Introduction

Disease is often conceptualized as a tempo­rary state and recovery as close as a single dose of medication, a round of antibiotics, or a few days of rest. Sometimes the “quick fix” doesn't resolve the issue.

Veterinary medical schools are designed to prepare their graduates for the practice of med­icine. How prepared they are is directly related to how those institutions define that practice. Is it merely the ability to apply diagnostics and treatment protocols, surgical preparedness, and so forth? Or does the practice of veterinary medicine include something more: the ability to define and seek an optimal outcome when there is no quick fix or any fix at all?

Veterinarians need to graduate with the knowledge, experience, and resources clients need and expect to properly handle these situations. Veterinarians must learn and apply other nonmedical skills if they expect their medical knowledge to be put to good use, particularly in situations of chronic disease management. These nonmedical skills include displaying empathy and active listening. So what is the importance of learn­ing these skills and methods that go beyond veterinary medical science? Simply put, these tools are needed when treating patients with chronic diseases.

Empathy, active listening, and other non­medical skills form the solid rock upon which the veterinarian stands when imple­menting medical knowledge to the highest potential allowed by the client. Only by establishing rapport and trust with clients will veterinarians help them expend their financial, emotional, time, and physical resources to make the investment necessary to improve the health, well-being, and qual­ity of life of their pet.

Managing chronic disease brings a great deal of change for both the patient and the family. This change can happen both quickly, in the form of a terminal diagnosis, and/or subtly, in the form of symptomatic changes evolving over a period of time. Establishing this solid trust-based relationship is particu­larly important. Therefore, how a veterinar­ian establishes a relationship with a client, then delivers the news of change, and finally manages the emotions surrounding the change may determine whether medical treatment is facilitated for the well-being of the pet. Because veterinarians have the obli­gation to deliver the best medical care to patients, which hinges almost entirely on the veterinarian-client relationship, they must develop and utilize the skill sets necessary to communicate with, find common ground with, and persuade their clients.

Box 1.1

It would be interesting to investigate how veterinarians may be impacted in situations where the client could not serve as legal proxy.

In veterinary medicine, our clients served as proxy for their pet's wishes in almost every interac­tion they have with a veterinarian. As veterinarians, we have two parties to serve; the owner/ client and the patient. (Shelter medicine is the only exception to this rule, as treatment of animals in a shelter setting rarely include an owner.) In human medicine, the client and the patient are generally one person. Even in pediatric medicine, the parent is the guardian of the child, not the owner of the child. The parent generally has the levity to make decisions, but if that decision is not in the best interests of the child (as reasonably determined in a court of law), then the parent will lose the ability to make decisions for that child. In fact, it took a groundbreaking case in 1984 (In re Guardianship of Barry, 445 So.2d 365 (Fla. 2d DCA 1984)) to determine that a parent can serve as proxy for their dying infant child's wishes, allowing the removal of life support in this case.

And particularly in cases involving chronic disease, we remove “life support” frequently in many different ways. Legally, clients are owners of the patient and our communication and established rapport with that owner is imperative if we are to gain the trust such that our medical knowledge will be put to use for the betterment of the pet and/or the treatment of a disease.

This first chapter will explore how veteri­narians can properly implement techniques to communicate the ideas learned in medical school to the client to improve the treatment and/or supportive care for the betterment of the chronically/terminally ill or aging pet. We will then discuss various specific skills that will aid the veterinarian in setting up the conversation appropriately, ensuring all par­ties are on the same page, learning how to adjust one's communication under certain difficult situations, and, finally, having the conversation about potentially ending a pet's life to mitigate pain and suffering.