Talking to Clients About Science

Interview with Deborah Thomson, DVM, on Central Line: The AAHA Podcast

Note: This is a partial transcript of a recent episode of Central Line: The AAHA Podcast. Catch a new episode of Central Line every Tuesday on all major podcast platforms, YouTube, and at aaha.org/podcast. This episode was made possible with generous support from CareCredit.

What does working on Capitol Hill have in common with a puppy vaccine appointment? During a conversation with host Katie Berlin, DVM, for Central Line: The AAHA Podcast, Deborah Thomson, DVM, chair of the World Veterinary Association’s One Health Education Subgroup, founder of One Health Lessons, and author of The Art of Science Communication, shares what she’s learned through her work as a teacher, clinical veterinarian, and science policy advisor about having productive conversations about science—with all kinds of people.

Deborah Thomson: Before going to vet school, I was teaching. My youngest student was five or six, and my oldest student was 65. Then I went to vet school and heard about One Health, and that just blew my mind, honestly. I did an internship and went into clinical medicine full-time, but after my 10- to 12-hour workdays, I created lessons for children and adults about One Health. Then I got to be the AVMA’s Congressional Policy Fellow, so I moved from the West Coast to Washington, DC, and that’s where I am right now. And from working in policy on Capitol Hill, I learned a lot about communication with people with . . . substantial influence, let’s say that.

Communicating in the classroom, with the general public in the appointment rooms, and then with politicians—it’s an art. And from that experience, I wrote a book called The Art of Science Communication.

At my interview at vet school, I said I wanted to be a vet because I wanted to take care of animals, but also the people relying on those animals—be it for emotional support, food, whatever. I saw that whole picture. I still see that every single day in the hospital when I’m working. It’s not just the old client who just lost her husband or his partner, and who’s keeping the memory alive through their dog. It’s also thinking about what flea and tick preventative do we need if there’s a toddler running around the house because their hands go everywhere.

Katie Berlin: I always say our real patient is the bond between the patient and their people, whether they’re a milk producer or a family pet, and the communication is absolutely the backbone of the relationship that we have with that family.

So today, what I really wanted to talk to you about is talking to clients about science. I think we have all been in that exam room where we’re faced with this client who doesn’t want to hear what we have to say about why whatever they read on the internet is probably not in the best interest of their pet’s health or their family’s health. Why do clients come in and argue with us about science? What can we do?

DT: There are two different ways to respond. You could tear out your hair, that’s option one. Or you could take an internal deep breath and listen to them, knowing they mean well and they’re doing the best with what they’ve got. We all typically do the best with what we have.

The goal is to say, “I understand that there’s a lot of information out there. I get it. I see it too. What I’m providing to you is information that I have from sources that I really do trust. And I know this from veterinary school. I know this from experience. And here are the websites that I really like. You’re welcome to bookmark them.” And then see what their response is. The first thing is to introduce them to what you value as a clinician, as a science professional, as a scientist. And then open up a conversation. And stay even-keeled. People pick up on that.

KB: Especially because it’s so emotional for so many of them. Assuming good intent is so important. We want them to assume that about us. Often, it’s just an emotional topic. DT: Sometimes clients say to me, “Oh, I’m such a bad owner.” I’m like, “You’re not allowed to say that. You’re in the vet hospital with me. You are a good owner because you got here.” KB: Do you think it’s possible to change someone’s mind who seems like they’re absolutely dedicated to believing this pseudoscience that they read online?

DT: I think reading the room is definitely the first step in how to change somebody’s mind.

KB: Often it’s not the veterinarian who’s getting faced with this question first. It might be the front desk when somebody calls for a recommendation or when they are asking them if they want to take a bag of dog food home, or it might be the veterinary technician who’s taking a history. And they’re getting sort of barraged with things like, “Oh, I don’t think a Lyme vaccine is safe for my dog. I read it online.” So the entire team has to know how to communicate with clients about this stuff. Do you think it’s possible for vet teams to get ahead of this by either talking to clients a certain way from the beginning or having specific training about it so that they can head this off at the pass?

DT: If you see that there are concerns from the owner about a vaccine, it’s important to mention that all vaccines, all medications, anything you put in your body has possible side effects. That’s just the way it goes. You know, just say it matter of factly: “That’s just the way it goes. So let’s review possible side effects of vaccines. Chances are, we’re not going to have to deal with it, but it’s always good to review and have a conversation about this before we get started.”

KB: We are supposed to talk about vaccine reactions with everybody, and I don’t think we always do that. When we do, it’s often because the client has asked, “Will I notice anything after this?” I know there was a study recently that vaccine hesitancy was increasing before COVID. So even before COVID, the vaccine hesitancy in people seemed to be spreading into the veterinary world, so now, I can only imagine after the last two years what people are thinking when they come in and we’re recommending all these vaccines—even though they’re not new, and they’re so safe.

DT: What they pick up on are those outliers—and I think it will hurt us if we ignore those because then they’re like, “Wait a second, I heard this from my friend. You’re telling me my friend’s lying?” But if we can just nip it in the bud and say, “I say this to everybody, so just hear me out. Signs of vaccine reactions are rare, but, . . .” and then do your thing. Then put it in your SOAP.

KB: I wanted to switch tracks a little bit here. You are a science policy advisor, and I just want to know what that was like!

DT: I serve as a technical advisor to a senator right now, so I serve to help advance legislation and bills especially focused on One Health. My portfolio on Capitol Hill was really One Health. I applied for the AVMA’s Congressional Policy Fellowship and moved cross-country to go to Washington, DC. AVMA pays for the year but doesn’t tell you what to work on. The people at AAAS, which is the American Association for the Advancement of Science, are the ones who train you how to work in policy on the Hill, along with about 200 other people who are often not in veterinary medicine. They could be particle physicists or chemists or evolutionary biologists.

Then you have interviews with lots of different offices on the Hill that have desk space for you, and you share what you would like to work on in the policy space, and they tell you what they need from you, and you see if it’s a match. So, you arrive in Washington, DC, without knowing where you’re going to be working. You know it’s going to be somewhere in the Senate or in the House of Representatives, but you don’t know where or exactly what you’ll be working on, which is exciting.

KB: When it comes to exam room communication, there is a little bit of politics involved. You have to make sure that you’re reading the room, like you said, and communicating in a way that is not inflammatory or reactive. That times a billion is what it must be like working on Capitol Hill! Did you learn lessons from that position and from the communication that you had to do there that you can carry over into practice?

DT: Reading the room is number one. I have a lot of interns with me for One Health Lessons, and I tell them that the very first step to strong communication with another person is to actively listen. Don’t be the first one in the room to talk. Listen, see how they say things, see what they avoid saying, think through why they could be avoiding saying certain things. Is it because of fear?

Is it because of ulterior motives? On the Hill, voters coming in could be scientists, physicians, veterinarians, engineers. . . . They would come in and pitch their idea for a bill that could hopefully become a law, and they gave us the information that they have at their disposal on one piece of paper, like a client handout. Often, they missed the mark. I saw that there was good intention, but they said it in a way that was confusing for the folks that speak policy. After the meeting was done, my colleagues would come at me and say, “Deb, can you just translate that for us?” And that happened so many times that that’s what my book came down to.

KB: Those skills are essential for just living today, because as veterinary professionals, we forget that the people who are leaving comments on the internet don’t necessarily have the background we have. I think we go into that exam room armed for battle because we feel like the people leaving these comments are also in the exam room facing us, and we go in with that internet warrior attitude. Do you feel like that’s true?

DT: Let me just discuss disinformation and misinformation. Misinformation is that unintentional “Oopsie, I got something wrong.” Disinformation is purposefully feeding falsity to the general public—a form of manipulation. Misinformation can be managed because the intentions are good. Disinformation comes from not a good source.

KB: This reminds us that not all incorrect information is coming from the same place or the same intent. Maybe their aunt told them something about her dog that she heard from her cousin’s vet, and then it’s probably not going to be quite accurate. And it’s different if they’ve been going to a website about dog food and they’ve been fed information that is absolutely not true. A lot of times we feel like we’re beating our heads against the wall battling this constant influx of both misinformation and disinformation. Do you have any tips for how we can use the internet to our advantage to help with these science communications?

DT: Let’s say [they need to know about] congestive heart failure. Something complicated that stresses the owners out legitimately. I like veterinarypartner.com. I like AAHA. I like anything associated with a veterinary school. I print out at least the first page of the website, and I tell people, “Bookmark this page.” Use technology to your advantage. Then at least they’re not sitting alone in the room, freaking out. At least they have some answers, which takes care of a bit of stress, even though congestive heart failure is a serious matter.

KB: I’m just thinking about that from a position as somebody who’s been a patient in a lot of doctors’ offices recently. Until you’re the patient, or the owner of the patient, and you’re sitting in that room alone and you don’t have answers. . . . It is one of the scariest experiences imaginable. Nobody said, “Here, I know we’re not finding answers. Here’s a website I really like, if you want to read about the some of the differentials that we’re talking about.” I wanted scientific papers, but I would have taken a website. Give them sources of good information before they ask, because a lot of people won’t even ask. I have one more question for you. When it comes to the entire veterinary team working together to talk to clients about science in a way that’s effective and empathetic, what would you say is one step that any team could take tomorrow to start doing that?

DT: I think a good guiding principle is to stay humble and admit when you don’t know the answer. “We don’t know what causes this yet, but we at least know how to manage it.” Just have a clear conversation about what can be done, what can’t be done, and set the expectations very early on. Be clear and respect the other person.

Note: Send us feedback or questions anytime at [email protected]. Find all of AAHA’s most up-to-date Guidelines, including resources for your clients and team, at aaha.org/ guidelines.