Commentary: Veterinarians need better boundaries

April 7, 2019
Brian Andrew Maran, DVM, MS, DACVIM (Cardiology)

Dr. Maran is founder and owner of Olympic Veterinary Cardiology in Mill Creek, Washington.

dvm360, dvm360 May 2019, Volume 50, Issue 5

Asking pet owners, colleagues and the rest of the world to be nice to us is not going to solve our veterinary professions problems with burnout, mental health and suicide. Its time to better manage our emotional and conversational boundaries.

During residency, I got a call from an emergency veterinary clinic that a patient was being transferred to the university because the client was being fired from the ER after complaining about price and then throwing a clipboard at a receptionist's head. I walked into the room after the call from that clinic, and the client immediately started telling me how horrible they were.

I stopped him: “Well, I got a call from the clinic, and I understand you threw an object at the receptionist's head.”

“Yeah, a clipboard,” he told me with a straight face. “That b**** had it coming!”

Ever had something like this happen at your clinic? Something dangerous? Someone lashing out? I'm positive you have. People sure can be mean.

Yet, as an answer to all the talk of depression and suicide in the veterinary profession, I frequently hear, “Everyone, be nice to your vet and vet techs! They care deeply, work hard and are not in it for the money.” That's 100 percent true and 100 percent on point, and I fully support and encourage that message, because we all should be kinder and more loving in our lives, to everyone!

But let's be honest. Are people nice to the staff at the Department of Motor Vehicles? To police officers? To the homeless? To cashiers? To TSA agents at the airport? To dentists? Overall, the answer is yes, as long as they get what they want. A mentor hit me between the eyes with the revelation that under heightened emotions we all revert to an immature emotional state. We don't change personality types, but we revert to immature states of them. Any stressor can trigger this degradation. Even those aware of this (myself) have moments when we fail to rebalance ourselves in a moment of stress.

We ... doctors and technicians are trained to put emotions aside, to assess and to act. Clients are not, and we must remind ourselves of this.

We veterinarians deal with a constant barrage of “I can't afford that” or “It's just a dog/cat” or “I can't make a decision” (when, medically speaking, we have moments to decide). And I can deal with that. There's no problem with a client who can't afford the best treatment available, or a client who's emotionally distraught and paralyzed in a crisis, or a client grief-stricken and guilty because he ignored something for too long. I'm happy to help and educate and work with them, as long as they work with me and treat my team with respect. In fact, I love the challenge of it. We, as doctors and technicians are trained to put emotions aside, to assess and to act. Clients are not, and we must remind ourselves of this during an “obvious” decision or “obvious” mistake. We see it … they don't. Our job is to educate and help.

On the other hand, we all need to learn when clients are not being reasonable. When an upset pet owner's first reaction is, “You're just a greedy b****!” that's not a signal you've done something wrong. But some of us take it as a personal affront and feel guilty for charging for our years of training, education and expertise. Some of us respond to insults by discounting the price and apologizing for the high cost, because they think that will calm the client down.

Here's my suggested response: “I understand you're frustrated, but you will not speak to myself or my team in this manner. We'd like to work with you and help your pet, but only if we can have appropriate conversations. You are also welcome to seek care elsewhere, if you'd prefer.” (Remember that ER clinic that fired a pet owner earlier?)

In my more than 10 years in practice, the small discomfort I feel at saying this to clients has saved me countless more emotional blow-ups from them. Clients understand they must keep their emotions in check-or they can go elsewhere. And I won't be picking up the pieces of angry and frazzled team members for the next two days.

Now, remember that client who called my colleague a b****? I said, “You have two options here. Behave perfectly or leave. If you have a problem or issue, you discuss it with me. If it gets physical, I will defend my staff and myself, and you will be arrested and charged with any assault charges I am legally allowed to file.”

He tried to defend himself, but I stopped him again: “This is not a discussion. This is a decision for you to make right now.”

He tried to defend himself, but I stopped him again: “This is not a discussion. This is a decision for you to make right now.”

Believe it or not, he wound up a phenomenal client after all that. As I recall, baked goods were delivered, and we had a long and positive relationship thereafter where other university students enjoyed working with him as a client too.

I have been down the road of taking the blame and feeling guilty when pet owners told me something was my fault when it wasn't. It ends in a dark place. So, it's time for a change: Learn to set boundaries about how you're treated, how your staff is treated and what behaviors you allow in your office, on the phone and around the hospital.

My suggestions to make that happen? Correct obvious outbursts from clients early. Empower your team, so every team member knows the boundaries and has the authority to fire a client without question or without fear of reprisal. (Don't tolerate the clients who are rude to the reception staff but sweet as candy to the doctor.)

I believe that most pet owners are wonderful people across the board and love their veterinarians. As a specialist, I hear from your clients daily, “Our vet is the best person on this planet! We love her!” We have the coolest careers in the entire world. We help animals of all kinds-day in and day out. But part of being a good veterinarian is setting boundaries. Google “personal boundaries” and you'll find countless videos and books on the subject. Pick one that fits your personality and get reading.

If you're hurting emotionally, remember: You are needed in the profession. You are needed by your family. You are needed by your friends. The world needs your unique gifts, experiences and personality. There is help for you, but you must seek out help-from a book, from a therapist, from a psychiatrist. You may not feel it right now, but you are in charge here and you have control.

Brian Andrew Maran, DVM, MS, DACVIM (Cardiology), is founder and owner of Olympic Veterinary Cardiology in Mill Creek, Washington.

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