Compassion Fatigue and Veterinary Suicide Part 5: You Are Never Alone

Over the past several weeks, I have tried to bring attention to a very real problem facing the veterinary profession. I am not a veterinarian, nor do I work in the veterinary profession. I write as a freelancer when time permits, and have written many articles on rescues, shelters, pet placement services for active military personnel, and service dog organizations over the years. When a vet tech friend of mine suggested last year that I write a little article on compassion fatigue and veterinary suicide, I told her I would consider it. I honestly never heard that suicide was an issue that was affecting the veterinary profession, but I had to push it off until I had more time to look into the issue.

What I discovered over the past several weeks brought tears to my eyes. I found it hard to actually write on the sensitive topic as I kept picturing myself in the veterinarian’s shoes. I felt myself drawn into their world and wondering how I would manage the same issues if I was faced with them every day. I love animals, writing and sharing information with others. Like most little girls when I was in 2^nd grade, I wanted to be a veterinarian. My parents were very honest with me and said they would be unable to help me financially. As I got older, I accepted that and went into an unrelated field. I was able to work for a very short time in a small animal practice while going back to school in my early 20’s, but then I faced two situations in one day that did not set well with me:  assisting the veterinarian with the cropping of a Doberman puppy’s tail and docking it’s ears and then assisting the vet with the euthanasia of a 12 year old dog who, despite some physical disabilities, was a healthy senior. I wanted to ‘save’ the dog from death and became emotional. Why couldn’t the veterinarian tell the client no to euthanasia? I learned that day that working in a veterinary practice was not for me and sometimes, the decisions they have to make are not easy. Thankfully, the veterinarian in charge that day, pulled me aside, explained why the position was not be a good fit for me and I was released. After writing this blog series, I now understand more fully and have to say I am very thankful for her honesty. If those two incidents are still vivid in my memory after 35 years, I can only imagine how the job would have affected me on a daily basis. She spared me a lifetime of mental health challenges.

This topic was too important to rush through and just bullet issues, and I tried to cover many issues. However, two issues I did not delve into were HIPAA and the availability of controlled substances.

The first time I was handed a HIPAA form at a vet, I admit I was taken back. Why would my veterinary office be handing me a Health Insurance Portability and Accountability Act form for my dog when it is designed for the human healthcare industry? I recently learned why. Attached to every animal is a human and that human’s financial and personal information is collected by the practice and must be protected. Maybe HIPAA is not the correct wording for this form; however, veterinarians are required not only to secure their clients information but also are required to abide by the Principles of Veterinary Medical Ethics (PVME). Though the PVME is comprehensive, under the Principles with Supporting Annotations, it specifically states under Section 5.1:

“Veterinarians and their associates must protect the personal privacy of clients, and veterinarians must not reveal confidences unless required to by law or unless it becomes necessary to protect the health and welfare of other individuals or animals.”

When complaints are posted on social media, veterinarians and their staff must not violate HIPAA or the PVME. For them, it is best to not respond and ensure the trust with clients is retained. Sadly, they are unable to defend themselves from cruel and one-sided defamation which can have long lasting effects on their practice and their reputation.

With the ease of availability to controlled substances and the knowledge how to use these substances to humanly end to a life, it unfortunately makes this a more accessible option for those contemplating suicide. I will not go into details on this option since there are so many other factors involved with controlled substances which are critical in the veterinary profession.  However, I am sure control measures will be looked at in more detail over the years in an attempt to minimize the possibility of suicide by veterinary staff through this means.

The bucolic lifestyle of an animal loving veterinarian living in the Yorkshire countryside and made famous in the James Herriot books was a ‘perception’ created by Alfred Wight to help him deal with his own depression in the 1960’s, yet this ‘perception’ resulted in many entering the veterinary profession. It is not until that perceived lifestyle has slipped out of reach, when the debts become unescapable, when a procedure does not go as expected, when clients yell, scream and post disrespectful comments on the practice’s website, will the veterinarian begin to ask themselves over and over what went wrong. Society has become demanding; expecting veterinarians and staff to have all of the answers, to be open 24/7, to have more access to fancy expensive diagnostics, pharmaceuticals, and treatment. On top of this, clients balk at paying for the services and complaining of the excessive costs every time they have an appointment, when in reality, they may only visit the vet once or twice over a several year period. The hours are long, the demands keep coming, but the gratitude and praise are less each year.

As I wrap this up, it is my hope that those in the veterinary profession that have been following these posts realize that they are not alone. Mental health is no longer considered the stigma it once was. Help is always a click or a phone call away, and as more people become aware that the veterinary profession faces a crisis, the more resources become available to help those in need.

I hope that veterinary staff will unite when they suspect a colleague is struggling; that they will initiate QPR which means to question, persuade, and refer those in need to available resources which can help them through tough times.

I also hope that clients will learn to be more patient, kinder, and understanding toward their veterinarians and the staff. They are doing their absolute best under the parameters of the law with the knowledge and resources they have to keep pets happy and healthy under stressful conditions.

So how do veterinarians work through the mental health and financial challenges that haunt their profession? Instead of going into detail. let me highlight a few key points.

• Learn to protect your own needs:  physical, mental, and emotional. This also means learning to say NO.
• Identify your personal goals and objectives
• Improve employee teams:  insist staff take scheduled breaks, lunches, and time off
• Offer benefits; support wellness programs such as gym membership; offer an Employee Assistance Program (EAP) or an insurance which includes mental health benefits
• Provide training and growth opportunity
• Allow paid time off when a pet dies
• Understand the legal parameters in which the vet tech is allowed to perform and identify opportunities to utilize them more fully

AVAILABLE RESOURCES FOR VETERINARIANS/SUPPORT STAFF/STUDENTS

• Not One More Vet Home | Not One More Vet (nomv.org)
  • NOMV helps veterinary professionals through peer-to-peer support, financial support grants, education presentations, and by collaborating with partner agencies to extend services to the veterinary community. When we say veterinary professionals, we mean everyone – veterinarians, veterinary technicians, veterinary students, and veterinary support staff. 
  • Online support also includes How to Deal with Cyberbullying, Help for Compassion Fatigue, Access to Crisis Intervention Training, Crisis Numbers for the United States and Abroad, and Facebook Forum Groups:  Not One More Vet, Not One More Vet Support Staff, and Not One More Vet Student
• American Veterinary Medical Association We are AVMA | American Veterinary Medical Association
  • Online resources, annual wellness summit, Train-the-Trainer courses, Free Access to QPR (question, persuade and refer), ProQOL Assessment (professional quality of life assessment – balance of positive & negative, personal, and work experiences)
• Merck Animal Health Veterinary Wellbeing Study | Merck Animal Health USA (merck-animal-health-usa.com)
  • Collaboration with AVMA and NOMV, provides links, resources studies and toolkits
• Mighty-Vet Homepage – MightyVet 2021
  • On demand Continuing Education, Global Mentorship Program,  Office Hours with Industry Professionals and Thought Leaders Globally, Free Continuing Education
• Mentor Vet About — MentorVet
  • A national mentorship program designed to help newly graduated veterinary students in the United States with locating mental health interventions.

In regard to your clients and the public, consider posting the following in your facility, on your website, or offering it as a handout to clients. Feel free to curtail it to your practice.

Dear client: We value you as a client. As we navigate through the continued COVID-19 fallout which has affected all of us, we ask that you remember that veterinarians and their staff are humans and are doing their best to help your pets with the in-depth knowledge they have gained through their education and experience. Here are a few tips that can help us service you better.

Veterinarians are on your side and want to provide the absolute best care for your pet. I hope this 5-part series helped shed light on this growing issue not only for veterinary staff but also for the general public.  I have learned so much and will do what I can to get the word out to help a profession who has always gone above and beyond to keep my pets healthy.

• Trust your veterinary team and take an active role in following our advice. We are on your team.
  • We are well educated and will always give our best professional advice in regard to your pet as well as alternatives if they are available. If you choose not to follow this advice, those decisions may have irreversible consequences or lead to other conditions such as obesity, diabetes, arthritis, or early death.
• Be patient, kind, and understanding. Ask the vet and staff how they are doing when you see them. Let them talk. They will not discuss another client’s case, but it may allow them the time they need to gather their composure after something very emotional.
• Be reasonable and rational when on-line. If you do not have something nice to say, do not say it.
  • Post positive reviews whenever possible. If there is a disagreement with a veterinarian or their staff, be a mature adult and ask to speak to them regarding the issue in private.
  • Negative words affect personal and professional reputations as well as business operations, but they could also open up legal ramifications against the poster.
  • Due to the Principles of Veterinary Medical Ethics (PVME), reviews will always be one-sided.
• Be flexible with appointments. Plan far enough in advance to reserve your preferred provider. Be clear about what you plan to discuss and your expectations.
• Plan refills for your pet’s medication by using their preferred method.
  • Prescriptions need to be signed off by a veterinarian and we prefer to do this at one time rather than interrupting someone else’s appointment to sign your prescription.
• Thank the veterinarian and the staff by sending a card, dropping off cookies, or updating us on how our recommendations are helping your pet recover, lose weight or have more energy.
  • A simple thank you goes a long way to let staff know they are appreciated.
• Be a responsible pet owner. Keep up with routine care and preventatives
• Own your financial responsibility.
  • Obtain pet insurance, have a separate savings account, or credit card to help with unexpected costs that arise. Setting aside so much per week will enable the amount to accrue and it will be there when needed.
• Make sure you do not have more pets than you can responsibly manage. Pets are luxuries not impulse decisions and require time and money. One pet should not have to suffer or go without so another can thrive. The more you invest in them, the more they will thrive.
• Veterinarians and their staff NEED time to decompress. When they are not working, refrain from asking for advice. Focus on helping them find a healthy work-life balance: go out to eat, go to a movie, a concert, sports game, a hike, the beach…but do not talk about work.
• If, during a visit, you sense a staff member is struggling emotionally, do not hesitate to ask if they know about Not One More Vet (nomv.org).

Thank you from your Pet’s Healthcare Team!

Veterinarians are committed to the well-being of animals but with such dedication, long hours and numerous stressors, their mental health is challenged every day. They want to provide the absolute best care for animals, but they also need to take care of themselves. Resources are available but they need to be aware that they are available.

I hope this 5-part series shed light on this growing issue not only for veterinary staff but also for the general public.  I have learned so much and will do what I can to get the word out to help a profession who has always gone above and beyond to keep my pets healthy.

I want to give a special thank you to Stephanie for bringing this topic to my attention and to Jen for her professional insights. I highly recommend anyone in the veterinary profession that is struggling to overcome a challenge to head over to Not One More Vet (NOMV.org) or one of the other sources identified above. The partnerships and resources they share are exceptional. Knowing that you are never alone can make all the difference in the world.