1 Communication styles
Background
Paternalistic style
Historically paternalism was the most used communication style in medicine. In a paternalistic approach, one individual (for our purposes, the doctor) dominates the medical encounter. They collect information, form a plan, and tell the client what should be done. This approach focuses heavily on the knowledge, perceptions, and decisions of the provider/veterinarian/doctor. Whether intentional or not, paternalistic communication may emphasize behaviors that display the physician’s power, status, authority, and professional distance (Shaw et al., 2004). Patient satisfaction has been negatively associated with these behaviors.
Unfortunately, this approach does not leave room for input or collaboration from the client. This style can further ostracize people and lead to feeling brushed off, unconsidered, and undervalued. Imagine a veterinarian working up a patient and being told by another veterinarian to do it differently. Whether the suggestion was helpful or not, approaching a problem in a paternalistic way leaves little room for collaboration and understanding. Remember there are reasons O/A clients farm as they do, and they know those reasons better than the veterinarian. A paternalistic style is unlikely to result in a strong working relationship with O/A clients as it creates separation and negative feelings between clients and veterinarians.
The following scenario will be used throughout the rest of the chapter to describe, show, and highlight key factors in communication styles and techniques:
Scenario – Part 1
Farmer Jane is an organic dairy sheep farmer with 100 milking ewes, two mature rams, 220 yearlings, and five ram-lambs. She does not routinely vaccinate her herd and emphasized that her practice of optimizing animal health focuses on managed rotational grazing, good genetics, and stress-free handling. Her farm recently experienced a few late term abortions. You sent samples to a diagnostic lab that came back positive for Campylobacter fetus (vibriosis). Your plan for this herd would include disease prevention changes (separation, quarantine, isolation, removal, and proper disposal of affected tissues, cleaning and disinfecting, etc.) and starting a vaccination schedule. You know that Campylobacter fetus is a zoonotic disease and will also discuss zoonotic disease transmission and that she should talk to her doctor for more information regarding her health and Campylobacter spp. Communicating this in a paternalistic way could sound like this:
Jane, your sheep have been diagnosed with vibrio, a disease that can cause abortions, stillbirths, and weak kids, and more. To fix this, you need to separate the sick animals, remove all tissues, clean the areas thoroughly, and vaccinate the flock. Vibrio is a zoonotic disease, so talk to your doctor too.
Oh, that’s a lot to take in. Was there something I did that caused this?Well, this disease can be routinely vaccinated for and is strongly recommended. Our office has the vaccine and can supply it for you.Okay. Are you saying my animals must have this vaccine?Yes. Vaccinating sheep for vibrio is a common practice.Okay. And I can’t let my ewes eat their placenta? That seems unnatural.Their placenta could spread disease; it must be removed and disposed of properly.This is a simplified scenario – but take a minute to think about the following questions:
- How do you think Jane will respond to the recommendations?
- Are you missing out on an opportunity to learn more about Jane and her farm?
- Could more information improve the outcomes for everyone, including the animals in this situation?
- Think about the goals for this conversation and farm. Is this an effective way to communicate them?
- Do you think Farmer Jane feels considered?
The veterinarian may give medically correct information, but by approaching the conversation in a paternalistic way, the veterinarian did not provide an opportunity or comfortable conversational environment for Jane to express her feelings or concerns. In this situation, does the veterinarian understand Jane’s reasons for vaccine non-use or concerns about the placenta? Losing that interaction and collaboration can negatively affect Jane’s likelihood of following the vet’s recommendation and thus negatively affect the animals involved. In addition, Jane may not feel this veterinarian can help her or her livestock.
Relationship-centered style
Relationship-centered communication has become the more predominant and preferred method of communication by clients and veterinarians in recent years. This communication style focuses on animal care being a joint venture between the veterinarian and the client. Decisions are made by combining biomedical knowledge from the veterinarian with the lifestyle and social factors of the client.
This approach can help create lasting working relationships with O/A clients. O/A clients often indicate veterinary collaboration and communication as a factor of major importance in their decision to work with a veterinarian ((Steneroden, 2021).). Moreover, they request a desire for their veterinarians to respect the knowledge of O/A farmers regarding O/A practices and treatments.
Scenario – Part 2
Now let’s revisit the Farmer Jane scenario
A relationship-centered approach to the previously described scenario would consider not just vibrio’s medical facts and requirements on a sheep farm but would also seek to incorporate some of the “why’s” and “how’s” involved in managing animal care. For example, why does Farmer Jane specifically ask about the placenta? Or what are the reasons Farmer Jane does not routinely vaccinate? Some issues are more complex than can be explained in this chapter, but but veterinarians can’t be sure of the underlying concerns unless they ask when it comes to client decisions. They cannot assume their motives or reasons. Communication in a relationship-centered approach with Farmer Jane might sound like this:
Jane, your sheep have been diagnosed with vibrio. Vibrio is a disease that can cause abortions, stillbirths, and weak kids, among other things. Some things to fix this may include separating the sick animals, removing all tissues, cleaning the areas thoroughly, and vaccinating your herd. In addition, vibrio is a disease that humans can get from animals or handling animal tissues that have vibrio. Some of the items I described can help prevent you from getting the disease. However, you should also speak with your doctor for more information on vibrio in humans.Oh, that’s a lot to take in. Was there something I did that caused this?Vibrio is a contagious disease that can come from a few sources, and we can look into what may have been the initial source on your farm. Routine vaccination helps lessen and control diseases like this. Can you share your thoughts on vaccinating your sheep and your past decisions to vaccinate or not?
Okay, looking into that would be helpful. I feel awful my animals are sick. I don’t have a strong stance on vaccinating, I just live so far out here, and I’ve never had this problem before, so I figured I didn’t need to.No one wants their animals to be sick, and I hear your concern. We will do our best to get them healthy again. And I understand you do live a way out and being separate from other herds certainly helps keep diseases out. Unfortunately, there are still opportunities for disease to enter a farm, such as through interactions with wildlife, or they can be brought onto a farm on clothing or equipment. We can discuss more options to decrease these chances, but some are out of our control or nearly impossible to control. That is one of the reasons why I find vaccines can help prevent and control diseases. If vaccinating your sheep is something you want to do, we can create a vaccine plan together that fits your farm.Okay, that makes sense to me. And I can’t let my ewes eat their placenta? That seems unnatural.
Vibrio infects reproductive tissues, so the placenta is likely contaminated and could cause the disease to spread if they or other animals come into contact with it. To prevent more animals from getting sick, placentas should be removed and disposed of them properly. However, may I ask why you think removing the placenta is unnatural?
Well, I don’t want any more of my animals getting sick, but the placenta has so many nutrients, and I don’t want to deprive my animals of receiving those. Besides, that is natural for them to do after giving birth. So, I feel like that would be cruel or unnatural to interfere with.
Thank you for sharing that. I hear your worry about being unnatural. I don’t want to tell you to do anything that you feel would be cruel, unnatural, or not right, but I want to work with you to help get your animals healthy. Unfortunately, these placentas are very likely to cause other animals to get sick. Let’s continue thinking through some options that are less risky but just as rewarding.
Take a minute to re-think the following questions
- How do you think Jane will respond to the recommendations?
- Did the veterinarian learn more about Jane and her farm in this situation?
- Could more information improve the outcomes for everyone, including the animals in this situation?
- Think about your goals for this conversation and farm. Is this an effective way to communicate them?
- Do you think Farmer Jane feels more considered and included in this approach?
The veterinarian is still medically correct in this second version of the scenario. However, approaching the conversation in a relationship-centered way prompted Jane to express her feelings and concerns more. In this situation, the veterinarian took the time to learn why Jane was not vaccinating her flock and her concerns about the placenta. As a result, the veterinarian may work with Jane to make some changes to improve her animals’ health. This style helps provide client empowerment, which can positively affect Jane’s likelihood to follow the vet’s recommendation and thus positively affect the animal’s involvement. In addition, Jane may be more likely to feel that this veterinarian can help her and her farm. Using a relationship-centered style is not about coercion, manipulation, or persuasion – but about working together – the goal might be a change of perspective for both the client and veterinarian, not a change of values.
Relationship-centered communication encourages collaboration and fosters a group approach toward resolving issues. Moreover, collaborative communication has been associated with positively changed client knowledge and initial beliefs about medications, client satisfaction with medication, and client use of prescribed/recommended medications (SHAW). This style is important and useful for working with O/A clients or groups with various beliefs or goals to improve understanding and increase satisfaction for all parties involved. It is more likely to result in positive change and positive feelings associated with the interaction. There is no one-size-fits-all, and no one should expect the veterinarian to have all the answers. However, it is in the veterinarian’s best interest to work with all differences in opinions and beliefs. Clients learn from veterinarians, and veterinarians learn from clients. A team approach through relationship-centered communication fosters using the knowledge and skills of both parties. Staying open-minded in this process is good for personal and professional development and business, as this can be attractive to new clients and helpful in maintaining a good reputation.
Situational needs for different styles
There is no one-size fits all style that applies to every conversation. Effective communication depends on situational needs and should be considerate of social factors and influences. Extenuating circumstances may influence which communication style is most effective in each situation.
Relationship-centered communication is the preferred communication style for veterinarian-client interactions. Under some circumstances, such as natural disasters, foreign animal diseases, animal health emergencies, or urgent animal welfare situations, time may not allow for the usual back-and-forth conversations of relationship-centered communication, and more direct action may be necessary.
Brief descriptions of risk communication and conflict resolution follow. Specific communication practices under emergency/disaster situations are beyond the scope of this article. However, engaging and working with those involved is part of the process, even in high-risk emergencies.
Risk communication
Risk analysis is an assessment process that identifies the potential for adverse events and is used by businesses, universities, governments, etc., to prepare for adverse events. Risk communication, an element of risk analysis, is an interactive process where risk information is openly exchanged with the involved parties and includes an explanation of risk findings and decisions. Risk communication is an open, two-way exchange of information and opinion about the risk, leading to better understanding of all involved. Good risk communication builds support and empowers those involved to make informed decisions about the risk they are facing. For a risk communicator, the goal is to translate the information into understandable language and tailor it to the audience; self-efficacy is fostered by giving those at-risk appropriate actions to lessen the risk. Best risk communication practices include assessing, involving, and listening to the audience.
Suggested risk communication resources for additional reading are located at the following centers:
