Abby Whiting, DVM
As long as I can remember I have been fascinated by lighthouses. I am drawn to the ocean. I have framed photos, statues, and paintings of lighthouses in all of my favorite spaces. I love the imagery of seeing the violent ocean waves crashing against the quiet peaceful tower of unwavering light. The thoughts of sailors trapped by ferocious winds and storms, seeing the glow of the lighthouse in the distance and knowing their lives will be spared. The idea that the light goes on, unchanged by the chaos surrounding it is inspiring to me.
Whenever I get to talk to people who are thinking about veterinary medicine as a career I am always a bit surprised when I ask them why. Many people say “because I love animals”. I love animals too; but for me I went into vet med because I love people. I am a companion animal general practitioner by breed. In my daily practice I get to work with all kinds of animals, but not without working with their people. In reality I help people with their pet’s problems. At the end of the day my business centers around the humans I help.
There are days when I wish Fluffy came waltzing in with a note on her collar and a credit card…no human attached…but that isn’t my reality, and it shouldn’t be. Yes I have had my fair share of challenging or let’s say difficult, clients. Yes I have had true frustration, hurt, disdain, and sadness as a result.
I have had the benefit of working as full service GP and as an emergency DVM in busy multi doctor practices. What holds true throughout is the impact I get to make on the pet and their people. One of the greatest super powers that we vets have, and yes we are super heroes...absolutely, is the ability to be the light house in the storm on someone’s worst day. To be trusted in those frightening and difficult moments that life throws at you, or to be consulted for one’s valued opinion…that’s truly an honor. In ER I generally see people in bad situations, perhaps the worst pet situation they have ever been in. Many of them are near losing or are losing their beloved friend and companion. This level of loss stretches the human psyche. Not all of us can be graceful or kind when we are under the level of pressure. I enjoy these interactions. I like to meet you in the middle of the night on emergency. I like to tell you we can do something about it…no matter what the clinical outcome of the case is, I get to be the hero for that family when they needed someone the most. In many cases I am the hero the pet desperately needed too. I get to triage, stabilize, educate, give options, counsel, console, help, hug, laugh, cry. It is such an honor to be trusted by someone who is at a time of need. Instead of letting these heavy interactions sap my energy and drain my bucket, I have reframed them to refill my soul. I am always happy to have been that person. When you see yourself more as the lighthouse and less of the victim of a client’s inability to respond with emotional intelligence or grace, you start to see the profound impact you have on people.
I think the same is true of our colleagues here in vet med land who are struggling. If you have the opportunity to be a lighthouse for them, take it! All of us need help in one way or another at different times in our lives and our careers. This is what I admire most about NOMV. The ability of a stranger to post a comment that flickers the light on the horizon for someone in pain. Or a message to the admin team that initiates a reach out, a private message from one likeminded heart to another from miles away, or an emergency services call when the need arises.
There is great beauty here in vet med land if we choose to look for it. We are blessed in many ways to be able to see the healing forces of the universe as focused through the lens of science, medicine, surgery, and human compassion. To continue to be the lighthouse I aspire to be, I must maintain my strong foundation. I have to work on it, up keep it, rest it. No tower can withstand constant storms, or unyielding pressure. That too is what NOMV has taught me. To be who I want to be I need boundaries, time off, self-care, exercise, rest, laughs, and perhaps the occasional margarita! Without proper maintenance my tower will crumble.
In my career I am learning to let things go, and not take certain interactions personally. Rarely are they actually about me, they are generally about human suffering and inability to cope with heavy emotion. I am learning to recognize stress, exhaustion, and burn out in myself at earlier stages. I am trying to provide routine maintenance to my tower. I, along with many others, are trying to restructure veterinary medicine. We are making it a healthier, happier place to live and work.
Dr. Maria Brink
As I’ve alluded to in my previous blog post, my life has been turned upside down and wrung inside out in
the past two years. From this, I’m struggling to find the reason to continue to scuffle along through life.
I’m aware that many people have had these thoughts from a young and tender age, however I was
blessed not to deal with that particular issue while growing up and during the beginning of adulthood.
Now that I’m looking at depression from underneath its weight, I have an entirely different
understanding of it. Wow. It’s all encompassing. It blocks all the light and adds thousands of kilograms to
every movement that I take. More recently, I’ve had the addition of suicide ideation. This scares me, yet
I can’t seem to change it, and I think it’s far more dangerous for me to ignore it. The second my mind is
left without something to fill it, the ideas of how dying would be best creep in. Slowly, yet with great
determination it creeps, until I’m left with nothing but how much better the world would be without me
The scientist in me is fascinated by this. This is new, you see. Novel. My lack of ability to control it is
astonishing and I am intrigued that I am such a prisoner of what used to be my greatest ally. Perhaps,
even if you don’t experience depression, you can understand what I mean. We, doctors treating multiple
species, need to use our minds all day, every day. Innumerable decisions to be made, medical principles
to apply in situations that we have never encountered before, creative problem solving, brilliance and
kindness towards our patience who can’t speak for themselves. Whenever I needed to, I could always
rely on my brain to support me and help me and to solve the problems I set before it. I could also retreat
into it whenever I needed some space away from how my day had been. This scuttling back into my
mind is now a terrible idea. I should not spend time inside my head, particularly when I am alone, as
doing so increases my risk of not seeing the sun rise tomorrow. What used to be an ally of mine is now a
nasty enemy that is constantly considering how to kill me.
Fighting this enemy adds to the fatigue and exhaustion that I feel every moment of every day.
Yesterday, in particular, was a day that I was very tired of fighting. So very tired. Crushingly exhausted in
a way that sleep can never resolve.
Adding to this, I also have a form of dysautonomia called postural orthostatic tachycardia syndrome
(shortened to PoTS). The definition of this syndrome is that when I change position from supine to
standing, my heart rate increases by at least 30 bpm, without a significant change in blood pressure. My
heart rate likes to go from a resting rate in the 60s up to the 170s. It is horrendous. Additionally, any
part of the body that is controlled by the autonomic nervous system is affected (digestion, oxygenation
to the brain, urinary bladder voiding, sleep, etc). Essentially, my autonomic nervous system is a jerk.
There are also other medical issues that I am waging war against on a moment by moment basis. The
point that I am trying to get across is that these are not visible if you walk by me in the grocery store. To
the casual observer, I look like a healthy, albeit out of shape, young woman. So, when I need to sit down
in a line because I am pre-syncopal, the judgement is intense. I get stared it, scrutinized, judged, and
even pitied. Most of the time, when I share that I am unable to stand for more than 10 minutes at a time
I am not believed. I am accused of faking it, of lying, or of overexaggerating. All of this contributes
significantly to my depression as it makes it so much easier to continue to believe that I am worthless.
This struggle against the invisibility of my health issues has brought to light something that I was not so
aware of before - each person you interact with throughout your days is dealing with something in their
life that you can’t see. If we all could extend just a bit more kindness and understanding, it would make
the world a much better place for you and for me. I am working at being much more understanding and
kind to others when they tell me that they need something. I don’t question, I validate. I believe them. If
a human being is being vulnerable and sharing something that is true for them at that time, it costs
nothing to be supportive, yet it is a priceless gift to the person who receives it. Even when I can’t see
exactly what they are experiencing, that doesn’t mean it’s invalid.
To borrow from Ellen: be kind to one another. Today.
Dr. M. Brink
By Caroline Brookfield, DVM
Have you recently seen a wave of public articles from veterinarians about our challenges in working in a high stress and emotional career? Articles that highlight our struggle with student loan debt, the high rate of suicide, long hours, high client expectations, and the stress of having a less than desirable salary. Shocking statistics that are shining a light into the dark areas of Veterinary Medicine.
In a short time frame, veterinarians have gone from well-respected community members to being open to scrutiny - in some cases being distrusted and vilified. As a practicing vet for 20 years, I've seen the transition from clue-less to "clued in" by Google, any random person with a dog, and anyone with access to a smartphone. I don't know how many that is, but it seems like a lot. When I first started practicing, email was pretty new. "Dr. Google" had just started through listserv groups, but most people still ultimately trusted their vet. If they didn't, they found another vet. It sure felt like clients had less access to random and anecdotal information from a variety of sources. All of this information and misinformation leaves clients distrustful and feeling powerless when it comes to their pet's health care.
When I observe vet reactions to a client challenging their plans, I often see vets withdraw into defensive mode. WE aren't in it for the money, WE love animals, WE just want to make a good wage, WE want to have qualified staff that last more than a few years, WE just want you to appreciate how hard we work to make your pet better.
I'm curious about this. Because, honestly, nobody gives a crap about us. What they care about is themselves. And their pets. So I don't think playing the victim card is going to be effective. Yet there is clearly a crisis among veterinary professionals. So what should we do? We all want to be appreciated, live a good quality of life, help animals live better lives, and have enough money to live on.
What if we switch from defensive mode to offensive mode. Hear me out. Those roadblocks and criticisms we get from clients like "I don't want to spend money on an old dog" or "I won't pay for that test", or even "my breeder says...." are just part of the buying process that is common among all industries. Are we just figuring this out? Objections have always been there, but clients are now emboldened by public support and an online forum to voice their concerns.
Here's a crazy thought - why don't we start to sell our services? I hate "selling" too. I'm still not overly good at it, but I'm learning. I used to think, like many of my colleagues, that selling was unethical, manipulative, and demeaned my professional standing. I had an epiphany after taking a professional communications course. In the introduction to the course, our instructor defined the difference between Persuasion and Manipulation.
per·sua·sion - the action or fact of persuading someone or of being persuaded to do or believe something.
ma·nip·u·la·tion - the action of manipulating someone in a clever or unscrupulous way.If you believe you are manipulating a client when you recommend pre-operative bloodwork, or that you are being unscrupulous when you advocate for a fine needle aspirate on that suspicious lump - then I would argue that you don't believe what you are doing is in the best interest of the animal. If you are using techniques to "sell" them on these ideas, in the animals' best interest, is that unethical? If you think yes, then don't complain that your client is asking Susie at the pet store about nutrition, or Jeff the breeder in North Carolina about the lump. Because you can bet your bottom dollar that Susie is selling. Hard. And maybe not in an ethical way, with less education, and possibly an inferior product. I'm not advocating that you persuade people to spend money they don't have, or to do unnecessary tests. That would be manipulation (see definition above especially the “unscrupulous” part). A treatment plan, as we all know, is always titrated to the individual situation and client. Let's use sales to put adequate conviction behind a recommendation.
Learning sales techniques to increase your message's effectiveness, is the same as learning the most effective technique to treat a disease.Why don't vets sell? We hear that sales objection, and it stops us dead in our tracks. We take it personally, we get offended, we roll our eyes and think "oh cripes not one of these....insert annoying client behavior here". We feel judged, criticized, vilified.
A google search on "dealing with sales objections" revealed 410 000 results. I guess it's a common problem. Who knew? The first article that came up on my search was from Salesforce, a popular customer relations software. I found it helpful to summarize what are objections and some ways to handle them. In the book "To Sell is Human", Daniel Pink speaks specifically on the challenge of "selling" ideas in healthcare and education. The three qualities that Pink suggests are the new requirements for moving people to action are; Attunement, Buoyancy and Clarity. A few of his tips that I believe veterinarians should be using in every appointment (read the book for more) include:
So, the next time someone says "but that's too expensive" you can think Ah!!! Here is the Objection!!! Put on your rational process pants, and realize "I know how to handle this"! Ask questions. Keep asking questions. Then ask a few more. Come from humility and service to the client and the pet. You might find you don't need the "spiel" at all. In fact, I'll bet you see better results without it.
Using ethical sales techniques, your patient, you, and your client will be rewarded with a richer, more fulfilling relationship. A side benefit may be a better bottom line and you won’t even have to mention your rusting beater car or your hefty student loan.
Dr. David Bledsoe
By any measure, at 54 years young I have plenty of experience in life, and by “experience” I
mean I have made plenty of mistakes. Some mistakes come with no lasting consequences,
others carry profound ones, to which a friend of mine recovering from a traumatic brain injury
caused by a drunk driver can attest.
Mistakes come in multiple flavors. In sports we talk about “mental errors” and “physical
errors”. In football, for example, an offsides penalty is a mental error and a missed tackle is a
physical one. Anyone in medical practice for more than a day has made mistakes. Some are
errors in judgment (e.g. a missed diagnosis). Some are errors in practice (a dose calculation
error, for example).
While it’s important to accept that medical practice involves mistakes large and small, it’s
equally important to accept the following principles:
1. Not all poor outcomes are the result of an error.
We all wish animals were like my truck (which I affectionately call La Trucka. Of course, I
see her as a woman). If my truck has a problem I just take her to the mechanic and he
hooks her up to the computer, which diagnoses her issues straightaway. He then
explains the issue to me in clear and simple Portuguese; “well looks like your
beamihater has busted your duel zibers and fucked up your fuel injectors. That’ll be
about a $1,000 to fix”.
Animals are so much more complex. We can run all the diagnostics available and still not
get to a diagnosis. Even if we do, there’s no Pep Boys or Napa Auto Parts from whom to
get replacement parts. Animals die in our care and so much of the time – I venture the
overwhelming majority of the time – there is nothing we can do. Period.
2. Responsibility is not the same as fault.
When we are in charge of a case, we are responsible for the patient’s care. No question
about that. We are the captain of the vessel and as the captain we have the
responsibility to make sure the best care possible is provided. The key word here is
“possible”. Sometimes we are limited by facilities, access to equipment (personally, I’ve
always wanted a Tricorder like on Star Trek), or often the greatest limitation of them all:
money. We do the best we can and take responsibility for the care we can provide
within the limitations in which we must sometimes work. And while we are responsible
for the care, it’s not necessarily our fault – or anyone’s – if things go badly.
3. Accept that we are not perfect.
Excellence is not perfection and one should strive for mere excellence. No more, no less.
4. Give yourself (and others) grace to fail.
In our pursuit of excellence, we will experience failure. Extending grace to ourselves can
be the hardest thing to do, even harder than extending it to others, but we must if we
are to maintain some semblance of professional sanity.
Life experience can be a tough teacher, but keeping these principles in mind can make the
lessons less painful.
The Admin Team of NOMV is a group of veterinarians dedicated to improving veterinary mental health.