There is no correct way to grieve.

As a long time veterinarian I have to deal with grief.  Grief when a pet gets a bad diagnosis and grief when that pet’s life comes to an end.   In a blog that I wrote two weeks ago, I wrote about how grief and love go hand in hand and how we should embrace grief as being a part of love.  I do believe that, but it got me to thinking about how we navigate that grief.

My amazing husband reminded me about the work of Elisabeth Kübler-Ross and David Kessler in the books “On Death and Dying” and “On Grief and Grieving”.  In the books they talk about the stages of grief.  David Kessler writes, “The stages…are responses to loss that many people have, but there is not a typical response to loss as there is no typical loss.”  Grief is as unique as the person that is experiencing it.

I find that to be true in my experience with my clients and their pets.  Each situation is unique and there is not a proper way to express grief.

The five stages are denial, anger, bargaining, depression and acceptance.  David writes that not everyone goes through all of the stages, and not everyone experiences them in the same order. 

Denial is usually the first stage of grief.  Denial involves confusion and shock and is our brain’s way of guarding us from the emotions that will follow.  We are blocking reality, so we don’t have to feel the terrible emotions that are to come.  Denial is what causes us to avoid the reality of the situation until we have the capacity to really feel.  I remember feeling this when I lost my first dog as a young adult.  I could not face the fact that I was going to have to make a decision to let her go.  

Anger is the second stage.  Anger is what gives our grief structure and makes us feel stronger.  When we feel anger towards another person, the current situation, or even God, it makes us feel more in control than the denial that feels so chaotic.  Anger is the manifestation of the underlying pain.  Lashing out makes us feel more in control of something that we cannot really control.  I have experienced my personal anger when losing a family member or pet.  I also have been on the receiving end of anger as a veterinarian when delivering bad news.  I do not take it personally as I know that it is just grief talking and is a necessary part of the natural grieving process.

Bargaining is often the third stage but I have seen it mixed in with denial and anger.  Bargaining is the thinking that “if only” I had done something different this would not be happening.  We say, “I wish” or “I should have”, brought the pet in earlier, paid closer attention, or been there when the pet died.  Veterinarians do some bargaining of their own when a severely ill pet is presented to us.  We think, “Why didn’t this pet get to me sooner?” or “Why did they wait so long?”   We think that we may have been able to do more if we had seen a pet sooner.  Bargaining allows us to remain in the past and avoid the reality that we are facing.  Bargaining seems to crop up over and over again as we navigate grief and is the thing that makes us question our euthanasia decisions.  We wonder if we chose the correct time or waited too long.

The fourth stage is depression.  Once we have let go of the bargaining we feel the true weight of the situation.  This is not just feeling sad but really feeling lost.  The realization that your loved one is gone and is not coming back causes profound sadness and is an appropriate response.  It is one of the steps that we need to go through to get to the other side and move on to acceptance.  There is no proper way to deal with this stage, except to say that getting help from others is very important.  Talking through your grief with a family member, friend, support group or therapist is often needed to navigate this stage.  Remembering that pets are a significant part of our lives and not being ashamed to talk about it to others, will help us to progress beyond the depression and move into acceptance.

The fifth stage is acceptance.  Acceptance is not being “ok” with the loss or “feeling good” about it and moving on.   It is about accepting the reality of your pet being gone but not forgotten.  Accepting that life has changed and will be forever different going forward.  I see acceptance in one way, as a veterinarian, when people adopt a new pet after a loss.  They are not replacing the love that they had for the deceased pet, they have accepted the loss and have chosen to love again.  The new pet is not a replacement but an addition to a their life.  I personally spent a year without a dog after I lost both of my previous dogs within four months of each other.  When I got to the point of acceptance and my house felt empty I adopted Trent my current Sheltie.  I will never forget my other two dogs, but I chose to open my heart to another. 

I write about this subject not to make you feel sad but to help us all to feel supported and understood.  There are people that judge us on grief surrounding pets.  They may be unkind or lack empathy when it comes to the choices surrounding pet care, illness and euthanasia.  I want everyone to be assured that most veterinarians and veterinary technicians will treat you and your pet with compassion, love and support in all situations. 

Guilt, judgment and regret have no place in this discussion. 

There is no correct way to lose a pet and no correct way to grieve. 

Dr. Julie Cappel

If you would like to comment on this story or any other, please leave a comment here or visit my Facebook group “Veterinary Life with Dr. Julie Cappel”

Learn to love a little conflict

It may sound very strange, but I really do enjoy a good conflict.  I just experienced one yesterday with a group of my most trusted colleagues, and even though it was passionate and uncomfortable at times, I think we are all better for it. 

In veterinary practice, upset clients are the main source for confrontation and conflict.  Even the kindest, most efficient and most experienced practice will face client dissatisfaction, because no veterinary hospital is perfect.  I have faced my fair share of upset clients and although they are not always pleasant, I do enjoy the challenge of confronting their problem and repairing the relationship with our practice.

How do we look at an upset client as an opportunity to improve and grow instead of a problem to avoid?  

Let’s remember that all clients are unique individuals and have different preferences and needs. One client will be happy to sit and wait in the reception area for 40 minutes on a busy Saturday, and the next will storm out after waiting for 15.  One client will happily wait for your phone call back after business hours, and the next will call back in thirty minutes and wonder if the doctor forgot about the message that they left “hours” ago.  Because everyone’s expectations are different, we are bound to disappoint someone in spite of working diligently to please everyone. 

When faced with a client issue, the best thing that we can do is address the problem as soon as possible and do so face to face.  Bring them into an exam room and sit in a chair facing them.   Take a deep breath and relax.  Your body language will make all the difference, so stay relaxed and do not get defensive.  Allow your client to speak freely and actively listen.  It will be tempting to interrupt, but don’t do it.  Let them get it all out.  Everything that they are feeling needs to be expressed before you try to resolve anything.  Once you feel that they have told you the entire story, ask a few questions to clarify that you really do understand the problem.  Most people just want to be heard.   You cannot change their experience or change the past, but you can allow them to express their frustrations and work towards resolution. 

Also remember that sometimes clients complain for good reason.  Your practice may have a very valid issue that you would not have realized, if it were not for their complaint. Thank them for bringing the problem to your attention and give them a sincere apology for the inconvenience.  Once you have listened, thanked them, and given them a sincere apology, ask if there is anything that you can do to repair the relationship.  Assure them that you will address their concerns with the entire veterinary team.  If they feel that they were truly heard and something is going to change, they will feel validated and less likely to leave the office upset and retaliate on social media. 

If they do retaliate on social media, be sure to again address their concern, but never argue with their review.  It will only fuel their fire and make you look bad to boot.  Thank them for speaking to you personally to try to resolve the issue and assure them that you are working on a solution.  Ask them to call you again so they know that you are open to further discussion.  Many times when you follow up with a kind response after you have also been kind in person they will remove their Internet rant. 

My practice is fabulous and I can confidently say that we have the best veterinary team anywhere.  We rarely have conflict with our clients, but when something does go wrong I can jump right in and enjoy the challenge of conflict.  I consider it an opportunity to improve my communication skills and for our practice to grow; making things better for our clients, patients and veterinary team.  

Conflict is a part of life, so why not learn to enjoy it?

Dr. Julie Cappel

The Answer is Love

Today, like many other days at a veterinary hospital, I had the unique privilege to share in a woman’s grief. 

Why do I call this experience a privilege? Please let me explain.

As veterinarians we often have to deal with the death of a pet.  Most often the death is brought on by a difficult choice called euthanasia.  Clients say, “Doctor, I don’t know how you do this everyday.“ Or friends say, “How do you deal with all the grief?”  I am never sure just how to answer, but in my mind I always think that I am witnessing something uniquely beautiful.  That may sound strange, but it is my truth.  In those difficult moments, I am witness to the profound love between a person and their pet. 

There is a quote from Zig Ziglar that says, “If there were no love, there would be no grief.” 

One of my daily appointments was for a cat named Tigger.  I had seen Tigger just a few short days before because his health was quickly failing.  He was losing weight, having trouble eating and falling over while walking.  Tigger was a sweet old emaciated, dehydrated, 17 year old cat with a beautiful personality.  He was very ill, but he remained dignified and friendly, purring weakly when he was stroked or touched.  The women that cared for him was very distraught, telling me that this cat had previously belonged to her relative that had died.  She had struggled with the decision for several days as we came to the conclusion that Tigger had cancer and would not recover.   Today was the day that she decided that she had to say goodbye.  As he lay on the blanket that we laid out, the woman talked to him gently stroking his chin and he returned the gesture by purring and leaning into her hand.   I watched the woman grieving over her sweet cat and the cat returning her love by lifting his head and allowing her to rub his boney chin for the last time.    As she whispered her last goodbyes, her tears landing on his little face, he gazed at her with a look that could only be complete trust and love.  The love that passed between them was amazing and beautiful.  She quietly left the room as I gave him his final rest.

I have lived through so many versions of this story, with many clients and with my own personal pets.  Over and over again I come to the same conclusion.  Grief is the price we pay for love, and a life without love would not be worth living. 

So the answer to the question, “How do you do this everyday?”

The answer is simply, love.

Dr. Julie Cappel

Getting over our money guilt – Let’s be confident about charging for our services.

 Do you ever feel guilty about charging a client for veterinary services? Can clients make us feel ashamed about what we do everyday?

I think the answer is absolutely yes, if we let them.  It is one of the main reasons that our profession is so wrought with anxiety.  I can feel it almost daily, wondering if the next client will give me a hard time about charges.   Just last week I made up a treatment plan, including prices for my services, presented it to a client for approval and the client looked up at me and said, “Are you kidding me? You are CRAZY doc, I can’t afford that.”  (Exact words from an actual client)

How would this comment make you feel?  Embarrassed, humiliated, angry, and resentful? What can we do to combat these negative feelings and learn to feel differently about charging for what we do?

Remember that you don’t set the prices and most clients have no idea how much it costs to keep a veterinary hospital open, or any business for that matter.   Check out your hospital’s financial statements and see the tremendous amount spent on overhead.  The veterinary hospital needs to make money to be sure that the bills get paid, the team gets paid, and ultimately the doors stay open for another day. If the hospital is not open, many pets and clients will not be served. 

Remember that veterinary money usually comes from clients' discretionary income.  They may argue with us about our prices, then go to the Apple store, Starbucks, or Amazon and gladly pay the price marked on the products. They may think that it is perfectly reasonable to have a $500 smart phone and risk their dog’s health by declining an $20 vaccine or pay for Netflix and decline heartworm preventative.  Great!   They get to do what they want with their extra money.   Your job as a loving veterinarian is to explain to the client why our services are important and valuable to their pet’s wellbeing. If they understand the value behind what is being offered, most will gladly pay for your services.  If they choose to spend their money on fancy coffee or cell phones, it is out of your hands.  

Be aware of what you are actually giving away.  All those little charges that you decide to discount to appease your guilt may add up to a lot of money over the course of a month or year. Every recheck exam, nail trim, ear cleaning and tooth extraction that you fail to charge for, or discount, come off of your bottom line and the bottom line of your practice. It cuts into the salaries of you and your support team.  Just think about it, or track it for a month and see how much money you are truly giving away.  You may be shocked at the amount of cash that your guilt costs you. I am not saying that you cannot give anything away, just be aware of it when you do and what it is costing you and your team.

You are part of a unique and wonderful profession that deserves to be well paid.  Keep these things in mind the next time a client challenges your services or attempts to guilt you into a discount or free service.   You can be generous with your time and energy and still charge for what you do.   You can be kind and helpful and still earn a living.

So the next time you start to feel anxiety or guilt over a fee for your services, remember that most of our clients think we are well worth what we charge. The clients that don’t will spend their money elsewhere and that is OK.    

Once we embrace our value we can feel confidence and pride in our profession and charging appropriately for the brilliant work that we do.

Dr. Julie Cappel

Let’s Love Receptionists – taking care of you and your business.

 Last week I was working harder than normal because my two associate veterinarians were away at a summer conference.  For part of the week, I was the only doctor working at my very busy hospital.   It can be fun to be the only doctor on one hand because I have the entire support team at my disposal.  The down side to this arrangement is that I am responsible for everything – every pet and client that comes through the door.  It can be overwhelming especially when clients don’t behave as expected.

Thank goodness for my veterinary receptionist team, defending the front of the house.

Veterinary receptionists are terrific at handling everything important from the initial client contact by phone, to the collecting of charges, to the “Have a nice day” goodbye.  They handle very important things, which I sometimes forget, as I am frantically moving from exam room to exam room. They are rock stars as they deal with a steady stream of clients and pets.  They handle phone shoppers, appointment scheduling, price quotes, prescription and food pick up, client concerns, dogs barking and even the occasional “accident” on the reception room floor. They handle our regular cast of client characters, with style and grace.

I saw a great example of this Tuesday.  Early in the day I was scheduled to see a woman and her teenage daughter with the daughter’s little pet bird.  The mother was obviously unhappy from the minute she walked in the door about having to spend money on an inexpensive pet.  The mother scowled as the technician escorted her into the exam room. She sat with her arms crossed, glaring and grunted while her daughter talked with me about the pet bird. She didn’t say much of anything except when I suggested that surgery maybe needed. “We are NOT going to pay for surgery on a nineteen dollar bird.”  I told her that I understood and I would do my best to treat the pet with medication, which I sent home.

Once she was back at the front desk the woman exploded at my receptionist. She berated the receptionist, who had nothing to do with the charges, and threatened that she was going to leave a bad review for us on Yelp because of her outrageous bill.  My receptionist kept calm and cool explaining the services rendered.  She was kind, warm and patient.  She may not have won over this particular client but she did impress the observers.

The very next client was a couple that had seen the interaction between the receptionist and the woman.  They came to me impressed and in awe that my receptionist had stayed calm in the face of the rudeness. I told them that it was all in a days work for these rock stars of my front desk.  It is something that they deal with infrequently, but also far to often.  They take the brunt of most of the problems that occur in any business. They are client service professionals of the highest caliber.

So remember to love your veterinary receptionists.  Pay attention to their needs.  They are so important to the success of the veterinary team.  I would argue that they are key to your success.  They are the people that guard you from the cruel world that waits outside your veterinary hospital doors.

I would like to honor Joanna, Adrian, Erika, Jace, Miranda, Danielle and my manager Kathy for the terrific job they do everyday to keep the problems in the front from affecting the doctors in the back. 

We appreciate and love you everyday.

If you have a receptionist that you love please leave a comment here so they will feel your support.

Dr. Julie Cappel

"Yes, but..." - How to handle client objections.

How many times have you stood in an exam room with a loyal client, given them your undivided attention and your best advice only to have them say, “Yes, but…”

They may make excuses, argue with you or just completely ignore your recommendations.  Sometimes you may even find out that they disregarded your instructions completely to take the advice of a groomer, friend or relative.

They say things like, “I already tried that.” “He won’t eat that prescription food”; “I am too busy to do that.” Or “I can not afford it.”   Being faced with all of these objections can lead us to feelings of inadequacy, frustration, stress and even hopelessness.

Just this week I had a client almost lose her bird because she ignored my warnings about taking a bird outside unrestrained.  She was very fortunate to get him back safely, but why didn’t she listen?  I could give you at least five more examples of objections that I received this week from my clients and even from my veterinary team.  I have the most amazing loyal clients and fabulous ambitious team, but their human nature causes them to voice objections to recommendations almost daily. 

How can we manage our minds around these objections and accomplish our goal of serving our clients while decreasing our stress?

Fully listen to the objection.  There are some objections that are valid and have nothing to do with disrespecting you.   Do not get defensive or discouraged.  Listen to the reason that your client has for objecting and see if you can come to some kind of compromise to satisfy your interest (the pet) and theirs.  If you truly listen to everything that they have to say about the subject it will increase your understanding of their situation. Through careful listening, you will be better able to get to the solution that they desire and keep yourself from feeling frustrated. After all, your job is to serve the client as well as their pet.  If you listen with an open mind, your client will leave your office feeling heard.

Ask questions about the objection.  I find that asking questions about a particular objection not only helps me to understand my client better, but can also move them closer to my way of thinking.  Asking questions to gain understanding helps me to design my discussion to better educate the client around the importance of our medical advice.  Asking questions will help you get a feel for their capabilities and understand their concerns. It will also go a long way to strengthen your relationship and bond them to you as their veterinarian.  Ask honest open-ended questions to really get to the root of the objection.

Respond with kindness and understanding.  There are many circumstances where our clients want to do what we ask, but they are just unable to do so.  They have budget constraints, they have physical constraints, they have family issues and even personal things that can prevent them from properly treating their pet.  If you remember that clients are human beings with their own unique set of problems and seek to understand their challenges, you will be better able to agree on a solution that they are more likely to follow.  

If you approach each client interaction with the heart of a teacher, listening, seeking to understand, and responding with kindness, you will be better able to deal with objections and turn objections into successful satisfying client interactions.

Dr. Julie Cappel

“An objection is not a rejection; it is simply a request for more information.”  Bo Bennett

It is only money.

One of the most significant daily concerns for working veterinarians and veterinary technicians is money.  Our client’s money influences how we can treat our patients.  Our practice’s money influences the equipment that we use or the drugs that we have at our disposal.  Our personal finances determine our lifestyle and our families’ future.

Our beliefs about money and our discipline around it will determine the abundance that we are able to create.  Money thoughts can certainly give us anxiety unless we learn how to manage our mind around our situation and change our habits when it comes to our personal finances. 

According to a study by the American Veterinary Medical Association, the average debt load for veterinary school graduates was $167,534.89 and over 20% of those graduates have over $200,000 and up to $300,000 in debt.  Those numbers will truly give you nightmares.  A recent poll of college students with loans found that 30% of those students used student loan money to pay for spring break vacations and other lavish lifestyle enhancements.  What were they thinking?

When I got my first job as a veterinarian fresh out of school, I bought a new car. In fact I have a photo of myself standing by my new red Ford Escort ready to drive to my first day as a veterinarian.  My mom took that photo, just like she took photos of me when I was going off to my first day of school.  When I think about that picture and the fact that I had serious student loan debt at the time, I can’t believe how stupid I was.  Why didn’t I just drive the beater car that I was driving in veterinary school until my debt was paid off?  What was I thinking?

Now that I am older and have learned from my many silly mistakes with money, I want to encourage you to do things differently.   Smarter decisions will put you well ahead of your peers and move you toward financial security and even millionaire status if you practice some simple money managing principles. 

First, bag the new car!  If you have debt, the last thing you need is a car payment.  The average car payment in America is over $450.00.  That is insane!  Buy something cheap with cash. You drove a beater in college and it got you where you needed to go, so continue to drive the paid for beater and put that car payment towards your student loan.  Once you have your debt paid off you can buy yourself a new car with cash.

Make a monthly budget.  Write down your spending every month so you can teach yourself to behave with money.  If you have a plan before you start passing out the cash, you will learn where you spend and where you can cut corners to get rid of the debt faster.  Bring your lunch to work, make your own coffee, skip the latest fashion trends and don’t spend money on vacations that you can’t afford. 

Do not use credit cards to buy things.  It is much easier to overspend with plastic than with cash.  Cash leaving your hand causes much more pain than the plastic card.  

Take advantage of your hospital’s 401K or IRA plan.  Many hospitals match the contribution that you make, so once you have your debt paid off, max out the allowed contributions to get the free money match.  Who would be so stupid as to refuse free money?  You would be surprised how many people do.

There are many programs, podcasts and budgeting tools that are free to the consumer to help you manage your money.  I am a big fan of Dave Ramsey and Suze Orman but you can study anyone with financial common sense.  Talk to a parent or relative that is winning with money and follow their advice. Think about every dollar that leaves your hand as a step towards your financial freedom and future generosity.  Work to change your mind around money and financial success will follow.

Over the years when I expressed worry about my financial situation to my Dad, an accountant, he would always say, “It is only money.”  I think that he was teaching me that if I applied common sense and controlled my spending, that money is just simple math.  

I think I finally got it.

Dr. Julie Cappel

The power in being Present - When clients bring frustration

Let’s face it; people can be annoying and frustrating.  For those of us who work in the veterinary world, where people come attached to each patient, our frustration and stress can build throughout the day.  Each client’s idiosyncrasies piled one on one, combined with the eternal love and concern for their pets, can cause us to reach the end of our day totally drained. 

 I had one of these challenging client situations last week.  It is a perfect example of turning an annoying client experience into something wonderful if we can just remain present.   Amy Cuddy defines presence as “bringing your boldest self to your biggest challenges.”  Presence allows us to listen with an open mind and convey to people that we truly care about them.  It allows us to avoid giving up on a difficult client encounter and makes us work for the pet.

The short version of this story is that a client brought her adult terrier to me because the dog had been vomiting and having diarrhea for at least 3 days.  The terrier was sweet, but appeared to be depressed and somewhat dehydrated.  I proceeded to do my job as I normally would, getting vitals, asking questions and getting permission to do testing to try to diagnose the illness and choose the appropriate treatments. 

The annoyance started when the client kept referring to her cell phone to look up different diagnoses and asking me if I knew what the various diseases were.  She was also texting her friend who was apparently telling her about ways to save money in this situation and asking her to challenge me about the things that I was explaining. 

I attempted to remain kind and patient, but in my head I was getting annoyed. “Yes, I do know what gastroenteritis is.”  “ Yes I know about Parvo virus.”   (Me thinking - Yes I am a licensed veterinarian and I think that is why you are here.)

Well this appointment went on and on with the client declining my proposed plans and her reading about the things I should be doing on her phone.  After over an hour of this back and forth, she declined almost every test, asked me for a prescription for the medications, and almost denied treatment.  I say “almost” because that is when I decided to be more present and become my boldest self.

I used my most patient kind doctor voice to insist that she allow me to at least give the dog some fluids and an anti-vomiting injection to try to get her on the path to healing.  I would be happy to write her a prescription for the medications and bland diet to appease her frugal friend.  I knew that if I totally lost my cool the dog would be the one to suffer, so I accepted the reality of my situation and worked to make it the best that it could be.

Because I remained present I was able to convince her that her pet needed treatment and that I was the one competent enough to help her.  She left the office with a budget friendly bill and a dog that is on the road to recovery. 

So when you are faced with a challenging person, remember to not take it too personally.  Remain present and bring out the boldest, best version of yourself.  It will get you beyond the frustration and bring you through to a successful, albeit not perfect, outcome.

Dr. Julie Cappel

“Whatever the present moment contains, accept it as if you had chosen it.  Always work with it, not against it.”   Eckhard Tolle.

Am I good enough? Hello self-doubt.

Have you ever stood outside an exam room door and felt anxiety about what is waiting for you on the other side?  Do you wonder if you are up to the challenge or have the skills to get it right?   

If so, my veterinary friends, you are dealing with self-doubt.

What if the client does not like me?  What if I cannot make a quick diagnosis?  What if I make a mistake and the pet does not do well or even worse, dies?

Self-doubt is a struggle for us in the veterinary profession.  Every human can suffer from it, but we have many seemingly valid reasons for feeling it daily.  We are required to be brave and make decisions with little solid evidence, often guessing at where a pet feels pain, or about the source of their illness. Many times we do not have the benefit of proper diagnostic procedures due to a client’s financial situation.

To make matters even more difficult, most veterinarians have perfectionist tendencies.  The pursuit of perfection is tricky.  We want to adhere to high standards, but since perfection is impossible, our need to be perfect can hold us back causing us to avoid making efficient decisions.

How can we mitigate self-doubt, strive for perfection, deal with uncertainty and overcome our anxiety?  It takes some concentrated mental effort, but it is definitely possible.

Remember that you are a talented and unique individual.  You did not become a veterinarian by accident.  It took many years of incredibly hard work and dedication.  If it were easy, everyone would be doing it.  Remember that the clients appear in your exam room because they trust and respect you.  They are paying you for your education, discernment and expert opinion.

Realize that veterinarians, like all other humans, are not perfect.  You can strive for perfection, while knowing that the goal of perfection is impossible.  You can choose to accept imperfections or small failures as part of your learning process. Accepting that failure is part of the human experience may help to relieve you of some of the pressure that you place on yourself.

Recognize your successes and celebrate your accomplishments.  Keep a journal, or list of outcomes, of the cases of which you are particularly proud. Read it every time that little bit of self-doubt starts to surface.  Hold on to those thank you notes and cards that your clients send to you even after a pet dies.  Your clients know that you do everything in your power to help them and they acknowledge it.  Read a few of them the next time you feel anxiety or self-doubt creep in.

Daisy and Lambchop

Confide in a mentor, coach, or peer that understands where you are coming from.  Seek help when you feel that the self-doubt is keeping you from being the best veterinarian that you can be.  By understanding that everyone in this profession struggles with some feeling of self-doubt, you will recognize that you are not alone and will be able to quickly accept your feelings when they arise.   

Dr. Julie Cappel