1. The need to know

Adults are relevancy-oriented and must know why they need to learn or do something. Any change from their current way of doing things must be justified, because time is at a premium and there are many other demands on their attention. One's "need to know" is based on the gap between his/her current knowledge and what he or she must know in order to perform the job.

A Harvard psychologist conducted an experiment in which she tried to move to the front of a long line at a copy machine. In some cases, she simply stated that she had five pages to copy and asked to move ahead. In others, she stated that she had five pages and asked if she could go ahead because she was in a rush. By simply adding the "because" clause, she increased compliance from 60 percent to 94 percent.

Beware of falling into the trap of "data dumping" or "doctor speak." There are limits to a client's capacity to absorb and comprehend information. Be alert for signs of information overload, such as nonverbal expressions of withdrawal or discomfort. Provide information in chunks and check in with the client after each concept, asking if she or he has questions or would like clarification. Don't introduce more than three new concepts at a time, saving additional information for the next visit. Be very conscious of the words you use, and speak in layman's terms.

2. The learner's self-concept

In general, adults have a sense of independence and responsibility for making decisions. They resent the feeling that others are imposing their wills on them. For physicians, three models of health-care decision-making have been described.

• In the paternalistic model, the doctor makes all the decisions. Information flow is one-way, and any deliberation that occurs is between the doctor and other professionals.
• At the opposite end of the spectrum, the informed (or consumer) model puts all decision-making in the hands of the patient. Information is still one-way from the doctor, but the patient decides on the course of treatment after consulting family, friends or others.
• In the middle is the shared decision model. The doctor and the patient share information that allows the physician to understand the unique components of the patient's life that may affect decisions. Deliberation occurs between doctor and patient, and the final decision is reached by negotiation and agreement.

In one study, 62 percent of the patients preferred shared decision-making; 28 percent preferred consumerism; 9 percent preferred paternalism. Research has demonstrated that when the patient and physician are congruent on the decision-making model, there is increased satisfaction on the part of the patient and a self-perception of better health.

Although similar research has not been done in veterinary medicine, these results are relevant to the doctor-client relationship. The client's preference can be determined by asking how much information she or he desires.

"Would you prefer that I give you a detailed description of the condition, or would you just like the key points?"

"Have I given you enough information?"

Use open-ended questions to invite the client to tell his or her story. Use partnering terms to invite the client to participate in the process.

"We'll work together to make Fluffy better."

"It is important for us to agree on the proper treatment for Fluffy."