May 4, 2009
Veterinary medicine embraces interpersonal skills training
Compassion, empathy can be taught, experts say
By: Timothy Kirn
For The VIN News Service
Many medical professionals once believed that bedside manner and empathy traits were hardwired — clinicians either displayed compassion or they didn't — and few schools bothered to teach the skills required to comfort and reassure patients.
Now that notion has been turned on its head. During the past few years, the veterinary profession has embraced the idea that clinicians can be taught to become better listeners and more sympathetic, and some say that in veterinary medicine, this type of training is sorely needed.
“Hands down the evidence says you can teach bedside manner,” says Jane Shaw, DVM, the director of the Argus Institute at the College of Veterinary Medicine and Biomedical Sciences at Colorado State University.
A conference now focuses attention on the development of improved communication skills. It is called the International Conference on Communication in Veterinary Medicine, and it has been held annually for four years. In addition, the Bayer Animal Health Communication Project has been training veterinary school faculty members in effective interpersonal skills since 2002, and now trains faculty members at every school in the United States. Even the National Commission on Veterinary Economic Issues has developed a communication training module.
While it is impossible to pinpoint the exact genesis of any movement, some of the impetus for the present efforts to improve bedside manner might be rooted in the late 1970s and early 1980s, when some human medical schools began to assign students with journal writing and the reading of great literary works as a way to open their hearts and inspire them to develop greater sympathy. The schools were concerned that the demands of getting into medical school and the technical aptitude required to master the curriculum meant that a preponderance of medical students were well versed in biology and chemistry, but were lacking in other areas. They worried that technology was usurping the art of displaying sympathy and empathy.
Many medical schools still have such electives, such as the University of Wisconsin, where students study the songs of composers with chronic afflictions.
In veterinary medicine, the movement often is attributed to the Argus Institute's Dr. Jane Shaw. Early in her veterinary career, she struggled with delicate situations in the clinic, and it prompted her to become interested in how veterinarians relate to their clients. She went on to earn a doctorate in epidemiology, with a dissertation that was the first scientific study of veterinarian-client-patient communication. She has been at the center of many of the efforts to teach veterinarians better people skills.
The Argus Institute runs a course on effective clinical communications skills for third-year veterinary medicine students and has a workshop for practicing veterinarians. Shaw and others say that a prevailing characteristic of veterinarians is that they tend to be introverts, which hurts them in dealing with animal owners.
“When I started working, veterinarians would proudly tell you that they could have gotten into medical school but they went into veterinary medicine because they didn’t want to have to deal with people,” says Susan P. Cohen, the director of counseling at the Animal Medical Center in New York City, who teaches communication skills to trainees.
Shaw adds, “As a characteristic of the profession, we are not necessarily outgoing."
Kathleen L. Ruby, of Washington State University (WSU), has been collecting Myers-Briggs Type Indicator personality data from her own students and veterinarians around the world for a decade. While 25 percent to 35 percent of the general population scores as introverts on the test, 60 percent to 70 percent of veterinarians do, reports Ruby, who heads the counseling and wellness department at WSU's College of Veterinary Medicine.
Moreover, two-thirds of women in veterinary schools score as “thinkers,” which means that they put problem considerations first and people considerations second when making decisions. In the general population, about two-thirds of women score as “feelers,” those who put other people's considerations first.
“Much of what we have learned is extremely relevant to explaining the gap between what clients want from their veterinarians and what vets are most inclined to naturally give in the way of compassionate communications,” Ruby says.
In another study, researchers found that persons planning on entering the medical professions tend to have what one expert called an “empathy deficit.” J. Kenneth Arnett, of Eastern Washington University in Cheney, and his colleagues surveyed 224 undergraduates using two tests, the Hogan’s Empathy Scale and the Balanced Emotional Empathy Scale. When the results were organized according to the professions the undergraduates said they intended to pursue, the study showed that those entering the medical profession, which included veterinary medicine, scored only about as high as those entering law or business and much lower than those entering education or a mental health profession.
While most owners probably do not want a veterinarian who starts blubbering when talking about having to euthanize their pet, a caring, nurturing interaction in the clinic is important because it affects client compliance with treatment directives, Shaw says. Clients are less likely to listen to a veterinarian who they deem to be uncaring, and they are less likely to return to the practice.
That might be why compliance with veterinary care is terrible, as gauged by the American Animal Hospital Association (AAHA). The 2003 AAHA study showed that compliance rates are routinely overestimated by veterinarians and can be as low as 21 percent for diet recommendations, 48 percent for heartworm prevention and 35 percent for dental care.
The number of studies showing that training can improve the communication and the interpersonal skills of medical professionals is overwhelming, Shaw and others say. According to a review conducted in 1999, there were 81 studies looking at training, and all but one found a positive correlation.
In one of the most recent studies, teachers at five different academic medical centers met at least twice a month to practice skills designed to enhance compassion, or they reflected on their own work through discussion or writing. At the end of 18 months, they were evaluated by their students, who rated them on how well they listened and connected, how well they taught communication and relationship-building and how well they inspired a caring attitude toward patients.
The trained physicians consistently outscored controls who also were evaluated in all of the domains explored. The differences were significant enough to suggest “practical importance,” wrote lead researcher William T. Branch, Jr., of Emory University.
One critical feature of the study might be that the training required active involvement and took some time.
Shaw says that one thing the studies show is that a lecture or two does not do it. The training must be intensive. In her course for veterinary students and the workshops for practicing veterinarians, participants engage in role-playing exercises with trained actors, and that role-playing is a common feature of many programs that teach communication skills to medical professionals.
“There is a big leap between hearing about these skills and actually using them,” she says.
The trick in teaching communication in this way, she adds, is to give feedback in a supportive, non-threatening way since personal communication style is tightly bound to a person’s self-concept.
Lenny Laraio, DVM, is a practicing veterinarian and self-described introvert in Denver who took one of Shaw’s classes. He had no training in communicating with clients in veterinary school, apart from a single, one-hour lecture, he says. But he learned its importance early on in practice when he had situations where he could clearly perceive that clients did understand what he was telling them.
A few times, he had clients ask him to see a different veterinarian.
One of the main lessons Laraio learned from the workshop is to pay attention to body language — his own and the client’s. It helps him to not seem distant, and to discern what the client is feeling and how engaged he or she is in what he is telling them.
Laraio had three role-play exercises in the workshop. In the second, he had a client who was uncommunicative and brusque because he was angry that he had to wait half an hour to see the veterinarian. Laraio did not do so well with that guy, he says. In the third scenario, however, he had a client who was also taciturn and brusque, but this woman was uncommunicative because she was worried about her pet receiving vaccines, and Laraio was able to elicit that information from her, in part by reading the clues of her body language.
That third scenario taught him another valuable lesson, Laraio says. In his day-to-day work, he often is told what kind of a client he has before he enters the examination room. Now, he puts that information aside and tries to just observe.
“I really try not to go into an examination room with a preconception of what is going on,” he says.
Based upon his experience, Laraio says he "would definitely recommend the course.”
VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email firstname.lastname@example.org.
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