People might be shocked to find out that veterinary care providers experience traumatic events on a regular basis. These events, when experienced repeatedly, put veterinary care providers at risk of compassion fatigue, sometimes referred to as secondary post-traumatic stress disorder (PTSD). Contrary to popular belief, veterinarians do not spend their days vaccinating puppies and kittens and discussing deworming regimens with pet owners; the average companion animal practice deals with illness, disease, death, and dying 75% of the time. Veterinarians diagnose serious and often terminal illness; they experience unanticipated outcomes after implementing treatments; they witness signs of animal abuse; they perform euthanasia; they handle fractious or aggressive animals; they navigate difficult or demanding clients; and they manage conflict among co-workers. But perhaps the most damaging traumas that veterinary care providers face in practice are moral stressors.
Moral stressors occur when a veterinary care provider does something that is contrary to his or her personal and professional values, instead of doing what he or she feels should be done. This action undermines integrity, morals, and authenticity, and causes psychological distress. Moral stressors are considered the leading cause of compassion fatigue in veterinary practice.
Having spent more than a decade practicing emergency medicine, I have had the misfortune of experiencing moral stressors many times. I recall several situations when I was asked to euthanize an animal because the owners could not afford medical care and the animal would suffer without treatment. In most of these situations, despite contacting rescue organizations, animal shelters, and staff members, a foster home could not be arranged. Other times I have had to euthanize animals because they had no owner and due to the severity of their illness, rescue organizations and animal shelters could not afford their care. Is it any wonder that one-quarter of veterinarians express feelings of “failure” when performing euthanasia?
Ultimately, because veterinary medicine is not publicly funded and since most pet owners do not have insurance, finances often come into play when deciding whether to treat an animal or perform a necessary surgery. This is especially common in emergency practice because emergency care due to accidents and acute illness are usually not anticipated and many clients are not prepared financially to pay for necessary care. So, it really should not come as a surprise that veterinary care providers experience psychological distress secondary to moral stressors…especially when clients insist that veterinarians should provide care for “free” and “because they should want to help animals”.
Most veterinary practices already undervalue the care that they provide and if they were to work free of charge all the time, they would most certainly go out of business. Even so, I know many veterinarians (and technicians) who have paid out of pocket to care for animals that have been abandoned or surrendered because owners could not afford care. Of course, this is because veterinary care providers are extraordinarily compassionate people and feel that it is their duty to heal animals whenever possible. Unfortunately, this compassion comes at a cost. When exposed to moral stressors on a regular basis, veterinary care providers are at risk of repeated psychological distress in the form of anxiety and even depression. A recent study reported that 1 in 10 veterinarians in the USA are currently experiencing psychological distress and depression is reported by as many as 2 of 3 veterinarians. Compassion fatigue is an all too common consequence, resulting in the loss of ability to provide the same level of compassion and care for others after repeated exposures to trauma.
So, how can we prevent compassion fatigue among veterinary care providers? While the purchase of pet insurance is on the rise and many practices commonly save funds to care for patients with curable illnesses whose owners cannot afford care, it is unlikely that moral stressors will completely go away any time soon. In the meantime, veterinary care providers must recognize the perils of practice and take measures to look after themselves. Appropriate self-care in the form of physical, emotional, spiritual, and intellectual renewal is essential for all care providers, as well as debriefing difficult situations with colleagues, friends, family, and counsellors. Veterinary care providers should also know that these experiences are normal and not something to feel ashamed or guilty about.
As Lynda Myers said, “I could walk a mile in your shoes but I know they’re just as uncomfortable as mine. So let’s walk next to each other instead.” In other words, let’s lean on each other as veterinary care providers and be advocates for the mental health and well-being of everyone in this amazing profession.