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Better ways to break bad news
  1. Christine Magrath

Abstract

Telling a client their beloved pet needs to be put to sleep is one of the most challenging and stressful parts of the job. But Christine Magrath says there are ways to make it easier all round.

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Christine Magrath is a consultant at VDS Training

How often do you find yourself thinking about a consultation that could have gone better? Often the hours spent stressing and mulling over it can be disproportionate to the situation. The good news is research has demonstrated there are specific skills that can support us in handling challenging consultations and that practising them with simulated clients can help develop them. To that end, have a think through the scenario in the box below.

The elderly cat

Miss Holmes has come to the practice with her 17-year-old cat, Daisy. Daisy is off her food, lethargic, vomiting and has lost weight. Blood tests reveal organ failure and you palpate an abdominal mass. You have to break the news that the best option is euthanasia but, when you do, Miss Holmes can’t understand why nothing can be done. After all, her 85-year-old mother, with whom she lives, has had a tumour removed and is fine. She’s also seen many happy endings on TV. Through tears and agitation she is adamant that Daisy – who she describes as her ‘only friend’ – should not be put to sleep.

When we use this scenario in our experiential teaching workshops, the following key themes emerge on just why the client has reacted in this way. Together they give a sense of how to handle this and other tricky situations.

  • ‘I didn’t have any warning that it was bad news’

    Remember that often more than one ‘warning shot’ needs to be delivered and this will have more impact if followed by a pause.

  • ‘Nobody asked me how I thought Daisy was doing’

    Giving clients the chance, early on in a conversation, to explain how poorly they think a patient is can help start the acceptance process. It also means it’s possible to tailor the discussion to the client’s perception of the situation.

  • ‘I didn’t hear what the vet was saying – there was too much information’

    Information is more easily understood if it’s delivered in ‘chunks’ and does not contain any jargon.

  • ‘I didn’t have enough time to take the information in’

    This is an interesting one, because the majority of vets know to allow time for their clients to process information. But the reality is we often underestimate how much ‘wait time’ we need to allow. This goes further than listening – it means that instead of thinking of our next question, we should give all our attention to the client, even if there is an awkward silence.

  • ‘They weren’t interested in my mother’

    ‘Touch and go empathy’ is important here. Acknowledging such comments and then moving on can be enough to address a client’s ideas and concerns.

    In contrast, another interesting point we often hear is:

  • ‘I felt this vet cared because they were upset’

    Vets often worry about showing emotion, but generally clients read this as empathy. Sharing rather than repressing your feelings can also help with your own wellbeing.

These reflections are the tip of the iceberg, and there is much more we can do to ensure encounters with our clients don’t become difficult. Reflecting on these points, though, should hopefully be enough to start you on your way.

Get on your hobby horse

What’s your favourite holiday location? What’s the one thing that always helps at the end of a stressful day? What’s the best book you’ve read recently, the best film, your new Netflix addiction? On a scale of one to 10, how gorgeous is your own dog/cat/goldfish/hamster? How is that new hobby going?

In the Take Some Time Out part of the Balance section, we want to celebrate the ways in which our readers look after themselves so they can better look after their clients.

Send your stories, photos and recommendations to vet.editorial@bmj.com or reach us Twitter at @Vet_Record or using the hashtag #VetRecordBalance.

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