Difficult client encounters

A difficult client encounter between a veterinary staff member and a client is normally characterised by problematic communication and/or the triggering of unpleasant emotions for either or both parties. Typical difficult client encounters reported by veterinary professionals include situations where:^1-2

• the client demonstrates negative responses (e.g. anger, aggression) or uses communication strategies which are perceived as ‘rude’;
• internet-(mis)information impedes the conversation;
• a clash between the beliefs and values of the client and veterinary professional occurs;
• the client has a long‘shopping list’of what they would like to address in a visit;
• complex clinical situations with an emotional aspect, e.g. breaking of bad news, discussing veterinary costs.

Whilst there is scant research-based evidence on difficult veterinary-client encounters,^3-4 we can draw insight from human medicine where several decades of work exists. Our human counterparts estimate that approximately one in every six interactions with patients can be classified as ‘difficult’.⁵ It is also recognised that such interactions can have a real and negative impact for healthcare professionals; one US study revealed that physicians who perceived a higher volume of difficult encounters were significantly more burned-out and dissatisfied with their jobs than those reporting fewer difficult encounters.⁶

In human medicine, discourses have evolved from use of the terms‘difficult’or ‘heartsink’patients (which have the potential to problematise – or place blame with – the patient) to those of‘difficult‘encounters/relationships’. The latter term better reflects current thinking, i.e. that the reasons behind difficult patient/client encounters are multifactorial. Three contributing components have been proposed:^7-8

1. Situational issues – time pressures, hectic environment, language/literacy barriers, financial constraints, multiple people in the consult room;
2. Doctor-related factors – personal anxieties, motivations/values/beliefs, tendency to defensiveness, being“overly nice”;
3. Patient/client-related factors – tendency to anger or defensiveness, unrealistic expectations, relationship/bond with animal.

A further consideration, which comes from the field of clinical psychology, is that of‘transference’. Transference is described as“the phenomenon whereby we unconsciously transfer feelings and attitudes from a person or situation in the past on to a person or situation in the present.”⁹ In other words, a client who is expressing anger towards us may be exhibiting behaviour which is consistent with his or her previous (likely negative) healthcare experiences. Transference can work in both directions, and healthcare professionals may experience a strong negative response towards a client who reminds them of a previous difficult encounter/ relationship with another client (known as‘countertransference’).

Fortunately, there are a wide variety of communication and self-management tools which can help veterinary staff to prevent difficult encounters from escalating, and to preserve the relationship with the client. These include: ^1-2,10-11

• Learning to recognise a potentially difficult encounter quickly, through monitoring the verbal and non-verbal cues of the client, and our own emotional responses;
• Creating space to select the most appropriate strategy to work with the client, e.g. using a short, in-the-moment breathing exercise, leaving space for the client to speak, and attempting to depersonalise our reactions by rationalising that the anger may not, entirely, be related to the current situation;
• Selecting an appropriate communication strategy, e.g. active listening, rapport building, suspending discussion of the clinical issues to attend to the client’s emotions;
• Using self-reflection techniques to consider the situations that make us feel uncomfortable and explore these;
• Using mindfulness, or other techniques, to develop a ‘clean slate’mindset between consultations;
• Developing a clinic-wide strategy to manage difficult client encounters (e.g. formal record keeping, developing a protocol for angry or aggressive clients, staff debriefs and training).

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