Showing compassion benefits practitioner, client alike

Veterinarians are likely familiar with clients who bring in their now critically ill cat after a prolonged progression of clinical signs. Or clients whose dog is sick, but they just had new flooring installed, and now they can’t afford surgery. Or horse owners who are known to talk for the entire appointment.

These situations can be stressful to practitioners, take up a lot of time, and be emotionally draining—at least without proper preparation and the right mindset.

Dr. Garrett J. Ryerson said the advice he was given in veterinary school—“You need to care, but not care too much”—never set well with him. He and Dr. Katie J. Reese, both small animal practitioners in Bozeman, Montana, gave the presentation “Compassionomics in Veterinary Medicine” on Jan. 5 at the AVMA Veterinary Leadership Conference in Chicago. They took a deeper dive into compassion and how it relates to clinical medicine, as well as tips and tricks for veterinarians and their teams to practice more effectively and efficiently.

Drs. Ryerson and Reese said compassion doesn’t cause burnout but instead can be an antidote to moral distress and empathy fatigue. Despite how busy a practice can get, time should always be made to listen and respond to clients because the long-term benefits ultimately pay off.

Professional boundaries

Dr. Reese has been in practice for 24 years, first with exotics, then in critical care, and now with companion animals. “Compassion is my native language,” she said. She defined compassion as the emotional response to another’s pain or suffering, involving an authentic desire to help.

Professionally, Dr. Ryerson said, veterinarians want to approach empathy as an acceptable means of engaging with clients in a way that prevents over-identification and internalization of what’s going on in clients’ lives.

“We don’t want to ignore the emotional signals and feelings of the client,” he said. “But we also want to perceive and to understand the feelings of that client in such a way that we can tailor our approach and tailor the compassion that we’re providing in the exam room to the client’s unique set of circumstances.”

Essentially, the goal isn’t to stop at, “Wow, that’s really bad, and I’m sorry about that.” Instead, he said, “It’s ‘How can I help? What can we do next? How can we make this better for you?’”

Taking that step to relieve someone’s suffering—making people feel seen and heard, even if it doesn’t fix everything—activates a reward pathway in the brain, making the experience pleasurable for the giver and receiver.

“Just remember that you don’t need to internalize somebody else’s emotions to be compassionate,” Dr. Reese said. “Just being a witness and conveying to your client that they are not alone is an act of compassion.”

A 2018 paper in the Canadian Veterinary Journal suggests compassion fatigue is misnomer and should be replaced with the term empathy fatigue, which is the cumulative effect of internalization of clients’ painful emotions and being unable or unwilling to act in the face of client suffering.

And then there’s moral distress, which is a violation of one’s professional integrity and obligations. Veterinarians are frequently exposed to morally conflicting situations, which stem from clashes among client needs, patient needs, financial needs, professional duties, and social expectations.

Drs. Ryerson and Reese said empathy fatigue and moral distress are the actual causes of burnout, and compassion is the antidote to both because compassion for others can overcome the distress associated with seeing other people in distress.

A 2017 literature review in the journal Burnout Research found that eight of 10 studies reported a negative correlation between burnout and empathy. Not only that, a 2013 paper in Social Cognitive and Affective Neuroscience shows that compassion for others can be a coping strategy to overcome personal distress and strengthen one’s own resilience.

Less than a minute

Taking the time to communicate better is one of the greatest acts of compassion a health care provider could give, Dr. Reese said. In doing so, veterinarians and veterinary technicians are helping increase client compliance and trust in their recommendations, resulting in fewer angry clients and higher revenue for the practice.

Dr. Ryerson said: “When we allow clients to feel heard, what we’re doing is we’re making them more likely to listen to us because in any relationship, we know that there’s reciprocity of attention, right? If we allow clients that time on the front end, then when we’re going to talk about our recommendations, we demand everyone to be on board, paying attention.”

Further, communicating better with clients can decrease malpractice cases, medical errors, provider burnout, and absenteeism, Dr. Reese said, citing research from the book “Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference” by Stephen Trzeciak, MD, and Anthony Mazzarelli, MD.

Despite these potential benefits of better communication, many health care providers say they are too busy to provide compassionate care. But Dr. Ryerson said having a compassionate conversation can add less than a minute, generally, to a veterinary visit.

“We don’t have a lot of time to build trust, but we can do it more rapidly by engaging in compassionate conversations with clients,” he said. “The mileage you get from that minute is worth it.”

Putting theory into practice

So what does compassionate care look like?

Verbally, it means health care professionals reflect and confirm what the patient is telling them. They make partnering statements such as “We will be with you all the way” or “We will continue to do our very best for you” or “Together, we will have a careful look at the decision you have to make and will keep a close eye on your concerns.”

Instead of asking “Do you understand?” providers can ask “What questions do you have?” Even offering to get back to clients later with answers or having someone calling clients can make them feel valued.

Also, leaving more time for clients to talk can go a long way, allowing uninterrupted time for them to tell their story.

“Usually, they’ll give you something about what they are worried about or the actual diagnosis or something to latch on to,” Dr. Reese said.

Nonverbally, compassionate conversations involve good eye contact at the same eye level, so health care professionals should sit if clients are sitting; getting rid of distractions, including moving the patient to another room if needed; and mirroring body language, such as nodding or smiling, depending on the context.

“We as veterinarians sometimes have to be like improv actors to a certain extent,” Dr. Reese said. “We have to walk into euthanasia one minute, and then we’re back into a puppy visit the next.”

Time and effort

Being open to giving time and space to discover what is not obvious can make for more compassionate practitioners. Alternatively, making assumptions about a client can mean veterinarians or their team may miss potentially important information.

Dr. Reese said it’s easy to be judgmental when clients have financial constraints or in other situations, but the practitioner may not know the whole story. The health care provider’s role is to make information available without judgment in a respectful but compassionate way. Often in these cases, she will ask for permission to have a global discussion.

“I’ll say, ‘I’d really like to tell you everything you need to know about Fluffy’s condition and what’s available for us to diagnose and treat Fluffy. I want you to understand the costs, limitations, and potential outcomes so you have enough information to make an informed decision in this situation. … You can ask questions and help me create a plan for you and Fluffy that feels right for you,’” Dr. Reese said.

Sometimes guilt is involved, especially when clients don’t want to spend the money, but they want to see their dog alive. Or they waited too long to bring the cat in and the condition has become more serious than they realized.

Dr. Reese advises removing any guilt or shame from the situation. It can be as simple as saying, “We don’t do guilt here. We are here for this patient at this time.”

She said: “A lot of time people feel guilty for any number of decisions about euthanasia. They want to talk about it but feel bad, so I introduce it. I’ll say, ‘I just want to bring up it and talk about it and clear up any feelings and make it OK to have the conversation.’ Give them permission to feel the feels. Once they’ve gone through feeling the real feels, then we can find a solution that feels good to client and gets me out of my moral distress.”

Dr. Ryerson said training the veterinary team on compassionate care is possible through a number of training programs. Just as key is having leadership model the behavior.

“In such a way, the team picks up on it and is able to engage with it and feel supported if they also practice it,” he said.