We’ve all seen it happen, and chances are that we might have even done it ourselves on a stressful day. Someone makes a derogatory comment to another team member about a client’s inability to hospitalize their pet for parvovirus, or a team member can’t help their frustrated sigh as they review the treatment plan. Overhearing and witnessing these reactions can magnify a client’s guilt over not being able to pursue the most extensive diagnostics or treatments.

Clients who sense that a veterinary team member doesn’t agree with their decision may feel pressured to choose something different.

“When a veterinarian or any of their team members individually offers confusing information or their verbal and nonverbal communication are not in sync, it undermines trust and further complicates decision factors for clients,” said Carolyn Brown, vice president of medicine for Community Medicine at the ASPCA.

Clients’ choices are influenced by many factors—including finances, extenuating circumstances in the life of their family, their ability to travel, or the pet’s tolerance for treatment. The choice a pet family makes is not a reflection of the bond they share with their pet.

While we may not agree with the choice that every client makes, we must remain empathetic throughout the visit and work to find a solution that prioritizes the health and comfort of the patient within the individual client’s limitations.

“It is absolutely essential for the communication, both verbal and nonverbal, of all team members interacting with a client to support the same philosophy of practice,” Brown said.

The role of CSRs in spectrum of care

As the first voice that many clients hear on the phone and the first face clients see, the client service representative (CSR) team plays an essential role in setting the tone for the visit.

They may be the first to hear a client’s concerns about finances or the way their pet responds to being medicated. It is important that they acknowledge these concerns and pass them on to the rest of the patient care team.

If, upon hearing the client’s concerns, the CSR sighs heavily, rolls their eyes, or displays other nonverbal cues that convey frustration, the client may feel judged for the level of care they can offer their pet, causing them to enter the appointment in a defensive mindset.

Instead, CSRs can assure clients that estimates will be provided throughout the visit and make them aware of alternative payment strategies, such as third-party financing options.

CSRs are also the last ones most clients see at checkout. They must be aware of any required follow-up care for the patient, when the next appointment should be scheduled, and what the client should be monitoring for.

It can be helpful to provide written discharge instructions that the CSR can review with the client to ensure that nothing is missed. Additionally, CSRs can end the visit with a compassionate reminder that the team is available to support them and their pet if any concerns arise.

The role of the vet tech team in spectrum of care

Of all team members, veterinary assistants and credentialed veterinary technicians may have the most direct contact during the visit. As such, they can play an important role in goals-of-care conversations by asking specific, open-ended questions during history-taking, such as, “What is your goal for today’s visit?” or “What is your biggest concern about Fluffy right now?”

Conveying this information to the attending veterinarian will help guide the way options are presented. For example, the veterinarian can determine whether the client’s biggest concern might be based on cost, convenience, or a desire to know the full range of options before making a decision. If finances are determined to be the biggest issue, then the first option presented would be the most cost-effective one.

After the veterinarian presents the diagnostic and treatment options, a team member should review a detailed treatment plan and estimate with the client. Credentialed veterinary technicians have the medical knowledge to answer client questions, which makes them ideal for this task.

The way the treatment plan and estimate are presented can influence how a client feels about their decision. It’s essential for the team member reviewing the estimate to understand the recommended plan and the individual client and patient factors that influenced it. Team members can support the client’s decision to pursue a less-extensive treatment plan by sharing their own experiences or observations of similar cases.  

While reviewing discharge instructions, the team member should ask clients if they feel comfortable administering the medication or if they have any remaining concerns. Taking these few extra moments provides space for the client to share something they’re anxious about but afraid to bring up on their own.

How to support team involvement in spectrum-of-care conversations

Veterinary team members are part of the patient care team and should take an active role in educating clients. All team members benefit from communication training on essential skills, such as open-ended questions, empathy, and nonverbal communication. Team meetings are ideal for this training, especially if the team spends time reviewing specific cases to better understand why certain options were offered.

Communication within the team is just as important as talking with the client, and veterinarians are at the center of this communication. They must take the time to educate their team members about the options offered for certain conditions to help improve team confidence in alternative options.

If a veterinarian senses that team members are upset about a particular case, sharing key points from the client communication can help explain why certain choices were made, allowing the team to better empathize.

Ultimately, offering a spectrum of care maximizes patient quality of life within individual pet family limitations while meeting the moral, ethical, and legal obligations of the veterinarian. A team that understands the reasons behind the spectrum-of-care mindset, supports the concept in practice, and has the communication training to succeed in executing these strategies will always get the best outcomes.

Kate Boatright, VMD, is a small animal veterinarian, speaker, and author in western Pennsylvania. She graduated from the University of Pennsylvania in 2013 and has worked in rural small animal general practice and emergency clinics ever since. She is passionate about inciting positive change in the profession through mentorship and servant leadership in organized veterinary medicine. She writes a monthly column for NEWStat on the role of the spectrum of care in improving outcomes in clinical practice.

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Disclaimer: The views expressed, and topics discussed, in any NEWStat column or article are intended to inform, educate, or entertain, and do not represent an official position by the American Animal Hospital Association (AAHA) or its Board of Directors.