Podcast #54

crocodile
Some clients are dangerous, and you need to be careful, take precautions, and ensure your own safety, above all else!
Introduction:
See previous blog on Upset Clients for introduction…

Some of the most tricky difficult clients are those that are downright dangerous. Whether they are aggressive physically or verbally, intoxicated, or just unstable, these clients can shake us to our core. Especially given that the veterinary profession is female dominated, and often there are only 1-2 female staff in the building, this leaves us vulnerable!

It is these types of clients which this blog will focus! Our other blogs will address some of our other types of difficult clients such as the Upset Clients, Bully Clients, Manipulative Clients, “I Know Better” Clients and General Tips on Difficult Clients along with Self Preservation When Dealing with Difficult Clients.
Safety First:
With this subset of clients, we need to remember SAFETY FIRST. No amount of money, care, intervention, theft of money or drugs, etc, is worth your personal safety. If you feel unsafe, give the client whatever they are demanding, whether that is caring for their pet or the money out of the register, and call the police!
Aggressive Clients:
Working emergency, especially if you work in low socio-economic areas, when you have limited staff overnight, you will at some point feel vulnerable. I have personally been threatened, had phone calls to the clinic threatening to bomb the clinic, go to the boss’ house and kill him, had clients posture themselves in the exam room to be threatening, etc. I have laid awake at night going over scenarios in my mind of what I would do if someone came into the clinic in the night with a gun, and how I would react and direct the other staff to ensure my own and their safety. I have called the police. I have however, more often, diffused these clients to downgrade the threat.

The key with these clients is identifying which ones are just talk, and which ones will strike. Obviously, just with treating and handling dogs, this can be tricky. There can be those that surprise you, so it’s best to always be cautious, and if you are worried, handle with care just like you would muzzle a dog that you think might bite.

FEARFUL FOR SAFETY:

For the owners where you are very fearful for you safety, don’t mention finances at all, just treat the animal as needed. Your safety is more important.

“I understand that you are angry and scared because Fluffy is sick. You obviously love Fluffy and just want Fluffy to be OK, so do we! We are going to do everything we can for Fluffy.”

“We are currently giving Fluffy everything he needs, and stabilizing him as best as we can. Nothing is being held back for Fluffy. I know you are scared and worried about Fluffy. In order to care for Fluffy our team will need a bit of time and space. Why don’t you go outside and have a bit of a walk (or a smoke if they are a smoker!) while we work on Fluffy.”

Try to say something that shows the owner you are doing everything, and then see if you can get them out of the building. Then, lock the door and call the cops!

FOR THOSE THAT CAN BE DIFFUSED:
Essential Oil Diffuser
Most angry clients will be able to be diffused by acknowledging their stress, informing them that their pet is being looked after, politely asking them to speak more calmly and then giving them time to come relax.
For those that are aggressive but you don’t fear for your safety, you can either try diffuse the situation or you can ask them to leave. Which you choose will depend on the situation, and the severity of the pet’s injury/illness.

As a general rule, aggressive clients with stable animals that don't require immediate treatment can be asked to leave if they don’t change their ways:

“I understand that you are upset and stressed, but we cannot work with you to get Fluffy the care she needs if we can’t communicate with you. I need you to speak more quietly and calmly, otherwise we will have to ask you to leave. I’m going to check on __(their pet if it is in the treatment room, “another patient” if not)__and I’ll be back in a minute so we can figure out what Fluffy needs.”

This acknowledges the owner’s stress, addresses that the behaviour won’t be tolerated, tells the client exactly you need/expect, the consequences if they don't, and time to calm down without needing to respond immediately. It also gets out of the room for a minute because likely you will need to debrief a moment yourself!

If the client remains aggressive, continues to yell, attempts to go into the back or out front to continue being abusive, ask them to leave.

“We cannot work with you to treat Fluffy when you you won’t communicate with us politely. I feel it is best for everyone involved if you pursue treatment for Fluffy elsewhere. The closest clinic is ___.”

Or

“We can’t work with you when you speak and act in that manner. I feel it is best for you to take Fluffy to another centre for care. The closest clinic is ___.”

The hardest situations are when clients are very aggressive, but their animals are very unstable or very sick, and not stable enough to be taken to another clinic. As veterinarians, we are required to provide pain relief and supportive care. Most clinics will address the needs of an unstable patient right away, including pain relief, oxygen, fluids, and tapping of life-threatening situations such as GDVs, pneumothorax or pericardial effusions.

The best way to manage these clients is to ensure them that Fluffy is getting stabilization care right now, and try to remove that immediate stress and anger. That will often diffuse most owners. You then go on to re-direct the anger to the situation, and away from yourself.

“Hello, I am Dr. ___, I am looking after Fluffy. We have given Fluffy pain relief, have placed a catheter and have given fluids, oxygen and the supportive care that Fluffy needs right now. We are doing everything that Fluffy needs right now. I know you are scared, but just know we are doing everything we can for Fluffy right now.”

This should bring down most clients, that are worried won’t provide treatment right away without money right away. You can then go on to communicate the next steps.

“Unfortunately Fluffy is very sick/injured and her current status is ___. I know this is a very upsetting situation, and I am sorry that she is in this situation. We will need to discuss next steps soon, but right now I want to go back and continue to try to stabilize Fluffy. I need you to come into this exam room for now, and when I come back we will figure out the next steps for Fluffy.”

This phrase re-directs the anger to the situation, shows that you are currently treating Fluffy but the situation is dire, and gives the client a directive and information on next steps. This will stop the yelling in most clients, as they will want you to get back to Fluffy's care. Also, in this way you get the client into the exam room, away from your receptionist, other clients, or out of the treatment room.

If clients just continue to yell and scream at you, you may need to be more aggressive:

“We cannot focus on Fluffy’s care when you are behaving this way. I know you are scared, but I need you to go outside and calm down so we can focus on stabilizing Fluffy.”
Intoxicated Client:
child throwing temper tantrum
Intoxicated clients are like toddlers, they are unpredictable, irrational, and can be dangerous. But, also like toddlers throwing a tantrum, they can be distracted easily with tasks.
Sometimes you will be in a situation where clients will come in, and they will be drunk, high, or otherwise intoxicated. These clients can be very dangerous as they can be incredibly unpredictable and completely irrational. They also won’t listen to reason, and if you ask them to leave, calm down, or otherwise act rationally, it often just makes the situation worse.

You have to treat these clients like they toddlers, on the verge of a tantrum. And just like a child, the best tool in your basket is distraction. Whether that is a task, or tea/coffee or water, or some food, anything you can to keep them placated and non-volatile.

They want to make sure they are being taken seriously, so whatever they think is going on with their animal (and those that are high often can be hallucinating!) make sure you address it as a serious concern.

Often, with these clients, I go out, take their animal and say…

“I am the doctor, I am going to take Fluffy and take care of Fluffy for you. Why don’t you sit down in this room and I will be back as soon as we look over Fluffy.”

Giving these clients a task to distract them often works very well.

“Here is a pen and paper, I need you to write down ___(exactly what happened with Fluffy/ what meds Fluffy is on/ What drugs Fluffy could have gotten into/etc)__.”

If the client is too intoxicated to make decisions, try to get a second phone number of someone else you can call to discuss the case. Otherwise you can do the bare minimum to stabilize until the client is in a better position to make decisions.
Let's Get Personal
I was once working emergency, and a client comes running into the clinic, 10pm at night, screaming that their dog is dying. The little dog was looking at me, totally normal, no concerns. The owner however was obviously distraught.

I took the dog and said to the owner “OK, we are going to take Fluffy and look after him closely.” The owner kept saying he was worried the dog had been fed ICE (Crystal Methamphetamines) by a friend. We gave him a room to sit in, got him water, and a pen and paper to write out the time-line of when the drug could have been given.

We then just popped the dog in a kennel and monitored, it was completely fine, and I checked in on the owner periodically. He sat in the room, with repeated refills of water, for about 5 hours overnight. He was quiet and polite, but very strange, with variable clothing combinations on as I checked in on him throughout the night.

At about 5am he seemed to be down from his high, and he took the dog and left.
Unstable Client:
jenga game with tower knocked over.
Unstable clients are those that can fall apart with the slightest nudge, and these clients need some emotional coddling, and someone to take control so they can feel secure.
Unstable clients can be tricky. These are the ones that are depressed, psychotic, or emotionally so distraught they cannot communicate. They can be incoherently screaming/crying, vomiting, convulsing, refusing to leave their pet to allow for treatment, and various other behaviours.

For these clients, you need to really take control and direct the situation. You need to give the client space and time to break down, and ensure them you are looking after their pet in the mean-time. You need to acknowledge their fears and stresses, and then give them direction, as they feel totally out of control.

“It’s OK you are scared and stressed. Take your time and we will look after Fluffy. Come with me into this room, we will get you water and in the meantime we will look after Fluffy.”

Finding a support person for them if needed can be important. Asking if there is anyone you can call to come and be with them can really help. If they are otherwise alone, if you can spare a nurse to sit with the owner and get them water, a hug, and someone to lean on and re-assure them, that can be very helpful.

If their pet is very unstable and you need them to communicate their wishes immediately, you can try to convince them to find some calm by getting them to try find strength for their pet.

“I know you are scared and stressed, we are too. Fluffy really needs you right now to focus for a moment, because we need to talk about his condition. Unfortunately he is very sick and I need you to make some decisions. Can you take a few big breaths with me, and try to find some calm for a moment so we can make a plan for Fluffy?”

For more blogs on dealing with particular types of difficult clients, see blogs on Upset Clients, Bully Clients, Manipulative Clients, “I Know Better” Clients and General Tips on Difficult Clients along with Self Preservation When Dealing with Difficult Clients.
Written by Dr. Ann Herbst BSc, DVM

Published April 8th, 2021

Advocate for yourself, you are the only one that will!

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