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It may sound counterintuitive but being too friendly with clients can lead to all sorts of unforseen problems. By Kathryn Piper*
To begin, let’s restate the obvious: client relationships can be one of the most challenging aspects of our work as vets. As our profession has changed and improved over time, an increasing focus on how best to manage our clients and keep them bonded has been a very welcome development. However, in more recent times I have been surprised to observe the emerging belief that the best way to have good client relationships is by endeavouring to be seen as a friend or member of the family. While usually well-intended, advice to solve client-vet relationship problems by making clients our friends is potentially harmful for both vets and patients, and is ultimately disingenuous to our clients.
It is abundantly clear that good client relationships should be a high priority in our profession, and that building and maintaining such relationships is one of the most challenging aspects of veterinary work. Further, it is an uncomfortable reality that a significant number of problems arise, or are exacerbated, directly as a result of vets’ attitudes and behaviours towards and within their own profession. But despite the fact that many of our client problems are indeed self-inflicted, the notion that these problems will be solved by making a client feel like a member of your family, and you of theirs, is more cause than cure, and completely ignores the real (and inconveniently more complex) reasons why client relationships can become difficult.
Genuinely difficult clients come in all flavours, but in general the origin of most client relationship problems can be boiled down to one or more of three reasons:
1. Unrealistic or unreasonable expectations.
2. No idea (and no desire to find out) about the costs and responsibilities involved in pet ownership.
3. A strong sense of entitlement as to how they should be treated.
Sometimes these issues originate primarily with clients themselves. For example, the idea of pets being a member of the family can evolve into unhealthy over-attachment which then leads to unrealistic expectations. As can seeing pet ownership as a right rather than the luxury and privilege that it is. In more recent years, the rise in popularity of “designer” pets has seen many people acquiring pets after no more thought than what the animal looks like. But all three of these issues can be exacerbated, or even created, by our own behaviour as vets, and developing excessively close relationships with clients may encourage this to happen.
Blurring the lines between client and friend can have unintended negative consequences and can actually create conflict rather than resolve it. We should not be aiming to “nurture the client as a friend”. While that might sound lovely in theory, and is very appealing to clients, it is in fact not in pets’ best interests as it places “how the client feels about me” above animal welfare.
People experiencing strong emotions don’t make good decisions. One way that inappropriately close client-vet relationships can lead to poor welfare outcomes is if vets become over-attached to their clients’ pets. An owner is (rightly) emotional when their pet is unwell or hurt, and it is our job to help them make clear-headed decisions that are both right for them and have the best possible welfare outcome for the pet. However, I have experienced many occasions where a vet has become overly invested in the client and pet and it has clouded their clinical judgement.
This is especially common in settings where a discussion about euthanasia is warranted. If a vet is unable to offer euthanasia as an option because they feel they are ‘giving up’ on a patient, this places unfair pressure on an owner who may think that if their vet has not suggested this option, then it is not an acceptable choice. These sorts of situations lead to avoidable distress for a client—they can feel guilty about ending their pet’s life—and possibly unnecessary suffering for the pet. Just because a vet has personal and emotional ‘distance’ between themselves and a client doesn’t mean that they don’t care. Unfortunately this erroneous assumption is very commonly encountered in practice.
It is at best unhelpful to make clients think that they will not get the best care if their vet is not as emotionally invested in their pet as they are. At worst it can make decent, capable vets feel like they are somehow failing their patients, which is an unnecessary personal burden to place on people in an already emotionally draining profession.
Moreover, being excessively chummy with someone can lead to abuses of trust. If and when problems do arise, it can make them more awkward and difficult to resolve if there is an overly close relationship creating a conflict of interest. Worse, vets can be tempted to engage in risky or inappropriate behaviour in order to avoid doing anything that might upset a client, or to make undesirable personal compromises in order to mitigate or avoid difficult situations. For example, filling a prescription for a client when the patient really needs to be seen, reducing bills or not charging when they should, giving out personal contact details so clients can be in contact 24/7, or leaving hospitalised patients to make home visits. As well as the obvious welfare implications of such behaviour, vets inadvertently put themselves in vulnerable positions with respect to complaints. In this type of situation, all the risk lies with the vet. Even if those risks are small, we should avoid voluntarily taking them on, no matter how good or helpful it makes us feel, as these sort of actions can be difficult to defend in the event of a complaint.
Avoiding potential or actual conflict purely to keep a client happy is a bad habit to get into. It does no-one any favours, least of all the pet.
We all know that communication is the key to creating and sustaining good client relations. To communicate effectively in a medical setting you need to develop secure trust. Conflating a mutually trusting professional relationship with friendship obscures this aim.
Effective communication is not about going through the motions of seeming like you are listening and interested. Advice to smile, nod, make eye contact or to adopt whatever positive body language postures are fashionable but without genuinely engaging with the client and paying attention, it is empty rhetoric. Of course many of us have something of a professional persona, but there is a difference between this and superficial play-acting. At this point it is worth reiterating that a client doesn’t have to like you; they need to trust you. All clients should be treated with courtesy, sensitivity and respect. Anything beyond that is a personal choice depending on the vet’s personality. Being highly gregarious is not mandatory for solid client relations.
Another important but commonly overlooked aspect of effective communication is the need for the client to play their part. Clients have a duty to be civil, concise, to listen properly and to genuinely try to understand what you are saying. They also need to be prepared to follow instructions, and to let you know when they do not understand something. While these duties comprise a small facet of the overall communication process in a consult, it is nonetheless an essential one. If a client is not genuinely fulfilling their responsibilities then effective communication is not possible, no matter how good we may be at our part.
The approach of ‘client as friend’ as a way to create good relationships is not only misguided, but is symptomatic of one of the major stumbling blocks to improvement in small animal practice. And that is that vets voluntarily take responsibility for things that are either out of their control, or should be the client’s. I think this is partly out of feeling like they are being nice (and as I have explained above, being nice is often confused with providing a good service), and partly because vets are compassionate, hardworking perfectionists who have a natural tendency to blame themselves for outcomes or problems that are out of their control. Caring and worrying about patients is something that we all do and is of course a good thing, but we should be aware that it can be a double-edged sword, especially if taken to an extreme.
The idea that vets should take responsibility for everything that happens in the client relationship is unhelpful. Vets cannot and should not be expected to fit in to every different client’s idea of what their vet should be like. Everyone has a unique personality and some people may just clash. This is not the vet’s fault and we should stop making it so.
In our line of work there is no ‘one size fits all’ approach to client relationships that is valid or reasonable. There are as many different styles of clinician as there are types of client, and of course it is important to find ways to develop good relations between this wide variety of groups. But the idea that you cannot have a solid, effective, and mutually satisfactory relationship with a client without being ‘best buddies’ is absurd. As appealing as it sounds, people need to understand that encouraging vets to become personally involved with their clients—along with setting the expectation that responsibility for all aspects of the relationship lies solely with the vet—is unreasonable, unmanageable, and ultimately not good for animal welfare.
Perhaps part of the problem is the emergence of a more corporate approach to client management over recent years, which has led people to try to apply techniques that simply aren’t appropriate for the veterinary profession. We are vets and as such have good animal welfare as our goal. As much as smooth client relations are important for achieving this goal, welfare must remain our number one priority. There are many factors not involving the patient that need to be considered and balanced in order to provide the best possible care, and as a consequence we work in a world that is often far from ideal—requiring sensitivity, on-the-fly problem-solving and compromise. This is the nature of the beast, however much we might wish it were otherwise. We are not salespeople striving to make clients like us so we can sell a product or service. Ours is a unique and in some ways rather unusual profession, and trying to shoehorn it into a particular management style or model, no matter how successful that model may be for non-veterinary enterprises, just isn’t going to work.
* Kathryn Piper graduated from the University of Cambridge in 2000 and spent the first part of her career in the UK before moving to Australia nearly 10 years ago. She has extensive experience in effective communication with clients from all walks of life through working in a wide variety of small animal clinics in both countries.