Grim findings. Poor prognoses. Medical errors.
Breaking bad news is an inevitable part of every veterinarian’s professional duties, but the delivery of the news to the client is as important as the message itself. Poorly conducted conversations not only affect the client’s understanding and impression of your practice, but over time can also affect your mental health and potentially your career.
While every veterinarian develops their own style and approach, a framework for breaking bad news that guides the conversation and manages the outcome can help reduce frustration, compassion fatigue, and other harmful emotional reactions.
Established protocols for delivering bad news
The two most recognized protocols for breaking bad news were developed in the human healthcare field and are referred to by their mnemonic device. They include:
- SPIKES — A six-step model whose key points include setting, perception, invitation, knowledge, empathy, and summary/strategy
- ABCDE — A five-part protocol that includes advance preparation, building a therapeutic environment, communicating well, dealing with patient and family reactions, and encouraging and validating emotions
In addition to being easy-to-remember mnemonics, both models share similar steps and a common goal of ensuring the recipient (i.e., patient, client) can best receive, understand, and process the news. A conversation that is clinically informative and emotionally supportive accomplishes this goal.
Key considerations for delivering bad news to veterinary clients
Whether you decide to adopt an established protocol or create your own, you must include several key components when you break bad news to ensure you convey critical information with clarity, compassion, and composure.
#1: Organize your thoughts
When you know you need to have a bad news conversation, take time to assemble and order the information. If the recipient is a familiar client, consider their preferences and personality—for example, will they prefer a gentle approach or a straight-shooter delivery? Will they have a lot of questions or need lots of repetition? If the client is new, consider how you can quickly establish trust and rapport. Finally, ensure you are emotionally prepared for the conversation.
Although sometimes the diagnosis, prognosis, or series of events seem straightforward to you, with few grey areas, taking extra time to prepare for the conversation can help you relay the information in a professional, unhurried manner and ensure you don’t omit important pieces or overwhelm the client with too much information.
#2: Select an appropriate time and place
Bad news should be delivered in person or by telephone in a quiet, private location, such as an unused consultation room or office and, if possible, scheduled during less busy times of day. This can minimize ambient noise (e.g., laughter, loud voices, barking dogs) and the risk of interruptions, which could disrupt critical points in the conversation and potentially distract the client. A private setting can also prevent you from feeling rushed and allow you to present the information and provide support in an unhurried manner.
If these steps are impossible or impractical (e.g., a small clinic, a busy ER), veterinarians can create a supportive emotional setting with relationship-building strategies. These can include empathetic language (e.g., “I’m sorry, but…,” “I know how special Rufus is to you…,”), appropriate touch (e.g., a hand on the client’s shoulder or arm), and connection (e.g., “Let me know how I can help you,” “I’m here for you”).
#3: Communicate thoughtfully with verbal and nonverbal language
Although softening the blow of bad news with lots of qualifiers and preamble is tempting, a direct, frank approach usually is best. Speak in plain language and avoid veterinary terminology or complex explanations to ensure client understanding and build rapport. Break down large concepts and let the client absorb smaller pieces of information. Be prepared to repeat or rephrase more complex ideas, especially for emotional clients.
As you speak, monitor the client’s reactions and body language for cues to pause or check in (e.g., “What are you thinking right now?” “Would you like me to continue?”). These active listening strategies allow your client space for their emotions and improve their ability to listen and comprehend the message. Pausing to reflect and checking in also demonstrates empathy and compassion for the pet-owner relationship.
Finally, ensure your own body language and nonverbal signals match your words and intent (e.g., keep your arms loose and relaxed, face the client, make polite eye contact, lean forward slightly). Avoid crossing your arms or legs, standing near the exit, and nervous habits such as leg-bouncing or checking your watch.
Recognize that no matter how well you communicate, clients are unlikely to remember everything you said. Provide clients with written resources and a conversation summary that they can review when they feel more composed.
#4: Take care of yourself
Delivering bad news can harm your health, especially when clients direct their anger, frustration, or sadness at you or the veterinary team. So, you must perform regular self check-ins and prioritize self-care strategies, such as exercising regularly, eating well, prioritizing sleep, engaging in non-work activities, and using all your vacation days. If the stress persists, reevaluate your conversational strategies, speak to your supervisor, or get help through veterinary-specific mental health resources, such as the Veterinary Mental Health Initiative and Not One More Vet.
Breaking bad news to veterinary clients is necessary, but emotionally draining. However, working with a conversational structure or framework and thoughtfully balancing facts and emotions can ensure that everyone involved receives the best possible outcome from these challenging and sometimes unpredictable conversations.
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