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What can veterinarians learn from studies
of physician-patient communication
about veterinarian-client-patient communication?
Jane R. Shaw, DVM; Cindy L. Adams, MSW, PhD; Brenda N. Bonnett, DVM, PhD
There is limited information in the veterinary literature on veterinarian-client-patient communication, and
what is available is predominantly based on expert opinion and anecdotal information, not peer-reviewed scientific studies. In contrast, the human medical communication literature contains a large number of empirical
studies. Thus, a review of research of physician-patient
interactions is a logical starting place to determine what
steps veterinary researchers, educators, and practitioners could take to investigate and address veterinarianclient-patient interactions. The purposes of this report
were to summarize recent advances in human medical
communication research and education, link findings in
human medical communication research to veterinary
medicine, and provide a rationale for development of
communication research and education programs in veterinary medical schools.
T
he importance of communication skills in veterinary medicine is an emerging topic. For instance, 1
of the 6 critical issues identified during focus-group
sessions of the KPMG study1 was that “while the scientific, technical, and clinical skills of the veterinary profession remain high, there is evidence that veterinarians lack management and communication skills necessary for success in private practice.” These are general
findings and may not be reflective of the skills of all
veterinarians. However, many veterinarians participating in that study reported that they did not receive sufficient training in communication skills. When the
researchers asked pet owners to rate the most important factors in choosing a veterinarian, the 2 factors
most commonly listed were that the veterinarian is
kind and gentle and that the veterinarian is respectful
and informative. It is apparent, therefore, that pet owners value the interpersonal skills of their veterinarians
but that many veterinarians perceive that they are lacking these valuable skills.
Over the past decade, veterinarians have witnessed substantial changes in the profession. One of
the major changes is the increasing recognition of
From the Department of Population Medicine, Ontario Veterinary
College, University of Guelph, Guelph, ON, Canada N1G 2W1.
Supported by Novartis Animal Health and the Ontario Veterinary
College Pet Trust Fund.
Address correspondence to Dr. Shaw.
676
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the relationships that people may have with their
companion animals.2 When asked about their relationship with their pets, 85% of pet owners reported
that they viewed their pets as family members.1 In
conjunction with this, there is a growing recognition
that provision of veterinary services in a manner that
acknowledges the human-animal bond will lead to
better outcomes for veterinary practices and their
patients.1 Appreciating the impact of animal companionship on the health and well-being of humans creates a new dimension for veterinarians in public
health. Veterinarians’ responsibilities have expanded
to include the mental health and well-being of their
clients, as well as their clients’ pets.2
In a recent address, Blackwell2 stated that today’s
veterinarians are faced with educated clients armed
with questions and greater expectations. Veterinarians’
responsibilities for addressing questions and providing
client education are increased. In an increasingly litigious society, consumers are not forgiving of unprofessional services.2 Most complaints to regulatory bodies
are related to poor communication and deficient interpersonal skills,3 with breakdowns in communication
being a major cause of client dissatisfaction. In addition, it has been predicted that by the year 2005,
women will become the majority in the veterinary profession,4 and in a recent essay, Rucker5 stated that
women judge job satisfaction by different criteria than
men do, placing greater emphasis on relationships with
employers, staff, and clients. Interpersonal skills are
integral to a positive and adaptive response to these
societal and professional changes.
There is limited information in the veterinary literature on veterinarian-client-patient communication,
and what is available is predominantly based on expert
opinion and anecdotal information, not peer-reviewed
scientific studies. In contrast, the human medical communication literature contains a large number of
empirical studies, and as a result, evidence-based recommendations inform physicians with respect to
physician-patient interactions. Thus, a review of
research on physician-patient interactions is a logical
starting place to determine what steps veterinary
researchers, educators, and practitioners could take to
investigate and address veterinarian-client-patient
interactions.
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The purposes of the present report were to summarize recent advances in human medical communication
research and education, link findings in human medical
communication research to veterinary medicine, and
provide a rationale for development of communication
research and education programs in veterinary medical
schools. The human medical communication literature
was chosen for review because both physicians and veterinarians are health care professionals and service
providers who use their talents and resources to care for
living beings. Physicians and veterinarians share the
common goals of improving patient health, promoting
adherence to medical recommendations, and ensuring
satisfaction with care. In both professions, the success of
the medical encounter is dependent on human-human
interactions and satisfaction is derived from those interactions. Beyond this, the structure and content of the
medical interview are similar in human medical and veterinary medical practice, and the tasks that make up the
clinical interview in human medicine (ie, initiating the
session, gathering information, building the relationship, explaining and planning, and closing the session6)
are also used in veterinary clinical medicine. Finally, the
methods used to evaluate the dialogue between a physician and patient are applicable to evaluating the dialogue between a veterinarian, client, and pet.
Communication Skills
Communication skills are a vital component of
interpersonal interactions. Three broad types of communication skills have been identified: content skills,
process skills, and perceptual skills.6 Content skills are
what doctors communicate—the content of their questions and the information they give. Process skills relate
to how doctors communicate through verbal and nonverbal methods of communication. Verbal communication is composed of what is said and how it is said. It
includes not only word choice but also other verbal
indicators such as voice tone, volume, and pitch and
the pace of speech.7 Nonverbal communication is the
message that is communicated without the use of words
and is conveyed through facial expression, eye contact,
proximity, posture, and gestures.7 Nonverbal communication bridges the gap between what is said and what is
interpreted. Perceptual skills include cognitive skills
(ie, problem solving and critical reasoning) and relationship skills (ie, awareness of others, self-awareness,
and personal attitudes and biases). Content, process,
and perceptual skills all contribute to the overall efficacy of communication.
Interpersonal communication skills are vital clinical tools in general and specialty veterinary medical
practice and for veterinarians working with companion
animals, exotic pets, horses, and food animals.8 Such
skills are not limited to private practitioners and are
essential for veterinarians working in academia, public
health, industry, and government.9 In addition, effective communication is important not only in the veterinarian-client-patient relationship but also when
communicating with staff and colleagues. Finally, communication skills are transferable from the professional environment to community and personal settings
and can be used when interacting with others in volJAVMA, Vol 224, No. 5, March 1, 2004
unteer organizations or dinner clubs or on sports teams
and with spouses, friends, and children.
Measurement of Physician-Patient
Interactions
Measuring physician-patient interactions presents
unique challenges. Researchers have used participant
observation and audiotaping or videotaping to capture
conversations between physicians and patients during
clinical encounters. The difficulty lies in how to evaluate the content, process, and meaning of these conversations.10 Although a large variety of qualitative and
quantitative methods have been developed, many have
not been validated11 and have been used in only a single study. Few publications provide a meaningful rationale for the choice of instrument or indicate the relative advantages and disadvantages of 1 instrument versus another.12 Beyond this, there is a lack of agreement
on basic definitions for communication variables,12 and
the level of detail, description, and number of communication variables measured vary greatly. As a result, it
is difficult to compare differing methodologies.
Determining the Ideal Physician-Patient
Relationship
A gold standard does not exist for assessing physician-patient interactions, nor is there an accepted definition of the ideal physician-patient relationship. In
fact, under different clinical circumstances, different
models may be appropriate and effective.13 In addition,
the choice of communication style should be tailored
to the individual patient.14
In human medical practice, the most common
model for the physician-patient relationship is still
paternalism.15 In this model, the physician dominates
the medical encounter, setting the agenda and goals for
the visit, and the patient’s voice is diminished. The
content of the discussion is predominantly biomedical,
and the physician plays the role of guardian of the
patient and acts in the patient’s best interest.
In contrast, it has been proposed that the optimal
model for physician-patient relationships is relationship-centered care, which reflects a balance between
physician paternalism and patient autonomy.15
Relationship-centered care is characterized as a partnership, in which negotiation and shared decisionmaking are used to take the patient’s perspective into
consideration. The role of the physician is as an advisor or counselor.
In veterinary medicine, relationship-centered care
represents a joint venture between the veterinarian and
client to provide optimal care for the animal. Respect
for the client’s perspective and interests and recognition of the role the animal plays in the life of the client
are incorporated into all aspects of care. In a recent
essay, Rucker5 stated that veterinary medicine is a relationship profession that includes the veterinarianclient-pet relationship, the relationship between the
client and his or her pet, and the relationships between
the veterinarian and his or her staff members. On the
basis of her personal experience, the author5 suggested
that practices that foster relationships can expect to be
more successful, both personally and financially.
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Communication as a Core Clinical Skill
In human medicine, communication is considered a
core clinical skill, alongside knowledge, physical examination, and problem solving.6 Dr. Peter Eyre, then dean
of the Virginia-Maryland Regional College of Veterinary
Medicine, stated that there is a skills gap between the
content of the veterinary school curriculum and the
actual skills required to be a successful veterinarian.16
Likewise, Dr. Lonnie King, then dean of the Michigan
State University College of Veterinary Medicine, emphasized that veterinarians require a skill set that will allow
them to serve the needs of society.17 Such veterinarians
would not only have strong grounding in the traditional
areas of medical knowledge and technical skills but
would also have training in life skills such as interpersonal competence, the ability to work in teams, and selfconfidence. One subgroup of the National Council on
Veterinary Economic Issues, which was established in
response to the KPMG study, is currently studying the
skills, knowledge, aptitudes, and attitudes of successful
veterinarians.18 The consensus of the group members is
that scientific and technical skills alone are not sufficient
for veterinarians to be successful and that business
expertise, interpersonal and communication skills, and
the ability to work well in a team and understand cultural differences and values are important skills.
Practitioners recognize the importance of interpersonal communication. In a survey,19 veterinary alumni
of North Carolina State University stated that communication skills were 1 of the topics that should have
been addressed during their veterinary education but
were not. In addition, communication skills and dealing with clients were listed as the most important skills
for success in veterinary practice.19 Likewise, 1994 and
1995 graduates of Australian veterinary schools, when
asked what criteria they used to select new graduates,
identified interpersonal skills as the main selection criterion.20 Similarly, when alumni enrolled in the
Queensland Veterinary Surgeons board were asked
what skills veterinarians should possess on graduation,
95% of respondents indicated that the most important
were communication skills, including the ability to
communicate with clients and gain clients’ confidence.21
Surveys22,23 of fourth-year veterinary students in
the United States indicated that veterinary students
understood the importance of addressing the humananimal bond and the need to provide pet loss support
in interacting with clients. Similar research in Canada
found that students and alumni of the Ontario
Veterinary College would like to receive more training
in human relations.24 Taken together, the results of
these surveys demonstrate that veterinary educators,
practitioners, and students have a strong interest in
incorporating communication skills training into the
veterinary curriculum.
Effects of Physician-Patient
Communication on Quality of Health Care
For 30 years, medical researchers have been studying physician-patient interactions, and a wealth of
information has been gathered on physician-patient
communication and its relationship to important med678
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ical outcomes.10 Effective communication can significantly improve medical outcomes, including patient
health and satisfaction, adherence to medical recommendations, and physician satisfaction.
Patient health—A review25 of 21 studies (10 analytic studies and 11 randomized, controlled trials) concerned with physician-patient communication and
health outcomes concluded that physician-patient
communication has an important and demonstrable
influence on many patient health outcomes, including
emotional health, symptom resolution, functional status, physiologic measures (eg, blood pressure and
blood glucose concentration), and pain control. For
example, in a cohort study26 of patients with a new
complaint of a headache, patients who perceived that
their headache symptoms were fully discussed with
their physician were 3.4 times as likely to experience
resolution of their headaches as were patients who did
not have the opportunity to fully discuss their
headache problems. In randomized, controlled trials27,28
of patients with chronic disease (eg, breast cancer, diabetes, hypertension, or peptic ulcer), patients who
expressed themselves fully, including their feelings and
opinions, had better health and functional status. The
following elements of communication appeared to be
most influential to improving health outcomes: allowing the patient to fully share his or her story, providing
empathy and support, providing clear information,
sharing decision-making, and achieving agreement.29
Although empirical evidence linking communication with patient health outcomes is lacking in veterinary medicine, the authors hypothesize that effective
communication between veterinarians and clients
would also be strongly associated with better patient
health outcomes. Certainly miscommunication could
adversely affect patient care, as proper communication is
needed to ensure correct administration of medications
(eg, route, dose, and frequency), proper home care (eg,
special diets, exercise restrictions, and bandage or
wound care), and appropriate follow-up examinations
(eg, recheck visits and repeated diagnostic testing).
Patient satisfaction—Patient satisfaction has been
the most frequently studied outcome of patient-physician communication.30 A meta-analysis31 of 41 studies
of patient satisfaction identified a number of determinants of patient satisfaction. The strongest predictor of
patient satisfaction was how much information was
provided to the patient, with patients who received
more information being more satisfied. Social climate
was also a major factor in patient satisfaction, with
partnership-building, social conversation, positive
talk, and positive nonverbal behavior associated with
greater satisfaction. A warm and friendly emotional climate was more satisfying. A separate meta-analysis32
investigating patient satisfaction with 11 aspects of
care in 107 studies found that humaneness was ranked
first after overall quality of care, followed by technical
competence. Patients are most satisfied when physicians ask about psychosocial issues (eg, problems of
daily living, social relations, and emotions) and do not
focus solely on biomedical topics, such as the medical
condition or therapeutic regimen.33,34 An affiliative
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style, characterized as a positive relationship between
the physician and patient that includes behaviors
reflective of interest, friendliness, empathy, warmth,
and compassion, has been positively related to patient
satisfaction, whereas a control style, which includes
behaviors that maintain the physician’s power, status,
authority, and professional distance, has been negatively associated with patient satisfaction.14 Finally,
patients of physicians who demonstrate a patient-centered approach are significantly more satisfied.35
Few scientific studies on client satisfaction in veterinary medicine have been published. However, there
is some anecdotal evidence that client dissatisfaction
has a substantial negative impact on practice income.
In particular, it has been suggested that each dissatisfied client tells 26 other people36; therefore, improving
client relations has the potential to increase practice
satisfaction and economic health. Results of a limited
study37 of client expectations in 3 small animal clinics
suggested that clients seek out a veterinarian who provides good medical care for their pets and expresses
concerns for them. Specifically, clients expected veterinarians to treat them with respect, to provide medical
information about their pets, and to listen to what they
had to say. Characteristics of a good veterinarian-client
interaction include respect, courtesy, full disclosure,
true sincerity, listening, and high-tech medicine.38 The
foundation of a sound veterinarian-client-patient relationship is fulfilling the client’s expectations. Patients’
expectations of their physician appear to be similar to
clients’ expectations of their veterinarian.
Adherence to medical recommendations—Medical
recommendations range from prescribing medications
to requesting return for follow-up appointments to suggesting lifestyle changes. In human medicine, it is estimated that the rate of patient noncompliance with treatment plans ranges from 30% to 60%30 and most
researchers agree that only 50% of patients are taking
their medications as prescribed.30 A review29 identified 4
dimensions of physician-patient communication that
are associated with patient compliance: patient education, negotiation, an active role for the patient in the
interaction, and physician expression of empathy and
encouragement. In addition, a separate study31 found
that patients were more likely to be compliant when
their physician offered more information, used more
positive talk and less negative talk, and asked fewer
questions overall. Question asking was inversely related
to information giving, in that the more time physicians
spent asking questions, the less time they spent providing information. A study39 of the patient’s perception of
the emotional versus informational components of care
on the patient’s compliance decisions found that the
informational component was more influential. Finally,
a study40 of patients for which a new antidepressant
medication was prescribed found that use of a collaborative communication style by the physician positively
changed client knowledge and initial beliefs about the
medication, client satisfaction with the medication, and
client medication use.
Studies41,42 involving owner compliance in veterinary medicine have investigated short-term use of
JAVMA, Vol 224, No. 5, March 1, 2004
antimicrobials and suggested that compliance is a
problem. An important determinant for adherence was
that animal owners felt that the veterinarians spent
enough time during the consultation.41 Other factors
that were suggested to improve client compliance
include establishing 2-way communication and trusting relationships, a compassionate health care team,
collaborative planning of the treatment regimen, provision of specific verbal and written instructions about
medications, and timely encouragement.43
Physician satisfaction—Physician-patient communication has been shown to have a positive impact
on physician satisfaction. A cross-sectional study44 of
the degree of satisfaction of general internists and their
patients identified a positive association between
physician and patient satisfaction, although whether
satisfied patients resulted in satisfied physicians or satisfied physicians produced satisfied patients could not
be determined. In a separate study,45 physicians were
less satisfied with encounters in which they were
responsible for taking the initiative for the encounter,
felt pressured by other medical commitments, or were
on call and had high satisfaction with encounters that
included nonverbal encouragement, compliant
patients, and humor. Four distinct factors that relate to
physician satisfaction include the quality of the physician-patient relationship, the adequacy of data collection during a visit, the appropriate use of time during
the visit, and a nondemanding, cooperative patient,
but the physician-patient relationship is the most
important determinant of physician satisfaction.46
Various authors have postulated that the veterinarian-client-patient relationship is important to veterinarian
satisfaction, suggesting that talking to clients contributes
to the pleasure and satisfaction of practice47 and that measures of success and worth in veterinary medicine include
the care provided to clients and patients.48 Veterinarians
derive happiness as a by-product of helping others,48,49 and
30% of alumni of the College of Veterinary Medicine at
North Carolina State University responding to a survey on
satisfying aspects of veterinary medicine stated that working with clients and building relationships were the most
satisfying aspects of being a veterinarian.19
Problems with Communication
in Human and Veterinary Medicine
A cross-sectional study50 assessing the physician’s
knowledge of patients’ problems during a clinical
encounter reported that physicians did not elicit 54%
of patient complaints and 45% of patient concerns.
Similarly, a cross-sectional study51 of physician-patient
agreement on the problem list found that the physician
and patient did not agree on the main presenting problem after 50% of visits. A separate study52 found that
during 69% of visits, the physician interrupted the
patient’s opening statement, and as a result, the patient
failed to disclose all of his or her concerns. When the
latter study was repeated,53 similar results were found,
in that physicians solicited the patients’ complete set of
reasons for the visit in only 28% of visits and physicians interrupted patients within 23 seconds of the
beginning of the clinical interview. In 65% of visits,
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doctors underestimate their patient’s desire for information and overestimate the amount of time they
spend informing their patients.54
Similar studies of veterinarian-client communication have not been performed; however, communication is a challenging issue for veterinarians.1 Client
relations and noncompliance are considered some of
the biggest professional problems facing practitioners,19 and an association between interpersonal communication and faltering practice incomes in veterinary medicine has been proposed.55 A cross-sectional
study55 of the business behaviors of small animal practitioners reported that many veterinarians are not earning up to their potential and suggested that a limiting
behavior was the failure to use management practices
proven to improve business performance. The 3 management practices that demonstrated the largest potential to increase income were related to employee
longevity, employee satisfaction, and client satisfaction. A primary component of these practices involves
staff and client communication.
In the same study,55 self-esteem was identified as
an important personal characteristic related to income
potential. Those veterinarians in the study with the
highest level of self-esteem also earned the most
money. It is unknown whether those veterinarians with
high self-esteem earned larger incomes or veterinarians
with large incomes had greater self-esteem. Self-esteem
is a complex construct and a reflection of interactions
and relationships with individuals in day-to-day activities. These results suggest that interpersonal interactions play an important role in the personal and financial success of veterinarians.
Various studies have suggested that communication deficiencies are evident during veterinary
school. A survey56 of the deans of the schools and
colleges of veterinary medicine in the United States
and Canada indicated that 63% of deans felt that students did not read, write, or speak as well as they
should. Communication problems that were identified included participation in rounds, laboratory discussions, and classroom discussions; education of
clients; and formal presentations. A survey57 of
Australian employers of new graduates reported that
the area where new graduates needed the most support was interpersonal interactions, especially in difficult situations. Specific areas where new graduates
were lacking necessary skills included working in a
team environment, communicating with clients and
employers, listening to clients’ needs, and taking
responsibility when communication became a problem. A survey58 of California veterinarians suggested
that communication skills related to building and
maintaining relationships with clients was a major
deficiency of graduates; problems that were identified included difficulties with providing compassionate, courteous, and effective communication with
clients; showing respect for clients; understanding
the relationship between communication and successful functioning of a veterinarian; and establishing rapport with clients, colleagues, and staff.
Two studies59,60 indicated that difficult situations,
such as discussing finances, dealing with a confronta680
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tional client, or supporting a client through the death
of their pet, were more demanding of veterinarians’
interpersonal skills. Australian graduates reported that
their most common deficiency was communicating
with employers and clients, especially under difficult
conditions.59 Students and graduates of Ontario
Veterinary College felt that they did not receive adequate instruction in professional skills.60 In particular,
participants did not feel competent delivering bad
news, discussing euthanasia, interacting with demanding clients, and delivering quality care under time and
financial constraints.
Malpractice—Patient complaints in human medicine are usually a result of communication problems
and not related to technical competency or quality-ofcare issues,61 and a breakdown in communication and
resultant patient dissatisfaction is the most common
reason underlying a complaint or malpractice claim.29
A study62 of physicians against which claims were filed,
compared with physicians against which claims were
not filed, found that physicians against which claims
were not filed conducted longer visits, used more orientating statements (ie, statements that guide patients
in terms of what to expect) and facilitating statements
(ie, statements that encourage patients to talk and
share their opinions), and expressed humor during visits. In-depth interviews with obstetrical patients
revealed that physicians with prior malpractice claims
were more likely to be perceived by patients as hurried,
uninterested, and unwilling to listen and answer questions than were physicians without prior claims.63
Patients of physicians with prior claims were less satisfied and offered twice as many complaints as did
patients of physicians with no prior claims.
A review29 found that the most frequently identified communication problems were inadequate explanation of the diagnosis or treatment plan and a feeling
by the patient that he or she was ignored. Qualitative
analysis of plaintiff depositions found that problems
related to the physician-patient relationship were identified in 71% of malpractice claims.64 The 4 common
communication problems that were identified included
deserting the patient, devaluing the patient’s or family’s
views, poor information delivery, and failing to understand the patient’s or family’s perspective. Thus, malpractice suits often arise from patients who feel uncared for or inadequately informed.
Published information on malpractice claims in
veterinary medicine is difficult to find; however, 1
study65 indicated that 80% of claims contained an element of communication breakdown. Simple frequency data obtained from the College of Veterinarians of
Ontario indicated that at least 50% of client complaints between 1999 and 2001 resulted from a communication issue.a Some of the concerns expressed
by clients included failure to provide appropriate
information, a disrespectful approach to the client,
and a lack of communication with staff or other veterinarians. Various educators have suggested that
avoiding malpractice complaints is a major reason
for communication skills training in veterinary medicine.65,66
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Teaching Communication Skills
Measuring changes in behavior resulting from a
communication skills training program has its own
unique challenges. Nevertheless, there is evidence that
communication skills can be taught and that communication skills training can lead to improvements in communication skills. For instance, a review67 of 15 intervention studies reported that physicians could learn
communication skills. An example is a randomized
clinical trial68 investigating the effect of communication
skills training on patients’ emotional distress found that
physicians who went through emotion-handling skills
and problem-defining skills training courses used more
of these specific skills than did the control physicians.
In addition, trained physicians recognized more psychosocial problems in their patients and used more
strategies to manage emotional problems, and patients
of trained physicians, compared with untrained physicians, showed a greater reduction in emotional distress.
Fourth-year medical students who served as standardized patients for examination by first- and second-year
students consistently demonstrated superior scores in
clinical examination when their own communication
skills were tested, compared with their inexperienced
peers.69 Physicians who attended a course on patientcentered interviewing asked more open-ended questions, more frequently asked for patient opinions, and
gave more biomedical information.70
Studies of the effects of communication skills
training in veterinary medicine have been less common. Nevertheless, in 1 study,71 measurements of cognitive knowledge of interpersonal skills were significantly improved after students took an 8-week course
on client relations and communication skills.
Communication is a series of skills that can be learned
through appropriate training.
Methods for Teaching Communication
Skills
In 1995, the Liaison Committee on Medical
Education, which accredits medical schools in the
United States and Canada, stated that communication
is integral to the education and effective function of
physicians and that medical schools must provide specific instruction in these skills.72 In the past decade, the
amount of time dedicated to teaching communication
skills in medical schools has increased substantially.
Some of the challenges that remain are a lack of trained
faculty and clinical role models, a lack of funding,
problems with coordinating the teaching of communication skills throughout all the years of training, and
making room in a curriculum that is already too
crowded.72 Research efforts in medical communication
have focused on the development of communication
curricula, teaching methods, and assessment techniques.73
Surveys of communication skills training programs
in medical schools describe great variability among
schools. Medical educators state that experiential learning techniques have been favored over traditional didactic lectures,73 and the use of small groups and videotaped
or live patients or role-playing actors, together with
observation and constructive feedback, has been shown
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to be far more successful than didactic teaching in terms
of skill performance. Teaching methods include self- and
peer assessment, provision of descriptive and nonjudgmental positive feedback and constructively phrased
negative feedback, offering suggestions for alternative
phrasing and behavior, and participant practice. The
educational method should be based on the expected
outcome. For instance, if the objective is to improve
communication skills in a clinical interview, the training
program should involve repeated practice with guidance
and feedback in the professional context (ie, the examination room).67 This repetitive process reinforces learning efforts and builds skills over time. Communication
skills are best taught by providing safe and supportive
opportunities to practice.73
In the past 15 years, 2 influential studies1,74 of the
veterinary profession highlighted the need for communication skills training in the veterinary curriculum.
The Pew National Veterinary Education Program initially called for training in communication skills in
1988.74 In 1999, the KPMG study1 emphasized the need
for interpersonal skills training in the veterinary profession. Client relations and communication skills
training varies among the schools and colleges of veterinary medicine, although some schools were teaching communication skills as early as the 1970s.75,76
Other schools have only recently developed and
applied communication skills training in their veterinary curricula,77 although most schools and colleges of
veterinary medicine have now incorporated interpersonal and communication skills into their curricula. In
1996, the Ontario Veterinary College identified interpersonal communication skills as 1 of the 7 general
competencies required of veterinarians,78 and in 2001,
the University of California School of Veterinary
Medicine, in a comprehensive listing of the attributes
expected of its graduates, included scientific, technical,
and life skills, stating that veterinarians must be compassionate, altruistic, dutiful, knowledgeable, and
skillful.79 Effective and empathetic communication was
included within the professional life theme in a list of
attributes of Australian veterinary graduates.80
Communication has been included as a component of veterinary practice management curricula.81,82
The North Carolina State University College of
Veterinary Medicine offers a career and life program
workshop on life skills that includes information on
self-awareness, managing change, communication,
teamwork, problem solving, and making informed
judgments in the face of risk and ambiguity.83
Communication is included in the professional practice program at the Faculty of Veterinary Science at the
University of Sydney.84
A recent seminar indicated that for communication
skills training programs in the veterinary medical
schools and colleges to be successful, there was a need
to identify a cohort of trained individuals who could
run the program, to set aside the necessary time in the
curriculum, and to locate adequate funding.65 In addition, the educational team should be multi-disciplinary,
including researchers to describe veterinarian-clientpatient interactions and evaluate and monitor the efficacy of the communication skills training programs.
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Future Directions
Results of cross-sectional studies of veterinary
educators, practitioners, and students reflect the
importance of communication skills in veterinary medicine, identifying deficiencies in communication abilities and training, and emphasizing the need for communication skills training. Research in medical communication provides a solid foundation on which to
build an educational and research program for veterinary medical communication. However, for any such
program to be effective, it must incorporate methods
for evaluating the program and determining whether
the program is adequately preparing veterinarians for
practice.
Human and veterinary medicine share much in
common, allowing extrapolation of medical communication research to veterinary medicine. However,
there are several contextual differences that deserve
special attention and are rich areas for future
research. One large difference is that veterinarians
care for nonhuman patients. As a result, it is possible
that veterinary medicine attracts individuals with
different characteristics than does human medicine.
Another unique aspect of veterinary medicine is the
human-animal bond. The veterinarian-client-patient
relationship has been likened to the pediatrician-parent-child relationship; however, the client-pet relationship differs from the parent-child relationship.
As more and more clients consider their pets to be
members of the family, there may be more similarities
than differences. Importantly, euthanasia is an
accepted medical practice in veterinary medicine,
and special communication and support skills are
required when discussing an emotional issue such as
euthanasia with clients.85 The death of patients is a
substantial cause of stress for veterinarians,86 and it
has been estimated that veterinarians experience the
death of a patient 5 times as often as do their medical
counterparts. Finally, financial issues play a role in
the clients’ ability to afford veterinary care for their
pets, and a lack of finances can necessitate euthanasia of a pet for economic reasons.
Conclusions
For 30 years, medical researchers have been studying physician-patient interactions, and the results of
these studies have yielded 4 basic conclusions: physician-patient interactions have an impact on patient
health, patient satisfaction, adherence to medical recommendations, and physician satisfaction25; there are
major deficiencies in communication between physicians and patients29; communication is a core clinical
skill and an essential component of clinical competence87; and appropriate training programs can significantly change students’ communication knowledge,
skills, and attitudes. As a result, communication skills
training is incorporated into medical school curricula,
and interpersonal skills are assessed throughout training and in licensing examinations.
Research on veterinarian-client-patient communication is lacking in veterinary medicine despite the fact
that the trust and rapport that result from a healthy
veterinarian-client-patient relationship have the poten682
Vet Med Today: Reference Point
tial to motivate clients to make appointments, show up
on time, consent to treatment, follow recommendations, pay their bills on time, and refer other people.88
Good communication improves staff relations, results
in a smoother-running practice, promotes an environment conducive to best practice, decreases conflict,
increases motivation, and reduces staff turnover.89 The
end result is personal and professional success resulting from healthy long-term veterinarian-client-patient
relationships, veterinarian-staff relationships, and veterinarian-veterinarian relationships. It is clear that a
focus on interpersonal interactions in veterinary medicine is essential to the ongoing evolution of the profession.
Addendum
Since the submission of this paper, 2 publications90,91 have been released that make important contributions to the field of veterinarian-client-patient
communication. The first is the personnel decisions
study,90 which identified non-technical competencies
for career success, including interpersonal competence, work and life balance, effective communication,
leadership skills, and business acumen. The second91
was the American Animal Hospital Association compliance study,91 which investigated compliance with 6
basic healthcare recommendations: heartworm testing,
heartworm preventative, dental prophylaxis, therapeutic diets, pre-anesthetic screening, and core vaccines.
Non-compliance ranged from 17% to 82%, and 1 of the
primary reasons for non-compliance was not making a
recommendation owing to inadequate communication.
a
Robinson R, Co-coordinator for Complaints, Discipline, and the
Deputy Registrar’s Office, College of Veterinarians of Ontario:
Personal communication, 2002.
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