Communication with Pet Parents is Important – In Life and In Death

Education about medical treatments is just as important as education about death care processes

Here´s the article that Dr. Marty Becker shared – in its entirety:

Sticks and Stones May Break Your Bones, But Words Can Cost Your License
By James F. Wilson, DVM, JD; Christina Moore, DVM candidate 2012; Erich Roush, DVM candidate 2013
November 15, 2011

A 10-year-old Yorkie died unexpectedly after receiving the third mitotane (Lysodren, drugs.com/pro/lysodren.html) tablet you dispensed to treat her Cushing´s disease. You know that either you or your room technician told the client about the possible risks and complications of this treatment because “someone always does.”

Now you are being investigated by the state veterinary medical board, your license is at stake, and Ms. Loveherpet is threatening a lawsuit for $100,000 in damages for emotional distress for the loss of her best friend “Gigi.”

Even worse, she´s threatening to trash your practice by starting a website to determine how many other pets you have “killed.” You couldn´t sleep last night because all you could think about were the 14 years of your life you´ve spent building a practice that is now at risk because of a simple breakdown in communication.

According to Laura Downes, executive director of the Maryland State Board of Veterinary Medicine, unprofessional conduct lawsuits often boil down to charges of negligence or issues with communication. She says, “It is not uncommon for investigations to indicate that the standards of medical care have been met but documentation of the communications by the veterinary team was inadequate. If the pet´s condition deteriorates or the pet dies while under veterinary care, clients often assume that substandard care was provided. Excellent communication at the beginning and throughout treatment can assuage misunderstandings later should the pet not respond favorably to treatment.” Complaints from clients can result in hefty fines, mandatory continuing education, and even license suspension.

Facing the Facts
Many veterinarians will face situations like this at some point in their careers. Downes estimates that 75% to 80% of client complaints to state boards are the result of breakdowns in communication. Poor listening skills are cited in a large percentage of medical negligence cases as one of the main reasons why individuals take legal action against health care professionals.1

One of the main issues in these cases stems from obtaining educated owner consents. Without discussing diseases in lay person´s terms and documenting communications in patients´ records, clients can easily come back and say, “I didn´t realize this procedure required so many follow-up visits and care or had so many possible adverse effects, or I never would have agreed to it.” For this reason, the use of clear communications as well as written, signed consent forms that educate clients about the course of treatment and risks associated with various procedures helps minimize communication errors and omissions.

See the Informed Consent Form

What´s worse is that these facts may not change any time soon. Only 6 of the 26 veterinary schools researched for this article list a specific communications course in their curriculum, either as a required class or an elective.2 Some schools, like Washington State, Wisconsin, and Minnesota, require multiple courses that are specifically focused on communications throughout the 4-year program.2 Many others have some coverage of this important skill scattered throughout the curriculum.2 Still, the community of veterinary schools as a whole is not doing enough to provide veterinary students with sufficient client communications training.3,4

Common Mistakes
Typical communication mistakes veterinarians make include the following:

1. Assuming that other team members provide accurate and relevant information to clients without providing them with detailed scripts, question lists, educational consent forms, and/or operational instructions to use for key client interactions.
2. Assuming that clients understand what is being explained just because they are nodding along or saying “yes” or “uh-huh.”
3. Using closed and/or leading questions that suggest certain answers without allowing clients to expand on them.1 While closed questions make it easier to control the discussion, they can make clients feel intimidated or threatened; open-ended questions allow clients to describe their experiences, feelings, and understanding of the subject under discussion.1
4. Assuming that clients do not have the resources or are not willing to pay for what´s best for the patient and failing to explain why that course is the best option.5
5. Failing to use legal consent forms and discuss the issues they contain.6

Communication Strategy
There are many things you can do to ensure that you or your associates never face state board complaints, investigations, and/or disciplinary actions as a result of simple communication errors.

Use the term “medical care plan” instead of “estimate” to focus on courses of action for patient care. This semantically different term emphasizes the diagnostic and treatment part of the plan and diminishes the focus on money.

When possible, stand side-by-side with clients as you educate them, using “show and tell” models, images, or handouts. Encourage them to stop you for clarification and ask questions as you are explaining procedures or as they read the consent forms they are signing. When clients hesitate to sign consents, say, “Please be sure to tell me about any concerns you may have.” The side-by-side posture decreases the image that you are using confrontational communication techniques and, instead, illustrates rapport-building communication.

As much as is practicable, document all forms of communication in the medical record, including in-person educational discussions, phone conversations, and emails. Recording modestly detailed notes during and after these conversations allows you to refer back to them later, when time has faded your accurate recall of events. Detailed records ensure that you and your staff look and are “smart”; incomplete records make all of you appear careless. Remember that documenting courses of action that were recommended and deferred or refused is just as important as documenting the risks and adverse effects of procedures that may have been accepted.

Learn to use personality assessments such as Myers-Briggs (myersbriggs.org) or DISC (discprofile.com) to help staff understand their communication styles. Practice communicating with clients and staff who have different personality types to better understand how to be more effective.

Do your best to assure that someone on your team can speak Spanish or at least communicate in this language using medical terminology. According to the 2009 U.S. Census Bureau, 12% of the population is Spanish-speaking-and that number is only expected to increase.7 Keep an English/Spanish medical dictionary in your clinic and hang posters in or around the exam rooms with translations for common phrases and terms used in veterinary exams. Don´t let language be a barrier between you and your clients!

Invest in books that teach communication skills. Handbook of Veterinary Communication Skills by Carol Gray and Jenny Moffett, Getting Past No by William Ury, and Legal Consents for Veterinary Practices, ed 4, by James F. Wilson are good resources.

Communication regarding medical subject matter is a skill that is developed over a lifetime of effort and experience. You can educate yourself and your team regarding the most common mistakes and how to avoid them. Fundamentally, if we communicate well, then our clients will be happier, our patients will get well quicker, and we will all enjoy our jobs more.1 | EVT

References

1. Handbook of Veterinary Communication Skills. Gray C, Moffet J.-Ames, IA: Blackwell Publishing, 2010; pp 15-26.
2. Research performed by Christina Moore referencing web-based course content for all U.S. veterinary school curricula, 2011.
3. The KPMG study: The current and future market for veterinarians and veterinary medical services in the United States. Brown J, Silverman J. JAVMA 2:161-183. 1999.
4. NAVMEC Report, final draft. aavmc.org/veterinary-educators/navmec.aspx.
5. Law and Ethics of the Veterinary Profession. Wilson JF, et al-Yardley, PA: Priority Press, 1989, p 112.
6. Legal Consents for Veterinary Practices, 4th ed. Wilson JF-Yardley, PA: Priority Press, 2006, pp 4-7.
7. Language spoken at home: 2005-2009 American community survey. U.S. Census Bureau; factfinder.census.gov.

It´s Your Responsibility to Educate The Pet Parents

It´s your responsibility to educate!
Once again, I heard another sad voice say “I didn´t know that there were unethical pet loss services out there – and now I find out that one of those businesses is who took care of my beloved dog.” It just breaks my heart when a precious pet dies and the pet parent does not know what their options are to honor the life that was shared.
However, I can´t shame the pet parents that say that. I, too, was one of those pet parents. I shame myself because I had been in the industry for 18 years when my dog died. I was in the preneed industry, spending time educating people on the benefits of planning ahead and I did not heed my own advice. When she died I didn´t know what my options were.
Nor did I know that not all pet cremation services were created equal. Luckily I found a place that had an “open door” policy and I met the person who I handed her precious body to. While the process in its entirety was not as it should have been, I, at least, knew that her cremation was handled properly and in the manner that I requested.
So while many “caregivers” will fight the very thought of being a sales person – and say that it feels “too weird” to sell their pet loss services – I encourage you to look at this differently. While it may feel like selling, we as a pet loss profession need to understand that it´s our responsibility to get our educational information to the public so that our services are easy for a pet parent to find. And, our services have enough information to educate a pet parent on the right pet loss practices that will provide the right amount of support and experiential services that a family will want.
Furthermore, it´s also our responsibility as pet loss professionals to guide our veterinary partners on what the right processes are. As a pet loss professional running your business, it´s your business to run. It´s your business whose standard operating procedure is to get the correct paper work completed. It´s your business to educate the vet care professional on why it´s better for them to send the family to you to handle the pet´s death.
So, today – make a commitment. If you don´t feel comfortable calling it “selling” – then call it what you feel comfortable with,…. Educating. Providing information. Teaching. Training. Spreading the word. Call it something.
Because I call it “your responsibility.” Go forth!

Becoming the Best Pet Loss Professional!

A chance for learning and networking you won´t want to miss!

As a the co-chair of the Pet Loss Professionals Alliance, I´m proud to be a part of the leadership team – watching the association grow and be what every pet loss professional wants in their business association!

It´s already been a very exciting year for the PLPA team! First of all, we have over 200 members in our association! What an amazing accomplishment given our very short time of existence! A true testimony to the excitement from you, our members, in wanting, as well as needing, an association that answers to your organization´s needs as pet loss businesses.

Secondly, we are about to hold our Charter Certified Pet Loss Professional course on October 3 – 4, 2011, in Fort Worth, TX. This course is shaping up to be an incredible opportunity for you, the pet loss professional, to further your skills as a specialist in this field. If you´ve not registered yet – there´s still time! You most certainly don´t want to miss this phenomenal course – and an awesome opportunity to network with other professionals in the field. REGISTER NOW! Time is running out to take part in this Charter course! We´re excited to honor you at the next ICCFA/PLPA conference in Vegas as a graduate of the first CPLP Course! Click here to register for the CPLP Course,… http://www.MyPLPA.com

Next, have you also registered for the Pet Loss and Grief Companioning Certification program being held at the end of the CPLP week – October 6 – 8, 2011? Whether you get this incredible learning to be a better resource to your veterinary clients – or because you work daily with grieving pet parents, you will most certainly find this course to be not only rich in content – but even richer in the sharing and networking with the other attendees. A most moving experience – as well as some well-rounded learning on the topic of Pet Loss and Grief. There´s still time to get registered for this session as well – click here http://www.Pet-Loss-Grief.com to let us know you want to sign up for this amazing learning too!

By the way – if you have a veterinary client that you work especially close with – think about bringing them to the Pet Loss and Grief Companioning Certification course as well. Not only will they get 15 hours of continuing education credit – but you will have a priceless opportunity to bond with your client – and learn at the same time!

Next, we are working to continue to fulfill our promise of “more educational courses” for you and the veterinary community! Our first webinar was held in August – with 16 attendees, including attendees from the veterinary industry! These courses will run monthly – with a variety of topics to whet any pet care professional´s whistle! Another fabulous opportunity to bond with a veterinary client – by participating and viewing these sessions together and then taking an opportunity to share after the session. Remember – be a partner to your veterinary clients when it comes to the topic of pet loss education!

Thanks for all of your support of the PLPA – and for being a part of this amazing journey together! There´s much more to come for our association in the area of standardization for business practices, educational opportunities, and more,… as a team – we will all make it happen together!

Unconditional Love – Even in Death

Hawkeye shows his love for his master and friend

It was a tragedy heard round the world, the loss of numerous Navy SEALs in combat. A loss that breaks anyone´s heart; tugging at my heart even more with a son-in-law SEAL.
But, what began to tug even more so at hearts was a photo taken at U.S. Navy SEAL Jon Tumilson´s funeral in Rockford, Iowa. A photo showing unconditional love at its finest – Jon´s buddy, Hawkeye, his loyal friend, not leaving his master´s side, even when his master lie in a casket.
Huge kudos to the Hauser Funeral Home staff for supporting this act of love. An act that, as described to me by Mr. Allan Whiteside, funeral director and manager of the Hauser Funeral Home, made all of the sense in the world. For, as Mr. Whiteside said “Hawkeye was a huge part of Jon´s life. Therefore, it only made sense that he was a part of this too. It´s what Jon would´ve wanted. It´s what all of his friends wanted, and needed.”
While the Navy SEAL´s team was mostly in charge of the arrangements for Jon´s service, the Hauser team was there to support their every need. Therefore, when it was mentioned that Hawkeye should be there, Mr. Whiteside said “we were all for this, too. Having Hawkeye there was an incredibly appropriate thing to do.”
So, again, kudos to the Hauser team for supporting this act of love!
And, now I turn to you – as pet care professionals, we are serving pet parents every day in our business. Are you proactively asking if there´s a pet at home that should also be involved in the final arrangements; a part of the visitation, a part of the service, given a chance to say their “good-byes?”
For, although, these may not be deaths that were broadcast nationally, these people are heroes in someone´s eyes. And, that someone possibly might have four legs.

How much is too much to spend on a pet funeral?

Make it be about what the pet parent wants and needs!
“How much is too much to spend on your pet´s funeral?”
Ah, yes, another article picked up by my Google Alert about pet funerals. Actually it was a blog that was exploring the question “How much is too much to spend on your pet´s funeral?”
I personally find these types of conversations absolutely astounding! In fact, almost uncomfortably embarrassing! After all, who on earth would think that it would be appropriate to tell another person what´s acceptable to spend on ANYTHING?
Furthermore, being a veteran of the funeral industry, it was never, ever in any of my training to learn how to guide a family on what´s acceptable to spend on their loved one´s final service. I never heard “If you loved Mom enough, you´d buy this casket” or “ that type of casket doesn´t really show how much you loved your husband, does it?” Rather it was about a service and the memorialization pieces that provided the most VALUE to the family in creating this final tribute. The VALUE of the services and memorialization pieces, right? There was nothing in this process that equated the amount of love to the amount of money spent. Quite the contrary – our goal was to provide a service where the value of the service delivered far outweighed any amount of money spent!
Furthermore, I have never heard people having a conversation about when to stop providing medical care to someone because of the expense of the care.
But, I find it almost amusing that people are forthright with these opinions when it comes to pets. For those that aren´t pet parents, there are opinions on what´s “acceptable” to spend on health care, on daily care, and ultimately on the final arrangements for the pet. And, the only time that scrutiny comes into play is when it´s “too much.” Whatever that number is – based on each person´s own opinion!
62% of our society has a pet. And, as a pet parent, I, as well as other pet parents, take pride in being a responsible pet parent. It´s what we sign up for when we take one of these furry creatures into our homes. It´s an option that we have that we knowingly and willingly commit to when we accept this role.
But, it´s a role that for the 38% of our population leaves us open to shame and criticism. When all we want to do is celebrate these little creatures when they are alive – and pay tribute to them when they die.
In a way that´s right for us! And, let me be the one to determine what´s the right amount to pay for this type of honor! It´s what I WANT to do!

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