It's not just any review that popped up on Yelp. It's a scathing diatribe full of personal attacks on you and your team. And you've been reading and rereading it in the minutes between appointments.
This has perhaps never been more evident in veterinary medicine than since the suicide of New York veterinarian Shirley Koshi, DVM, in February (see the April issue of dvm360). Still fresh in the minds of the profession, this tragedy has prompted experts to urge the profession to take veterinarians' emotional health seriously.
Before you write off the idea of compassion fatigue as the need for more "balance," disregard that headache you can't shake or even try to ignore those ever-more-intrusive feelings of hopelessness, you should know that denial is as common as compassion fatigue itself.
She says common symptoms include intrusive negative thoughts, physical problems such as GI issues, headaches and lethargy—even being accident-prone. There are also spiritual indicators, such as a loss of hope, questioning life in general, questioning one's contribution, skepticism and excessive guilt.
Brandt says veterinarians and team members should also pay attention to signs in coworkers: anxiety, anger, sadness, hypersensitivity or numbness, irritability or depression. "It's really going to be in the nonverbal clues," she says.
Unfortunately, many people in the veterinary profession try to muscle through compassion fatigue, but the symptoms mount until it becomes overwhelming, Smith says. "Some people can go for years and then it can hit them," she says. "Or it can happen in a month."
Veterinarians who are practice owners and bosses are especially good at hiding their symptoms because they don't want to appear weak, Smith says. Loneliness from the isolation this creates eventually sets in, and that feeds the trauma. Smith says this is especially hard for sole practitioners who are socially and geographically isolated.
A major part of the solution is a support system. When Smith worked as the manager of an animal shelter in 2000, she didn't feel like she could share her feelings with her family or friends. "They didn't want to hear about my experience—they're all animal lovers—and I was so used to sharing with them," she says. The solitude in her grief over what she witnessed at the shelter convinced her of the need for human support.
Brandt says that when you deal with death and dying on a daily basis, simply being able to talk about loss can help. "Veterinarians deal with death at five times the rate of any other healthcare profession, but we don't offer five times the training to deal with death and morbidity," she says.
Shawn Finch, DVM, an associate at Gentle Doctor Animal Hospitals in Omaha, Neb., agrees that it's harder for veterinarians than other professionals in this regard. "Our patients all die no matter what," she says. "We can't save them all just because of mortality."
The repeated experience of death takes its toll. Add that to the countless other challenges of the job and it's a perfect storm of potential malaise. "Oftentimes the ones affected by compassion fatigue are the kind of people who drive themselves into the ground trying to make things better," Smith says.
But many veterinarians identify that drive as who they are—it's their purpose. "This is a profession that says, 'We're expected to do all things at all times for all people,' and there's some discomfort in saying, 'I may not be able to do it. I may need help,'" Brandt says.
From her front-row seat at a veterinary school, Brandt says the culture of high-achieving people equates to "Don't ask for help" and "Never let them see you sweat." "We really need to teach that it's OK to ask for help," she says.
Brandt and Smith agree that managing compassion fatigue starts with awareness, seminars, having resources available and even talking about bad days at staff meetings. "We have to set limits at work," Brandt says. "We tell ourselves, 'If we just work ourselves into the ground we'll be OK,' but that doesn't work—it doesn't pay off."
While it may seem like an impossible—even laughable—notion for veterinarians to put themselves first, Brandt says this is just the thing everyone in the practice needs. "They can serve as leaders for everyone else," she says. "They can lead by example."
She says the path to wellness starts with one thing that's measurable and accountable, like going to the gym three times a week or stopping to eat lunch every day. It can be as simple as taking a walk with coworkers at lunch or calling a family member during a break.
Finch says that sometimes she just gives herself some time to regroup. "Coming home in the evening and reading a book; being with family will refuel me," she says. She keeps an eye on her coworkers as well. "If we've had a sad day or a sad run of days, we talk together and that will often help."
That moment of connection and acknowledgement often restores balance. Without it, compassion fatigue begins to erode an individual's emotional and physical strength. "Caregivers have a gift and they want to continue to do that throughout their life," Smith says. "If they have nothing to give, that's when things fall apart."
When the effects of compassion fatigue go beyond what daily self-care can ease, Smith says it's time to seek help. "If the symptoms start affecting your life—if you have recurring nightmares, for example—I would highly recommend getting help with a psychiatrist who understands what compassion fatigue is," she says.
However, mental health services focused specifically on the unique experiences of those in animal health fall short, Brandt says. "There are options for medical doctors and other professionals, but the veterinary profession is behind," she says. Still, the help of an excellent psychiatrist or therapist can be invaluable in restoring equilibrium.
Smith says that emotional balance often hinges on not overlooking one's joy in work. "Caregivers often don't give themselves credit," she says.
Brandt agrees. Veterinarians often get to the end of the day and worry about everything they didn't get done, what went wrong and where they failed. She encourages them to turn that inclination on its head. "List the things you did get done, what you did do well—so there's some balance in the brain," she says.
Maybe then, when you can't help yourself from reading that review for the 56th time, you'll at least notice the five-star one posted right above it.