I often see new graduate workshops and tutorials advertised where the seminar leaders address the problems of communication. Similar events are offered to older codgers, too.
I’ve been to a couple; the Veterinary Defence Society points out the majority of complaints it handles involve some form of breakdown in communication. The speakers often lay the blame squarely at the feet of the vet, but I think this is somewhat unfair. People need to learn to listen, too.
In my view, it isn’t simply because a vet or nurse hasn’t explained something properly. All too often, one hears a vet protest: “… but I TOLD them that”, so I think greater forces are at play here. Something I have noticed in people in general is their style of memory.
I have done only a cursory search and cannot find any reference to style of memory in texts, so I don’t know if there is any truth to it or whether it is merely a personal theory. However, I do think people use more than one type of memory. Some have very literal memories and can remember the words and phrases used; others remember their own interpretation of what was said, which can be fogged by emotion, worry, and panic. The latter is quicker to make, and perhaps quicker to recall, but seems to be the root of misunderstandings when going back over a conversation with people to clear up misunderstandings.
Our practice has a call recording system. Initially, I hated the idea of everything I said being recorded permanently. It felt like I was being watched all the time. Then, when trying to find a recording of a disputed phone call, the reality hit me there was far too much for anyone to monitor, and to be able to monitor it someone would have to sit there and listen to the whole conversation. There are better ways to spend your life, I think.
The reality was recordings were only reviewed when there was a complaint or dispute, and it was almost invariably a valuable tool in investigating and clarifying things – as well as acting as a learning mechanism.
The other thing to set me thinking was each time there was a complaint I had or hadn’t said something on the telephone, the recording backed up my version. Usually, I had given a different estimate or a different prognosis than the one the complainant remembered.
You could take away from this complainants were being dishonest and trying to get away with something, but I don’t think that’s true. When talking to people, both about complaints and otherwise, it seems many retain their interpretations of the conversation rather than the words used, so this has to be borne in mind when structuring a conversation in your head –for example, when relaying the results of a blood test. This might also provide a guide when people try to “put words in your mouth” when talking to them.
This theory also works quite well when examining animals in an emergency. After, for example, a suspected traffic accident I will do a quick nose-to-tail exam, weigh the patient, then I’ll go get some pain relief (usually an opiate, either buprenorphine or methadone), saying I’ll talk about the findings after I’ve got those working.
Don’t forget buprenorphine in single-use vial form can be given transmucosally (orally) to cats, which makes it really easy to get on board as quickly as possible. Not only does it get the patient more comfortable quicker (there’s always a “lead time” after you’ve given the pain control and before it starts to work), but there is usually a noticeable change in its demeanour during your more detailed examination; it gets more “chilled” out and more permissive in letting you look at it. Perhaps, just as importantly, the owner, usually distraught, can see his or her pet getting more comfortable, so it demonstrates in ways words cannot convey you care about the patient’s welfare. Everyone, then, is in a better frame of mind to talk about what’s happened, what’s wrong, and what can be done about it.
I don’t have a solution to the “interpretative memory” issue, but I think just being aware of it has helped considerably. What do you think?