Please excuse the expletive, but that’s a real text from a friend. They’re well off, have no kids and their two whippets are their fur-children. For one of them, a bout of acute pancreatitis and a protracted period of anorexia in the aftermath led to the placement of a N-O tube. Their baby recovered and the well-equipped local vet hospital did a great job, but with two exceptions: Continuity of care and making a strong recommendation.
Continuity of care is a challenge in a big hospital and the topic of another blog, but the frustration expressed in the text message is about the type of decision making my friends where expected to participate in. Options galore, but no clear recommendation.
How do you make your therapeutic recommendations?
Dr Knows Best – paternalistic, priestly and telling only what you believe the client needs to know? It’s often denounced but still a common mode, especially for the vulnerable, frail and anyone who tends to do what they’re told.
Dr Informative – the vet is the tech expert and the client is the consumer? It’s a retail relationship where the vet provides the options and the consumer supplies the decisions. It can work beautifully is the choices are clear cut, trade offs straightforward and people have clear preferences. But it drives uncertainty, causes confusion and fuels fears. A really good vet put my friends in this place.
In truth, we want both information but crucially guidance, so a third way emerges:
Dr Interpretive – the vet’s role is to help determine what the client wants by asking, “What is most important to you? What are your worries?” Then, knowing your answers, they tell you about the options and what would most help you achieve your priorities.
Think hard about it and you’ll realize it’s easily encapsulated for most vets when the client asks, “What would you do if it were your pet?”
Emmanuel and Emmanuel explore this in human medicine and note a fourth Deliberative mode too. Each style has the doctor adopt a conceptual role of guardian, technical expert, counselor or friend respectively. Where do you sit and where do you think you should be?
Consulting room theory, such as the Cambridge-Calgary model, always has making a recommendation as a key stage in the consultation. Have you checked the strength and clarity of your recommendations recently? Get in touch and we can help you make sure they stand out.
A pets’ life or a client’s satisfaction with your clinic could depend on it.
 Ezekiel J. Emanuel and Linda L. Emanuel. “Four Models of the Physician-Patient Relationship.” JAMA 267:2221-6, 1992