How to beat 'Dr. Google' in nutrition

Introduction

In the daily practice routine, are you often frustrated when a client wants to discuss a particular subject, but you struggle to address it properly? Or are there topics that you want to focus on during a consultation – such as vaccination and nutrition – but which can lead to long and often tedious debate, so that you tend to avoid them? Certainly with the former topic, given that current recommendations are changing dramatically, with a move towards less vaccination overall, individual protection schedules and longer vaccination intervals, client education is essential. With the latter, the constant exposure to new feeding recommendations and dietary products from an infinite number of "experts" can lead to owners becoming confused. Both topics have one thing in common: "Dr. Google" has become an integral part of pet care, and owners now have access to countless websites and apps vying for their attention that often employ content which, at first sight, appears to be both interesting and convincing. What can the veterinarian do in these situations?

An ad hoc approach to communication?

We can only offer a premium service if, in addition to purely technical expertise, we also have a communication model for specific topics which can be used to reach out to clients. What is your position? Do you have a method for providing nutritional advice, or does it simply happen "on the go"? In other words, does your approach vary depending on the day, client, and your own motivation? If you are one of the few veterinarians who plan and conduct their consultations in a precise and structured manner, then you can read this article, feel vindicated in your approach and maybe get one or two (new) tips. However, the ad hoc approach adopted by most veterinarians is not the best method for providing successful advice – regardless of the topic in hand – and inevitably gives rise to conflict between clinician and owner. This may be swept under the rug (i.e., avoidance behavior) or dealt with in a manner that takes time and effort; this is especially the case if a client has a focus on a particular topic, such as the pros and cons of commercial petfood and home-prepared diets.

Take home message: You have to actively decide whether and how you incorporate the topic of nutrition into your daily practice routine and then implement it – this is the only approach that will be successful.

Your decision

To implement a strong and convincing communication method for animal nutrition, it is essential to first acknowledge the importance of this topic within the practice. Without an active commitment, discussion with your clients will either not work or will just be ineffective and time wasted. If you decide not to provide dietary advice, the pet owner will simply look elsewhere for answers to their nutritional questions, so the choice is yours as to whether to relinquish this service to the search engines or not. In fact, offering sound, effective advice on animal nutrition is not particularly difficult and can even be enjoyable.

The client perspective

No matter what type of diet an owner chooses for their pet, it is almost always an emotional issue, because love goes via the stomach. Apart from a few individuals who have a restrained “working” relationship with their animal, most owners have a strong emotional attachment to their pet. Because feeding is strongly associated with caring, it is a major factor in the human-animal bond, and most people believe that a balanced healthy diet is very important for their pet. It is not surprising that there are currently distinct trends towards home-prepared "fresh" foods for pets, and these will often mirror the dietary preferences of the owner: vegetarian, vegan and so on. Therefore, many people will research recipes and prepare food as an act of love for their pet, and especially those owners in the “millennial” and “older single” categories. Essentially this means that the topic is emotional and cannot be dealt with by simply giving the client a scientific lecture on the subject.

The Foundation

Although a technical lecture on animal nutrition in itself will probably not inspire a client, solid knowledge of the subject, as well as excellent communication skills, are essential prerequisites for a successful conversation. An owner will expect the veterinary team to know about the latest trends in this field and to make individual recommendations for their pet.

The key word here is "individual" because this is exactly what search engines cannot do, at least not yet. Whilst there are numerous recommendations, recipes and instructions on the internet, it is doubtful that such sources genuinely offer tailor-made solutions for a specific animal – although an owner may believe that this is the case when, for example, they fill out an online "questionnaire" to identify the “best” diet. It is obvious that it is the veterinary team who really knows a pet and the owner, but to maintain this relationship all practice members who provide advice to clients must have excellent nutritional knowledge.

However, this is a major sticking point; a recent study of opinion-leading veterinary practices in Austria and Germany 1 that asked “Is there someone in your practice with special training in the field of animal nutrition and dietetics?” reported that most respondents replied "no” – even though over 90% of those questioned offered pet food for sale in the practice. Remember that we have unique training in other matters such as vaccination, yet we would not recommend vaccines if we didn't know all the facts; detailed knowledge of animal nutrition is therefore a core aspect of veterinary work.

Take home message: Clients are generally interested in optimal nutrition for their pets. With expert knowledge, good communication and careful use of emotion you can win them over!

Creating communication

Even if a client persistently pursues a strongly held opinion on certain aspects of nutrition, it can at least be argued that they are interested! It is much easier to talk about a topic that captivates and engages someone than something unexciting, such as discussing routine parasite control. Full use must be made of this advantage, and to ensure the client's interest is channeled in the right direction when discussing animal nutrition, a communication protocol should be designed. Three key questions can guide this process:

• Who is the main point of contact for the topic in the practice – i.e., who takes care of current information and updates, orders pet food and maintains the product range on offer?
• How is new information transmitted to the entire team?
• Who broaches the subject with the client and how is the topic specifically addressed – i.e., how is communication integrated into the daily practice routine?

Although practice members will frequently know which topics to raise with clients, they may lack the knowledge to respond properly – and may also be afraid of potential conflicts, controversial topics and questions they cannot answer. Unfortunately, only a minority of practices regularly provide nutritional advice to their clients (Figure 2), but because animal nutrition is so important, a proactive approach is essential.

The essential factors required for a good communication procedure are shown in (Figure 3), and the team should develop a technique for this together. Initially design an approach for the “standard” client, and then move on to construct dialogs for “difficult” clients. Role-playing can be invaluable to develop the technique, and may be enjoyable, even if it feels strange, as it offers a protected space where everyone is allowed to make mistakes. Consultation scenarios can be repeated as necessary, and conversations can be worked on until everything is in place. Playing a difficult owner who asks problematic questions can help prepare the team properly, so that ultimately everyone can confidently discuss nutritional basics with clients.

What does the client need?

As veterinarians we will often give clients information on a topic that is important from our expert point of view. Although this is basically a sound professional approach, it does not usually correspond with what owners need, and what interests them; they live in their own world and will often have a completely different perspective from us. Inspiring clients and meeting them where they stand is the fine art of an exciting and mutually successful dialog. The easiest way to do this is to ask the client what they need and want, so when discussing nutrition use a specific, open-ended question to start the conversation and to emphasize your focus. For example;

• “What do you feed Rex?”
• “What can I do for you?”
• “What interests you about feeding fresh food?”
• “Why do you find BARF so interesting?”
• “What information can I give you on grain-free dog food?”

So if the client replies: "I wanted to talk about fresh food” there are basically two options: either begin by discussing the pros and cons of fresh food, giving all the information you think is accurate and important, or start with a counter-question to find out what the client's reasons and motivations are. This allows you to offer a better and more specific response, and will signal interest and build trust. So a possible conversation could develop as follows;

Client: "I wanted to talk to you about fresh food."

Veterinarian: "What particularly interests you on the subject of fresh food?"

Client: "I read in a dog magazine that it's better, because all the ingredients are natural and healthier."

Veterinarian: "I understand that a healthy diet for your dog is very important to you. What fresh ingredients do you use?"

Client: "Well, basically what I eat too; mainly vegetarian, for example, zucchini, pasta, tomatoes and herbs, although of course for my dog I leave out the spices, which are supposed to be less healthy."

Veterinarian: "That sounds tasty! But I'm concerned that this type of diet does not contain enough nutrients for Rex. Have you had the mixture analyzed to see whether it contains everything a young dog needs? This is very important, especially in the growth phase."

Client: "No, do I have to?"

Veterinarian: "It would be a good idea if you want to be on the safe side. And, as I understood you, health is very important to you?"

Client: "That's true. What do we do now?"

Veterinarian: "I suggest that for now I give you a small bag of our food designed for young dogs and that you bring me your recipes, which we will review with our computer program; we can then discuss the results and find the best solution."

Client: "But it must contain some fresh ingredients!"

Veterinarian: "I understand that, and I'm sure we'll find an optimal way to incorporate them."

Keep asking questions

The best way to develop the conversation is to keep asking questions. This will ensure that the dialog with the owner is meaningful and remains focused on the dog's nutritional requirements. So follow-up questions should be a little more direct in order to share the client’s point of view and understand their existing knowledge and assumptions. This is especially important to break down any barriers that may exist, because arguing does not help to comprehend the reasoning behind what a client says and means, and understanding this is essential. Follow-up questions could therefore be as follows:

• “Where did you read or hear that BARF is the best nutrition for all dogs?”
• “What do you think is the benefit of preparing the food yourself?”
• “What are your concerns regarding dry food?”

Take home message: Questions are the best way to start a dialog, learn about a client's needs, and get information about their opinion and concerns – all important ingredients to get your point of view across.

Use the statements

Whoever asks questions gets answers; whoever asks good questions gets good answers. So it is crucial to know exactly what you want to find out before starting a conversation. Only then can you identify the right questions and obtain answers that can be used properly. The next step is to evaluate the client's answers, because they have then revealed their opinion, knowledge and point of view. The aim is to keep in touch with the owner, to promote real exchange and to work out starting points for your advice. Remember that someone’s beliefs are generally their own “dominion”, so tread carefully when a client has a strong point of view. Your technical expertise is certainly superior, but your veterinary degree will count for little; for a client to believe in you he must trust you – and this has to be earned and nurtured over time. (Box 1), (Box 2) and (Box 3) show examples of questions and answers, what information the answers provide and what they mean, and how you can respond to them (Figure 4).

Client categories

The awkward client

With certain individuals we may find that that the interaction is just not right. At the very start of a consultation, before anything has been said, there may already be a perceived tension and a slight uneasiness. This is important to recognize, because for some reason this client has activated one (or more) triggers within ourselves. This is usually linked to the body language perceived within the first few seconds of meeting, and is based on the brain’s primeval ability for making quick decisions, such as: “Who is in front of me – friend or foe? Do I have to flee, fight or is everything okay?” So if our brain classifies a situation as a “threat" we feel uncomfortable and will be prejudiced toward the other person, and the subsequent conversation will be suboptimal, as we concentrate on the perceived threat and not on the person (and the pet) in front of us. However, recognition of this mechanism allows application of active countermeasures, so if we feel uncomfortable with a client, pause briefly and analyze the situation:

• What is my own state of mind? Am I relaxed and in a good mood? Or was I annoyed by the last client? Our state of mind and mood at the beginning of an encounter largely determine the outcome.
• What did the client say or do that activated a trigger? This can be something very simple; perhaps they brought to mind a relative or friend who uses every get-together to offer an unwanted opinion to everyone present and who blocks real conversation.

This quick check usually allows you to know exactly what is going on. You can free yourself from it and then approach the client with an open mind.

Take home message: Difficult clients can be approached with an open mind, specific questions and a dash of composure. Deal with it competently, and you often get a second chance!

The client who says “no”

Pet owners who say "no" to everything you suggest or who simply know better can be exhausting, and a solution may not be found in all cases. Such clients usually have another person or thing that they use as a reference, perhaps someone who either has more influence on them or was consulted before you were, or an internet source. It can be worth trying the "what if" method to find out if the client has valid arguments (from their point of view) or simply wants to be contrary, as follows.

Client: "Your food is far too expensive; the food in the pet shop is just as good and cheaper!"

Veterinarian: "I understand that the price of Lucky's food is important to you. What if I price match, would you buy it from me then?"

There are two basic responses here; either the client can say "yes, can we talk about it?" or “no, the other food is still better in my opinion." With the first response you now know that the price is what is important, and you can consider how far you want to go with this, along with offering additional services (weight checks, calculation of rations, discounts when purchasing certain quantities). With the second response you know that the client has more trust in the other food and is less concerned about the price. This allows the opportunity to speak specifically about your food and its quality, and whilst you may not convince the client, it does open the door to a constructive dialog.

Client: "No, the other food is still better in my opinion."

Veterinarian: "I understand that you are concerned about the quality of the food. What do you think makes our food inferior?”

Client: "There is no rice in my food, because rice is bad for Lucky!"

Veterinarian: "I appreciate that you are concerned about rice. What have you read or heard about it?"

Client: "It causes allergies and it is only a filler!"

Veterinarian: "Who says so?"

Client: "The breeder. He recommended feeding lots of meat and minimal carbohydrate."

Veterinarian: "Okay, so suppose we make an appointment for you to bring in your bag of food so we can analyze the nutritional content, compare the two foods using a computer program, and then decide what is best for Lucky?"

Basically, the client can either say "great idea!" or “no, I believe the breeder. He knows what he says and does!" With the second response it is fruitless to invest any more time and energy in this client at this stage. He has his own opinion and wants to stick to it – although this can change when his dog enters the next lifestage, if it falls ill, or does not tolerate the breeder’s food in the long run. And if you continue to provide nutritional advice at every opportunity, then you may get another chance later on!

The "uncooperative" client

Perhaps the most difficult thing is dealing with a client who seemingly cannot be reached with any argument and who doggedly sticks to their opinion, no matter what strategy is used. Reassuringly, even the most skilled communicator will reach their limits from time to time, because there is no such thing as 100% success in life. So if you occasionally hit a “brick wall”, the rule is – analyze what you could possibly have done better, check it off, and face the next client without prejudice.

Action points

In order to deliver good nutritional advice, three points need to be actioned:

• Ensure solid, up-to-date knowledge on animal nutrition, e.g., from online seminars or congresses
• Know how to communicate (see above)
• Ensure there are protocols in place to deliver nutritional advice within the practice: who speaks to the client, where, when and how?

Experience shows that the last point is the greatest hurdle in a daily routine, as few practices have set procedures for this. This means that no one in the team knows exactly how to deal with the topic and only reacts to client questions, instead of approaching the owner proactively. But only a positive approach can be successful, and using a defined protocol, as set out below, can be rewarding.

• Each animal is weighed when brought into the practice (even if the owner is not attending for a consultation) and the weight documented. This is not only a practical step to ensure correct dosage of all medications, but also invaluable for nutritional advice.
• Every patient receives a nutritional assessment. This can be done when an owner registers as a client; ask what they feed their pet daily, including snacks, and record the data in the patient’s file. A questionnaire that the client can complete whilst waiting for a consultation, and which is then inserted into the animal's file, is also suitable for this purpose.
• A responsible member of staff analyzes the existing diet, discusses it and, if necessary, adapts it to the current needs and lifestage of the animal. A follow-up consultation should be scheduled on a yearly basis, or if the animal has to be switched to a different diet for health reasons.

A structured approach will ensure that the practice staff always have up-to-date data on the dietary needs of their patients; this will allow them to prioritize the topic, creating an awareness with clients and ensuring that the practice is the “go-to” place for complete and trustworthy nutritional advice. On this basis owners will gradually accept and appreciate that the practice team is the preferred expert to be consulted when it comes to a healthy diet for their pets – but the bottom line is that nothing good happens unless you do it! A proactive approach to pet nutrition will strengthen client loyalty, improve your practice image and increase profits.