This is something we need to talk about in our industry. Our work is very difficult, the situations are emotional and owners become trapped between difficult veterinary decisions and personal finances. In my three decades of employment in vet med, 15 as a manager, it has been my consistent experience that finances, not medical mistakes, are the primary reason that owners become upset during a veterinary interaction.
It is with an open and understanding heart that I fully acknowledge the difficulty of the decisions that surround providing a beloved family member with veterinary care and simultaneously slamming into a wall of financial inability. Its an awful spot for an owner to find themselves.
What we know about clients (and humans in general) is that they tend to reason from an emotional place. They don’t speak medicine, so they translate medical speak into financial terms, which is a more universal language and something they can understand better.
They say money isn’t everything. Well it’s a pretty damn big one when you are facing down the option of an insurmountable veterinary bill OR euthanizing your pet! Owners begin to surface personal emotions around areas of self-worth, life choice, and the results of their success navigating life. They often counter those emotions by leveling blame or corrupt intentions upon the veterinary staff. It’s a process we can identify, define and demonstrate over and over in the exam room. Veterinary medicine does not really use third party insurance providers. Fido care comes from “extra” discretionary income that many people simply don’t have. So this challenge repeats itself every day in veterinary hospitals around the nation.
It’s a real struggle and we need to define better tools and resources at the hospital level to help our clients get out of this tight spot. Payment plans are not the option. As a career veterinary manager, I can tell you that all clients will promise you everything in the moment, but sadly the default rate is tremendously high and when you offer a structured payment plan most of the time you won’t get paid. You might as well do it for free right from the start…and that is not the answer either. Our ability to pay our staff, hire and retain them requires that we run a business that does not operate on “low cost” clinic mentality. That will not result in a hospital that provides great medicine with great people. It results in cheap untrained labor, cost cutting and less reliable outcomes for pets. Not the things we are supposed to be offering.
In a world with growing internet social and review platforms where people can attack from the comfort of their home, the amount of salacious content written on the daily is increasing exponentially. Most people would rather avoid direct confrontation when it is so much easier to share your thoughts through the anonymity of a screen name rather than speak with the other party face to face about your disappointment. Trust me when I say that I have been the recipient of many awful online reviews for things that honestly were handled fairly and without mistake. I’ve made many mistakes and the negative feedback from those don’t sting nearly as much. I suppose it is because I feel somewhat deserving of it and over the years I have learned that it is better for me to accept it, study and learn from it and ultimately own it so I don’t repeat it. It’s the unearned attacks that hurt the most. Current best practice prevents us from jumping on to the review site and countering the review with fact. An online debate of the facts never ends well. So upset clients are allowed to post personal attacks, often packed with misinformation and misunderstanding and we are stuck, defenseless and often deeply personally wounded.
So what do “we” do?
I’m not trying to get all woo here, but these problems are not going to change. The world is not going to suddenly abandon social review sites. Nor are the incomes, education or emotional stability of the client base going to suddenly jump up to new and improved levels. Financial hardship and emotional red zones will continue to control many of our clients. The extremely high cost of vet school is not going down and the high cost of running a quality veterinary hospital isn’t either.
What we can do is remember that these awful situations are not representative of all our clients, just some. And that for every upset owner there were far more that left content and satisfied with your efforts. As a manager, try to ask for and capture as many reviews as you can so you can provide a balanced report of feedback to your team and don’t let your team get bogged down by the minority negative reviews. When a negative complaint comes across our desks, we need to slow down, look at them and communicate. If a mistake has been made, own it and realize that we are all human. Stand up and be accountable to that mistake. It will likely stay with you for years, but it will find an appropriate place inside you.
I remember a dog that died under anesthesia 25 years ago as a result of my failure to apply monitoring devices correctly as a young veterinary assistant. Of course there are lots of additional factors, but that was my part in the outcome. I recall hearing the owner screaming in the exam room as the doctor explained what happened. I remember the room, the sounds, the temperature. That moment is indelibly scratched into my life. Today, I discuss that case with every new assistant I hire to impart the impact upon them of their role in the provision of care to our patients. It has become a major talking point in my life and I use it to hopefully prevent it from happening ever again in any facility under my watch (I’m sorry Aimee and thank you for your sacrifice). The point being, mistakes are inevitable, yet we will recover from them if we approach them from a place of sincerity and honesty.
But these mistake-based interactions are far less common than the interactions that come from client misunderstanding or financial inability. Doctors, you need to ask yourself if you are communicating in the best way to your clients. I have witnessed countless doctors talk to clients using fancy medical terms or over explain the 15 items on the rule out list and walk out of the room feeling like they have done their part. Sadly, the client is left even more bewildered and still confused about what to do next. A suggestion if I may. At the conclusion of your veterinary exam, ask the owner to explain back to you the plan. See if they can. If not, you need to explain again in a different way until they grasp the medical reality and are fully on the plan. Exam room staff, don’t be afraid to discuss finances. Many clients are embarrassed to reveal their lack of finances and so they will suffer in silence. Communication is key. It is your job to advocate for them and introduce as many options as you can to help them overcome financial obstacle. Managers, invest in training. Our industry tends to put the newest employee in the exam room, putting more value on the staff that can place catheters and take dental xrays (also important), but completely miss the import of a room assistant that can actually communicate with an owner. We intentionally keep doctors out of the financial discussion, but are we providing staff that can effectively translate the exam plan to the invoice in a way that truly answers client questions. Can your team explain why the DVM has ordered a CBC/chem with a UA (MIC). In my humble opinion, your room staff should be some of your very best players. And if they can’t communicate you need to get them out of the rooms because that is probably where most of the client communication issues are beginning.
Look, we are all good people trying to do the best we can every day…on both sides of the exam table. Life in vet med IS hard. So is life working at the grocery store, the mechanic, the school. Let’s try to deploy a lot more mutual respect, understanding and empathy. And let’s try to back away from the keyboard and learn how to confront our problems like adults. We’re not running veterinary hospitals, we’re developing our communities and teaching our children. We can do this if we maintain some respect and cool heads. No one benefits from being nasty and no one benefits from suicide…so stop it. If you are a veterinary team member and you are feeling like suicide is a reasonable plan for you, please contact me. I have no idea if I can help, but I want to try because you do matter and it will be okay.