When a dog cowers and tries to bite us, we can safely assume a traumatic event occurred in its past. The reaction probably had nothing to do with us; it was just the situation. When one of our team members lashes out at us, what if we consider the underlying cause instead of taking it personally? When clients refuse to follow our recommendations or share information, we may be quick to blame them, but why don’t we treat them more like scared patients? Why should we save our behavioral techniques only for distressed cats and dogs?
While I am not a mental health professional, I argue that in addition to having excellent surgical and medical skills, veterinarians striving for excellence must be mindful of human psychology.
I want to discuss one of the greatest psychological threats to thriving in veterinary medicine and how the threat can manifest within oneself, between teammates, and between veterinary professionals and clients.
What is this disease? Read more to find out.
Beneath the Surface
It’s no secret that with diseases, there is usually more than meets the eye.
I’m sure we’ve all heard clients say something like, “Oh, my cat got into a fight and got this little swollen scratch. We just need antibiotics.” The pet owner fails knowingly or unknowingly to appreciate the risk of deeper underlying concerns, such as an abscess.
While we may sometimes dismiss our clientele’s shortsighted thinking, veterinary professionals can miss signs of an underlying issue.
What issue might you not have included in your last differential list?
Shame.
I argue that shame is one of the most significant issues in veterinary medicine. But what is shame?
Shame researcher Dr. Brené Brown defines it as “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging — something we’ve experienced, done or failed to do makes us unworthy of connection.”
Also, according to a paper from the British Sociological Association, shame is “virtually ubiquitous, yet, at the same time, usually invisible.”
Shame can be likened to an iceberg: It’s visible at sea level but can have a far greater impact beneath the surface.
Although shame does not take long to define, it can be challenging to notice in the veterinary clinic.
I’ve outlined a few scenarios and how the lessons learned might help you in your practice.
June’s Puppies
People who learn I am a veterinarian tend to respond positively. Veterinarians are experts in animal health, and we’re regarded with trust, respect and dignity. I want to share an experience where that status quo was severely inverted.
Enter June, the happy Frenchie. The client disclosed that June’s puppies were recently born a few days premature, and none survived. I told the client that being born a few days premature was not a good enough reason for all the puppies to have died and that I was concerned something else had happened, like an infectious disease.
The owner started to get upset and argued that if I knew anything about Frenchies, I would understand that being born prematurely essentially guarantees puppy death.
Our interactions grew more and more tense. At one point, the client became nonverbal and gave me a death stare from across the exam room. I calmly removed the stethoscope from around my neck, my situational awareness telling me he could use it to choke me. I then excused myself from the room to help make up an estimate for brucellosis testing, but more so to get a breath of air and calm down. (While I am not a theriogenologist, I knew I needed to consider a reportable infectious disease.)
The client declined further testing, asserted his dog was fine and left. Even then, I was still upset.
I took a moment to call a theriogenologist from veterinary school. It turns out the client was right: Being born even a few days early can result in 100% mortality.
I was wrong.
It felt like a punch in the stomach. So shaken up by the experience, I took the rest of the day off and requested to never work with the client again.
The pet owner’s arguing with me wasn’t what soured our relationship. It was his hostility.
In the days that followed, I had to overcome a wave of turbulent thoughts that reverberated throughout my consciousness. “You’re an idiot.” “You should not be a vet.” “You’re a failure.”
I was shaken up. I doubted my career, competency and capabilities. I felt unworthy of the title of veterinarian because of my lack of knowledge.
That is one example of how shame can affect us deeply and hinder our ability to practice veterinary medicine. It disrupted my ability to focus. I felt terrible about my mistake, and ruminating on it further disrupted my peace.
That is the first example of how shame can prevent thriving in veterinary medicine and is arguably the greatest psychological threat to thriving.
Liking Animals
Prior to becoming a veterinarian, I worked with mentors. Some were supportive and great role models. Others taught me what not to do. Either way, I learned a tremendous amount.
This next experience focuses on a pre-veterinary mentor. I’ll call her Jane.
I was taking care of a lot of animals, big and small, and putting in a lot of physical work. The program had scheduled breaks free of animal care responsibilities. Another student and I often used the breaks to decompress and recharge in preparation for the afternoon of sweaty labor to come.
Our mentor, Jane, expected a lot from us. She was incredibly detail-oriented and gave explicit instructions on how to care for each animal. While the other student and I tried our best to meet her expectations, it seemed like everything we did was never enough, and she always scolded us for doing something wrong.
One day, she made those points exceedingly apparent.
After Jane briefed us on our daily duties, she paused. Her brow furrowed, and her body was tense. I’ll never forget what she said next. “Do you even like animals?”
My colleague and I were stunned. Jane knew we were applying to veterinary school in less than a year, had thousands of hours of experience, and were passionate about helping animals. How could we do all of this and not like animals?
Jane elaborated. “Every day, after the morning duties are done, you go off and take a break and don’t come back until it’s time for the afternoon duties. You guys never ask if there are ways to help. It’s like you don’t want to be here. It just seems like you don’t even like animals.”
Wow.
My face flushed. A wave of frustration and shame washed over me. I don’t think I had ever been insulted like that before. I’ve experienced my fair share of insults, but for some reason, this one stung deeper than all the rest. Never mind that we had been told we were free to rest between the morning and afternoon rounds. Now, we were accused of one of the most offensive crimes in health care: apathy. That hurt.
While I learned a lot from Jane, that occasion illustrates how shame damaged our relationship. I felt that everything I did was never enough. While the work environment was unhealthy, I am grateful to Jane for helping me develop significant grit.
The situation also taught me to be extra considerate when speaking with people I mentor. A mentor’s words and actions can have a lasting effect — positive, negative or both.
To be clear, I do not blame or resent Jane for the experience. It helped me become the veterinarian I am today. It helped me develop more empathy. As you’ll see in my next story, empathy helped me connect with a client going through a rough time.
Money Issues
“I know I’m a [jerk] because I can’t afford all the medications today, but that’s all I can do,” the young man explained to me, a pained, tense look in his eyes.
He repeatedly called himself a “jerk” and explained that he was short on money.
Although I didn’t comment on his finances, ignoring his self-deprecation made it seem like I was judging him.
A bit of awareness and empathy made me realize something important: It was not about me. His emotions were present in some form before I drove out to examine his pet.
After realizing that his reaction was likely a defensive mechanism, perhaps related to some sort of trauma, I knew what I had to do. I did my best to assert three things:
- He was not a jerk.
- He was doing what he could.
- I wasn’t judging him.
After that, his defensiveness lowered a touch, the self-deprecating talk stopped, and we connected on a deeper level for a moment.
Walking back to the mobile veterinary unit, I couldn’t help but wonder what had caused that man to talk so poorly about himself.
Our veterinary team did not express any judgment toward him or show any reason for him to beat himself up. No, the issue wasn’t current. It was something from his past. Perhaps he had a bad veterinary experience. Perhaps another veterinarian said something that made him feel bad about not choosing the ideal Plan A. Perhaps it wasn’t what was said but how.
Whatever might have happened before, he was experiencing shame.
Shame might seem like a non-medical topic, but if it can hurt pet health, doesn’t that make it medical?
Awareness and Hope
Whether we notice it or not, shame can have far-lasting effects on nearly every aspect of veterinary medicine. As I showed, shame can significantly impact veterinary professionals, veterinary teams, clients and even pets.
Fortunately, even though shame’s impact can be significant, there is hope. The first step in overcoming it is awareness. By labeling shame for what it is, we can become more aware of its influence and how to address it.
To be clear, the intent here isn’t just about reducing employee turnover or maximizing client retention. It’s also about improving our profession so that the next generation will be excited to help animals and want to make a difference in the world.
LISTEN AND LEARN
Dr. Brené Brown’s TED Talk, “Listening to Shame,” explores what can happen when people confront their shame head-on. View it at bit.ly/3wy5drG.
1987 STUDY
An article published in the Journal of the American Medical Association found that “Patients are at high risk for experiencing shame and humiliation in any medical encounter. This is because they commonly perceive diseases as defects, inadequacies or shortcomings.” The full text is available to JAMA subscribers at bit.ly/4bKkPZs.