Tuesday, February 5, 2013

Getting Crispy Around the Edges

Burnout can be insidious. I noticed the signs in myself today as I prepared myself to call a client regarding the findings on his dog's physical exam. The dog had been dropped off for grooming & my exam had revealed some significant progression of the dog's heart disease. I could hear the conversation playing out in my head before I picked up the phone. I was sure it would go like this:

[ring ring]
Mr. Apathy: Hello?
Me: Hi, Mr. Apathy. This is Dr. VBB from VBB Animal hospital. I'm calling about Foxglove.
Mr. Apathy: Well, I'm at work. What do you want?
Me: As you requested at drop off, I did perform a physical exam on Foxy today and-
Mr. Apathy: Can we discuss this when I pick her up?
Me: No, Foxy needs additional diagnostics and treatments because her heart is-
Mr. Apathy: She saw a cardiologist six months ago. We already did the heart stuff.
Me: well, today she is having trouble breathing and -
Mr. Apathy: I'm not talking about this again right now. I'll discuss it at pick up.

I was so sure I would be having that conversation that I postponed making the call for probably an extra ten minutes. I got myself all worked into a frenzy internally. I'm sure I ground off some tooth enamel. However, after a few deep cleansing breaths I psyched myself up for it. I made the call.

[ring ring]
Mr. RealGuy: Hello?
Me: Hi, Mr. RealGuy. This is Dr. VBB from -
Mr. RealGuy: Doc! How's Foxglove?
Me: I have some concerns, and -
Mr. RealGuy: is it her heart? I know, I was supposed to bring her back to the cardiologist for a recheck in December, but I got so busy and she seemed fine. Is she in trouble now? I feel terrible.
Me: well, I think her medication needs some tweaking. I'd like to go ahead and give her some extra diuretics today, but I do want her to see the cardiologist as soon as possible too.
Mr. RealGuy: I was actually planning to take her next week, but they almost always can get me in same day. I'll call them right now and see if we can go there this afternoon or tomorrow.
Me: Great. I'll have her records ready to go for you.
Mr. RealGuy: thanks doc! See you soon!

I was of course really pleased that my patient will get the specialty care she deserves. I was also really pleased that I had a nice client interaction. I was DISPLEASED by the realization that I am starting to always expect the worst. This bothers me a lot. I don't want to be one of those old and crispy burned out people!! I want to be able to think positive! Or even be like the Whether Man from The Phantom Tollbooth, who said "Expect everything, I always say, and the unexpected never happens!" But to always expect the worst - well, it's draining. Any creative tips on dealing with burnout??


  1. I did that same thing last week. I put off the call longer than you. It was a guy with an ancient cat who had only been to the vet 5 times in her whole life.. once a few months ago where they diagnosed stage 4 renal failure. He said he didn't want to do anything for her right off the bat, and that he didn't want to know if she was "going to die soon," but I was able to convince him to do bloodwork anyway.

    When I got labs back and the thyroid levels were through the roof as well, I thought for sure he wouldn't want to treat it. I thought he wouldn't even listen to my reasons for starting meds. But he did, and he started them. Sometimes I think people just surprise us and its a good reminder that all is not lost.

  2. The way I avoid burnout, or try to, is to celebrate the positive. We tend to dwell on the bad things and times, the bad clients and interactions... but I bet far more of our days actually deal with happy things, happy clients and their happy pets... or at least neutral!... and if all we do is focus and dwell on the bad things, it will eventually seem like that's all there ever is.

    It's like anything else in life, if you focus on the bad things, you'll miss out or overlook the good ones. Focus on the good things, no matter how small they may be, and it'll help you avoid feeling like everything and everyone sucks!

  3. Makes me feel so bad to hear that vets are feeling that way. Some of us are pretty decent pet owners (we've had a pup in the hospital now since last Thursday, 4 yo SF pointer with Addison's disease -- ate something, obstructed, came home at 3 days and after a couple of hours something was really wrong . . went back to the ER, she vomited up more fabric - they open her back up and there was a teeny tiny hole -- she's in the hospital now for the rest of the week but improving rapidly THANKFULLY!). . . Addison's is stable through all of this and internal med is overseeing the whole thing in conjunction with the surgeons.

    That all being said -- the vets have always seemed so reluctant/hesitant to give us the quote, and it is so sad. I feel terrible every time they walk into the room with that piece of paper -- it's like they are so weary of being beaten down. We are lucky to have been able to say every step of the way -- "just do it here's a credit card." She's our dog. She's a part of our family and we take care of her.

    On top of all that though -- looking at the bills I'm pissed off FOR the vet community. You guys are trained, and trained well. Vet school = not cheap (I'm paying off grad school too -- and y'alls debt I know is worse -- I have "just" an MS). The surgery costs, testing, doctor's visits, communication between vets, and all the hospitalization etc etc for our pup is still under 10k -- when my hubby had to have a similar surgery years ago the surgeon's costs ALONE were 10k, when you add in the hospital, ER, radiology etc it was a lot more -- probably 5-7x what the dog's care is costing. And the vets have spent more time talking/explaining to us and dealing with her than any of the human docs did with my hubby or me.

    After following your blog -- I had a new appreciation moment for wanting to smack the people who complain about costs. Would they DARE ask the human surgeon to "give them a deal" or "be compassionate"? Actually they probably would . . .

    Me, I'm just grateful for people like all of you who can save my animals. Especially the ones that get personally invested in the outcomes and love our animals too.

    Thanks for all you do . . .and please send positive vibes to my pup. :)

    1. As a student about to start vet school - you give me hope. I wouldn't be doing this if I didn't appreciate the profession, and it's rare to have a client to appreciate it as much as I do. I wish your pup a speedy and healthy recovery. I wish all of my future clients would be as thoughtful as you.

    2. Can I just say thank you for your insightful, intelligent and very thoughtful comment. We as veterinarians always offer the very best medical care or "gold standard" recommendation that will give your pet the VERY best chance of proper treatment and recovery. But it is difficult when time after time you go in with this recommendation and the client is flabbergasted and "insulted" that you want them to pay this much to treat their pet.

      I hear all the time "Why is this so expensive, don't you love animals? You are just trying to get me to pay for a bunch of tests I don't need." Trust me, as a veterinarian I only want the best for you pet. I WANT them to get better. I want the tests to show me a conclusive answer. I don't want to blow off your concerns and your pets clinical signs as nothing, not offer the best care, and then 2 days later your pet is in the ER, critically ill, or even worse, dead.

      It is true that we tend to focus on the negative a lot more than the positive, because as a whole, we are very compassionate and sometimes emotional people and it really is hurtful when a client just doesn't get that.

      We just have to think on the wonderful clients, like yourself that understand the cost of veterinary medicine, know we aren't trying to "rip you off" and just want to do anything possible to get their pet home and healthy.

      Again, thank you. reading your response made my day.

  4. Twinzmommy, thank YOU for such a wonderful reply! Rest assured that we vets appreciate clients you more than you will ever know. You're the kind that gets us to give our cell phone numbers, email addresses, Sundays, etc. because you not only allow us to be doctors in the truest sense, but also because it's people like you that give us hope and restore our trust and faith in humanity. As a profession, we ARE beaten down - myself included - and it's a daily struggle to keep moving forward... but the clients like you make it all worth it. I'm sending huge positive vibes your way for your doggy!! Thank you for being an amazing owner and person. :)

  5. Doctor Sarcasm, Twinzmommy is an amazing owner and person! I've known her since her dog was diagnosed with Addison's and I know she does what ever it takes for her boy to feel his best. I know many more people like Twinzmommy through an online forum for owners of dogs with Addison's disease.

    We see great owners and AWESOME Vets who worked hard to save our dogs. Vets who partner with us in the care of our dogs. We could not do it without you.

    Keep a memory box and put your "Atta Girl or Atta boys" in it. Pull out those thank you cards or pictures on those bad days and remember how you felt..

    Then if that doesn't work remember you just can't fix stupid..

  6. Everyone in this industry feels this way sometimes. I just prepare the plan I think is most advisable given the circumstances and present it to the owner then go from there. The anticipation of idiocy is just punishing yourself for things you have no control over, you really can't love the pet more than the owner does ( at least not if you want to eat), just do what you have been trained to do until circumstance forces you to recalculate. I have been amazed at people who looked like they were in an Oscar the grouch skit coughing up thousands and I have been depressed when MD's with jaguars had me euthanize a tail wagging GDV. In both cases I felt stupid bring the estimate into the room and for opposite reasons I was surprised in both. Difficult clients stick with us longer than cooperative ones try to appreciate the happy surprises with the same intensity you lament the dirtbags. Truly the money fight doesn't really burn me out anymore, now it's the client who would do ANYTHING and have perfectly reasonable expectation and I have run out of treatments to offer. Always remember that if the owners show up at our door it means they care more than most, since most pets in this country won't see a vet this year. Be direct and unapologetic when presenting a treatment plan and the owners are more likely to accept than if you are circumspect. If you are really certain that they won't accept plan A then prepare plan B simultaneously for added efficiency and then smile to yourself if it isn't needed. Take time for yourself and force yourself to do the things you like even if you feel like just vegetating. Some days it's hard for me to get fired up after 4 dismal 12-15 hr ER shifts in a row and get the boat and poles together but once I'm actually fishing I never regret it, you have to prevent the negative experiences from work (had an awful euthanasia tonight) color your whole existence. This actually has been pretty therapeutic for me do I really hope one of thd above anti-burnout cliches helps you.

  7. Just wanted to say to try to remember the good ones. Every time you have a good owner, reward yourself with a piece of candy, and extra shot of creamer in your coffee, five minutes to sit down and visualize Tahiti, whatever works for you.

    I'm a poor grad student who still finds a way to keep my 75 lb. baby who is asleep on my feet right now up to date on shots, tests, heartworm and flea and tick preventatives, medications, etc. with the GOOD food and treats. I'll live on Ramen for her. My folks will show up to our vet's with a credit card in a pinch, since she's the closest they're getting to a grandkid (although we've been such constant and regular faces there, we *gasp* get billed for later sometimes. All of it, including and especially your services, are worth it. All of my friends feel the same way about their animals and vets, I know. Now go have a piece of chocolate on the beach of your choice.

  8. "Scripting" is tough. Anyone in the helping professions does it once they've been burned enough. I remember every call I made as a teacher, very concerned about a particular troubled student, to a parent who just could have cared less about their kid. I took a lot of abuse from some very nasty parents/guardians, and yeah, it hurt a lot. Eventually, I decided to teach adults only. I didn't want to get so hardened that I stopped caring altogether. So it's important to notice your stress levels and think through your options before you get to serious burnout!

  9. As a pet owner who values her vet more than I can say, I hope you know there are clients of yours that feel the same way. There's a lot of good advice here which I second, particularly focusing on the positive.

    Having worked in animal rescue for many years now, I see a lot of burnout. When others ask me how we continue on with all we see, I say the same thing - Because each time we succeed, a life is made better. I've had people screaming at me and worse, people who just didn't care to make any effort for their animal. I focus on the animal, what they need, and move on. And yes, sometimes all I've been able to do is hold onto them as they pass away since we got to them too late. Yet that was important for that animal.

    What you do is important. The smart clients value you. The others are lost and not worth letting yourself forget all those moments when you made an animals' life better and all those moments yet to come.

    1. That's a great way to look at it. I really admire people who can do what you do. I would have a hard time in animal rescue.

  10. I had a few months where I felt that way a lot. My recommendations became more hesitant and less confident and I found myself no longer looking forward to helping the pet as much as I was thinking about what compromises I would have to make when the owners declined care and preparing myself for their anger or sadness. It occurred to me one day that my attitude in some cases might be a self-fulfilling prophesy and in all cases, it was making me depressed and I wouldn't be able to spend decades doing this if I felt this way. It's something I've been working on.

    I try to take a moment before each appointment or phone call to visualize a positive outcome and make myself excited about what I can do for the pet. For most big things, I make three tiers of plans where I can, and I try to think about the benefits I can offer with each (if they can't do joint supplements, NSAIDs, and Adequan, the dog will still feel a heck of a lot better if they at least start NSAIDs).

    I also try to remind myself at hard times that most owners want to take care of their pets but they're understandably upset about their illness or worried about their ability to care for them and that fear and anger and sadness sometimes gets in the way of them making a rational decision or makes them sound harsher or more critical than they might be otherwise. I try to remember not to take it personally, even though I'm naturally inclined to think any unhappy client is the result of some failure on my part.

    Also, as many people have said: remember the good things. Humans naturally put more emphasis on bad experiences than good ones, but try not to shrug off happy clients and healthy animals as "well that's how it should be". Let yourself feel good about convincing Old Man Smith to finally agree to bring in a fecal for Buck or when Mrs. Fitzegerald tells you she wouldn't trust anyone else with her Precious.