How Do We Communicate?
An article recently came across my desk that I found enlightening and hope you will too. The topic today is about communication, specifically, communication with owners and vets about neurology. I find myself using a LOT of words in my consultations with owners and often wonder if those words are having an effect. You are not alone if you find neurology daunting – many clinicians do – and that innate worry can lead to communication barriers, too! Prior to COVID I used a white board and wrote key points on the board as I spoke to owners. The COVID pandemic resulted in a large percentage of telephone based conversations and the white board wasn’t there. Now that I’m back to in person consulting, the white board is back too and I think, highly subjectively, that I see a difference in client comprehension. That is why this article sparked my attention. I am always trying to figure out ways to communicate as effectively as possible with you, my actual client, and your client (aka the pet’s owner) so that the pet gets optimal care.
The article I’m referencing is by Dr. Thomas Flegel (a German neurologist) and his colleagues (JVIM 2024 1-4). In this article Dr. Flegel and his team evaluated the client’s recall of the discharge and compared that to the clinician’s recall of the discharge. There were 3 parts of the study. Part 1 and 2 were only answered by the client and they pertained to demographic questions of the owner and atmosphere/comfort level during discharge. Part 3 was about the diagnosis, treatment, and long-term plan. A raw percent agreement was then calculated for different questions. Part 3 was repeated 2 weeks later.
Results
I had preconceived ideas that age, maybe native language speaking and level of education would influence these results. I was wrong! The only statistically significant difference was the client’s age; increasing age lead to a decreased raw percent agreement. This meant that clients over 50 years old had a more difficult time recalling the specifics about the case compared to the clinician. I don’t believe they accounted for clinician age in the study, but they did evaluate clinician experience.
The three questions that had significantly lower raw percent agreement 2 weeks later. Those questions were
“Should you give the medication before feeding your pet?”
“What are potential adverse effects of the medicine you have to give your pet?”
“If your pet has to live permanently with signs of the disease, which are those?”
Their conclusion was that we should emphasize the most important parts of a pet’s medical care when we discharge them (or finish a consult, in my case). The researchers also commented that many clients could refer to the discharge instructions to answer the questions therefore resulting in similar answers but their response was “who cares?” In a practical sense, if the client wants to remember the side effects of the medication, for example, we HOPE they will refer to the discharge paperwork!
After each consult I summarize the findings for both the attending clinician (you) and the client. I know many of you write summaries for your clients as well. Some parts of my written summaries will be over the heads of some owners because it is intended for you (my client) and some of the discharge will be too simple for you because it is intended for the client. But having all the information available to all parties can only improve understanding and follow through. Hopefully this limits the number of clients coming back to you with questions after my consult, and I have been told it helps many of you recall my BILLIONS of words when the client calls with questions. I know they’re long but hopefully they’re not unapproachably long. If you have a suggested change to the summary forms, I’d really love to hear from you!
Thanks for including me in your patients’ care. I look forward to working with you (and writing down my findings) soon!