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Vet Talk

C is for Conflict (Resolution)
June 16, 2014 (published)


For most people conflict brings about the same sort of squidgy, nauseating unease as a letter in an IRS envelope or the realization that you have no idea what’s in that container leaking all over the back of the fridge.

But sometimes conflict is inevitable. People, unique as fingerprints, snowflakes, etc., often interpret the same situation differently. Though scary and uncomfortable, conflict can be necessary and even useful if handled with care.

As far as I can tell, veterinary-client clashes fall into a few standard categories, coincidentally starting with the letter C.

  • Cost
  • Character(s)
  • Communication
  • Care
  • Calendar

Cost leads the list because, let’s face it, that is the elephant in the veterinary exam room. Cost-related conflicts usually come in a few flavors.

  1. The diagnostic workup, procedure, or medication was more expensive than the client thought it would be.
  2. The client can’t afford the recommended workup, procedures, or medications.
  3. The diagnostic workup didn’t provide answers, the procedure either failed or needed follow-up, or the medications didn’t work and the client doesn’t understand why he or she needs to pay.

Character really is more about personality and personality differences in most cases, and often directly relates to Communication.

  1. Veterinarian is a quiet, withdrawn sort of person. Client is generally more bubbly and effusive. Client perceives veterinarian’s quietness as being “cold” or is even intimidated by it.
  2. Client is a direct, “Just tell it to me straight, doc.” sort. Veterinarian is someone who is uncomfortable looking at things in black and white terms, but her attempts to convey nuance come across as wishy-washy, and the client loses faith in her competence.
  3. Veterinarian is more comfortable with orderly progression. Client is someone who recalls events as they pop into her head, in no particular chronological order. Veterinarian becomes frustrated, and client gets upset trying to explain her pet’s needs.

Care is another obvious place where the road can get rocky.

  1. The animal dies during, because of, or in spite of treatment.
  2. The animal turns out later to have a disease that wasn’t diagnosed by the veterinarian.
  3. A third party doesn’t understand, doesn’t like, or doesn’t agree with the treatment.

I think Communication is the point where the wheels come off in most interactions. Some days it feels as though two people are speaking completely different and untranslatable languages.

  1. Client feels like the veterinarian wasn’t listening or didn’t care.
  2. Client doesn’t understand or misinterprets the veterinarian’s explanation.
  3. Client feels judged or criticized by the veterinarian.

Calendar - Timing, as they say, is everything. It amazes me how many angry moments can arise around appointment times and scheduling.

  1. Client is worried about a pet, and an appointment slot isn’t open for a day or so.
  2. The veterinarian the client usually sees is away – vacation, personal leave, illness.
  3. The veterinarian is running late due to an emergency or a backed up schedule.

All of these situations can cause tension, anger, and misunderstanding on both sides. Even if everything is running buttered-clockwork smooth, veterinary visits, like tax preparation or dentistry, are often anxiety-laden events. Clients are worried about their pets, worried about how to pay the bills, and worried about explaining a mysterious medical SOMETHING to children or other family members. All things considered, most folks would rather be on the beach.

For our part, vets know that even when people love us, most of our clients would rather be somewhere other than in our exam room or next to our truck in their barnyard. Some of my favorite clients used to tell me, “Don’t take this the wrong way, but I’d rather just run into you in the grocery store.” Most of the time we’re okay with this knowledge, but if we have a sinus infection or our kids are going through “a phase,” it’s pretty easy to become defensive about the fact that we aren’t the brightest spot in everyone’s day.

Fortunately, there are ways to step back and address conflict without everyone losing their minds and blowing up like cartoon teakettles.

Smarter folks than I have come up with various systems of steps to resolve conflict, such as the principles of Non-violent Communication and the University of Wisconsin-Madison’s 8 Steps for Conflict Resolution.

Most of these things involve taking a step back – looking at what you really need or want, where you feel that need hasn’t been met, and figuring out a way to express that need without blaming or shaming.

It ain’t easy.

By now you may be saying, “Yeah, yeah, yeah…I’m angry about the results of my dog’s surgery and the fact that I had to go to the emergency clinic at 2 a.m., and about the monster bill ON TOP of the bill at my regular vet, so cut the foofy stuff and tell me what I can do.”

Fair enough. I’m getting there.

The best place to start is with a talk.

Before that, however, breathe. Take a walk. Take some time to let your emotions settle. Not so much time that it will impact your pet’s health, but enough time to let that pounding tightness in your chest and head dissipate. Let your brain get past the fight-or-flight response that is screaming “I HAVE TO FIX THIS NOW!” Trust me, as a veteran of internal adrenaline wars, I’ve learned that life goes much better when I set the thing that is upsetting me on the mental shelf for a bit.

Then talk.

Schedule a face to face, or at least telephone, conversation with your veterinarian. If you’re confused or upset by something the vet has said or done, it’s best to talk it out with that person for starters rather than complaining to the receptionist, boss, another clinic, or Yelp right off the bat. Most of the conflicts I’ve encountered in practice were just misunderstandings that could be sorted out with a good discussion.

If you truly feel that you aren’t being heard, then you may want to talk with the clinic owner, if he or she is not the person with whom you’re having an issue.

If you feel like you’re getting nowhere at this point, you’ve got a few options:

1. Step back and try rephrasing your concerns. Sometimes what one person says is not what the other person hears.

2. Ask to have the records transferred to a specialist or another clinic and take your pet for a second opinion. Before going this route, make sure that you and your vet are on the same page as far as understanding what his or her recommendations are. But a second opinion can be useful in either giving the case a new direction or confirming what has been done already.

HOWEVER, if you decide to seek a second opinion, do yourself and your pet a favor, and consider asking the veterinarian who has been handling the case for a suitable referral rather than just packing up and huffing off to any clinic down the street. Your pet stands a much better chance of getting a solid diagnosis and treatment if there is continuity in the management of the condition.

3. Vote with your pocketbook. You always have the option of taking your business elsewhere if you feel that your needs or the needs of your animals aren’t being met. If you go this route, consider writing a letter or having an “exit interview” to explain why you are leaving. It’s pretty difficult for a clinic to fix a problem if they don’t know one exists.

CAVEAT: As a veterinarian, I have an admitted bias against the next two courses of action. In my mind, these are options to consider only if EVERY other reasonable attempt at reaching an understanding has failed. They are the “nuclear options” of veterinarian-client relations. And like weapons of mass destruction, they may enact a resolution, but it may be a resolution with a number of casualties.

4. If you have reason to believe there has been a medical error (NOTE: Failure of a patient to respond to treatment or surgery does NOT necessarily mean that there has been a medical error), you have the option of filing a complaint with the veterinary licensing board for your state.

However, it’s a really good idea to do some careful soul-searching and research before filing a complaint. Did Vet A actually do “something wrong” or did he take a different, yet equally valid, approach from that of Vet B? Did Vet A fail to inform you of possible adverse effects of a treatment, or are they written down somewhere on that sheet you signed but lost because you were stressed?

It’s not that I think that I and all of my colleagues are perfect. We’re human. We all make errors. But with most undesirable outcomes, the reality is despite a veterinary team’s best efforts, a case simply goes south.

5. Small claims court is the place to turn if you believe you’ve suffered a financial loss and wish to recover fees. Bear in mind, though, that the justice system works both ways, and if the judgment doesn’t go in your favor, you could wind up on the hook for MORE money rather than getting money back.

BEYOND HERE THERE BE DRAGONS!

There are a few responses to conflict that are more like throwing dynamite onto a fire than actual steps toward resolution. In any sort of relationship, if the thoughts, “I’m going to make him/her pay for/sorry for this” cross your mind, there is a good chance that you are sailing into stormy waters.

Trying your case in the court of social media, be it Twitter, Facebook, or an on-line review, can be more destructive than productive and has far-reaching and unintended consequences. You may have wanted to warn people about poor service that you received or about something you consider dangerous, but the Internet has a way of magnifying such things and bringing the crazies scurrying out of the woodwork. “Going to the media” in this reactive age, whether Internet, print, or television, is often the equivalent of summoning a village mob with pitchforks and torches.

Sure, you may be devastated by something that happened to your pet. And you may want someone to pay, to feel the pain that is eating your heart and stomach lining. But it’s worth taking a breath and reflecting.

Did the person you are angry at truly cause your situation?

If they are responsible, then:

  1. How much pain or destruction of their personal and professional life does any person deserve?
  2. What has their family done? Do they deserve to see a loved one pilloried in the virtual village square?

Here’s my last thought: for most veterinarians (often to our emotional detriment) veterinary medicine is more than just a job. It becomes part of our identity. So, as much as you’d like a clear resolution to your conflict with your vet, I’m betting that on some level, she feels the same way.


 
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