When the bond breaks: Examining clients who jeopardize the veterinary team relationship

Difficult clients can make even the most confident veterinarians question their place in the profession and their self-worth. Veterinarians often attach their identity to their work. If work becomes an endless cycle of negative energy due to one bad interaction after another, then veterinarians may lose their sense of self.

Up until now, research has primarily focused on what we can do as a profession to improve difficult encounters through collaborative case management and communication strategies based on relationship-centered-care. But what has not yet been addressed is the elephant in the room: When is enough enough? In other words:

> When does a difficult client become dispensable?

> What triggers a veterinarian to cement the fissure in a fractured client relationship and make that final break?

> When is firing a client not only reasonable, but in fact necessary to sustain oneself within the profession?

We dug into those details with a survey (see "Survey details" above), and here are our results, plus a few tips for maintaining a healthier emotional relationship with the clients we serve-and our profession.

Phew! That's a lot to take in. But remember: Not all difficult clients remain difficult. With the proper support from management and early intervention strategies, difficult clients can be turned around. Work these four tips into your practice protocols and management strategies:

1. Set boundaries for clients

Establishing boundaries for both the client and the veterinary team is key. The veterinary team needs to model for clients what behavior is expected. When client behavior crosses the line, clients need to be called out on it appropriately so that future episodes are squelched rather than reinforced.

2. Set boundaries for yourself

Additionally, members of the veterinary team needs to set limits for themselves. Specifically, team members must accept the reality that they're not superhuman and can't do it all, and they nneed to rely on teammates to back each other up rather than going at each task alone. True, clients rely on us, but if we don't take care of ourselves first, we cannot possibly refuel the tank to keep on giving.

3. Talk it out

We need to maintain open doors of communication with one another and be honest about what we're feeling. Sincere conversations with trusted colleagues, in real life and online (see the Facebook groups Not One More Vet or Veterinary Medicine: Staying Alive or Veterinary Professionals Association for Wellness), serve an important role by ensuring that even veterinarians who practice in isolation have a safety net of people to reach out to during hard times.

4. Accept reality

Finally, we must be realistic and truly accept that not all cases have positive outcomes and not all clients can be satisfied. As much as we try to please everyone, we remain limited by certain circumstances that are-and always will be-outside our control. Releasing a client from your care is not giving up on them or giving up on yourself.

We need to move beyond seeing client dismissal as a failure when it's used as an appropriate tool for the practice. It's time to accept firing clients as a viable solution (here's one article about that) before we reach the ultimate breaking point: our break from the profession. That's not to say we should fire any client for any reason-only that there's a time and place for it, and that client dismissal should be an option when veterinarians and clients are unable to find common ground.

Think of it as giving the client the freedom to find a better fit elsewhere-one that will be infinitely less frustrating for all involved.

Dr. Ryane E. Englar is an assistant professor of small animal primary care at Midwestern University in Glendale, Arizona. Alyssa Show-Ridgway is a 2019 DVM candidate at Midwestern University.