My name's Larra Wilson. I'm here to talk to you today about building trust in the emergency setting. Just a little bit about me before we start.
I work as a district veterinary surgeon for vets now. I graduated from Glasgow in 1996. I got two dogs, a cat, and a pony.
I started off my career in mixed practise for 8 years and then I moved to emergency work with vets now, and I've been with them ever since. I have a particular interest in client communication, and I really enjoy taking part in in training and learning more about that. At the moment I live in Armagh in Northern Ireland with my husband and 4 children, along with the pets.
So just about what we're going to to learn and chat through today. So we're going to learn some incorporate some techniques into your introduction to the client to develop some mutual understanding. We want to talk through the importance of body language and how you can use that to help to build trust further.
We'll look at assessing and adjusting your consult room layout so you can really maximise client comfort on the ability to communicate effectively with your clients. And we're going to apply the share principle to our client interactions, which is always to approach the client with clarity, honesty, empathy and respect. We'll come to those things later on as we go through.
I think it's important to say, before we start off, some people feel I'm a good communicator, or I'm not a good communicator. And it's important to remember always that communication skills, they're not innate. They're not something that people are born with, and they can't be dismissed as bedside manner.
They do make a difference to The outcome of patient care and they can be learned. So let's go and look at how we might use some of these communication skills in an emergency setting. Firstly, if you've had communication from a client, Is it an emergency?
Well, really, what we're talking about today is client perception and client perception is everything in this situation. If they perceive it as an emergency, it is an emergency until you can reassure them otherwise. Most of the time they will make first contact on the telephone, unless they just rock up at the door.
If they've had an accident close by, they know where you are and just scoop up the patient and come on ahead. It's going to be important that every opportunity you have, you express empathy on the phone and let them know what they can expect on arrival, where to go, will you be there? Might they need to make wait if you're travelling into the clinic from another call?
So just a few examples of why we shouldn't draw. Too much From what the client says on the phone and how we do have to assess the patient. And it's really important to consider how we assess the patient on the phone when inviting the client to come in.
So the first case I want to talk about was Bonnie, who was a master, and her owner had called because he was quite concerned that she'd become pregnant. I was a bit surprised. She wasn't spayed, so it was always going to be a possibility, but he felt this evening her belly's got really quite big, and he thought that she might be pregnant.
So he contacted us. Out of hours on the emergency line to discuss her with us. Our receptionist, thankfully thought, well, this is slightly strange, so she advised that he should bring her in right away.
And even though he had just initially called to say that he thought she would be pregnant. And On the journey on the way in, she collapsed and she actually died as she came through the door because she'd had. DTV rather than a pregnancy.
And it was the perception of the owner that this maybe wasn't an emergency. He thought she was pregnant, but he'd like to get her scanned and see. So that was a really sad situation.
And it is really important to consider that the owner's perception might not be what's actually happening at the time. We had a call from Stella's owner, Stella was a Dalmatian and Stella's owner was very upset. And she was crying, quite emotional and told us that unfortunately, Bella was off her back legs and it was clear they were going to have to put her to sleep.
So, obviously, we said right, we need to see her right away, bring her on ahead and. But when she got in, we were met by a Dalmatian that was bounding across the floor and seemed to be in almost perfect health. The owner was still very upset, but had moderated slightly as obviously she could see that the dog was now able to walk and was comfortable.
So on examination of Stella, the only thing we could find was a anal sacks, and actually after we unpacked everything with the owner, what had been happening is Stella had been scooting along the floor, and the owner had perceived this as her having a serious back injury and paralysis. So it's important to be open minded, listen to the clients and not make too many assumptions about what's happening when they're on the phone. So in terms of the client perspective and emergency.
It's a difficult situation for them. They're going to be worried about their path. The very nature of an emergency.
This is an unplanned visit for them, and they could have some considerable schedule disruption as well, particularly if they may work or or school planned or or children to look after. Quite often, they might have to go to an unfamiliar building. It might be that they go to a different branch than they normally attend for an emergency, or it might be that they're visiting you as an external out of hours provider.
So it's important to consider they're an unfamiliar surroundings, which will make them slightly more on edge than they already are. Also, it's emergencies, they happen through the night as well as the daytime. So do consider as well how your practise looks from the outside.
It may look beautiful in the sunlight, but the clients coming in at night may be facing something that looks like this. So do give consideration to what's happening outside as well, so that it creates a welcoming atmosphere for the clients. Often they'll be seeing a different vet as well.
Now that just might be you're never going to be Mrs. West and that they've seen at every appointment ever since Dexter, who's now 17, was a kitten, and they've never seen you, or it might be that they are coming to a separate practise for the emergency care, and that can be difficult for them as well to manage. Sometimes there may be a waiting time as well.
So all these things can build up and really add to the client's anxieties and feelings of concern about their pet, which is the core of their anxiety at this point. So where do you as a vet seeing there? Their pet fit into this an emergency situation.
Well, they have their circle of trust, their normal experiences and expectations, and you're sitting well without that. So we do need to work as a vet to build the trust with the client, develop that relationship and that rapport with them, so we can help move forwards and treat their pets as effectively as possible. But when the client arrives, it's really important they're promptly greeted on arrival.
Now, in a lot of situations, the vet will greet them, and we can start with the consultation straight away at that point. However, if that's not what's going to happen, the vets maybe already in a consult, travelling in from seeing another case, or, or could be in surgery, and they're greeted by perhaps the veterinary nurse or the receptionist. It's important.
That the same posts to the clients, what will happen next when they expect to see somebody, given a rough outline of wait time, if there is going to be a wait. And We tend to work to have triage done by a nurse if the vet's unable to see the client and patient as soon as they arrive. When the client arrives, we do have quite a challenge.
This is that we have a very limited amount of time to make a good first impression on the client. So let's see just how long it takes. It's been shown that people form their first impression within the 1st 7 seconds that they see you.
So it's best that those 7 seconds aren't spent with you rooting around the reception desk looking for a pen and the client maybe assumes that you're a receptionist isn't quite sure you're the vet or what's going on. So it's important to consider how critical that first contact is with the client. In order to make sure that's best, we need to start before we meet the client.
Need to make some practical preparation. So we need to make sure our personal appearance is appropriately professional. Good to have a mirror check.
This could be particularly important if you're not just in small animal practise, but you're on call in a mixed practise. And going back a few years, I remember being stopped by the police as I was travelling back in after a call. Normally I get quite a brief questions asked, and then you'll be allowed to, to drive on.
However, The policeman that had stopped me was asking me more and more and more questions, and there seemed to be some anxiety with his colleagues in the background. Once he then said, check your face, I realised I had blood smeared all over my face after a C-section. I just had not noticed.
So do check your face, forearms for blood. If you're, if you've been working with other small animals, a quick brush down, any excess hair cleaned off. Do look at the surroundings, make sure they're they're welcoming, ready to see the clients and your consult room is clear and tidy.
Try and get the name of the client and pet, which most of the time you can do unless they have just turned up and have an idea of what the presenting problem is. This will allow you to inform your team. And if you have others there with you of what's happening and sort out any equipment that you might find you need.
For example, if you think you've got a suspected block cat coming in, you might want to lay out your IV fluids and catheters. If it's a large dog RTA, then having the stretcher there is going to be really beneficial. So make sure you're prepared in advance.
Oh, we need to consider when we're meeting the clients, their circumstances, the condition their pets in, and what they're doing when you go to greet them. So we need to think about, are we letting them into locked practise or just calling them in from the waiting room? Are we driving into the yard or are we going out in the car park to help them into their pet?
If we're going out, important tip, do make sure you have a way of getting back in again. And also let anybody else know that you are going outside for for safety purposes. Recognise what state the client's in?
Are they anxious or are they quite relaxed? And you need to be able to respond to them in terms of how they are. And also we need to act appropriately in terms of how the patient is, what needs to the patient have immediately.
Do they need to go through to the prep room, or can they wait with the clients? We need to assess these things very quickly as we first meet the clients. Also consider other people.
So that's other people, both within your own team that you need to maybe need to introduce to the client, or perhaps the owner has turned up with the pets, but also with family or friends. Sometimes there might be animal taxi driver there with them. There might be members of the public who've met them and help them into you.
So it's important to identify who's who and be very clear about who the owner is. Before you go and approach the client, it's important to adjust your attitude. Remember, this is a fresh client that you're seeing perhaps for the, for the first time, and you have to put other worries from your mind.
Just focus on the client that you're about to see. Straighten up your posture. That's important.
That will look you, make you much look much more confident if you put your shoulders back and make the client feel that you know what you're doing or what you're talking about. If it's appropriate, do smile and make eye contact with the client. A good trick is to look long enough so that you notice the eye colour and that ensures that you've made good consistent eye contact and it can become a habit.
So when you meet somebody and you notice the eye colour and that makes sure you've got that eye contact there and raise your eyebrows as you approach them, which helps to show interest in them. Introduce yourself. So you always want to include your name and your role.
Most of you'll have a usual introduction that you run through. Mine's usually, Hello, I'm Lara Wilson, and I'm the duty vet tonight. They'll usually then introduce themselves, and you can confirm their name on that of the pets.
Good to meet you, Mr. Jones. I'm sorry, it's in these circumstances.
This must be quite difficult for you and Billy. Do shake hands. If you feel comfortable doing that.
I would encourage you, even if you don't feel comfortable doing it, do push yourself a bit out of the comfort zone and try offering a hand to clients. A handshakes a real shortcut to build rapport and Some people would say that the handshake is equivalent to the level of rapport that can be built up with 3 hours of continuous interaction with a client. So do give it a try.
And you might find it comes easier after a while. That was certainly my position a number of years ago and now I will shake hands fairly reflexively with clients. To greet and compliment their pet.
Everybody likes to have their pet recognised and obviously, that their pet is the most important in these circumstances. So just something along the lines of this must be buster. And a safe compliment is often, don't they have a lovely shiny coat.
If they're dressed, then you can go for that's cute. But best avoid, calling it a working dog, cute, but there's always a genuine compliment that you can give to them, because all clients. They do appreciate you appreciating their path.
If they don't normally see you, then do refer to their usual vets. It's worthwhile asking them if you don't know already, you know, which, which vets you normally go to, and if you go to Riverside vets, who do you normally see there? It shows a good level of interest in the client, and also gives you an idea of whether they're particularly bonded to one vet or another.
And if they are particularly bonded, it can mean they find it more challenging to be meeting a different vet and putting the care of their pet into their hands. And if you know the practise or the vet, then do let the client know that. So you, you might just want to say something that you know, this lovely building there and it's great location.
Oh, I know Susan, she's a very caring vet. And that can be reassuring as well for the client. These things don't take long, but just help.
To build that rapport between you and the client. Want to maintain a reasonable distance from the client, that does vary between cultures, but you don't want to be shouting from the far side of the room and round about arm's length tends to be quite comfortable for most people, closer than that can be, can be difficult, even though it does sometimes happen when we are restraining animals and things. And do try if time allows to ask some non-clinical questions, just to build a rapport and have an opportunity to to chat through things about their pet.
At this stage, you're probably going to bring them into the, into the consult room. And do you always look for opportunities to use an empathic statement. If you can demonstrate to them they care.
Do that at every opportunity. Well, chat through a bit about consult room layout and how we set it out. So sometimes you can move furniture around the room.
Other times it's quite fixed. But when you bring the the client into the consult room, you want to have a way of settling down, so you're both round about on level eye level with each other. And ideally with you at a bit of an angle to them rather than face on.
Do consider where the table sits in the interaction. So with picture one, that can be quite a traditional approach that stands on one side of the table, the client stands on the other side, but that table can create a bit of a psychological barrier between you. So it's always worthwhile discouraging the client from scooping the pet up onto the table immediately and just taking time away from the table to chat through the history.
Before you commence the examination, and it can be helpful to have done that, and then move around the table after the report has been built. If there's only one chair, as in picture to here, that can create some issues, because what we want to avoid is that towering over the clients and looking down on them quite literally. At the same time, it would be very inappropriate for the vet to sit on the client to stand.
So I would encourage you, if you have one chair in your consult room, do try and get, get two chairs in. Sometimes though, you can be positioned as a number 3, where you're at angles to each other with the table there. But my, my preference for their initial conversation is to be sitting near the client, to be able to converse with them in a relaxed manner.
Consultations where people sit down have been found not to take longer, but the client's perception is That the vets has really taken time with them because they've sat down, and that's sitting down with the client with the client indicates that you are willing to spend that time and help them settle down. So just a little bit in terms of the client's viewpoints and what they see. So with you towering over the vet, then your view is literally big forearms, small heads and sort of disapproving face because you are looking down, sitting next to them, it feels much more, much more comfortable.
And what I will find I have to do if there's only one chair in the room, as I'm generally on the floor with the pet, looking up at the client so we can have an open conversation and make collaborative decisions as to where we want to go with the pet's care. Things do change slightly if there's a critical situation. If the patient is clearly unwell, if it's in severe pain or collapsed or having severe breathing difficulty, then we do need to act quite quickly.
But it doesn't mean that we should skip the key stages and in the introduction as above. We need to introduce ourselves. We need to know the client's name, their pet, their regular vets, if we can, if it's not ours.
But then we may need to move the patient to the prep room and ask the client to take a seat. So I would encourage you never to say that we want to take the patient to the back, but use either prep room or treatment room can be quite good because that describes quite well what it does and what we're going to do that we're going to take the pet for treatment. But it's really important to keep the client informed.
Now that can be challenging where you have only one person. There in the clinic. So that can involve some popping backwards and forwards.
However, if there are More than one of you in the team, so if you have a nurse or an animal care assistant there to help you, then you can have them pop up and keep the client informed and give an outline of how long it's likely to be before they get the next update. And it's important in that circumstance, you may need to ask the client some closed questions really, really quickly. Do recognise that that can be difficult for the client and recognise that as you speak to them, so do say something like this may seem like an interrogation, but it's vital that I get this information quickly.
So can you please tell me, and that gives you then permission to fire a number of short closed questions at them to get some fast answers that you need before you can make your initial emergency intervention with your pet. In the last emergency situation, it is really important that we're using lots of open questions. We're really listening to the clients and letting them tell us what has happened.
So I like using Tell me as an opening to my main question. So for example, I understand poor Ben has been hit by a car this evening. Can you tell me what's happened?
Or if he's not been doing well for a couple of days? Tell me what he's been doing. What's been happening with him?
So nice open question, so the client can respond and really let them let you know what their chief concerns are and what they're hoping to get from the visit with you. It's very important that you don't interrupt. Let them get that story out, and then you can follow up with questions afterwards.
Now you can support that listing and encouraging them, them to continue to talk by active listening, by showing physical signs that you are listening, so head nodding and perhaps hand gestures to indicate, you know, do continue. If the client pauses, you can reflect back your understanding. So what, what I'm hearing is that he's vomited 3 times today and has then had diarrhoea.
Is that correct? And that can, you know. Show the client that you're really listening to them, you've understood what they've said, and also it checks your understanding of what's happening.
You can use verbal sounds such as mm or -huh. And a nice open body posture, so shoulders back, no folded arms. Don't interrupt, give them time and do give them a seat.
It's really important to be aware of any nonverbal cues. Don't let them skip by because they're often an indication that the owner has a concern that you haven't picked up on. If they're, for example, glancing at their watch, do say, I can see you're concerned about the time.
Is there somewhere you need to be? Is there something we can help you with? Can we pause this while you do something?
If there's not, then you can say, well, look, we should be finished this consult in about 10 minutes. And explain them what the next stages would be after that. If the clients exhibiting very close body languages they got their legs crossed, they're pointing away from you, then.
Do stop what you're saying, so you, you seem uncomfortable or uncertain about what's happening. Can you explain to me what your concerns are? So don't, don't let those concerns slip, do ask for them and recognise them.
Now If you can be anybody, be sure, do excuse the drawing, it was the best I could produce. But if we go into each consult, I share, we know that we're going in with the right attitude, and we're going to do a good job for the clients. Let me explain a bit more.
So in any interaction with the clients, especially when they're new, we need to be clear. We need to be honest, we need to be empathic, and we need to be respectful. So being clear, we need to avoid jargon.
We need to give information in small chunks and check that the client has understood what's happening. It's physical physician communication is significantly positively correlated with patient adherence. We get better compliance.
We get better treatment results if we communicate clearly with our clients. So we need to strive at all times to be understood by them. No such thing as a little white lie.
If we're late, let the client know why we're late. We are obliged to be open and honest with clients and respect their needs and requirements at all times. We need to be empathic.
So that's an appreciation of the patients or in our case, the client's emotions, and expression of that awareness to the patient. Study by Shaw showed that vets express empathy and only 7% of veterinary visits. So we don't want to be that bad.
We want to make those empathic statements. We want the client to understand. That we care about how they feel that we can see this is difficult for them, and we're there to help them.
The client satisfaction was more highly correlated with how the owner was treated than how the pet was treated. But We don't always express empathy, so please do look for those opportunities to make empathic statements. You need to show you care and not just think it.
So do say I can see you're really upset. Don't tell them you understand how they feel because you don't. And that will provoke a negative response to the client, but do say things like, it really must be hard thinking about what's happened.
You look for every opportunity to make an empathic statement. And be respectful. We want to be polite, honour, and show care.
To our clients. This is important. I is it good to think about, you know, why this is important to you, and it may be just the clients are presenting their pets to us because they trust us and they seek our expertise and our care for their patients.
But for me, I suppose my feeling is I come from a position of egalitarianism. I think that all people are, are equal and deserve equal rights and opportunities, not least our clients that are trusting us with their pets. So that's been a quick trot through really how to introduce yourself to the clients on how to build trust.
Hopefully You'll have learned something that you can apply in your daily work as you go about it. And I would encourage you just as you go into consults over the next week or so, do take that time to really think about how you're introducing yourself to the client, how you're making them feel welcome and how you're presenting yourself to them. And these can be used in every single consultation, but they're much more important in the emergency setting.
So thank you very much for listening to me. I appreciate your time.
