Have you ever walked into an exam room and realized your ability to communicate with your client is complicated by a conversation-paralyzing language barrier, with a strong undercurrent of cultural disconnect? Welcome to my everyday world.
While I grew up multicultural and multilingual in an increasingly international city, (Miami), and have practiced here for more than 25 years, interpreting the nuances of smiles, nods, frowns, groans, and sighs does not often come easy. Make no mistake, it is all about the nuances.
You may think you have communicated your findings, explained your plan, secured a buy-in on your estimate, and gotten a green light to get going on a critical pyometra when—next thing you know—the client is carrying his dog out the door without so much as a glance at the receptionist (who is dutifully trying to get his attention in three different languages). So much for effective communication.
Then there is the scenario in which all is similarly agreed upon with a client you have known for years, but—here’s the hitch—this is her mother’s dog. Said mother understands your Spanish perfectly, of course, but the cultural modulation is significant enough that you have clearly missed a key feature in the dialog. She does not want the same thing her daughter wants, and you have just missed this crucial bit. Ultimately, it does not matter whether she has signed on the dotted line or the bill gets paid. If the client expects something other than what she receives, there will be hell to pay. (And there was.)
As we all know too well, being a capable veterinarian is not just about our well-honed clinical skills or encyclopedic medical knowledge. It is not enough to have brilliant diagnostic capabilities, extensive surgical experience, or an über-intuitive understanding of animal behavior. None of these matter much if we cannot communicate effectively with those responsible for our patients’ care.
Sure, we would be forever grateful if our profession ever granted us the enviable ability to whisk our patients to the treatment area, perform any necessary diagnostics, declare our findings, lay out our treatment plans, and perform them all to our everlasting satisfaction without ever engaging the fundamental impediment we like to call “the client.”
Yeah, I would be grateful if someone handed me Scottie’s trichorder, too, but an infallible, intergalactic intervention is even less realistic than the above scenario. Interfacing with humanity is both a necessary “evil” and a requirement for success. After all, these patients will go home again, and few conditions can be effectively managed (or prevented) without a viable partnership.
Ultimately, our patients’ people do not just have to understand our assessments, agree to our terms, and pay the bill when it is due. Of course, informed consent and funding the work are critical, but it is also about what happens when our patients go home. How are we supposed to defend our surgical skills when our patient’s perianal mass dehiscence is the direct result of our client’s failure to follow our aftercare instructions?
Now, I understand common sense is not common and home-care instructions are routinely ignored by the world around. It is also true culture and language are no excuse in most cases. (Thinking people should know that a dog cannot be allowed to sit and spin on his backside when he has had surgery there.) In examining this scenario critically and compassionately, however, it is clear this sprawling, multi-generational household was ill-equipped to manage a post-op patient with very specific needs.
In this example, detailed written instructions in two languages were no match for this four-generation household. A fuller understanding of the home environment would have helped, and it is where we, as a practice, inadvertently did our patient dirty. The solution would have been to require medical boarding or refuse the surgery (we did offer to board, but did not demand, as we should have had we been more diligent in our history-taking).
Now, you may believe thinking multiculturally is too big an ask for any veterinary practice. I mean, with everything else we handle, how is it possible for us to muster the bandwidth for the subtleties of foreign languages and cultures?
While I would desperately like to agree with you, it is not exactly negotiable. In the real world, either you address your clients’ needs or you accept poor outcomes. I’m not willing to accept poor outcomes—not without a fight.
While Miami is not exactly Middle America, neither is it singular in its trajectory. It matters little whether you like it or not. Your city is changing, and if you want to cater to the population where you live, you will have to adapt. Or retire. Or be unhappy. Or accept you will not be offering the quality of medicine you think you are offering if your clients are not picking up what you are putting down.
Of course, it is not going to be easy. Despite being steeped in several cultures with decades of Miami-style crazy under my belt, I still find myself flummoxed almost every single day of my life. Nevertheless, there are ways to make things work more smoothly with a maximum of information flow and a minimum of cultural backlash. Here’s how I dress my practice for battle:
Make language and cultural literacy a hiring priority. You do not have to speak your client’s language to make contact, but it does help, of course. Arm yourself with a multicultural and multilingual team and employ their skills liberally, but be sure not to abdicate all communication responsibilities just because you do not speak the language.
Communicate what you can. If you cannot speak the language, you can still write in it. Concentrate your communication efforts on writing and use a language-translation app to print out or email discharge instructions. It is also very easy to use spoken language translation apps to converse or text in real-time. If you are feeling ambitious, you can also make your PIMS bilingual or trilingual for more easily understood estimates
and invoices.
Learn the lingo. If you commute, you will have time for some simple audio instruction. You can also find English translation books on medical terminology in many different languages. There is even one for veterinary terms in Spanish, which I like to use since it helps me navigate the wide variety of Spanish dialects I deal with daily. (You have no idea how many words for “castrate” the Spanish language is capable of.)
Take cultural differences seriously. Cultural literacy is the hardest bit to navigate, in my experience. In fact, sometimes, speaking the same language fools you into thinking you have made real contact, when you have done nothing of the sort. An emphasis on our patients’ comfort, a positive attitude, and making it clear we are trying hard goes a really long way to achieving effective communication.
It is ultimately about compassion and empathy, right? Unfortunately, in the midst of a challenging day, these can seem even less common than common sense. But then, that’s the price of being a veterinarian in challenging times.
Thankfully, there’s an upside, too. There’s nothing like knowing you’ve made a real connection across a cultural divide to cement a relationship. Do it right and you’ll have a client for life.
Patty Khuly, VMD, MBA, owns a small animal practice in Miami, Fla. and is available at drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.