Died by suicide 09/28/2014
BURNOUT V. COMPASSION FATIGUE: The importance of understanding the difference
- Is burnout, which so many people experience at some point in their life, the same as compassion fatigue?
- What exactly is compassion fatigue?
- Why does compassion fatigue, if left untreated, affect the veterinary practice and lead to thoughts of suicide or committing suicide?
Burnout is ‘a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress.’ It is often associated with the workplace, and is a consequence of stressors in the work environment. These can be an overdemanding boss, long hours, inadequate pay, and poor benefits. Oftentimes, a simple change of the work environment can help with burnout and life goes on with little interruption.
Compassion fatigue, also known as ‘secondary traumatic stress disorder,’ is much different. There is no doubt that this is more serious and follows a person despite leaving the environment where it originated. Without proper management and treatment, compassion fatigue can lead to not only thoughts of suicide, but with some, like Dr. Sophia Yin, Dr. Shane Cote, and numerous others; suicide was the end result.
According to the statistics at the US Centers for Disease Control and Prevention as well as Auburn University Journal of the American Veterinary Medical Association (JAVMA), from 2003-2014, male veterinarians died of suicide at a rate of 1.6% higher than the national average, with 51 % choosing firearms and 33% choosing to overdose. During the same time period, female veterinarians who committed suicide were 2.4% higher than the national average with 18% choosing firearms and 64% choosing to overdose. Veterinarians are dying by suicide at high rates, beset by stress, death, and debt (inquirer.com). Today, veterinarians are 3.5x more likely to commit suicide than the general public. With euthanasia drugs being readily available, the veterinarians possess the knowledge and the means to an end.
Thankfully, there is less of a stigma on mental health issues in 2022, and suicide prevention programs are more available through resources like Mighty Vet (founded in 2018) and Not One More Vet (NOMV) which was founded in 2014, after the tragic suicide of Dr. Sophia Yin. Over 400 veterinarians have died tragically,, and these numbers continue to grow.
In my last post, I spoke about the James Herriot Effect and how it presented “a life as it should be for a veterinarian”: bucolic settings, small financially secure practices where people paid or bartered for services, received gratitude from clients and were highly respected in the community. Veterinarians spent many days going from farm to farm to help bring newborn baby animals into the world, to heal sick livestock, equines, and swine which all resulted in the farmers to continue operations without much interruption. The veterinarians were depicted as happy and satisfied both in the books and on television. It seemed like the perfect life. So how did we get from the preconceived ideas of veterinary medicine portrayed by Alf Wight to losing over four-hundred veterinarians to suicide since 1979?
If we take a closer look, veterinary professionals realize that there is a sacred bond between the pets owner (caregiver) and their animal companion. In this bond, the caregiver provides the necessities of life: food, shelter, medical care, grooming, protection, and love. The caregiver assumes a responsibility to provide these necessities as well as giving a voice to their pet in times of need. The pet trusts that their caregiver will take care of them, In return, the pet provides comfort to the caregiver through their silly antics, soulful eyes, the cocking of their head as if they are trying to understand what the owner is saying, and allowing their owner to run their hands through their fur or pat them on the head which somehow relaxes their owner. All of this aids to balance a person’s mental health. When we care for another while also being cared for, it is definitely an emotional and sacred bond.
Oftentimes, the staff has cared for the animal since it was a baby or first adopted. They have been through vaccinations, illnesses, injuries, good times and bad. Some veterinarians send birthday wishes to the animal via their owner and in turn some owners send cards at the holidays. Animals, like people, do not live forever, but the bond that formed in such a short amount of time often affects people worse than losing some family members. When the owner’s bond is severed, it transfers to the veterinarian, vet techs and nurses who have treated the animal all the way down to the front desk and back-office personnel. They own the burden of a dying or ill patient. Although emotional, the staff is expected to hold in their emotions and move on to the next patient as if nothing happened moments before. Picture reliving those feelings several times in a week with no relief.
Veterinarians are the only profession that can legally end a life. When a patient is suffering, it is often the kindest alternative, but that does not make it easier. The sad reality is, the medical necessity is not always there, and they wish they could refuse to perform the service. Pressure from owners or pressure from the practice to “keep moving ahead with patients” leads to moral and ethical issues for the veterinarian.
Animals may come in with a behavior problem, either to a veterinary office or a shelter. Though many behavior issues can be overcome, there are often times the caregivers do not want to invest the time or money for the training or they have been told by authorities that if the animal repeats a specific behavior, it will be deemed dangerous and faces euthanasia. The owner can be charged both criminally and civilly. The caregivers answer at this point is usually euthanasia. Lack of training on the owner’s part most often leads to this result and the veterinarians realize this as well. Some veterinarians struggle with the moral and ethical issue of euthanizing an otherwise healthy pet. Some offer to take the animal and invest their own time and money to avoid taking a life when there is help available. Trying to address a moral/ethical dilemma in this way pushes the legal responsibility onto the veterinarian should the animal injure someone. It is risky to say the least. They see it as a waste of a life that never had to happen, especially those veterinarians that service shelters. They face even more pressure from the public and experience first-hand more animal abuse cases sometimes brought on by behavior issues that could have been corrected.
Other times, the caregiver lacks the funds for the treatment needed. Despite wanting to help their pet, when faced with an expensive surgery or treatment, many owners have no alternative but to euthanize. Few clients have pet insurance, and even if they do, many insurances require that the client pay up front and file for reimbursement. Veterinary practices cannot front the funds for the animals care even though they would like to see the animal get the best treatment. Those that have done so in the past risk never receiving payment back by the client once the animal has been released.
Sometimes, there is nothing that can be done, and the pet must be euthanized. Those in the veterinary profession are highly intelligent and many are thought to be over-achievers. They strive for perfection and when something goes awry in an animal’s treatment, or moral/ethical issues creep in, they take it personal and obsess to the point of pushing their mental health to the brink of collapse all while trying to manage these adverse events, interacting with difficult clients, working in teams, and balancing work and home life. Ethical issues face the veterinarian several times a week.
As feelings of inadequacy and loss start to affect personnel, compassion fatigue enters the picture. The whole practice is affected in one way or another with higher levels of anxiety, depression, and psychological stress. Efficiency drops, workers compensation claims rise, and turnover rates increase. Staff talks. Sadly, rumors and gossip run rampant, and staff will be unable to complete their tasks. This leads to a lack of team cohesion and unhealthy competition among staff which can become aggressive. The veterinarian must now deal with the animals, the clients, and a toxic work environment.
Covid 19 has had both positive and negative effects on the profession. Teams were over worked and overwhelmed due to shortages of staff that were a result of government mandates in regard to lockdowns, quarantines, and social distancing. School closures forced working mothers to be absent from the workforce for two years. The interruption of staff was significant. What many people fail to realize is that some medical supplies were now being diverted for human medicine during the COVID-19 crisis which also contributed to postponements of surgeries due to lack of supplies.
Veterinarians were an essential business during the pandemic so in an effort to meet the client’s needs as much as possible and still comply with the government’s mandates, they refocused their practice for urgent cases only creating new workflows, operating procedures, safety protocols, transitioned to curbside pickup, splitting staff members into rotating teams, and sanitizing exam rooms and other surfaces after each visit. Unfortunately, this forced wellness visits and elective surgeries to be postponed. Since people finally were spending more time with their pets and not on frivolous entertainment, they noticed more health concerns in their pets and started requesting more services as practices started to re-open with the ralaxation of COVID-19 restrictions.
In the next installments, I will shed a light on why financial stress and cyberbullying lead to mental health challenges and finally, in the last post I will address the resources to help veterinarians and their staff overcome these challenges while also identifying measures for pet parents and the public to take to help end this serious issue.
MEMORIAL VIDEOS:
- Dr. Shane Cote died March 19, 2013
- https://www.youtube.com/watch?v=TkRsLU9742c
- Dr. Sophia Yin dies September 28, 2014
- https://www.youtube.com/watch?v=jRSjinj_ftY
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