Stress and communication

When a reporter writing a feature article for the local paper asks the veterinarians at the Downton Veterinary Hospital what contributes the most to their on-the-job stress, they give the same answers they give to their casual friends. Dr. Stegemier mentions how stressful coping with the challenges that often arise when dealing with critically ill patients can be.

“When animals are critically ill even the most routine diagnostic procedures can be problematic,” she explains. “For example, some of these animals may not be able to withstand anything beyond the most minimal handling. At the same time, they may be poor anesthesia risks or the nature of their problems may limit the kinds of drugs we can use safely. Older animals in particular may have more than one problem and the best treatment for one may be ruled out by limitations associated with the other. Until you get the animal stabilized, things can change in an instant.”

When asked this same question Dr. Stegemier’s colleague, Dr. Phelong, notes that he finds performing euthanasia highly stressful.

“I accept that sometimes this is the best and even only humane option,” he readily admits. “But I define myself as a healer and I can’t help feeling that I’ve somehow failed the animal as well as the clients when this happens. It stresses me just thinking about it.”

Later when the reporter interviews Dr. Broule, the practice owner, over lunch, the veterinarian mentions another source of stress that does not surprise the interviewer any more than it would surprise other practitioners or most of the public: dealing with fractious animals.

“I don’t know what’s worse — the animal I’ve never met who turns out to be aggressive or out of control, or the known patient with chronic behavioral problems whose owner ignores my recommendations regarding what to do about it,” she tells the other woman as they wait for their meals. “Those animals can make even the simplest procedures so grueling that I can stress out just thinking about them!”

Although these stressors are familiar to most practitioners, would these 3 veterinarians give the same answers in more confidential settings? The results of a recent survey suggests that they may not. In 2015 dvm360, Veterinary Economics, and Firstline magazines repeated a Job Satisfaction Survey originally done in 2005. Comparison of the findings of the current survey of more than 900 male and female associates and practice owners to those of the 500 respondents in the 2005 one is thought-provoking (1).

Of particular interest to the Downton Veterinary Hospital practitioners following their interviews with the local media were the responses to the question, “Which of these contributes most to your on-the-job stress?” The list included the stressors they had mentioned as well as the following: difficult boss, difficult coworkers/staff, difficult clients, time management issues, clients’ inability to pay, and “other.” What caught their attention was that, although the 3 stressors they mentioned were represented, they were only 8% of the total mentioned by respondents. Additionally all of the other stressors mentioned but one — difficult boss — were more strongly represented than these 3 stressors combined (Figure 1).

Figure 1.

Which of these contributes most to your on-the-job stress?

Although all three of the veterinarians read the article, none of them mentioned it to the other two. However the discrepancy between the prevalence of the top stressors they mentioned for public consumption and the others included in the survey did not escape their notice. During the following weekend though, all of them mentioned the survey results to others. And regardless whether they discussed the subject with a trusted partner, relative, or best friend, they all received the same kind of feedback.

When Drs. Stegemier and Phelong showed the graph to their respective confidants, neither of those individuals was surprised by the findings. Both noted that while the exact percentages of the other stressors may not be identical, their work-related conversations with the veterinarians were far more likely to include the practitioners venting about problems with co-workers, other staff members, their employer, or other issues unrelated to their one-on-one interactions with animals.

“You still get upset about those obnoxious clients and those who didn’t pay their bills years ago!” Dr. Stegemier’s long-time best friend reminded her. “And it seems like you’re always irritated by something that one of the staff members or your boss did.”

“I know it upsets when you have to euthanize an animal,” agrees Dr. Phelong’s partner. “But that doesn’t happen every day like some of the other stressors on the graph. You’re always complaining about not having enough time or something one of the other vets or staff members or clients did.”

Dr. Boule’s husband reminds her that while fractious or critically ill patients or euthanasia did possess the potential to upset her, more often than not these were offset by more rewarding patient interactions. On the other hand the time and business management issues, the people issues were chronic concerns of hers.

“The stressors you and the other vets mentioned to the reporter are those the media and public expect to stress you the most because they’re directly related to animals,” he points out. “They don’t want to hear or read that you experience the same kind of work-related communications problems that stress them too.”

As Dr. Boule considers the role public expectations might have, she realizes that there is some truth in what her husband said. She did believe that the answers she and her associates gave were the expected ones. Once she admitted this, she also realized how this had undermined her willingness to address the other stressors that were affecting her and members of her staff.

As she explained to her associates later, “Once I defined those animal-related stressors as the most important ones, the others were automatically demoted. Or I thought they were. According to my husband, they still bothered me but I stressed out and complained about them to him instead of doing anything to resolve them.”

When Drs. Stegemier and Phelong indicated that they were doing the same thing, the practice owner set aside time to address all of the stressors in more detail. At the meeting, they began with a discussion of the stresses associated with critically ill or fractious patients and euthanasia. Although they always had agreed that these were stressful events, this time Dr. Brule mentioned coping strategies that she had found helpful over the years and encouraged her associates to share theirs. In addition to sharing and gaining insights about these topics, they also established a format for addressing the other ones by the end of this discussion.

Next Dr. Brule focused the discussion on the two client-related stressors as she and they perceived them. Relative to non-paying clients, the practice owner discovered that her associates often felt personally responsible for this even though they had followed the practice policy of discussing costs before commencing treatment. Dr. Brule assured them there was no reason for them to feel that way when this was the case. Furthermore she apologized if her personal concern about these had caused them to feel that way. For their part, the associates admitted that there were times when discussing payment options was difficult for them. This led the practitioners to share old and develop new strategies to help them diminish this stress.

It did not take long for the practitioners to realize that the stresses associated with difficult clients and co-workers were quite similar. Although individual scenarios varied greatly and they spent more time with coworkers, the fundamental challenge remained the same: how to have meaningful communication with someone they found troublesome for some reason at that particular time. By discussing this in an abstract way, they were able to see that the biggest problem was a reluctance to address the issues that bothered them when they occurred. Not only did this increase the probability that the problem would persist or recur, it practically guaranteed the stress associated with it would increase too.

To give this awareness more relevance, Dr. Broule had her associates role-play various stressful scenarios that involved clients and staff. By trading roles and keeping the tone light and nonjudgmental, the veterinarians progressed from mild stressors to major ones. The more they engaged in the roles, the more they understood their own as well as others’ responses in certain situations. Dr. Broule also asked them to repeat the exercise with the boss as the stressor with them assuming her role while she assumed theirs or that of clients or other staff members. At the end of each scenario, they shared their observations and the strategies they found the most helpful to address the stressor if possible, or minimize its effect if not. They also decided that the entire staff would benefit from a similar activity.

Using these approaches, Dr. Broule and her staff learned to appreciate the critical role quality communication plays in preventing or minimizing stress in a busy veterinary practice.