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End-of-Life Relationship-Building Begins Before Death

Tuesday, October 14, 2014 11:57 AM | Administrator Administrator (Administrator)
From Veterinary team Brief 

Carrie La Jeunesse, DVM, CT, CCFE, LaJeune Consulting, Fairfax, Virginia

Shortly before my mother died, she flew from California to Washington State to visit with my family. During her stay, she fell and suffered a severe head trauma. While she was in the Intensive Care Unit, a palliative care doctor briefly became involved with her care. The compassion, understanding, and information that doctor provided my siblings, my mother, and me is emblematic of the type of end-of-life relationship building that not only offers critical support, but also fosters warm feelings toward caregivers long after a patient has died. The doctor sat with us, listened, reflected back, was honest with regard to realistic expectations, and then advocated for my mother’s care with goals of quality of life and comfort. Even after my mother’s death, the doctor holds the fondest spot in my heart of all my mother’s caretakers, despite the fact that she was not her primary physician.

Build a Bond Before a Patient’s Death

It does not matter how nice are your letters of condolence, how lovely the hand-rendered clay footprints, how quickly remains are returned to clients, or how kind your offers of tissues, tea, or time after a euthanasia. The time to establish a foundation of empathy and trust and form a true “team” approach with clients is when the patient is alive. When you level the inherently skewed playing field of veterinary “authority” over client, and decisions are made in partnership, best outcomes are more likely and warmer relationships have a better chance to develop.

The time to establish a foundation of empathy and trust and form a true “team” approach with clients is when the patient is alive.

Pay Attention to the Patient

Compassionate care is delivered somewhat differently in veterinary than human medicine, but the principles are the same. When my older dog, Comma, was about to have her second knee surgery, I was anxious and a bit emotional, questioning the wisdom of another orthopedic procedure in an older dog with other medical problems. The surgeon, who was also a long-time professional friend, is probably one of the nicest people to have ever walked the face of this earth. Comma knows it. She loves him. Comma sat as close as she could, leaned against him, laid her head on his lap, and waited for his gentle hand to stroke her head and soft ears. My questions waited while they had their private little moment of “catching up” since her last visit. The genuine affection and “conversation” with Comma eased my angst. It was clear the surgeon genuinely cared about my dog, not just the technical aspects of surgery and the post-op recovery period. He showed that animals are beings deserving of kindness and compassion. As the pet owner, I needed to know that.

Be Yourself

Even when difficult news is delivered, one office visit with an emotionally intelligent practitioner can cement client–veterinarian loyalty. Several years ago, I referred (to the same surgical practice) a dear friend whose cat, Tilly, had an aggressive interscapular injection-site sarcoma. The news was not good. The veterinarian sat on the floor, snuggled Tilly, made up his own endearing nickname for the cat, and won my clients’ hearts through his honesty, expertise, and clear demonstration of caring for this cat, these people, and their shared bond. This veterinarian often sits on the floor with patients while he is speaking with clients. It is his styleundefineda true representation of who he isundefinedand this authenticity builds trust that encourages compliance with recommendations and long-term client loyalty.

Even when difficult news is delivered, one office visit with an emotionally intelligent practitioner can cement client–veterinarian loyalty.

Be Still and Listen

According to researchers Kurtz, Silverman, and Draper, communication is one of 4 core competencies essential to an “affective medical interview.”1 Communication must be practiced and cultivated just as diligently as other “doctoring” skills. 

In the examination room, following introductions or greetings, invite clients to share their stories and concerns around the “presenting complaint,” which will allow you to hear completely what the clients have to say. Depending on the circumstances, begin with questions such as, Can you share with me what your concerns are today? Then, be quiet. Do not interrupt. Do not ask clarifying questions. Actively listen. Make sure there are no barriers between you and the clients (eg, charts, examination tables, folded arms). Face the clients, sit at same level, and lean in a little to signal your full attention. Then, at a minimum, clarify that you understand what the clients are saying, answer their questions, and then reflect back what you heard to be the client’s concerns and questions to ensure your understanding is correct and the clients’ concerns and questions have been fully addressed.  Ask them if your understanding is correct so that they are comfortable correcting anything that may have been misinterpreted.
Be authentic. Be compassionate. Be honest. Listen. The clients will remember these things, perhaps not consciously, but at a “heart” level, and they will likely feel a bond with you, even when you have euthanized their animal companions.

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