Difficult clients

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Editor’s note: All names and businesses in this dilemma case are fictitious, but the scenario is based on real occurrences.

Hess Veterinary and Urgent Care Center (HVUC) was a busy practice with 44 veterinary and professional support team members. It is not unusual for clinics this size to have significant challenges beyond patient medical care. For example, human resource issues; client interactive stresses; and, recently, several “difficult clients” caused some disruption among the staff and several behind-the-scenes discussions. Every practice has its challenging clients—something veterinarians sign up for when dealing with pets with critical issues. The HVUC hospital manager felt that the recent client discussions were becoming a distraction and that the situation warranted a staff meeting.

The hospital administrator, a veterinarian with 43 years of clinical experience, coupled his experience with some research to try to assist his staff. A staff meeting in the form of a lunch and learn was simply titled The Difficult Client. The staff generally felt that the difficult client was confrontational, did not want to listen to staff, and was dismissive. The administrator began by saying that such clients enter the clinic stressed and anxious, triggered by their pet’s medical issues. Clients who are anxious and stressed can behave very differently from other clients. When assisting these clients, staff should understand they should not take the clients’ actions personally, and it is always best for the clinician to put on their “professional hat.” Do not escalate the situation or engage in confrontational behavior, and always respond professionally.

It is vital that the client knows you are listening to what they have to say. Stating that you are there to help and then asking for their input empowers them. One reason for the client’s stress and anxiety is that they feel powerless, often because they have no idea why their pet is ill or how to help their pet. At this moment, the veterinarian is the only person with this information. Add to this a white coat and a hospital setting, and anxious clients are often intimidated.

For the veterinarian to be less intimidating and the client more receptive to hearing and complying with a diagnosis, the initial encounter should be an icebreaker. The goal is for the pet owner to see the doctor as a member of their community who knows more about pet care than they do and is interested and willing to help. You can accomplish this by greeting and complimenting the pet before engaging the owner. You might tell the owner, “I’m glad we could get together today.” Asking them what they think is the cause of the pet’s problem immediately invites them to be part of the treatment team.

Finally, addressing the elephant in the room in a professional manner is a must. Many challenging client encounters are due to financial restraints and the cost of care. These alone can cause stress, anxiety, anger, and guilt. When significant fees are involved, you should discuss this sooner rather than later with the client. Ideally, the client would have this discussion with a staff member they have worked with before. Directing them to account management is often necessary but not recommended.

Some veterinarians and technical staff members objected to the administrator suggesting they should have to discuss finances with clients. As one veterinarian said, “This is not part of my job description.” However, it is part of any compassionate clinician’s job description. Relieving anxiety and assisting the patient and owner is always the primary directive. Employing some of the administrator’s suggestions will convert many demanding clients to helpful assistants in the care of their pets.

Rosenberg's response

In this day and age of larger practices and corporate-owned facilities, the division of labor within clinics is more strictly defined. Specific staff are assigned to billing, international travel requirement details, and follow-up care and assessment under a veterinarian’s supervision. This setup may be more efficient. Nevertheless, the veterinarian should participate to a greater or lesser degree in every component of the client-practice relationship. This is the essence of the practice’s image and reputation in the community.