To prevent violence at your veterinary clinic, start client care with compassion

Getty ImagesFor the most part, every veterinary team knows its troublemakers and its high-needs clients-whether they just walked in the door or have been a client for years. Difficult healthcare and end-of-life decisions can cause common reactions like sadness and grief for most pet owners, but for others those difficult times can spiral into depression and even result in violence. 

It may be impossible to imagine an assault or other violent act happening at your veterinary clinic, but a quick search for “assaults at veterinary clinics 2014” on the Internet reveals nearly two million results. Sadly, workplace violence is a fairly common occurrence. According to the U.S. Department of Justice, on average, two American workers are assaulted, murdered or raped while on duty every minute of every day.

That knowledge, though disturbing, is powerful. We know the most common acts of violence to expect and we know what preventive measures help to deter them. Phil Seibert, CVT, clinic safety expert, SafetyVet consultant and author of The Veterinary Safety & Health Digest, says violence in the workplace typically happens due to one of these reasons:

> Robbery or intentional assault

> Customers or clients under extreme duress who “lash out”

> Random acts of violence (crimes of opportunity)

> Unhealthy personal relationships (jealous or estranged domestic partners)

While Seibert suggests there are many things a veterinary business can do to make it a less appealing target for crime (to read more about Seibert's security advice, go to dvm360.com/clinicsafety), Joelle Nielsen, veterinary caseworker at the Ohio State University College of Veterinary Medicine, says there is much a clinic team can do to better care for clients and prevent emotionally-driven outbursts as well. All businesses must consider the risks of crime at the workplace, but not all have to manage the complex emotions tied up in the bond between owner and pet.

Nielsen says veterinarians should acknowledge and understand that the human-animal bond is different from any other relationship. Veterinary practices that use a protocol rooted in compassion may reduce negative incidents and increase a client's bond with a practice. She believes every client should be offered emotional support when faced with difficult healthcare decisions. “A lot of people would like the support but they don't know to ask or are too embarrassed to ask,” Neilsen says.

The specific needs of pet owners aren't always obvious. In a profession where veterinarians are focused on their animal patients, human emotional cues can easily be missed. Making compassionate care part of standard protocol alleviates the need to identify troubled clients and ensures that the bond every client shares with their pet is honored.

Tools of compassion: It's not if but when a client needs support

Veterinarians can start by building a rapport to assess the level of human-animal bond between a client and a pet. This rapport can be built through years of treating a patient, but it can also involve asking just a few simple questions during an exam.

Nielsen says veterinarians don't have to be their client's therapist, but simple, telling questions can help. For example: “How did Fluffy come to you?” “How long have you had Fluffy?” Or even, “Tell me about your and Fluffy's relationship.”

“It's all about communication and showing an interest in that relationship,” she says. Nielsen says most clients don't recognize their veterinarian's medical knowledge, but it means everything to them if a doctor will sit down and listen to them.

“It's not about sitting down and having dinner with your client, but just asking a few extra questions,” Nielsen says. This is especially important if a client's emotions or decisions seem misplaced. The client's motivations may make more sense once the background with the pet is known. “You may not get it, but it may help you understand.”

These questions can also reveal warning signs. Nielsen says pet owners who focus on their pet like it's a human are highly likely to require emotional support during difficult times. They may say things like, “I don't know what I'm going to do. She's my only friend.”

Getty ImagesNielsen says the clients who often need extra care when a pet is ill or dies are those who have no other source of support. “The biggest one is the owners that come in alone and don't reference others,” she says. Ask clients who can help them through a difficult time; some may say family or their church. “The ones that worry me are those who have nothing,” Nielsen says.

For those situations where empathy and compassion are not enough, Nielsen says, veterinary staff should have grief and mental health resources available. “Search for people in your area, such as therapists,” she says. She suggests having a handout ready-or better yet, keeping pet grief brochures and other resources available in the lobby. This normalizes the response in a client's mind, she says, which may help him or her cope more effectively.

Nielsen says most clients feel embarrassed, like they're the only pet owner who feels grief. They need to know the feeling is normal and common. Veterinarians and team members should acknowledge that losing a pet is difficult and that they understand that loss well, even if other people don't. A sample response? “We know we have strong relationships with our pets and it can be hard to lose them.” It's simple but direct, Nielsen says, and it means a lot to clients to have their emotions acknowledged.

Nielsen says veterinary teams don't always ask how clients are feeling when facing end-of-life moments with their pets because they're afraid of the answers they might get. For example, clients might say, “When my pet is gone, I'm going too.” But Nielsen says that's an opportunity to intervene. You might ask, “When you say that, does that mean you might harm yourself?” or “I'm worried about you-are you open to receiving help?”

“It does get very dicey,” she acknowledges. “There's a stigma attached with mental health. That's when it goes back to normalizing. Acknowledge the grief in your lobby like it's an everyday part of life.”

As difficult as it is to broach that subject, Nielsen says it's far worse to do nothing. “It's much worse when you had a gut feeling, didn't address it and the client went out and did something,” she says. “We ultimately can't control what others do, but we can control what we do.”

Of course, some clients will refuse help. “At least you offered,” she says.

Some clients may take good intentions as an insult. Some people simply process difficult emotions with anger. Nielsen says those clients often show early warning signs by bringing up previous complaints or making unhappy comments about money. “People in a veterinary practice know who the troublemakers are-document the heck out of it,” she says. Yes, it's a pain, but she says it's vitally important to do it so you and your team can better prevent or manage a possible outburst if bad news must be delivered.

“The best thing to do with anger is to let them say what they say-if it's just verbal,” Nielsen says. She suggests reflecting the feeling back to the client: “I understand you're upset.” She says it's never a good idea to tell an angry person what to do-like calm down.

Nielsen says she's pretty good at tolerating anger. She asks herself, “Is this person yelling at me or about the situation?” “When it starts becoming directed at someone, that's when I become more concerned.” She says that's when a veterinarian or team member has to address the behavior. She says to let the angry person know you want to hear what they have to say, but cursing, yelling and threats may force you to end the conversation until another time. “Sometimes you do have to walk away,” Nielsen says.

If the disruption continues, staff members shouldn't hesitate to call police. Nielsen says if a client threatens physical violence, the veterinary staff should immediately cease discussion, retreat to a safe place and call police. She says you never know what is a threat and what will turn into action.

She feels many who react violently when a pet is injured, is ill or dies have preexisting mental health issues. “A lot of people with true mental health issues have pets,” Nielsen says. “Sometimes that bond is the best one they have.

“These folks that have such a strong bond with their pets-our pets don't talk back, they rely unconditionally on us-it's so different than human relationships,” she says.

When veterinarians find it difficult to communicate effectively with a potentially high-risk client, Nielsen says not to hesitate to bring in a team member. Nielsen is often asked to be present when veterinarians have to give difficult news or explain courses of treatment for seriously ill pets. “It helps having me in the room to interpret things because I'm not a medical person,” she says. “If I don't understand it, the client probably doesn't either.”

When a veterinarian rattles off a long list of drugs he's prescribing for the pet, she might suggest writing up a chart to outline the treatment plan and medication schedule to make it more clear for clients to follow.

She also spends time with clients when euthanasia is discussed. “I can spend an hour talking to a client when the doctor doesn't have that time,” she says. She is also present during many of the euthanasia procedures themselves. She helps support the clients and carry out any special requests they might have.

While it's not realistic to think that every private veterinary practice would have a veterinary social worker like Nielsen on staff-or even an extra hour to talk with clients-she says team members who show an interest in that role should be encouraged to step up and clinic owners should provide extra training.

Nielsen says teams need to remember that veterinary medicine isn't just about the medicine. Every clinic will deal with the often-unpredictable emotions tied to the human-animal bond. “The reality is almost every animal is attached to a human,” she says.