Every veterinarian understands that the struggle for work-life balance is real. We all know how difficult it is to take time for ourselves and, if we do manage it, we feel guilty about it.

But the solution to the problem isn't just doing more yoga or eating healthier, although those things can certainly help. We talk about work-life balance, but what does it really mean? Is it more vacations, fewer work hours, not as many commitments? What makes you 

Millennials (I'm one) have been stereotyped as lazy. The reality is, we just want more out of life. We don't want to spend our entire lives working just to find out at age 65 that all we have to show for our hard work are a broken marriage, kids who wished we would've been there for them, two houses, a few new cars and a big retirement account we can't enjoy because we now have health issues or can't get around like we used to.

Mistake No. 1: Don't do what makes you happy in practice

The ideal way to be a happier veterinarian is to do what makes you 

. Of course, that's easier said than done. We can't avoid every blocked tom (my nemesis) that walks through the door. But we can focus on our favorite things and be the best we can be in those areas, in practice and our private lives. You'll get a reputation for excelling in these areas and enjoy that aspect of the field more often. On the flip side, you also may want to take time to learn more about the things you don't like so much. 

 You may find you like these areas of practice more once you learn more about them and build more confidence.

You are allowed to spend time with your family and have a life away from work.

Mistake No. 2: Refuse to face your imperfection

. We are not perfect, although we may strive to be. You don't need to accept offers to be on every board, volunteer for every event in your area or take every emergency call that comes in. You are allowed to spend time with your family and 

. It's OK to work to live and not live to work.

Mistake No. 3: Spend time with people who make you feel bad

Surround yourself with people who build your confidence, not tear it down. Find a great support system. Unfortunately, this isn't always family because family may not understand fully the struggles we face. 

 or old classmate is the perfect person to confide in when work or life becomes challenging. You can mull over that dog with pancreatitis that just won't stop vomiting or discuss the challenges of working for a baby boomer. Sometimes we just need to remind each other that we're good people and good veterinarians and that we have each other's backs.

Find a way to leave work at work. Restless nights spent worrying about cases are only going to make you exhausted the next day. You owe it to your patients to be on top of your game, and lack of sleep is not going to help anyone.

Of course, getting a good night's sleep may be much easier said than done. Cut your 

 early in the day. Turn off your phone or TV well before bedtime. If worries keep you awake at night, set time aside in your schedule to go over events or stressors that occurred throughout the day. Avoid large meals and alcohol in the evening.

If you are truly unhappy in your work situation, then change your situation. 

. We are constantly concerned with our patients' quality of life, yet we often forget about our own.

If you're put in a situation where you are unable to practice the type of medicine you feel is best for your patients, are being verbally abused or your work environment is hostile, make a change for your well-being. Most importantly, learn from these experiences. They will mold you into a better person and veterinarian. Even if you simply discovered what not to do, you were allowed to grow and sometimes growth can be difficult and painful.

Dr. Shana Bohac is the owner of Navarro Small Animal Clinic in Victoria, Texas. She has a passion for surgery as well as compassionate wellness care. She has a husband, Brandon, daughter, Aiden, three crazy cats, two dogs and a handful of horses.

Articles

I think that we well-meaning, hard-working veterinarians sabotage our own happiness, job satisfaction and personal health by doing these five things.

5 ways veterinarians lead imbalanced lives

If you haven't been living under a log this year, you have heard of the magnetic minimalist Marie Kondo and the 

. You may even have caught onto the craze as many Americans have—disposing of things and looking for sparks of joy amidst a world of chaos. I believe that the reason the decluttering movement is so compelling to us is that we, more than perhaps any nation in the world, drown in the burden of our material possessions. It is compelling to reconnect with the freedom that is afforded by having fewer things in the quest for a more meaningful life.

While the KonMari Method is all the rage in the home, business managers have not as eagerly tackled decluttering in the workplace-particularly the medical workplace-where stuff piles up because of the nature of the business. But why not? Why compartmentalize tidiness and joy, as well as the other efficiency benefits, to the home? Why shouldn't veterinary professionals discover the freedom, productivity and serenity that a tidy hospital can bring? I challenge you to take advantage of this opportunity in your workplace while we're all tidying up together!

The question you may ask first is-why? After all, it will take effort to tidy your hospital, and who really cares? Will you make more money decluttering rather than tending to patients and clients? Is it really your job to do this? Aren't there enough pressures in the profession as it is, without the need to emulate a perfect, orderly space as well? Well … yes. Allow me to provide you with some well-founded reasons for working in a decluttered medical environment:

 It is well understood by biological risk management experts that cluttered medical spaces are difficult to sanitize. All those things on the floors and counters are potential fomites, and no one can afford the time required to clean under the piles or the wheels of the roll-around IV poles. Keeping your hospital organized and tidy will vastly help with the ultimate efficacy of your cleaning efforts. 

 Have you ever had a strong, sudden urge to clean your desk when you are trying to start on an overwhelming or potentially unpleasant task? This form of procrastination is a displacement activity that your mind compels you to do in an attempt to control something. In her 

,” journalist Emilie Le Beau Lucchesi explores the relationship between clutter and procrastination. These phenomena are closely linked because they are tied to the same behaviors. Rid yourself of clutter and you also rid yourself of excuses, which can help encourage better workplace efficiency.

There are a variety of oft-quoted statistics regarding the vast number of hours employees spend looking for things on their desks every year. Even if we don't know precisely what this toll is in the veterinary hospital, we know that clutter in the workplace leads to time spent searching for things, which diminishes the time dedicated to productive work. In addition to this, clutter can be a distraction. In his book 

Goodbye, Things: the New Japanese Minimalism

, well-known minimalist Fumio Sasaki explains the way in which the objects around you demand your attention and become your “silent to-do list.” In the veterinary space, glancing at your cluttered surroundings while working can distract you from the care you are providing to patients.

If your space is disorganized, it's easy to order more of something because you can't find where the first stash went. If you don't know where your supplies are, you also don't know if resources are being used responsibly and tracked accurately. The relationship between lack of clutter and good inventory management is well known among warehouse managers. We can apply the same rigor to small animal medicine if we assume that physical space organization directly relates to good management.

Excess clutter is linked to anxiety; this is most evident on the extreme end of the spectrum with hoarding disorders. For those of us in only moderately cluttered surroundings, piles of objects can still disturb a sense of well-being. Clutter is also easily observed by your clients. They can be put off by stacks of paper and other visual distractions too. Imagine the mental refresh that a clean and tidy space will be for you, your employees and your clients. 

The bottom line is that your excess piles are not doing anything good for you or your business and are likely actively working against your day-to-day enjoyment of your job. This is a shame since veterinary professionals already work long hours and under a variety of pressures. 

Let's get started envisioning and executing this beautiful, clutter free and peaceful space! 

While I recommend you read (or listen to while commuting, as I do) a couple of books on minimalism, below are some practical suggestions focusing on your veterinary space:

Almost every minimalist and decluttering expert recommends this as a first step. If you know where you're going and can envision the beautiful environment you wish to attain, then it will be much easier to keep your focus toward that vision. Create a Pinterest board or find ideas in 

 and then put these in a place where your team members can see these ideas and participate in enacting them.

Ask each of your team members to start this journey on his or her own by tackling personal work spaces before working together on common work space. This way, when you do group cleaning activities they will already be positively engaged. Let them have a go at it first and encourage them to take home, recycle, donate or trash items they don't need at work anymore. Make sure you set a good example by cleaning up your own personal items as well.

 Humans tend to hoard objects they think might be useful someday. As Fumio Sasaki sagely advises, “Let go of someday.” Here are some examples of items you should dispose of:

 If it's old technology, it's NEVER going to come back into vogue. If it still works and you feel bad about trashing it, then send it to a deserving non-profit.

 Seriously, you're never going to come in on a Saturday and fix that chair. 

 If that part has been lying around for a long time and you don't even remember what it's for, get rid of it. If it comes to pass that you do need it, order a new part.

 If you have equipment that doesn't fit in your space, you aren't going to suddenly need it. Send it to the same non-profit you used for your old technology.

 You know what I'm talking about. You don't need twelve squishy balls with company labels on them or 500 cheaply made pens. Next. 

Once files have expired legally, shred them. Extra educational materials that you aren't using, brochures and defunct manuals all belong in this category. Shred sensitive items and recycle other papers. Buh bye. You won't miss them, and no one under 40 is going to look for them when online medical references are at least as good. 

 Items that are sentimental to people who no longer work there. 

Former owners of a business may be horrified to know you got rid of the Snoopy statue or the clunker of a surgery table that he got from his father. But if it isn't useful to you, offer your gratitude to the person who helped you get started with your business, and let it go.

If your furniture looks like you robbed a 1980s beach condo or if the Norman Rockwell prints on the walls are sun faded and dog-eared, let them go. New and stylish items make a huge difference in signaling that your practice is up with the times. This is important to your clients, as they will believe your style relates to your medical and technological prowess.

At this point, you've likely done a pretty good job; perhaps you've even gotten rid of a third of the excess items you have in the hospital. Good job! But really, your space is still a mess. It's time for the big group effort.

Now you need to organize a group cleaning day with defined tasks. Knock off a few hours early on Friday, order some pizza and get to work. Give each of your team members an area of the hospital with instructions about what should be done with items. For example:

Expired medications and supplies go in one area for proper disposal.

Books go in one place. When you sort books, ask yourself if you'll ever use it again at the office. If not, it goes home or gets donated. 

More papers go in one pile to sort to see if they're needed. (Here's a hint-if you didn't know they existed, they aren't needed.)

Good, useful supplies go in one area to reorganize once the space is clean again.

The next day, come back in, perhaps with one stoic coworker, and get rid of the items marked for disposal. Restage useful supplies in one area so they are ready for restocking.

Heather Lewis, AIA, NCARB, is a partner at Animal Arts, an architecture firm in Boulder, Colorado and frequent HospitalDesign360 conference speaker. She's a lighting geek and a (seriously) devoted advocate of minimizing pets' stress and anxiety during their veterinary visits.

Say bye to the junk. Declutter your practice. Spark joy in part one of this series that will help you learn that a streamlined practice is an efficient one!

The tidy veterinary hospital

By and large, veterinary clients whose pets are diagnosed with 

 do not, at the outset, appreciate all of the implications of that diagnosis. Many pet owners think that if their veterinarian uncovers pain in their pets, it's a straightforward solution for a straightforward issue. Clients sometimes think of chronic pain like an infection, and they want us to treat it like it one: identify the problem, treat that problem and watch as the problem goes away forever. Correcting this misconception is a critical component of creating success.

So, how do we do that? Where do we start?

Steps 1 through 3: Education, education, education

Our clients cannot know what they don't know. The foundational principle of 

-respect for the client's autonomy-obligates us to inform and educate clients to understand, to the best of their ability, what's happening in their pets' bodies. We must illuminate pain, identify where in the body it's present, diagnose the cause whenever possible and give them an appreciation for the intensity of that pain. A careful pain palpation in front of the client is the first step.

Before beginning the pain palpation, demonstrate the pressure to be used by palpating the owner's forearm (with their permission, of course). This shows the clients what firm pressure feels like and helps them appreciate that palpation, while not painful by itself, can reveal pain that's present. Seeing (and feeling) is believing. It allows the pet's reactions to take on deeper meaning. Radiographs or other imaging may also be needed before undertaking treatment.

Step 4: Taking the pain out of pain conversations

Once clients understand their pet's pain, education continues through common questions. Here are some sample responses to questions like these that provide helpful language for pet owner understanding about their pets' pain problems.

I feel terrible! I had no idea Max was in so much pain. I just thought he was getting older and slowing down. How could I have missed it?!

“I know it can be upsetting to learn a family member is hurting. Don't be too hard on yourself. It's important to understand that animals do their best to hide any weakness when they don't feel their best. They're masters at hiding pain, and they do their best to carry on with all the things they're used to doing.

“When I'm doing my physical exam, I'm asking my patients very specifically, “Does it hurt when I touch you here?”, and I watch for the reaction. My examination is very different from the ways in which you touch and interact with Max.

“Max always wants you to think that everything is fine.”

So, now what? How can we help Max feel better and get back to normal?

“The good news is, we have many tools to help Max. But it's important to understand that there is no “magic bullet” for chronic pain. We'll include a lot of these tools in our approach. That could mean nutrition, supplements, medications and physical medicine options like chiropractic that together work better than any single option works on its own. And we'll talk about modifying Max's home environment and lifestyle to help him be more comfortable and active.

“We'll work together to tailor specific treatments to meet Max's needs. Breaking the pain cycle quickly is our No. 1 priority, so we'll use medications that target pain and inflammation as well as medicines that work on the nervous system itself. Some or all of the medications we choose may be in place long term.

“We'll also focus on scientifically proven nutrition and supplements to support joint health, decrease pain and inflammation, and allow us to decrease the doses of medications to the lowest effective doses.

“Finally, we'll discuss physical medicine options-for instance, acupuncture, chiropractic and physiotherapy-that could benefit Max.”

That sounds like a lot. Exactly how long will Max need to take all this medication or use special food?

'It's important to take the long view. You and our healthcare team are now partners in Max's care, working together to help him as his body continues to age and change.'

“Unfortunately, chronic pain is the gift that keeps on giving, so we will need to be doing something for Max's pain management for the rest of his life. It's important to take the long view. You and our healthcare team are now partners in Max's care, working together to help him as his body continues to age and change.”

I'm not sure I can do all of this for Max. To be honest, I'm feeling a bit overwhelmed.

“Don't panic. Part of my job as Max's veterinarian is to partner with you, set priorities among Max's medical issues, and help you understand what we need to focus on first, second, third and beyond. I'm also here to help you identify what you can do at home to help Max remain comfortable and active. I think you'll be surprised at how simple some of that can be.”

Dr. Robin Downing holds a master's in clinical bioethics and is a diplomate of the Academy of Integrative Pain Management, a diplomate of the American College of Veterinary Sports Medicine and Rehabilitation, a Fear Free Certified Professional, a certified veterinary pain practitioner, a certified canine rehabilitation practitioner, and hospital director at The Downing Center for Animal Pain Management in Windsor, Colorado.

How veterinarians can discuss options with clients for pets who need long-term pain medication.

Sample veterinary script: Lets talk about chronic pain

Clients get mad for all kinds of reasons. Sometimes it's a matter of displaced frustration or sorrow. Sometimes a client has a difficult case, loses a pet or even has 

. And sometimes they displace some of those frustrations onto you. Then there are the clients who you just can't make happy. You did everything right, but they wanted something that you couldn't provide such as discounted services or the fulfillment of unreasonable treatment requests. In my experience, the primary reason clients get upset is because they don't see the inherent value in the service you provide to them. This is a result of poor communication.

When clients don't see the value in what they're paying for, they're prone to turn against you. They may feel that unnecessary procedures were done or that your team is “just in it for the money.” Although many of us have been in the industry for decades and have heard this numerous times, it still stings. It's insulting to be misunderstood on both a professional and personal level, especially when you've earned degrees, licenses and other experience in the pursuit of helping animals. Personally, I handle these situations by introducing myself and explaining to clients that I've been told they're unhappy with their experience, which is concerning to me. I ask them to tell me what happened while I take notes so we can find the cause of the issue. Listen to their entire story without interrupting and then summarize it back to them to make sure you understand correctly. Most of the time, you'll be able to pinpoint what went wrong right away, but sometimes you may need to consult a fellow staff member to figure out what happened. If a part of the experience didn't match your practice's customer service expectations, explain how the situation should have gone and let them know that you'll speak to those involved, figure out what happened and get back to them as soon as possible.

The goal (regardless of the situation) is to validate the client's concerns. Once I figure out what happened, I call the client and tell them what information I found, why I believe it happened and how the practice is going to prevent the situation from occurring again. Acknowledge how the situation made them feel and thank them for bringing the issue to your attention so that it could be resolved. The last thing I usually do is ask whether they would be comfortable with my bringing up the issue at the next staff meeting so that the team and I can discuss the situation and its repercussions, and brainstorm ways to prevent it from happening in the future.

It's important as veterinary professionals that we explain our rationale, recommendations and reasons for treatments in ways that the client can understand. Veterinarians and veterinary technicians should always verbalize exam findings to the pet owner so the client is aware of all areas examined. This, along with emphasizing the importance of the physical exam, going over the treatment plan, and detailing your diagnostic and treatment recommendations are critical things that could influence a client's decision regarding a pet's care.

Good communication is necessary to portray value. It's imperative to make sure clients receive follow-up calls from staff or doctors to review results or discuss the continuation of a treatment plan. Follow-ups aren't always necessary for well-pet visits, but there's no harm in reaching out with an automated survey asking clients how they felt the visit went. Doing so might open the door for questions, comments or concerns that pet owners might have kept to themselves had they not been prompted. Communication is key. Whether it's written or verbal, communicate the value of your services through a clear explanation of not only the exam, but also the written treatment plan for their pet. No one should have their pet disappear into the treatment room without seeing a plan and then end up at the front desk with a $300 bill without any idea as to what procedures were done.

Be diligent. Make sure that you're portraying your skill and value as well as your concern and care for the client and their pet by having the best communication game in town.

Meg Oliver is practice manager at Cicero Animal Clinic in Brewerton, New York.

It's happened to all of us. The phone rings and an irate client wants to speak with you. What do you do? And what can you change in your veterinary practice to make sure it doesn't happen again?

Bettering veterinarian-client communication

Veterinarians' brains are stuffed with a million and one pieces of information directed at taking the best possible care of patients. Among that mass of intelligence there may even lurk a few stances, long held as truths, that simply aren't accurate. 

 speaker Robin Downing, DVM, DAAPM, DACVSMR, CVPP, CCRP, CVA, MS, is here to help you take a step back and question some beliefs you may have taken as gospel.

In the video below Dr. Downing lowers the boom on three theories about pain as they might appear over the course of pets' lives. Here's a summary.

Myth one: "Puppies and kittens don't feel pain the way adult animals do"

Dr. Downing says that, as veterinary students, some were taught that younger pets hadn't developed to an extent to experience pain the way adult patients would. She cautions that this idea is incorrect.

"Now what we know is if we violate the nervous system with such a profound pain experience that early on, we can actually damage [pets] for the rest of their lives," she says.

Dr. Downing adds that this approach may even lay the groundwork for chronic pain.

Myth two: "Shorter surgeries require less attention to pain relief"

One school of thought proposes that patients undergoing so-called "commodity surgeries" (ovariectomies, castrations)-because the procedures are relatively short-need less concern for their level of pain. Dr. Downing calls that another whopper.

"Nothing could be further from the truth," she says.

Here she borrows from human medicine research, pointing out that lack of attention to pain can establish a path for future pain at the surgery site and more.

"What it also may do is set the stage that, if they need another surgery later in life, they may have a worse pain experience than they would if we had taken care of their pain well at the first surgery," Dr. Downing says.

Dr. Downing bristles at this one: "I'm here to tell you that old age is not a disease!"

She urges practitioners to listen for key client observations that may indicate a pet in pain. Prompts might include, "My dog used to be able to walk for miles, but now tires out more quickly," or "My cat used to sit in the window to watch birds, but not so much anymore." Dr. Downing says these are red flags that should precipitate additional investigation.

"When we hear those kinds of cues, we in the veterinary profession have an obligation to ask some more questions," she says.

Watch the video for much more from Dr. Downing.

At Fetch dvm360 conference, we're the support system you need. With every conference this year, we intend to nurture your mind (meaning quality CE for days) while also encouraging you to take stock of your physical and emotional health. 

Videos

From "young animals don't feel pain the same as adults" to "my Lab peters out after a short walk," Dr. Robin Downing sets the record straight.

3 veterinary pain myths busted

Our practice is considering offering a wellness plan to our clients. Do you think they're worth the time they take to administer?

Wellness plans are definitely “a thing” right now, but I believe it's with good reason. Banfield was way ahead of their time when they offered these packages to clients, and here's why: Clients want to be able to accept your recommendations for care- otherwise, why would they bother coming to the vet in the first place?

The hurdle for most clients is the cost. As an industry, we generally respond to that hurdle by lowering or discounting our prices. What Banfield did was genius. They took all of their recommended services, added up the price (not discounted) and divided it by 12! Now, the client simply pays an affordable monthly fee and they feel good (value!) that they're able to follow the doctor's recommendations and care for their pet.

So yes, I think they're worth the administration time. However, if you're going to offer more than five variations on your wellness plans, I would go with a third-party company like Veterinary Credit Plans to manage it for you.

Katie Adams, CVPM, is director of Curriculum Development at IGNITE Veterinary Solutions. Got a question for Katie? Email us at

Give it to me straight, says one reader to our CVPM advice guru: Are veterinary wellness plans worth the time?

Ask Katie: So, wellness plans  well?

When we asked Chen Gilor, DVM, PhD, DACVIM, for highlights from his CVC presentation on diagnosing Addison's disease, he pinned down these two pointers:

Don't just think about the sodium-potassium ratio-there's a lot more to Addison's disease than just the classical presentation. It's important to remember that there are lots of other presentations: Some dogs have gastrointestinal signs, some look like they have protein-losing enteropathy, and some come in with just megaesophagus.

Be screening for Addison's, even if your index of suspicion is not very high. You can skip ACTH stimulation testing at first and measure a baseline cortisol concentration, which is relatively quick, inexpensive and readily available. If the baseline cortisol concentration is high or high normal, it's very unlikely the dog has Addison's disease. If the concentration is low, then do an ACTH stimulation test. "You will do a lot less ACTH stimulation tests in dogs that do not have Addison's by running baseline cortisols. And you will do a lot more ACTH stimulations in dogs that do have Addison's if you run baseline cortisol," says Gilor.

These two quick tips from Dr. Chen Gilor will help you more readily identify affected dogs.

Vetted September 2019

5 ways veterinarians lead imbalanced lives

The tidy veterinary hospital

Sample veterinary script: Lets talk about chronic pain

Bettering veterinarian-client communication

3 veterinary pain myths busted

Ask Katie: So, wellness plans well?

Addison's disease: Beyond the classical presentation

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