5.2 Communication Styles – Paternalistic

Historically, paternalism was the most used communication style in medicine. In a paternalistic approach, one individual, the doctor or veterinarian, dominates the medical encounter. They collect information, form a plan, and tell the client what should be done. This approach focuses heavily on the provider’s knowledge, perceptions, and decisions. Whether intentional or not, paternalistic communication emphasizes behaviors that display the medical professional’s power, status, and author,(Shaw et al., 2004). Patient satisfaction has been negatively associated with these behaviors.

Unfortunately, this approach does not leave room for input or collaboration from the client. This style can further ostracize people and lead to feeling brushed off, unconsidered, and undervalued. Imagine a veterinarian working up a patient and being told by another veterinarian to do it differently. Whether the suggestion was helpful or not, approaching a problem in a paternalistic manner leaves little room for collaboration and understanding. Remember, there are reasons O/A clients farm as they do, and they know those reasons better than the veterinarian. A paternalistic style is not likely to result in a strong working relationship with O/A clients as it creates separation and negative feelings between clients and veterinarians.

The following scenario will be used throughout the rest of the chapter to describe, show, and highlight key factors in communication styles and techniques:

Scenario – Part 1

Farmer Jane is an organic dairy sheep farmer with 100 milking ewes, two mature rams, 220 yearlings, and five ram-lambs. She does not routinely vaccinate her herd and emphasized that her practice of optimizing animal health focuses on managed rotational grazing, good genetics, and stress-free handling. Her farm recently experienced a few late term abortions. You sent samples to a diagnostic lab that came back positive for Campylobacter fetus (vibriosis). Your plan for this herd would include disease prevention changes (separation, quarantine, isolation, removal, and proper disposal of affected tissues, cleaning and disinfecting, etc.) and starting a vaccination schedule. You know that Campylobacter fetus is a zoonotic disease and will also discuss zoonotic disease transmission and that she should talk to her doctor for more information regarding her health and Campylobacter spp.  Communicating this in a paternalistic way could sound like this:

 

Jane, your sheep have been diagnosed with vibrio, a disease that can cause abortions, stillbirths, and weak kids, and more. To fix this, you need to separate the sick animals, remove all tissues, clean the areas thoroughly, and vaccinate the flock. Vibrio is a zoonotic disease, so talk to your doctor too.

Oh, that’s a lot to take in. Was there something I did that caused this?

Well, this disease can be routinely vaccinated for and is strongly recommended. Our office has the vaccine and can supply it for you.

Okay. Are you saying my animals must have this vaccine?

Yes. Vaccinating sheep for vibrio is a common practice.

Okay. And I can’t let my ewes eat their placenta? That seems unnatural.

Their placenta could spread disease; it must be removed and disposed of properly.

The veterinarian may give medically correct information, but by approaching the conversation in a paternalistic way, the veterinarian did not provide Jane an opportunity or comfortable conversational environment to express her feelings or concerns. Does the veterinarian understand Jane’s reasons for vaccine non-use or worries about the placenta? Losing that interaction and collaboration can negatively affect Jane’s likelihood of following the vet’s recommendation and thus negatively affect the animals involved. In addition, Jane may not feel this veterinarian can help her or her livestock.