In today’s VETgirl online veterinary CE blog, we review the effect of client complains on veterinary internists. And let’s be real here. This podcast doesn’t just apply to veterinary internists. It applies to everyone single one of us in the field of veterinary medicine. This is a subject near and dear to VETgirl’s heart, as wellness, self care and our emotional wellbeing as veterinary professionals is really important to us. That’s why we hired Jeannine Moga, MA, MSW, LCSW, as our Chief Happiness Officer in 2019.

Thankfully, in this age ruled by social media, mainstream media has picked up on our profession’s sad plight with emotional health. We are gaining recognition, not just for our unfortunate high rates of suicide, but for the factors that are contributing to this dismal stat. We are finding that work factors influence our emotional health in a substantial way. With limited studies to date on factors influencing our emotional health, today’s VETgirl podcast will discuss a recent article entitled Effect of client complaints on small animal veterinary internists. Bryce et al wanted to gives us insight into the small animal veterinary internist’s world. In this study, they sent out an anonymous questionnaire that was modified from a similar study of human physicians in the UK regarding how client complaints affect aspects of their work lives. The questionnaire was made available to small animal veterinary internists through the American College of Veterinary Internal Medicine’s E-mail list-serve. Participants were asked basic demographics, if they have experience with formal or informal client complaints, and whether the client complaint affected their practice of medicine and career satisfaction.

Of the 92 completed and included survey results, 59 internists reported having a client complaint filed against them in the past 6 months. Over half (53.3%) of the client complaints were due to the clients’ perceptions of cost of services. Other causes included client-perceived quality of care (19.5%), doctor availability (10.9%), support staff issues (9.8%), and the internist’s “bedside manner” (6.5%). Forty-nine of the complaints were filed to the hospital management, 23 were directed to the internist, 12 complaints were filed online, and 8 were board complaints. Sadly, 86% of participants said they receive client complaints at least once every few months. Only 4.4% had never received one (This article doesn’t state whether those who have reportedly never received a client complaint were recently boarded or seasoned internists). Shockingly, 34.8% of participants said they were verbally assaulted by clients during the previous 6 months! With the push for law schools to teach veterinary litigation courses, I am sadly not surprised to see that 1/3 of participants reported being threatened for litigation by clients within the past 6 months. With these numbers, it’s not a big surprise to reach that most internists reported worrying about client complaints with over a third of internists worrying most or all of the time.

In this world dominated by social media, about ¾ of participants said their associated hospitals are concerned or very concerned about their online reviews and 75% of the internists said these online reviews were not fair representations of the services they provided to clients. Sixty percent of respondents reported that there is no way to effectively address bad online reviews. Furthermore, only 75% of respondents feel their hospital management would support them in a client complaint, and only 50% felt their medical board would support them in a board complaint. It would appear we need to have more conversations with our veterinary managing boards on how to handle client complaints against our veterinarians. The aim of these discussions should be to minimize the anxiety and depression caused to the veterinarian by how these complaints are handled. Similarly, we should also focus on veterinary management training on handling of client complaints to improve the experience for the client as well as for the veterinarian.

Money is a sore spot for most of our clients and this is reflected as the number one cause for client complaints against our small animal internists. This article offers that miscommunication between client and doctor is the driving reason for client perceived cost issues. However, I’m sure many of us will agree that it’s more likely the clients’ perceptions of medical costs in general for their non-insured pets. Clients generally do not recognize the cost of medical care. They only pay a small fraction of their actual medical with human medical insurance covering – and, in essence, masking- the large costs associated with medical treatment and diagnostics. The veterinary profession charges on average less than their human counterparts for the same medical procedures and same medical equipment used, but our clients generally do not understand this. As a profession, what we can do to ward off these cost-associated complaints is to provide full disclosure of the fees associated with the specialists’ consultations and to clearly state that consultation fees do not include costs of testing or treatment. Then it is up to the veterinarian or staff to explain the costs associated with the specialist’s recommended testing, which can be buffered by the veterinary specialist explaining the need and benefit behind the recommended testing.

Client complaints don’t just make us feel bad, they can actually influence the way we practice medicine. There’s a phenomena out there called practicing “defensive medicine,” which is well documented in human medicine, and describes the practice of ordering tests and prescribing treatments and follow-ups that the clinician feels likely to be unnecessary, yet protective to their medical practice. Defensive medicine doesn’t come about solely from client complaints, it can also be adopted due to how we feel our medical practices are being judged by our peers. A couple thoughts on this point: Number one being, WE NEED TO SUPPORT ONE ANOTHER. Help us stop any judgment happening in your own practice, and instead focus on positively influencing each other on a daily basis. Regarding how clients perceive our medical practices, it is ok to always recommend the best course of action for your patient. If you’re worried that a client may not want to pay or pursue your recommendations, let the client be the one to decline, but always present what you feel is the best course of action. In emergency medicine, sometimes I’m lucky for the client to agree to a simple radiograph, let alone hospitalization and treatment. Pick your battles, explain it all to your clients so they feel involved in the decision-making, and if the client wants to decline a test you feel is not vital to your workup, then document that they declined it. Documentation of your recommendations and whether the client was responsible for accepting or declining the recommendation will provide you with support for your medical practices. I even go so far as to make a list of all diagnostics and treatments I recommend to the client and list next to each recommendation that the client approved or declined the recommendation (and I specify which client is responsible for the decision-making for the pet, just to be extra careful!).

This article points out to us that there can be merit behind some client complaints. Human medicine reports the use of “reflective medicine” where the content of the complaint is evaluated to help improve communication or medical practice. There are no veterinary studies yet regarding reflective medicine. Our human medical counterparts have established a system for more thoroughly categorizing and stratifying client complaints called the Healthcare Complaints Analysis Tool. The complaints are assigned one of three categories: clinical practice, managerial performance, and healthcare provider relationship. Then within each category the complaints are graded from low to high severity. Development of a veterinary version of this system could help us to better manage these client complaints from multiple perspectives. It can shield a clinician from complaints that are not reflective of their handling of the client/patient, it can help show management whether problems are more heavy-handed towards the client-patient relationship or towards management and support staff handling of clients, and it can help our clinicians identify cases where reflective learning is warranted.

A limitation of this study is the surprisingly low response rate from our small animal internists. (Come on folks, there’s thousands of internists and less than 100 filled out the survey?!). It is unclear why so many internists were reluctant to answer this survey. An increased number of respondents would strengthen the findings of such a survey and allow for more areas of investigation to be unveiled such as regional demographics and experience level (as assessed by time spent in practice). Another limitation to this study is that it does not account for individual pre-existing mental health conditions so the client complaint direct affects on veterinarians may be altered by how many of the veterinarians already have mental health issues.

So, what do we take from this VETgirl podcast? Based off this study, we now have evidence that client complaints are a frequent problem among veterinary internists and that client complaints have a detrimental effect on how satisfied with our with our career. What needs to be highlighted from this article is that 71.7% of respondents reported feeling depressed as a result of their client complaint; 77.2% said the client complaint affected job satisfaction and even 43.4% said they considered changing careers as a result of client complaints. Client complaints add significant psychological distress to our jobs. If we don’t start producing honest exposure in mainstream media of this issue, we may not only continue to have one of the highest suicide rates of any profession, but we may lose our animal health care providers to other professions.

It would be great for our profession to pick up this article as an outline for future studies in each of the veterinary specialty fields and general medicine field. Perhaps, someone reading this article may help to devise ways for us to fix the problem of the social media monster and provide us with a voice against bad or unwarranted reviews. The more we can expose our profession’s high incidence of depression and identify the causes, the more we will be able to make positive strides to improve our work conditions and our client-perceptions.

Our field is tough. Thank you for doing what you do. We may not get the appreciation that we want, but know you are saving lives.

References:
1. Bryce AR, Rossi TA, Tansey C, et al. Effect of client complaints on small animal veterinary internists. J Sm Anim Prac 2018:1-6.