Natalie L. Marks
DVM, CVJ, CCFP, FFCP-Elite
Fearless columnist Dr. Natalie L. Marks is an educator, consultant and former Chicago practice owner, the chief veterinary officer at Mi:RNA, and the CEO of the Veterinary Angel Network for Entrepreneurs. As one of the original leaders within the Fear Free movement, she passionately believes in pursuing the best physical and emotional health of all patients.
Read Articles Written by Natalie L. Marks
Because our profession is filled mainly with introverted, people-pleasing perfectionists — I raise my hand — one area of the hospital that can harbor much of our anxiety and fear is the exam room. Don’t get me wrong. I’ve also experienced rewarding moments in exam rooms with patients and clients I connected with personally. However, many of our troubling interactions revolve not around persistent ear infections or chronic diarrhea but our deeply held beliefs formed long before the veterinarian-client relationship started. Whether it’s a pet owner convinced that vaccines are harmful, a client adamantly feeding their cat a raw-only diet or someone rejecting “toxic” parasite prevention, the tension during these moments can feel less like a clinical disagreement and more like personal confrontation.
Another reason for the fear is our training. As veterinarians and scientists, we spend most of our time learning to navigate clinical conversations. Yet, time and again, we find ourselves caught in the undertow of misinformation and personal ideologies lacking scientific support. These situations can be uncomfortable, especially when they occur repeatedly throughout the workday.
If all this feels like you wrote it, you’re not alone. A 2021 American Veterinary Medical Association survey found that 63% of veterinarians reported avoiding specific conversations, particularly those regarding vaccine hesitancy and controversial diets, due to concerns about damaging the client relationship. Additionally, 78% reported fearing a negative online review if clients saw them as too assertive or dismissive.
Everyday Fears
Why the widespread hesitation to speak up in our industry? Is it just us, or is the trait common to humanity? Here is what I’ve learned.
- Fear of conflict: Avoidance alleviates short-term anxiety, but it ultimately backfires by reinforcing the belief that you can’t handle conflict.
- Fear of losing clients: COVID-19 resulted in an influx of new pet owners and long waitlists, but we’re now seeing a steady decline in patient visits and average client transactions. For many decision-makers, this fear is further backed by a VetSuccess study, which found that 40% of clients who had a negative interaction regarding vaccine discussions switched clinics within six months.
- Fear of judgment: With 90% of pet owners reading online reviews before choosing a veterinarian, according to a 2022 study, even a single negative post can lead to significant reputational harm for a veterinary professional.
- Emotional burnout: According to Merck’s 2023 Veterinary Wellbeing Study, 44% of veterinarians reported experiencing moderate to severe emotional exhaustion. A significant contributor was emotionally charged client conversations.
Understanding Belief Systems
As people-pleasers, we can feel somewhat defeated when clients hold deeply ingrained belief systems that are beyond our influence. However, those beliefs often come not from ignorance but from emotions, experiences and ideologies similar to those that shape our lives. For example:
- Mistrust of institutions: Trust in the U.S. health care system has steadily declined over the past two decades, according to a 2022 Gallup poll.
- Anecdotal experience versus evidence: Psychology studies suggest that narrative evidence might be more persuasive than statistical evidence for general audiences.
- Social media echo chambers: Nearly 50% of pet owners rely on social media as their primary source of pet health information. The same study found they often value advice from influencers over that of licensed professionals.
Rather than grappling with our awkward silences or defensive responses, we can acknowledge and embrace our clients’ motivations and engage with them using our veterinary superpowers of empathy and patience.
How to Manage Disagreements
After a challenging month in practice ownership, marked by an unending series of angry pet owners and frustrated veterinarians, I knew I needed to take a different approach for myself and my team.
One strategy that significantly helped our team — and one I recommend for high-functioning veterinary hospitals — is personality testing. Whether it’s the Myers-Briggs Type Indicator, DiSC or the Big Five, investing time in such assessments can enhance team synergy and client relationships. Once we better understand ourselves and how we react to others, we can be more effective team members and better communicators with diverse clients.
Here are six practical and actionable steps that veterinary teams can take to reduce the inherent fear of conflict in the exam room.
1. Lead With Curiosity, Not Correction
Curiosity is essential to human relationships. We crave curiosity, kindness and acceptance in the workplace, so why don’t we provide our clients with the same opportunity? Change is hard for most people, so let’s make it as easy as possible using a concept called motivational interviewing. These techniques can foster client cooperation and have been shown to improve compliance by up to 40% in both human and veterinary medicine.
Let’s use vaccine hesitancy as an example. Instead of allowing your shoulders to rise and your cheeks to flush the next time a client refuses a rabies vaccine or opts to feed a cat only a raw chicken diet, take a cleansing breath and consider one of these responses:
- “Can you tell me more about why you’re hesitant about this vaccine?”
- “What led you to try a raw diet for Luna?”
Empathy doesn’t mean we must completely agree with our clients. However, it does mean we can be curious and try to understand what shaped their beliefs.
2. Validate the Emotion, Not the Misinformation
One of the fastest ways to erode trust and collaboration is by failing to validate someone’s emotions. During a difficult and extremely sad euthanasia case early in my career, I saw my later appointments piling up while the pet owner and her family lingered, struggling to say goodbye. I finally decided to walk in, upon which the client poured out her heart about the family’s profound loss. Instead of validating her feelings, I told her how she could pay her bill. Not only did I receive a furious response in return, but I also received stern feedback from my boss after a highly negative online review. After many subsequent nights of feeling like a failed veterinarian, I ended the pity party and embraced why I needed a different approach.
The same applies to client adherence to our recommendations. Pet owners are more likely to accept professional guidance when they feel emotionally acknowledged. Empathy-based communication correlates with greater satisfaction and trust, even in cases of disagreement.
3. Anchor to Shared Goals
Identify the goals and truths common to your clients and team. There’s always something to find. Stay curious and discover it. At the very least, we should prioritize the patient’s health as a clear starting point.
Collaborative language boosts compliance. The days of one-directional client communication are over. Instead, we must adopt an approach where the veterinary team acts as the medical advocate in the practice and the client serves as the patient’s medical advocate at home. Clinics utilizing these shared decision-making frameworks report a 25% increase in vaccine and prevention adherence.
Here are examples of what you can say:
- “I see how much you care about Jimmy’s diet. You’ve done so much research. His nutrition is critical to me, too. Let’s see where we can align.”
- “I loved meeting your whole family today, and I can see how proud of a mom you are of all your children. Let me help you keep them all protected and safe.”
4. Use Stories, Not Just Science
Although we tend to be introverted and typically lead data-driven lives, many clients enter our exam rooms motivated by emotion. For those of us who have attempted to reason with an emotionally charged person using logical and statistical arguments, we quickly learn that such an approach is ineffective. This is when storytelling can be highly effective. Stories are something no veterinarian lacks.
An example is a vaccine-hesitant client who declines parvo vaccination or one who refuses parvo testing for a young puppy with diarrhea. Even though parvovirus has a 91% fatality rate in unvaccinated puppies, according to one report, storytelling is often more compelling than numbers alone. Personal narratives enhance message retention and acceptance.
5. Offer Options, Not Ultimatums
This strategy is critical, and thankfully, it reflects another tenet of shared decision-making. Choice architecture is effective. A Canadian study found that 38% of vaccine-hesitant clients accepted titer testing or delayed vaccination when it was offered as a middle ground.
6. Know When to Let Go
And finally, there is a season for everything, even in the exam room. One of the biggest yet understated reasons for professional burnout is the emotional toll of rejection. It becomes especially challenging when the client’s refusal is due to misinformation, even after we deliver the correct education. Sometimes, success is as simple as respectfully planting a seed. It might be the most you can do. Repeated, respectful engagement increases the likelihood of long-term behavioral changes.
Your Turn
Many of these recommendations might make you uncomfortable, and to be honest, that was my intent. Disagreeing with a client respectfully takes courage. More importantly, understand that respectful disagreement with a client is not a failure; it’s a form of advocacy. You’re not alone in facing these moments. Your voice — firm yet kind and grounded in science — matters.
Our goal should never be to control a pet owner. Instead, it’s to guide and advocate. Even if you don’t change a client’s mind today, your calm, evidence-based storytelling presence might make all the difference later.
PROTECTING PET ADVOCATES
Disagreeing with veterinary clients can be exhausting. Protect your team’s well-being with these additional recommendations:
- Team debriefs: Clinics that hold short post-appointment discussions report lower stress levels and higher team morale.
- Unified messaging: Consistent clinic-wide language reduces the individual burden and supports a culture of clarity.
- Training and CE: Targeted communication training leads to a 30% boost in clinician confidence.
- Boundary setting: The American Veterinary Medical Association’s Code of Ethics supports terminating client relationships that compromise patient welfare.
RAW FACTS
A recent peer-reviewed article in Today’s Veterinary Nurse concluded: “The veterinary team must also recognize that some pet owners may elect to continue feeding raw meat diets. Providing tailored nutrition recommendations that align with a client’s preferences can increase compliance and safety.” Learn more at go.navc.com/4fKbVgd.
