Hesteeierkommunikasjon med Annelies Decloedt, episode 1: teorier, verktøy og virkelige eksempler

00:00:13: Hello and welcome to Hest Veterinärna or Hester Deleggene.

00:00:17: Today we are diving into one of the most vital yet often overlooked aspects of veterinary medicine, and that is client communication!

00:00:26: Whether it's explaining a diagnosis guiding treatment decisions Or simply offering reassurance The way we communicate with horse owners can make all the difference.

00:00:36: Strong communication builds trust, improves compliance and ultimately leads to better outcomes for both the horses and their humans.

00:00:46: To

00:00:46: help us unpack this topic Louise and I are joined today by a very special guest that is Dr Anneliste Kloet.

00:00:54: She's a veterinarian and researcher at The University of Ghent in Belgium.

00:00:59: she is a specialist in equine internal medicine with a focus on equine cardiology where she has also done lots of research.

00:01:07: But she also has a deep interest in client communication and has been doing a lot of research around that.

00:01:15: Annalies brings both clinical insight, scientific perspective to this conversation – we're thrilled to have her with us!

00:01:22: Welcome Annalis to the podcast!

00:01:25: Yes thank you for inviting me.

00:01:27: I'm very honoured because i looked at previous episodes on the podcast.

00:01:31: then you had a number great speakers so I am happy to be here.

00:01:35: That's good nice to hear.

00:01:38: So can you start by telling us a little bit about yourself?

00:01:42: What's your education and research, what do you do.

00:01:50: I graduated as an Aquine Veterinarian in Gendt University of Belgium And then after that, I immediately started doing PhD.

00:02:00: So research on cardiology in horses because we have a very active cardiology research team and do a lot of cardio-clinical work as well together with Professor Günther Van Loon.

00:02:10: Um...and so i did the phd.

00:02:14: Then did postdoc research about cardiac arrhythmias echocardiography anything cardiac you can think off uh..with a horse actually

00:02:21: um

00:02:22: but then in two thousand fifteen They introduced a new course in the curriculum, which was clinical and communication skills at Ghent University.

00:02:32: And they needed somebody to teach this course so that position was open.

00:02:37: I thought it sounded really interesting.

00:02:38: So its both clinical skill teaching with simulators and models Which i mainly coordinate actually.

00:02:45: Then also communication skills which is something that I was really interested in, didn't know much about it at the time but yeah.

00:02:57: It's been ten years now that i've been doing this and no so now I'm an associate professor at Gantt University teaching their clinical and communication skills.

00:03:05: um...and yeah..it's

00:03:07: something that has intrigued me Always, I think like the psychology that is behind veterinary medicine The fact that we need human behavior to change as well if we want to do something good for the animals.

00:03:21: And so i'm still doing the cardiology research at the moment and still have the cardioclinical work.

00:03:26: But i'm also doing research in veterinarian client communication.

00:03:31: Um

00:03:31: one of our research project Is looking antibiotic use in veterinary medicine.

00:03:38: And we're also using some motivational interviewing and client motivation theories behind that,

00:03:46: to try

00:03:46: do like an intervention in veterary practices or not necessarily reduce but go through more responsible uses of antibiotics.

00:03:55: Interesting.

00:03:57: so you are now doing both cardiology and the clinical communication?

00:04:05: That's an interesting mixture.

00:04:08: Yes, yes it is a lot of variation which was really nice and I also think its enriching to combine both because i do have some client conversations maybe not on the daily basis but still.

00:04:29: So I can use my technical experience as well when teaching communication skills, which is really nice.

00:04:38: Super!

00:04:40: You mentioned term client motivation and for anyone who's listening... don't really know what this is.

00:04:48: Can you explain the term?

00:04:50: Because I know that there's a lot of science and research behind it, so in short... What does it mean?

00:04:57: And why is it important for veterinary practice?

00:05:01: Yes!

00:05:02: So i think it will be difficult to say it in short because there are indeed many different theories.

00:05:09: Well, what I often say to my students is there's a lot of theories on human behavior and behavioral change and motivation.

00:05:19: And as we know in veterinary medicine when you have a certain disease... ...and there are lots potential different treatments.

00:05:24: usually this means that actually none really works very well.

00:05:29: so i think it's similar with behavioural changes.

00:05:32: There're many different theories.

00:05:34: they all

00:05:34: are

00:05:35: very valuable.

00:05:37: but

00:05:37: It's not that we can explain human behavior with just one simple theory, but I do like all the theories behind it.

00:05:48: And if i have to pick one that really explains what is client motivation?

00:05:57: For example, the self-determination theory which explains why people have intrinsic motivations because there are a whole continue of motivation or why you do a certain behavior, like it can be just controlled.

00:06:11: or extrinsic motivation because somebody tells you to keep sticking to the speed limit.

00:06:25: But then there's also intrinsic motivation, for example if you come home with your baby from the hospital You're probably gonna drive really slowly because very careful and highly motivated To be very careful.

00:06:39: And so when we look at client motivations ideally I think that we want our clients have this intrinsic motivation situation and they're just highly motivated to do whatever you told them too.

00:06:59: And the self-determination theory actually explains what makes people intrinsically motivated, so why being controlled by someone.

00:07:15: And it also really works well with colleagues, by the way.

00:07:18: so for people listening and who have to work with a team... So there's actually three components of this theory because its very simple.

00:07:27: I always remember ABC.

00:07:30: The ABC is autonomy, belonging

00:07:34: and

00:07:35: competence.

00:07:37: Autonomy feels that you're in charge Your client or your team member feels that they have something to say, and can also decide.

00:07:49: There is a choice there not being forced to do anything.

00:07:52: And

00:07:53: then belonging.

00:07:54: So the B it's actually more relatedness if you look at a correct term in the theory, which is that there's connection with person who tells you to do something.

00:08:07: So a connection with veterinarian feeling understood and respected.

00:08:12: And then the sea competence.

00:08:14: it also really important.

00:08:16: people have feel they are capable of doing what we want them to Do

00:08:21: because

00:08:22: if don't be able to do it They might say yes but they already think, oh this is going to be impossible.

00:08:32: So I think the theory really nicely explains what's important for people to feel motivated.

00:08:38: and then of course there are a lot theories that will explain how you get people as far as becoming motivated or something.

00:08:50: so many different theories but all

00:08:54: very

00:08:56: practically applicable.

00:08:58: So your aim then as a vet who is consulting with an owner.

00:09:03: you are You realize that you have to get this honor too.

00:09:09: To follow your advice basically.

00:09:12: Then the idealist that you would try and two get this person Intrinsically motivated, it's at the point Yes so not to enforce anything but they feel like want to do That you're trying to ask them

00:09:32: Yes, well that would be.

00:09:33: mainly if you want

00:09:34: really

00:09:35: more long-term behavior change and that's gonna Be more important because

00:09:40: it

00:09:40: really depends on the situation of course.

00:09:44: but If you want really long-term behavior change and people have to change the way they've been doing things, like feeding their horse exercising.

00:09:53: Then this is gonna be more important.

00:09:55: if it's about short term

00:09:57: you know

00:09:58: You have to give this medication for a week then probably your just not forcing them but Your authority as a veterinarian will be enough.

00:10:08: But If you want behavioral changes its going to be difficult.

00:10:15: What are some of the most common reasons that horse owners in particular struggle with these lifestyle changes?

00:10:24: Because as you say, it's probably more challenging for you as a vet to make people do more persistent management changes or lifestyle changes.

00:10:37: And we're going back different techniques when they come into reasons why you would want to have an owner, but what do you think is the most common reason some horse owners really struggle with a strict diet?

00:11:00: Why it's difficult for them.

00:11:05: I think there are lots of potential reasons they struggle in making change.

00:11:11: On the one hand, changing is just very difficult for people.

00:11:16: And

00:11:17: there's this funny meme like who wants change?

00:11:20: Everybody wants to be changed but nobody wants to BE changed!

00:11:23: So...

00:11:26: There's a difference in deciding yourself or somebody telling you that you have to change.

00:11:31: Actually, nobody really likes that.

00:11:33: And people

00:11:34: usually love to stick to their habits and so making changes is just a difficult thing.

00:11:42: Then if you think of the reasons or potential different reasons I'm gonna drag in another theoretical model here which is like this stages-of change model

00:11:57: Which

00:11:57: states to go through different stages before you actually make the change.

00:12:03: And so at each stage, there's different things holding your back.

00:12:07: So this model starts with a pre-contemplation phase they call it where people don't consider change because they are not aware that there is problem.

00:12:18: for example and I know we have the podcast about obesity which i think So, you know the people that say oh but my horse is just big boned or he's always been a bit chubby.

00:12:33: They're still in their pre-contemplation stage where actually they don't see problems so there are no need to change and thats why they might not make this change of course.

00:12:45: Then on second problem theres like the contemplation phase

00:12:49: Where

00:12:49: people do see the problem But they aren't really taking action yet because probably they either think, you know I might have to do something but i cannot do it.

00:13:02: so the first stage.

00:13:03: there are more like...I don't want to do it.

00:13:05: The second thing as well is going be really hard and that may be practical issues or financial issue depending on situation.

00:13:18: Always easy to change things, especially if you have multiple horses or your.

00:13:22: maybe the horse is at a stable where they cannot make all the decisions.

00:13:26: That's gonna be barriers as well.

00:13:28: And then

00:13:29: you have this the second or third and fourth phase.

00:13:33: It's

00:13:34: like the

00:13:34: preparation and action stages of change.

00:13:38: So then we're getting into those Action phase but then off course.

00:13:42: it might also be hard for people

00:13:45: because

00:13:46: Once they get into action, there might be other hurdles.

00:13:53: They find that their horse is unhappy when making the change or are unhappy because it has to change certain habits.

00:14:01: and then of course... I was already talking about the circle, but because it's... The stages of change model is a circular model often.

00:14:08: Because there also high risk for relapse like when you quit smoking.

00:14:14: Smokers on average have a relapse seven times before they actually quit smoking.

00:14:20: so same thing with making changes

00:14:23: in your

00:14:23: behavior whether its diet or exercise of the horse and housing of the horses.

00:14:28: It easier to go back into old habits to stick to the new habits for a long time before they are your normal, new behavior.

00:14:38: What... Because that's interesting because in lot of cases you can regardless if it is your own lifestyle or management of an animal You sometimes see motivation initially as really high and try to put a lot of effort into it to make it succeed and then after while as you say, you fall back in your old habits.

00:15:06: Why is that?

00:15:07: What's happening there?

00:15:08: so people are losing the motivation?

00:15:14: Yeah

00:15:15: I think also... And thats why they're all so many theoretical models about behavior,

00:15:20: because

00:15:21: at first I thought you know behavior is rational

00:15:24: and

00:15:26: it's not.

00:15:29: So that's one of the main... there are a lot of emotions coming in also subconscious things.

00:15:36: so if You really have to choose and when you're trying create new habits, rationally they make that decision every day for quite a long period.

00:15:47: Sometimes I say we need at least six months before it's your normal behavior because subconsciously we are also biased towards doing what just following our own habits.

00:16:04: And that's why some of the behavior change scientists, they say well maybe we should

00:16:10: need

00:16:11: more notches and then notches are like things you know subconsciously.

00:16:14: your helping yourself to get into this new behavior.

00:16:19: So for example,

00:16:21: if

00:16:21: you want change your own eating habits make sure that the cookies and potato chips they are like somewhere on top of a shelf when you have to take a chair together then the fruit is more close because otherwise it's going be just really hard to adapt to that new behaviour.

00:16:41: And this is just really normal human psychology and it can help also to make people aware of that from the start.

00:16:53: Also, to help them reinforce their new behavior by for example checking in on a regular basis... ...and don't think when they start antigenically the first week then okay now there are off and its gonna

00:17:07: be

00:17:08: ok for rest of your life.

00:17:10: because

00:17:12: Yeah,

00:17:12: a lot of chance or risk of recurrence relapsing into that old behavior.

00:17:18: And that's why they say for example with obesity especially companion animals as well do first checkup within two weeks because then you're in the early stage where it probably started energetically with new behaviour

00:17:34: and

00:17:35: still catch them at point becoming more difficult.

00:17:39: If you wait longer, it's gonna be even harder for the owner to come back and say like yeah I tried but didn't work.

00:17:47: so... You have to make sure that your there pretty early So that you can help them

00:17:53: And

00:17:53: find out what is going wrong.

00:17:57: That a good practical tip as well i think.

00:18:00: Yes.

00:18:01: one specific example of where an owner can struggle with your recommendations.

00:18:09: That stuck to me when actually it was a psychologist that we had over at the faculty for cost of care discussion, and she has her own story where I said well couple years ago The vet came and

00:18:29: then

00:18:30: gave all the recommendations.

00:18:32: I also mentioned that we should definitely test for cushing, if it was cushing not a big deal.

00:18:40: there's medication that can be administered at this point which is so hesitant

00:18:48: of

00:18:49: going on with doing these things for the pony.

00:18:52: And the vet saw my hesitation immediately started about the financial part And she said like, yeah but the financial part was not a problem for me at that point.

00:19:02: I had

00:19:03: my mom recently diagnosed with Alzheimer's

00:19:06: and

00:19:07: who is then moving to hospice.

00:19:10: we had uh...to sell their house where i grew up in clean this house and it just couldn't deal with this sick pony and with you know potential life long treatment of the pony And that was an example stuck with me, because it indeed shows as a vet.

00:19:31: It's really hard to know what is going on in people's lives and there are just so much... ...that can make

00:19:37: them

00:19:38: be fully aware of the problem or wanting for their animal but they don't see how they can do it.

00:19:47: Yeah, I think this situation comes up more than we as veterinarians actually realize in conversations with clients and And the hard part is for us as veterinarian to really know what's going on without our clients.

00:20:03: So do you have any tools?

00:20:05: In your toolbox on how to assess whether the owners are hesitant To the actual plan that you're putting forward Or they're hesitant because of something else that's going on in their lives.

00:20:17: How do you as a veterinarian handle these things and get more information about what is going?

00:20:24: Yeah, I think... The difficulty is a vet to do this and then on the other hand of course, keep it efficient because you

00:20:34: want

00:20:35: your consultation time-efficient.

00:20:36: You don't wanna spend an hour talking with these clients probably about their situation but... It's important that in mind they will be more efficient if you spend little bit longer trying find out client perspective and then hopefully they will be more compliant to your recommendations.

00:20:58: or you can

00:20:59: maybe

00:20:59: also alter your recommendations based on what you know about their situation.

00:21:04: But

00:21:04: it's probably gonna take a little bit of time, first of all build report, build the relationship with the client which might already have but its not because this client quite well that things could have changed in their situation that you are not aware of like I can this example.

00:21:23: So building report, you know spending a little bit time in your consultation just to ask how things Are going?

00:21:29: You know outside of the like them.

00:21:31: Just purely biomedical Situation of the animal is gonna be important.

00:21:36: and then second when see or feel maybe this hesitation, because it might be just a nonverbal science as well.

00:21:45: You might feel that there is some hesitation but you don't know exactly what's going on.

00:21:50: to use open-ended questions really try and figure out What are they doubting about?

00:21:58: And what I usually say, but I don't know if it's the same in Scandinavia or not because this is a bit of language thing.

00:22:05: Is to try and be careful with.

00:22:07: why question?

00:22:12: Why do you want to do that?

00:22:13: Because at least in Dutch there are often Yeah, connotation to it of like

00:22:23: making

00:22:24: people feel guilty or you know.

00:22:25: You have some bias when you ask that.

00:22:28: why question?

00:22:29: Like they're

00:22:30: being questioned.

00:22:32: Yes, yes.

00:22:35: Like

00:22:35: for example an owner that calls you with a sick animal and the animal has been sick for couple of days or even weeks.

00:22:42: maybe why do call me now?

00:22:45: There's little bit judgment in there

00:22:48: And

00:22:48: don't want that judgement because then they're not going to tell what the story and their actual doubts.

00:22:56: So

00:22:57: I usually

00:22:57: recommend to try and phrase a little bit differently, like what's the reason that you are doubting or something like that?

00:23:05: Or maybe even What Are You Thinking About That?

00:23:07: How Do You Feel About That?

00:23:09: Have To Try And Find Of Course The Words That Work For You.

00:23:14: Like

00:23:14: how do you feel about that?

00:23:15: Maybe Some People Are Thinking Now Oh!

00:23:17: I'm Never Gonna Ask That To An Owner.

00:23:23: this coaching

00:23:24: course

00:23:25: as well, a postgraduate course like to be able to guide the students better.

00:23:29: And

00:23:30: at first when there were these questions coming up because that's questions that of course come up a lot in coaching I was like oh no!

00:23:36: That is not for me to ask people how they feel about things but you also grow into it.

00:23:40: so sometimes if you try it works out better than what you think.

00:23:47: So its those kind of question that you want to ask Like open-ended questions what you think, how do you feel about it.

00:23:55: I can see that your doubting is the reason for this and then try to find out what's

00:24:01: at

00:24:01: play there?

00:24:05: A good tip could be used as well if you agree with me instead of asking which concerns we have on our plans because when you enforce people to give you an answer.

00:24:22: They can say, oh I have no concerns but at least do you give them a opportunity?

00:24:25: To...to say that.

00:24:27: okay i actually DO have this and this concern.

00:24:31: sometimes if you ask Do You Have Any?

00:24:33: it's easy to Say No

00:24:35: Yes

00:24:36: But which Concerns do you have?

00:24:38: because everybody almost always has something they think could be hard with the plan that you present them And then you Give Them An Opportunity to Actually Address That when you say, which concerns do you have?

00:24:52: But it's just something that I've thought about once in a while.

00:24:55: That gives me better outcomes sometimes...

00:24:58: Yeah!

00:24:58: I think this is great tip.

00:25:01: and to try make an open-ended question because often we are asking the same thing like with Do You Have Any Questions?

00:25:12: Yeah, it's

00:25:12: probably going to be the answer.

00:25:13: It's probably gonna be no maybe yes but you could also just ask which questions do we have about this?

00:25:21: Just really make it open-ended.

00:25:23: yeah

00:25:24: cool

00:25:25: I think it all makes a lot of sense too.

00:25:29: try to get people understand that they can raise concerns and that they that even if you are under a lot of time pressure, If you make it very obvious then maybe owners will be more hesitant to

00:25:50: come

00:25:51: with their concerns than if they try and mask them.

00:25:55: I can also imagine this is pretty difficult but... your own sort of behavior in that situation, and if you yourself appeared very stressed under a lot of time pressure then it can potentially make the owner more hesitant also to ask whatever concerns they have even though there are lots of concerns.

00:26:22: Yes, definitely.

00:26:24: And I think it can be really in small things.

00:26:26: now of course for an equine vet It's maybe not so easy to do this But

00:26:31: they have.

00:26:31: there is very interesting research and human medicine that shows That when you sit down with the patient instead Of standing up in their room?

00:26:39: Mm-hmm already gives them The impression that you spend a lot more time With

00:26:43: him.

00:26:43: So of course as equine vets are gonna Be hard to just sit Down everywhere but When your out on the field Your non-verbal language can just... trying to show that you have time can actually make them feel, express their concerns much more easily.

00:27:06: And in the end it's going be a more efficient consultation than if you appear stressed and rushed.

00:27:15: then people are not gonna say so much... Actually we did really interesting research about this with My previous PhD student, Pia Keller.

00:27:23: she looked at communication about alternative medicine

00:27:27: specifically

00:27:29: well for horses also for dogs but

00:27:31: and

00:27:32: then she did interviews with horse owners.

00:27:34: And one of the reasons why a horse owner's

00:27:37: often contact

00:27:38: an alternative therapist like an osteopath chiropractor often than veterinarian, for example if their horse is lame or has back problems.

00:27:50: One of the things they mentioned was that a veterinarian doesn't have

00:27:52: time

00:27:54: and it's hard to reach them while alternative therapists can much more easily reach them also through social media.

00:28:03: And we did recordings on consultations between veterinarians And the therapists spent much more time talking about non-biomedical content, like training of a horse and just in general how it is doing.

00:28:18: People feel that there's more time available for them and they're going to express their concerns easily as well.

00:28:28: I think that's been shown in human medicine as well, with different sort of therapists.

00:28:35: The reason why you would go to someone who gives you herbs is not necessarily the herb but it's conversation and caring.

00:28:45: they feel tended too another way.

00:28:51: Yeah, definitely.

00:28:52: But I think as veterinarians we can also include that in the consultation while keeping it efficient.

00:28:58: because

00:29:00: well...

00:29:00: The way we teach communication skills at Gantt University is using Calgary Cambridge model which was used a lot of different faculties and so building rapport.. Building their relationships or what were been talking about right now this very important component.

00:29:14: but other things are structuring the consultations.

00:29:19: If you just really have a clear structure for the consultation yourself and also communicate that to the owner, You can still keep it efficient.

00:29:28: And don't be afraid to clearly communicate the agenda.

00:29:31: or if For example The Owner comes in there's lot of different things they want to discuss...

00:29:37: ...and you already

00:29:37: feel like okay There is not going to enough time for communicating that Just right from start.

00:29:43: being very clear about your structure Like we're gonna able

00:29:47: look at, you know

00:29:48: this problem

00:29:49: and Problem

00:29:50: A and Problem B but we're not going to be able To discuss Problem C today.

00:29:55: But We might Be able to make another Appointment for that For example.

00:30:01: And That's Where The Years that You've Been the Venerian Will Help You Because When You are Young and New?

00:30:09: That'S the Hard Part because You don't Know How Long Things will Take.

00:30:14: so it's obviously just a harder thing to do when you're young, but that's what you learn through the years.

00:30:21: And there is no way that you can really be good at it until you've tried it a couple of times.

00:30:26: so... So having in mind this is helpful.

00:30:30: I guess That practice makes perfect!

00:30:35: The curse on being new and young You know?

00:30:39: When you get older.

00:30:44: If we go back then to the horse owner, because we talked a little bit about the vet now and how they can approach different situations.

00:30:51: But if you look at the horse owners... Would there be any difference in motivation between new and inexperienced horse owners?

00:31:00: And experienced ones when it comes to lifestyle changes or diet or treatment schedules similar?

00:31:12: Yeah, I think it's a really interesting question.

00:31:15: And

00:31:19: we discussed the questions before.

00:31:20: so i went to have a look in the literature as well because there is some research that came out last year from Itzke-Elte and her team at Utrecht University in The Netherlands.

00:31:32: It was more about client satisfaction, actually.

00:31:36: And

00:31:36: a client preferences and they looked at different types of horse owners.

00:31:41: They did see that there wasn't difference but didn't really look new horse owners or experienced ones like professional horse owners.

00:31:49: so you might say well these are definitely the experienced one's.

00:31:52: then also people doing competition compared to not doing competition.

00:31:59: A bit of difference is in the preferences that they had regarding veterinary care, so professional and competitive horizontal owners.

00:32:10: They

00:32:10: more prioritized like financial aspects or cost-of-care was a little important to them although in general for horizontal costs especially when there were surveyed about it with you know at least an important thing.

00:32:23: but... that was a bit more important for the professional ones.

00:32:27: And then also, the professional attitude of their veterinarian is more important than non-competitive horrors owners and nonprofessional ones.

00:32:38: The

00:32:39: quality care was more important as well as interpersonal skills like communication skills.

00:32:45: so there might be some differences.

00:32:50: more experienced horizontal owners.

00:32:51: They probably also have experience with more veterinarians, more therapists and so on because usually especially more experienced homeowners often don't just one veterinarian but they might

00:33:08: even

00:33:08: have a vet that they call for emergencies where they go to therapeutic issues.

00:33:15: But I think the main message is actually, which was also in that paper of Itzaka Elta.

00:33:19: That it's not because there were some differences between groups... ...that you can really extrapolate this to individual horizoners so you cannot say oh!

00:33:28: This a new or inexperienced one?

00:33:33: will just be most worried about the welfare of their animal and my communication skills, then this experienced horse owner is going to care more about costs because it really depends.

00:33:48: even with the professional horse owners, they might have some horses that are you know actually not being used for competition anymore.

00:33:54: Maybe retired horses maybe horses where they have a very strong emotional bond and then the financial aspects will not play their role there.

00:34:02: it's going to be more about really the emotional human animal bonds.

00:34:05: so I think its hard to say this is new horse owner You know, they need a different treatment because it's still going to be very individual differences.

00:34:17: Yeah we're gonna come back to the understanding of different types of horse owners without stereotyping in this second episode.

00:34:31: but you also mentioned that there are more experienced or professional horse owners might have different veterinarians for different purposes.

00:34:42: And another thing that you can sometimes observe is when people aren't really happy with your consultation or the outcome of or your advice for that matter, and they just go to another veterinarian.

00:34:56: To have an other advise or hoping for a treatment plan... What's the good way of approaching these vet hoppers?

00:35:06: That won't stick with their plans but rather having second- or even third opinion from other vets!

00:35:13: And what are you tips there?

00:35:16: How do you motivate them so as stay with you in order to trust the process?

00:35:24: Yeah, so

00:35:27: I

00:35:27: well actually this is something where i have some personal experiences with not as a veterinarian but we had used to have like uh small horse riding school my family couple of years ago and there we also had these you know stable hoppers let's say because You could also put their horse at our stable, and

00:35:50: it made

00:35:51: me very wary of those people that are highly enthusiastic about you when they just come over.

00:35:57: And

00:35:57: very negative about the place or maybe the vet where they have last been.

00:36:04: there's

00:36:05: Yeah,

00:36:06: without stereotyping the owners of course.

00:36:09: But you have some people that are always really enthusiastic about something new and then the old is not good And they're enthusiastic for a couple months or maybe year... ...and find something else which even better.

00:36:26: so I would definitely say be a bit wary of the people that are super enthusiastic about you and negative about other veterinarians, for example those vet shoppers because

00:36:39: Yeah

00:36:40: they might switch again in a couple of months.

00:36:42: And then Be negative about use.

00:36:44: so I'd say first of all being quite neutral About maybe if there are negative about others veterinarian's where they have been.

00:36:51: Because well off course we have to be as veterinarians.

00:36:55: We had I don't think about the word in English, but you know have to be good colleagues of each other.

00:37:03: So that's really important.

00:37:05: That we're not gonna Be negative about other vets as well.

00:37:09: now took get them to motivate him, to trust the process and stay with you.

00:37:14: Again I think building rapport... Building that trust is going be really important.

00:37:19: That they trust you And in general actually horozoners do trust their veterinarian.

00:37:24: Because it may seem also what came out of our research regarding alternative therapies.

00:37:29: It might seems that owners then go an alternative therapist or to another vet, it's because they don't trust you.

00:37:37: But actually in general the owners that we interviewed and surveyed over a thousand five hundred horse owners their trust on veterinarian was really high.

00:37:46: so when we asked them like do you trust your veterinarian?

00:37:50: They think your veterinarians competent...they love their veterinarian.

00:37:56: Over seventy percent of those horse owners that filled in the survey did go to an alternative therapist

00:38:02: Probably

00:38:02: a bit biased there.

00:38:03: That those owners

00:38:05: Were

00:38:05: more likely to fill it in this area, but still.

00:38:08: So it doesn't mean when they go to someone else that they don't trust you.

00:38:14: It's sometimes just because their desperate I really want to do everything.

00:38:19: They just wanna.

00:38:21: They maybe do trust your advice, but they just want to

00:38:24: be

00:38:24: sure you know that there is not something that they missed and Or they don't see immediate improvement.

00:38:30: And then they think well we need to do something else.

00:38:33: So we need go another veterinarian.

00:38:37: I Think for that it's really important to be very transparent about the process and what will happen if You give recommendations also called a safety netting to provide the safety net, like what if things don't go as planned?

00:38:54: So you tell them I'm

00:38:57: gonna maybe

00:38:57: inject this joint and then you have this rehabilitation plan.

00:39:02: But

00:39:03: what if the horse doesn't improve the way that you expected it too?

00:39:08: What should they do then?

00:39:09: And ideally we want him to call us a vet again not just immediately goes somewhere else.

00:39:16: so be very transparent about what could go wrong, and at which point they need to call you or contact.

00:39:26: That's the safety net that you want also give them by the end of your consultation.

00:39:33: just make sure there is an option where things might not go as planned but know when this happens.

00:39:43: Probably a really important tip because most times stuff do go exactly as planned but sometimes they don't and then it's good to have sort of a backup.

00:39:54: Yeah, I think one of the important things is that people might feel like a burden if they continue to re-contact And I think that communication needs to be very, very clear.

00:40:13: That the goal is to have them call you back if things are not going as planned.

00:40:20: so they should never think that their burden just because they approach again with a same problem over and over.

00:40:27: That's how diseases are once in a while.

00:40:30: They reemerge and you know the whole story already as the primary vet, so it is easier for you to pick up where were left than having new vets start all over again.

00:40:42: So yeah

00:40:44: Yeah definitely And I think that something can be reinforced too.

00:40:48: It really important also keep reinforcing the owner throughout a whole process.

00:40:54: And for example, so when they contact you and have this feeling that there might feel like their burden to you just do it to reinforce.

00:41:03: Oh!

00:41:04: It's good that you called me.

00:41:06: That is the best thing I could do Just re-enforce that behaviour So that they can keep contacting in future.

00:41:17: Can you share an example from your practice or real life, where you had a good success in outcome when it comes to communicating of advice and recommendations?

00:41:35: I have an example which is cardiology related.

00:41:41: A couple years ago we had international... rider, it was actually an eventer which the horse came to us and had atrial fibrillation so irregular heart rhythm.

00:41:57: examined the horse and it was an excellent candidate for treatment, for cardioversion to sinus rhythm.

00:42:02: It had international competition in a few months I think.

00:42:07: so we thought you know this is an excellent candidates for just... We prefer electrical cardioversion again because that's something typically do has less side effects.

00:42:17: So we explained all of these through the owner.

00:42:22: we saw that the owner was hesitating, you know asking a few questions about it and not really saying yes.

00:42:29: We go for it because usually owners when they come to us They already made decision

00:42:35: And

00:42:36: once we explain everything just give us the green light.

00:42:41: So this conversation is going on.

00:42:44: so the owner asked some question then thinking about, even maybe I should retire the horse.

00:42:50: The horse was like thirteen or fourteen.

00:42:52: so we were like well no you shouldn't retire the horses it has an excellent prognosis based on our examination.

00:43:00: then he's doubting that competition and explained doping when the horse would not be doping positive.

00:43:10: We're giving a lot of arguments But we were not really getting through until in the end Figured that maybe I should try

00:43:21: my

00:43:22: own.

00:43:22: you know communication skills Classes and actually hot like, you know but I see it.

00:43:27: You're still doubting.

00:43:28: And what is making you doubt about this?

00:43:30: um...and

00:43:32: then the owner said well Actually i have a special bond with his horse because he's first horse who got me to international level.

00:43:43: I mean, i want to make sure that nothing happens to this horse

00:43:46: and

00:43:47: it's a very stressful horse.

00:43:49: And i'm just really afraid because we explained that the horse had to stay in the clinic for five days... ...I am really afraid he is going to get colic when his here cause.. ..he is very stressed at competitions so usually you sleep next to him

00:44:01: You know?

00:44:02: We take care of all these feet everything!

00:44:04: And im afraid thats not gonna be able do this here In The Clinic.

00:44:12: That was something that we didn't expect at all.

00:44:15: I mean, We had felt he was a bit afraid of something so i think we also even explained the risks of general anesthesia and so on but it wasn't really an issue.

00:44:26: I was so afraid that the horse would be collicking

00:44:30: and

00:44:31: really stressed at a clinic.

00:44:32: And then once we knew, we could talk about it... ...and discuss how he can bring his own feed to sleep next to the horse in the clinic.

00:44:42: but

00:44:45: we

00:44:45: couldn't manage him.

00:44:46: He could stay in the neighbourhood!

00:44:49: Then he decided to do treatment and the horse went on and competed successfully.

00:44:55: And so I think that just at one open-ended question really made a big difference.

00:45:00: Before, we did feel the hesitation but were trying to smash him with all of our arguments and interesting pros & cons But it was not what he had.

00:45:16: That's very good example that you come up with, maybe I should try what i teach.

00:45:28: And it's also a good example of where your prejudice or idea is who this person should be according to the stereotype and doesn't fit in at all.

00:45:41: because if he thinks his professional competition writer has these concerns then turns out No.

00:45:49: It wasn't that,

00:45:49: so... And you just think like oh yeah but he probably needs some more details about it because this is what's going to be important for him the competition and those kind of things.

00:46:00: But yes there was not a concern that he had.

00:46:05: I do have another example which really struck with me Which actually has small animal examples

00:46:12: And

00:46:13: I think it was Dr.

00:46:14: Alec German, who is a small animal nutritionist

00:46:18: that

00:46:18: gave... told this example at the conference It's about dietary change and really struck with me because of an

00:46:26: obese

00:46:27: dog where they were following up.

00:46:30: This was very motivated owner you know?

00:46:32: That came to their nutritionists To get like these specific dogs on a diet.

00:46:37: so the motivation was not a problem.

00:46:41: But they

00:46:42: couldn't get the dog to lose weight, and then so asked their owner to really record what she was feeding the dog.

00:46:48: And she was really sticking to the plan except for... The dogs still got his daily cheese.

00:46:55: So of course it's not ideal.

00:47:01: Again same thing They follow up try give other recommendations.

00:47:05: It doesn't work until What's the reason that you are feeding the cheese here?

00:47:13: And then

00:47:13: they always say, well so I stick to his diet.

00:47:27: take some cheese and then I grate the cheese on top of his feet.

00:47:31: And that's for him, he is like standing next to me in a kitchen, super enthusiastic about it!

00:47:38: He knows my food coming up so I love this!

00:47:45: It wouldn't be his feet if I don't put the cheese on top of it.

00:47:50: And then they talk to this woman and found out that its not really about the cheese, right?

00:48:01: making,

00:48:02: getting the food ready for a dog.

00:48:04: And then they talk to her about what she could do and change it into now.

00:48:08: just have this water thing that you can use to water your plants like sprays.

00:48:16: She just sprays some of the water on top of feed.

00:48:19: It has exactly same effect.

00:48:21: The dog knows if he is coming super enthusiastic finishing up this plate for my dog, and the dog is not getting cheese anymore.

00:48:33: So I think that was also a really nice example of how finding out what's... The reason why people do things.

00:48:41: it's important

00:48:44: because just telling her to stop in that case would probably have been efficient.

00:48:50: No, because then she misses that.

00:48:52: You know?

00:48:52: That's the best part of her day!

00:48:54: The dog was so enthusiastic about getting his food and I think a really nice example.

00:49:02: Yes absolutely.

00:49:05: Thank you so much, Annalis for this episode.

00:49:07: In the next one we're going to be talking about horse owners and assumptions that we can make as veterinary professionals.

00:49:16: We've been touching on it a little bit but I'm gonna get too explain in detail how we could better understand different types of horse owners.

00:49:26: So...we are looking forward to that!

00:49:28: But thankyou for now.