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Saturday, May 28, 2016

Veterinarian Or Therapist? The Conversation That Wouldn't End

The other day I saw a cat owned by a regular client.  I had only ever talked to him and he was always very pleasant.  He had come in because his cat was having soft stools and was eliminating outside of the litter box.  Typically if a cat only defecates outside of the box it is due to a behavioral issue.  I spent time really trying to find out if there was any stress, changes in the environment, or anything else that could have induced behavioral problems in the cat.  The owner said that there was nothing, and it seemed like that this was the case.  I ended up suspecting inflammatory bowel disease and starting appropriate treatment for that.

Today I returned a call from his wife, whom I had never spoken to before.  She had questions about the new diet and several other things, at least according to the note that had been left for me.  When I started the call I didn't anticipate what I was getting into.  I just wanted to help the client and make sure the pet was getting the right treatment.

I spent 35 minutes on the phone with the lady.  The conversation should have lasted 5 minutes.  During that conversation I learned that she was mostly bed-ridden due to health problems, that she and her husband argued, that her husband worked and traveled a lot, what kind of shelter they had gotten the cat from, and numerous other details that I didn't really need or want to know.  And it wasn't just the sheer volume of information.  This poor woman didn't seem to breathe and talked so fast and long that I couldn't find any normal breaks in the conversation to jump in and ask questions.  There was one point where I didn't say anything at all for 10 minutes straight (yes, I timed it) as she continued to simply talk.  

In a way I felt bad for her.  She was obviously a shut-in and didn't have a good relationship with her husband.  She was frustrated by many aspects of life.  I didn't want to be rude and I was trying to be very understanding and empathetic.  I was also learning some important information about the cat that her husband hadn't shared.  In fact, her explanation of the situation fit perfectly with what I had originally suspected....behavioral issues.  As I listened to her I tried to piece together the relevant details while sorting through the plethora of useless and private information.  My heart went out to her at the same time that I was looking for an opportunity to move on to my next patient.

In all my years I can't remember a more frustrating situation.  I had a woman who honestly wanted to help her cat and didn't feel that her husband was giving the full picture.  I had a cat that needed help, and I had to get the right information in order to be able to do so.  I also had a woman who was apparently lonely and unhappy in her relationship, and I was a friendly, patient voice.  I really did feel bad for her and her situation.  But I couldn't afford to stay on the phone for over half an hour, as I had other patients to see and clients to call.

That 35 minute conversation resulted in the following details:  her husband didn't clean the litter boxes and they were often full of waste, and there was significant stress between the people in the home.  That was what I needed to know!  Unfortunately it took me far too long to get there, and there was no easy way to break in during the conversation.

Vet school doesn't prepare us for things like this situation.  We aren't trained in how to be a therapist to our clients or how to handle seemingly endless conversations.  Such skills are hopefully picked up over time and with experience.  It is often surprising how many things a vet has to handle other than being a clinician and surgeon.  Sometimes I wish I had taken psychology courses in order to be able to better understand and handle some of my clients.

I really do hope that things work out with her husband.  I also hope her health improves and she will have other people who can help her.  But I hope that it will be a while before I have to talk to her.  If I do, I'll have to allocate plenty of time.

2 comments:

  1. I feel you. We have this woman at out clinic with mental problems, we aren't really sure what she has exactly, probably autism mixed with other things. We don't have anything against her, but she is a terribly high demand client with very severe problems we are just not trained in dealing with.
    She's monitoring her cat like a hawk all the time, measuring every ml of water it drinks, the exact amount in grams of canned food that it eats, the exact number of kibble, the number, smell, size colour and consistency of every single stool or pee.
    Whenever anything is not 100% right, she either calls or come in with her cat (sometimes up to 5 times per day) and each conversation with her last at least 30 minutes with her talking none stop. We are really at a total loss of what to do with her...
    Unsurprisingly, her cat is followed at out clinic for chronic idiopathic cystitis, which always 'magically' stops whenever we hospitalize the cat...

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  2. I currently work in a different industry but am hoping to retrain as a vet soon. Our work is very customer focussed and quite honestly no-one is traied to deal with people like this. Some of our guys who work alone on nights etc. have special training on how to deal with agressive situations or real extremes like that, but people with mood disorders or mental illness simply aren't covered. I'm not sure how you could provide that training in a suitably sensitive manner without full on training customer service staff as therapists anyway.

    On placement I've seen vets deal with these customers in good and bad ways and I think it always just comes down to experience and personality. I think across many different sectors these things happen and in general you just have to adopt your own response. We reach out to vulnerable customers in a lot of situations but at the same time have to remember they aren't our responsibility, they're adults too and we're not therapists or their mum.

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