https://todaysveterinarypractice.com/table-of-contents-november-december-2020/
From the Field, Personal/Professional Development

Lasting in the Veterinary Profession

Participating in open and honest conversations about compassion fatigue is one of the first steps toward addressing mental health issues in veterinary medicine.

Kimberly-Ann TherrienDVM

A graduate of the University of Montreal, Dr. Therrien joined Banfield Pet Hospital in 2006 and is currently Vice President for Veterinary Quality in the Midwest region. She is a member of AVMA, KVMA, and FVMA; a member of the Banfield Foundation board; and president of the Women Veterinary Leadership Development Initiative.

Dana NovaraDVM

After graduating from the University of Minnesota in 2008, Dr. Novara spent time in small animal practice before moving into veterinary leadership roles within Banfield, where she was most recently Vice President Veterinary Quality in the Southwest region. Currently, she is building her own practice, Urban Paw, in Denver, Colorado.

Lasting in the Veterinary Profession
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From the Field shares insights from Banfield Pet Hospital veterinary team members. Drawing from the nationwide practice’s extensive research, as well as findings from its electronic veterinary medical records database and more than 8 million annual pet visits, this column is intended to explore topics and spark conversations relevant to veterinary practices that ultimately help create a better world for pets.


As veterinarians, we do not always realize that, because of the complexity of our work, we are at high risk for compassion fatigue. The constant roller coaster of emotions that comes from euthanizing a long-time patient, then celebrating a new puppy exam, followed by treating a complex medical issue, creates extreme emotional highs and lows throughout the day. Because of this, there continues to be research into the causes of burnout, compassion fatigue, and the higher-than-usual rates of mental health concerns in veterinary medicine.1

A study conducted by the Centers for Disease Control and Prevention (CDC) revealed approximately 1 in 3 veterinarians has anxiety and 1 in 6 has considered suicide, with a suicide death rate 2 to 3 times higher than the general population.2 These findings are startling—and mean that it is very likely you work with someone who is struggling and/or are suffering yourself.

By bringing this conversation to light, we hope to destigmatize these topics and help break down the barriers to getting help.

COMPASSION FATIGUE

Compassion fatigue can manifest itself in many ways. Burnout—or the detachment from work and other meaningful relationships—along with trouble sleeping, increased alcohol intake, depression, and psychosomatic complaints can all be indicators of compassion fatigue.

In addition to caring for yourself, it is also important to lean into conversations with your peers when you recognize it in them. They may not yet have the tools to deal with this, and we owe it to each other to help. As a community, we need to get better at recognizing, destigmatizing, and seeking help around this important topic—it could literally save a life.

It is also important to realize that compassion fatigue is not something that we can remove from our profession altogether—it’s a byproduct of the work we do. As doctors, we look to treat and cure, but we cannot cure compassion fatigue. However, we can manage it. We need to learn how to do this job and care for ourselves at the same time. This takes planning and practice.

CREATING A CARE PLAN

To help prevent emotional distress, create a care plan with the goal of taking care of your whole self to ensure resilience under tough circumstances. A successful plan enables us to release blocked emotions that we carry with us throughout the day. This plan should be multi-faceted and ever-changing as part of our work. Start by recognizing the 5 key elements of health and wellbeing: healthy body, healthy mind, healthy career, healthy community, and healthy finances. When we take time consider each element, we create a care plan that can help us face compassion fatigue.

L.A.S.T. IN THE VETERINARY PROFESSION

The care plan can be a great long-term tool to help maintain your health and wellbeing. But given we cannot take the risk of compassion fatigue out of the work we do every day, it is also important that we have tools and resources to help us in moments of need.

One such tool is the acronym L.A.S.T., which stands for Listen, Accept, Seek, and Test. Remember it by thinking, “If I want to last in this profession, I need to L.A.S.T.” Running through the steps outlined below can help unblock your emotions in the moment.

  • As you leave an exam room after an emotional case, encounter with an angry client, or euthanasia, your first instinct may be to compartmentalize the emotions you’re feeling to get through the day. Our profession requires a certain level of skill around compartmentalization, but it still takes a toll on your wellbeing. Next time this happens, try taking a micro break, and Listen to your body. Maybe your back is hurting or you’re hungry, sad, or frustrated. All these things are real and need to be addressed.
  • After listening, it’s time to Accept. This may seem abstract; however, we often judge ourselves harshly by telling ourselves things like: “I’m the doctor, I shouldn’t cry,” or “I have too much to do to stop for lunch.” It is often hard in our busy days to allow ourselves to accept how we are really doing, but it is critical to practice accepting without judgment.
  • From there, Seek a plan. Instead of judging yourself for how you feel, think about a possible solution. Maybe you need to go cry, seek support from a colleague, take a longer break, eat some food, take 5 minutes to meditate, or stretch. The important thing is not that you fix how you feel immediately, but that you’re trying something. Whatever it is that you are feeling, whether you judge yourself or not, is real. When you ignore that fact and do nothing, your emotions and physical injuries can start to compile. 
  • Next, seek a solution and Test it out. If what you tried didn’t seem to help, try something different next time. Compassion fatigue is not a static condition, so the solution will not be static either.

It is important to remember that L.A.S.T. isn’t just needed in extreme circumstances. Small moments and emotions build up over time, and the better you get at unblocking the smaller-scale emotions as they arise, the better your chances are at lasting in this profession. 

As we continue to research and understand compassion fatigue within the veterinary profession, we also need to start addressing what we can. Defining compassion fatigue and learning how to recognize it is the first step. Lean into difficult conversations with colleagues when you notice the symptoms. Create a sustainable care plan to take care of your whole self and prevent the compounding effects of compassion fatigue. Also, be sure to act in the moment when you are most stressed by using the acronym L.A.S.T.

We help animals and families for a living, but we can’t continue to help others without first helping ourselves. Those called to this profession should not only be able to survive but also thrive.

Case Studies: Compassion Fatigue in the Real World

Dr. Novara’s story: I was 2 years out of school, working in a busy 4-doctor small animal practice. As a leader, I felt it was my responsibility to not only take good care of my patients and clients but also my team. What I didn’t see was that I was trying to protect my team from negative emotions by taking them all on myself. I often found my days loaded with multiple euthanasia appointments and hearing my team say things like, “Put it on Novara’s schedule; she doesn’t mind them.” Eventually, the team started calling me “Dr. Death.” I told myself this was a compliment, that my team appreciated that I could handle this for them, and that maybe it didn’t affect me in the same way it did them. Unfortunately, I learned the hard way that I was not being honest with myself. One day, I found myself with 5 euthanasias scheduled. The last of the day was a dear, long-term patient of mine. Not only was this hard to get through, but it also kept me late at work and prevented me from getting home to a gathering with friends. I walked out of the last room and told myself, “Don’t let them see you cry.” I was so emotional on the way home that I almost drove off the road, called and yelled at my husband, and heard myself tell him “I wish I had just driven off the road.” To this day, I don’t believe I really meant that, but I should not have let myself hit the bottom before stopping to listen to myself. Through the love and support of my husband, I was able to see that my mind was trying to tell me that I was not OK and things needed to change. Together, we came up with a plan for talking to my team and setting boundaries at work.

Dr. Therrien’s story: As a “type A” kind of person (someone who is a perfectionist, highly motivated, and self-critical), working full-time through vet school and then landing a dream job in a very busy private practice, I never knew anything other than working long days and constantly challenging myself to learn and do more. Over time, work became my everything. When I wasn’t at the clinic, I was filling in at another job so others could take a vacation or a sick day. It got to a point where there was no more happiness or joy in my life because work consumed every minute of every day. In full transparency, I was completely unaware until, one day, my husband helped me see how out of balance my life had become. The more I worked, the more I needed to prove to myself that I was “good enough,” and it was costing both my physical and mental health as well as my relationships. I came to realize that internally I suffered from self-doubt—frequently referred to as “impostor syndrome”—and it was rapidly turning into compassion fatigue in the form of burnout. If I continued to do what I was doing, it became clear to me that I would not survive in this profession. So, I made decisions that would allow me to find a balance once more, and I distinctly defined the triggers that could cause me to fall back into old ways. I became very clear with my goals and intent, and to this day continue to check in with myself to ensure I am feeling balanced. I now know the signs and openly discuss them with those around me so they can help me be on the lookout for them too.

Additional Resources

Books

  • Figley C, Roop R. Compassion Fatigue in the Animal-Care Community. Washington, D.C.: Humane Society Press; 2006.
  • Kabat-Zinn J. Full Catastrophe Living: How to cope with stress, pain and illness, using mindfulness meditation. London: Piatkus Books; 2001.
  • Kabat-Zinn J. Wherever You Go There You Are: Mindfulness Meditation in Everyday Life. London: Hachette Books; 2005.
  • Dana D. Conflict Resolution. New York: McGraw-Hill Education; 2001.
  • Rosenberg M. Nonviolent Communication: A Language of Life. Encinitas, CA: PuddleDancer Press; 2015.
  • Fisher R, Ury W, Patton B. Getting to Yes: Negotiating Agreement Without Giving In. New York: Penguin Books; 1991.

Websites

Apps

  • Calm – Mindful mediations and help falling asleep
  • Headspace – Mindful meditation
  • SAM – Self-help anxiety management
  • Happify – Evidence-based activities and games to reduce stress and negative emotions
References

1. Bartram D J, Baldwin DS. Veterinary surgeons and suicide: a structured review of possible influences on increased risk. Vet Rec 2010;166(13):388-397.

2. Centers for Disease Control and Prevention. Notes from the Field: Prevalence of Risk Factors for Suicide Among Veterinarians — United States, 2014. cdc.gov/mmwr/preview/mmwrhtml/mm6405a6.htm. Accessed June 2020.

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