Communication is a clinical skill (part 4)

Facilitative responses

Facilitative responses are both verbal and non-verbal communication skills and they include:

• Encouragement
• Silence
• Sharing of your thoughts
• Echoing
• Reflective listening or paraphrasing

Encouragement

Along with head nods and facial expressions, attentive listening signals clients to continue their story and it demands that we refrain from interrupting when they are speaking. Neutral facilitative comments might sound like:

• “uh-huh”, “go-on”, and “yes”.

Silence

For the most part verbal facilitation provided to clients is less effective unless it is followed by silence on the veterinarian’s behalf. Longer periods of silence are especially important when a client is having difficulty expressing himself, gathering his thoughts or trying to deal with difficult news regarding the patient. If the silence starts to feel uncomfortable it’s best to check in by reflecting on what you are seeing or sensing by your sensory acuity to his non-verbal communication:

“I’ve given you a lot of information just now. Would you be willing to share your thoughts.”

Sharing your thoughts

Sharing why you are asking certain questions is an excellent way to invite the client into your train of thought and encourage him to participate (Figure 1):

“Sometimes when a cat starts peeing outside the litter box it can be a sign of stress. I’m wondering if you think this might be what’s going on with Squeaky?”

It is also useful to let clients know the reasoning behind your line of inquiry. Assume that the client came to your clinic to have her rabbit euthanized. The rabbit was a gift to her children from her former husband and she is tired of caring for it. You might be thinking about options for re-homing the rabbit and embark on taking a history. You notice that the client is getting frustrated and giving you short, curt answers to your question. Sharing your thinking at this stage might sound like this:

“You must be wondering why I’m asking all of these questions about Fluffy when you are really just wanting me to euthanize her. Our practice does not euthanize healthy animals so I want to get an idea about Fluffy’s health in the event that we can come up with another home for her. Does this make sense to you?”

Echoing

Echoing involves repeating the last few words that a client said. For example:

• Client: “I have a lot of money and time tied up in breeding these Devon Rex cats and I really need to maintain a good reputation as my cattery is new to the community.”
• Veterinarian: “You sound concerned… You have a lot tied up for sure (echoing).
• Client: “Yes, for sure. I really wanted to breed these Devon Rex cats because they are high demand. Now that this last litter has some upper respiratory infection I’m super concerned about my cattery not to mention reputation. I’ve got to get these kittens healthy.”

Veterinarians often worry that echoing sounds contrived or awkward, but this facilitative response is easily taken up by clients. In the example above, echoing opened up the conversation to the point that the veterinarian learned that the client is anxious and committed to taking good care of the patients.

Reflective listening or paraphrasing

Now we turn our attention to facilitative responses that are essential for more detailed information gathering. Reflective listening involves restating in your own words what you heard the client say:

 “Just to be sure I heard you correctly, you were able to give her 2 doses of her medication yesterday but today she put up a fight and you weren’t able to give her the medication.”

OR, the feelings behind what the client has said:

 “It sounds like you are worried that he might be blocked again.”

In either case the client is in a position to add, clarify and correct what we heard or assume they are feeling. In other words, reflective listening is a diagnostic aid in addition to a demonstration of your interest in what the clients is saying and your desire to understand what the client is saying. This particular skill is intended to sharpen rather than just confirm understanding and therefore tends to be more specific than the original message.

It’s important to note that it can be counter productive to move too quickly to reflective listening if the client has not had full opportunity to tell her story.