See the Full Issue
October 2024
Combating Misinformation
“Doctor Google!” Say these words to any medical care provider—human or veterinary—and you will immediately get a negative reaction. But actually, there are vast quantities of excellent, accurate and useful information available online. So why the attitude?
Navigating Conversations With Clients in the Age of Dr. Google
“Doctor Google!” Say these words to any medical care provider—human or veterinary—and you will immediately get a negative reaction. Frustration, irritation, and annoyance come to mind, not to mention the occasional eye roll. But as an avid online researcher, I find vast quantities of excellent, accurate, and useful information available to me, and I don’t think I’m alone. So why the attitude?
Let’s start with why veterinary clients look online in the first place.
First, the internet is available 24/7 and provides us with immediate answers. When working with practices I find many have excellent content available on their websites to provide quality pet care education to their clients. Unfortunately, they rarely share this with the people it is designed to help. Therefore, clients with questions visit their search bar instead of their veterinary practice’s website.
Second, knowledge is power, and as anyone who has been a patient or caregiver knows, medicine can be confusing and intimidating. By self-educating, people feel more in control, and their fear is reduced.
Mistrust. If clients have had past negative experiences with providers, they seek no-cost second opinions online. It is more common to see this behavior in newer clients who have not developed trust in their veterinary team than those we have built relationships with over many years.
A sense of community. By joining online discussion groups and forums, clients find solace with others in similar situations. They also seek tips for successful treatments and husbandry of ill pets and compare information.
None of these motivations are intentionally meant to be disrespectful to veterinary professionals. They are merely clients seeking information at a time they have available and in a way they can understand. Instead of being offended, we should embrace the fact that clients are interested in learning and being good partners in care.
As practitioners, it is vital that we build our clients’ trust in our knowledge and abilities, but we can’t do that by dismissiveness or argument. Certainly, there is highly inaccurate information available online, but refusing to consider the client’s efforts erects a barrier between doctor and client rather than opening a dialog.
In the book, Crucial Conversations: Tools for Talking When Stakes Are High, the authors talk about using active listening to get all the information out into the “pool of common meaning.” This means using curiosity to ask good, open-ended questions of the client while listening intently to understand, not just waiting to respond. This can be incredibly difficult when the information the client is sharing is in opposition to all scientific and medical facts. Still, it is vital that we know where the client is coming from and why they feel their information is valid.
The next step is to offer validation. Appreciate the effort if not the accuracy. You may offer, “I can see you have done a lot of research and care deeply about your pet’s health.”
You can also empathize with their situation by saying, “A diagnosis like this can be very concerning and the care can be complex. I appreciate your situation and am here to help.”
Now you may offer to discuss the challenges and limitations of internet accuracy and the vast amount of science and research that goes into veterinary knowledge. Explain how rigorous the trials behind new medications are and the effort needed to get US Food and Drug Association approval of any new product or medical technology. Share how this is for the safety of the pet, which you both value.
As practitioners, it is vital that we build our clients’ trust in our knowledge and abilities, but we can’t do that by dismissiveness or argument.
Approaches to Effective Communication
When educating clients on internet fallacies, there are several helpful communication approaches veterinary teams can use. The Sandwich Approach involves “sandwiching” information that is corrective between neutral and collaborative statements of support. For example: “I appreciate your concern for Fluff’s diet and agree with your assessment that good nutrition is important to her health and longevity. However, the information you shared has some inaccuracies according to the research done by veterinary nutritionists who are specialists in the subject. Here is some information holding the latest research I am sure you will find valuable…”
The next approach is Ask-Tell-Ask. This involves asking the client what they know or believe about a topic. Listening intently. Then sharing accurate information and asking what they think. Since the pandemic there has been an increase in misinformation about vaccines so we may ask, “Can you tell me what you have read about vaccines?” Wait for the reply, then thank them for sharing. Now it is time for you to “tell” them what you know. “Mrs. Smith, as you know there is a lot of conversation on the internet about vaccines, but what we know from scientific studies and over years and years of vaccinating animals is… How does that fit with what you have read?”
I have a neighbor who likes to ask me medical questions about her pets. One day she said, “Debbie, the folks at the beauty shop say I shouldn’t take the flu vaccine because big pharma is just trying to kill us all off.” She is 78. I replied, “Hilda, since pharmaceutical companies sell many more medications to the elderly than to 20-year-olds, why would they want to bump off their customer base? That would be unbelievably bad for business! Don’t you think?” She laughed and said, “Well, that makes perfect sense. You are right!” So, she went and got her flu shot.
Analogies are a terrific way to simplify complex information for nonmedical folks. This is one of my preferred techniques because it often involves storytelling. One of my favorite replies to the question, “Why do puppies get so many vaccinations?” came from my associate veterinarian. He used to tell clients that maternal immunity was like a seesaw. He used the analogy that at some point, the mother’s immunity would drop like the end of the teetertotter and the puppy would lose protection, but no one really can predict when that will occur. So, we vaccinate at intervals in order to catch the drop in immunity before it “reaches the ground.” Another favorite was the DVM who compared a blocked cat to a clogged toilet—the client at once understood the problem, and no medical terminology was used.
Finally, we should have and use reliable resources. Although manufacturers and vendors provide us with excellent tools, they can be perceived as biased by distrustful clients. It is necessary to have “tools in your toolbelt” such as veterinary college websites (Tufts Petfoodology is a favorite of mine for nutrition), peer-reviewed journals, professional associations like AVMA, AAHA, or your state association’s articles and infographics. Offer handouts or links to validated sites during your discussions with clients and share your own website if you have educational materials available. For many years, I linked handouts to service codes so they automatically became part of a client invoice. By providing the information at the visit, you end the need for further research.
Analogies are a terrific way to simplify complex information for nonmedical folks. This is one of my preferred techniques because it often involves storytelling.
When Clients Don’t Listen
Even with the best skills we will have resistant clients. It is a quirk of human nature to think you are “in the know” and have information others don’t. Overcoming this is challenging. Our biggest hills to climb tend to be food and vaccines, but we also see pushback about medications.
Good debunking tactics can be found in human medicine. For food, discuss the importance of a balanced diet and how all the fad diets have harmed people’s health. Show reference materials from government guidelines. When sharing vaccination importance, share how widespread vaccination of herds have stopped deadly diseases like anthrax and the fact that mandatory rabies vaccination has all but eradicated the danger we have from pets. Drug adverse reactions can be put into perspective too. Share success stories from patients who have benefited from the drug in question and relay how rare adverse reactions are compared to the hundreds of thousands of doses administered.
If none of these techniques are successful, always remain calm and respectful. Slamming the door on dialog leaves no hope for future progress. You may even set up a follow-up call or appointment to revisit the topic after the client has had time to read and digest the information you have shared. Remaining kind and curious will pave the way for progress. Ultimately, the pet is the responsibility of the client, and they have control over their care choices. You must work with the permission of the owner, or if you can’t ethically tolerate their choices, send them to a different provider.
Some proactive campaigns to head off misinformation can be modeled from our human health providers. There are excellent health information campaigns provided by veterinary associations. Local veterinary groups can work in collaboration with each other to provide consistent messaging. If multiple practices in an area are all in agreement with science-based recommendations, then clients going from practice to practice will find agreement and likely give up their misinformed beliefs.
Veterinarians and their teams must embrace better communication training. Realize that being “nice” doesn’t mean you can guide a challenging conversation to the preferred conclusion. According to organizational psychologist Tasha Eurich, PhD, who studies self-awareness, 90% of people believe they are self-aware and know how they are perceived by others, but only 10%–15% actually are. We must do all we can to relay our message with compassion, patience, and a commitment to lifelong learning and communication excellence.
Our role as a veterinary professional and the “trusted guide” to a healthy pet is more vital than ever. By understanding the motivations behind our client’s internet searches, we can address their concerns and help them succeed in navigating the often murky waters of Dr. Google’s internet.
Photo credits: Thomas Northcut/Collection via Getty Images Plus; brightstars/Collection via Getty Images Plus; SeventyFour/Collection via Getty Images Plus