The VBMA is the fastest-growing student veterinary organization with more than 3,000 members, and with chapters at all 28 U.S. veterinary schools and a number of international schools. Banfield Pet Hospital’s Chief Medical Officer, Jeffrey Klausner, DVM, MS, DACVIM, and I both participated again this year in the VBMA annual conference held in conjunction with the North American Veterinary Conference (NAVC) in Orlando, Fla., Jan. 14-18. We were able to meet with approximately 130 of the veterinary profession’s future leaders during their annual VBMA conference.

We took part in an evening speed-networking event, and presented lecture topics on the importance of preventive care and the value of lifelong professional development. Banfield Pet Hospital’s dedication to the future of the profession through Banfield student programs and our new graduate on-boarding programs were singled out as setting an example for the rest of the profession to follow.

Banfield looks forward to our continuing partnership with the VBMA and our joint efforts to develop leaders with the necessary communication skills, business acumen and leadership attributes necessary to meet the growing needs of our exciting profession.

~ Mathieu, 2007

When we have compassion fatigue as individuals, or it infiltrates the veterinary organization, many things happen. As mentioned above, the veterinary professionals become jaded about their work. Being dispirited, or no longer feeling that “calling” to help animals, can cause apathy which in turn can make the individual more susceptible to making clinical errors…they just don’t care as much. Certainly too many people on a team with compassion fatigue can contribute to a toxic work environment overall. Yet probably the biggest factor related to our practices’ success and the reputation of veterinary medicine overall is the tendency for team members with compassion fatigue to either discard acting respectful to clients, or be out-and-out DISrespectful to our clients. Besides the danger to the “big picture” of the practice’s success, this type of attitude or behavior can lead to an abrupt halt in employment at a practice, or ruin our professional career for good.

The danger is that it is very difficult for an individual to objectively gauge how well they are communicating with clients. Already in the shroud or fog of compassion fatigue, it becomes nearly impossible to look at ourselves in the mirror and gain an honest perspective on the person we put forward to those around us. Certainly if there are squabbles and run-ins among the team members, you can suspect that this type of behavior spills over into client communication. By the time a member of management calls out a veterinary professional for problems with client communication, it’s often been happening for a while, and negatively affected many clients before it came to the attention of management. This typically happens when a client finally launches a complaint, and the old adage is that for every one person who complains, there are ten others who would have liked to but didn’t. So it’s imperative that team members and management recognize when compassion fatigue is interfering with the level of client care provided by the practice. The personal symptoms of compassion fatigue give us a guide to determine if compassion fatigue is negatively affecting our client communication.

• Bottled up emotions: when a team member is holding in his or her emotions for too long, s/he finally explodes; this does not only happen in “the back” but can occur during interactions with clients. A team member may respond with anger, frustration, or even grief that is much stronger than the situation calls for. The reaction is blown out of proportion.

• Impulse to rescue anyone (or anyTHING) in need: at our very core, we want to help animals. This impulse is put to the test when a family cannot afford or chooses not to pursue treatment for their pet. In this situation, team members become tempted to ask to adopt these animals, rather than see them humanely euthanized. This becomes a problem at many levels. In regards to the client, this family who might have had extreme difficulty coming to this conclusion is now faced with the decision to keep their pet alive, but living with someone else. This may be a conversation that the practice wants to avoid altogether, in which case a policy should be constructed to protect both the family and the team member.

• Isolation from others: there are team members who tend to thrive on the fringe of the group, and they may have been like that from the beginning. Then there are those who may begin pulling away as compassion fatigue takes hold. This can be recognized by other team members, because it affects their relationships. This isolation can in turn make it more difficult for this team member to connect with clients. They will sense this separation, and may not have the level of trust in this team member.

• Sadness and apathy: it’s obviously difficult to communicate with others when sadness is a pervasive emotion. Yet apathy is even more dangerous. Clients can sense when someone doesn’t care, about them, their pet, or the outcome of the visit. These clients will be reluctant to agree to the care that is being recommended, and more likely to find fault with the services. At the bottom of most all complaints is the simple fact that the client didn’t feel compassion from the team member. Apathy and compassion do not often coexist.

• Feeling the need to voice excessive complaints about management and coworkers: while we may only think this affects the world “behind the scenes”, it can go way beyond this and creep up front. When team members feel pressed into a corner by a client, for example, they are more likely to blame the practice’s policies, the management itself, or even their coworkers. The motto “it’s not your fault, but it is your problem” is one that needs to be grasped by team members; even if they were not involved in the specific issue mentioned by the client, they are responsible for finding a way forward to an agreeable end. This acceptance of responsibility won’t happen with team members who are experiencing compassion fatigue.

• Lack of interest in self-care practices: we communicate by words of course, but this is only 10% of the message we send out. The majority of the message is body language. When team members cannot rouse themselves to take care of their personal needs such as hygiene and appearance, this sends a message to our clients. It demeans the professional atmosphere and can lead to mistrust. Everything in the practice affects the client experience, especially the people they come into contact with during a visit.

• Reoccurring nightmare, flashbacks: when a team member is experiencing these more severe symptoms of compassion fatigue, they will come to believe that if they do not connect, they may be able to avoid these “hauntings”. Again, apathy becomes the safest way to reduce the negative effects of forming relationships with clients. The connections become very superficial, if they indeed fit the definition of “relationship”.

• Persistent physical ailments: a team member must be physically present, in the best shape possible, in order to form healthy connections with clients. When a team member is not feeling their best, they can’t put their best foot forward with the client interaction that is part of their job. If the ailments result in absences, they aren’t there to serve your clients at all!

• Difficulties concentrating and mentally tired: a team member is responsible for taking information from the client, and relaying it to the rest of the team or assessing how it will affect the animal’s care. This requires concentration, and the ability to be mentally alert to absorb the details and process the impact of this information. This cannot take place with a team member who has “checked out” mentally.

• Prone to accidents: when a team member is involved in an accident with a patient, such as becoming bit or scratched, this information must be relayed to the client. In some states, it’s a legal requirement to report all bites, and the authorities follow up with the family. Otherwise for the sake of the team member’s health and recovery, often times the family needs to understand how their pet was involved. It’s not the fault of the animal if the accident occurred because the team member wasn’t concentrating on proper restraint, for example, yet the client becomes negatively affected. Injuries are bound to happen at times, but a rise in these types of accidents will have a trickle-down effect on the clientele of the practice.

Compassion Fatigue may begin as a “personal issue” affecting an individual team member, but as it takes root it affects the person’s behavior, attitude, and interaction with others. This includes our clients, the pet owners we are committed to helping with the animals they love. This ability to help requires a connection, both emotional and intellectual, in order to best serve the pet and the family. When compassion fatigue exists, these connections become difficult if not impossible to generate and maintain. This negatively affects the veterinary practice and its success, and also dooms the individual veterinary professional to a myriad of unfavorable outcomes.

The first step is to recognize the effect compassion fatigue is having on the individual, and sometimes this is initially made apparent by client complaints regarding communication with the veterinary team and a team member in particular. Take these complaints seriously; solve them to the client’s satisfaction, but then move beyond to examine the root of the issue and perhaps discover the individual on the team that needs to become aware of how to recognize and recover from compassion fatigue. In a very real sense, we’re all in this together!

Resources:

Healthy Caregiving by Patricia Smith

There is a great AAHA article about life stages that includes a table of their classification system.

Knowing that Sami is at the chronological equivalent of an 80-year-old human highlights all of the changes she’s experienced over her lifetime.  As a kitten, she learned so many things.  Sami learned to run, jump, and play, how to use the litterbox, and how to eat solid food.  She was also one of those kittens who climbed up your leg to sit on your shoulder the minute you came home.  During this life stage, kitten vaccines and deworming were at the top of the list.  Then it was time for her spay. I paced and paced until the procedure was done, then rushed in to hold her during recovery.  I tell my clients not to worry about being needy and nervous, that they don’t hold a candle to how I am when my own pets are on the surgery table!

Things were pretty status quo during the junior and prime years.  Routine wellness care, the occasional bout of hairballs, and fights with her sisters were her only trips to the vet school with me.  She moved to a few different houses and dealt with various dogs and cats that my roommates brought along.  Things continued to roll along during her mature years.  She began to be challenged by obesity so I put her on a diet.   Sami went back to being a normal sized kitty although her pooch remained.  She even handled a move across the country in her usual Sami style.  She hung out on my lap and shoulder for three days of driving.

In her senior years, Sami began to have problems.  The first was vomiting and diarrhea which began occurring on a fairly regular basis.  Bloodwork, radiographs, urinalysis and culture, ultrasound were all normal.  The diagnostic rule-outs that we think about in older kitties such as hyperthyroidism and renal failure didn’t appear to be a cause.  The oncologist was very worried it was early lymphoma; I hoped for everyday ordinary inflammatory bowel disease.  This went on for about 6 months, then spontaneously resolved.  I definitely gained a new appreciation for the frustration my clients went through when dealing with the ups and downs of life with a senior pet.

Next was the torn Achilles tendon from racing away from the dog.  It really hit me when the surgeon asked how old she was to determine her suitability as a surgical candidate.  The first thing I said was she’s young.  He asked how old.  I replied, 14.  Ok, that really hit me.  She wasn’t young.  My Sami was old.  My purring, climbing, scrawny kitten had turned into an old lady, seemingly overnight.

The Banfield Applied Research and Knowledge (BARK) team report confirmed my experience with Sami and the life stages of disease.  You can read the whole report at here.  As a practitioner, I always suspected that hyperthyroidism and renal disease were the top concerns, but these numbers prove it.  The proportion of these diseases in cats younger than 10 years was essentially negligible, where the proportion in cats over 10 years was 7% and 8% respectively.  Malaise and heart murmur were also overrepresented in older kitties.

Why is this important for Sami and our geriatric patients?  Early Intervention!  Diagnosing hyperthyroidism early can have tremendous benefits.  Treating these cats early can prevent some of the long term complications associated with the disease.  These younger cats are better candidates for I-131 therapy which can be a cure in lot of cases.  With renal disease it is a bit trickier.  This progressive disease isn’t curable, but diet can have a tremendous positive impact in longer term quality of life for these cats.

One important lesson I have learned from our research is that even with all of the trouble it takes to bring in cats to the office, it is well worth it.  These early detection tests are crucial to maintaining a long, high quality life which falls in line with my experience as a 10 year veteran of veterinary medicine.

This is the basis of evidence based veterinary medicine: augmenting experiences and observations with the use of hard evidence.  Banfield is unique in the world of evidence based medicine in that we have millions of records in which we can perform this kind of research.  The State of Pet Health Report referenced above contains a wealth of information in what we have found in these records.  Additionally, you can check out this website on evidence based veterinary medicine.

My parting thoughts are that we must embrace every life stage of our cats as we should do for ourselves.  With preventive care maybe someday for cats, 20 will be the new 15.

Now this is someone I’ve known for 13 years and have lived in the same town with him for the last 4-5 years.  We’re not best friends, but we know each other well.  I also know how his family feels about this pet, especially considering that they have four children.  When I called him to tell him what I found, I realized that I had slipped into “doctor mode” and was talking to him like I would talk to any other client.  I had to work hard to change my voice and pattern into something more familiar and friendly like I normally talk to him.  Honestly I don’t think he noticed, but I certainly did and I didn’t want to sound that way to him.  It actually bothered me, as I felt that I should be talking to him as a friend and not just a vet.  Yet I found it difficult to change my way of speaking and was fully in my professional stance.

It can be strange how your professional life and attitude infiltrates your personality and can cause a change in your behavior without you realizing it.  I often say that being a vet is what I do, not who I am.  But maybe I’m a little in denial and at least in part it has become who I am.  Thought it may be a part of many veterinarians and other doctors, we need to be aware of our speech and how we talk to clients.  We certainly want to be professional and authoritative, but we need to keep the compassion and understanding in our speech.  Our clients will appreciate us most when we find a way to blend the two modes.

Since the advent of the internet, clients are more educated with regard to their pet’s health and they want to know how to prevent their pet from getting sick.  As such, veterinary professionals need to not only provide adequate and correct information, but we need to help facilitate informed decisions, especially concerning preventive care recommendations.  How do you answer a client when they ask, “What is the chance of my dog worsening if we’re unable to administer the medication?” or “What is the chance of my cat getting diabetes from being overweight?”  It can be difficult to answer these questions since no one can predict with certainty the outcome of any intervention for any pet. 

Even so, being an effective communicator helps clients understand their pets’ risk for disease(s).   Clients need to understand disease risk in order to fully embrace and accept the need for preventive care (e.g., dental prophys, year-round heartworm protection, nutrition/weight management – all things that cost money and/or require frequent office visits and time); otherwise, why should clients care?

As the most trusted professionals in a pet’s life, veterinary professionals are critical in helping clients understand the benefits of preventive care.  For instance, knowing that poor oral care (e.g., dental tartar buildup) is associated with periodontal disease, which is linked to cardiovascular disease, can be extremely persuasive in helping clients concerned about anesthetic risk decide whether they should pursue dental prophylaxis for their pets.  Periodontal disease is the most common chronic infection affecting dogs and cats, yet it is completely preventable!  Consequently, we need to be prepared to discuss risk of disease versus risk of anesthesia-related death.  Whew, this can be a complex, emotional and time-intensive conversation!

To overcome challenges involving discussions on disease risk and benefits of preventive care, visual aids can be useful. Aids, such as risk charts, are simple to comprehend and can help in shared decision-making while encouraging dialogue between the veterinarian and client.  They take data and turn them into meaningful and understandable information.  It might be hard to express that there’s a X% risk of periodontal disease but only a miniscule (< 1%) risk of death due to anesthesia, and it may be even harder for a client to appreciate the difference. However, when those risks are displayed, whether in a pie chart or other graphic image, such visuals can not only facilitate the discussion but can also help clients better picture and then weigh the pros and cons.  

Risk communication using visual aids has great potential to strengthen veterinary-client-patient relationships and promote preventive care for pets.  As you work to develop and improve your veterinary-client communication skills, consider learning more about this and other risk communication strategies that can help you deliver the best available evidence on treatments and/or interventions to your clients.

During my first semester of technician school, I started at Banfield. That was just under six years ago. Banfield was my first experience in a veterinary hospital. I was so excited! I quickly began to enjoy the fast paced environment as well as the variety of cases. My experience with Banfield helped me excel in the veterinary technician program. I have also gotten to witness the practice evolve over the years. We now offer continuing education courses for our technicians, up to $200 for continuing education, reimbursement for license and license renewals, and we now cover certification exam fees! Wow! Banfield also offers technicians BLC courses which reinforce the learning we acquired in school.  We utilize our technicians in this Practice. Here at Banfield, the technicians have a lot of responsibility. I know that I would not want to work for a practice that didn’t utilize me. I personally enjoy the technical aspect of my career. The responsibility I have makes me feel valued in my career. The Practice trusts me to do what I was trained to do, and I take pride in being good at my job!

I moved from a Veterinary Assistant to a DPN within a matter of a few short years and have now since moved into a Field Trainer role. I have had the opportunity and privilege to continue to grow and develop within Banfield and that gives me great job and personal satisfaction. Now it is my turn to give back. As a field trainer, I enjoy working with our hospital leaders and teams and giving them the tools and development needed so they can be successful in their roles. Although I am no longer working directly with pets, I do my part to advocate by engaging our associates, ensure our teams are ExCeeding our clients expectations as well as give them the tools and resources necessary to deliver quality preventive care. I continue to look forward to my future with Banfield as a Certified Veterinary Technician.

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