I don’t like to ruminate or regretfully think about “should have” or “what if” moments in my career (or life, for that matter). But as I get older, I realize that objective debriefs about the past are healthy. They help us recognize where we started and the choices we had, and what we can change as we grow personally and professionally. When I apply that thinking to my time in veterinary school and my preparation for small animal practice, I know these two things are true:
- My medical education was thorough and detail-oriented, and I’m grateful for the foundation it gave me as a young associate.
- If I had to do it all over again, I would need training in how veterinarians can rebound from rejection.
That last statement might seem out of place, considering that most veterinary students are high-achieving, internally driven, well-rounded individuals with a minimal history of failure.
In the same vein, however, the same group is often introverted and shows perfectionist tendencies. They sometimes avoid failure or rejection by excusing themselves from learning a new skill or pursuing a job opportunity. That combination makes us especially vulnerable to the consequences of one of the most challenging scenarios we weren’t trained to face: the moment of “no.”
Of course, we’ve all experienced rejection to varying degrees. I would argue that rejection happens every day if we look at veterinary life in microbursts. Psychologist Dr. Guy Winch boldly states, “Rejections are the most common emotional wound we sustain in daily life.” You can see it in a co-worker’s dismissive look, a client’s rejection of your vaccine recommendation and a patient’s reluctance to respond positively during an exam.
Those examples scratch the surface. Other interactions linger longer and cut deeper, like a client’s refusal to euthanize a suffering patient or approve a treatment plan for an obstruction in a puppy.
Rejection adds to compassion fatigue. Veterinary professionals know the pain all too well. That being said, it should come as no surprise that rejection activates the same parts of our brain as when we experience physical pain.
Rejection Sensitivity Dysphoria
While many of us do our best to manage the roller coaster of rejection and rebound, some suffer severe emotional distress. Rejection sensitivity dysphoria (RSD) describes people hypersensitive to rejection, criticism, judgment and a sense of personal failure. People with RSD usually feel rejected much more than reality dictates.
Interestingly, research supports a genetic component linking RSD to attention deficit and hyperactivity disorder (ADHD). Studies by Dr. Eugene Arnold, a psychiatrist and behavioral health specialist, showed that 70% of people with ADHD displayed RSD signs and that 99% of adults with ADHD are more sensitive to critique.
People with RSD tend to show these character traits:
- People-pleasing
- Easily embarrassed or self-conscious
- Low self-esteem and self-doubt
- Sudden outbursts of emotion
- Negative self-talk
- Difficulty managing relationships
- Withdrawal from social interaction when rejection occurs
- Perfectionism
If this topic triggers questions and further exploration in you, know that cognitive behavioral therapists have treatment options.
Managing Patient and Client Rejection
Let’s dig into specific veterinary rejection scenarios. How often have you walked into an exam room only to have a startled pet owner shout, “Stop! He doesn’t like women!” (Pick the character trait.) Or consider the struggle of a younger associate who hears, “No, I requested Dr. Smith. I mean, how old are you anyway?”
While we know that dogs, cats and people develop fears associated with specific visual cues and experiences, store those fears in the amygdala, and then display escalating fearful behaviors each time the imprint is recalled, we still perceive personal rejection. Research shows the amygdala is the key part of the brain responsible for fear imprinting and anxious and stress responses. Ironically, the amygdala processes rejection in people and responds with negative self-talk and messaging.
Why is that critical to know? When we talk about a patient rejecting us, we have a greater understanding today of anxiety, stress and fearful behaviors in pets, and we can adjust our behaviors and body language to try to repair the interaction.
Here are a few key points to remember if the owner of a fearful dog is open to a new strategy:
- When you enter the exam room, avoid direct eye and physical contact, knowing that a dog’s ability to choose when and how to interact leads to a more positive interaction.
- Dogs are more accepting when you approach at a 45-degree angle. Try squatting or kneeling and keeping your body sideways.
- Immediately note your body language and vocal tone. Keep hand movements to a minimum and your voice soft.
- Scattering high-reward treats or allowing a dog to choose to take them from an open palm can help.
- Anxiolytics and other pharmaceutical interventions might be appropriate, too.
Lessening the Fear
How can we respond in healthier ways in moments of human rejection? First, we must do our best to not assume rejection is personal. Most professional rejections are due to circumstances, a misfit or factors out of our control.
Another component of dealing with rejection is feeling confident and secure in our responses. When a client turns down a recommendation, our default response lands somewhere between an impatient, defensive statement and a passive, submissive retreat. We can respond more appropriately by stopping, taking an intentional breath and checking our body language.
Another strategy for managing and lessening the frequency of rejection is to alter our communication. What I and many colleagues learned in veterinary school was the one-directional delivery of information. In the exam room, we typically stood in a starched white coat as an emotional and worried client sat across from us, listening to us regurgitate a lot of technical medical information and the recommended course of action. There was no discussion and minimal interest in the client’s goals and needs. If a client started speaking, we jumped in to talk over them. (A 2011 study found that, on average, veterinarians interrupt clients within 15.2 seconds.)
Remember that up to 93% of communication is nonverbal, including body position, facial expressions, hand movements, eye contact, tone of voice, muscle tension and breathing patterns. If you re-enact in your mind the organic response a veterinarian might show when frustrated, impatient or uncomfortable, no wonder many of the instances end in client rejection.
It’s essential that we strive for two-way communication and shared decision-making. This concept involves thinking of oneself as the medical advocate for the patient and the client as the medical advocate at home. Instead of starting with recommendations, we should use empathetic body language and ask questions to better understand the client’s perspective.
Understanding clinical empathy is one of the last technical pieces of managing rejection, especially with clients and in the exam room. It’s one of the secrets to connecting with pet owners, strengthening the veterinarian-client relationship and protecting ourselves emotionally.
Here are three critical components for success in client relationships:
- Understand the client’s perspective, including the person’s emotions, thoughts, beliefs and circumstances.
- Communicate the understanding back to the client.
- Act on that understanding in ways helpful to the patient and client.
I know colleagues who think we must bend backward to satisfy our client base. Not so. Displaying empathy doesn’t require agreeing with another person or sharing similar experiences. Focusing on clinician and client similarities contributes to overidentification, so we lose objectivity. Instead, we need a healthy understanding of boundaries when rejection occurs.
Finally, the last point for veterinary professionals is to avoid isolation. Dr. Winch, the psychologist, stated that rejection destabilizes our need to belong, exacerbating and prolonging the feelings of rejection. I know that when I’ve experienced client rejection, I’ve been reluctant to share the feeling with colleagues due to embarrassment.
While rejection will always be a part of life, knowing appropriate strategies will help us rebound faster and lessen the fear moving forward.
SELF-HELP
Boosting one’s self-esteem after rejection is vital but challenging. Psychologist Dr. Guy Winch recommends “emotional first aid,” which consists of:
- List five meaningful qualities you possess.
- Choose one and write a paragraph about why that quality matters to others.
- Explain to yourself how you would express that quality in a specific situation.