Consultation Skills VMS1002 PDF

C O N S U LTAT I O N SKILLS VMS1002 EMILY AUGER “MISSY” You have started in your first job as a newly graduated veterinary surgeon. Your next client is Mr Green, with Missy. Missy is a 2-year-old, female terrier. Missy has been booked in today to discuss neutering....

C O N S U LTAT I O N SKILLS VMS1002 EMILY AUGER “MISSY” You have started in your first job as a newly graduated veterinary surgeon. Your next client is Mr Green, with Missy. Missy is a 2-year-old, female terrier. Missy has been booked in today to discuss neutering. LEARNING OBJECTIVES By the end of this session, students should be able to: Recognise the importance of relationship centred care. Describe the five stages and two themes of the Calgary- Cambridge guide. Apply skills from the Calgary-Cambridge guide to a routine consultation. R E L AT I O N S H I P C E N T R E D C A R E “ Relationship-centred care involves engaging the client in a shared decision-making process, considering their perspective and the human-“ animal bond, to achieve the best outcomes for the animal ADAPTED FROM VET SET2GO B E N E F I T S O F R E L AT I O N S H I P C E N T R E D CARE Improved client satisfaction Client Increases trust Improved accuracy of assessment Patient Better compliance with treatment Improved outcomes Vet Shorter consultation times W H Y A R E C O N S U LTAT I O N S K I L L S S O I M P O R TA N T ? Clients are 4x more 9% of time in a 15.3 seconds is the likely to add consult is spent average time for a vet information at the end gathering information. to interrupt a client. of a consult if vet centred approach. 10% of vets didn’t use Consults are 13% 59% of vets did not any open questions longer when vet use any empathetic when gathering centred. statements. information. 78.9% of diagnostic 56.3% of diagnostic errors in human errors in human medicine related to medicine are patient:medic specifically related to encounter. history taking.  CALGARY-CAMBRIDGE GUIDE Initiating the Session Preparation Establish rapport Identify reasons for consult Gathering Information Building the Providing client Discover medical/patient perspective Background information/Context Discover client perspective structure to relationship the consult Non-verbal Signposting Physical Examination Rapport Attending to Explain the process Explain each step Ensure patient and client at ease flow Involving the animal Explanation and Planning Provide correct type and amount of Shared understanding of patient’s Shared decision making information illness Closing the Session Summarise Forward planning Saying goodbye I N I T I AT I N G T H E S E S S I O N Preparation Create a professional, safe environment. Check previous patient history. Establish rapport Introductions – vet, client and patient! “Chit chat” – how was your journey, summer holiday, weather etc. Identify reason for consult Open question – e.g. “What can we do for Buster today?” Listen to the answer – The Golden Minute Follow up question “Is there anything else you are worried about?” G AT H E R I N G I N F O R M AT I O N Medical/patient perspective Specifics of presenting complaint(s) e.g. duration, frequency, progression Start with open question and move to closed questions to fill any information gaps. Background information Past medical history, management at home (e.g. feeding, exercise) This step is often just confirming or clarifying information we already have on our records – “I can see Buster is 6 months old and I believe he was already vaccinated when you got him, is that correct?” Client perspective Every client has different ideas, concerns and expectations. Client ultimately will make the decisions, the more information we have, the better we can help them with this. “MISSY” – INTRODUCTION AND HISTORY TA K I N G How are you going to prepare for your appointment with Mr. Green and Missy? How will you initiate this consultation? How will you obtain a history from Mr. Green? What information do you want to know any why? P H Y S I C A L E X A M I N AT I O N Explain the process “I am now going to examine Buster, starting at his head and working my way back to his tail.” “I am going to give Fluffy her physical examination now. As Fluffy’s injured right forelimb may be painful to examine, I will leave that part of the examination until last to give Fluffy a chance to get settled.” Explain each step “I am now checking Buster’s mouth for signs of dental disease or infection, and I will check his ears and eyes as well.” “I am now going to listen to Fluffy’s heart and lungs. This might take a minute or so, and as I will be listening through my stethoscope, I won’t be able to ask or hear any questions during this part of the check.” Ensure patient and client at ease “I am going to examine Buster now; is there anywhere in particular he might be more sensitive or worried about me checking?” “I am going to check Fluffy’s painful ear now. There is a chance she may react to this part of the exam, but I assure you it won’t damage Fluffy’s ear, and if she does get stressed, we will stop.”  CALGARY-CAMBRIDGE GUIDE Initiating the Session Preparation Establish rapport Identify reasons for consult Gathering Information Building the Providing client Discover medical/patient perspective Background information/Context Discover client perspective structure to relationship the consult Non-verbal Signposting Physical Examination Rapport Attending to Explain the process Explain each step Ensure patient and client at ease flow Involving the animal Explanation and Planning Provide correct type and amount of Shared understanding of patient’s Shared decision making information illness Closing the Session Summarise Forward planning Saying goodbye B U I L D I N G A R E L AT I O N S H I P Non-verbal communication Eye contact Open body language Developing rapport Establish a connection with your client. Provide empathy and support. Involving the animal Greet and interact with the patient. PROVIDING STRUCTURE Signposting Explain to owner how consult will be structured. “I am going to start by asking you some general questions about Buster’s routine, then there will be more specific questions to fill in any gaps. Then I will examine Buster to ensure he is in good health for his vaccination today.” “There are three options for treating Fluffy’s condition, with a range of costs associated with them. I will take you through each option in turn, and you are welcome to ask for more information as we go through them.” Attending to flow Structure the consult in a logical sequences e.g. history taking, clinical exam. Ensure you keep to time (10–15-minute consults are routine in the UK for companion animals). “MISSY” – STRUCTURE AND R E L AT I O N S H I P How will you build the client relationship? How will you signpost this consultation? What could you do to develop rapport?  CALGARY-CAMBRIDGE GUIDE Initiating the Session Preparation Establish rapport Identify reasons for consult Gathering Information Building the Providing client Discover medical/patient perspective Background information/Context Discover client perspective structure to relationship the consult Non-verbal Signposting Physical Examination Rapport Attending to Explain the process Explain each step Ensure patient and client at ease flow Involving the animal Explanation and Planning Provide correct type and amount of Shared understanding of patient’s Shared decision making information illness Closing the Session Summarise Forward planning Saying goodbye E X P L A N AT I O N A N D P L A N N I N G Providing the correct amount and type of information Find out the client's current knowledge base. Shared understanding of patient’s illness Give opportunities for clients to ask questions to check understanding. Acknowledge the emotional load of information: “I realise this is a lot to take in. Would you like a minute to process this information, or is there anything you want to ask me?” Shared decision making Clients need to be able to make an informed decision for their pet’s treatment. Client should contribute their thoughts, ideas, suggestions and preferences. Give choices, not directives. CLOSING THE SESSION Summarise Check client understands agreed plan “Would you mind repeating our plan back to me so I can check we’ve covered everything?” Check client is happy with outcome from consultation “Have I missed anything?” Forward planning When do we want to see the patient again? “Buster seems in great health today, so unless you have any concerns, we will see him back in 6 months for his next health check.” What to do if agreed plan is not working “If Fluffy seems to be getting worse before your next appointment, please call so we can get her seen earlier.” Saying goodbye Lead client to consult room door or take to reception to collect medications or book next appointment. “I’ll see you again in one week but please do contact us sooner if you are worried. If you are happy waiting at the reception desk, one of our team will be out with Fluffy’s medications shortly.” “ M I S S Y ” – G I V I N G I N F O R M AT I O N A N D CLOSING How will discuss the neutering procedure with Mr. Green? How will you ensure shared decision making? How can ensure Mr. Green has understood this information? How will you close this session? FURTHER READING: BVA: The Most Common Complaint Triggers in Veterinary Practices (and How to Avoid Them) Crowe, C. and Oxtoby, T. (2019), Strengthening the vet-farmer relationship. In Practice, 41: 275- 277. https://doi-org.surrey.idm.oclc.org/10.1136/inp.l4231 Gray, C, & Moffett, J (eds) 2010, Handbook of Veterinary Communication Skills, John Wiley & Sons, Incorporated, Hoboken. Englar, RE 2020, A Guide to Oral Communication in Veterinary Medicine, 5m Publishing, Portland.