Laurie's Blogs.

Have you ever had one of those experiences where you came to learn (after the fact) that your client didn’t come away from your assessment / treatment session with the information about what you thought their dog’s diagnosis was?  I’ve experienced it, as a clinician, as a second opinion practitioner, as an allied health practitioner, and as a client myself.  So, I got to thinking about what might contribute to these miscommunications.  Here’s what I came up with:

1.  Medical Language:  Maybe the problem stems from the use of medical jargon that means something to us, but not to the client.  For example, “I think we’ve got a bit of intervertebral disc disease going on here.”  To you and me in the medical fields, we can interpret this to being a disc herniation or extrusion of some sort that can make sense of neurologic findings and back pain.   But the client may have no clue what that diagnosis truly means.  

I experienced a similar phenomenon recently.  I’m looking to sell our cottage and I met with the realtor onsite.  I understood most everything, but had to ask for clarification when he said I’d need to get a “RPR” and after that he thinks he’d put it up as a “pocket sale” until the new year.  I told him, that I didn’t speak his language, and that if he wanted to talk medical or agricultural, I’d be on board, but I didn’t speak ‘Realtor’.  (The answers are Real Property Report, and a sale that isn’t officially listed, but a property that can be shown to buyers if a realtor knows about the property and its listing.)

2.  Down-playing the Tentative Diagnosis:  We might think that we are being kind in downplaying a presumed or tentative diagnosis.  For example if we do think the problems is IVDD, or a tumour, or hip dysplasia.  In a medical profession, we recognize that to be able to ‘officially’ make diagnoses such these, further diagnostics would be required.  As a result, we might downplay what we are thinking until it is confirmed by such diagnostics.  Maybe in such a case, we don’t do a good enough job of explaining how our clinical evaluation leads us to believe that the problem to be XYZ but that further diagnostics would be required to confirm that.  

I’ve noted this phenomenon when I’ve had clients come to see me after being to their veterinarians, the emergency clinic, or a specialist.  I’ve been told, “The veterinarian didn’t really seem to know what was going on.  She said she would need to do more testing.”  However, when I read the dog’s chart, the veterinarian most certainly noted what they thought was going on and/or had a list of differentials.  So, I can only assume the that communication was lacking, leading the client to believe that the veterinarian didn’t know what the problem was!

3.  Too Chatty:  Okay, I’m guilty of this, especially with clients that I know well.  We end up talking about dog shows, husbands, life, politics, TV, snow, etc., and I’m well into treatment mode with their dog after I’ve done a reassessment, and at the very end of the appointment, I’m asked, “So what did you find exactly?”  Thank goodness they ask, because we’ve covered a million subjects except the one for which they came!  It’s easier to fall down this rabbit hole with clients you know well, and I think this is the one that catches me the most!

I decided to ask this on an AI search to see what other answers came up… and there were plenty more.  

4.  Being Too Conversational:  Health practitioners might aim to be friendly or casual, which can sometimes lead to the critical information being delivered in a less formal or structured way, making it easy for owners to miss key points.

5.  Glossing Over Details:  In an effort to not overwhelm or scare the client, practitioners might skim over important details, assuming the client understands more than they actually do.

6.  Time Constraints:  Busy schedules can lead to rushed appointments where there isn't enough time to explain diagnoses thoroughly, resulting in owners not receiving full explanations.

7.  Cultural or Language Barriers:  If there's a language barrier or cultural differences in communication styles, the message might not be conveyed effectively.

8.  Owner’s Emotional State:  Clients might be too anxious, stressed, or in pain to absorb new information, leading to a lack of comprehension or retention of the diagnosis.

Ah yes, I’ve seen this one for post-operative dogs!  The owner isn’t used to seeing a shaved, bruised, bandaged, or freshly stitched leg, and they are ‘freaking out’ on the inside while the veterinarian is telling them what they did surgically or the technician is providing post-op instructions.  The client is not absorbing any of that information!!

9.  Information Overload:  When too much information is given at once, clients can become overwhelmed, leading to selective hearing where they only remember fragments or none of the diagnosis. This can often also happen when providing treatment options.  The client’s brain may have shut down long before this portion of the conversation took part, and they are not capable of understanding the options, let alone making a good decision!

10.  White-Coat Syndrome:  Some clients might not ask questions or engage actively in the conversation, perhaps due to deference to the doctor's authority, fear, or simply not knowing what to ask.

11.  Assumption of Understanding & Health Literacy Levels:  Practitioners might assume that the client already knows certain basics about their condition or has prior knowledge, which isn't always the case.  As well, a client’s level of health literacy can greatly affect their ability to understand medical information. Those with lower health literacy might struggle to understand even basic concepts.

12.  Poor Communication Skills:  Some medical professionals might not be trained well in communication, focusing more on the technical aspects of medicine rather than client education.

13.  Documentation Practices:  If the diagnosis isn't clearly documented or explained in layman's terms for the client, follow-up or understanding might be compromised.  Do you provide a Report of Findings to your clients?  I tend to do this for New Assessments, but I often forget (or get lazy) for those that are existing clients but whom have a new issue with their dog.

14.  Distractions in the Exam Room:  The presence of technology, noise, or other interruptions can distract from the conversation, leading to missed information.

To mitigate these issues, healthcare providers are encouraged to practice clear communication, use lay-person-friendly language, check for understanding, provide written summaries, and encourage questions. However, these practices are not universally adopted, contributing to the phenomenon where clients leave without clear knowledge of their pet's diagnosis (or treatment plan).

I’d welcome your feedback and thoughts on this subject!