Dear Second Opinion,
A young, unvaccinated puppy was recently presented for diarrhea. The puppy was dehydrated and lethargic on examination, and I could immediately sense this would be more than a routine sick visit. We performed a test for canine parvovirus; the result was, unsurprisingly, positive. After discussing the severity of this disease with the client, I recommended referral for hospitalization, which the client declined due to financial constraints. We then discussed outpatient therapy and reviewed the estimated cost. That’s when the client informed me they could not even cover the cost of the parvovirus test. I began to discuss various payment options and strategies, but the client became extremely agitated, and the situation escalated. They made a scene in the clinic waiting room, yelled at team members, and accused us of “only being in it for the money” before storming out with their puppy.
Unfortunately, this is not an isolated incident. Accusations like this are disheartening and frustrating to the entire team—especially when we are staying late, picking up extra shifts, and doing our best to care for as many patients as possible.
We cannot do our jobs without appropriate resources (eg, testing), which carry a financial burden. How can I help clients better understand the value of the services provided, and how can I continue to cope with frustrating situations like this without getting burned out?
Sincerely,
- Not in It for the Money
Dear Not in It for the Money,
I am so sorry for the emotional toll this situation and others like it has taken on you. Being accused of being in it for the money can feel deeply disheartening and unjust, especially when you are working tirelessly to provide the best care for your patients. Please know that you are not alone—this scenario is, unfortunately, all too common in veterinary medicine and can wear down even the most dedicated professionals.
When faced with such accusations, it is crucial to remind yourself this is not about you. These comments often stem from a client’s frustration, guilt, or feelings of helplessness, especially when they are unable to provide the necessary care for their pet. Although it can be difficult, try not to take their words personally. Instead, take a deep breath and focus on remaining calm and professional. Approach the conversation with kindness and remind them that the goal is to work together to find the best possible solution for their pet.
After such encounters, take time to debrief with your team and lean on your support network. Sharing the emotional burden with trusted colleagues, friends, or mental health professionals can help you process the moral distress (ie, the psychological and emotional distress that results from an individual’s moral integrity being compromised when they feel unable to act in line with their ethical principles1) of these moments. Recognize that the real heartache arises from who really suffers in the end—the patient. Talking about these cases out loud and prioritizing self-care in whatever way that resonates most with you is vital to your healing and resilience.
A proactive approach would be to establish clear, consistent policies regarding financial discussions. Saying, “I’m sorry, this is the clinic’s policy,” allows you to shift the responsibility onto an established procedure. You may add, “Let me speak with my administrators about this,” to demonstrate an active effort to advocate for the client, so they can see you have tried. In addition, having team members ask, “How will you be paying for your pet’s care today?” in a nonjudgemental and procedural tone during scheduling can help set expectations early.
We can help clients better understand the value of the services we offer by providing detailed, itemized estimates from the beginning. Transparency is key when discussing financial matters. Being upfront about the standard cost of individual resources and demonstrating flexibility to work with clients to offer alternatives that best fit their needs can help make that tough financial pill a little easier to swallow.
Building trust with clients is invaluable. Before finances are even brought into the discussion, it helps to have already established a foundation of understanding so the client can see your genuine dedication to their pet. Offering spectrum of care options and explaining the risks, benefits, and prognosis of each choice allows clients to feel more involved in the decision-making process. Your efforts to discuss payment plans and financing options show your willingness to find solutions. You may also try providing a list of charitable organizations that can assist clients with financial needs (see Suggested Reading).
If a client is truly unable to afford any care, suggesting relinquishment of the pet to a rescue or shelter may be an alternative. Euthanasia is also an unfortunate but realistic option.
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The truth is that this will not be the last case that makes you feel this way. Your response to these situations may vary depending on the patient, client, context, what else is happening in your day, and any other personal or professional challenges you may be facing. Remember that you are one person, you are doing your best each day, and carrying the burden of all patients that cannot be helped is simply not possible. This is the challenging reality of being a clinician, but your journey is not defined by these difficult moments.
We often shrug off the good outcomes, which far outweigh the difficult cases we obsess over.
Please be kind to yourself and don’t forget to celebrate your wins, no matter how big or small. Take pride in the difference you make; your clients and patients are counting on you.
Sincerely,
Zenithson Ng, DVM, MS, DABVP (Canine & Feline)