Hacking Client Communication

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You can spend a lifetime learning about communication. Countless books, online resources, coaches and entire university degrees are readily available to educate and inform. Unfortunately most of us don’t have spare lifetimes to commit to this, meaning that the active improvement of communication skills often get relegated to ‘something I’ll do later.’ Yet the positive impact that improved client communication can have on how effectively you ‘re able to do your job and how much enjoyment you can get from veterinary science cannot be overstated. So what to do? Well, you can start by considering just these concepts:

Don’t talk down to your clients.  Listen.  Have a sense of humour. Respect.

There is good evidence that focusing on these small number of key principles can go a very long way towards achieving better communication outcomes. Malcolm Gladwell’s book ‘Blink – The Power of Thinking Without Thinking ’ deals with the subconscious and the cues and responses involved in how we interact with each other. (https://www.amazon.com/Blink-Power-Thinking-Without/dp/0316010669). 

In the book he refers to the work of two researchers who studied communication between doctors and their patients, with the aim of determining if there are things doctors say and do that affects the outcomes of the consults. The conclusions drawn from these studies provide such delightfully simple and practical advice that I was compelled to look up the original research.

The first is a study by Wendy Levinson MD – ‘Physician – Patient Communication’ (JAMA 1997). The research for this paper involved listening to recordings of conversations between medical doctors and their patients. Half of the doctors in the study had a record of having had two or more claims made against them during their careers, while the other half had never been sued. The purpose of the study was to see if there were any differences between the two groups with regards to how they communicated with their patients. The results showed some very clear differences and provides some valuable advice, but more on that later. What really fascinated me was a subsequent study that pares down the information from the recordings right down to the core:

Psychologist Nalini Ambady and her team took those same recordings, cutting each conversation between surgeons and their patients into 4 ten second snippets. Next they removed all the high frequency sounds from the recordings, which had the effect of erasing the spoken content and retaining only tone of voice. They had the study participants listen to these sound bites of garbled conversation, asking them whether they could differentiate between the claims and no-claims surgeons based on only on those 40 seconds of sound.  

(http://emerald.tufts.edu/~nambad01/surgeons%20tone%20of%20voice.pdf)

It turns out that they could do so with remarkable reliability. But how?

By recognising dominance in the voice of the surgeon. Surgeons who were rated by the participants as  having a high degree of dominance in their tone of voice were significantly more likely to be sued than surgeons who were low in dominance. Dominance in voice tone was conveyed through “deep, loud, moderately fast, unaccented, and clearly articulated speech.”  Basically – they sounded superior, and talked down to their patients. (Scientific proof that nobody likes a cocky know-it-all! I’ll refrain from making jokes about surgeons at this point…) 

‘Surgeons who were rated by the participants as  having a high degree of dominance in their tone of voice were significantly more likely to be sued than surgeons who were low in dominance.’

Or to put it another way: a large part of communicating effectively with your clients is not so much about what you say, but rather how you say it. If you can convey a sense of genuine concern and a desire to help you clients and their pets the client is unlikely to ever lodge a serious complaint against you, even when you stuff up! Why? Simply because they like you too much.

The true value in this is not in avoiding being sued or getting into trouble. It’s about getting the most out of your career. In my research I ask experienced vets what their biggest challenges were when they started out in their careers.  One of the most common answers to this question is “working with people”.  No surprises there, but here’s the kicker: the answer to the next question,  “What do you enjoy most about veterinary practice?” is also “working with people.”  So why this apparent contradiction? I think that to a large degree it boils down to communication skills. As you progress in your career you’ll get better at communicating through trial and error. Once you’ve mastered the skill of quickly establishing a connection with clients you will not only keep them happier – you’ll keep yourself happy. Suddenly the thing that starts off being your greatest source of stress can become a major source of pleasure. 

Before we move on I want to take a moment to emphasise the length of those edited recordings: 4 X ten seconds. It took listeners just 40 seconds to reliably judge whether a surgeon is likely to get sued. Let that sink in.

How quickly do you think your clients decide whether or not they trust you and whether they think you’ll do a good job, without even realising that they’ve decided? How important is your head space just before you walk into that consult room and open your mouth? Is it perhaps worth a few moments of pause before you open that door to reset your attitude, thinking: ‘don’t talk down, listen, respect’? 

Back to the original Levinson study, which focussed more on the actual content of the conversations. What did the ‘no-claims’ doctors say or do differently to the ones who ended up in trouble? Note that nobody avoided trouble by never making mistakes. It was simply the bond that the no claims doctors had with their patients that stopped the patients from taking action against them when mistakes did occur. Again, not only did they avoid legal repercussions, but it’s likely that they’d have a much more satisfying working life because of the relationships that they created with their patients.

The results of the study produced some practical and easily replicable advice:

  • No claims doctors spent more time with their patients. Their patients did not feel rushed, and felt that the doctors took time to understand their problems. How much more time? On average only 3.3 minutes more! You don’t need to be one of those vets who only do two consults per hour. You just need to remove the haste and be present for a few more moments. 
  • What did they do with this extra time? Did they explain things more clearly? No – they took time to actively listen. They asked questions to facilitate the conversation and get the patient’s opinion, encouraging them to talk, rather than overwhelm them with facts. “Tell me more about that”. They made sure to check the patient’s understanding of what was being discussed. Note that there was no difference in how much information was given to the client between the two groups. It’s not about you and what you know – it’s about them.                                                                                                                           
  • They often laughed or used humour during the conversation. 
  • They make orienting comments early on in the consultation to let the patient know what to expect from their consult: ‘First I’ll ask you a few questions, then I’ll examine you, and afterwards there’ll be time for you to ask me questions.”

And that’s it. Not rocket science is it? In contrast: the patients of doctors who had multiple claims made against them felt “ignored, treated poorly”, and felt that “the doctor didn’t take time to talk and never asked me about other symptoms.” 

Malcolm Gladwell wraps up his chapter about this research: “But in the end it comes down to a matter of respect…” . I couldn’t agree more. If you start every interaction by making a conscious effort to approach your client with respect and with a genuine desire to help, you’ll find that the topics discussed here will mostly come naturally. You’ll automatically listen harder, you’ll be less inclined to rush, and you’ll find it hard to act or speak in a dominating manner.

“The secret to the care of the patient is in caring for the patient.”   Dr Francis Peabody, Harvard, 1925.

Of course you’ll encounter plenty of people who will not reciprocate your attitude; people who don’t listen, who’ll talk down to you and will show you no respect. You know the ones. Just stick to your guns and don’t stoop to their level. If you started the interaction from a place of respect and a desire to help,  and you avoid being drawn into their way of acting, all the shit that they fling at you will mostly just blow back to hit them in the face. You on the other hand will walk away roses, ready to focus on creating more meaningful relationships with the ones who deserve you.

Dealing with mistakes: Part 1

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It’s the weekend. You’ve had a challenging week at work, but you coped, and it’s over. You’re sitting in the sun with a few friends at your local pub relaxing with a drink when your phone lights up: work calling. A small crack appears on the edge of your previously contented state of mind. Maybe it’s nothing… You pick up the phone and leave the table. It’s the boss: “You know that cat that had the surgery on Thursday…” “Yes…”  “There’s been a problem…”  The small crack spreads like a bolt of lightning across an empty sky, and your sense of wellbeing shatters into a million pieces. 

 

The fear of making mistakes and the question of how to deal with them rated amongst the top concerns that young vets have about their careers, according to a recent survey that I was involved in. This should come as no surprise: by the time you graduate as a veterinarian you are well aware of all that is expected of you and of the myriad of ways that you can stuff up. Add to that the horror stories we are told about litigation, then mix in our innate fears about embarrassing ourselves and appearing stupid, and it’s a small miracle that we don’t just surrender to a constant state of paralysing panic.

Anxiety and the overall decrease in wellbeing that can arise from a fear of making mistakes is a big enough problem in itself, but there is a more insidious and possibly more damaging consequence that arises from an ‘error avoidance’ based career: the risk that you might not grow into the best possible version of yourself. 

“By not trying things you are aiming to remove all danger and risk: the risk of failure. This does not protect you in the long run. It keeps you weak and stunts your growth.”   Ray Dalio

Challenging yourself by learning new skills and trying different things exposes us to the risk of failing. Failure is pain, and our natural inclination is to avoid pain, but in order to allow growth you need to continuously push yourself and risk making mistakes along the way.

“Negative emotions help us learn. We need to learn, because we are stupid and easily damaged.”  – Jordan Peterson

“To do exceptionally well you need to push your limits, and when you push your limits you will crash, and it will hurt a lot. You will think you have failed, but that won’t be true unless you give up. Believe it or not, your pain will fade, and you will have many opportunities ahead of you. 

The most important thing you can do is gather the lessons these failures provide and gain humility and radical open mindedness in order to increase your chances of success. Ray Dalio 

The flip side of pain is the pleasure of success. The rush of positive emotions that you experience when you succeed at something hard will create positive feedback loops that will motivate you to challenge yourself again and again. This will not only affect your growth as a professional, but increase your general sense of self worth and mental well being. In the absence of this kind of stimulation it is likely that you will become bored, dissatisfied and eventually stagnate. 

It’s easy to be philosophical about it, but the reality of actually making a mistake really does hurt. Other than the immediate deleterious effects on the patient that you are trying to help we also worry that it will affect our future careers as well as our self confidence. We worry about loosing the respect of our colleagues and peers. We want to feel and appear smart and capable – after all, most vets have a long history of success and achievement, so to suddenly be a position where we’re faced with the embarrassment of failure is an uncomfortable space to occupy. So how do we get past this? 

Well, for a start we can get over the idea that we are above making mistakes, that errors are a sign of weakness or inferiority, and that we have to pretend to know everything. If you acknowledge to yourself and to others that you have room for improvement you will make it easier on yourself and those around you. You don’t always need to be right. In fact you almost certainly aren’t. 

“Always remember that you are stupid, or at least don’t presume that you’re too clever to make mistakes.”  – Ray Dalio

If you don’t mind being wrong on the way to being right you’ll learn a lot and increase your effectiveness.” – Ray Dalio

This way, when you do mess up, (and you will!) it’s much easier to see it as an inevitable part of our profession and an opportunity for learning, rather than a personal failure. Reframe ‘mistakes’ as ‘lessons’. Take comfort in knowing that if you are making mistakes that you are operating at the edge of your abilities, and it’s at the edges where the fastest growth happens. Big wave surfer Shane Dorian once said that if he’s not regularly wiping out it’s a sign that he’s not pushing himself enough, and that his surfing will suffer for it. Instead of sticking to the easily makable waves in life, go looking for the ones that can hurt you. It might be scary, but this is where you’ll get the ride of your life. 

Of course you need to know which waves may hurt, and which ones can kill you. You need to be fit and prepared, and know your limits. And if you end up in a big wipeout you need to know how to respond to get yourself out of trouble. You need to not drown. In our next blog we’ll look at some practical tips on how to best deal with the realities and the fallout of making mistakes. 

Vet Long And Prosper

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Google tells me that the edge of the universe is expanding outwards at 68 kilometres per second per megaparsec. To clarify: a parsec equals 3.26 million light years, and a megaparsec equals a million parsecs. Get it? Me neither, but suffice to say that it’s faster than the speed of light. NASA’s Solar Probe Plus, the fastest spacecraft ever built, has the potential to travel at 0.067% the speed of light. In other words, it is impossible to get to edge of the universe. We will never ever get anywhere near to catching up. (We can’t even see the galaxies at the edge of the universe, because they are moving away from us so fast that their light will never reach us.)

Does anyone else ever get a similar feeling when you think about knowledge and technology? That no matter how much you learn and how hard you try to keep up, everything just seems to be getting further and further away from you? Even within your own field of knowledge keeping apace with the changes can seem impossible. Perhaps 50 years ago one could choose a field within veterinary science and manage to know most of the things that there were to know in that field, but these days we are developing so fast and acquiring knowledge at such breakneck speeds that you cannot hope to ever know it all.

Small wonder then that veterinary students and new graduates feel so overwhelmed and under-equipped for the careers that lie ahead of them: like being flung into space in a primitive spaceship, trying to reach the edge of the universe. 

This feeling of not knowing enough was recently highlighted while I was sifting through the answers to a survey that was sent out to veterinary students from around the world. One of the questions asked was: “What concerns you most about your future career as a vet?” More than 30% of respondents listed the same thing as their main concern: “How will I ever know everything that I need to know?” The same theme pops up again and again throughout the rest of the questionnaire in various iterations: “I don’t feel like I know enough.” “Where is the best place to get more information?” “How do I best improve my skills?” “Everyone will think I don’t know anything.” You can almost smell them shitting themselves.

 

Launching a rocket into space requires an unthinkable amount of energy. During the first few apocalyptic seconds after launch while everything shakes and rattles, threatening to fall apart, the rockets will use up almost all of the fuel onboard just to overcome gravity and fight friction. By the time it reaches the outer edges of the atmosphere it’s travelling at 28 000 kilometres per hour, glowing white hot with effort.

Watch this – it’s awesome!   https://www.youtube.com/watch?v=1Tx6jrvCCd4

And then everything suddenly becomes easier… As the craft leaves the atmosphere and is slingshotted into orbit friction reduces dramatically. Forward motion becomes much easier and progress requires a fraction of the fuel that was needed for lift off. As the spacecraft moves further along it’s journey the earth’s gravitation pull becomes exponentially less. Soon the craft is coasting along at tremendous speed, using only small bursts from thruster rockets to maintain forward motion and adjust it’s course.

 

Launching a veterinary career is not entirely dissimilar. You could think of your early education as going through the space programme: you’re preparing for your journey into space. Another major concern for the students in the survey was: “Am I good enough?” Well, if you’ve been selected into a veterinary degree then you’ve made it into the space programme. The space programme doesn’t generally take in people who don’t have ‘the right stuff’. So let’s put that one to bed: you’re good enough. 

Then, toward the end of your studies the countdown starts, and somewhere around final year you’ll launch: 5, 4, 3, 2, 1…we have lift off! The effort required during this stage will be tremendous. You’ll need almost all the skills and knowledge that you have to just get you moving. At times it may feel like things can fall apart at any minute, and it may seem impossible that you’ll ever have what it takes to be successful. There’s nothing you can do to decrease the effort of the launch. Trust in the integrity of your spaceship (yourself and your education) and that you have enough fuel to get you into orbit, because you do. Your course is structured to teach you more than enough to launch your career. 

And then you graduate. You’re flung into space. It’s unfamiliar territory, it’s huge, and it’s scary. But you’ll notice something: as you proceed on this journey it gets easier. The further you progress the less effort you’ll need to keep moving. The momentum that you’d built up during the launch will carry you along. Experience and subconscious learning takes over from conscious study, and things that previously seemed impossibly complicated become simple. (Remember how daunting driving a car seemed when you first started learning to drive?)  You’ll need progressively smaller bursts of effort and learning to keep you moving or to help you change direction. 

Which brings us to another important point. If you start this journey without aiming at a destination you will likely end up lost and aimlessly wandering around the vastness of space. If you don’t know where you’re going, you’ll end up nowhere. Try to pick a path – choose something to aim at, and follow that path. This will help you to focus your learning and will speed up your growth. If you later find that it’s not the destination that you had in mind you can always change direction  without too much effort. Remember, out here in space you just need a few bursts from the booster rockets to change your journey completely. 

If you don’t know where you’re going, you’ll end up nowhere.

Don’t get me wrong – a career as a vet will never be easy. It’s still a huge journey, and challenges will be plentiful. This is no return trip to the moon. It’s a lifelong journey exploring the farthest reaches of space, boldly going where you’ve never gone before. You will need to take stock, make mistakes, recalibrate, change direction, and you’ll definitely need to refuel. Luckily refuelling stations abound in the veterinary space these days: congresses, textbooks, mentors, on-line CPD, blogs, podcasts… take your pick – they can all keep you moving forward. If you don’t, you’re likely to start drifting aimlessly, or plummet spectacularly back down to earth. Try to delay this until you’re ready to retire! 

So how do you ever know everything I need to know, young explorers of the veterinary universe?

You won’t. You will never know everything you need to know. You need to never stop learning, and never think that you know enough. The more you learn, the more you’ll realise how much there  still is to know. Rather than becoming paralysed by what feels like a critical lack of knowledge and skill, be inspired by the prospect that you never need to become bored or stagnant in this career. 

It’s not about trying to reach the edge of space –  about knowing all there is to know. It’s about journeying well and to never stop exploring.

And one more thing: remember to occasionally look back at how far you’ve come, appreciate the view, and try to enjoy the ride.

The value of your art: reframing perceptions

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How often do you feel guilty for charging for a service? Have you done things and not charged for them, because they were ‘easy’ jobs, or ‘only took a minute’? I have to confess that during my working life I would have done hundreds  of procedures for free, or for a fraction of what they should have cost, and in the process lost my employee, and later myself once I started my own business, tens of thousands of dollars. 

To be clear – there is a place for ‘freebees’, for rewarding a loyal client by doing a favour, or doing that little something extra that’s not about the money. This can help build lasting relationships with clients and make you feel like the caring kind human being that you try to be. But when the motivation for not charging properly stems from an inherent inability to  recognise the value of what you do; that’s when we need a mental shift.

Recently I read a little story that helped me reframe my own thinking about this:

The story goes that Picasso was sitting in a cafe doodling on a napkin. When he had finished his meal he started getting up, leaving the napkin on the table. A fellow diner who recognised him and had watched him draw approached him and asked if they could have the napkin:

“I’d be happy to pay for it”.                                                                                                         “Sure”, said Picasso, “I’ll take $5 000.”                                                                                            “5 000 dollars!  But it only took you a few minutes to do it!”                                                   “No,” the master replied, “it’s taken me 60 years.” 

And with that he crumpled the napkin, shoved it in his pocket and walked away. 

It may not always feel like it, but your veterinary skill is an art. You started practicing it back when you could hardly walk, when you first figured out that your cat liked it’s ears rubbed just so. You started studying for it the moment you started to learn to read. You’ve learnt so much about animals and diseases and biology  since the start of your degree that you’ve forgotten how little you once knew. In your years in practice you’ve fine tuned your instincts to the point that your subconscious tells you what to do before you even have to think about it.

That thing that takes you 2 minutes to do and requires almost no brain power is probably something that is impossible for your client. If they could do it they wouldn’t be in your clinic – you’ve just forgotten how hard it is.  It’s a valuable skill.

Charge accordingly. 

Dear anonymous vet

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Somewhere in an old diary of mine, wedged in between ‘phone blood results for Spotty Jones’ and ‘book ute for a service’ on my to-do-list these words are scribbled:

“If not this, then what the fuck?!?!?!?!”

I suspect this pretty much sums up what you feel? Like you, and like so many countless other vets, and plumbers, and doctors, teachers, poets, office workers, dive instructors, travellers… (you get the picture), I’ve stared down the long dark barrel of that question for a substantial amount of time. And it’s not an easy one. 

I’m always so jealous of people who have a singular passion in life. Imagine being one of those vets who just fucking love treating animals so much that no matter the hour of the day and how many days they’ve been working in a row they still get excited about that weird and challenging case! Those vets do exist, but take comfort in knowing that they are the exception to the rule – there are way more of us who’d see that case on the wrong day and feel ‘please not now – I just want to go home!!!’

You ask for resources to help you discover what you want: the number one resource you need is time. It’s impossible to think clearly, to dig deep onto your own psyche and explore other pathways when you are working 40 + hours in clinical practice and doing after hours on top of that. Your mind is too worn out and crowded with practical problems to be able to think creatively about possible solutions for your situation. You need to make some time to read, try out new hobbies and revisit old passions, exercise, join a club, travel, develop some new skills and get some sleep. Don’t worry too much initially about following a defined path – just kick some rocks and follow your nose. If you are going to find a new career path it’ll most likely be born from a new person you meet or a passion that you discover. And even if it fails to produce ‘the answer’ – at the very least you will find things that will increase you’re general well-being and build resilience so you can cope better with the down sides of life. 

Speak to your boss about cutting back your hours. Even if it is just one extra day off per week for  a few months or a year to start. Take a pay cut and adjust your expenses so you can make ends meet. Money is only money, and you have the rest of your life to get back into the rat race. Or if you really need the money then cut back your vet work and get another job elsewhere. It doesn’t have to be your dream job – work at the checkout at the nursery, flip burgers at maccas – just prove to yourself that you can do something else. 

Or if you can afford it consider taking a ‘mini-retirement’. If it’s as hard to find vets for rural practice as it sounds then the odds are that your employer will be open to discuss a 3 or 6 months unpaid break. And if not then you can always find another job at the end of your break. You can say many bad things about being a vet, but the ability to be flexible and move between jobs with relative ease  is a giant bonus. Go travel, go work in a turtle sanctuary in Indonesia or rescue bears in India. Or avoid animals – volunteer in an orphanage or become a surf instructor. But don’t do this just to run away from your problems – keep your goal of growth and self-discovery front of mind, otherwise you might come back even more dissatisfied, with the added curse of seriously itchy feet.

As for me : I never found ‘the one thing’. Time away from clinical work showed me that that was my solution: just more time away from clinical work! Turns out that I do actually like being a vet – just not ALL THE FRIGGIN TIME! My solution is less clinical work and more time to pursue other passions. None of those passions have generated any income or turned into a new career, but what they give in terms of well-being is priceless. We’ve adjusted our long term financial goals to remove the pressure of having to earn X amount of dollars, and I’ve found ways to increase the money I get per hour of vet work that I do. Perhaps one day one of my interests will turn into something bigger – just look at that vet who was involved in the cave rescue in Thailand! But for now I focus on the things about vet work that I like, minimise the things I don’t like, or find ways of learning to love, or at least tolerate, the things I don’t like. 

Which brings me to the philosophical part of my reply: keep in mind that life is inevitably linked to suffering. Problems are an inescapable part of life. You’ll move from one situation that you don’t like to something that looks much more appealing only to find a new set of problems waiting for you. My seven year old has problems. Richard Branson has problems. They’re just different problems. The desire for constant improvement is nothing abnormal and nothing to be ashamed of – it’s universal to our species, and why we have progressed so very far: we’re never quite satisfied with the status quo. The key is to try and identify which problems you’d be ok to work on solving, or even find some joy in solving. If you love everything else about your life but just hate on call then perhaps you simply need to find a way to do less on call, or find ways to cope with doing on-call? 

Just don’t ask me how to cope with on call! I did on call for over ten years and it nearly made me leave the industry. The only reason I put up with it for so long was that it was the norm for most of us back then, and misery loves company! That, and I watched my Dad uncomplainingly do on-call as a doctor for his entire life, so I figured if he could do it so could I. (I once asked him how he coped, and he said that there just wasn’t another option – he wanted to be a doctor and doctors did on call, and that questioning your career choice because you didn’t like some aspect of it just wasn’t a thing back then. We’ve come a long way, no?)

Defining the Small Stuff

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I was sixteen or seventeen. It was late on a Saturday night, and I was lazily flicking through channels like only a teenager can when I stumbled upon an interesting looking movie. I never did catch the title and I’ve long forgotten the plot, but it featured a young boy of about 13 years on a road trip of sorts with a wise old American Indian. What I do distinctly remember is a scene where the kid is upset over something that has happened. He’s crying and exasperated when his travel companion tells him that there are only two rules in life:

Rule number one: don’t sweat the small stuff. 

Rule two: everything is small stuff. 

I’ve since learnt that this is a well known quote, and even the title of a book,  (Don’t sweat the small stuff…and it’s all small stuff, by Richard Carlson PHD) but late on that particular night during my formative years, when things like exams with actual consequences, girl problems, career choices and the slow realisation that childhood was over were front of mind, it was an epiphany: very few of the things we agonise over are nearly as important as we make them out to be. Simple words. Not always so simple to apply.

About a decade later and two years out of vet school I found myself doing a sole charge locum in a mining town in South Africa. After my first few years of experience in the UK I was confident that  I could handle most cases that came my way. Boy was I wrong… A blue collar mining town in South Africa will throw cases at you that you can’t even imagine while working in rural gentrified England. By the last day of the job I felt like the partially digested sock that I’d cut out of a dog the day before. I was both literally and figuratively ready to go home. And then the bulldog caesarian came in: failed to go into labour, 5 overcooked pups, all dead. Not my fault… until the practice owner phoned me the next week. The owners came home two days after surgery to find the bitch dead on the lawn with her guts hanging out of the popped open surgery site and a rotten pup stuck halfway down the birth canal. I didn’t check the birth canal! The owners were furious – they wanted a new dog of course. The clinic owner was unhappy. He made no secret of his opinion of my standard of work. My world fell apart: sleepless nights, stomach cramps, cold sweats. I gave all the money I’d earned during that hellish week to the breeder. I seriously considered fleeing back to the UK to run from my shame, but who would ever employ me again? I was ruined.

Surely this was not small stuff?! Surely some of the things that we worry about deserve a bit of worry? They have real consequences that can make real world differences to our future.

But here’s the thing: A week later I noticed that the sun still rose every day, I still had food to eat and a bed to sleep in. My friends were sympathetic and my mom still loved me. I applied for and got another locum job, replaced my lost income in a week, found more work, and within 2 months I landed a great permanent job. (And I’ve never failed to check the birth canal after a caesarian again!) My big crisis turned out to be a blip on the big picture that was my life. The further I removed myself from that scenario the less it mattered. It was just small stuff. All what really mattered had been my emotions – my response to the problem. 

‘Ask yourself; will this matter a year from now?’ R. Carlson, from ‘Don’t sweat the small stuff…and it’s all small stuff.’

We all have a skill available to us that can help put our worries in perspective: we can mentally test-drive any given scenario and all it’s possible outcomes before doing a thing. We can imagine experiences, responses, tastes and smells and even feel the associated emotions. What will it feel like when you when you glide down the slopes on that ski holiday next year? What will that glass of wine taste like when you get home from work and how good will it make you feel? It’s an automatic but underrated tool that we use to decide if, based on the imagined outcomes achieved during the simulated experience, we should proceed with a particular action. It’s also why nobody ever needs to make broccoli and onion flavoured ice cream to see if it’ll be nice.

During the early stages of human evolution individuals who showed the earliest signs of this nifty mental trick probably managed to select themselves for reproductive success by avoiding certain fatal mistakes: ’Should I try to steal a bit of mammoth meat from that sabre tooth cat?’ These days  we mostly use our ‘life-simulator’  to make decisions about fairly mundane, non-life threatening things, but sometimes our mid-brains  struggle to tell the difference between whether we are merely considering how to navigate a tricky social situation, or how to best avoid being eaten by a large carnivore. This can lead to exaggerated levels of negative emotion about things that do not necessarily warrant it. If we fail to specify what exactly it is that we are afraid of and what actual damage it can do to us we run the risk of living in a state of vague but perpetual anxiety. As Dr Jordan Peterson puts it: “Something is out there in the woods. You know that with certainty. But often it’s only a squirrel.”

So how do we differentiate squirrels from bears? Well, we can examine the thing that worries us – find out what about it scares us and which of those things are valid concerns by test-driving  the experience. What would actually happen if the worst case scenario came to pass? Writer, investor and podcaster Tim Ferris calls this exercise ‘fear setting’ (https://tim.blog/2017/05/15/fear-setting/):

For example: You’re a recent graduate, and tomorrow you have to spey a fat Rottie.  You’ve done quite a few routine spays, and they’ve gone pretty well,  but you also know that they are not easy surgeries. You’re scared. (And you have good reason to be – things can go wrong!) But have you defined what exactly you’re afraid of? What is most likely to go wrong, and what will the consequences be if it does?

Picture yourself doing the surgery. You know what you should do – you’ve been preparing for years. Now picture it all going wrong: you’re cutting the ovarian pedicle, but your ligature slips and you see blood welling in the abdomen. You follow all the steps for finding and ligating a bleeding stump, but you can’t find it.  It keeps bleeding. Nobody comes to help you, the dog goes anoxic, arrests and dies. What then? Well it’s a nightmare! You have to phone the owner to tell them their previously healthy dog is dead. (She was a nice Rottie by the way. Or maybe it was a Labrador.) The owner is furious and lodges a compliant with the Board. Your boss fires you, you’re found as negligent and you loose your licence to practice. You’ve lost your livelihood, and that nice dog is dead. And it’s all your fault. Surely that’s not small stuff?!

Now you’re sweating and panicking: “I cant do that spey tomorrow. It could be the end of me!”

          See things for what they are. Do what you can. Endure and bear it. 

Go back to the start of your pretend scenario and look at what is more likely to happen: see things for what they really are. Your worst case scenario is highly unlikely. Bleeding stumps are normally found, or they stop bleeding. Spays don’t normally die. Occasionally things do die: it’s a fact of life. Did you let her suffer? Did you try your best? Was it your intention to kill her or to upset an owner? Will it affect your personal relationships, your ability to pay for food, your survival? The owner is upset: can you control her response or her anger? The veterinary council does not readily take licences away for honest mistakes, just like employers don’t easily fire for it. Would you want to work for a boss  who does? If you lost your career, would you still have your intelligence? Your health? Could you find another job? A different, maybe even better, career.

Then you do what you can: you make sure that you are well prepared, get enough sleep the night before the surgery and eat a good breakfast on the day, you follow the techniques that you’ve developed for spays, and if something goes wrong you follow the protocols for what to do in these scenarios. Can you ask for help? Make sure you know what to do in case the dog does crash, or that somebody who does is there if you need them. And if she does somehow die – make sure your records are adequate, contact your association. Are you insured? If you’re prepared you can minimise the risk of things going wrong, be prepared in case they do go wrong and mitigate the fallout. 

But it would still suck. Sometimes things happen that suck. It’s not personal – it’s just life. You can’t always control it, but you can control your response to it. It will pass. Things will get better. You can endure and bear it.  You can learn from it, try to take something useful from it –  even if it is only a valuable lesson learnt. 

Are you still afraid? What do you have left to fear? A damaged ego, appearing incapable? Fair enough – the loss of face in front of others is a fear that’s right up there with fear of death for most of us. But will it matter in a year’s time? Will it even matter next week?

A half filled glass isn’t enough

Around fifteen years ago in a parking lot in Kilkenny, Ireland, I saw this stencilled onto the toilet block wall of a restaurant:

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This bit of street art has always stayed with me. It’s front and centre in my mind when I’m faced with any decision that involves both money and ethics, and I’m pretty sure I’ve made some major life decisions influenced in no small measure by this snippet of vandalistic wisdom.

 About 5 years into my veterinary career,  at the nadir of my job satisfaction and all round well being as a vet, the thought occurred to me that the same thinking could, and should, also be applied to veterinary science: Don’t love veterinary science – it won’t love you back. Why put your heart into a career that will only repay you by slowly breaking you down? 

It seemed to me that as vets we invested so much of ourselves into veterinary science, and for what? For demanding ungrateful clients and uncooperative animals, for low wages, high stress and a shoddy personal life? What kind of a job is that?! I resented my career choice, dreaded my work days and lived only for weekends and holidays, so I invented the hedgehog approach: roll into work each day with the best of me  safely tucked inside an impenetrable prickly exterior.

You can survive like this for a long time. You may even be successful. But it’s not sustainable, and it’s not necessary.

When we adopt this attitude we go to work saturated with preconceived ideas of how bad it is to be a practicing vet:  how stupid our clients are, how challenging it is to work with animals, and how undervalued we are. We learn this from our peers and our mentors (and we are taught this lesson early on in our careers). We discuss it on social media and lament it over dinner. And then we confirm these beliefs in our day to day work. It’s called confirmation bias: the tendency to search for, interpret, favour and recall information in a way that confirms one’s previously held beliefs, and the rejection of any new information that casts doubt on those beliefs. 

In reality the majority of our work life will consist of routine jobs interspersed with unusual and satisfying cases. We’ll have many success stories  and meet countless happy clients who are grateful for what we do. But life being the way it is and people being people, there will inevitably be unhappy clients, complaints, aggressive animals, mistakes and bad days. Our biassed little brains, with their minds already made up, will forget the mundane and will discount all the good stuff, and instead latch onto the handful of negative experiences. Then it will add this new evidence which supports the belief that it sucks to be a vet to the pre-exisiting sea of negativity, and happily (or miserably!) wallow in the cesspit that it has created for itself.

It took me more than 10 years to realise that this way of thinking is a subconscious choice, but a choice none the less. This also means that you can consciously choose the opposite: you can choose to expect good things. You can lean into every encounter expecting magic, and keep your eyes open so that you recognise when magic does happen. When the inevitable bad things happen you might now just say to yourself “hey, I didn’t like that”, instead of “you see – it’s just as I expected”. And when all those good things do happen: when that client is genuinely thankful or you get a quick cuddle with that pup or that very sick cat starts to eat for the first time in weeks, or a colleague makes you coffee, your mind will now use that experience to confirm your newfound belief that you were right to expect a good day. Luckily confirmation bias works both ways. 

If you love veterinary science – if you decide to love it and put your heart into it completely, it will love you back.

The upshot of this is that your demeanour might change. That permanent scowl that you didn’t even know you had may disappear. You might look forward to that next consult, and eventually some of the people you deal with will start to mirror your attitude. This in turn will make more good things happen, creating a self-fulfilling feedback loop of good vibes.

Once you are out of your negativity rut you will start to identify with clarity which things really do bother you without exaggerating them, and which things you enjoy. You can start looking at ways to actively change your situation: you can gird yourself with extra knowledge about those cases that scare you, you can find and develop your niche so you can do more of what you like and less of what you don’t.  Make sure it’s the right workplace for you. Maybe you like being a vet, but you just don’t like who you work with? In the words of Jordan Peterson: “Consult your resentment. …resentment always means one of two things. Either the resentful person is immature, in which case he or she should shut up, quit whining, and get on with it, or there is tyranny afoot – in which case the person subjugated has a moral obligation to speak up.’

Are you getting enough sleep and exercise? It’s very hard to have the right attitude if you’re neglecting the very basics. Perhaps you actually love your job, but you are simply working too many hours and you’re just tired, and not actually depressed?  When you can be honest with yourself and say hand on heart that your attitude is right, and you’ve changed everything that you can change, and you still hate it, then (and only then ) can you say that maybe this really isn’t what you are meant to be doing.

I still hold firmly to the fiscal wisdom learnt from that Irish toilet wall all those years ago, but these days I believe  that if you ‘love veterinary science if you decide to love it and  put your heart into it completely, it will love you back.’ It might be a slightly twisted kind of love that kicks your ass every now and again, but it’s love none the less.

Do vets lack empathy?

A few years ago I bought a motorbike. I’d never been much of a petrolhead, but I was approaching 40, so… It was a 1975 Honda XL 350, with style and character in spades, but it ran a bit rough, so I took it to a mechanic who specialises in old bikes for a top to bottom service. One thing lead to another, and a service soon turned into a partial engine rebuild. After the rebuild that little single cylinder engine thumped along beautifully, and man, I loved riding that bike. I felt like Steve McQueen as I puttered along to the beach or rattled down to work and back. I loved it so much that I rode it almost every day. For months on end. Without ever checking the oil level. Not because I didn’t care, but because I was ignorant to the fact that, unlike modern cars, old motorbikes needed regular TLC. 

Luckily I was only about 2 kilometres from Scott’s workshop when that newly refurbished piston inevitably and violently seized onto the wall of the chamber, instantly destroying the cylinder head with a heart wrenching clunk. The crestfallen look on Scott’s face when he saw me pushing the bike into the workshop all red faced and sweaty  was almost as painful as the realisation the I’d ruined my bike through sheer stupidity. 

“Never attribute to malice that which is adequately explained by ignorance.” – Hanlon’s razor.

By it’s very nature veterinary science is a profession of empathy. It’s very hard, if not impossible, to care enough to be a vet if you don’t have empathy for animals. Are you able to imagine what the animal is feeling? Can you extrapolate from your own experiences and sympathise enough to be able to construct ideas of the problems that need to be solved? I have met very few vets who lack empathy for animals, and in fact when I personally feel a lack of empathy I take it as a very urgent warning sign of compassion fatigue and the need to step away from work for a while. 

But empathy for our patients is not enough. Not only do we need to take upon ourselves the suffering of the animals entrusted to us – we also need to be empathetic to their owners. Yes, even those ‘stupid’ people who let their own pet suffer for days before deciding that maybe they should bring it to the vet. 

Whether it’s at work,  socialising with vets or on social media, those in the veterinary industry like few things better than complaining about our clients. I’m guilty of it as much as anyone. It’s completely understandable: we sacrifice years to study to be able to most effectively help animals, and then we diligently dedicate our days and our years to that task. Small wonder then that we get frustrated when the owners who are supposed to be our partners in caring for their pets act like our opposition by disregarding our recommendations and second guessing us, or by simply appearing careless about something that we care so deeply about.  

“This poor dog has been sick for days, and now they bring it on at 5pm on a Friday afternoon and expect a quick fix, and I bet they are going to bitch about the bill!” Like I said, getting angry at clients is understandable, but it’s not acceptable. 

Here’s the thing: when I ruined my motorbike I knew that I was to blame. I felt like an idiot; I still do. I needed Scott to fix that bike. I didn’t need him to berate me, or to remind me that I should have been checking the oil levels, or make me feel stupid or lecture me in how to care for old bikes. That lesson had just been learnt, (and would be reinforced when I had to pay again to have the engine RE-rebuilt!)  And if Scott had done anything other than sympathise and do his job I would definitely not still be taking my bike to him for regular services. (Including regular oil changes…)

So when that dog with the chronic ear infection shows up AGAIN, two weeks after you said they should come in for a recheck, and the ear is even worse than it was before, frustration is natural. But your job is to help them, not make them feel bad. And even if, like most of us, you remain polite to the owner and refrain from telling them exactly how stupid and careless they are, you are probably still raging in your head, or going off to your nurses about it. This achieves nothing other than ruining your day and adding negative energy to the work environment. And chances are that the owner can pick up on your anger anyway.

A much better approach would an attempt to think empathetically: the client probably genuinely wants the ear to be better. They love this dog, and they are very likely not cruel or bad people. They are busy people, with 99 problems and a hundred other priorities. The care and wellbeing of animals is one of your highest priorities, but not necessarily one of theirs. You have years of study and a lifetime of being obsessed with animals behind you. They don’t. What they may have is two needy kids, or a shitty week at work, or a sick parent. Or they’re a bit scared of the dog, or they love it so much that they can’t bear to pin it down to get the drops down it’s ear, so they choose not to do it and naïvely hope for the best. And then one day they get to the point where they realise that they have to bring the dog back to you. In fact, they thought that they should do it about two weeks ago, but they were busy. Or maybe, probably, they were avoiding bringing the dog in because they’re embarrassed that they haven’t been able to medicate the dog and that the ear is now a total mess, and they worry that you’ll judge them. 

And when you do judge them, even silently, they can probably tell. Which means next time they won’t come in, or they’ll go somewhere else because they are too embarrassed to see you again. And all you’ve gained is a little bit of extra bitterness in your soul.

Instead, why don’t you take a step back. Recognise that you’re feeling angry and frustrated, but then try to think about why this client isn’t doing what you’ve asked them too. At worst it’s probably just ignorance, or laziness, or the fact they they are all too human and are unable to manage all their priorities effectively. (Are there some things in your life that you know you should be doing, but you just don’t get around to it?) Acknowledge that maybe this is a very hard thing for this person, and allow yourself to feel sympathy. Empathy. You’ll be surprised how quickly these emotions will supplant anger and frustration, and how much nicer they feel than anger and frustration. And how much better you’ll be at your job.

“This ear looks very painful. You really should have brought him in two weeks ago like I asked. I was worried that this might happen. Now we’re back at square one and we’ll need to send a swab for culture again.” All true. All reasonable. And bound to make an owner feel like crap. 

Instead:

“Have you been finding it hard to get the drops in? I struggle so much to medicate my own dog, especially because it makes me feel so bad when he hates it so much. We’re not where I wanted to be with this ear, so we need to get serious to get on top of this. Here’s our new plan…. I appreciate that it’s time consuming and can be stressful, so if there’s anything that is unclear or that you need help with please let us know. If you want you can come in every day so the nurses can help with the drops until you get the hang of it. Or we can hospitalise Fluffy for a few days to administer the treatments so you don’t have to stress about it, until the ear starts being less painful.” 

Find time for empathy. Find solutions in stead of criticism. You may just find yourself very popular with clients, and with a bit of extra peace of mind. And sometimes you’ll be wrong. The client will be careless and uncaring and will try to blame you for their mistakes. Some people are just assholes, but by looking for the best in people and aiming as high as you possibly can you will at least not be the asshole.