Sharon Kramper joins us to discuss her research on the prevalence of PTSD in the veterinary workplace and its implications for veterinary teams. Together, Dr. Andy Roark and former veterinary practice manager, Sharon Kramper, explore various factors, potential index events, and what can be done when a team member may be experiencing debilitating symptoms. Tune in to this episode of the Cone of Shame Veterinary Podcast for important insights and strategies to support mental health in the veterinary field.
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LINKS
NOMV Lifeboat: https://www.nomv.org/lifeboat/
National Alliance on Mental Illness: https://www.nami.org/
Shanti’s Veterinary Mental Health Initiative: https://www.shanti.org/programs-services/veterinary-mental-health-initiative/
Sharon Kramper on LinkedIn: https://www.linkedin.com/in/sharonkramper/
Dr. Andy Roark Exam Room Communication Tool Box Team Training Course: https://drandyroark.com/on-demand-staff-training/
Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Sharon Kramper is preparing to receive her PhD in Clinical Psychology from Auburn University in August 2024. Before entering the field of mental health, Sharon worked in veterinary medicine, including being employed as practice manager in a small companion animal hospital. Here, she was sensitized to the workplace-specific stressors and risk factors that contribute to negative mental health outcomes among veterinary professionals. Her research during graduate school has included describing experiences of discrimination reported by LGBTQIA+ veterinary students and professionals, estimating the prevalence of PTSD in the veterinary workplace, and characterizing the types of ethical dilemmas that support staff encounter. She is looking forward to two things after graduation: 1) being called doctor and 2) rescuing a new dog buddy.
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Guys, I got a great one for you today. I’m here with Sharon Kramper. She is a former practice manager, future clinical psychologist, and she’s been doing research with PTSD in veterinary medicine. We talk about her research and kind of what she found, what PTSD is and what it means and how it manifests in our profession and that’s what we get into. It is a really interesting discussion. I will give you just a little bit of a warning. We do talk about things that might cause PTSD or that would rise to the level of being index events for PTSD. We don’t talk in graphic detail or anything like that, but you know, we give some sort of broad examples and things like that, and they might be upsetting to people.
So know that, know that it’s not something that, that we lean into in any way, shape, or form, but, but we do talk about the types of things in vet medicine that, that might that might serve as or might cause, you know, that might cause harm. So anyway, just know that that’s there, so it’s, it’s not surprising. But that, that’s it. Gang, this is a good episode. I hope you’ll enjoy it. Let’s get into it.
Kelsey Beth Carpenter: This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast. Sharon Kramper, how are you?
Sharon Kramper: I’m great, how are you?
Dr. Andy Roark: I’m really great. It’s so good. It’s so good to see you and get to catch up with you. For those who don’t know you, you are, you are finishing up your doctorate in clinical psychology. You are 120 days away from being called doctor at this point. You fascinate me. In that you have this previous life and career in veterinary medicine. You were a practice manager. You’ve been in the profession for a long time. And then you went and went into clinical psychology training.
And so now as we talk, you’re currently working with inmates in a correctional institution as you finish your training. I don’t know if you’re going to come back to vet medicine after that. I think you’ll be well prepared if you do. I think you will be. Honestly, is all of this an elaborate plan to make you a very specific kind of practice manager? Is that what this?
Sharon Kramper: Oh, gosh. I mean, I do have, have dreams of coming back to veterinary medicine and I would love, like, I have this image of myself as being like the, the Mary Poppins and like a cardigan coming in and, and, and to like practices and helping them with their culture and, and with their mental health. You know, you, you come in and they kind of sprinkle some magic and then get out. I mean, that would be fun, but we’ll see.
Dr. Andy Roark: I, I, I love, so I, you, you’re, you’re up on the literature, you’re actually doing clinical psychology practice and then you have this great wealth of knowledge of the vet industry and you’ve all these stories from experiences that you had and things like that. When when you and I were talking you know, a couple months back and everything, you, you were really interested in PTSD and you were sort of Uh, part of your research and part of your training was focusing on PTSD, and so you’re studying PTSD, and I was really curious in sort of how PTSD as a as a, as a phenomenon, as a, as a condition people have to overcome how that interfaces with veterinary medicine.
And, you know, we, we talked a bit at the time about sort of ethical dilemmas and, and some of the challenges in vet medicine and some of the, was some of the hardships of vet medicine. And so let me sort of stop right here for a second and sort of say, Sharon, can you talk to me a little bit about what is, what is PTSD in a, in a, I don’t know, in just a general context? And then do we see PTSD in veterinary medicine?
Sharon Kramper: Great questions. So to start off with, from a psychology point of view, PTSD or post traumatic stress disorder is a little bit different from many other disorders we see. Think of like depression or anxiety because it involves and what we call an index event, right? Something happens and then you develop symptoms afterwards, and those symptoms persist over time.
I think a really good example when talking about PTSD is to think about a car accident. And so, for example, you might get into a fender bender, right? And it shakes you up a little bit, but maybe you’re unharmed and you are you kind of go up on your way very quickly, versus, let’s say that you were in an accident where maybe your passenger died, right? Or it was very serious. You were hospitalized for a while. You had to have reconstructive surgery. You know, maybe you thought you were going to die at the moment of impact. Right? We think about the difference of scale and the difference of severity there where one is life threatening. And so when we think about things that could potentially be an index event, we’re thinking about things that could potentially be life threatening.
So, when we think about veterinary medicine, there are things that happen in the workplace that are potentially life threatening, right? You could be mauled by a dog, even if you’ve had a cat like attack you in the face, you know, and go at your eyes. If you’re a large animal veterinarian, you’re working with horses and you’re working with, with cows and bulls.
I mean, you’ve very likely had maybe some near misses or even some serious accidents that have happened to you. And so, getting back to this idea of PTSD takes two things. And one is having an index event that happens. And then there are symptoms that develop afterwards and that don’t go away over time, right? So if something’s minor, let’s say you get bitten on the finger by a dog may hurt for a little while. You may need some antibiotics, clean it up, but you know, the next day you’re probably able to go back to work. On the other hand, if you were mauled by a dog at work, okay. You might be feeling some trepidation.
It might be hard to go back to work. And so you might even have nightmares about what happened. You might find that you avoid breeds that look like that particular dog. You might find that you don’t want to go into that corner of the office where the thing happened. You may find that a certain pitch of bark will, will, you know, just set you off and you feel like you can’t even stay in the room with a dog, even if it doesn’t resemble that.
You know, I mean, there are so, so many things that can like trigger the stress response in our bodies. And when we think about PTSD, those things are things that don’t go away over time. Like they stay with us for about six months or more.
Dr. Andy Roark: So, is is that so that was part of my question? So for example, I was visiting with my nephew. He’s six years old and he was he was around this weekend and we both got stung by bees. Yeah, we both got stung by bees. I shook it off much faster than he did. I have to say, I– not trying to, you know, flex on a six year old, but really, he was very dramatic about it.
And, and, so, he’s like, I don’t want to go back to, I don’t want to go back out in the yard. And, again, this is a six year old that we’re talking about. And Well, he will forget this probably by tomorrow, and so I’m assuming that. But he did. There is technically an index event, something bad that happened.
And then he did remember. And then he did not want to go back out to the yard. Surely that doesn’t rise to the level of PTSD, right? And then when we say, Well, what would be the difference? Is that the amount of time? Is it the severity of the index event? Are there are there caveats on that? I guess I guess where I’m kind of going with this is just sort of understanding, I mean, I’ve gotten, I got bit on the finger by an old cat one time and when I see old cats, I always remember getting, cause it was bad, and I always remember getting bitten, but I, I mean, it’s not, I wouldn’t call it PTSD, it was just, I, I learned a lesson kind of like burning my hand on a stove where I’m like, oh, I’m, I don’t want to do that again, help me, help me start to parse that apart,
Sharon Kramper: Yeah, some things are stressful, but they don’t rise to the level of being traumatic or resulting in like a cluster of symptoms. Generally, what we look at is what is your level of impairment afterwards, right? So let’s say that you did have something happen at work, and you found that you couldn’t get yourself to go back to work.
Well, we would look at that as like a level of impairment, right? If you, if you were trained as a veterinarian, but now you can’t go back to work, you know, we might start considering PTSD because the level of impairment of what happened…
Dr. Andy Roark: Yeah.
Sharon Kramper: is so high, versus, you know, is your, it was your nephew, right? You know, he’s probably gonna be able to go back out in the yard like you said.
It’s probably not gonna impair him, but there, you know, there are people who have things So, you know, a lot of the times when we are thinking about PTSD, we’re also thinking of examples having to do with like the military, combat, physical…
Dr. Andy Roark: Of course.
Sharon Kramper: assault, and things like that. And so we think about people who associate certain triggers, smells, sounds, types of people, locations, environments, with the thing that happened to them, the index event. And therefore, let’s say, let’s say they were in a car accident and now they can no longer drive, right? They’re too scared to get into a car. They’re too scared of what’s going to happen. And so that would really impair your life if you could no longer drive yourself anymore, right?
Dr. Andy Roark: Yeah, absolutely.
Sharon Kramper: That is one of the things that we look at with PTSD, we take into consideration is how impaired has your life been?
Dr. Andy Roark: Interesting. Okay. How much, how much of a prevalence of PTSD did you find in, sort of, in your research when we look at, at veterinary medicine versus, versus the general population?
Sharon Kramper: Yeah. So, in the research that I did, we collected stories from veterinarians, but also support staff. And we asked them to tell us about an event that had haunted them, right? Something that really stuck them. And We looked at those stories and we evaluated them for whether we felt that they were an index event, like I’ve been talking about, right?
Did something rise to the level? And let me tell you, so there’s actually A little detour here. There are four guidelines that we use when we’re considering whether something might be a traumatic event. And one is that the thing happened to you, right? Are you the one who got mauled by a dog, who got gored by a bull?
Did you witness something happen to someone else? Did you witness someone get mauled by a dog or trampled by a horse, right? That could be traumatizing. Did you hear about the violent and sudden death of someone who’s close to you? So this is not like grandma died of cancer and I found out.
This is like, I found out that, you know, my sibling was coming over to my house and I found out that he was shot dead in the convenience store robbery, right? It has to be sudden and violent and somebody who’s really close to you. And then the fourth thing that we look at that could be potentially traumatic events would be repeated exposure to extreme and gruesome things happening.
Like, for example, First responders having to pick up human remains or being exposed to stories of child abuse, right? We look at things like that, like this accumulated experience over time. a little bit more background on that. So in veterinary medicine, so one of the things that I was curious about is The I thought that there were things happening in veterinary medicine that might qualify as like these index events, but they don’t fit neatly into those categories that we just talked about.
And so we went through these narratives and read people’s stories and tried to see if they met the criteria for possibly being an index event. And what we found is that there were especially stories of people who had had a patient die during a procedure related complication that seemed really analogous to what can happen in human medicine, right?
Where doctors can lose patients and those can be considered traumatic events. But when you look at, like, the very strict definition of what an index event was, for a psychologist, it didn’t include anything about animals. Right? There was nothing, nothing saying like it was about having to pick up human remains.
Well, what about if you’re working in an environment where you’re seeing gruesome animal remains? You’re seeing, you know, big dog, little dog kind of things or car accidents and you’re being exposed to that. Or maybe you work in shelter medicine where you’re performing a lot of euthanasia. And so one of the things that I wanted to, to look at is are we making the bucket large enough as psychologists, right?
Do we maybe need to expand our criterion a little bit for what an index event is? And then, once we had an idea of we would categorize these different narratives that we had captured then I went through and analyzed for, we’d ask, also ask people what kind of symptoms that they’d had associated with that event.
So we were able to kind of calculate, okay, they’re having an event and they’re having a symptom, right? Because it takes both in order to have a diagnosis of PTSD. And so, we’re finally getting to the meat of this here. So, the prevalence of PTSD within the sample that I was working with, was 3. 6 percent if we only considered a very, like, small, strict interpretation of what an index event was, right?
So if we were only considering It’s like, humans. Let’s see if I can explain this a little bit better. So we actually had gone through the narratives and evaluated them for whether they met the strict criterion for whether they were an index event under, like, a very strict interpretation, meaning it was like you had to do something with human remains or basically there’s a human victim involved.
But what we did is we also went through and we re evaluated every one of the narratives for what if we consider animal victims Then, so basically if we expand this idea of what an index event could be that include animal victims, then what does our prevalence of PTSD look like? Does that make sense?
Dr. Andy Roark: Yeah,
Sharon Kramper: So it’s kind of like we figured out PTSD with a very strict definition that like psychologists are using, but then we also like I opened it up and I said, well, but what if we consider animals as victims? What does that do to the prevalence rate of PTSD within veterinarians? So we went from 3. 6 percent under the very strict interpretation of what an index event is, which is very similar to what you find in the general population, like everyone who’s not working in veterinary medicine.
But when we, when I expanded that definition of what an index event could be, the prevalence increased to 13. 9%, so just about 14%. . quite a difference. And what it means to me is that there are potentially a lot of people out there who have been impacted by traumatic events that have happened at work, but we’re not catching that.
Dr. Andy Roark: Hey guys, did you know that I have another podcast? I am the host of the Uncharted Veterinary Podcast with my dear friend, practice management goddess, Stephanie Goss. We have been answering questions for years. We started a year before Cone of Shame. I started doing the Uncharted Vet Podcast with Stephanie.
We take questions from our mailbag. We have listeners who write to us and they tell us about what’s going on in their practice and we try to answer their questions and they are all about communication, leadership, management, things like that. It’s about working with clients. It’s about working with staff.
It’s about working with your boss. It is about all of those sorts of things. We have everything from, trying to establish some trust in your team when you’re a brand new baby doctor, actually fresh out of vet school to managing an employee with mental health issues to how to give notice without, without the guilt.
If you are in a place, you just can’t be there anymore. We’ve got all that stuff. We’ve got hiring, firing, working together, working with clients, reviewing your systems, getting your practice to run smoothly and efficiently, and how to manage your time. All that stuff is there. Check it out. I said 250 episodes.
You can see what everyone is about, from the title because it’s what, it’s basically the question that we’re being asked. But anyway, it is a very popular podcast. I hope that you’ll check it out and enjoy it and love it. I just love making it. So anyway, I just want to tell you it’s there guys. Let’s get back into this episode. So help me with this a little bit, right? So we’re talking about PTSD. It’s really interesting when we talk about this way a big part of PTSD is in the response of the individual to the event and I’m not saying I’m missing is a choice that the person has but but, you know, two people could have a similar experience.
Like, you know, two people could be in different car accidents. They could be in the exact same car accident. And one person is going to be terrified to drive thereafter, and the other person is, is simply not. I mean, I would assume that that’s kind of the same thing when we talk about this with vet medicine, right?
I mean, there’s, there’s a, just because there’s a larger, there’s a, there’s a high percentage of people who could develop PTSD. A lot of, a lot of them presumably won’t, right?
Sharon Kramper: That’s correct, yes. Just because you are exposed to something that could be an index event does not mean that you are going to develop PTSD. And so there are like resilience factors, and I’ll be honest, I’m wading into a territory that’s not as familiar to me because we didn’t really look at resilience factors in my research, right?
But there are individual differences between people. There could be people who have been through similar situations in the past and they become more resilient as a result. Right? We’ve probably seen that in veterinarians or, or support staff who you know, they’ve been through it so many times that These things just don’t get under their skin anymore.
On the other hand, there may be someone who I’m thinking of like your nephew, right? If he’s never encountered a bee sting before, right? If you’ve never had something terrible happen to you, and all of a sudden, boom!
Dr. Andy Roark: Yeah.
Sharon Kramper: Your whole worldview changes, and what you thought was safe is no longer safe. And actually a lot of PTSD treatment tries to get at that, at how, essentially like the, what you believed about the world and your safety in the world has now changed.
And how do we, how do we go so essentially you kind of become more extreme in a way, right? Like nothing’s safe anymore. You, and so what we work with during treatment is how do we get you to a more realistic place?
Dr. Andy Roark: Right. Gotcha. Okay. So, when we look at, you know, just say that, that there is, that there’s a 14 percent chance of a vet professional being exposed to a potential index event if we use this sort of more broad, bigger bucket, as you said, sort of, sort of idea. Are there things that we can do for our teams or for ourselves to kind of say, well, hey, look, this, this exposure might happen.
Are there things that we can do to kind of, to prepare ourselves to, to maybe lessen our reaction? And again, I don’t say it’s not, it’s not emotional numbing, but are there conversations that we could have or just things that we could start to, I don’t, I mean, I’m thinking about, about training, you know, is there a, is there a way of sort of having at least conversations about what these things look like if we’re having at, at veterinary technician school or at veterinary veterinary school or, or for onboarding into, into working at the clinics?
Are there? Are there sort of expectations that we should set, or things like that? I don’t, I don’t know, and like, that we may be headed on a very gruesome path of bringing people in and, and exposing them to horrible things, or telling them about horrible things. I, I don’t know. Do you have any insight there?
Sharon Kramper: Let’s see. So first of all, I kind of want to go, go back and the, the 14 percent would be like the number of people who would actually be potentially diagnosed as clinically having….
Dr. Andy Roark: Oh, diagnosed. Oh, oh, I thought that was, I thought a percentage was coming in to contact.
Sharon Kramper: The exposure is much higher, right? Yeah. I mean, think about how many veterinarians are, but you know, like how many people you’ve worked with who’ve probably been exposed to something in the, you know, it’s much higher.
It’s going to be over 50%. but, but like you’re pointing out, like a lot of those exposures happen, but they don’t result in PTSD. So, how do we prepare ourselves, or how do we, because here’s the thing, is we can’t this is one of those things where we can implement all this safety, like safe handling guidelines as we want, and things are still going to happen, right? So we kind of, rather than trying to completely eliminate that from the workplace, because that’s probably not a reasonable goal, yeah, how do we prepare ourselves? So getting back to like, how would we treat somebody if they have PTSD?
And one of the things we do is prolonged exposures. Okay, I don’t know if you’ve heard about this, but so, a lot of times what happens is that the, the body, getting back to this idea that people start to avoid things that, that cause them distress. Because it’s related to the thing that happened to them, like avoiding a particular breed of dog or maybe the area in the hospital where the thing happened to them is as much as possible exposing yourself to that thing that happened.
So you don’t have to do it in a dangerous way. But It’s that sort of adage of getting back up on the horse again in a safe way so that your nervous system learns like that thing happened to me once, but it’s not going to happen to me every time.
Dr. Andy Roark: I have a friend who is terrified of roller coasters, and, and and she worked through it. And the way she worked through it was, at first, you would go to, like, the fair and just be there. And then, she would go and she would stand in line for the rollercoaster. Never intending to ride it, I’m gonna stand in line.
And then, you know, and then she kind of worked her way up like that of just, kind of this exposure to this thing until ultimately, she never got, she never got to where she loved rollercoasters, but it wasn’t this you know, debilitating thing. I think she felt compelled to sort of tackle this thing that, that she felt she was maybe overly afraid of in her, in her mind anyway.
And so that, that, that totally makes sense.
Sharon Kramper: Yeah, just said a really key word there, which is debilitating, right? It’s, it’s getting back to this idea of like the level of impairment that it causes. So if that thing is really getting in the way of you being able to go about and do normal things in your life, things that you want to achieve, things that you value that are important to you.
Like if you want to go to the fair, like, you know, the roller coasters there. Yeah, a lot of times it’s, it’s just a matter of deciding, right? I just, I don’t want to be afraid of that thing anymore to that extent. And yeah, exposures over time.
Dr. Andy Roark: I mean, I’ve seen vet professionals work through fear of cats or, I mean, through, like, again, I’m sure that, I’m sure people work through fears of dogs, but, like, the one I’ve seen and remember is someone who, like, they, they didn’t have cats as a kid, they weren’t very familiar but they wanted to be a companion animal veterinarian, and, and it’s one thing to say, well, this is, I, Yeah. I don’t want cats to be my primary focus. It’s another thing to say, I don’t want to see cats at all. And that person was like, I don’t, I don’t want to, I don’t want to be that way. But it was something where they, they had to spend time with cats. They had to, they had to be around them. And like, they would go, they’d go to my friend’s house, who had a bunch of cats.
They’d just kind of be there. And, and then they would sort of start to see them in the exam rooms and stuff like that. But it was, but it was very much just sort of a process through that. So I like this topic and then I think it’s, it’s important for us to be aware of kind of how we stress ourselves so that we can support each other and then also if there’s things that we can do to try to build resilience so that people don’t get sort of, blindsided and, and put into a bad place and then also I, I really love the idea that, that there’s always things that we can do to try to sort of work through these issues and I, I think that’s an important
Sharon Kramper: Yeah. Some, some of them. And then I do want to bring up, like, there is a whole other category that we found in my research of things like, losing a patient through you know, from procedural complications, right? That is the kind of thing that can be traumatic, especially if maybe there was like a medical error and, and that’s related to why the pet died or animal died.
And so, that’s the kind of thing where exposure to it, you know, that, that may not be the right route for getting that. Except, well, going back to surgery, right? Going back to surgery is going to be a route through it because you’re going to have many, many more successful surgeries, right? That one go well, but you take what you can learn and you go back to surgery.
But I’m thinking of, for some people, it’s just the getting stuck in like that mental state of you know, I did something wrong. You and I have talked about this before, that you get into like a negative cycle of yourself, right, all the things that you are, all the awful things that you’ve done in your life.
And so that might be the point in time when it’s good to get an outside perspective from like a mental health professional.
Dr. Andy Roark: Oh, that, yeah, that totally makes Yeah. Some, sometimes getting back on the horse is just like that. Maybe that’s not, maybe that’s not the immediate right suck it up kind of move.
Sharon Kramper: Going back to surgery is, but going back to like losing patients isn’t, right?
Dr. Andy Roark: No, exactly. Right. Yeah. Let’s not do it. Let’s just, let’s just not do that again.
Sharon Kramper: Right, yes, yes, and yet, every time you go into surgery, you are taking that risk.
It’s always going to be there, and it’s so hard to, it’s so hard to face it, and that’s one of the places where the mental health professional can kind of help you to get into a more neutral place about going into surgery and how do you handle the risk that you’re taking every time, what the outcome could be.
Dr. Andy Roark: Yeah, well Sharon thanks so much for being here. Do you have favorite resources in sort of the veterinary mental health kind of space? Yeah.
Sharon Kramper: Yeah, one of them that I would recommend that is very specific to veterinary professionals would be it’s called Lifeboat, L I F E B O A T and that is through NOMV, right? Not one more of that. And Lifeboat is a peer support application that you can find on the computer. and like if you’re seeking help for burnout, depression, anxiety, PTSD, you will be supported by peers who are also veterinary professionals and who can, who have been there, right?
They’ve been there, they’ve had their own mental health struggles, and they can help support you. If you wanted to go more broadly than veterinary medicine, there’s of course NAMI, which is also usually called, like, NAMI, I think, the National Alliance on Mental Illness, and they’ve just got a lot of great resources for a variety of different kinds of mental health issues.
And if you yourself were like, I really would like to find a psychologist, I would probably say go to Psychology Today Their website, they’ve got a, a directory of psychologists all across the country.
Dr. Andy Roark: Very cool. Cool. Thank you for being here. Thank you so much for sharing with us. Where can people find you online? And are you on LinkedIn? Are you out in the world where people can you re–
Sharon Kramper: I am LinkedIn, yes, yes, you could probably search for me as Sharon Kramper. But yes, I don’t have a very large social media presence, to be honest.
Dr. Andy Roark: We’re gonna, we’re gonna blow, we’re gonna blow you up. That’s, that’s what we’re gonna do. Great. Well, thank you for being here, guys. Thanks for tuning in, everybody. Take care of yourselves. I’ll talk to you later. And that’s what we got. Guys, I hope you enjoyed it. I hope you got something out of it. Thanks to Sharon for being here. Guys, thanks to you for listening. Take care of yourselves, everybody.
