Unlock happiness—meet client expectations, great and small

By Greg Bishop, DVM

Are you in the mood for a grand formula that simplifies life, explains everything, and does not require a scientific calculator? Wonderful! Here it is in full:

e - r = H

Figure 1. The formulaic equation of , where e = expectations, r = reality, and H = happiness.

Far be it for me to tell you how your brain works, but this is how it works. Believe it or not, happiness comes down to a simple mathematical equation that is easier to remember than which day of gestation Veratrum californicum causes cyclopia in lambs. Obviously, all sorts of individual components are involved in these two factors, but if you can give me an accurate value on both, I will reliably compute a highly accurate assessment of your happiness.

You want proof, you rascally little evidence-based professionals, you? Fine, here is an example: If I expect a sandwich to cost $10, but for some reason I end up paying $100 (parking ticket, rising egg prices due to avian flu, etc.), I'm going to be disappointed—by about 90 bucks. On the other hand, if the sandwich is not only free, but is served with a complimentary chocolate chip cookie and the eradication of my student loans, I will be ecstatic!

The beauty of this formula is you can back-calculate and solve for the missing variable if you know the other two. Happiness is—come on—pretty damn easy to assess in any given species if you can read their body language. Since you, as a veterinarian, work within reality (i.e. the constraints of physics and biology), you can quickly figure out that someone's—say, your client's—unhappiness must be a product of literally unrealistic expectations.

Okay, that is probably not shocking info to anyone who does not regularly prescribe turmeric for FIP, but the point is, we deal with reality and our clients don't. Most of them do not even know where their xiphoid is. Veterinarians spend a lot of time, effort, and money learning about the reality of things, such as predictive values, therapeutic protocols, median survival times, and sustainable pricing. These may be hard truths of medicine to us, but—and this is a "but" so big Sir-Mix-A-Lot's ears just perked up—our clients have very different expectations. Wildly different. We have all seen a one-star review from a client complaining the pyometra surgery on their 14-year-old German Shepherd named "Maserati" cost too much. When expectations are high, reality can really suck.

Unfortunately, clients often vent their frustrations on us. There is no excuse for them to act like spoiled children, but many of them do it anyway. I get it. It would be ideal not to have to deal with this on a daily basis, but we do. It is our reality. If we expect them to be more mature, well, then we will be upset! See? The equation works!

So, what do clients expect?

There is a growing body of research into the quality of the relationship between pet owners and their veterinarians. The overwhelmingly important thing is communication. Almost all the research emphasizes the importance of clear communication.^{1-6, 8-10} Clients expect veterinarians to clearly and efficiently convey medical information like diagnoses, treatment options, cost estimates, and at-home nursing care.¹ Plus, they expect all of these things even if they are 10 minutes late to a 20-minute appointment, and while they are scrolling on their phones.

Clients do not realize we do not get extensive training in communication skills.1 Explaining the odds of success of CPCR in a 22-year-old Cavalier with heart failure in less than 90 seconds might seem impossible, but this is the job. We have to deal with the hand we are dealt, because we are big kids who swore an oath to protect animal health.

Jerks are asking for help

Clients also expect empathy,^1,2,3 especially the difficult ones. A client might storm into the clinic, offended because a receptionist did not treat them like a Victorian butler when they announced Fluffy sneezed once last Tuesday. That client has high expectations. Dismissing their concerns or rolling your eyes does not help. Clients want to feel heard, no matter how trivial their concerns may seem.²

Also, before you flip your lid at a client throwing a tantrum, understand they may not understand the gap between their own expectations and reality. Clients expect us to care—and act like we care—about the things they care about,² even when those seem meaningless or ridiculously misguided to us. Telling an emotionally fragile client not to worry about the medically irrelevant thing they are worried about (Snickers' coprophagia) is unlikely to earn you a five-star review.

Listening and exploring clients' anxieties and concerns, as bonkers as they may seem, will likely earn you the trust that is the cornerstone of the VCPR.^4,6 Put anguish out of its misery with kindness.

Your teammate, the non-expert

There is a scene in Jurassic Park, where Jeff Goldblum runs in front of an angry T. rex with a road flare against the urgent advice of the paleontologist. He was trying to be helpful. Just because he ignored the animal expert, acted emotionally, and ended up hurt after making the problem much worse for everyone else does not mean his heart was not in the right place.

In the good old days of medicine, clients did not get involved in treatment plans. We just chose whichever one of the four medicines we had available, and nobody asked any questions. Sadly, those days are over. Now, clients want to be actively involved in decision-making. This comes up again and again, with studies showing the majority of veterinary clients expect to play a part in choosing what happens to their animals^3,5—the nerve!

They really need to feel like they are a part of it, even if their judgment seems suspect. Preferences for essential oils, homeopathy, reiki, seances, and Ouija boards must be respected, if not adopted. Exclude them from the process, and you can expect the relationship to turn sour, whereas collaboration fosters trust and adherence to treatment recommendations.^3,4,6

The value of expectations

Remember the sandwich example from a thousand words ago? Well, in that lunch-based analogy I laid out the monetary aspect of displeasure. It works for medical care, too. If clients expect futuristic healthcare at 1965 prices, you can imagine how hard today's reality is going to hit.

Unfortunately, money is just part of the job. We all understand this, and we all recognize the cost of veterinary care is rising. There is no way around it, no matter how much we would all prefer to just act like metaphorical ostriches with our heads buried in the sand. At the end of the day, if you want to get paid for being an animal doctor, the money that goes into your pocket probably must come out of your client's.

Which is perfectly okay if your cost fits within (or below) their expectations. However, be crystal clear about this: financial transparency is probably the most important way to avoid upsetting clients.^1,6,7,8 You cannot afford to leave them feeling they paid more than you were worth.

Be smart, but also seem smart

I wish I could say being a nice, empathetic veterinarian with good listening skills and clear pricing structures was enough for the modern client, but they also want you to be good at your job.^2,9

Clients think veterinarians should have answers to all their questions, even though we know that medicine can hardly be compared to a game of Trivial Pursuit. No matter how impossible or ridiculous their concerns may seem, they want their vet to take them seriously and have a thoughtful response.²

Waving hands and shrugging are not going to inspire confidence, but analytical thinking and self-confidence go a long way toward making a non-answer more palatable.

Conclusion

These are all consistent and well documented client expectations in modern veterinary medicine. Of course, they are going to vary across individuals (to some clients, the thought of actively participating in decision-making is likely terrifying!), but if you want to leave your clients satisfied—for your own sake and for the benefit of your patients—an awareness of what they think is going to happen is an invaluable asset.

Expectations—high or low—drive human satisfaction. It is how gambling works. Heck, it is how marketing, dating, parenting, balloon animals, and emergency splenectomies work, because it's just how life works.

This does not mean expectations are static–you do not need to suddenly become a miracle worker. There are all sorts of ways to manage someone's expectations, from gauging answers to questions carefully, planting seeds of doubt early, and expressing cold, clinical constraints in a warm and approachable tone. Doing so actually begins to align someone's expectations closer to the reality that you are so acutely aware of as a practicing clinician.

Weirdly, this is a wonderful thing. Showing them how unrealistic they are, in a compassionate way, can dramatically change their experience, which in turn improves veterinarians' wellbeing.¹¹ You only need to change (and only have so much control over) one part of the happiness equation. Triaging the gap between expectations and reality allows you to limit the suffering experienced by dissatisfied clients, which is good for everybody.

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

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3. Küper AM, Merle R. Being nice is not enough—exploring relationship-centered veterinary care with structural equation modeling. Front Vet Sci. 2019;6:56.
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10. Belshaw Z, Robinson NJ, Dean RS, Brennan ML. Owners and veterinary surgeons in the United Kingdom disagree about what should happen during a small animal vaccination consultation. Vet Sci. 2018;5(1):7.
11. Shaw JR, Adams CL, Bonnett BN, Larson S, Roter DL. Veterinarian satisfaction with companion animal visits. J Am Vet Med Assoc. 2012;240(7):832-841