other additional things my mind says, we might want to reprioritize those differently than how you present it.
Is that okay?Well absolutely, but I just I don't like his nails being long and so I you know, I thought we could Trim those okay, of course, we will I'm going to kind of go revisit the stairs getting up this that type of thing.So it's a it's a dialogue as opposed to just grab and hold and taken off.
Mmm.This is that make sense.Yeah.Oh, yeah, totally.Yeah, the the other thing that really kind of highlighted for me as I was reading was that when we start to ask closed-ended questions, right?We start to control the conversation more and it's generally I think there was a one section in there.
And it talked about how that's that's us going to diagnosing mode.So because it kind of close down the the actual consultation until the interview really and then go into our diagnosis mode.What information do we do?We need as doctors to solve your problem.
Right?So we then close ourselves off to actually developing Partnerships and and having a conversation.It's like did he vomit?How many times did he vomit did he have diarrhea when he was last dewormed Okay, so Had vomiting diarrhea is a puppy hasn't been dewormed and so months he's got worms or something write that down these Pathways trying to ask questions which which match your particular differential that you've got in your head as opposed to actually still continuing the conversation and being open to what they may say because with an open-ended question there, they might actually develops more and more information than he got into the bin and he ate more food and my the children's leftovers.
On the table that may upset.It's got something instead.So it's a valuable book and we'll put it in the show notes, but I've found the the text actually quite insightful for anyone who out there is is wants to read it.
I think it's worth reading.So that's great.Not just night at bedtime.Yeah, it took me about two months to read like I didn't read that section.But yeah, but I'm certainly guilty of that but it's a turning it into a question for you Cindy.
So the reason we probably do that is time pressure.So most veterinarians have have time pressure.We want to get through the day how it what's your take on that the having a perfect communication wise Consulting style.
Is that more time consuming or how do you teach that to just still make people you can't have a half?An hour console there is every time and and have a deep and meaningful connection with every client or can you and still do it in a timely fashion?Well the science that we see the work that we've done we've actually shown that once mastered this takes less time.
So having a more bile bile lifestyle social conversation, which has a relationship Centre to care approach which is really a balanced between them talking us talking because we're doing as you suggest for asking some open-ended questions pausing and letting people talk She takes less time ten point three seconds post Mastery compared to 11.6 when you're more biomedical eating drinking vomiting diarrhea when you've got this kind of go in a real heart and asking those clothes any questions what I've what we see in the data is we go in like really Firm close any questions and if we get all relaxed at the tail end of the conversation, we use empathy statements.
We start letting you know letting her hair down a bit and the whole thing just goes it extends extends the length.So this tightening of Estrada said this, you know starting with are open questions because open-ended questions, you know things like tell me what PJ typically eats in a day starting from first thing in the morning to the end of the day tell me about your greatest concerns, if we go through with this those types of questions, not only yield good data, but they also invite client perspective and that's something that is terribly shy shy lie.
Developed in Veterinary client patient consultations, you know its clients concerns their expectations their beliefs, rightly or wrongly might not be right, but they still believe in something and if we don't acknowledge it they're not going to let it go.It's their values.So it's that's that that that invitation through open-ended invites and as we get more astute in this work, you might be saying oh for heaven sakes, how do you do that?
All in the ten point three seconds, we get a little more precise about what we ask a little more skillful. about being engaged with people like the accepting response doesn't mean that we agree or even maybe necessarily adore the client, but it means that we accept them as a human being and once we get that tidy We're off.
So that's the work that we've done.Can I can I just clarify so an example of an open ended or a closed-ended versus an open-ended question what two examples or one example, well an exam so an open-ended question doesn't it does not result in the ability of a person to say yes or no.
So close any questions, is she drinking, okay.And those types of things that we often do because we're trying to skirt along versus you know, what are your thoughts on starting Rory on heartworm preventative your rounds?
What are your thoughts about starting them versus is she on heartworm.Have you ever used courtroom before has she ever been in heartworm meds?Yes.No.Yes.No verse is what are your thoughts?What are your thoughts about that?So, you know, it's a bit of a your stick only both types of questions.They're both very valid.
The issue is we are Tennessee has been to start.There versus the invitation to be open up front earlier on okay when we went through the training with a vet's I found like if you can put a what at the start of it of a sentence generally makes whatever thing you're thinking an open-ended question.
So it was like used if you have an idea and you just start you opened and you see what and then you have to finish it off but still ask that question it generally. an open-ended question I found so but when we talked before Cindy about empathy statements, one of the things that we tackled was actually people who don't necessarily feel naturally empathetic but feel like asking a pathetic question or trying to become more empathetic feels a bit fake to them like so I'm a very clinical person and I like science and and I like the problem solving aspect of veterinary medicine then I realized over time actually one thing.
I really realized empathy was actually when I used to work as a librarian.Maybe you'll see this beat that out.Actually I'm not going to say But what I went through when I went through uni, I love and before uni action before I became a bit a bit started studying.
I was a librarian at local Council libraries and there was a whole lot of used quite a lot of interactions with the elderly public and developed.I think over time I really developed the the appreciation for people who deceased have conversations with them all the time and and and they used to share their stories and I think naturally there I started to develop this feeling of empathy or wanting to demonstrate empathy because they should stick share quite quite quite long stories about, you know about their lives that think there's a lot of shopping books, but I wanted to say something that I was like acknowledging listening like I heard I can see I can hear I can fit, you know, I can imagine or something like that, but for those who are clinical and Like the kind of concise conversation and not necessarily feel like they should have to develop and cultivate this kind of relationship with the client empathy statements.
I find out I found really don't come naturally to them.And like I said, how do you Broach that with with the students or with clinicians?Who who feel uncomfortable with demonstrate empathy?Yeah, well again another you got you both ask really good questions.
So what we do know again from the research is that we can teach empathy some of us it comes to us more naturally than others.Some of us like me I have to tone it down sometimes because I can be annoying great.It depends on the environment every context doesn't warrant a lot of empathy and so in some situations don't as well, but it's clinical skills.
So I teach in the frame of it.It's clinical skill.This isn't about being Like a psychotherapist it's about having in your repertoire of skills.One of it is such a powerful way of building Rapport and the science that we've been chipping away at his we found two things one is that empathy and shared decision making or two of the strongest predictors of adherence?
So we got it build this into our toolbox for sure.We teach it in that kind of pro forma way.Like I can see I can hear I can feel that sympathy 101 and naming effect.I can hear that.You're sad.I can't And here that you're thrilled I can see that you're super excited about this new puppy your life.
So it's not just for sad situations are there's a sentence I find if people can practice with something that's less emotional or effectual.It might be easier.The other thing that we do is I mean when we teach it we have actors so and as you may have had at your school they will they will let students know how that felt and if the timing of an empathy statement what impact it had was it too much too little It too late in the consultation for which relationship was never established until later on and then it was kind of too late.
And so this is this is good skill.The other thing is some of the research coming out of medicine is finding that developing the practice of mindfulness is a strong predictor of advanced levels of empathy of ability of people to be empathetic.
And so I don't know if it's about the Stillness that we participate in will be do mindfulness.In this practice, but there's something about being in touch with ourselves and a little more grounded than enables us to be more compassionate or empathetic towards other people.So that's kind of a branch of science.
It's going on at the medical school probably in your schools to and so we might need to tackle that which is interesting because that's kind of on a radar and vet Med as well.So, how do you at this point?How do you recommend working on mindfulness?What's your strategy for that?
Well, you know, I don't think that I'm an expert in that area.I know that it is one of our part of our strategic plan here in the veterinary curriculum to try to provide more training more opportunity for students and faculty to grab hold of this particular practice of mindfulness.
I think starting off we got to get a you know, I don't think I want to be having people laying and chairs and doing mindfulness right off the bat.I don't think that would work for everyone.Much like meditation or yoga and such.I think it's a little bit of inner work that needs to happen just around some inner matters related to authenticity learning how to ask open and honest questions like really getting an inside the Box a little bit before we can put them into these exercises.
The last part of my answer is in our curriculum in this course and communication.They do a number of assignments like reflective Journal writing which rule that didn't start off her.Good in the 2000s, but the writing the reflecting on interactions with clients.They're also doing self-recording appraisals of their interactions.
So we record everything and then they have to take it away and dissect it and think about answer questions.Like what were you thinking, you know at certain points?What did you think the client was thinking, you know, it's like getting up on the balcony and watching themselves on the dance floor is as I described it right Scotty got to get up here and see what you're doing down here.
So we try to facilitate that.Whether it's sticks, I don't know.Why did he say didn't start off?Well when you started it.Oh, I think it's back to your point because it was so new.I mean these Veterinary students destroy said that your scientists like it's writing a journal that's just painful for them right that being referred being reflective and and and thinking about how they were feeling and how the other person is feeling.
It was just as well lost my job over it really just it was just so new But it's becoming a narrative medicines becoming more and more popular investment.So narrative medicine, so I would yeah explain that.
Sorry.Yeah.Well, I think it's again further to both of your points.It's about things that are happening in practice.Now, we're practices are fostering and facilitating writing and using the writing as a forum for Rounds having specific sessions around people's writing and Third, you know the what they took away from an interaction what they did and what they could have done better what they did.
Well, so yeah, I mean, I think that's sort of where I'm seeing this going a little bit.So this very successful practices are starting to integrate this into their their their routines.We as part of our training of our veterinarian to transition into our practice.
So we're emergency after I was hospital.We will they Shadow our consultations Regardless gone how long they be now because we had quite a lot of procedures and Protocols of that kind of for a large hospital.But then also what we do is depending on how long they be now for we have closed loop security systems and I might be in a different room listening to a consult as as the as the veterinarian's going through the console unit.
Especially if they're new grad and quite often what might happen with the BD that they would be give them some lines.Up and get out of the room.I left my with the moment at the back.Actually.I just got to go check something with us the senior colleague or something or do you mind if I take fluffy out the back so that so that I can get his temperature or something, you know, so the have give them some way of getting out and then quite often what will happen is they'll use that escape word or something and they'll come into the next room there.
Like what happened then and I was like, okay you didn't hear what you said and what you did here that actually, you know, maybe go back and say this and then that might open the doors again and then address their concerns and understand and so forth and go back in and then they try something different and I'm like, I'm not saying I'm a pro consulta, but I learned so much from the text and Allison Lambert stuff as well.
Yeah and and listening back to your own consultations was really powerful, especially when you think that I'll you know, I was in there for so long and you realize or any in there for 8 minutes or so.Yeah, and that story that the client said went on forever when it was like only 45 seconds.
That was our opening statement those kind of things.So, I don't know whether some people out there have the ability but also sometimes we will do is we'll ask the client rather than we can record this for training purposes and stick your phone in the room put on recording these they soon forget it's there.So that's excellent.
I mean, that's say that the Earth that's that's that's really where we need to be to be going with this work.I mean we can do as much as we can.An in schools, it's really when you know the rubber hits the pavement in your own practice and to have coaching and feedback and that kind of mentorship is spectacular because you can be you're integrating now other clinical content with communication skills and you know, and even back to the schools.
We need to ensure that communication is not a standalone weird kind of thing, but it's integrated with clinical medicine and other procedures.So that's I wanted to just kind of go back to that and your point.I mean, that's just brilliant if you can.What I found was clients is when we tell them that recording so that we can get better too thrilled to think to think that we're really looking at ourselves, you know, and trying to improve how we communicate how we interact that's that's great.
So you guys yeah, it's going to ask you when both of you how did the Vets respond though to the idea of being recorded and enter your big brothers by don't do you get any resistance to it or people pretty open to the idea?Yeah, I'd we get a little bit of in the interview.
We actually say look as part of your training we will watch applications and things and and don't to be honest actually the the video recordings the security camera footage is there for safety?Yeah, and also it's there to clarify what's being discussed in the room.
So quite often we will use it for client complaints and they will make accusations or they'll sell their And like my of the consultation conversation may be different so he would go back and listen and then we'll say that actually was said this way and our veterinarian did say that would you like to hear the recording and quite often?
They like I did I say that okay.No, that's fine.Like I'm sorry doesn't mind misunderstanding.So and sometimes what we do is we you must use it as a as a treatment waiver some what it's like, so just clarifying that that it that it that and you decided to did it that at that.
Dart so if that's okay.I just want to make sure that we clear on that or we're on the same page.Is that okay?Is that what you know, is that what your thoughts are at this stage?And then so therefore it's on camera in those situations where you don't want to pull out a documented down the history, but sometimes it's enough that actually, you know, you don't want to go.
Hey look on the way out.Can you sign a treatment waiver just to say that you actually you went against my recommendations?No go.Yeah, so but quite often so that it is at least My experience is that the veterinarian is do feel a bit uncomfortable, but they feel a lot better about you listening in right rather than you sit in the corner like a weirdo listening their consoles, especially if I'm a guy in the Vets a female.
Like they'll the the owners will look at me and it's like no I'm not leaving this.I'm just in the corner like a leader, you know.Yeah, so I don't know City.What's your perspective or what your thoughts on that?Yeah.I think it's I think very much.Much the same.I mean, I don't think everyone's there's not a Readiness on everyone's behalf for this work.Right?
I mean some people are really not comfortable.I think if you set it up at a point of hiring, it's a Brilliance.I think also you have to have people as you describe yourself like it's you've got to do this in a supportive fashion.It's not about catching people doing the wrong things and it's got to be really balanced and I always like to what I'm giving feedback I use this the model called a low-budget gendell Ed outcome based analysis, and I'm happy to share that with you, but it's always Starting with the Learners agenda.
You know, I'm going to be hanging outside the door today.I'm going to be listening or going to be buzzed table or whatever.And what do you want to work on?Like what's your focus so really making it their stuff not me going in and saying dang you really need to work on that John like, you know, really really letting them feel empowered.
So I'll send that along and you might find it useful.Yeah.Yeah.Yeah.So in your in your teaching and then you say it earlier before we started recording that you do consulting or teaching in private practice as well to two veterinarians.
I think one of the most common communication related problems that you find that people struggle with all mistakes that people make in the in the veterinary communication.Oh gosh, some of the some of the lovely thing is is that there's themes and so at least I'm not we're not working on everything so much is good.
Like there's a lot of good work going on.I think taking us back to earlier in the conversation agenda-setting that's rare very very rare and quite often clients are producers aren't asked what it is that's on their mind.Really, I mean sort of the presenting complaint they get right to the patient Bingo versus, you know, my lead hand sikri.
He you don't have any help with the with the cattle.I can't have any, you know, I can't be doing anything frequent with these animals, you know, and so not Standing the context or the story or you know, I am pregnant as you can see.I'm eight months.
This dog is very I'm having difficulty.I had to get my neighbor to come over and help lift your in the back of the car.I really I need to I need some options here without taking the time to do that.So that's not happening.What we see is a fair bit of asymmetry where we think that our veterinarians are thinking that they're doing a lot better than our clients are experiencing.
Okay.So that's a little rough.I see the interruptions are wicked.I think you've read some of my work and we thinking Point fifteen point three seconds if we're lucky if we're lucky but it's even more insulting references it until until you interrupt and I just interrupted, you know cutting with that at him with a closed or something.
Well, I think it's a society we do that to write like we're rapidly think fast we move fast sorry and I introduce you I noted that at all.That's really funny.Yeah, I am I listen to you to your lectures at the at the APA conference earlier this year, which I really enjoyed and you you talked about the interruption things as ever since then I've been aware when I consult the problem is I catch myself say a second after I've interrupted.
I'm like damn it.I've done it again such a such a hard thing as you say if you can because you are you're in a rush to trying to trying to get through consults and ever since you've said that I find myself.Get over and over again, but it's good because that's mindful.There's at least I'm aware of it.
So I guess I could stretch that period of time until I entered have two little bit a little bit longer.Well, you know your use of the word mindful again in a different sort of way than I was taking it having getting some of the science in front of people.I mean not to make everybody read the book maybe highlight some sections or whatever else you think is important.
It starts to give a bit of a reference point right then they can be a little more aware of their behavior of our behavior.And so I think think you know starting with small goals a couple of things is is more manageable than taken on, you know, the 73 skills that are listed in the Calgary Cambridge guide, but really, you know, as you suggest being aware of going.
Oh gosh.Look at I read that I think we're doing that as a profession.I need to not do that anymore.And so I say, you know, start start small and some of the stuff we can practice at home.Yeah.Yeah, give us an example like what can I go practice on my God my family?
Well, I'm yeah on your kids.I mean open any questions empathy statements not interrupting just stuff stuff like that.I mean it just it goes a long way in you know our ability to practice but building relationships with them builds good solid scaffolding much like it does with clients you mentioned agendas sating.
When I when we when you started talking about common mistakes what clarify agenda-setting what what the hell what what you do to do to do that?Yeah.Well and so and then I'm going to answer your question and I'm just going to know I'm no I'm what I'm going to say is that this should set the frame for the entire consultation.
So we use this a bit of as a as a cape table of contents.If you will, it's sort of your table of contents of how this interaction is going to go and if As a result of clients revealing somewhere halfway through information.That wasn't kind of up in the agenda.
Something new comes up and you prioritize that is the doctor you pull it back up and say I'm adding it to the agenda.So the agenda is really about identifying what brings the client in the patient to the practice don't make any assumptions it also in light of what they've revealed.
It's up to the doctor and other professionals to prioritize reprioritize based on kind of your diagnostic reasoning that's already happening and this and that and your differential eels and then to screen and just double check as I mentioned earlier just check back in and just say, you know, you've mentioned that you won't use the example again, you want me to trim his nails you mentioned having trouble going up and down the stairs a little bit of a naughty thing is dinner as much as he used to and he seems to maybe just not to be as energetic.
What else so again opening a question not is there anything else because that's a closed-ended question right?It's shifting our mind to say what else and a pause and then what we do is we let people know and this To be for emerge as well.I mean, it's just a little more expedient some is a little more truncated.
Sometimes you got to get the patient back to treatment to get it stabilized.So things might be happening and more of a rapid place our state.I always think of My Little Shelter you that got hit by a truck and I went into a merge and I was incredibly impressed.Not only with triaging taking care of her getting her stabilized and and the technician said to me Cindy.
What's your what's your greatest worry?I said this sounds so ridiculous.I said but her first so mad at and covered in.Dirt, you know, I'm like at that it was not a priority at the moment, but this is a little show sheltie and she had been tumbled under a truck and everything for me seeing her all mucked up like that.Like that was just kind of the epitome of how bad it was.
She's broken pretty badly and I'm she's you know, it will get her cleaned up this other stuff we need to do as well and you know hand on shoulder and this is really tough.It's not we expect to be doing tonight great.So even in those more urgent's, you know, the context changes, but the skills don't it's just our You know of what we need to do and use in that moment and without dropping the relationship.
It doesn't have to be dropped.It just might have to be expedited.Yeah, that's excellent.If you don't mind me asking but maybe even more narrative questions.It's not necessarily covered very much in the textbook, but I don't know if there's resources that you've come across because I'm this is be a big topic for Ian's out there know this for sure and it be around communicating finances and and having conversations about money and so forth and things like that, like how do you know how the frames into a question as opposed to?
Like, how do you tackle that?How do you teach that new students how to have conversations around?money money, really Yeah, it's some yes, great question again.Both of you have great questions.We just we've published a fair bit on money.
And again, I'm happy to send you those manuscripts.If you want.We know that failure to discuss cost of energy carrot front contribute to client suspicion and mistrust.Hmm.And that's again why any verbal clue that's dropped about cost, you know, you know that sort of the in and the Yang of cost.
Is that regardless of Whether people have enough money to do stuff, they still want to know all the options.They don't want to be pigeonholed into already what we think they need to be doing or what we imagine that they can afford or whatever.So they, you know, 90% of the clients.
We've surveyed regardless of whether they have the bucks or not.They want to know and they want to know they want to talk about money in terms of the value not in terms of cost and service for us.They don't care.They don't want to see our fact sheet in the door that says well compared to human medicine because we And of did that in North America for a while, we grab human health costs and we compare and contrast and clients found it to be very offensive.
They want to talk about the value in terms of prognosis their ability to care for the animal in light of what's going forward their ability to maybe travel with their animal to highly infected a parasitic places or whatever.So they want to talk about it in that way.What does it mean for them and their animal and the way we teach this is we get students to grab hold of and and and Or just even say you know, this might seem awkward or kind of funny and I'm but I recognize the cost of energy carriers that consideration of most people so can I just check in with you and find out is there some concerned anything you need to be attended to as it relates to going forward with Kate taking care of Molly.
So it's about having the verbiage and the softness and the appropriateness and respect I would say in just about every consultation.I mean relative to where you are in the series of consultations, but are frustrated that we aren't talking money and then they end up feeling outrageously guilty.
They feel that they're you know, many two cases for caregivers are that we are underhanded and sneaky and just out to make money on this but I think to put things into context in a strategy or all that Marion's discuss the actual fees or at least in our practice and gibbet and when I was in general practice, we should talk but in states are there.
Like some wood takes or something or or would they be Financial officers who communicate the actual dollar value or something or or is there a trend with Community money isn't communicating the console room things are done and then they kind of hit at the reception desk or something on the way out a little bit of everything.
So what we've been you know, we I would say there's no consistency here necessarily at a practice or might be where they may get the cost of service when they leave we've found that unless our Missions are really fully trained.They're not necessarily equipped to have the cost conversations as with the doctor be because it just the issues related to you know, prognosis and diagnosis and such like that.
They end so again clients they don't quite get what they need.So it really depends I'm not saying that across the board depends on the training that they've had but class discussions.It's something I don't know.We we grapple with here and it sounds like you may be as master that better than us.If clients are given the cost estimates there may then be an opportunity to just you know, obviously check-in.
I mean, what do you do when you're given the costs and the estimates?How do you manage a people say you've got to be kidding me?I am Liu no.Yeah me it's it's acknowledging and hearing it.I got an hour and I'll say something like oh look, I can appreciate this is a significant funds and also appreciate that you weren't paid.
For this no one's prepared for emergency situations.Nice.Well done those men and then I also try to normalize and go.Hey look if I was in your situation, I'd be struggling to you know, I'd be feeling the pinch to So I listened I acknowledge.
I kind of normalize it and try to get on the same page and then I don't justify I don't go.Well the cost of this is because facility was three and a half million dollars and so forth.Okay, I then go somewhere.Lines of I link it back to what value the Diagnostics will tell us.
So they look very going back to what we discussed.The reason why we want to do the x-rays was to address the concerns regarding the that you said regarding him eating bones and also to it will the other things it will demonstrate to us will do this that is this and rule out this and then I'll generally roll off with Like, you know, do you have any concerns or what are the questions you have and then and then offer them something I will go we do have finance options if that helps case and then I think that I do this awkward kind of count of four seconds in my head.
One, two, three four point.It's kind of but that's them thinking this them doing math in their head calculating the value versus the cost and then also trying to generate Solutions on how to make finances move.The silence isn't them going all rarely is it them going you're an ass, you know, if there's bigger as they normally say it outright.
Yeah is Wayne it up and their head.That's very Australian.You see we in Canada.Don't do that.No, that's that's a really great example and and to further to your point, you know, I often say like resistance.
Means they're engaged resistance doesn't mean they're saying no but it worked and it requires a skilled Communicator to say Hey, you know, I'm hearing you and I'm seeing your hand up and I'm seeing this is really not what you expected.Tell me what you're thinking.So again, we're going to do some research on the side around resistance and what we see right now is that people when people run from it like they just take off it's like, you know know if there's a prescription of food prescription or preventative Dentistry or surgery and and That quite often that when there's resistance it's dropped.
So that's what we've got to build this toolbox of skills.We have a say, you know, what I can do this.This is a helix.It's the back and forth is iterative raid is once it has never enough and I'm hearing that you're overwhelmed with what it is.I'm proposing let's talk about that.So you also you know to do that.
You got to have some guts to be able to it's not always going to be always that nice.It's not always going to be a pat on the back and you're so lovely people might get frustrated.And so again, we're teaching communication for teaching to that higher level of Mastery so we can weather the storm and go beyond just kind of running if someone says no, yeah if they say no, but then we could do this which is like and two Jabs of injections or something or Jabs are administering medications and then home you go, you know, yeah, like going from one spectrum of what you believe needs to be done based on the conversation you've had with the client and the problem is that was generated at so forth and straw.
Sudden, like the complete other Spectrum, which is like well we could do that instead, which is just do injections at home.And I've had we've had complaints actually one that I generated myself which was like, we went around through discussions around the concerns they had or what was influencing their hesitation to proceeding with the diagnostic plan up with the treatment plan which was around about thousand dollars for a laceration of the eye and kind of trauma to the eye.
And then after several discussions, we realized that finances were a big issue and one of the main ones was the fact that her husband was non-contact herbal and she needed to make that decision with him.So then then I developed a plan which was essentially okay the next step down which was that's give pain relief and manage and so forth rule out severe ulcers and then have a discussion with your husband around try to allow more time for a discussion to be had to address that concern even I can have the discussion.
My phone and there was too much of a difference between what I was proposing to what I actually so what I originally proposed in what I finally proposed that she felt like as if I didn't stand up hard enough for my original original recommendation.
So then the complete shift to something different.She was like like she was confused by that and actually lodged a complaint because cuz I'm not complained but she provided some feedback on the grounds that well because I resisted then that was the other option.
Why didn't he just give me the other option from that from the outset?And so I'm not sure of a particular articulating this properly but it was it was kind of like as if she felt like that was a push to see we're not they would take it and if they want to take it too hard take this instead.
So but if I really believed it then That would have been a bit more resistance to actually to make it to try to help her adhere and get through overcome the roadblocks to accepting the plants.Oh, wow.Well and you sorted that out.I guess I'm hearing you got that sorted out or we able to have a conversation with the patient was fine in the end and we've had conversation and but it was really quite insightful for her to provide that feedback.
Yeah, it's going to say it doesn't happen all the time because yeah, it was very rare.We get the feedback.We're they provide.Us information about when we are giving them an alternative option that's cheaper quite often that will take that and be happy with that as opposed to actually be confused by that right only if you like, you know the feel like as if as if the more expensive option was just you know, a standard try to make some money when the second option was what really needs to be done.
So is there is there a way oh, sorry.No, no.No you go.I was just going to say is there a way in hindsight that you might have kind of reframed your trajectory you're offering in a way that was more transparent for her that you think might have made a difference.
Hmm.Yeah.I actually listened to back to the consult and just try to see where the conversation changed because actually it's for this consult went for an hour in between different emergencies.I letter had time to think I mean address. another concern came in and out in and out in and out and I expressed numerous times to through the consultation about my reasons why I felt that the option A was the best and and tried to like build ways around finance options and so forth to make that happen, but I think in the end, I don't think it was maybe right at the end where we decided to go with option b where I kind of I kind of dropped the The concerns I had regarding option b and then and I'm trying to make it feel good about option T.
Right, but made it to made it feel to good about option b, that's you was like why didn't we just go to option b option A was just for you trying to grab some stuff out of me.Okay.Well there is like I made it.I didn't address my didn't really be repeat my concerns in the end statement that look up as we discussed.
Well, the regional plan addresses all these concerns and And would have helped us to rule this out.But at this stage we're going with this plan and I can appreciate why but and I just want to make sure we're on the same page that it means that I can't rule out these three things or something.
But you know, so just being at the end I should have just reiterated the concerns I had in a nice manner, right and what you just described right now is it would be in the you're probably already know this would be a beautiful example of how to round on communication.
That's the mind.A sets up on the balcony looking at herself when the dance floor in the only other thing I'd ask but I won't ask I'll ask you though is to add perceptual skill what was going on for you?And again if you can take it that next Notch, so there's the contents kill the knowledge.There's your process skills what you're describing and then there's what's going on for you.
And if you could be transparent with your staff, I don't know what it was but she attractive I don't know.There's something that there's something that pushes our buttons right?Sometimes we kind of get off her game and if we can figure that one out, that's that's the Full picture and that that's what I was going to say earlier money, especially but but a lot of communication things a lot of that probably comes down to our own beliefs and values and how you brought up and even personality style and that so I find the money conversations particularly hard, but I think that's to do with our was raised and how much my parents were with money in that.
So I my dad it doesn't listen to this disease.That's right.I'm trying to decide what my dad.My dad would be the the the this the person who would if somebody gave him a an estimate that he thought was what was a lot of money he would be it'd be the best nude react and go.
No, that's ridiculous.That's yeah, so I don't know if that's why but I hate that reaction when I when I give an estimate and a person comes back with a with a completely understandable negative attitude.It is I'm with Gerardo.I understand it's a lot of money.
I have complete empathy.With that I don't like spending a lot of money at the mechanic but I take that that reaction almost personally, so I try to avoid it at all cost and then I'm very quick to do a Gerardo says to go.Oh, that's okay.If you don't, you know, we've got a plan B, that's yeah, but it comes great exist great example, but it comes back to me and I'm aware of that.
I try to avoid giving estimates because I've learned that I despite my best efforts.I really struggle with it.I try and find different ways to It but that the question I want to ask is so that's clearly a personality trait of mine.How much how much how much in your teaching or you thinking or what you guys do with communication?
How much variation do you allow for let's call it personality types or like Gigi keep detected and account.You recommend people look into that what they're like, what are they Tendencies and those sort of things?Yeah.Yeah again a great question.We do as I mentioned, you know, we're teaching the content in the process and the perceptual skills.
So in our you know in our safe little Laboratories here at Calgary, our coaches are trained.I mean we're inviting students to get inside their own self all the time.What it what are you thinking?Like?What is your thought process could be exactly like you said to us, you know, well, you know money we didn't talk about that at home.
My parents brought the metal box over under the bed on Sunday night and I was told to leave the room and so it's very I feel that it's very personal.It's really none of my business and then we have to talk about well if it's none of our business, but people want to talk about it.What impact is that going to have on your outcome?
So we're constantly doing now does it mean everyone's ready to examine their own biases and values?No, Way, I mean, this is lifelong skill.This isn't just take a course and you're off to the races.This is about and I'm loving you how you're both describing how you're integrating this into your world of work because again, I don't think if we don't have it that level would just sort of it we know from the science and medicine skills deplete right down to about thirty to fifty percent so we can graduate them really as rock stars and if they're not getting the mentorship in the coaching when they're out there.
It's they're only holding on to a few pieces.Is so yeah, dude.Do you guys in your course to do any sort of business ality assessments or personality Styles or so people can learn what like to do believe in the whole personality testing moment.
I call it a trend.Yeah, he's out there.Well, you know, I don't a lot of people do believe in it if I'm out working doing work cross country and I'm working in a practice.That's new to this.I might use it just as a starting point the gamma my you know, the Myers-Briggs is good as you probably know what are other ones that sun is just fun as a like getting things going to Sunday's people have not really even thought about the fact that there's people that have different preferences and styles.
What I what I don't like is when people get hung up on.Well, that's my style.It's like well it is your style.It's good to be aware of it.Now.We need to stretch and grow, you know, it's further further to Lovely point about you know, your Dad's reaction to money and you're finding other ways of working with that.
But number one, you know it, you know that that's a bit of a challenge and so you're trying to iron out the Kinks in that and so not just saying that's who I am and I'm not going to deal with it.So as long as we can get past our style and then you know, I really preach on it's not it's not necessarily about how you want to be treated.
It's about how they want to be treated.It might mean you're going to have to act a little different.Aunt and trying some new skills to be able to meet people where they are.Mmm-hmm.That makes sense.Yeah.Absolutely.Yeah, totally a lot of those things are what they call we called flexing flex your style.
You know, it's good to know what you're good at and the fallback said you have in but also it's also good to know how it is that you respond to stress.And so how do you communicate in stressful situations?
So myself I'm a Ivor become quite autocratic and and directive and controlling and I know now like and in it and it's and it's hard because it just comes out.Naturally.It's like what would you do right now?
It's like I think what do you think?That's great, but it's about flexing so I always find I've when I listen back to consultations I and we talked about interruptions and things and and you know in our console coaching and when I listen back to consoles and you get these expressive people that come in that love the story.
I tell this amazing the energetic and creative kind of story as to what's happened over the last 24 hours in a not soaking here at manner as well.So with facts flying around all we need to do this but there but then what they did and then and then you can hear the veterinarian and then you just got with slow down.
They just let him finish it off their thing a real direct kind of persons come in and they would just go like you hurt his leg.What do we need to do?And then you're like what?Yeah, so like you can hear it.
It here at back and I found that reflecting there and mirroring their energy and communicating the way they communicate with you somewhat skin, sometimes really help in terms of matching conversation Styles.Yeah, so I don't know that's something that that I feel when we're listening to the consult a veterinarian said it helps them be bit more mindful of how how to be how to have a comfortable conversation.
Station with someone in the console room and H of the communicating listening to in the way that the kind of it's comfortable for them.So but yeah when I just going to add to that and also to start proxemics right like our proximity to people what the barriers are.
So there's the Talking part and then there's just setting up the room properly and you know, if you've got someone, you know, you might not be staring people down.You might be kind of, you know, just in your body so that it's not so threatening.I mean, it's all of that and it's not just the one size.If it's alright, it really depends on the person the situation all those kinds of things.
Well, I think for good communication.
Yeah.Well again, I never got a chance to go into your concert rooms when I was in Australia, but here we're still back at the stage of even having a couple of As in a room and again, we might be really behind it's about managing the exam table ensuring that it's not a barrier recognizing when we are sitting behind it why we're sitting behind it is that appropriate me the safety of the patient as well.
We got computers happening in rooms.Now, there's a whole art around engaging people in front of a computer so that that again so I might be out dating myself like you making yourself and like dinosaurs.Yeah.I mean, it's just you know that do you have chairs in your clothes?
What rooms where you would take the initial history if this is like a you know Wellness visits is that something that you're doing already know, we have a we have a in our Clinic.We have a bench an examination bench with the with the computer screen.So there is definitely client on the one side me on the other side, but I personally don't use it like that.
Well, I'll tell you what I do in a way that's a good or a bad thing.But we also have a little bench for the for the client to sit down and I'll Jam.During history taking go sit down.Okay, there's your tall.Yeah.Yeah.Yeah, it's I just I just find it's well.I also don't like standing all day.
So it's a nice break for me.Yes.I'll sit down and got all the dog more than examine, but start examining and start observing all dog or cat or whatever and and sit next to the client and have a chat first and then I'll say okay.
Let me let me examine the dog and we'll put them on the table and there but then they It becomes a practical matter of the client has to be that side to help me control the animal and I'll be on the other side.Okay?Yeah, great.Well, it's great to have a look at we found in the gender work we've done that same-sex dyads are more satisfied.
So that tends to create more of a relaxed atmosphere.If you're with another fellow versus a female veterinarian.Yeah, and it was it's quite remarkable the satisfaction relative to same same Jen from the clients point of view.It's a yes and From the veterinarians point of view.
It's interesting.It's interesting.So again something to be aware of like what's what's what's going on.Anyway, I mean satisfaction is important, especially for our clients.Yes.So I find maybe it's just in Australia that the main are generally more difficult clients and it might be different in Australia.
Maybe that's just North American Trent.Yeah, maybe it's my own perception, but that it's that they more more like Likely to have an issue with the money in that I find I find most most female clients are quite happy to do you know they say they might they might just not be verbalizing it.
Maybe they still thinking it but there's just go along with what you recommend much easier ways to the male's we deal with maybe just my area as well are they the ones are going to say I can dreaming no ways.Yeah.Yeah how much?Yeah.Yeah, and it could be a court could be a cultural thing a gender thing.
I just want to finish up your question about The proxemics are the setting we are really committed to helping our students.It depends on the urgency of our the episode but to getting a history before they get their hands on the patient's.Okay.
And so the work that we've been doing is that this is that this is I mean, you're still collecting history while you're doing a physical but that's why the chairs any kind of prompt that says we're going to sit and have a visit and I'm going to learn a little bit about what's going on.It's just a lovely an opportunity say to get off your feet for a bit.
To invite people to sit relax a little bit and some of them won't sit right and so you're going to be Matt teaching them as well and maybe not saying have a seat and I'll be saying so try to get your history.Then you can integrate what you've gathered on History obviously into your differentials as opposed to trying to pull it all through the physical exam.
So I love the idea around the seat and house-sitting perceptually for them feels like as if the interaction has Belonging than actually has as opposed to actually so you've taken the time to sit means that you've kind of you now you're prepared to listen and you are taking you are giving them your time.
But also their perception of time is longer than yeah.I don't know like if there's that correctly.Well it is correct.And we just have just reading another report about sitting to eat versus standing.Is that a were more satisfied in the food?
Tastes better and different when we sit to eat versus stands, but we tend to eat more when we sit.So so again, you'd have to be skilled because if people that you don't want everyone sitting around for 45 minutes to an hour, right?So this is where once the skills are integrated, you know your sign posting you going.
Oh my gosh.I I love hearing a story about your granddaughter and I wish I could sit here all day long.I got to pull us back on track mrs.Smith.So it's have a really good way to to wrap that up a little bit.Jana main light yeah, those are just transition statements and signposts and all those lovely skills.
I'd love to ask you a couple of more specific questions if you're okay with it, how absolutely everybody good for time delay between minutes.I'm sorry.I'll get it to work sometimes.Yeah, so we before chatting to Sydney.I put a post out on social media to ask for questions from our listeners to say well what are difficult situations that you write the deal with regularly?
So that I could can ask you what do you say in the following situations or how do you deal with them?I'll start with our church.And I know you had a few good ones as well.So we'll take it back to the money.One one that people worry a lot about and they don't know how to respond is you've discussed money and it's not going all that.
Well in the client says to you, all you vet care about is the money.How do you how do you how do you answer that?Hold your wrist?Come back come back with that one without starting a fight.Yeah.Well, I probably is an open-ended question.Tell me more about that.
Tell me about your past experiences sounds like you've had a situation where you felt that it was more money than you wanted to pay or was worth the what really the what the offering was for Barney.So I would use a skills open-ended questions reflective listening or you might just say You know you sent you sound concerned.
I want to learn more about that.So what we end up doing quite often is we think that we have to have a rebuttal and we have to have a net have to have an answer and my rule of thumb is when in doubt ask a question.So when in doubt about what he's thinking or what his past experiences or what's in his craw, you know, what's maybe it's a pre-Christmas and he wants to put a couple more presents under the tree.
I don't know but I want to create an environment where I am.Ask open honest questions and you know, he might just say well, you know might just get really even more frustrated and just the absolutely you're frustrated.This stuff is expensive.I also know that you're really care for Barney and so we got to figure out what to do about that.
So again now you're going back to client perspective because you've understood the role that this animal plays or I know you don't really give a damn but I know your wife does and I heard you say early on that that dogs in the house now not just sleeping out in the garage.Okay, so I got to get real clear on what it Is that you all want for Barney so that we could come up with the best plan?
So that's where we integrate that clients story and use that when we come back to these difficult conversations or when we're explaining and planning.We're taking into consideration the Gestalt or again in small end and what stuff for your tougher right you go to farm and you get you can get a picture you can smell you can look at the ventilation.
You can see who's working what state the places in it's tougher and small I find you've got to get a little No more more story.Hmm.That's true.So I just had one of those moments where I go, right?Hello light bulb moment.
Okay.Okay.I like the question, but that's that's excellent.Jyotin money and you got me.All right, one of the one of the listeners wrote in and said as a female vet she struggles to give feedback or advice to her male colleagues with its weather.
It's an especially if it is not criticism, but but disagreeing with them she struggles with that.How do you what do you tell your daughter to deal with had to had to had to deal with that in a better way?Yeah, and so with this be an owner and Associate is this a new graduate I think of more recent graduate so not super experience.
But but yeah obviously knows is knows his stuff and and needs to disagree with one of her colleagues about about something.Okay.So I mean it's that's that's its that's a tougher one sounds like she wants she wants to disagree and had and so she might if she's got the stealth.
She might want to just have a conversation before she wants to disagree.And just investigate just so you know, I'm not quite sure how it rolls here.But when we have disagreements with one another what's the protocol what has the practice being?So open ended question?
Well, I don't know.We don't really have a protocol here.Okay.Well, that's funny.You know, there's sometimes sometimes where I'm thinking you're not going to agree with me and there's times where I'd like to share my ideas with you about what what your thoughts are and just wondering if that's something we can do.It's a conversation and if she's got the guts to set the environment.
Moment up.She's going to change the culture, but I would certainly start with you know, what is your perspective on us giving each other sharing ideas and giving each other feedback should get some some kind of reaction.She'll probably have to use some reflective listening and eventually they'll have to kind of Tidy that up and make a plan.
Okay, excellent.And and the same same person said, how do you how do you give instructions without sounding like you're giving orders?So I'm presuming she's talking about asking.The technicians to help her with something of that but she doesn't want to sound like she's ordering people around.
Okay?I mean, it's kind of maybe the same kind of thing.How are we how it's the same kind of thing and I would she might want to just have a little visit with self.Is she is this relationship Centre practice?She's engaging it.Is it more doctor centered kind of more directive and so might want to just have a little check in and have a look at what her style is what her tone is when she's asking I mean, sometimes she's got to give instruction.
Right?I mean if it's a more serious situation, but I think I would have a discussion ahead of time about how that's To go down and for her to do a little bit of checking in with herself good.Okay, you got any generator now like like the Euthanasia question.
That's a good one.Haha you go.You ask it then what to say when a client?Thanks you after performing a euthanasia.Yeah, because that their the situation is and I really enjoy that have spoken about this before you do these days.
It's all good.And then at the end the client says thank you very much and your reflex responses.Oh, it's a pleasure, but you can't say that.So this is how I got my career started was end-of-life communication and what I did a ton of work with clients post animal death and They are is such a personal time for so many of them.
It's like you're you know, you're kind of the artist that has painted a picture and it's hung on the wall.You will forever be valued and they will talk about you years later.And so I mean, I might just say something like if they say thank you and I might just say something.
I so appreciate you trusting me and that I could be here with you and Molly today.Thank you for letting me be part of your Healthcare team.So it might Maybe something more a broader kind of comment just acknowledging that they feel grateful that they're appreciative that this is tough.
And you were there for them.I don't think I did interpret more into it.I might just say thanks for picking me.Thanks for picking our practice.Thanks for trusting us to take good care of you both.That's really good.
That is awesome.I'll I'll add that into my repertoire as well.Excellent.And then the last one said the something's going wrong during a during a routine procedure and you need to make that horrible phone call to explain to somebody that that we've lost your pet or something.
Something went wrong.How do you start that?How do you even cross that bridge?And so I like to get people face-to-face right if we can get them in if they're not too far away.That's not always possible when we're so far away from one another.
And so let's imagine that we've called them and we don't want to wait long on these people get frustrated.They don't trust us and so as soon as we're in a position to grab that phone, I would be calling.Mr. Jameson and saying, mr.
Jameson.I'm wondering about your day how it's going.You know that Rusty came in for a routine dental and I needed to speak to you about that things have not gone as we planned.So I might do that if we can get him in and I would say if you have someone like I mean, I'm worried about them driving.
So I'm going to try to manage all those types of things.I mean disclosing medical error it that's a whole that's a big kettle of fish.So it's very often we start with the signpost and just say this is something that we this doesn't happen routinely he's died under anesthesia.
So it's signposting into this let him know what's happens and then there's a whole Dialogue that follows thereafter, which is a number of series of skills.And again, I have lots lots of information on these topics that I can share with you if whenever it's appropriate.
If you do we can we can put all of these in charge.Okay.I'm making notes issue.Did you want me to send you that cost discussion, please?Okay, okay a medical error.And this is because insightful conversation.
Thank you very much.Indeed.Okay, we're going to have to have law we could we could have a whole podcast series on this just communication with Cindy and IIT.
Should we wrap it up?Yeah, yeah, I'm good.Yes Indian reserve that.You wanted to cover in particular or something or?Well, um, no, I don't think so.There's only two points that I wrote down like in addition to what I've already snuck in here.
And there is that getting a client perspective is the new content of a history.We are we were still kind of stuck some places are very stuck some very traditional histories and we haven't begun to appreciate and integrate client perspective.It is so incredibly valuable in explanation and planning when we actually get to give the information planning going forward to grab hold of the story the component parts of Client situation of their experience my example of my pregnant client who could barely get the old male moved into the back of the car without help.
She really wants to talk about end of life.And so we got to get that story and then figure out how to factor that in to exclamation planning and and we really got to work on empathy.I think I shared when I was in your beautiful country that you know, 300 visits and hundred fifty the patients were six and there's only seven percent of those cases that had any utterance Of empathy 7% only 7% Yeah.
Yeah.Now again, this is done in North America.So I'm going to own some of that.But when I go around the world it run shy and I think we need to have a discussion and our practices as to its importance what it is.It doesn't mean that with sympathy.It's not like meaning we own it and then to talk about what holds us back from you from using that skill.
I'd like to see that happen.That's that's a big hobby horse of mine.I am in discovering what works for me and then trying to when I'm mentoring younger vets is the is the empathy thing but what I what I'm learning more and more is it's not for the clients benefit or it's not just for the clients benefit.
It's very to very large secrete my own benefit.If I if I if I take that in pathetic approach.I am much more.Alliant and much slower to feels much much slower to feel burned out in frustration because if I don't have that then I'm getting angry all the time and I'm already stupid clients coming with me this stupid problems and I never listened and they never that whereas if I change that mindset to to deciding to be empathetic because I was going to ask you how do you do it and they say you talk about practical examples of things that you can say and empathetic statements, but how to get yourself into that frame of mind if you got any advice.
I said that how how do you approach it?How do you advise people become more empathetic.Yeah.Well again, I go back to my daughter.I'm watching her evolve and develop her professional identity.She has Peaks and Bounds for sure.She deals with some really rough ugly stuff.And as we all do in the profession, I'm noticing her take being much more dedicated to taking care of herself.
I know that sounds very trite, but I know you know you the profession works hard it works long see stuff that stuff.She's also finding herself and practices that are as it sounds like both of yours are they they provide space to talk about these issues.They have grief rounds.
They examined their communication things that go well and Things That Go bad.I think that you know, there's there's a number of things in our profession that we have their sort of The Untouchables the things that we don't necessarily talk about that.I mean dealing with Death at a rate of five to one compared to human dogs, like there's just some stuff that I think we Expect ourselves to cope with and we don't we don't always I mean we put it we can be tough about some stuff and you know, the financial stuff and all of that but they're big issues.
So so I'm watching that work for her.And so again, I think you have to also have to be committed.So to want to survive in the profession we've most certainly found in our research that relationship Centre communication which you know consists it, which is you know that lovely Developing relationship not hugging and kissing everybody but you know that nice balance conversation with good skills is highly predictive of doctor satisfaction client satisfaction and adherence.
We've got three pieces of research that just showed that so it's worth getting comfortable with these skills.Absolutely and I mentioned early on mindfulness again that research coming out of medicine that the that the employment of a mindfulness kind of orientation to life is helping to deepen people's ability to Empathetic excellent.
So yeah, if you if somebody wanted to learn more about all of these skills, what are good resources?There's obviously your book and people can read but where do you go to to get better at this?Well, I mean, I think it's going to practice this like both of yours having mentorship.
I think there's some CEO there for sure any good ones that you can that you can off the top of your head.Well, I mean your school's on the east coast of the country are doing a you know, Michelle MacArthur it at Adelaide.You've got Allison across the pond a little bit Dan Shull is at C person.
Yeah.Yeah.Yeah, yeah, he's good.He's very good.So, you know maybe in light of the distance.I mean, I'd love to come see every month, but I don't think that's going to happen.But you know even grabbing hold of those folks.I know Michelle would love to put together a like either Retreat series or an in-depth Workshop series for people.
I think she's just waiting for the profession to kind of go.Hey, you know pick me down as well.I don't know about him how interested he is, but I think it's finding those people and empowering them and say hey we want this.Come to Canada.That sounds really good.
Did you mention some communication conference in st.Kitts coming up?Yeah, that's it.We were just in bounce bounce this year.Would love to have you in the mountains.And then st.Kitts is going to be June 2nd to the 4th at the Park Hyatt got a got a great rate on at this incredible if you have like someone special you want to bring.
I guess a honeymoon or something.They're just gonna go to this conference.Yeah, you know, maybe it's more podcast.Maybe it's I mean people need to practice.
This isn't just about reading the book, right if really got a practice practice the skills.I think that's the key thing is to forget it.And as Cindy said before it's one thing at a time the 70s.Something different things you can do and quite often we go.
What is the one thing you want to what's the one thing to resonate for humans Workshop?It's over.Listen more or I get a not interrupt and then the next thing what's next thing you're going to do after a month and knows my thing actually was consciously having insane at least one empathetic statement right in some way.
It was appropriate in the performance. these in nice.Okay.Yeah, and it DV he was awkward because like I felt awkward to me but that I could see than that that allowed them to then somehow open up again and gave them permission to then sort of Express how they felt somehow and it was only through scene that I saw the value of that.
But for me, it was a conscious decision that I wanted to try this so and and I just yeah, I see I hear I can I can I can like whichever I use it, but I had to keep it really simple.It's actually said empty what I want.
Otherwise, it was just too much of a big thing.And yeah, so well, please don't beat yourself up.I'm guessing if you read in the book about cognitive empathy.I'm thinking both of you use cognitive empathy a lot.So have a little reading that I can't teach that here because the students just get so hung up on it.
So and my I have examiner's and they examine them on this Ivo.And I'm going to send you a checklist that I work using a practice that I work in a, Florida.And they've included that in the performance review.So it's basically getting a bit of a metric around town skills that you're using and I used the carefully and playfully and supportive way.
So I'm going to send it to you so that again you might consider that gets it your point about.Well, how do you how do you teach this?How do you build on it?Mmm?No.Okay Federal.Fantastic.Okay.Thank you both.
Thank you both so much.

Prof. Cindy Adams