Dr. Boatright is a 2013 graduate of the University of Pennsylvania. She currently works as a small animal general practitioner and emergency clinician in western Pennsylvania at NVA Butler Veterinary Associates and Emergency Center. Her clinical interests include feline medicine, surgery, internal medicine, and emergency. As a freelance writer and speaker, Dr. Boatright enjoys educating veterinary students and colleagues about communication, team building, and the unique challenges facing recent graduates. Outside of the clinic, she is active in her state and local VMAs and serves on the VBMA Alumni Committee. In her spare time, she enjoys running and spending time with her husband, son, and three cats.Read Articles Written by Kate Boatright
Given that most people consider their pets to be part of the family, it is not surprising that strong emotions are often encountered in the veterinary clinic. In one exam room, a happy family shows off their new kitten. In the next, a 20-year-old man and his family cry as they say goodbye to his childhood dog. While one member of the vet team is thanked by a client for the post-op care they provided to a patient, another team member is accused of being “heartless” after presenting an estimate to treat a sick pet. These intense emotions can affect the client’s decision-making and require careful handling by the veterinary team.
Discussing Quality of Life and Euthanasia
Euthanasia is thought to be the hardest part of the job by many outside of the profession. In reality, it is the conversation leading up to a euthanasia that is considered the most difficult part of the process by many veterinarians.1 These conversations are often emotionally charged, though the emotions surrounding the decision to euthanize may vary in different situations.
In some cases, the client may present their pet for a quality-of-life evaluation. Some clients are open about this, while others may feel too nervous or guilty to begin the conversation. When the veterinarian or their staff senses this, using a question such as, “What is your goal for today’s appointment?” can give clients the opportunity to share their thoughts. While conversations surrounding quality of life can be emotional for both the veterinarian and client, when all involved agree that euthanasia is the best option the process is easier.
Unfortunately, not all end-of-life discussions are as easy. Finances often play a role in decisions surrounding treatment and euthanasia. For a client with limited finances and a pet that requires a life-saving surgery costing hundreds or thousands of dollars, euthanasia may be in the patient’s best interest. In situations of economic euthanasia, clients are more likely to express anger at the clinic’s payment policies or guilt surrounding their limited finances. The veterinary team can help guide clients in their decision and offer support if the client makes the difficult decision to euthanize. Providing reassurance to the client that they are acting in their pet’s best interest and withholding judgment on their financial situation are crucial to successfully managing these situations.
In other cases, a pet owner may be unwilling to euthanize despite the pet’s poor quality of life. As veterinary medicine becomes more advanced, there are often many things we can do for a pet. But should we? Most veterinarians have experienced situations where clients request treatment that the vet feels is futile.2 These situations are especially difficult for all members of the veterinary team who can see the pet’s suffering and feel unable to do the “right thing.”2 Utilizing existing quality-of-life evaluation scales, having multiple conversations, and offering to refer a patient to a hospice veterinarian are all strategies that can be used to help move a client toward the decision to euthanize. The longer these conversations take, the more distressing they can be to the veterinarian.1 It is important for veterinarians to stay aware of their own emotions during these conversations and avoid expressing frustration to the client.
In all euthanasia situations, veterinary teams can help the client through the process by clearly explaining the procedure and preparing clients for any potential adverse events. For clients who express high levels of grief, offering the services of a trained social worker or grief counselor may be helpful. Some grief counselors may be open to working with a client prior to euthanasia to help them make the decision to euthanize.
Emotions are often magnified in emergency situations when decisions must be made quickly, money is more likely to be a factor, and the situation is unexpected. Because of this, emergency hospital staff often take the brunt of an upset client’s negative emotions.
It is important to remember that emotions do not occur in a vacuum. Take, for example, the client who has just brought the family’s 2-year-old chihuahua to your clinic after he was attacked by a large dog on their evening walk. The patient is in shock, has numerous puncture wounds and a large abdominal hernia, and is in respiratory distress. You discuss diagnostic and treatment options and give the client a guarded prognosis. The client begins to yell at you and your veterinary nurse. While this client’s reaction may be inappropriate, it is likely driven by a number of emotions—guilt that he or she couldn’t protect the dog, shock at the situation, fear of losing the dog, anger at the other dog’s owner, or worry over the cost of veterinary care. By acknowledging these emotions, the veterinarian can begin to work with the client to make the best decisions for the pet. Expressing empathy is one of the most important things a veterinarian can do during these cases.
Managing Emotionally Charged Situations
Much of successful management of client emotions comes down to communication. Veterinarians with excellent bedside manner and communication skills are more likely to have a satisfied client and less likely to receive board complaints or malpractice claims.3 Communication is now considered a core clinical competency for veterinary students.3
Communication training can be provided for the entire veterinary team through mock situations or reviews of recorded client interactions. Key communication strategies that can be used in emotional situations include expressing empathy, providing information in small chunks, and reflective listening.
As discussed in my previous column in the January/February issue (todaysveterinarypractice.com/the-cost-of-caring-too-much), financial concerns are often a contributing factor to emotional situations. Discussing finances with clients is the third most common stressor for practicing veterinarians.4 There are resources and continuing education opportunities for veterinarians to learn how to best discuss finances with their clients, but here are a few tips to lessen the stress:
- Maintain compassion and empathy throughout your conversations. Always start your conversations by talking about the care of the pet first and the price tag second.
- Offer multiple treatment options to clients and do not jump to euthanasia immediately unless it is in the best medical interest of the pet.
- Be open about finances throughout the visit and provide treatment plans and estimates.
- If a client seems hesitant to approve diagnostics due to price, ask them what their budget is. Having this conversation early on allows you to make decisions on the most useful tests to run while conserving enough money to offer treatment for the pet.
- Never discuss finances in a public place (e.g., the waiting room).
- Empower your staff to feel comfortable and confident discussing treatment plans, estimates, and options with clients.
Managing the Veterinary Team’s Emotions
While it is important for veterinarians to take care of their clients’ emotions, they must also care for themselves and their team. In a recent survey, over 70% of veterinarians felt that situations where they felt they could not “do the right thing” caused both themselves and their staff moderate to severe distress.2 Acknowledging these feelings and discussing them with coworkers, family, or a professional is essential to maintaining wellbeing and continuing to provide the best possible care to emotional clients.
1. Matte AR, Khosa DK, Coe JB, Meehan MP. Impacts of the process and decision-making around companion animal euthanasia on veterinary wellbeing. Vet Rec 2019;185(15):480.
2. Moses L, Malowney MJ, Boyd JW. Ethical conflict and moral distress in veterinary practice: a survey of North American veterinarians. J Vet Intern Med 2018;32(6):2115-2122.
3. Shaw JR. Evaluation of communication skills training programs at North American veterinary medical training institutions. JAVMA 2019;255(6):722-733.
4. Kipperman BS, Kass PH, Rishniw M. Factors that influence small animal veterinarians’ opinions and actions regarding cost of care and effects of economic limitations on patient care and outcome and professional career satisfaction and burnout. JAVMA 2017;250(7):785-794.