We all can relate to this, particularly when the work load overwhelms our ability to do it all…and maintain a good attitude at the same time! The good news is that burnout is a process, not an event, and is marked by physical, emotional, and behavioral indicators that can be easily recognized. If we remain aware of our response to the increased workload, we can keep burnout in check by utilizing these coping methods:

• Accept that the situation itself is stressful
• Share your feelings with a trusted friend or colleague
• Enhance your communication skills to lessen feeling of being unheard
• Initiate positive action to change your environment
• Suggest solutions to proper management
• Care for your personal needs (i.e., good nutrition, hygiene, exercise)
• Take time away from your stressful situation, and allow others to help

So then what is this new term, compassion fatigue? As a perfect example, burnout and compassion fatigue were contrasted by member of the “human” medical profession: Burnout results from stresses that arise from the clinician’s interaction with the work environment…while compassion fatigue evolves specifically from the relationship between the clinician and the patient.  ~Kearney et. al., 2009

When the workload is heavy, the hours long, the coworkers grumpy, the equipment shabby, those are all examples of the work environment causing stress, i.e., burnout. But compassion fatigue is different; it’s about personal relationships with your clients and patients. It would stand to reason then that you have some measure of control over burnout. You can use some of those coping methods listed above, and make appropriate changes to your work environment. In fact, you can change your work environment altogether by quitting and getting a new job. Burnout is more about WHERE you work.

But compassion fatigue is more about the work you DO, and as long as you remain in a care giving role, you will need to be able to recognize and minimize compassion fatigue. First, how do you diagnose compassion fatigue? Here are the some of the symptoms:

• Bottled up emotions
• Impulse to rescue anyone (or anyTHING) in need
• Isolation from others
• Sadness and apathy
• Feeling the need to voice excessive complaints about management and coworkers
• Lack of interest in self-care practices
• Reoccurring nightmare, flashbacks
• Persistent physical ailments
• Difficulties concentrating and mentally tired
• Prone to accidents

As you may imagine, these personal effects also spill over to affect the organization as a whole. So how do we change to a healthier emotional status? It’s mainly about sustainable self-care. We must turn our care giving inward to provide for ourselves, so we have the energy to sustain our care giving role in the profession. Here are Eight Laws Governing Healthy Caregiving, from Patricia Smith, founder of the Compassion Fatigue Awareness Project:

• Sustain your compassion
• Retain healthy skepticism
• Learn to let go
• Remain optimistic
• Be the solution
• Embrace discernment
• Practice sustainable self care
• Acknowledge your successes

Resources:

• Compassion Fatigue workshops and webinars at http://www.katherinedobbs.com/
• Compassion Fatigue discussion forum at http://www.compassionfatigue.org/
• Compassion Fatigue in the Animal Care Community, a book from the Humane Society
• To Weep For a Stranger: Compassion Fatigue in Caregiving, a book by Patricia Smith

No other Iams foods are affected, and this recall is limited to Iams canned cat food in North America. The Procter & Gamble Company is recalling these specific lots because the product may contain insufficient levels of thiamine (Vitamin B1), an essential nutrient for cats.   Thiamine deficiency in cats can manifest with clinical symptoms including loss of appetite, salivation, generalized weakness, vomiting, weight loss, ventroflexion of the neck, ataxia, tremors, falling, circling and seizures. 

Diagnosis is made by history, physical examination, and response to thiamine supplementation.  Thiamine concentrations can be measured in whole blood (the sample must be frozen and protected from light during collection, storage, and shipment), or in food.   

Treatment requires thiamine, given either by injection or by mouth.  Recommended doses are 100 to 250 mg SC q 12 hrs or 2-4 mg/kg PO q 24 hrs.  Note that injections may sting, and rapid intravenous administration has been associated with anaphylaxis.     

Concerned pet owners who have purchased Iams ProActive Health canned cat and kitten foods with these codes should discard the product – please make sure the contents of the can are destroyed in such a way that no other pets can inadvertently eat the food. For further information veterinarians should call P&G at 800-535-8387.  Clients/Pet owners can call P&G at 877-340-8826.

I personally feel very passionate about the career of veterinary technician – and I know that with the right training and development opportunities, veterinary technicians will be empowered to invest in themselves and the career they’ve chosen.  At NAVTA Annual Conference there will be courses aimed to help vet techs at any stage of their career to develop professional and leadership skills, and to expand their career options.  (Note: This does not replace traditional lab CE at local and national conferences.)

Here’s just a few of the exciting new features that I’m looking forward to at this year’s NAVTA conference: 

• Speakers Skip Lineberg & Emily Bennington will be teaming up to teach one session on making the right first impressions– and attendees will receive a copy of their new book “Effective Immediately: How to Fit In, Stand Out, and Move Up at Your First Real Job”
• Aundray Collins, professional image consultant, will be on-hand to answer questions, and one lucky attendee will win a consultation & “attire makeover” valued at $250
• Stan Krejci will guide participants, via a multifaceted and personal approach, through positioning yourself on a board of your peers, focusing on effectively working toward common goals

Whether you plan to spend your career in a veterinary clinic, move into sales, education or various leadership roles within the field of veterinary medicine (i.e. serve on a local board, found a specialty group, support a non-profit, etc.), it’s important to you, the profession, and the Pets in your care to stay fresh on your skills. Looking forward to meeting you at this year’s conference!

The 2010 NAVTA conference is November 12-14, 2010.  For more details or to register, visit http://www.navta.net/index.php?pr=Annual_Conference.

Here are 5 ideas for creating a healthy working environment.

1. Reduce Stress.  Stress in the work place can lead to illness and accidents.  It is the nature of our profession that there will always be some level of stress.  What can you do to decrease stress in your hospital?   Having supportive co-workers is an important method to effectively minimize stress.  Sharing the load of the stress with colleagues will help remove the load on the individual’s shoulders.  It is important that we understand as veterinarians we must keep our stress in control.  Observe your words and actions and do not take out your stress on the support staff.
2. Encourage breaks.  Do you work right through the day?  Your body and mind will thank you for taking time to leave the treatment area for a break.  Make it easy and simple.  A 5 minute walk outside or quiet meditation in an exam room can really make a difference.
3. Encourage healthy eating.  It is important to take time to invest in our bodies by providing a balanced diet.  Low blood sugar can make you feel anxious and irritable. Keep some dried fruit & nuts, string cheese, jerky and whole wheat crackers on-hand for those busy days when you or a co-worker needs an energy boost.
4. Value employees and set clear job expectations. Basic respect goes a long way. Employees need to understand what is expected of them.  Set clear guidelines and offer positive reinforcement often. Job descriptions and regular reviews give the support staff the chance for growth and development. 
5. Encourage all staff to contribute ideas.  Feedback from everyone on the team is important for developing a healthy work environment as well as it is good for the practice.  Most employees have thoughts about how they can improve where they work.  Opening up the lines of communication is a healthy way to seek new insights from another perspective.

Feedback is always helpful when determining what is working and what needs work. For a well-rounded, accurate assessment of yourself, consider implementing a 360 degree evaluation in your practice, in which each person is evaluated by themselves, others on the team, and possibly even clients.

S: Subjective variables that relate to success include relationship quality, communication skills and attitude. How are your relationships with your boss, coworkers and clients? Do you communicate well? Do you work together as a team? How is your attitude towards your job, towards others? How are others’ attitudes towards you? Are there red flags of impending conflict?

O: Objective criteria are easier to measure, but are also easier to oversimplify or misinterpret. If the team is getting along well, and pets are well cared for but the number of patients you see a day is down from normal, have you succeeded or failed? I would contend you are succeeding with room for improvement. Fortunately, if subjective measures of success are positive, objective measures of success will usually reflect that. As my Dad always says, “Practice good medicine, and the money will follow.”

So what are good objective criteria to measure and track? A few to consider are number of patients per day and overall income for a day/week/month/year. Just remember that each statistic only tells part of the overall story.

A: Assessment of the data is the next step. Consider the subjective and objective data you have just gathered and determine what you are doing well and what needs improvement. Again, using the 360 degree evaluation concept, either formally, with standardized questions prepared ahead of time, or informally, by asking others for their feedback on your performance, will help you develop a more accurate assessment.

P: Plan how you are going to improve problem areas and maintain what you are doing well. With your assessment in front of you, this is the time for goal setting, for dreaming even. You are back where you started-envisioning success, but now it is even better, you are envisioning success with a personalized checklist of things to restore, develop and maintain.

Recheck: If you have found that things are going pretty well, you may want to revisit your self-evaluation quarterly. If you have problem areas that have been revealed, perhaps a weekly self-evaluation is in order until all is well. Write out your plan and jot a note on the calendar on the date that you plan to revisit your self evaluation.

Sound familiar? I thought it’d be easier to remember that way, Doctor.

When someone is addressing you with an aggressive tone, it’s difficult to keep your emotions contained and not fire back in some way. In fact, after a full day of seeing patients and trying to fit it all in, it’s easy, almost understandable, to retort with a knee-jerk response that stings in return which we know is never a good idea. At best, a tête-à -tête with a valued client will leave you feeling bad and, at worst, cause you to lose business.

Veterinary schools offer helpful information on how to deal with worried, grieving clients, but once you’re out and running a practice of your own, you may find yourself focusing more and more on the physical needs of your patients and less and less on the emotional needs of your clients.

It’s natural to feel a bit angry when someone is hostile towards you, but what you do with your anger can make all the difference in the outcome of your interaction. Below are two simple, but effective strategies that can help you bridge the communication gap between you and your client.

Pause for the cause

It’s been my experience that by merely slowing down the speed of a verbal exchange, I can actually raise the odds of a more positive outcome. Just pausing momentarily before I allow myself to respond allows my brain to engage, evaluate and better diagnose the problem. Solving problems doesn’t happen when our emotions are in the driver’s seat. Allow yourself a moment to process. Create some space to regroup, rethink and redirect.

Sometimes, I find it helpful to actually remove myself, physically, from a high-stress situation. People are accustomed to medical practitioners coming in and out of examining rooms, so excuse yourself from the room, if need be, take a few deep breathes then go back in with your emotions contained and your head on straight. Creating a self-imposed “time out” is an effective tool to gaining composure. Increasing your awareness of your emotional thermostat during stressful times will allow you to adjust your internal temperature up or down accordingly and better prepare you to handle any situation.

Objects are larger then they appear

Before you walk into your next appointment, take a moment to remember that the people who come through your door (unless it’s for a routine exam) are there because they are concerned about a potential health problem with their family member. And, this may not be the only issue they are dealing with. Job loss, family problems and financial struggles might be swirling around in their head too.

When clients are agitated, try to look past what is being presented and respond back with a softer demeanor. When you take a bigger picture perspective and strive to understand your clients better, you inevitably neutralize the tone, and consequently, the outcome of the exchange.

(Print and post a copy of these concepts and use the information to discuss “How to Handle High-Stress Situations” at your next staff meeting.)

Occasionally at hospitals a “war” between the “front” and the “back” will erupt where one group feels that the other isn’t carrying their weight. The first thing I do to try to avoid these “wars” is to ban all such language. There is no “front team” or “back team,” we’re all on the same team. The “back” is called the treatment room. Our “front” desk person is our Client Service Coordinator. I also try to have all team members as least partially cross-trained so that they understand the value and hard work that go into every position on the team. I doubt that it’s much more fun to make appointment reminder calls than it is to clean the fecal sink.

As a team, we all need to be mindful of the client flow so if there’s a back-up in one place we can step in to make things flow more smoothly. Oftentimes, the PetNurses will go from treatment to reception to help check someone in or out. We all, even the doctors, grab for the phone after three rings. Sometimes, I need my client service coordinator to come into the treatment area to hold a pet for me.

If we all realize that we’re on the same team, we’re all here to help pets, we’re all here to get through the day, then we’ll all have much higher job satisfaction. If we feel that the “other” team isn’t pulling their weight or that “they” don’t work as hard as “we” do, then we’re all going to be agitated by the end of the day.

When I hear someone say “that’s not my job,” I realize it’s time for me to remind everyone that their job description includes being part of a hospital team and that means doing whatever is necessary to help the pets that we see. I keep a list of topics that need to be readdressed periodically, and this is one of them. Periodically, I’ll schedule a team meeting where we can reset expectations and rebuild any lost sense of teamwork. I wish I could have this meeting once and never again, but with the addition of new team members, new duties, new products, etc., it’s a good idea to revisit this topic (and other basics) every three to four months.

Is there discord or perceived job inequality between your front and back office team members? How do you approach these type of conflicts? Feel free to share your stories and any suggestions you have for fostering team harmony.

Here’s an example situation: I want to have Pets checked in quickly; Jane* wants to ask a lot of questions during registration at the front desk. Emotions of conflict could build with my co-workers when I apply an underlying negative meaning to a given situation. For instance, “Jane takes forever checking in Pets even though she knows it slows my work down. Jane doesn’t respect my role.” Now, not only am I behind in my work, from my perspective, but my co-worker is insulting me! If this conflict has gone on a while, with me grumbling about “we sure could speed things up around here” with Jane in earshot, I should assume that Jane now has emotions about this, too.

To have a conversation about this conflict that will bring a positive resolution, it’s a good idea to follow these simple guidelines:

• Signpost the difficulty of the upcoming conversation
  Signposting is telling your co-worker to emotionally prepare for a difficult discussion. This prevents a feeling that they have been ambushed and leads to more openness.
• Attend to the relationship
  For your co-worker to consider meeting you halfway there needs to be some good will in the relationship. Your co-worker is more likely to work with you if they sense you want to get along with them, not assert your ideas over theirs.
• Speak to emotions
  There is nothing so powerful in a relationship as feeling like a colleague is trying to understand what it feels like, from the co-worker’s perspective.
• Focus on mutual benefit
  You want to enlist the co-worker in a project that will benefit both of you in your work.

Signpost difficulty: “Jane, I know this may be hard to discuss, and I think it’s important.”

Attend to the relationship: I have to have integrity without attachment. I need to focus myself on resolving the problem so that we can both accomplish our work. I need to let go of wanting to win.

Speak to emotions: Focus on empathy. “You want to make sure we have complete information before we start caring for the Pet.”

Focus on mutual benefit: “I want to talk to you about our differences on how to get Pets cared for when they come to our hospital. We both want efficient and effective Pet care. I want to understand why you see things the way you do and share with you my perspective and feelings.”

This approach often helps to ease conflict and develop constructive problem solving. It is not always easy to do, especially when you feel angry or upset. One additional benefit is that, when I use this approach, I feel that, whether or not I am successful with the co-worker, I have conducted myself with integrity.

How do these conversations go in your office? What have you found useful in talking to your co-workers about conflict?

Some additional articles about resolving conflicts:

• http://www.essortment.com/all/coworkerconflic_rbhc.htm
• http://cars.unm.edu/PDFs/resources/Resolving_Coworker_Conflicts.pdf

*sample situation not intended to reflect on any actual persons

What exactly does EBM mean to a practitioner? EBM is the conscientious and implicit effort to apply current best research evidence to medical decision-making. EBM should enhance clinical expertise in concert with consideration of patient needs and client circumstances.

For veterinarians, EBM is gaining momentum, but it is not widely employed in clinical practice. In addition to published research evidence, veterinarians still rely heavily upon textbooks, anecdotes, faculty expertise, and peer consultations. Depending on the clinical question, these may be the only resources to utilize, but they are often inadequate, outdated, and unproductive. Why has veterinary medicine been slower to adopt the practice of EBM? Is it because there is less rigorous, controlled research conducted and published in the peer-reviewed literature? These challenges create a gap between new knowledge and the practice of EBM in veterinary medicine.

How can the veterinary profession close the knowledge-to-practice gap? The gap represents a barrier to high quality care for individual patients. Where can veterinarians go to get evidence-based, synthesized information? Who teaches veterinarians how to incorporate it into clinical settings? The US Preventative Services Task Force (USPSTF) is well-known for providing physicians with recommendations and guidelines based on research evidence. According to their website, the USPSTF is “An independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services.”

Could similar guidelines for preventive care and screening be developed for veterinarians? These guidelines would support the most efficacious screening for optimal pet care. The BARK (Banfield Applied Research and Knowledge) team is using Banfield’s large database to generate new knowledge, in addition to critically appraising existing knowledge from a variety of sources, to create preventive care and screening guidelines for the common diseases of middle-aged and senior pets.

Next month, BARK’s Research Medical Advisor Associate, Patrick Shearer, BVMS, PhD, will talk about periodontal disease. Please join us, post your comments, and engage in a discussion about what we know about the disease and how as veterinarians we can promote the highest quality evidence-based dental care for the pets that we see.

• Each month thereafter, the BARK team will blog about topics such as:
• EBM and evidence dissemination initiatives in the profession
• Strategies to best apply evidence in clinical settings
• Current and future research initiatives at Banfield

Let us know if you have ideas about questions or topics that are of interest to you, especially in relationship to evidence-based medicine and getting new knowledge to our patients!

Further Reading: Click on the links below for two articles on EBM that recently appeared in the Banfield Journal. The current edition of the Banfield Journal can always be viewed online at www.banfield.net/banfield-journal.

• Banfield Journal May-June 2009
• Banfield Journal July-Aug 2009

During my research into conflict resolution and practice management, I came upon numerous and useful resources that I’d like to share with you. I could list all the great ideas that I found useful, but I find that the two I list below are the best. Not only are these initiatives innovative, they are practical and easy to implement.

Anticipate problems and prepare. Reduce the likelihood of disagreements by instating a Principles of Mutual Respect Policy (PMRP). In a non-threatening manner, this document can provide clear expectations, define desired behavior, and more importantly, acknowledges that every team member is important and the practice is dedicated to open communication and treating everyone with respect. Brenda Tassava, CVPM, has an excellent example that she implements as director of operations for the Broad Ripple Animal Clinic and Wellness Center in Indianapolis, Ind.

Distribute and discuss the PMRP at your next internal meeting and, on an on-going basis, make sure all new team members receive a copy.

Get out and eat some lunch. My second favorite idea comes from Florence Sanford, CVPM, practice manager at Nassau Veterinary Clinic in Nassau, N.Y., and she describes it as “When our team’s resolution skills aren’t enough to manage conflicts, I’ve sent feuding team members out to lunch together with $25 to talk out their issues. Neither person is welcome back unless there’s a truce. This has happened four times in 15 years and each conflict resolved. Some feuding team members even became good friends.”

I’m convinced this idea of removing quarreling co-workers works because I have done the same thing with my husband on those rare occasions when we continue to revisit the same disagreements with no resolution in sight. I take him out to dinner and discuss the issue. I know I am much better at communicating when I am “in public” and he is much more receptive to hearing my concerns. There’s something about sitting in a neutral place and sharing a meal that can allay bad feelings and open our minds to understanding others.

Each of us has unique life experiences, personalities and perspectives that shape the way we interact with our world and, consequently, impacts the way in which we communicate. Keeping these differences in mind, it’s easy to see how problems and animosity among colleagues can occur. Communicating expectations up front and listening to each other over a roast beef sandwich, might be what your team needs to work through bad feelings and improve team member relations.

References

http://veterinaryteam.dvm360.com/firstline/Communication+Strategies/Bring-peace-back-to-your-practice/ArticleStandard/Article/detail/529606

http://veterinaryteam.dvm360.com/firstline/Veterinary+team/4-ways-to-keep-the-peace-at-your-practice/ArticleStandard/Article/detail/642323?contextCategoryId=37267