Under siege: Veterinarians face spike in abuse from clients

Practitioners, consultants offer de-escalation tips as pandemic raises tensions

Published: October 27, 2021
Wikimedia Commons photo by Gibe
People seem particularly short-tempered and prickly these days, apparently worn thin by the ongoing pandemic.

Pets have provided a source of comfort to many households during the COVID-19 crisis. Unfortunately, the professionals charged with taking care of those animals have become many owners' pandemic punching bags.

Or, in one particular clinic's case, targets for unusual projectiles.

"There was a lady who threw a dead hedgehog at us," said Dr. Sarah Stead, manager of the Sore Paws Veterinary Clinic in northern England.

The angry woman, who rescues hedgehogs, was a regular at Stead's practice because it treats injured wildlife for free. Stead even let her keep a donation collection box for her hedgehog rescue in the waiting area.

That generosity didn't count for much a few weeks ago when the clinic couldn't immediately treat one of the woman's spiny friends.

When staff got around to seeing the injured hedgehog, they recommended it be put down. The client refused and took the animal home, where it died. She then drove back to the clinic and hurled the deceased animal at Stead's reception staff.

Nobody was pricked by the hedgehog's spikes, but the receptionists were left pretty shaken.

Stead said the incident was just one of many serious altercations that have occurred at Sore Paws in recent months, as clients, often frustrated by delays caused by pandemic-led safety protocols, unleash on her staff.

In brief

They aren't the only ones feeling like they're under siege. On message boards of the Veterinary Information Network, an online community for the profession and parent of the VIN News Service, dozens of practitioners have reported an apparent rise in client abuse since the pandemic began early in 2020.

The social media pages of many practices now include posts begging clients to show more consideration to burned-out staff and threatening to ban them if they become too aggressive.

Such struggles have brought into focus an abusive-client problem that long has plagued the profession and even been blamed for contributing to its high suicide rates. Veterinarians for years have suffered the ire of customers reluctant to pay for the increasingly sophisticated and expensive medical procedures they want for their pets, practice-management experts told VIN News. COVID-19, they say, is pouring more fuel onto that fire.

Dr. Ray Ramirez, who practices in East Peoria, Illinois, suspects clients are suffering more and more from "decision fatigue" the longer the pandemic drags on — especially in jurisdictions where COVID-19 cases again are surging and restrictions persist.

"It was initially supposed to take just two weeks to 'flatten the curve,' and now here we are, 18 months later," Ramirez said. "Folks are done."

A survey conducted in the United Kingdom by the British Veterinary Association indicates altercations have indeed become more commonplace.

The survey of 572 practitioners found 57% had felt intimidated by clients' language or behavior during the past year, an increase of 10 percentage points since the same question was asked in 2019. The problem was particularly pronounced in small animal practice, where 66% of respondents complained of harassment from pet owners. The results were released in July.

"I'm sure it's not just people in our industry who are having to deal with people's frustrations," Stead said. "But because we are dealing with exceptionally sensitive and emotionally charged scenarios, we are getting to the tipping point a lot sooner than most."

Getting to the root of the problem

Clashes between veterinarians and clients are underpinned by a few age-old fundamental factors, according to Susan Cohen, a social worker and founder of the consultancy Pet Decisions.

"There have been conflicts with clients as long as I've been in this field, which is 39 years," Cohen said. "While some things have changed, some things have always been there."

For one, Cohen agrees with Stead that veterinarians are put in potentially explosive situations by the very nature of their jobs: They make life-and-death decisions for animals considered by owners as family members.

At the same time, some veterinarians might not have the same skill for dealing with people as they have for helping animals. Training has improved in recent years, following the introduction of client-communication modules by veterinary schools, Cohen said, but they may not help practitioners with reserved natures.

"If dealing with people's emotions, or talking a lot during the day, doesn't come naturally, then every encounter with a client and a co-worker can be exhausting," she said. "Then, if someone gets very emotional, it can be disastrous."

There are other reasons why veterinarians hoping altercations will fade with the pandemic could be disappointed. Alongside COVID-19, two technological changes have been ratcheting up tension of late.

The proliferation of internet search engines such as Google and social networking platforms such as Facebook have given pet owners alternative sources of medical advice (much of it shoddy), diminishing their trust in authority figures.

Ongoing advancements in medical technology, meanwhile, are improving animal welfare but also putting pressure on owners to spend more money on veterinary care.

There was a time, Cohen said, when a veterinarian would just have to say, "You don't want Fluffy to suffer, do you?" Now, owners want to know what options are available other than euthanasia. "If it's something they can't afford, they feel horrible," she said. "That's a setup for trouble, especially in countries with low levels of pet insurance like the United States."

Cohen said veterinarians might feel particularly vulnerable to abuse compared with many other professionals when discussing the sensitive topic of money. "Clients that assume veterinarians are doing it for love might wonder: 'If you love animals so much, how can you let my animal suffer?'

"And then try telling them their dog has cancer and needs chemotherapy — while speaking through a face mask and standing six feet away to maintain appropriate social distancing."

A pre-pandemic shortage of veterinarians and veterinary paraprofessionals in some places, exacerbated by a pandemic puppy boom, is making matters worse, according to Dr. Philippe Moreau, who is based in Limoges, France.

"The first things pet owners will ask for is to have someone available," he said. "If nobody is, it gets them in an angry mood, so you start the journey on the wrong foot, and everything falls down after that."

Overworked veterinarians, Moreau adds, can be equally responsible for causing explosions. "If the people that are responding to pet owners are tired, they also respond in an aggressive way. So it's an escalation."

Conflict management techniques: de-escalate and prevent

Moreau is the founder of Medi-Productions, a client communications and practice management consultancy for veterinarians. He has spoken about managing abusive clients extensively, including back in 2004 at a World Small Animal Veterinary Association Conference on the island of Rhodes, Greece.

A piece of advice he gave then still holds today. "It may seem obvious, but don't forget to use empathy," he said. "When I try to help veterinarians dealing with conflict, that's something that always comes back. You have to put yourself in the client's shoes."

Doing so may be easier said than done, but Cohen, too, posits that veterinarians should be at pains to understand what's making that client so cranky.

A good starting point, she advises, is to avoid labeling them as an "abusive client" and instead focus on their behavior. "If you say it's abusive behavior, then you've got somewhere to go," she said. "You can deal with that."

She stresses, however, that showing empathy doesn't necessarily mean taking everything a client dishes out.

"You might say: 'I get that you're upset. I would be upset if I was just handed a $5,000 bill that I didn't expect. But we can't work together if you're going to curse at me — and if you continue to curse at me, I'm going to leave the room.' "

Moreau recommends inviting clients to explain why they're mad, so they can release steam gradually. "You might say: 'Tell me everything. I want to hear everything that makes you so unhappy because I want to understand.' "

If talking fails, leaving the room can act as a powerful circuit breaker, according to Cohen, who says she can think of plenty of polite excuses for taking a time-out. "You could say: 'Listen, I'm going to take Flossy off and weigh her,' or 'I'm going to take Flossy off and consult with my colleagues.' "

At that point, she adds, switching or adding another staff member to the equation might help. It could be someone who is great with people, appears less intimidating or, if the client happens to be an alpha male, another male in the practice.

There won't, of course, be a need to calm clients if they don't get triggered in the first place.

Moreau advises differentiating between "remarks" and "objections" from clients. A remark, he explains, might be a comment or question from a client that expresses a simple opinion or a desire for more information. An objection, by contrast, occurs when a client clearly disagrees with something.

Take a client demanding details about the components of their bill. "That doesn't necessarily mean it's expensive — they're just wanting to know," he said. "The danger is that if you act very defensively and think the person's going to criticize the price, you take the wrong approach."

If it's unclear whether a client's statement is a remark or an objection, Moreau recommends erring on the side of caution: Assume the client has made a remark. Moreau notes that not all remarks require a response. And if they do, the response can be a calm recounting of simple, objective facts.

For her part, Stead at Sore Paws believes conflicts can be prevented by keeping the lines of communication as open as possible, as soon as possible. To test that theory, she's trialing a new "host" role at her clinic, where veterinary nurses take turns welcoming clients warmly at the door and giving them a rundown on what to expect that day.

When it's time to say goodbye

But sometimes, no amount of conflict preparedness is enough. Everyone VIN News contacted for this story had no doubt that some particularly abusive clients need to be let go. Keeping them on, they said, can put people's physical and mental health in jeopardy, which sends a bad message to staff — a point that Stead knows only too well.

The woman who threw the dead hedgehog apologized for her outburst and has been allowed back into the clinic. But Stead said her staff recently endured a far more distressing tirade — this time from a client who was angry about treatment costs for a dog with lung cancer.

"The woman was shouting," Stead said, and it seemed like she might turn violent. "Due to the body language and aggression she was showing, my staff were trying to figure out ways they could barricade themselves in the building away from her."

The irate woman was a client's daughter (family members, Stead said, often become more abusive when hearing distressing news if they haven't been kept in the loop). After the incident, the daughter called to apologize "profusely." But it was too little, too late.

"She actually admitted herself that she'd have to go elsewhere," Stead said. "They're not welcome back, and I've made that quite clear to her."

Ramirez, the practitioner in Illinois, suggests clients don't have to become violently aggressive to qualify for expulsion. He recalls one, whom he happened to know outside of work, who would "question things to death" without listening to his responses. "Two questions later, she'd ask the same question again," he said.

The breaking point came when the client attended a social gathering at Ramirez's clinic, cornered his associate and started peppering her with questions. "I had to go in and 'rescue' the doctor … and that is when I sent the polite goodbye/firing letter."

Veterinarians have the right to choose whom they provide services to, according to VIN general counsel Raphael Moore. "Yes, there are usually local practice act requirements not to drop a client mid-procedure, so to speak, but even then, safety and well-being of your staff would override," he posted in a VIN message board discussion.

"Where there is an immediate physical threat concern — e.g., the belligerent client standing in your clinic demanding service — short of stabilizing a patient and providing a client with her records and suitable referrals to pick from, you don't need to do much more."

A poll of VIN members last month that drew 1,525 respondents found the preferred means of firing clients were pretty evenly divided among three options: sending a letter through regular mail, sending a letter by registered mail or with a phone call.

A firing doesn't need to result in permanent separation. Ramirez said it sometimes takes such drastic action for some people to see the error of their ways. Several apologetic clients, he said, have been allowed to return eventually, though with little room for second chances.

The woman with the hedgehog rescue was good enough to apologize to the reception staff at Sore Paws in person, having drawn a dressing down on the telephone from Stead (in what her husband described as a rare "Hiroshima" moment).

"When I was telling her off, I said that for someone who supposedly loves hedgehogs, how disrespectful is it to throw its dead body at somebody?" Stead recounted. "And I think that's when she thought, 'Yeah, I've behaved really badly here.' "

Stead told the repentant client, "Moving forward, I want to maintain this good relationship, but there's got to be mutual trust and respect. It won't work if we don't have that."

This story has been changed to correct the spelling of Dr. Sarah Stead's name.

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