Dear Second Opinion,
A recent recheck examination turned awkward when my staff and I had to discuss a patient’s behavior issues with the client. Initial consultation revealed the patient was extremely anxious and aggressive, and we were unable to complete a full physical examination. We instructed the client to administer both gabapentin and trazodone prior to future appointments. The client seemed onboard with the plan and left without any questions.
When the patient was returned for a recheck, we were still unable to perform an examination. One of our staff narrowly avoided being bitten. I described the incident to the client, and they responded that they had intentionally not given the recommended medications because the patient is “only a little nervous when at the clinic” but “totally fine otherwise.”
This isn’t the first time a client has denied their pet’s behavior issues. Not only does this denial put our team at risk for physical injury, it also creates a challenge in terms of devoting additional time and resources on a day full of appointments and tight staffing. We can deal with difficult behavior from a patient, but it is significantly more frustrating when the client refuses to acknowledge the issue.
How can I approach these situations with clients in the future to ensure we are all in agreement on addressing behavior issues?
—Dealing with Denial
Dear Dealing with Denial,
It’s hard when a client’s propensity for denial leaves you and your team at risk. First, try to understand the client’s perspective. These reasons may explain the behavior, but they don’t excuse it.
The client may be embarrassed and subconsciously downplay the issue out of shame or fear.
The client may feel it’s not that big of a deal, meaning they lack awareness of the severity of the issue because they sincerely believe their pet would never bite anyone, and they don’t understand the signs of fear in dogs.
The client may be frustrated because they believe the veterinary staff doesn’t understand their dog.
The client may be too preoccupied with unrelated life events (eg, career challenges, relationship problems, financial issues) to notice the dog’s behavior.
Next, the client needs to change their behavior as soon as possible. My suggestion is to use nonviolent communication (NVC) techniques created by Marshall Rosenberg, PhD, to explain why change is needed, what is needed, and clearly outlined consequences. NVC uses the following principles:
Observe the situation without judgment, and be specific without using global statements (eg, always/never) or attacks on one’s character: When I see/When this happens/When this happened
Take responsibility for your feelings. With NVC, what others say and do is considered the stimulus but not the cause of our feelings. We are responsible for our feelings. In this situation you can also explain the dog’s perspective: I feel/I felt/My staff feels/My staff felt; The dog feels/The dog felt
Make the connection between your feelings and unmet needs: Because I need/Because my staff needs/Because the dog needs
Make a request: Would you be willing to …
In your situation, NVC could look like this: When your dog is here, he/she appears scared and attempts to bite me and my staff. When this happens, my staff and I feel like we can’t adequately care for your dog because we are trying to protect ourselves. Your dog feels very nervous and threatened by what we are doing because he/she doesn’t understand and can’t escape the situation. We feel frustrated and sympathetic for your dog because he/she is scared and suffering. This makes it hard on everyone. Would you be willing to give your dog the antianxiety medication before the next appointment?
In this case, you will want to follow up with a clear consequence: If you are unwilling to help us in this way, then, regretfully, we will be unable to continue with your dog as a patient.
Then leave it in the client’s hands.
Document everything. Put a flag on the patient’s record that instructs the front desk or call center to remind the client to give the medication before the appointment and to ask whether the medication was given when the client checks in the day of the appointment.
Good luck, and I hope this helps!
Sarah Wooten, DVM, CVJ