Swipe left to get it right: Avoiding ethics exhaustion by matching with the right veterinary team

November 20, 2018
Sonnya Dennis, DVM, DABVP (Canine and Feline)

Dr. Dennis owns and practices full-time at Stratham-Newfields Veterinary Hospital in New Hampshire. She is currently the AAVSB representative to the AVMA’s American Board of Veterinary Specialties, chair of the AAHA Veterinary Informatics Committee and Diagnostic Terms Editorial Board, a peer reviewer for JAAHA, chair of the Al Hahn Award for Lifetime Achievement in Veterinary Informatics, and a member of the Outreach and Credentials Committees with ABVP. Dr. Dennis lectures nationally about topics including ethics exhaustion and informatics.

Determine how youd handle certain situations, like convenience euthanasia, and how your ideals fit in with a practices culture before making a match during the hiring process.

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In personal relationships, we swipe left if the profile doesn't match us. So why do we settle for “good enough” in our professional life? Poor choices early on in any relationship can lead to bad breakups later. Beyond thinking about salary, hours and location in a job search, there is more to assess, such as your personal ethics. Here's what to ponder and why it's so important.

A term I've coined is "ethics exhaustion," which is fatigue, emotional distress and a lack of will to continue to act in a way that is consistent with what you believe is the ethical thing to do.1 As I recently discussed at a Fetch dvm360 conference, ethics exhaustion contributes to burnout, compassion fatigue and depression in ways that better hours and higher salary cannot fix. To prevent ethics fatigue and ethics exhaustion when going through the hiring process-or if you are the one doing the hiring-discuss the issue of ethics up front. It's easier to figure out quickly that you're a bad match and swipe left to avoid an uncomfortable and more emotionally exhausting breakup down the road.

There are many forces pulling us apart in our careers: family, clients and patients, coworkers, the profession itself and self-care. Often we must label each as rock, paper or scissors so when a conflict occurs, we know which one wins. (Or sometimes, we might need to use the Big Bang Theoryexpansion: rock, paper, scissors, lizard, Spock, for more complicated cases.) But how we view our overarching obligations flavors how we approach each specific situation.

It's important to note that we aren't actually judging what's right or wrong. We're just looking to pair people with similar outlooks together, as opposed to thinking that we can change an ethical situation to suit our needs. Practically, you cannot make a list of every possible ethical dilemma, but you must honestly search for the ethical categories most meaningful to you and have a litmus test ready at hand for prospective matches in order to determine if they are right.

The leading example is how you define “convenience euthanasia,” since there is no standard definition of what constitutes “convenience.” Where do you draw that big red line? The black-and-white ends are usually easy: The case of an old black cat with the client's new white furniture goes in the "no" bucket, but unremitting congestive heart failure (CHF) that's nonresponsive to medication usually goes in the "yes" bucket. But what if a client doesn't want to euthanize the CHF patient? What do you say? How aggressively do you defend the patient's quality of life? What about a 5-year-old dog with a femur fracture whose owner can't afford surgery? What is the hospital policy on that, and what is your comfort level with that policy? What if the client could afford it without preanesthetic blood work? Or without intravenous fluids or pain medication?

Another example is how you present your treatment plan. Do you only present Plan A, then allow the client to discuss? Do you then present a stepwise approach? Or do you start with co-presenting Plans A, B and C, knowing that most will choose the middle road? Do you always present Plan E (euthanasia)? Is this a moot point because all your patients have pet insurance?

So, think about what might lead to ethics exhaustion for you when looking for a good team match, and swipe left until you find the right one. For a list of other ethical questions to spark a conversation, click here.

Reference

1. Dennis S. Compassion fatigue or ethics exhaustion? (Oral presentation). 3rd International Veterinary Social Work Summit at the University of Tennessee, 2013.

Sonnya Dennis, DVM, DABVP, is the owner of Stratham-Newfields Veterinary Hospital in Newfields, New Hampshire. She is the vice president of the New Hampshire Board of Veterinary Medicine, and a past director of the American Animal Hospital Association. Dr. Dennis is the immediate past president of the Association for Veterinary Informatics.