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Empathy is different from sympathy, which entails concern from outside the client's position. The practitioner must be able to identify what the client is feeling, or what emotions they are displaying (sadness, worry, anger, shock, denial). An empathic statement could sound like: “I can see that you are worried about the prospect of Willy having his teeth extracted” (Figure 2.7). You may want to explore exactly what the client is concerned about – perhaps they are worried their pet may not be able to eat properly. This message can be strengthened when combined with nonverbal signals, including facial expression, tone of voice, and even touch. This display of empathy is integral to building rapport with the client and enabling true relationship‐centered care because the client feels completely understood and has their concerns validated. In addition, it can help to build a trusting relationship. Trust is also integral to relationship‐centered care, and is a vital tool in being persuasive. It appears, however, that veterinarians may miss vital opportunities to display empathy (Shaw et al. 2004). The clinician should therefore try to identify these opportunities and practice displaying empathy.

Figure 2.7 A centralized position of the patient is necessary to display empathy and accept the unusual bond between owner and animal.

Table 2.1 Verbal behaviors significantly associated with positive or negative outcomes during consultation.

Source: Adapted from Beck et al. (2002).

Positive Outcome	Negative Outcome
Empathy	Formal behavior
Reassurance	High level of biomedical questioning
Support	Interruptions
Encouragement of questions	Irritation
Friendliness	One‐way flow of information to patient
Courtesy
Positive reinforcement of patient actions
Psychosocial talk
Increased encounter length
Listening
Orientation during physical examination
Summarization

In 2002, a systematic review of the existing primary‐care research was conducted in order to study the impact of the verbal and nonverbal behaviors of physicians on patient outcomes, including intention to comply, actual compliance, trust, quality of life, health status, and satisfaction (Beck et al. 2002). The findings are summarized in Tables 2.1 and 2.2.

Table 2.2 Nonverbal behaviors significantly associated with positive or negative outcomes during consultation.

Source: Adpated from Beck et al. (2002).

Positive Outcome	Negative Outcome
Forward lean	Backward lean
Head nodding	Indirect body orientation
Direct body orientation	Crossed arms
Uncrsossed arms	Frequent touch
Uncrossed legs
Less mutual gaze