Amanda L. Donnelly
DVM, MBA
Talk the Talk columnist Dr. Amanda L. Donnelly is a speaker, business consultant and second-generation veterinarian. She combines her practice experience and business expertise to help veterinarians communicate better with their teams and clients. She is the author of “Leading and Managing Veterinary Teams: The Definitive Guide to Veterinary Practice Management.” Learn more at amandadonnellydvm.com
Read Articles Written by Amanda L. Donnelly
Periodically, veterinarians and other team members must convey sad or devastating news. For example, I’ll never forget telling a young man that his 2-year-old golden retriever had a broken femur and pelvis. He couldn’t afford the expensive surgery the dog needed. That was one of many instances when I had to deliver bad news. The situations are stressful and disheartening for everyone. Clients might react with tears, denial, anger, blame, guilt, shock or profound grief. Our teams dread sharing awful news and might not know how to handle a pet owner’s emotions.
Let’s look at best practices in different scenarios.
A Patient’s Status
Telling a client about a pet’s illness, prognosis or death is a common occurrence. For instance, you might have to inform someone that you diagnosed a chronic disease such as diabetes or that a pet’s medical condition deteriorated. Even worse is when you report that a beloved companion has terminal cancer or died in surgery.
Here are the steps that should be part of any conversation focused on upsetting medical news.
1. DO IT IN PRIVATE
The setting usually is an exam room. Sit at the same level as the client. A wheeled stool is good, especially when seating is limited. That way, you can be at an angle and maintain a comfortable distance rather than sit directly next to or across from the owner.
2. SIGNAL BAD NEWS
This step is called a warning shot, which alerts clients that you don’t have good news and gives them a moment to prepare. You might say:
- “I’m sorry I have some bad news.”
- “The news is not as good as we had hoped.”
- “I’m afraid the situation is more serious than we thought.”
3. ALLOW EMOTIONS TO EMERGE
Recognize that pet owners will express a range of emotions. Therefore, give them time to respond to the news. You can validate feelings by saying:
- “I can see this is upsetting and makes you very sad.”
- “I understand you’re angry about hearing this outcome.”
- “You’ve done so much to care for Hannah. I appreciate that the news is worrisome.”
4. CONVEY EMPATHY
Remember that empathy means being fully present with someone and giving them the space to display feelings. Your response at this point shouldn’t be about offering possible treatment options or trying to make the pet owner feel better. I was reminded of that advice when a friend told me her dog had been diagnosed with malignant melanoma. I gave her time to express her worries and love for her special companion.
Be mindful of your body language when showing empathy. Compassionate nonverbal communication includes a caring look, nodding your head, making eye contact and leaning in slightly.
Here are excellent empathy statements:
- “I’m so sorry to hear about Davie’s diagnosis.”
- “I imagine you are worried. We will help you in any way we can.”
- “I know this isn’t what you wanted to hear.”
5. “CHUNK AND CHECK”
Remember that people need time to process bad news, and you don’t want to overwhelm them with too much detail about a treatment or prognosis before they’re ready to hear about it. Start with a few details, then pause to ask an open-ended question such as, “What questions do you have regarding what I’ve covered so far?”
Providing a few small details at a time allows the client to participate in the conversation. You also might need to give pet owners the time to think about how they want to proceed. You could ask, “Would you like to think about your options or call someone?”
6. BE COMPASSIONATE AND REALISTIC
Unless the pet died, strive to maintain hope and optimism about the outcome. Even if it looks bleak, this step gives a client the time to come to terms with the treatment plan and prognosis.
Explaining a realistic outcome is critical so the client knows what to expect. Here are examples of what to say:
- “I’m hopeful the surgery will successfully correct Oscar’s laryngeal paralysis.”
- “In my experience, this treatment plan can help Bella live comfortably for some time.”
- “Treating a dog with congestive heart failure can be challenging. We’re here to help you manage Duke’s medications and care.”
When the Unexpected Happens
One of the most challenging scenarios occurs when something goes horribly wrong. The situation might call for you to report that the client’s dog ran out the front door and that the team is looking for him. Or maybe someone gave the client’s cat the wrong medication. Or perhaps the team didn’t order an individual cremation, or someone lost the pet’s ashes.
After you signal the unfortunate news, be direct, clear and transparent that something terrible happened at your practice. State the facts and then explain what someone is doing to correct the problem or help the patient. Let the client know you will do everything you can to avoid a recurrence.
Be sure to document the incident and client communications in the pet’s medical record. Contact your liability and insurance company if appropriate.
Bear in mind that the best way to handle such situations is to apologize and express empathy. Use phrases such as:
- “I’m so sorry this happened. Please know we’re doing everything we can to help.”
- “I can imagine how difficult this is to hear and that you’re worried about Tigger.”
- “I understand this is extremely upsetting. We’re looking at our protocols to see how we can prevent future mistakes.”
Discussing the Cost of Care
Meanwhile, conversations about money can become emotional, particularly if a pet owner isn’t prepared for the cost of care. Such a reaction might happen if a team member failed to outline a treatment plan and associated costs before admitting a patient. Or perhaps the dental bill is double the estimate.
The best approach to talking about money is to engage in transparent, empathetic dialogue and provide payment options. Here is an example:
“I’m sorry to tell you that we discovered Ginger had two bad teeth, which required surgical removal using a gingival flap to suture over the extraction site. This means her oral treatment costs more than you expected. I know it’s expensive. We have payment options to help you spread out the cost of care.”
How well you deliver bad news can affect whether a client stays with your practice. Being truthful and conveying empathy builds trust and enhances loyalty, which ultimately helps more pets get the care they deserve.
START WITH ‘S’
Physicians developed the SPIKES Model to help deliver bad news to cancer patients. It also can be used with pet owners. Here are the six steps.
S: Setting (Choose the best environment, with all parties present.)
P: Perception/perspective (Ask questions to see what clients know or feel.)
I: Invitation (Ask for permission to proceed with a discussion.)
K: Knowledge (Convey a “warning shot” and offer information in small chunks.)
E: Empathy/emotion (Respond with empathy.)
S: Summary/strategy (Be supportive, and discuss the next steps.)