Caution: Rant in progress… Not the drug and supply manufacturers, distributors, or their reps. Not our landlords, government agencies, or lenders. Not the laboratory workers, consultants, or other service providers. Not the pathologists, radiologists, or even most specialists. And definitely not the schools. Nope. The blame lies with us… the general practitioners and technicians. Those of us engaged in day-to-day direct care and long-term client relationship management bear the brunt of the emotional workload in veterinary medicine. Here’s how it happens: Scenario A: Your geriatric patient comes in for an annual examination. His owner declines routine lab work, opting instead for the physical examination and bare bones core vaccination. The pet bloats overnight, and his owner wants you to pay for his extensive emergency care as a result of what “the ER doc said” was an obvious vaccine reaction. You explain you fail to see the connection between the vaccines and the condition. Consequently, you’re blasted on Google, Facebook, and Yelp (the triumvirate axis of evil) for being a cruel, money-hungry, vaccine-pushing “fraud” of a clinician. Scenario B: You diagnose a feline patient with an oral mass. One month later, this drooling, depressed, emaciated kitty suffering a swollen, putrid face is still barely clinging to what’s left of her pain-wracked existence because your client believes in “natural death.” Treatment options, including palliative alternatives, are rejected because they’re seen as “prolonging the inevitable.” Scenario C: You overhear your associate speaking to a client who demands to know “within 24 hours” what exactly caused her pet’s diarrhea. However, she refuses to “waste” any money if it won’t definitively pinpoint the source of the condition. Scenario D: Your obtunded patient is seriously hypernatremic and dehydrated. On your hunt for a cause for this adolescent dog’s laboratory finding, it comes to light he’s had his water restricted because he’s not yet been housebroken. In the history, however, his owners claim “he drinks more water than any other dog we’ve even seen,” and that he regurgitates when he drinks so much, which leads them to further restrict his water intake. Explanations fail to convince your clients, who subsequently take their pet home to die overnight. Scenario E: Your associate just diagnosed a probable pharyngeal mass in a feline patient. You recommend a surgeon and explain a CT is likely in order. Instead, your client seeks a second opinion from a “cat specialist” who, after performing a physical examination, reportedly diagnoses an upper respiratory infection. The client calls to complain about my associate’s egregious “misdiagnosis” and utter “negligence,” but admits the condition is no better a week later. Scenario F: You just learn you lost a client after diagnosing her cat with idiopathic cystitis (a.k.a Pandora syndrome) and engaging in a lengthy discussion of the condition and recommending a multifactorial approach to management. When you call to check in two days later, the owner claims she went to the ER and her cat was easily “cured” with an antibiotic. Oh, and the ER never sent any records to inform me of their magic trick. Scenario G: My beloved client comes in to donate medications. Turns out her dog was euthanized over a week ago at the ER and she was wondering why we never called to express our condolences as we usually do. Again, I never received a report. Scenario H: Another client heads to the ER for lameness in her 10-lbs. dog, who is diagnosed with a cruciate ligament tear and whisked to surgery. Rehab and acupuncture are scheduled. No ER veterinarian, surgeon, or rehabber ever calls me to discuss the case. I never get a chance to offer my client alternatives, including my surgeon, acupuncturist, or rehabber of choice. The client, of course, calls me to complain about her bill. All of these scenarios transpired within a month’s time. No lie. Now this was an especially bad month for us, but these are the kinds of things most of us deal with regularily. The real stress The feeling of not being good enough, despite our many years of schooling and experience, is commonplace. Impostor syndrome, in which we doubt our accomplishments and fear being frauds, runs rampant among us. Add that to the many pressures arising from animal welfare issues and garden-variety grief and it’s clear we labor under an emotional workload that’s likely to kill us if we don’t learn to cope with it. Euthanizing patients (as the experts tell us is the primary source of our stress) barely figures. After all, euthanasia is a beautiful death, one most of us have wrapped our heads around long ago. The alleviation of suffering, coupled with our clients’ typical expressions of gratitude, makes euthanasia almost a balm by comparison with scenarios like these. The real stress in our lives comes from managing our clients’ expectations, communicating carefully under duress, experiencing human unreasonableness, battling with our own inner demons, and struggling to balance what other people think of us with what reality has to say, if we listen hard enough. Fear is the real culprit. I once heard that FEAR stands for “false evidence appearing real.” This has always resonated with me. And when we talk honestly with our colleagues, when we’re not posturing or on the defensive, we’ll find we all carry the same emotional baggage, to some extent or another. Do some of us feel it more than others? Absolutely. And to those I say, “You are not alone.” This is an interesting profession. It’s hard. But if it was easy, everyone could do it. And they can’t. You can. And you probably do it very, very well. Remember that, and you’ll live to fight another day… and maybe even fall in love with veterinary medicine all over again. Patty Khuly, VMD, MBA, owns a small-animal practice in Miami and is a passionate blogger at drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.
