Hacking Client Communication

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You can spend a lifetime learning about communication. Countless books, online resources, coaches and entire university degrees are readily available to educate and inform. Unfortunately most of us don’t have spare lifetimes to commit to this, meaning that the active improvement of communication skills often get relegated to ‘something I’ll do later.’ Yet the positive impact that improved client communication can have on how effectively you ‘re able to do your job and how much enjoyment you can get from veterinary science cannot be overstated. So what to do? Well, you can start by considering just these concepts:

Don’t talk down to your clients.  Listen.  Have a sense of humour. Respect.

There is good evidence that focusing on these small number of key principles can go a very long way towards achieving better communication outcomes. Malcolm Gladwell’s book ‘Blink – The Power of Thinking Without Thinking ’ deals with the subconscious and the cues and responses involved in how we interact with each other. (https://www.amazon.com/Blink-Power-Thinking-Without/dp/0316010669). 

In the book he refers to the work of two researchers who studied communication between doctors and their patients, with the aim of determining if there are things doctors say and do that affects the outcomes of the consults. The conclusions drawn from these studies provide such delightfully simple and practical advice that I was compelled to look up the original research.

The first is a study by Wendy Levinson MD – ‘Physician – Patient Communication’ (JAMA 1997). The research for this paper involved listening to recordings of conversations between medical doctors and their patients. Half of the doctors in the study had a record of having had two or more claims made against them during their careers, while the other half had never been sued. The purpose of the study was to see if there were any differences between the two groups with regards to how they communicated with their patients. The results showed some very clear differences and provides some valuable advice, but more on that later. What really fascinated me was a subsequent study that pares down the information from the recordings right down to the core:

Psychologist Nalini Ambady and her team took those same recordings, cutting each conversation between surgeons and their patients into 4 ten second snippets. Next they removed all the high frequency sounds from the recordings, which had the effect of erasing the spoken content and retaining only tone of voice. They had the study participants listen to these sound bites of garbled conversation, asking them whether they could differentiate between the claims and no-claims surgeons based on only on those 40 seconds of sound.  


It turns out that they could do so with remarkable reliability. But how?

By recognising dominance in the voice of the surgeon. Surgeons who were rated by the participants as  having a high degree of dominance in their tone of voice were significantly more likely to be sued than surgeons who were low in dominance. Dominance in voice tone was conveyed through “deep, loud, moderately fast, unaccented, and clearly articulated speech.”  Basically – they sounded superior, and talked down to their patients. (Scientific proof that nobody likes a cocky know-it-all! I’ll refrain from making jokes about surgeons at this point…) 

‘Surgeons who were rated by the participants as  having a high degree of dominance in their tone of voice were significantly more likely to be sued than surgeons who were low in dominance.’

Or to put it another way: a large part of communicating effectively with your clients is not so much about what you say, but rather how you say it. If you can convey a sense of genuine concern and a desire to help you clients and their pets the client is unlikely to ever lodge a serious complaint against you, even when you stuff up! Why? Simply because they like you too much.

The true value in this is not in avoiding being sued or getting into trouble. It’s about getting the most out of your career. In my research I ask experienced vets what their biggest challenges were when they started out in their careers.  One of the most common answers to this question is “working with people”.  No surprises there, but here’s the kicker: the answer to the next question,  “What do you enjoy most about veterinary practice?” is also “working with people.”  So why this apparent contradiction? I think that to a large degree it boils down to communication skills. As you progress in your career you’ll get better at communicating through trial and error. Once you’ve mastered the skill of quickly establishing a connection with clients you will not only keep them happier – you’ll keep yourself happy. Suddenly the thing that starts off being your greatest source of stress can become a major source of pleasure. 

Before we move on I want to take a moment to emphasise the length of those edited recordings: 4 X ten seconds. It took listeners just 40 seconds to reliably judge whether a surgeon is likely to get sued. Let that sink in.

How quickly do you think your clients decide whether or not they trust you and whether they think you’ll do a good job, without even realising that they’ve decided? How important is your head space just before you walk into that consult room and open your mouth? Is it perhaps worth a few moments of pause before you open that door to reset your attitude, thinking: ‘don’t talk down, listen, respect’? 

Back to the original Levinson study, which focussed more on the actual content of the conversations. What did the ‘no-claims’ doctors say or do differently to the ones who ended up in trouble? Note that nobody avoided trouble by never making mistakes. It was simply the bond that the no claims doctors had with their patients that stopped the patients from taking action against them when mistakes did occur. Again, not only did they avoid legal repercussions, but it’s likely that they’d have a much more satisfying working life because of the relationships that they created with their patients.

The results of the study produced some practical and easily replicable advice:

  • No claims doctors spent more time with their patients. Their patients did not feel rushed, and felt that the doctors took time to understand their problems. How much more time? On average only 3.3 minutes more! You don’t need to be one of those vets who only do two consults per hour. You just need to remove the haste and be present for a few more moments. 
  • What did they do with this extra time? Did they explain things more clearly? No – they took time to actively listen. They asked questions to facilitate the conversation and get the patient’s opinion, encouraging them to talk, rather than overwhelm them with facts. “Tell me more about that”. They made sure to check the patient’s understanding of what was being discussed. Note that there was no difference in how much information was given to the client between the two groups. It’s not about you and what you know – it’s about them.                                                                                                                           
  • They often laughed or used humour during the conversation. 
  • They make orienting comments early on in the consultation to let the patient know what to expect from their consult: ‘First I’ll ask you a few questions, then I’ll examine you, and afterwards there’ll be time for you to ask me questions.”

And that’s it. Not rocket science is it? In contrast: the patients of doctors who had multiple claims made against them felt “ignored, treated poorly”, and felt that “the doctor didn’t take time to talk and never asked me about other symptoms.” 

Malcolm Gladwell wraps up his chapter about this research: “But in the end it comes down to a matter of respect…” . I couldn’t agree more. If you start every interaction by making a conscious effort to approach your client with respect and with a genuine desire to help, you’ll find that the topics discussed here will mostly come naturally. You’ll automatically listen harder, you’ll be less inclined to rush, and you’ll find it hard to act or speak in a dominating manner.

“The secret to the care of the patient is in caring for the patient.”   Dr Francis Peabody, Harvard, 1925.

Of course you’ll encounter plenty of people who will not reciprocate your attitude; people who don’t listen, who’ll talk down to you and will show you no respect. You know the ones. Just stick to your guns and don’t stoop to their level. If you started the interaction from a place of respect and a desire to help,  and you avoid being drawn into their way of acting, all the shit that they fling at you will mostly just blow back to hit them in the face. You on the other hand will walk away roses, ready to focus on creating more meaningful relationships with the ones who deserve you.

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