Studies in human medicine show that patients repeatedly mention the importance of the way conversations regarding bad news
are handled. Key factors that influence the way veterinary clients adapt to a pet's illness and treatments include the setting
for the talk, the choice in word use, and the emotional connection between you and the clients.
Laura D. Garrett, DVM, DACVIM (oncology)
It's best to have clients come into the office for bad news rather than to hear it by phone. Make sure you have adequate time
for the discussion, and use a private space with seating. The primary clinician should be the one to break the bad news. It
can be helpful to have family or friends in the room to help support the client and help the client recall information later.
Four core communication skills
While hearing bad news can be distressful for clients, delivering the news can also be distressing to clinicians. It is important
to have specific skills to rely on for this critical and difficult task. Be sure to use these four core communication skills
to improve the experience for all.
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1. Keep your nonverbal communication signals in line. Think about how you feel before you go into the room. Once you are in the room, maintain a calm tone of voice, have your body
position on the same level as the client, and maintain good eye contact. You can give a pat on the back, a touch on the arm,
or even a hug, as appropriate. Watch the client's nonverbal signals as well instead of charging ahead—gauge whether the client
is focusing, and pause if the client looks upset or ill. You can check in by saying something such as, "Would you like a few
2. Be empathetic. Let the client know he or she is seen, heard, and accepted. Verbally acknowledging a client's distress helps the client know that his or her feelings are seen and, thus, helps to validate
those feelings. A statement as simple as, "I can see this is difficult for you. It can be very hard to hear that someone so
close to you has cancer," can be grounding for clients and may help them to refocus on the medical discussion at hand.
3. Ask open-ended questions. Don't assume you understand what the client is thinking. Ask open-ended questions such as, "What are your thoughts about options
from here?" instead of "Are you thinking about euthanasia?" Ask rather than tell is a great rule of thumb. Also, asking a
client what they already know about a condition or disease can save time and avoid unnecessary client education. You will
not only begin the discussion at an appropriate level, but you can also show the client that his or her knowledge is valued.
4. Use reflective listening. This core skill involves restating what a client has said in your words—or even stating how a client appears—to show the client
he or she is heard and seen. Saying, "You look very worried," can help the client to acknowledge the fear and then move beyond
it toward a productive discussion. And your interpretation of what a client is saying allows him or her to correct any misunderstandings:
"So you were concerned about the cost of the treatment?" may elicit a "Yes, it seems very expensive," or possibly, "No, the
cost isn't the problem. It's the time involved."