Hacking the DVM brain: The psychology of change in the veterinary profession

Getty ImagesDr. Jane Smith owns a large companion animal practice in Nirvana Corners, USA. (Her name and practice name have been changed to protect ... well, you'll see.) She's a high producer. She's beloved by clients. Staff members call her brilliant.

But some of them also call her “Dr. Jekyll and Mr. Hyde” behind her back. They say she's dismissive. She throws frequent tantrums. She'll cut you to the bone with insensitive comments. Turnover in her clinic is high. New hires are cautioned by those who stay to be careful. “Make her mad and she'll crush you,” they warn.

10 takeaway tips for change

1. Remember that personal change can be hard. Be nice to yourself.

2. Remember that human brains are hardwired to be negative. Recognize that change could take a while.

3. Reflect and introspect. Take time to learn about yourself, the things that trigger bad responses and why. The reasons behind those triggers could be small or they could be serious past trauma. Self-awareness is necessary-and it's a process.

4. Start feeling your body. Start feeling your emotions. This can be hard or scary if those emotions are strong, so remember tip one.

5. If you are a high achiever (hello, veterinarians!), accept that even high achievers find change difficult.

6. Accept what is. Accept your emotions. Accept your failings. Accept your humanity.

7. Learn to recognize when you're feeling particularly angry, sad, lonely or overwhelmed, and don't hide from those feelings. Go discharge some of that energy at the gym or in meditation or talking to a close friend.

8. Don't get caught in the cycle of “I shouldn't do that. But I did it. Now I feel guilty and can't help doing it again. Now I feel even more guilty.” Accept some inevitable backsliding, don't beat yourself up for it and try again.

9. Set healthy boundaries. Know your limits. Just because you care a lot doesn't mean you don't have limits to your time and energy.

10. Be honest with yourself about what you need to change, for yourself and others.

As it turns out, the walls had ears in this practice, and they belonged to Shawn McVey, a seasoned interpersonal communication consultant. And Dr. Smith, McVey says, managed to accomplish one of the most difficult tasks human beings confront: personal change. It wasn't easy. It wasn't quick. In fact, it took three tough years for Dr. Smith to change how she dealt with those she employed and, not incidentally, depended on for practice success.

When it comes to personal change, most veterinarians-most humans, in fact-would rather express anal glands or clean kennels. This is why someone like Barbara Brewer Welsch, DVM, PhD, will have a job as long as she wants.

Change is hard

“Neuroscience has shown pretty well that our brain tends to go to the negative. It's an evolutionary survival mechanism to worry and be on guard all the time,” Welsch explains. “When we do that we create certain pathways that lead us to subconsciously perform the same stupid behaviors over and over again.

“If we don't work to decide that we're going to be successful at something or we're going to be happy about our life, if we just carry on as if leaving it up to fate, we tend to move toward the negative and believe it's not possible,” she continues. “‘I can't get my work-life balance better. I can't get in better shape. I'm not happy.' Change takes work. It takes effort. And it takes uncovering what's in the unconscious. And a lot of us don't even have time to think about what's in the unconscious.”

Welsch made a major personal change herself 13 years ago when she decided to leave the clinic where she had practiced since graduating from Ohio State in 1980 and pursue a degree in psychology. Today she maintains a small veterinary hospice practice but most of her career is spent counseling veterinary students at the University of Florida where she is an assistant clinical professor in the department of psychology and staff psychologist at the Counseling and Wellness Center in the College of Veterinary Medicine.

“As a psychologist and a veterinarian I'm in helping professions,” Welsch reasons. “That makes us very different from entrepreneurs and bankers. We tend to put others ahead of ourselves more than people who are not in helping professions. That may make change harder.”

Kimberly Pope-Robinson, DVM, says she found herself becoming the “queen of cynicism” surprisingly early in her veterinary life. “It was during my first internship,” she says. “It might even have been my senior year in clinics. It happened very quickly. In veterinary school you become analytical and perfectionist, and it becomes obvious that medicine is not black and white-it's very gray. You have to become comfortable with gray, and gray is a scary place. In order to cope with it, I became cynical and angry. I could throw you under the bus and make a joke about you faster than anybody.”

But that negative coping mechanism didn't work. It slowly ate away at her passion. A dozen years later, she says, change was possible when she decided to give herself permission to leave veterinary practice behind.

Sort of. Two years later she's working one-on-one with veterinarians and speaking to groups about how to change the grind and reconnect with the passion.

Getty Images“Before you can change, you have to recognize [the current situation] sucks,” she says. “I still love being a veterinarian. But you have to be able to accept [how difficult it is] to find out how to manage it.”

So is there a shortcut, a life hack for change? Although they come from a variety of theoretical perspectives, experts in personal change agree on one first step: awareness.

Learning to know yourself

It may seem odd that a person who knows at a glance that a dog has hip dysplasia can't see the behaviors that are holding him back. The same person who knows precisely what's causing a cat's pain can't identify the trigger for her own emotional pain. And that's a problem. Experts say self-awareness is the essential first step in personal change. It stands to reason-and to theory-that you can't make a significant change if you don't know what needs to be changed.

“The first step is to identify what needs to change, and then to be aware of when you're actually doing what it is you want to change,” Welsch explains. “Let's say you're afraid of cats. You get depressed when cats are on your schedule. You don't even know why. Or your father was a big football player and he was mean to you, so every time you see a big guy coming into the exam room, you become much more timid.

“First, you figure out, ‘I want to change this behavior of feeling down when I go in the room and there's a cat.' Second, you have to catch yourself doing or feeling it. Those first two steps can be in the unconscious for many people.” Welsch adds that understanding where the behavior comes from can help people forgive themselves for behaving or feeling a certain way.

But in a typical veterinary hospital, time to think about yourself and your behavior is scarce. Ann Marie DelSignore, who counsels veterinary students at Auburn University, thinks veterinarians' perfectionism contributes to the problem.

“Perfectionists just will not stop sometimes,” she says. “They need to keep going to validate themselves. They're trying to avoid feeling anything negative about themselves. If you ask them if they have a problem, they say, ‘No, this is just what I do.' It's a classic avoidance mechanism.”

The hack here, she says, is just to stop, take a moment and be reflective: “Check in on yourself,” she says.

Of course, today's technological environment makes disconnecting difficult, so DelSignore suggests using the technology in your back pocket to do it. She tells perfectionist students to set an alarm every day or even several times a day: “I tell them to stop when it goes off and ask yourself, ‘What am I doing this moment? What am I focused on?'”

Checking in, she says, is good for concentration. It also fights procrastination. Students tell her they sometimes discover they've just lost an hour when they check in.

Welsch thinks she left veterinary medicine to study psychology because it was the only way she could slow down and allow herself time to reflect. “We're so busy, we don't allow ourselves time to be with ourselves,” she says. “And some of us are running away from thinking about ourselves. We don't want to know. But you need to tune in and be quiet long enough to listen to what your body's trying to tell you.”

These experts say a key way veterinarians can become more self-aware is to tune in to their body when they feel emotionally challenged during the day. “The body remembers,” Welsch explains. “It remembers traumas from the past. Sometimes I can access that when I'm sitting with a client and I say something like, ‘What happens in your body when you see a cat? or ‘when you see that big man?' Where is it in their body, and what does it feel like?'”

Tuning in to one's body is a way to put words to problem, she says. Knowing that a stressor creates a pain in your chest-or a hollow feeling in your head, or a knot in your gut-can lead to understanding the underlying reason for stress, the original moment when you became afraid of cats or a big person pushed you around. The idea is that recognizing the original moment will help you learn to change your reaction to it.

But first you may need to become aware of the hidden “benefit” of the behavior you want to change. “Human beings do what works,” DelSignore says. “People in helping professions are usually high-achieving and self-critical. They've probably used frustration to achieve. They've always wanted to do more. They've always felt they've never accomplished the optimal result. These frustrations have actually worked for them.”

In counseling graduate students, she works to help them recognize the hidden benefit of all that anxiety or frustration. “This is one of my favorite moments,” she says. “The person goes, ‘Whoa! You know, I never thought of it that way before.' It's exciting for them and for me to see the light go on.”

Showing generosity-to yourself

The counselors who spoke with dvm360 all emphasize self-acceptance as a key to making change. You know why your chest tightens. You know when it happens. You know you want to change your behavior. But you can't. You backslide. You get so mad at yourself you want to just give up.

The day you don't eat, don't drink, don't pee for 12 hours-and lose it emotionally

Kimberly Pope-Robinson, DVM, has learned to be willing to be vulnerable. She remembers a day in her practice life 10 years ago-a time when she was seeing 40 to 50 clients a day-when three technicians called in sick.

The dental unit had stopped working, and one of the sick technicians was the only one who knew how to fix it.

Surgeries backed up while she and the staff members tried to figure it out. Three unexpected procedures, including a hit-by-car, complicated the afternoon.

“It was that day when you go the whole day,” she says.

“You don't eat, you don't drink, and you don't pee for 12 hours. You make every single decision. It's ‘Dr. Pope, so-and-so is on Line 1 and wants to talk to you about the blood results' and ‘Dr. Pope, they can't do the oral meds' and ‘Dr. Pope, she wants you to explain the same thing to her husband' and ‘Dr. Pope, the radiography machine isn't working.' We all hate those days.”

At day's end Pope-Robinson was facing four hours of records to complete when a patient-a kitten-needed a bandage change. In this corporate practice, brown gauze was used for everything and was definitely required for this bandage. But there was no brown gauze in her bandage tote. Staff members told her there was no brown gauze in the hospital.

“And I say, there's no way this hospital doesn't have brown gauze,” she says. “We're a $2 million gross hospital. We. Have. Brown. Gauze.”

At that point Pope-Robinson became “a tornado of frenzy,” she says. She flew around the hospital opening every drawer and every cabinet and hauling out everything inside. When she finished, she looked back and saw the massive mess she'd made. And she did not find brown gauze.

“My brown gauze moment is the time I lost my emotional crap in the hospital,” she says. “When I tell this story to veterinarians, I can see people in the audience laughing in a nice way because they're thinking of a time when they did it.”

She tells them, here's the deal: None of you judged me for my actions. So why do you judge yourself?

Exactly the wrong move. It may seem counterintuitive, but if you want to change a behavior, you have to let yourself off the hook. This technique has a name: acceptance and commitment therapy. “You teach someone how to accept what they have in life,” Welsch explains. “The question becomes how they can get along with what they're committed to.”

For example, some veterinarians feel deep-seated anger about pet owners who won't pay for the best veterinary care-anger that leads to irritability or other behaviors they want to change. “You have to accept that some people won't pay the same for their dog's care that they will for their child's care,” Welsch says. “I know a lot of young veterinarians who are idealistic who get angry and upset and resentful. But people don't have that kind of money. I think you're much better off if you just accept that's how it is.”

That leaves commitment-commitment to purpose. “You accept what is and then commit to a high purpose in life,” Welsch says. “You ask yourself why you're here. If you're a veterinarian, you're here to relieve animal suffering. In my hospice practice, I try to relieve the pain for humans who lose a pet, too.” With your purpose as a guide, she says, you push to change what you can and accept what you can't “without dwelling on it.”

Acceptance also means recognizing how difficult the job of change is and not giving up because you can't do it consistently at first. Welsch asks clients to identify the “bits” about a dreaded task they enjoy. If you're having trouble getting to the gym, identify something about going to the gym you like. If you prefer cats to dogs, identify something about puppies you like. It's a simple way to hack your dread in a way that makes it more palatable.

Pope-Robinson also sees acceptance as essential-acceptance of yourself. “We need to accept our emotions and find self-forgiveness,” she says. “How do you start that? Many of us have a feeling of shame because we feel we're failing and we're dipping below what I call the ‘fear of failure' line. So we have to have empathy for ourselves before we can move forward.”

Above all, to make change, Pope-Robinson says, you have to quiet anxiety and your fear of the unknown. She points out that veterinarians never know what sort of day will greet them when they walk into the clinic in the morning. Add to that, she says, the way perfectionists are driven, and you have an anxiety collision just waiting to happen. Compassion fatigue might arise or some primary psychological trauma. “The first thing you have to do is accept it,” she says. “Recognize it, accept it and manage it.”

Of course, all this is harder than it sounds. Pope-Robinson encourages veterinarians “to recognize they're not alone, they're normal and they have permission to find the path.” That path, she says, is specific to the individual but always must begin by accepting the way things are: “You have to be able to accept it to find out how to manage it. You have to realize you can't live that idealistic vision that we all think you can live. You can't be everything to everybody.”

Relearning how to feel

Fact: If you can't access your emotions, you can't get a lever on change. And for some veterinarians, the key to hacking change is restarting their emotions. Welsch recalls her years as a veterinary student.

“To get into veterinary school is so competitive,” she says. “I learned to just push through everything, to not think about how I was feeling. I learned to be the good student and get good grades.”

There's nothing in the veterinary school curriculum that lends itself to introspection, she continues, because students are so focused on memorization. And those kinds of patterns carry over into professional life. “We're not very good at knowing what emotions we're feeling or what body sensations we're feeling,” Welsch says. "We're mental giants, because we're very good at school and taking tests and making diagnoses, but veterinarians aren't quite as good at accessing some of the other stuff.”

Besides having to “wall off” from the emotional challenge of euthanasia and dealing with grieving pet owners, veterinarians may also have to bottle up energy from a client screaming at them or a dog biting them. One way to manage such stress, Welsch says, is to find ways to “discharge the energy,” a concept she has embraced from the work of psychologist Peter Levine.

A trip to the gym or other physical activity may help. Meditation may help. Standing in the middle of the floor shaking might help-it happens sometimes in Welsch's office-but is probably not as acceptable in the middle of the clinic. The key is to get in touch with your body, recognize what you're suppressing, then find a way to let it out. The idea is that the body is capable of healing itself.

Setting healthy boundaries

As a counselor, DelSignore is-like veterinarians-a member of a helping profession with all the behavioral pitfalls that come with the job. Avoiding those pitfalls, or changing the behaviors they cause, takes a good measure of self-care, she says.

“One thing we do here [in the counseling office] is set our own boundaries,” she says. “We have different thresholds for what is doable for us. For some it might be seeing eight clients a day. Others have to stop at four. But we have wait lists, and the temptation is that once we've reached our boundary, we want to take someone off of another counselor's wait list. But we have to stay true to what keeps us functional.”

DelSignore offers a major hack for staying engaged in the clinic. “When I come to work each day I leave my life outside the door,” she explains. “That way I can stay focused. And when I go home, I leave the office behind and just do home stuff. I don't even look at personal phone stuff at work.”

Being honest with yourself about your problems

Remember angry, judgmental Dr. Smith from the beginning of this article? Shawn McVey helped her develop what he calls “emotional intelligence” within three years. It wasn't easy. “People don't change,” McVey argues, “until they're in enough pain.”

The anonymous feedback he offered her from the staff was uncomfortable, but she needed to hear it. “In veterinary practice the owner is never challenged,” McVey explains. “It's a hierarchical environment. Owners rarely get any negative feedback from staff members. It can become a fear-based environment.”

McVey has spent his career helping develop interpersonal skills in veterinary practices. And the challenge of developing emotional intelligence can be tough for veterinarians and managers to face. But when their behavior is creating a fight-or-flight reaction in the clinic and they finally become aware of it, they will, McVey hopes, have reached the point of pain and change.

Dr. Smith went through a period of tears, anger, shock and “not liking the messenger” when she was given the task of transforming her interpersonal work relationships. But McVey showed her the evidence-something many veterinarians need in order to be convinced of the necessity of change.

“Self-awareness is the key. You have to become aware of how you affect the people around you,” he says. “You have to develop self-management. You have to be able to say to yourself, ‘I can't do that anymore.'”

Dr. Smith did move the needle. And if the bottom line is any indication, by all means she moved it dramatically. Her practice went from $21 million to $60 million. Her team learned how to give feedback. Turnover approaching 30 percent was stilled. The best and the brightest didn't leave anymore.

McVey thinks the key was hacking Dr. Smith's core beliefs. Like almost everyone else, Dr. Smith tended to see other people as basically good or basically bad-the latter of which meant they were dangerous and in need of control. You can't develop a healthy relationship in a practice, McVey says, until you can appreciate others for what's good in them.

By definition, emotional intelligence requires you to bring your emotions out of the dark and into the light. Pope-Robinson agrees with the need to let emotions out of the (veterinary practice) bag: “We need to stop ignoring and suppressing our emotions. Our emotions are our passion. By suppressing our emotions, we're basically telling our passion to go away.”

John Lofflin is a journalism professor and freelance writer in Kansas City, Missouri, and a longtime contributor to dvm360.