Both human and veterinary emergency medicine teams face several unique challenges that require situational and contextual awareness (Eisenberg et al, 2005). The nature of emergency work leads to a loss of control over case volume and admissions, necessitating the management of multiple cases with varying complaints and diseases simultaneously, often accompanied by numerous interruptions. Emergency medicine involves a high level of uncertainty, whether stemming from incomplete information about a patient in an out-of-hours clinic or the need to make clinical decisions before all diagnostic results are available for interpretation because of the inevitable time constraints associated with emergency work. George Bernard Shaw said, ‘The single biggest problem in communication is the illusion that it has taken place.’ Despite the vital role of communication, research indicates that miscommunication accounts for a considerable proportion of professional negligence cases in veterinary medicine, leading to negative client experiences and poor clinical outcomes (Russell et al, 2022). Several barriers to effective communication exist in an emergency setting, including environmental factors such as noise and interruptions; client characteristics such as cultural background, spoken language, emotional state and previous experiences; and healthcare provider characteristics such as knowledge gaps, attitudes and emotional intelligence (Moreira and French, 2019).
Communication is an important Day One Competence for Registered Veterinary Nurses (RCVS, 2020), with professional responsibilities to communicate effectively with clients and the public, and express appropriate empathy to owners during times of loss. In the 2024 survey of the veterinary nursing profession, 37% of nurses reported working out of hours, with 13% attending client visits. Respondents saw an average of 26 out-of-hours cases in practice per month and managed six remotely (RCVS, 2024). Veterinary nurses are frequently the first members of the team a client will encounter in an emergency situation, either when calling for advice or upon arrival at an out-of-hours hospital for an appointment. The nursing team can play a pivotal role in a client's experience, and building the client relationship through empathy, active listening and managing expectations can improve outcomes for the patient, client and veterinary team.
On arrival
The waiting room is a frequent source of tension for clients and veterinary professionals in an emergency service. This may be an unfamiliar environment for both client and patient, and there may have already been stressors such as time of day (or night as is frequently the case in emergency cases), arranging transport and finding the emergency provider before they even arrive at your practice.
Veterinary nurses are frequently the first medical professional a client meets on arrival with their pet to take a capsule history and triage the patient. Triage is the process of assessing an incoming patient to make initial determinations about the nature and severity of their problem.
When first meet ing a client, it is important to introduce oneself and clarify one's role within the team. One person in scrubs can look like everyone else so it is helpful for the client to know whether they are speaking to a veterinary surgeon, registered veterinary nurse, animal care assistant and so on. Aft er staff frequently failed to introduce themselves to the registrar and terminally ill patient Kate Granger, she launched the #hellomynameis campaign to encourage and remind professionals about the importance of introductions in healthcare (Granger, 2013).
Gathering history from the client on arrival allows for a thorough patient triage. It is crucial to allow the client to speak without interruption during this stage. Between 60 and 80% of the information relevant to a final diagnosis comes from history taking (Keifenheim et al, 2015); however, on average, a veterinary surgeon interrupts the client 15.3 seconds aft er asking a question (Dysart et al, 2011). If uninterrupted, a client will talk for an average of 150 seconds.
Open and closed questions are essential elements of history-taking. Although there is little literature published on veterinary nurse-client communication, on average, a veterinary surgeon asks 13 closed questions and only two open questions during a consultation (Shaw et al, 2004). Closed questions typically require a simple or yes/no answer. While they are important, the odds of a new concern arising later in the appointment are four times greater when closed questions are used at the start of information gathering rather than open questions such as ‘Explain to me what's been happening’ (Table 1).
Examples of closed and open questions
| Closed question | Open question |
|---|---|
| What diet do you feed Scrappy? | Tell me about Scrappy's diet. |
| How long has Merlin been unwell? | Why have you brought Merlin in today? |
| Is Shadow eating normally? | Describe to me Shadow's appetite recently. |
| Did Pepper collapse at home? | What was Pepper doing before and aft er the collapse? |
Empathy
Emergency presentations can be highly stressful for clients. Klingborg and Klingborg (2007) studied client perception. They found that highly stressed clients tend to evaluate a professional's clinical ability based on trust rather than clinical competence, judging the messenger before the message. Displaying empathy is, therefore, of utmost importance when first interacting with a client (Table 2).
Examples of high and low stress situations
| Lower feelings of outrage and dread – clients make decisions based on perception of veterinary expertise and competence | Higher feelings of outrage and dread – clients evaluate on capacity to listen, care and empathise |
|---|---|
| Voluntary, self-caused (such as an unvaccinated pet) | Involuntary (such as a road trafic accident) |
| Familiar (such as cancer) | Unfamiliar (such as an exotic disease) |
| Natural (such as immune-mediated disease) | Man-made (such as brachycephalic obstructive airway syndrome) |
| Reversible (such as a fracture) | Permanent (such as an amputation) |
| Affects an adult or older animal | Affects a young animal |
Adapted from: Klingborg et al, 2007
Empathy can be demonstrated by following the principles of the Empathy Cycle (Barrett-Lennard and Osipow, 1981):
The client's perspective can be explored using the ICE acronym, which involves establishing the client's ideas, concerns and expectations through questioning. Asking these early in the interaction helps develop a clearer understanding of their perspective (Figure 1).
Use of the ICE acronym.
A client's impression during a conversation is influenced not only by what is said but also by non-verbal and paraverbal communication. Paraverbal communication refers to tone of voice, speed of speech and emphasis on words rather than the actual words spoken. Pausing when speaking can help the listener process information and control the pace of speech.
Non-verbal communication includes body language, posture, facial expressions and positioning within the consult room. Non-verbal cues such as nodding, mirroring body language and appropriate eye contact can demonstrate active listening and encourage information sharing.
Empathetic statements help build trust and strengthen the client relationship; however, it is important to recognise that some expressions of empathy may trigger strong emotions. Telling a client ‘I understand how you must be feeling’ aft er they receive shocking news may provoke a sharp response, as without knowing their background it is impossible to know this. A safer empathetic statement that conveys understanding might be: ‘I appreciate this may be difficult for you’.
Financial discussions
A client's main concern may be the cost of their pet's treatment. While the primary responsibility for discussing charges and estimates lies with the veterinary surgeon overseeing each case, RVNs are expected to understand the varying economic backgrounds of clients, and they may be asked questions relating to a patient's invoice.
Treatment costs should be discussed at the outset as a non-judgemental conversation, as failure to do so can contribute to client suspicion and mistrust of the veterinary profession (Coe et al, 2007). Estimates should form the basis of these discussions to ensure care is within the client's resources, with attention paid to contextualised care–recognising that different treatment modalities may be equally valid in different contexts (Skipper et al, 2021). From a financial perspective, this may involve asking the client directly about their budget in a non-judgemental manner.
There will still be occasions when clients raise complaints about treatment costs. Although the aim is always to seek resolution with a professional and understanding approach, some clients may become angry, particularly if they have concerns about affordability which may have been exacerbated by the recent Competition and Markets Authority investigation, alongside reports of increased abusive behaviour towards veterinary teams (British Veterinary Association, 2024). Abuse or aggressive behaviour should not be accepted, and the safety of the team and individuals must remain the priority.
Types of medical jargon
| Type | Description | Example |
|---|---|---|
| Technical terminology | Classic jargon – phrases learned while training | Micturition |
| Alphabet soup | Acronyms and abbreviations | CPR |
| Medical vernacular | Familiar to most but not universally understood | Sepsis |
| Medicalised English | Words which have a different meaning in medical context | Negative/Positive |
| Unnecessary synonyms | Overcomplicating language | Ambulating vs walking |
| Euphemisms | Att empts to soft en language but provide less clarity | Put to sleep |
| Judgemental jargon | Phrases reflecting bias or hidden (derogatory) comments | Dog more intelligent than owner (DMITO) |
Adapted from Pitt et al, 2020
The following phrases may assist when dealing with a difficult client complaining about the cost of veterinary care:
Information retention
When providing information to a client, it is important to acknowledge the limits of working memory, particularly during times of stress. Working memory refers to a group of cognitive functions that enable humans to access, store, update and manipulate information actively (Baddeley, 1992). Working memory capacity is thought to be limited to three to five chunks of information (Cowan et al, 2005), and retention declines over time. Stress has been shown to negatively impact working memory (Geißler et al, 2023), and several factors can influence this, including gender, age, stress and sleep (Blasiman and Was, 2018).
When discussing an inpatient's care, ensuring sufficient information retention is essential. In a human emergency room setting, up to 70% of information discussed during the discharge conversation was incorrectly recalled by patients when questioned immediately after discharge (Marty et al, 2013), with 66% lacking key information about their diagnosis, planned examinations or follow-up treatment.
The Ask-Tell-Ask technique is a useful framework when discussing a patient's illness or diagnosis. This involves asking the client what they already know about a topic, providing the appropriate level and volume of information based on their response, and then asking them to repeat this information back to confirm understanding (Figure 2).
Use of the Ask-Tell-Ask framework.
Medical jargon
Information retention can be improved by keeping communication brief and clear, repeating and summarising key points to enhance recall and avoiding medical jargon. Jargon refers to technical terms professionals use to describe concepts that a layperson may not understand (Thomas et al, 2014). One study in human medicine reported that 81% of encounters between physician and patient in a diabetes clinic contained at least one unclarified jargon term, with an average of four per visit (Castro et al, 2007).
Medical jargon can take several forms, as described by Pitt and Hendrickson (2020). This includes technical terminology, such as classical Latin medical terms; ‘alphabet soup’, in the form of acronyms and abbreviations; and judgemental jargon, where biases or hidden derogatory comments are used. An example of judgemental jargon encountered in veterinary practice is ‘DMITO’, meaning ‘dog more intelligent than owner’, implying that the canine patient's intelligence exceeds that of the human client.
A common source of frustration is the use of the phrase ‘out the back’ when moving a patient from a consult room. In a straw poll of third-year veterinary medicine students and medically trained communication actors, most imagined ‘out the back’ to mean the back yard by the bins when no further context or explanation was given. Preferred alternatives include ‘the clinical area’, ‘treatment room’, ‘hospital area’ or ‘prep’, which provide greater clarity.
It is important to approach each client as an individual, regardless of perceived medical literacy, and to take care with word choice. Reducing jargon and providing clearer explanations are likely to enhance communication and improve patient care.
Expectations
Client satisfaction is determined by the difference between their expectation of an interaction and their experience. If a client's experience surpasses their expectation, satisfaction is likely. Conversely, dissatisfaction may result if the experience falls below expectations and is a common precursor to complaints.
Each client is an individual, and assumptions should not be made about the standard of care or expected level of interaction. Factors such as ongoing costs, hospitalisation arrangements, timing of follow-up phone calls and staff handovers can all create tension if expectations are not identified and either met or managed. Improving communication through shared decision making is important to help meet client expectations in veterinary practice (Ackerman, 2020). When clients feel like active partners in decision making for their pet's care, compliance with mutually agreed recommendations is more likely.
The aim should be to provide an excellent standard of care for hospitalised patients. However, by asking clients about their expectations for the nursing care of their pet and whether these are being met, care can be contextualised to the patient and client, particularly when a patient is expected to remain hospitalised for a significant period.
Conclusions
Effective client communication is critical in the dynamic environment of emergency and critical care. As miscommunication remains a leading cause of professional complaints, adopting an evidence-based approach to communication is essential. Prioritising empathy, active listening and clear communication enables veterinary nurses to address client concerns, enhance information retention and foster improved client relationships with the practice. Transparent discussions about client perspective and costs further build trust and align client expectations with clinical realities. These strategies improve client satisfaction and strengthen the veterinary team's ability to deliver compassionate, high-quality care, even in high-pressure emergency situations.