“Spa-see-ba” It’s the only Russian word I know. My clients’ faces lit up when they heard the familiar, awkwardly delivered expression in their native tongue. They had just thanked me in English and were exiting the exam room to wait in the lobby for their beloved pet, a one-year-old male neutered domestic shorthair with a broken forearm. The cat had fallen off the refrigerator a few hours ago, and I’d diagnosed him with a distal humeral fracture extending through the medial condyle. The fact my clients’ primary language was foreign was only one of the challenges of this case. The cat (let’s call him Vlad) was understandably upset, and we could not even get an exam done, much less radiographs, without heavy sedation on board. In person and over the phone, I communicated with the pet owners back and forth about Vlad. Did I have permission to give analgesia? How about taking radiographs? Did they understand the risks of sedation? Was everything making sense so far? It was a doozy of a fracture, involving the articular surface of a young animal. I had to communicate the near impossibility of normal healing without intervention, enter the emotionally jarring territory of amputation as a salvage procedure, and carefully navigate the idea of referral for orthopedic surgery within the next two to three days … with a clear explanation of a cost that could range up to nearly $10k. Of course, it was an already hectic day in the emergency room, and I was juggling multiple serious cases. My statements were choppy, and I kept my vocabulary limited to accommodate the young Russian couple’s limited English. I spent extra time confirming informed consent before proceeding with diagnostics and treatments. A barrier to care? Language barriers are not uncommon in veterinary medicine; one study found them to be a leading communication problem for veterinarians.1 Any time important information needs to be communicated, the added distortion of a foreign tongue means a risk of even less comprehension. Additionally, to complicate matters further in this case, although it was better for Vlad, the clients were interested and committed to seeking a referral for orthopedic surgery. Now I was in the position of calling local specialty centers, finding out about availability and estimated costs for fracture repair, and then relaying this information back to my clients. The technical aspects of the case–the time window for successful repair, the risks involved, the lack of a reasonably good alternative for returning to full function, not to mention the potentially shocking costs and options for financial assistance–all needed to be clearly communicated before sending the patient on his way. It needed to be done with clients who struggled with the English language. The young couple, by appearances still in their 20s, clearly loved their pet and were ready to do anything to fix his broken limb. I had no idea the distance they had already come, but their authenticity and graciousness quickly pulled me back to my task at hand: helping Vlad. GETTYIMAGES/SEVENTYFOUR More than words To do so, I had to recall a few things. First, regardless of whether there was a language barrier, establishing a trusting relationship with my clients was the best way to help their cat. Modern veterinary medicine has shifted away from old paternalistic models of “Doctor knows best” into a collaborative model, where client input is valued equally before agreeing on a mutual agenda for the benefit of the animal.2 Although at first glance, this may seem about as reasonable as letting a toddler decide which traffic route to take on a road trip, it turns out that inviting clients to participate in decision-making leads to better and more efficient medical care for animals.3 I also knew that the most important aspect of communication is universal: nonverbal cues. Body language, tone of voice, and pacing don’t require a translator. Empathy, critically important in establishing the veterinarian-client-patient relationship, does not even require any words at all. A caring facial expression, eye contact, and gentle body posture do more to convey your intentions as a trustworthy individual than the expensive framed degree hanging on your wall. Sitting with my Russian-speaking clients, I carefully reviewed the X-rays of the elbow fracture and ensured I had obtained informed consent. I then did my best to focus on clear acknowledgments and simplicity. I had to ensure the clients understood what they were getting into financially, avoid any guarantees, explain the referral process and reasonable alternatives, and confirm their understanding before discharging the grouchy little kitty. Through it all, I deployed some of the communication skills that keep client interactions running smoothly: a warning shot to let the clients know about the seriousness of the fracture, an internal summary to give us a chance to consolidate our mutual understanding of the process, and partnership statements to know that their American veterinarian was committed to cooperation. All of these and more I picked up from Cindy Shaw and Jason Coe’s book, Developing Communication Skills for Veterinary Practice.4 It’s one of several textbooks on communication skills for veterinarians, and although legitimately academic, it can fit in your back pocket (try that with Miller’s Anatomy of the Dog). Jam-packed with realistic case examples to demonstrate these coachable skills, this book has been my guide in taking my communication techniques to the next level. Hurdling miscommunication However, it’s not as if this Russian-American-Feline collaboration was without its stumbling blocks! Several awkward hiccups passed back and forth before we reached an agreement and an understanding of what plan worked best for Vlad. The clients asked questions about various financial assistance services for which I simply didn’t have the answer. Plus, even in my native language, I struggle to explain orthopedic surgery. At one point, I simply flipped over the intake sheet and started drawing an IM pin, reducing the luxated condyle (a visual representation that knows no language barriers). At times, the task of communicating this complex case to people with one or two years of English-speaking practice seemed impossible, but communication skills are never perfected. Just like the “feel” of manually loosening the suspensory ligament during a spay, or creating the beautiful, feathered edge on a blood smear, it takes practice, patience, and persistence. As with all difficult skills, mindset makes the difference. Even something as seemingly intuitive as empathy can be learned and improved.5 Finally, with a diagnosis and treatment plan for Vlad (cage rest, NSAID, and opioids, and follow-up with the specialty center in 48 hours), I wrapped up the client interaction in person with a final summary. I translated my discharge instructions into Russian (with the help of AI, which I couldn’t double-check because it looked like Matrix code to me) and handed a copy to the clients. Taking a collaborative approach That extra effort, which took no more than 30 seconds, brought a warm smile to the couple’s faces as they were handed their paperwork. They warmly received a methadone-pacified Vlad in his carrier and headed back home. In the end, the language barrier turned out to be nothing more than one additional challenge in my day as a veterinarian. Not insurmountable, and quite … um, surmountable? I just needed a few tricks and techniques, learned from both textbook and trial by fire, and sharpened frequently like a good dental elevator, to achieve the best-case scenario for my patient. That mentality keeps us as veterinarians in the correct position to help animals. For better compliance, comprehension, and ultimately, the quality of care for our patients, communication remains the number one clinical skill to continually strive for.6 Collaborative care means thinking like a partner, not a lecturer. It means meeting clients on equal grounds to achieve the maximum amount of participation on both sides. All of which means our patients receive the best possible care tailored to their unique situation. There’s only one inviolable rule in clinical communication above all else: Keep things simple, honest, and kind. When you see your clients as completely equal to you, this attitude follows naturally. This is the difference that collaboration, or shared decision-making, or whatever you want to call it, achieves. Simply put, it’s teamwork. In the case of Vlad, I was genuinely grateful for the patience of my young Russian-speaking clients in this difficult situation. In a foreign country, they listened intently and cooperated to the best of their abilities, showing far more proficiency in English than I did in their language. But as our interaction concluded, I couldn’t help but deliver the one Russian word I remembered from an introductory course 20 years ago: “spasibo.” Or спасибо, as it’s spelled in the Cyrillic alphabet. It means “thank you.” Greg Bishop, DVM, is a small animal veterinarian and a part-time veterinary technology instructor in Portland, Ore. Dr. Bishop also creates the monthly cartoon series, “The Lighter Side.” The author’s opinions do not necessarily reflect those of Veterinary Practice News. References Janke N, Coe JB, Bernardo TM, Dewey CE, Stone EA. Pet owners’ and veterinarians’ perceptions of information exchange and clinical decision-making in companion animal practice. PLoS One. 2021 Feb 1;16(2):e0245632. Groves CN, Coe JB, Sutherland KA, Bauman C, Grant LE. Clients prefer collaborative decision-making with veterinarians regardless of appointment type. Journal of the American Veterinary Medical Association. 2025 Jan 1;263(1):1-1. Shaw JR, Bonnett BN, Adams CL, Roter DL. Veterinarian-client-patient communication patterns used during clinical appointments in companion animal practice. Journal of the American Veterinary Medical Association. 2006 Mar 1;228(5):714-21. Shaw JR, Coe JB. Developing Communication Skills for Veterinary Practice. John Wiley & Sons; 2024 Mar 26. Shaw JR, Barley GE, Broadfoot K, Hill AE, Roter DL. Outcomes assessment of on-site communication skills education in a companion animal practice. Journal of the American Veterinary Medical Association. 2016 Aug 15;249(4):419-32. McDermott MP, Tischler VA, Cobb MA, Robbé IJ, Dean RS. Veterinarian–client communication skills: current state, relevance, and opportunities for improvement. Journal of veterinary medical education. 2015 Dec;42(4):305-14.
