Summary From Part 1:
Veterinary Medicine has a large % of veterinarians that are dissatisfied and unhappy with their profession. This is in part due to their expectations exceeding the reality of the career. This 4 part blog addresses common disconnects in the profession between expectations and reality, and hopes to improve happiness by closing this expectation-reality gap, and by providing recommendations to improve reality.
Part 4 of this Blog Series will focus on Veterinarians vs. The Clients
Expectation: RESPECT FROM CLIENTS
Once you are ‘doctor’, you expect people to trust and respect you, listen to you, and follow your advice. After all, that’s what you have spent the last decade of your life training to do!
1. With so much information out there from Dr. Google, breeders, Pet-store workers, Puppy Training, Breed Specific Facebook groups, the neighbour that has ‘owned a lot of dogs’, even ‘their own vet’, etc., you will need to FIGHT for respect and trust from your clients. You will constantly be justifying yourself and ‘selling’ yourself as an expert.
2. You will often be recommending best practice, and clients will come at you with “my vet always just ….” Or “the internet says…” . This is often ironic because they are coming to you for either a second opinion, or because the diagnosis and treatment the facebook group suggested isn’t working, which is why their pet is still sick. There are many ‘old school’ vets, breeders, etc. out there that are either just blatantly making things up, or more often truly believe that what they are doing is right and telling people this with confidence. These individuals and groups will get the respect and love from the client, even if they are completely wrong and not qualified.
3. Clients also like having an ‘answer’, and don’t evaluate or care if that answer is true or not and often prefer an answer that is bad news, to no answer that could mean good news. ‘Old school vets’, as well as uneducated individuals, love giving answers and diagnoses without confirming, because they either feel that their pattern recognition is accurate enough and diagnostics aren’t required, or they are too ignorant to know that there are other diseases that could cause the same signs.
4. Clients also respond to who they know, and also to confidence in how something is delivered. We need to be able to confidently relay that we don’t have the answer yet, and certain tests are required.
1. “NEW SCIENCE”: When suggesting a diagnostic or treatment plan that is different from their previous experiences, use “new science” and “most current recommendations” as part of your justification for tests or treatments. This helps fight the resistance they will have to do something different, and also you can make them excited about being on the ‘leading edge’ of medicine.
2. QUIRKY LINES: Phrases or statements to have up your sleeve are helpful. Make sure these aren’t mean, but get the point across. My favourite is “all your breeder did was buy 2 dogs and let them have sex” - it works abut 80% of the time. “Would you trust your child’s healthcare to your hairdresser” is a good one when the client is basing decisions on what the groomer has said.
3. COMMUNICATION: The most common problem that clients have is they have no idea WHAT is happening, or WHY you are doing what you are doing. Explaining what a test will show, and why you want to do that test, will help. To do this you need to discuss all the possible outcomes of each test, and how they will change your treatment plan. Explain the risks of not doing the tests, so owners understand the VALUE of the test. Your explanation of the test needs to highlight the VALUE of the DIAGNOSTIC INFORMATION of the test, so they don’t feel a negative test was ‘wasted money’.
4. CREATE GROUPIES: Staying in a clinic long term results in a client base that knows you, and trusts you, so you don’t end up having to ‘prove yourself’ over and over. (In Emergency Medicine 'proving yourself' is just part of the job, so this requires excellent communication skills).
5. LET IT GOOOooooo: Realize that some people just suck! Some people will fight you no matter what you say, they will never respect you, they will threaten you, they will try to bully you. Recognize these and don’t waste energy on feeling bad. Just state your recommendations and if they try to threaten or bully you give them the contact information of the nearest clinic where they can get a second opinion. OR, have them re-schedule to see your boss. If your boss doesn’t want to fire these clients, they can deal with them.
6. DON’T BE BULLIED: Do NOT perform procedures or use mediations if you are uncomfortable, no matter how much a client may push you. Your license, and your livelihood, is at risk if the case goes badly, not the owners. Also, you want to create a client base that is supportive of your medicine. If clients are pushing a procedure/medication that is ‘on the fence’, ensure you outline the risks to owners prior to execution and document this in your records.
Communication and Confidence are imperative when dealing with individuals that have a pre-set notion of what they feel is the way to pursue treatment or care of their animal. It is important to effectively communicate WHAT is going on with the animal, WHY you want to do diagnostics and HOW they will change the treatment plan. By educating owners you can sway most of these pre-set minds. Some owners however will just be jerks! Value yourself, do not be bullied, do not be abused, and do not perform medicine that you feel is wrong. Also, protect yourself, detailed records are imperative.
Let's Get Personal
I am NOT a bird expert. In emergency I once saw a bird that was egg-bound. I did some VIN searching and found that rest, warm/moist environment, time and a darker environment was best. I also remembered from school that removing an egg improperly can cause egg peritonitis which is very serious and often fatal. I recommended to the owner to wait, provide SQ fluids, warm environment, and time.
The owner pushed and pushed and I ended up conceding to trying to remove the egg, after discussing the risks in detail and saying that I did NOT recommend it. Needless to say, it did NOT go well. The egg broke, ‘sucking out the insides of the egg first’ did NOT work well, and the case was lost for follow up but I would be amazed if that bird didn’t get egg peritonitis or die.
I felt terrible for the bird, and held my breathe for months waiting for a board complaint. I would have been protected because I documented highly the conversations, and that I didn’t recommend the course of action, however I let myself be bullied into medicine I didn’t believe in.
I should have stuck by my guns and refused to perform the procedure.
Expectation: YOUR AVAILABILITY
Clients feel you should be available at all times of day, at a moment’s notice, and that their pet is your #1 priority in life.
1. Some owners will call you at all hours of the day or night, they will stop you in the street, at the park, in the grocery store, and they expect you to be happy to discuss their pet and to do it for free. They will come into the clinic 5 min before you close and want to have a 2 hour conversation about the diarrhea that has been going on for 6 weeks. They will email you and call you, and if they don’t hear back from you in 10min they will be upset that you ‘don’t care’ about them.
2. Most of us are so awesome at making our clients feel special that every client thinks they ARE special. They may recognized you would want a life outside of work normally, BUT you love their pet so much that you would WANT to work extra and for free... but just for them. Also, some of your clients will feel that since this is a paid service they should be seen the second they walk in the door no matter what else is happening in the clinic, with or without an appointment.
3. Due to competition, and due to the business/service industry nature of veterinary medicine, we feed this ‘entitled client’ culture. We give into ridiculous demands, we pander to make clients feel loved, we accommodate the ‘squeaky wheel’, all in the name of keeping business. Also, as a group our nature is desperate to please, so we often look for client validation to fuel our self-worth.
1. SET LIMITATIONS: Establish boundaries for yourself of how much ‘outside of work’ interaction you want and are willing to accommodate. If you want that interaction to be none, when someone approaches you outside of work, just simply say “Oh, I am sorry that Fluffy isn’t feeling well, you should bring him in for an appointment tomorrow/go to the emergency clinic”. Some people LOVE this outside of work interaction, and if that’s you- great, but don’t feel you HAVE to, that is NOT part of your job!
2. EMAIL AND PHONE- With new technology and ‘telemedicine’, clients will be looking for advice and treatment plans via phone, email, facebook, etc. without having to come into the clinic. You need to decide yourself, and with your clinic, how much telemedicine you want to perform. Have clear rules for your staff about whether or not they pass on phone messages, what your ‘call back’ policy is, and have a way to have this blocked out in your schedule because phone calls take time, and your time is valuable. For emails and other electronic messages, if the required response is more than what a nurse/reception can field, make a policy in your clinic about how these are addressed.
3. PERSONAL DETAILS: I recommend NEVER giving out your personal email or phone number. If you call clients from your cell phone, block your number. Working emergency I don’t know how many times clients would have called their vet, or wanted me to call their vet, in the middle of the night to get their opinion. If you WANT to be called then give out your number, you are a better human than I.
4. DON’T CREATE MONSTERS: When you have those clients that are always rude, always complaining, always wanting a discount, always threatening, always demanding certain medications/etc. don’t pander to this. You can be polite and respectful, but don’t give in or you will just make more problems for yourself. “You are here to get my expert opinion, and this is my opinion.' 'I am not comfortable performing this medicine because of ___ reasons. Of course you are always welcome to get a second opinion” If you have these problem clients, it’s better to fire them or have them go somewhere else than to make your clinic toxic. As an associate your boss might not subscribe to this approach. In these cases go to your boss and say “I am not comfortable dealing with client X for ____ reasons, and in the future I would like to not see them”. If your boss wants these clients, your boss can deal with them! These clients are far and few between, and any clinic worth its salt will fire these toxic individuals.
Set clear limitations about your hours, how you interact with clients outside of work, and how your staff deals with requests for ‘tele-medicine’. Create protocols and plans that are easy and straight-forward to follow for your staff regarding medication refills or tele-medicine. Also, refuse to be bullied or abused, and do not pander to the ‘squeaky wheel’ client.
Expectation: COSTS OF CARE
Clients often have a pre-conceived idea of how much a vet visit should cost, which are typically based on their desires or arbitrary thoughts. Sometimes these expectations are accurate, but often it is drastically less than true cost. Many individual believe that animals should be protected and cared for by the government, and that they as the owner should not be responsible for the vet bill. Some clients will also feel that you, as the veterinarian that loves animals, should be responsible for their bill and you are ‘evil’ for charging for your services.
Clients have a per-concieved idea of what costs should be, that is often arbitrary. It is our responsibility to use terminology that displays the value of our services, and to communicate effectively the costs of care, and options for care.
1. Current perception about the veterinary profession is that vets make tons of money, and that our services are drastically overpriced. Although some clinic owners may be making a good profit, it is not true for most or for associate vets, especially when you factor in the level of student debt that most graduates now have. The salary, and the reality that most vets now will not be clinic owners, often does not pay for investment of the cost of the degree.
2. Clients have no idea of what the true costs are for medicine. Clients often state “this is more than I pay for my own health”... because people also don’t understand that human health care subsidized or free due to government health care or insurance. Veterinary medicine is a business, and therefore in order to continue providing services people have to pay. Otherwise the business closes down and no services are available.
3. Owning a pet is a privilege, not a right, and pets are legally ‘possessions’. Clients need to pay for their pets the same as they would for their car. You didn’t make them get a puppy or kitten, it is NOT your responsibility to financially provide for their pet.
4. When clients complain about the costs of your services, or say things like “vets charge too much” or “vets are just in it for the money”, they are essentially saying “I don’t respect or value you, your education, or your time”.
5. We have the power to change clients perception of costs by the language and terminology we use when discussing costs.
1. STOP FEELING GUILTY: Your job is to treat animals, NOT to solve others financial problems. Every time you do something for free for a client, you are undervaluing yourself! Value yourself, value your time, value your knowledge. You went to school for years, you studied for hours and hours and hours, YOU have the student debt, they don’t! If clients want 'free' vet care, they can go to school and become a vet and run a business.
2. COMMUNICATION AND OPTIONS: Explaining WHY we need to treat, WHAT costs are involved and WHY, and providing options for different levels of care, helps owners to see value and to pick the level of care they wish and can afford to pursue.
3. BE PROACTIVE: Try to get your clients on insurance. Create processes where during their kitten/puppy visits you discuss costs of that breed/animal, what happens in an emergency, and how insurance can help. You can even have your nurse/reception discuss insurance, and you can just follow up quickly in your appointment. Getting clients signed up for free trials is great!
4. TERMINOLOGY & LANGUAGE: Don’t undervalue your services to your clients with how you talk about costs. When we use phrases like “I know it’s expensive” or “this is costly but…”. we are putting into clients minds that the service is not valuable and overpriced. Just present your recommendations and the costs to owners, and follow it with “is this something you would like and are able to pursue at this time?” This leaves an opening for clients to decline services. By just eliminating our natural tendency to undervalue ourselves, and changing our terminology to clients, we can change how they perceive the costs of care.
5. DON’T TOLERATE ABUSE: When you have clients make comments like “I am helping to pay for your Ferrari” or “vets charge too much money”, don’t laugh or say things like “I know it’s expensive” or “I know it adds up”. This perpetuates the perception clients have that we are overcharging, and is perpetuating dis-respect for your time. You can respectfully confront the issue and reply with “the prices are reflective of the cost of care to provide the patient care and medicine that is required for your pet. However, if you feel that you can’t pursue this treatment plan, we can always try options B or C”. It is important to be polite, however if you are being criticized, devalued or abused, do not tolerate this and say ‘sorry’, stand up for yourself! Until we collectively change the perception of the public by not tolerating these comments, we will be attacked for being ‘in it for the money’. In my experience that is the #1 comment that causes compassion fatigue, burn out, and dis-satisfaction with the career.
It is important to acknowledge that owners have no idea what the costs are of medical care. It is our job to effectively communicate the VALUE of our services, and provide options of service if owners cannot pursue treatment. It is NOT our job to tolerate verbal abuse, or sort out clients financial lives. Establish phrases for yourself (and your staff) to use when owners are being abusive, or making the ‘vets are in it for the money’ comments. We can change how we are treated, and clients perception of costs, by changing our own terminology and language. Value yourself, stand up for yourself, and effectively communicate your value!
Let's Get Personal
Here are some of the phrases I have adopted into my vocabulary. I no longer tolerate any comments of ‘vets charge too much’ or ‘vets are in it for the money’. I don’t laugh, I don’t smile, I respectfully but flatly use one of the comments below, and man it feels good! I feel more empowered than before, and the responses I have received have all been shame, apologies and embarrassment by clients. It’s a good feeling!
“Vets are not overcharging, this is just the cost of care for your pet.”
“Vets do not make a large salary, the costs go into providing care for your pet. Tests and treatments cost money.”
“Veterinarians care immensely about the animals, and are paid appropriately for their services. If you are unable to pursue this treatment plan can I suggest we try ___.”
For the very abusive and aggressive clients that are being purposefully hurtful... “Stating that veterinarians don’t care or are just in it for the money is contributing to veterinarians having the highest likelihood of suicide compared to any other profession. We will not tolerate this type of verbal abuse. If you would like a second opinion, or would like to discuss other treatment plans we are happy to arrange this.”
For the clients yelling or swearing on the phone... “We do not tolerate verbal abuse at this business, if you continue to yell/swear I will hang up…” (when it continues, just hang up)
Remember: We work our butts off for the patients, and we care SO MUCH about the animals that we tolerate huge amounts of abuse and aggravation to be able to treat them. When someone states that we ‘only care about the money’ it makes you want to scream. By standing up to these comments, you will keep a bit of your sanity intact knowing you stood up for yourself and colleagues.
The public will not magically change their treatment or perception of veterinarians. WE have to be the AGENTS OF CHANGE! Protect your own mental well-being and be part of the solution!
Expectation: LEVEL OF CARE
Clients all have their own thoughts and ideas of what level of care is appropriate for their pet.
1. As humans and veterinarians, we also have thoughts and ideas about what is appropriate for our patients. These personal biases often subconsciously come into play when we are recommending treatment options with owners.
2. Since our own biases influence what we recommend to our clients, often clients will end up feeling that their expectations weren’t met when we either don’t offer or discuss advanced options, or when ‘push’ options that they feel are too advanced. Our own ideas of what constitutes quality of life, appropriate amounts of money to spend, or appropriate interventions to ‘put the animal through’ often do not align with the clients.
3. Your personal bias doesn’t matter, except in cases where the animal is suffering. Your bias is only relevant if you are treating your own pet. Otherwise, it is your job to present owners with options and prognoses, and let them pick according to their own feelings and values.
1. ADDRESS YOUR BIAS: Determine where your own personal biases lie so that you can actively stay away from pushing them on clients. Put your personal bias, as well as any perceived client bias that you have created from either their appearance or previous clients, aside every new consult.
2. PEOPLE ARE SNOWFLAKES: Accept that everyone is different and that is ok. Don’t judge clients for either pursuing treatments that you wouldn’t, or for not pursuing treatments that you would. You never know what is going on in someone else’s life, or what that pet means, or doesn’t mean, to them.
3. DETERMINE CLIENT EXPECTATIONS: Ask clients what they want. Offer and discuss all options including what is involved and prognoses. Also, ask clients if they want to try to get the bottom of the clinical signs and work up the case properly, or do they just want to try something? By doing this you highlight what is recommended while giving clients the option to not pursue treatment they don't want, and letting them know they are choosing to not get an answer. This way clients don't think you are incompetent later when their animal doesn't get better, or they finally pursue more diagnostics.
4. CLIENT HANDOUTS: When an animal is diagnosed with a disease condition give owners a handout that has explanation of the disease, options for treatment, and prognosis. Let them read through, discuss with family, and think about the options. This will not only allow owners to make a more educated decision, but will also remove your own bias and save you time.
Personal biases are much more prevalent than we recognize. It is important to actively address your owner biases, and ensure you are not pushing this on owners. Also, it is important to ASK owners their expectations. Our job is to present all options and let owners make educated decisions. It is NOT our job to decide for an owner whether or not a treatment plan is ‘worth it’.
Let's Get Personal
I was doing a working interview with a vet that ‘diagnosed’ a cat with diabetes (it was overweight and was PUPD, no testing performed). This vet stated to the owners ‘Your cat has diabetes, there is nothing you can do, once it gets sick just euthanize.’ After the consult I questioned the vet about why we didn't test and offer treatment, and he stated ‘a diabetic cat is hard to treat, no one wants to do that’. He didn’t even discuss with owners about testing to confirm diagnosis/rule out other causes, or offer or discuss any options of treating. He injected his personal bias into every case he saw. Needless to say I didn’t take that job- another reason working interviews are important!
Written by Dr. Ann Herbst BSc, DVM
Published July 10th, 2019
Advocate for yourself, you are the only one that will!
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