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Difficult conversations and empathy

Dr Kristen Reyher talks about the importance of empathy and reflective language when having difficult conversations with clients.
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Welcome to the third section of motivating lasting change. I’m Dr. Kristen Reyher. And in this section, we’ll be talking about difficult conversations that might occur when you’re dealing with clients. We’ll talk about the differences between sympathetic responses and empathetic responses. And we’ll teach you how to use reflections in order to go a bit deeper with your clients. And to understand how you can create an empathetic relationship that will serve you well if difficult conversations arise. In the life of any veterinarian, there will always be difficult conversations with clients. As much as we try to avoid them, bad things happen. And lots of things are out of our control. Imagine the worst case scenario.
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A client follows your advice and their animal dies or gets worse. How can you maintain confidence in your advice and your service in this instance? How can communication help us in these instances? How can we learn to communicate well in these instances and continue to build a positive relationship with our clients? Difficult conversations may arise when we least expect them. We know from research that complaints to veterinary services are most commonly, a result of communication going awry and complicating an event. In these instances, if we can ensure that our client feels listen to, empathised with, understood, respected– that’s our best route to maintaining a positive relationship.
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The most critical communication skill is to be able to use an active and empathetic reflection when your client discusses an adverse event with you. Rather than explain why you made the decision you did or what happens in 90% of cases, what you really need to do is to listen. To reflect. To acknowledge what they’re going through. Research also suggests that having a positive relationship with clients has a protective effect when mistakes happen. We can’t change that these things are going to happen, but we can change the response that we have to them when they do occur. First, it’s important to note that empathy is very different from sympathy.
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Sympathy, which is fellow feeling or a community of feeling, is a feeling of care and concern for someone, often someone close to you, that’s accompanied by a wish to see them better off or happier. Sympathy is about feeling for someone. Saying something like this is a terrible thing to have happened, I really want to help. But empathy is about feeling with someone. It involves first seeing someone else’s situation from their perspective. And second, sharing their emotions, including if any, their distress. It’s a far more active process, which can be achieved through the use of a reflective statement such as, you are struggling to cope. We see this and we don’t just feel for them, we feel with them.
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Reflective statements then are important to learn how to do and how to do well. In essence, they’re fairly simple. They’re statements rather than questions. And they make a guess about our clients meaning, rather than asking them. They’re made by just changing one tiny part of how we might typically ask a question, as this tends to be how we ascertain the feelings of others. A reflection instead just presents this as a statement. And offers back to the person saying, this is how you feel. This can often, very well communicate client perspective and emotion. Consider the following example. Your client says, I know I shouldn’t be feeding too many treats, but now I’m realising that Buster is looking rather fat.
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Instead of asking a question like are you worried about this, we can use a reflection, you are worried about this. Building a conversation with reflections and integrating previous ideas that we’ve discussed, such as using open questions, providing feedback, and information only with permission, and surrendering your expert role in the conversation, means that you can build an empathetic interaction, focused on exploring how the client feels as your starting point. Whatever shape this takes following a distressing event, it is this connection and understanding that you build that will encourage your client to enter a positive conversational space. One where they can hear your thoughts on why and how this event might have occurred. And what, if anything, you could have done differently.
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So we use these parts of our positive communication tool box. Empathy, encouraging reflective statements. Evoking their point of view, asking open questions, getting them to tell you more. Things, as well, like surrendering your expert role. Asking them to tell you what they want to do moving forward, instead of telling them just what you think. And making sure to share your thoughts only with permission. I know this is a difficult time, would it help if I was able to share some things with you that I thought could improve this? From difficult conversations to more positive ways to communicate, to helping our clients change, we have covered a number of communication strategies in these sections.
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We’ve learned that ambivalence is a normal part of contemplating change. That we need to understand that and embrace that. And help our clients move through that change process. We’ve learned that we should avoid telling clients what to do. Instead, we should ask for their ideas because the best answers usually lie within them. And we’ve learned how to help clients develop discrepancy in order to move them forward. Helping shine a mirror on what they’re doing and what they say they want to do so that they can choose to make better choices.
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And we’ve also learned how to build a connection through active empathy, which will also support us in difficult conversations and difficult situations that will inevitably occur as we are veterinarians. I’d like to invite you to look up more resources at the Motivational Interviewing website. Or to search the Motivational Interviewing network of trainers, which is a group of trainers that are well-versed in this methodology. And can encourage you and help you to have even better communication. And I wish you lots of luck in your better communication in your everyday lives.
Now you have understood the stages of change (step 3.13) and how to improve general conversation with clients (step 3.14), Kristen Reyher will explain how motivating lasting change can be achieved even in the hardest of situations. This video will demonstrate the importance of empathy, and it will show you the need for reflection when having a difficult conversation with a client.
There will be times in veterinary practice where you will face challenging conversations with clients, perhaps when faced with a poor clinical outcome or needing to confront suboptimal management practices. Reflection and empathy are needed so that the client feels respected and you can maintain a positive relationship with them.
The key points from the video are as follows:
  • Empathise with clients and use reflective statements.
  • Evoke their point of view with open questions.
  • Surrender the expert role so the client can have their say.
  • Share your thoughts with the permission of the client.
Using these ideas, you will be able to reassure your client that their views are respected, while also working together to find effective solutions to move forwards.
What do you think is the most important thing to remember when having difficult conversations with clients? Why is it important in relation to AMS? Use the comments section to discuss.
Motivating lasting change within clients is vital, but it is not the only place where change has to occur. In the next step, you will be given some tools for change that can be applied to your local practice. Clinicians have to work together to implement AMS, and the next step will help teach you how to do this.
Please find a downloadable copy of the PowerPoint slides used in the video in the downloads section below.

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Antimicrobial Stewardship in Veterinary Practice
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