Communication strategies for delivering bad news

Make sure you are checking in with your colleagues to see signs of depression, emotional exhaustion, and despondency

When you are dealing with something like an unexpected illness, begin by gauging the client’s concerns, priorities, expectations, and goals for their pet’s care.
When you are dealing with something like an unexpected illness, begin by gauging the client’s concerns, priorities, expectations, and goals for their pet’s care.

While there’s no good time for conversations around complicated diagnoses, the holidays can bring emotions to a higher pitch with the added stress, worry, and pressure that comes this time of year–for pet owners and veterinary care teams alike.

As someone who has had to deliver bad news too many times to count, whether in an emergency, an end-of-life decision, or for an ongoing illness, here are tips that have become my best practices. They can guide you from the moment your distraught client arrives at the hospital throughout whatever medical journey unfolds.

Start with good communication

While it is critical for the veterinarian to use thoughtful communication strategies, the first point of contact is where it matters the most. In some cases, as in an obvious emergency, the client will likely be distraught and even aggressive in their manner. When faced with inflammatory emotions, it can seem counterintuitive to acknowledge and validate them outright, but naming those feeling as they present themselves can de-escalate a triggered client.

“I can see how worried you are. Let me bring Sammy to Dr. Loenser right away.”

“Your frustration makes total sense. I would be upset if I had to wait as long as you did, too. Our triage protocol is in place to make sure that the most critical patients are seen by the doctor right away. Let me see where Sammy is in the queue.”

“The cost of treating complicated conditions like Sammy’s can be very high. Many people are shocked at the prices since our medical technology can rival human medicine at times.”

If a client becomes hostile and aggressive, the staff member should immediately excuse themselves and get help.

Understand your client’s perspective to save time and build trust. When you are dealing with something like an unexpected life-threatening illness or an end-of-life decision, begin by gauging the client’s concerns, priorities, expectations, and goals for their pet’s care. Use open-ended questions, such as:

“I know I’ve just shared some difficult news with you. What concerns you the most about what I’ve said?”

“Hearing the word ‘cancer’ can be overwhelming. What are some of your priorities that you want to make sure we address today?”

“What expectations do you and your family have for Sammy’s care moving forward? Our team would love to know how best we can partner with you in these challenging times.”

“Now that you know more about what’s wrong with Sammy, what are your goals for the rest of our visit?”

Not only does that help steer your conversation in the direction that best suits the client’s agenda (i.e. palliative vs. aggressive supportive care), it helps address what is realistic considering the diagnosis you have just shared.

If the client’s goal is to have the patient back to normal for a rambunctious holiday visit with the boisterous grandchildren and you know exercise restriction and pain management will be central to the care, this will help the client picture what will be needed at home to facilitate proper healing without disappointing their visitors.

Communicate boundaries

By understanding your client’s agenda, you can set realistic boundaries for how your team will interact with them.

For example, if a client wants to dive into advanced care like radical surgeries, a lengthy ICU stay, and oncological care and expects hourly updates from your nursing team, it is important to express the boundaries the team has in place regarding client communication. Knowing a client’s goals and expectations does not mean you have to meet them, but it does allow you to express what is possible before they have a chance to not be met.

Empathy versus sympathy

Empathize without burning out. Conversations in the veterinary clinic are sometimes fraught with emotion, especially this time of year. I tend to see a big errors with how veterinary teams manage with clients in a highly emotional state: confusing empathy with sympathy.

Dr. Brené Brown differentiates between the two: “Sympathy is ‘I feel bad for you.’ Empathy is, ‘I feel for you.’ Sympathy can make us feel more alone. Empathy helps us feel connected. Empathy is connecting with people so we know we are not alone when we’re in a struggle. Empathy is a way to connect to the emotion another person is experiencing; it does not require that we have experienced the same situation they are going through.”

Example: A client is feeling scared, confused, and frustrated by having to decide what they should do for their two-year-old male cat experiencing his third urethral obstruction—surgery for a perineal urethrostomy, try medical management again, or euthanize. You do not need to have been faced with the same experience with your cat, but you can connect with the feelings of fear, confusion, and frustration, and affirm how hard it is to feel that way about a beloved pet.

Don’t rush to ‘fix’ the feeling

Many of our colleagues can get overwhelmed by feeling they need to “fix” the feelings of a person who has found themselves in an “unfixable” situation with their pet. Here’s the deal, though: you do not need to fix their feelings. Often, just listening to them and connecting to the feeling they are having is enough to have the client’s feelings of stress diminish. In fact, jumping to a solution to stop hard feelings from happening often only delays the inevitable and can be even more stressful, if the solution fails.

These strategies are designed to help not only clients’ needs, but also those of you and your team. Your mental health and that of your staff must come first, especially in situations where you are delivering bad news. There can be tremendous anticipatory anxiety associated with it, and the holidays can only exacerbate it, especially with the high rates of euthanasia we often see this time of year.

Make sure you are checking in with yourself and your colleagues to see signs of depression, emotional exhaustion, and despondency. If you see them, do not hesitate to act, by encouraging your colleagues to develop a relationship with a licensed mental health provider, like I have. Healing our healers is often the best way to provide the care our teams can be proud of, at any time of year.

Heather Loenser, DVM, is the chief veterinary officer for Suveto. A graduate of The Iowa State University, she has spent nearly 10 years as an emergency veterinarian, a communication coach and most recently served as the chief medical officer at the American Animal Hospital Association (AAHA).

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