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Wellness

“What Can We Do?”

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I have a bad habit of checking social media first thing in the morning, which I know can really set the day off on the wrong foot. This morning, I woke up to see a post from a veterinarian friend that she had two veterinarians in her life commit suicide this week.

As I read the many responses, one stood out to me above all the messages of condolences: “What can we as a community do?” This was not from a fellow veterinarian. This question came from a client, a neighbor, a friend.

As a veterinarian, I am well-aware of our profession’s mental health crisis and try to educate my friends and family about this problem. I have read the growing number of journal and news articles that try to bring awareness. I’m glad we are talking about it, but a lot of veterinarians still feel that the public “doesn’t get it” and “never will.”

But as that one response showed me, there are people asking to understand. There are people who want to help. We need to let them in — to share with them the good, the bad, and the ugly of our daily lives as veterinarians. Yes, there are some things that can never be understood by someone who doesn’t work in the field, but if we as a veterinary profession continue to be open, we will expand our community to include the clients who care deeply about us.

So welcome to the community, my non-veterinary friends. Wondering what you can do to help? Here are three ways to start:

1. Social Media: Think before you respond.

I also woke up to a text message from a veterinary technician friend asking my opinion of a recent viral social media post about alleged negligence on the part of a veterinarian. Sadly, many times, these two situations are linked—a viral social media post condemning and vilifying the veterinarian involved and the end of that veterinarian’s life.

I had seen and read that post. The first time I read it, I was angry and disgusted. But I’ve had time to think about it, and I knew exactly how to respond: “It does sound awful, but I always try to remember that there are two sides to the story.”

I’m not saying there aren’t veterinarians who make mistakes and try to cover them up or even at times do things maliciously, but they are the minority. Yes, veterinarians make mistakes — we are human. Sometimes, no matter how hard we try, those mistakes result in the loss of a beloved family member. But vicious attacks against the person who made that mistake won’t bring that pet back and may just result in the loss of another life.

So, dear clients, think before you pile on. There are always two sides to the story, and as medical professionals, our hands are tied with how we can respond. For more on this check out Dr. Nicole Palumbo’s post on “How to Decode a Bad Review.”

2. Dilute the negative reviews.

In vet school, we are taught that “the solution to pollution is dilution,” when learning how to manage infected wounds. In essence, flush out all the bad stuff with even more good stuff. This lesson gives the clients and friends who love us a chance to actively do something to help.

Have you had a good experience with your veterinarian? Was there a technician or other staff member who went above and beyond for you and your pet? Tell the world about it! Take a few minutes to write a positive review on your veterinarian’s website or Facebook page. Be specific and use staff names if you remember them.

Doing this will not only help to overshadow the inevitable bad reviews, it will give the veterinary team something to look back on when times are tough.

3. Send a thank you note.

I have a box of all the thank you cards I have received in my nearly six years of practice. I treasure each one and review them from time to time when I’m having a really bad day. I receive many verbal thanks and hugs after successful treatment of a sick patient or the peaceful passing of a beloved pet through euthanasia, but having a written note, something to physically hold on to, in the midst of a bad day makes a difference.

Consider sending a special technician or receptionist a note as well, or mention them by name in a card to the clinic. They receive even less thanks for their hard work than we do, and we could not do our jobs without them.

So, I invite you, my non-veterinary friends, to become a part of the veterinary community at large and help support us so that we can continue to love and care for your pets and you. And please, keep asking us what you can do to help.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

ABOUT THE AUTHOR

Dr. Kate Boatright, a 2013 graduate of the University of Pennsylvania, is an associate veterinarian in western Pennsylvania. She practices small animal general practice and emergency medicine with special interests in surgery, internal medicine and feline medicine. She is actively involved in her state and local veterinary medical associations and is a founding member of the VBMA Alumni. She is passionate about the veterinary profession and enjoys educating both members of the profession, students, and clients through writing and speaking. 

Media’s Emotional Blackmail Is Killing Veterinarians

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A previous version of this article first appeared on Medium.com.

Emotional blackmail is the new term being used to characterize the pressure that clients put on veterinarians to care for their pets, to feel guilty about charging, and for making money. It has catapulted our profession into a crisis of burnout, compassion fatigue and suicide.

Veterinarians are currently the profession with the highest rate of suicide. There are so many factors that contribute to making this profession the hardest job you will ever love.

One new aspect is media reaction. They are killing us. Literally. There have been several high-profile stories in the press recently where a pet owner takes a sick pet, often a puppy, to the emergency hospital for treatment. The owner is given a quote and cannot afford to pay. The puppy is sick enough that, without treatment, it will die. The veterinarian, who has likely been through this heartbreaking scenario countless times, tries to offer options to save the puppy. They are likely even a bit blinded by the fact that they just can’t euthanize another puppy that could be treated and have a happy life. They will go over third-party payment plans (they exist), asking for help from family and friends, Go Fund Me campaigns, trying a less expensive treatment option that is not optimal or euthanasia. The last-resort option is to have the pet surrendered to the hospital to try to find a rescue group or owner (often someone who works at the hospital) who will assume financial and legal responsibility for the pet. Hopefully, the treatment will be successful and the pet can be rehomed. This is a monumental effort on the part of the veterinarians and staff that try to make this work, and likely costs the hospital money. Veterinarians are not looking for more homeless sick puppies to rescue. We don’t want this.

The pet is surrendered to the hospital and no good deed goes unpunished. The pet owners, justifiably heartbroken by their loss, will sometimes go to the media — particularly social media — who jump on the bandwagon to try to get their puppy back. This scenario will invariably vilify the veterinarian and staff, who have gone to great lengths to save this puppy’s life. Some of them have done far more than the previous owner was willing to do. The media are executing emotional blackmail here, and it is on a massive scale and generally brings in our friend, the Internet. The Internet will then be let loose on the veterinary hospital and staff with unrelenting trolling. When stories like these break, veterinary staff have had to endure no end of online abuse, terrible reviews and even threats to their personal safety. Some hospitals have had to close temporarily to weather the storm.

There is no effort on the part of the media to try to educate the public that veterinary care is expensive, especially the lifesaving emergency care at 24-hour hospitals. There is no effort to educate the public about the responsibilities that go along with pet ownership. There is no effort to educate the public about pet insurance, which exists. (And no, you can’t get it after your dog is sick, which is an amazingly common question and also fraud.) There is no effort to discuss why veterinary care is expensive, or the resources that go into caring for your pet in this setting. Everyone is just angry that it costs money and they direct this anger at the people who are trying to help.

There are several results of this irresponsible reporting. The obvious one is the direct damage to the veterinary hospital and staff. There is also the widespread damage it does to all veterinary professionals when they receive the message that what we do is not valuable and should not cost money, and that we are terrible people who are only in it for the money. Suggesting we are only in it for the money, or that if we cared for animals we would do this for free, is laughable to any veterinarian. We love animals more than anything. We have made caring for their health and welfare our life’s work. We have given up so much to do this. How dare anyone suggest otherwise, just because we also have to charge for our services and, at some point, make a living and pay off our huge student loans?

The unintended consequence of “news” stories like these is that many veterinary hospitals are having to change their policies so that surrender and rehoming these pets is no longer an option. This brings us back to the previously stated options, which are third-party financing or euthanasia. So, along with killing veterinarians, these stories are also killing pets. Thanks, media. I know that puppies and heart-wrenching stories like these make for great TV, but I am begging you to report on these issues more responsibly and to think about the destruction you’re leaving in your wake as you move on to the next big thing. We are still here, trying to care for animals.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.


TISI: I’m Tired of Bullying in Veterinary Medicine

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Mental health. Self-Care. Anxiety. Depression. Suicide.

These are all words that have come to the forefront of veterinary medicine in recent years. It is finally a topic that is being addressed in seminars, conferences and articles. It is a real problem.

I have heard many theories about why it is such a problem in our field. Intense/Type A personalities, chronic stress, high debt to income ratios, long hours, the desire to help everyone, mistreatment from clients, the loss of patients, coping with disease day after day… the list goes on. Many of us had some level of depression or anxiety before we went into vet med, so perhaps it is an even deeper issue of the types of people drawn to this field?

This last week, another factor has been on my mind. One that seems to be discussed less than the rest, but one that I suspect may be one of the biggest contributing factors. Maybe it is even an elephant in the room, and I’m not supposed to bring it up?

What is this factor? It isn’t what the world brings through the doors of our clinics. It is what WE bring through the doors of our clinics. It is work place bullying and emotional abuse, and I think it is a bigger problem than we want to admit.

This can occur in a number of forms, from a head tech bullying other support staff, to managers, owners and veterinarians bullying the other veterinarians or clinic staff. I am not talking about the occasional harsh remark or bad mood, I am referring to targeted-ongoing abuse.

This week, a technician I know and deeply respect was targeted, blamed and humiliated for a mistake that was absolutely the responsibility of the veterinarian she was working for. She was shamed and reprimanded by one veterinarian while the responsible veterinarian stood by and said nothing. Later, she was told that she would not be allowed to explain her side of the story and was demoted.

This cycle can become frighteningly similar to domestic abuse. The abuser gains a position of power and uses it to crush someone who doesn’t feel they can stand up to them. And the behavior continues. The victim is torn down enough that they feel they have little or no worth, and have nowhere to go, because who would want them? Some victims are in a healthier place and deal with or leave the situation quickly. Some stay until they can’t take it anymore and have to get out. But then, how to get out? How do you muster the strength to take a chance on finding a new position and moving on when you’ve been convinced you aren’t of value? What if you are dependent on the abuser for a good job reference? Some choose the ultimately tragic way to get out, having been effectively taught that their lives have no value.

In these situations, abuse from clients or the loss of a patient may be the straw that breaks the camel’s back, but perhaps we would all have more reserves to handle these situations if we built each other up instead of tearing each other down.

I hope that many who read this will not have experienced these issues, but I suspect the vast majority of people in this profession will know exactly what I’m talking about.

Perhaps the bullies in our clinics learned this habit from being bullied themselves? Perhaps it is an expression of “imposter syndrome,” the fear that we aren’t really perfect and someone will find us out? 

Fellow veterinarians: We work in a small world. The words we say about each other not only erode the public’s trust in our entire profession, but they can quickly get back to the veterinarian being talked about. Let’s stop tearing each other down. And let’s stop allowing bullying in our clinics.

We need to be aware of what is happening within our own walls. We need to pay attention to our managers and people in lead positions. When staff complains about being picked on or bullied, it should raise a red flag. 

Clinic owners, please learn to be leaders, not just bosses. Don’t let your managers (or clients) tear down your associates and support staff. Don’t feel the need to prove how much more skill and knowledge your experience has given you than your younger associates have. Don’t tear them down to build yourselves up. Support and teach them. Build them into great veterinarians. 

Veterinarians, remember that our techs are the backbone of the clinic. They catch so many of our mistakes for us that we can’t afford to blame them for the one they might miss if it was ultimately our mistake. We need to be leaders, admit our own humanity and admit our own mistakes. We need to eradicate the cycles of abuse from our clinics. Maybe if we are intentional about what WE bring into our clinics, maybe we’ll have the emotional reserves to handle everything else that comes through the door?

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

The Growing Pains of Setting Boundaries in Veterinary Medicine

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I’m sitting in the car and crying outside of my daughter’s school. I’ve just left work and made my way to her school for her annual talent show. We are doing an aerial yoga routine together that we have been practicing for 2 weeks. I know that she’s inside nervously waiting for me and I’m trying to get a grip on myself before I go in. I don’t want her to see that I’m a mess and that I’ve been crying because there’s no way I can explain to her why I’m upset that won’t make me seem like the worst parent ever.

Let me explain; Buster is making his way to the hospital. He’s in pain and his mom is ready to let him go. Buster who I have been taking care of for the last 10 years. Buster who I’ve seen through countless ear infections, 2 sarcoma removal surgeries, chemo, radiation, heart disease, periodontal disease, and now a hemangiosarcoma that showed up on his leg overnight. I love Buster and I love his momma who is a sweet, dedicated and understanding lady. It took everything in me to say no, I can’t stay to euthanize him, the ER doctor will have to do it. And now it hurts. I’m in, what can only be described as heartache and I feel terrible. Not only that, but I feel terrible that this feels so terrible. My daughter and my husband are my priority and I’ve made myself a deal to act that way and to show them that they ARE my priority. I just didn’t know that it would hurt so much.

I’m having serious growing pains. Growing pains for setting boundaries with myself, my staff and my clients.  

As we start to dive deep into mental wellbeing in the veterinary profession you hear this all the time: “You need to set boundaries,” “you need to leave work at work,” “you need to learn to say NO when you need to.” However, no one ever tells you how and no one ever tells you how painful it is going to be as you begin to do this.

It is hard. And painful. And necessary.

It is necessary because if we do not have boundaries, we will put work first. And we will hurt those we love the most, including ourselves. If we are to live our life by design that means we need to be purposeful about the boundaries we place on our personal time. We need to actually think about what we want to spend our time, energy, and brain power on when we are not at work. We need to think about our loved ones and what they mean to us, and how do we want to spend our time together. So, for me, this means setting the following boundaries:

  • Leave work on time or as close to as possible. Sometimes I need to finish my notes after my “done time” so I put headphones in to block out the noise but also to signal to my staff that I am officially out of office and all calls/questions need to be directed elsewhere.
  • Leave work at work. No phone calls/texts/emails or updates about my patients when I am out of office. No looking up lab work or emailing clients on my off time. Re-route my brain when it starts to think about work when I am at home (be present).
  • Prioritize school/kid events in my work schedule and get there on time!

Once these boundaries are made within you, it is then time to share them with your staff. After all, you have been acting and doing things that go against these boundaries all along and if you don’t share them they will have no idea that they exist. It is time to be open and honest about what your new boundaries are and why they are important to you. Share what they mean to you and to your family. In my case it means that my husband and daughter get to feel like they are important to me, that they matter more than my work and to them this translates to love. For me it means that I get to spend my time with my loved ones without worrying about what is happening at work or with my patients so that I can take care of my mental wellbeing which enables me to continue to give.

Once you have shared your boundaries and the reasons for having them, you can then ask for help and understanding that when you do (and will) say no, it is never because you don’t care. It’s just that you need to take care of yourself and the people at home waiting for you.

This is life changing work we do.

You got this.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Can You Care Too Much? How to Draw the Line So You Can Keep Going

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With trembling hands and red eyes, the veterinarian looked at me pleadingly. “I have 12 pets I never even meant to have. There are IV bags that just stay hung up in my bathroom. I work all day, and then I go home and take care of animals I took in because clients couldn’t pay for them. I’m broke… and I’m tired… and I care so much it’s making me miserable. What do I do?”

For the majority of us in veterinary medicine, our challenge is not failing to find compassion. I think most of us came to this profession because compassion comes easily to us. Instead, we struggle to put boundaries on that compassion so that we are not emotionally wrung out day after day.

When that veterinarian confided in me, I remembered the first time someone told me, “You can’t love a pet more than its owner does.” I was volunteering as a veterinary assistant at the time, and I’ve heard it hundreds of times since then. But the truth? You can. And you will. And it will be a depressing experience.

Caring deeply for the pets of owners who are not able or willing to provide the care their pets need takes an emotional toll on all of us. We have to find a way to create emotional boundaries. So, how do we prevent ourselves from giving and feeling to the point of burnout, resentment, or even depression? For me, the answer lies in what I think of as the paradox of the special pet. Please hear me out… here’s how it goes:

The key to “not caring too much” is not withholding compassion. It’s realizing the truth about all living things. You can believe that each creature you encounter is special and wonderful. You can celebrate the beauty they add to the world. You can love each animal as much as you want. You can know in your heart that this patient is special.

And that patient is also not special. That is, to be happy and healthy, you must know that because all living creatures are special, none are special. Think of how many animals you’ve known in your life already. Now think of how many animals there are in the entire world. Pets are good, beautiful souls, and at the same time they are drops of water in an ocean: unique, countless, and fleeting. Even the most “special” among them lives and dies, and new “special” creatures are born every minute. The existence of a living being, in some ways, is the least special thing of all.

So, you can love a patient and at the same time still know that the animal is a tiny glimmer in an endless sea. No matter what we do, this patient’s life will come and go, and we’ll have thousands more to tend to. You can’t reach the impossible goal of doing enough to save them all, because none of us ever will. Twelve pets and an IV pole in the tub is not “enough” because “enough” isn’t something any single one of us can attain. Does that sound harsh? I don’t mean for it to. I mean for it to help you set yourself free from the need to take over for every pet owner who can’t or won’t care for their pet.

You might try this as a silent meditation whenever you need it:

All creatures are special
No creatures are special
This moment is temporary
All creatures are temporary

You cannot cling to individual drops if you want to keep your head above water. That’s the paradox of the special pet.

You are doing an ocean of good, and you deserve peace and strength. I hope this way of thinking can help you find it.

Are You Your Worst Enemy? Be Aware of Your Self Talk

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As a veterinary mentor and wellness coach, I regularly speak with veterinarians who are impacted by negative self-talk. Veterinarians often get into the habit of judging their abilities/performance and ruminating over their actions. Frequently, we are our own worse critics.

Being a vet comes with great responsibility. We are often faced with life or death situations as well as the need to counsel clients on grave medical issues. Evaluating the pros and cons in a case is an essential part of practice, so is reflection on the outcome. Too often in situations with less dire outcomes, we are susceptible to unproductive self-talk:

“I’m so dumb. What am I doing? I don’t even know what I’m treating.”
“Why does Mrs. Jones want to speak to me? I must have messed up with Fluffy.”

Negative self-talk is common during times of stress or when we’re overwhelmed. It can be the first indicator that you need to evaluate your current situation. It’s totally normal that we accept these thoughts as reality. After all, how many of us are used to debating that little voice in our head? However, that is exactly what needs to happen. Challenge the thoughts or statements that pop-up in your head! Don’t let them affect your confidence, feelings, mood, energy or behavior.

It’s easy to inadvertently develop a habit of over thinking – or more importantly, judging our own actions. When you buy into the “story” in your own head, you start down a slippery path of self-doubt, often to the point that impacts confidence or you become too anxious to act.

The high incidence of veterinarians who suffer from “perfectionism” and “imposter syndrome” are well documented.(Perfectionists aim to be flawless, have incredibly high standards for themselves and tend to be self-critical. Imposter syndrome (IS) has more to do with feelings of inadequacy and worthlessness despite having accomplished significant achievements requiring hard work and competency.) Individuals with IS have a huge fear that others will discover their perceived deficiencies. It is interesting to consider the involvement of unbridled negative self-talk in the development or persistence of these conditions.

The first step when the voice in your head starts to criticize is to challenge it!

How true is it? Other than the feeling or emotion it creates in you, what is the true evidence? (We are scientists after all.) I find writing a list of daily successes, accomplishments, activities or simple “whatever has gone right that day,” is a quick tool to discover reality, bolster your confidence and refute your thoughts. Write it down – it’s not as effective listing things in your head. Firstly, one doesn’t realize the number of items in each list over several days. Visualizing these accomplishments is powerful. Secondly, when one is facing a barrage of unproductive thoughts it is helpful to get “out of your head” and engage your prefrontal cortex, that part of your brain responsible for logic and reason.

Don’t succumb to negative thoughts. Catch this cycle early and question the reality of what is going on in your head. Awareness is helpful in preventing the escalation of negativity that is draining. Creating behavioral change can often be difficult or feel strange, uncomfortable and impractical. There are numerous resources available to support and guide you. There are too many incidences in the veterinary field of mental illness, burn out etc. to sit back and think “it won’t happen to me”. The best way to ensure you will never become a statist is to act now!

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

ABOUT THE AUTHOR

Dr. Kimberley Khodakhah is both an established Small Animal Veterinarian and a Veterinary Mentor and Wellness Coach. She is passionate about veterinary medicine and works with others in the field to make this a satisfying and sustainable career. (www.vetopia-inc.com) She works part time per diem in New York were she lives with her 2 and 4-legged-family.