The veterinarianclientpatient relationship

The veterinarianclientpatient relationship

DOKTERDOKTER HEWANVeterinarianClientPatient relationship. satisfying the client, caring for the animal and promoting professional fulfilment. The dynamics of the veterinarianclientpatient relationship are complex with multiple dimensions to take into accountA PARADIGM SHIFTRecent societal changes have caused a paradigm shift in the veterinarianclientpatient relationship.85% of pet owners viewed their pets as family members (Brown & Silverman 1999).acknowledges the humananimal bond will lead to better outcomes for veterinary practices and their patients (Brown & Silverman 1999).

Veterinary professionals responsibilities have expanded to include the mental health and well-being of their clients, as well as those of their clients pets (Blackwell 2001).Veterinarians responsibilities for addressing questions and providing client education are increased. Consumers are not forgiving of unprofessional services (Blackwell 2001). Most complaints related to poor communication and deficient interpersonal skills (Russell 1994), with breakdowns in communication being a major cause of client dissatisfaction.Given (1) growing client expectations, (2) the strong attachment between people and their pets and (3) increasing consumer knowledge demands a shift in communication style from the traditional paternalistic approach to a collaborative partnership. Many clients want to take an active role in decision making on their pets behalf.Paternalismthe veterinary team does most of the talking and the client plays a passive role.enhances efficiency and promotes time managementthe agenda and subsequent diagnostic or treatment plan may not be shared between the veterinarian and clientConsumerismthe client sets the agenda for the appointment; the veterinary team does not explore the clients values; the veterinary team plays the role of a technical consultant, providing information and services on the basis of the clients demands.The challenge in this situation is to engage with the client as a working partner and to build trust with the veterinary team to reach an agreement between the client and the veterinarian agendas.PartnershipBetween these two extremes is relationship-centred care, which represents a balance of power between veterinarians and clients and is based on mutualityIn the relationship-centred model, the relationship between veterinarians and clients is characterized by negotiation between partners, resulting in the creation of a joint venture, with the veterinarian taking on the role of advisor or counsellor.Key to this relationship-centred model is that clients must sense that their ideas, feelings, expectations and fears are understood (Epstein et al. 1993) and that they are being actively involved in the decision-making process.

The conversation content of relationship-centred visits is broad including biomedical topics, lifestyle discussion of the pets daily living activities (e.g. exercise regimen, environment, travel, diet and sleeping habits) and social interactions (e.g. personality or temperament, behaviour, humananimal interaction and animalanimal interactions) (Shaw et al. 2006).SHARED DECISION MAKINGShared decision making is a key component of relationship-centred care.There is two-way exchange between the veterinarian and the client, identifying preferences and working towards consensusAn interactive approach (e.g. Frisbee) is promoted in giving information, in contrast to direct transmission approachSilverman et al. (2005) recommend using a chunk and check methodThe aim of this technique is to increase recall, understanding and commitment to plans

Provides an opportunity for the client to participate in the conversation, provide feedback or ask for clarification.Taking the clients perspective into account and establishing mutual understanding and agreement encourage the client to fully participate in the discussion and commit to the diagnostic or treatment plan.This entails encouraging the client to contribute to the conversation (e.g. check) (What questions do you have?), picking up on client cues (You seem a little hesitant about surgery), asking for the clients suggestions (What options have you and your husband discussed?) and checking for the clients understanding (What will be the most difficult for you?).Use open-ended inquiry to explore the clients perspective (How do you feel Max is doing since the surgery?); ascertain the clients thoughts (What do you attribute to his good progress?); and assess the clients starting point (What do you know about the risks of arthritis?).Extrapolating from medical communication outcomes-based studies, obtaining the clients expectations, thoughts, feelings and fears about the pets health or illness enhances client participation in the appointment, with the potential to increase client satisfaction and adherence to veterinary recommendations (Stewart et al. 1995).Communicating with colleaguesEven the smallest practice will comprise more than one individual, and once there is more than one, communication, or lack of it, becomes an issue.The word communication comes from the Latin communicare meaning to impart, to share or to make common.Words may be important, but how we treat colleagues in terms of our attitude and our body language is just as important.THE TEAM AND ITS LEADEREvery team deserves a good leader who has the vision to see where they want to take their business, the confidence to know that the destination they are heading towards is the correct one, and the wisdom to know when, along that journey, adjustments need to be made to alter course.Leaders must have the ability to communicate that vision to the team as a whole and must know its constituent members well enough to understand what motivates each and every one of themdestination is reached with as many of the team on board as possibleWhen team members are asked what is important to them in their job, the following responses will usually appear high on the list of responses:Confidence in the leaderA sense of belonging Excitement in the job

why that confidence exists:VisionEnthusiasmAdaptabilityIntegrity ToughnessFairnessWarmthHumilityConfidenceWhen the only tool you have is a hammer, all problems tend to resemble nails (Maslow 1966).

The effective leader will have a comprehensive toolbox and will know just when to reach for a different tool, when to apply it, and will know just the correct amount of strength and/or leverage to apply to get the job done.The leader should lead by exampleadhering to standard operating procedures (SOPs) in a practiceIf the boss flouts the rules, then it must be okay for the rest of the team to do likewise.

Types of PeopleAnggota tim memiliki karakter dan perilaku yang beragamPraktik dokter adalah kerja TimSukses/tidaknya suatu Tim bergantung pada kerja tim sebagai unit yg kohesif BUKAN pada Skill individuTim yang baik memberikan hasil yang selalu lebih baik dari jumlah total kemampuan individu dalam tim tsbReplacing and/or recruiting new team membersThe introduction of a new practice member is a golden opportunity to introduce new skills into the team or to strengthen existing onesCommunication with new employees starts at the advertising stage.The interview is an important opportunity for both sides to communicate just what is on offer from the practice and what the potential new recruit wants.The interviewee should leave with a copy of the job description and the terms of employment.

DELEGATIONOne of the key objectives of any practice owner, leader or manager is to achieve their goals through the efforts of othersall too often it is a case of abdication rather than delegation with team members being left to get on with it with little or no instructions or backupThe other major fault is too much interference having delegated the taskTo achieve our objectives we have to motivate and delegate to othersThe basic components of successful delegation1. Communicate to the individual(s) what it is you want them to do. If it is a specific task, make it SMART or ideally SMARTER.2. Provide the necessary support in terms of materials and training and advice.3. Monitor progress without interfering.4. Encourage feedback and continue to offer support.

SMARTER ObjectivesPeter Drucker; it appeared in his 1954 management book, The Practice of Management:SMART areSpecificMeasurableAchievableRealisticTime-boundThe acronym SMARTER introduces the new words, extending and rewarding, which highlight the importance of engaging individuals.

SMARTER objectives can also be employed in agreeing and setting the personal development goals for team members.MotivationWhat can you do to motivate others?the prime motivators are intrinsic rather thanextrinsic and include such things as:Having an interesting job Working within a fair environment Having goals to strive for Receiving recognition and being regarded as an important member of the teamExtrinsic factors such as financial bonuses can play a role in motivating individuals and teams but need to be used with careIf one wants to use money as a motivator, it should be done with cautionRewarding one individual financially may incentivize that person but may well demotivate all the othersThe criteria need to be simple, transparent and under the direct control of the individualSTANDARD OPERATING PROCEDURESCommunication comes in many forms; a written format may be best suited to the joban SOP should provide detailed written instructions to achieve uniformity of the performance of a specific functionSOP should provide detailed written instructions to achieve uniformity of the performance of a specific functionSOPs can cover such diverse topics as registering new clients, credit policy, admitting and discharging patientsan SOP should have a title; the person writing it should write down what they do and those who are involved in that process should do what is written down.Why SOPs fail in the workplace? They are difficult to find. They are written in a foreign language. Instructions and general information are mixed. The procedure is described in an unfamiliar way. Users know a better method and can do the procedure in their sleep.

PRACTICE MEETINGSStudies proved that most complaints from members are lack of communication members desire to have more practice meetingsPractice meetings are the most effective way of ensuring good communications within the practice at all levelsbut only if they are structured to be efficient and effective.

Amongst the questions that need to be answered are the following: Which types of meeting need to be held and what are the functions of each type? Who should attend each type of meeting and why? Which types of meeting need to be held on a regular basis, and how often? Is there a call for one-off meetings?REPORTING STRUCTURETo ensure good communications within a practice, there needs to be a well-defined reporting structure, which is accepted and understood by the teamThe schematic or organogram should provide details of which topics should be communicated to whom within the practice.to facilitate the transmission of information, top down as well as from the bottom upThe schematic or organogram should facilitate any member to request or convey information to another individual, a group of people or to the entire team.Communicating with a wider audienceMark Twain once said, There are two types of speakers: those that are nervous and those that are liarsNearly 100 years later, public speaking still remains one of peoples greatest fears.There is, for example, anecdotal evidence to suggest that some individuals are more scared of public speaking than dying. Why is this? speakers fears included trembling, shaking, or showing other signs of anxiety, ones mind going blank, doing or saying something embarrassing, being unable to continue talking and saying foolish things or not making sense

If you tend to avoid public speaking like the plague, it is possible that this could hinder your personal development and careerpublic speaking is an excellent way of sharpening critical thinking skills such as gathering and recalling, organizing, analysing and evaluating informationprocess of discovering your topic, shaping it into a message and delivering it orally are comparable to writing in that it is a learning process

Preparation: what to sayWhen it comes to public speaking, Tilton (2002) says, Nothing can substitute for quality preparationKnowing your audience is the first step of this preparationyou need to decide what message you want to get across what is the main point of this presentation for youAssessing the right amount and level of information required is important.Raveenthiran (2005) says it is: boring to talk about what the audience already knows; futile to talk about what the audience cannot understand; arrogant to talk about what you know and ignore the interests of your audience; and dangerous to talk about things you are not sure about.Preparation: how to say itRehearsing your presentation is also an important act of preparationIt may seem time-consuming, but doing a dummy run will help iron out any difficulties and build your confidenceGo through your presentation out loud. This will allow you to proofread your slides for spelling or grammar mistakes, as well as work out whether you are finishing before or after the time limit on your presentationTry to remember key points, but do notmemorize your speech word for word; it is possible that you could go blankPerform in front of a mirror, or record it on a video, will enable to look at your own body language. Watch out for telltale signs of nerves such as crossed legs and arms or wringing handsrehearse it in front of a trusted friend or colleague. Get them to play devils advocate.Where practical, performing this dummy run at the actual venue of the presentation is the gold standardIf this is not possible, make sure you know what facilities will be thereIf you are nervous, deep breathing and body stretches can be used to relax.Whats the worst thing that could happen? Even if it does, youll live. Yes this presentation is important, but its not brain surgery (Petrini 1990).it is important to set realistic goals for yourself: not set out to engage 100% audiencenot to focus on the 10% or 15% who are not listening as this takes your attention away from the larger group of people who are listeningIf you are nervous, remember that the audience response is more likely to be empathic rather than hostile or derisiveThe presentation as a consultationAn oral presentation is similar to conducting a consultation with a client. You deliver a message but also to listen to your audience and gauge how they are reactingTwo key factors in the veterinary consultation model: providing a structure to the proceedings and building a relationship with the client (or audience)In providing structure to the proceedings, an oral presentation should have a beginning, middle and end that are arranged in a logical sequence An example of this is the concept of: Tell them what youre going to say, tell them and then tell them what you have just told them (Petrini 1990).A strong opening is important. It is the crucial time to convince your audience that you have something interesting to say. Get your main point out early and give the audience a good reason for being thereToday Im going to talk about mastitis and the three easiest ways to keep your herd cell count downAs in a consult, you need to eliminate uncertainty and inform your audience what to expect:Today Im going to talk about BVD. I have a short presentation that should take a half hour and, after a period for questions, well break for lunch.The end of your speech is also important.Summarize the main points of the presentation or leave the audience with a questionPublic speaking also reflects the veterinary consultation model in that it is important to build up a relationship with the audienceAs in a consult, body language is very important; you are not just communicating verbally through your speech and slides, you are also doing so non-verbally, with your body languageNon-verbal communication with your audienceadopt body language that appears comfortable and confident, it will help your audience to listenAim to achieve as open a body posture as possible this means coming out from behind a lectern, standing up, facing the audience at all times and using open body language including uncrossed arms and legs. Smile too audiences appreciate a speaker who appears friendly and enthusiastic.Eye contact is also key to involving the audience, and not just eye contact with the front rowStart by finding the person in the audiencewho is willing you to succeed (theres nearly always one), then look around at the rest of the audience.Use hand gestures to emphasize interesting or important points and try to move around the stage rather than standing in one placeYour voice is another form of non-verbal communication. When you are nervous, your voice naturally speeds up and increases in pitch, so consciously slowing down the rate of your speech will give out a message of confidence and control.Using variation in your pitch and rate of speaking will help prevent you from sounding monotonous. Also, as in a consultation, pauses and short silences can be useful to allow an important piece of information to sink in.As in a consult, body language is a two-way process. During your presentation, look at your audiences non-verbal feedback Do they look bored or confused, for example? Visual aidsWhen you give a presentation, visual aids such as charts, tables, graphs, movies and images can help support your speech and keep your audience interestedThe key to visuals, however, is simplicity.Visuals should support rather than distract from your ideas .They should complement your speech rather than replace it it shows lazy presentation skills to stand in front of an audience and simply read slide after slide verbatim.

Several recommendations for using an electronic presentation application such as Microsoft ppt :Use no more than one slide for every 2 minutes of your speech.Use contrasting colours, i.e. a light text on a dark blue or black background or vice versa. Care should be taken with red or green because of the potential for redgreen colour blindness in the audience.Use an appropriate style of text. Universal and Arial are the most popular fonts. Avoid calligraphy, sans serif or italicized fonts. Do not underline text and do not use words or sentences made entirely with upper case letters.Use an appropriate size of text. Text should be visible from the back row; try 36 points for titles and 28 points for the body of the text.

Limit the amount of information on the slide. Sentences should be short and punchy like newspaper headlines. Five points on each slide, consisting of five words each Ensure there is consistency between slides (same size, colour, background and the same font) Minimize animation and flashy gimmicks such as bullet point sounds. (except bulleted text) Simplify diagrams and use clear, bold pictures. Eliminate unnecessary elements to a slide.