Assessing and Handling Toxic Veterinary Clients with Dr. Cynde Courtney and Josh Vaisman

Mary Schwartz:

Hi, and welcome to Simple, Interrupted, a podcast about radical veterinary change. On today's episode, we welcome Josh Vaisman, co-founder and lead positive change agent at Flourish Veterinary Consulting, as well as Dr. Cyndie Courtney, speaker, writer and international consultant for workplace conflict. We'll discuss ways to help deal with toxic clients and how you can support your staff's wellbeing. Hey, Cyndie and Josh, it's so great to have you on the podcast today. I'm really excited to discuss difficult clients with

you, one of the favorite topics in a veterinary hospital. But before we get started, why don't you each introduce yourselves and let us know a little bit about what you do within the veterinary space. Cyndie, if you want to kick us off.

Cyndie Courtney:

Sure. My name is Dr. Cyndie Courtney. I am both practicing small animal veterinarian in the Kansas City area. Been in practice a little over 10 years now. Before that I was a vet assistant. Before that I worked with clients at a pet store as well. I've been dealing with pet owners for a long time here over half my life now, and they have had their challenges that whole time. I got into doing conflict work. I'm the founder of an organization called The Jerk Researcher, and we help people who either have been told they're difficult by their team or dealing with difficult teammates. I got into that because I much like Phil Richmond, who you guys had on last week was the difficult team member in my own practice. And in addition to having the help of my team, like any good doc had to dive into the peer reviewed research to figure out how to do this better and am now bringing that information to our colleagues.

Josh Vaisman:

I'm Josh Vaisman. Really the only title that you need to know is I'm the president of the Dr. Cyndie Courtney fan club. I am utterly delighted and truly honored to be on a podcast talking with Dr. Cyndie Courtney. I'm the co-founder of Flourish Veterinary Consulting. We are an organization that exists for the sole purpose of taking what the science, so also nerd herd applies here, what the science tells us contributes to human thriving, specifically in the workplace context. We're really interested about how can work actually be a conduit to wellbeing instead of something that we simply survive to get to the good stuff. We take that science and we translate it in a way that hopefully veterinary professionals and organizations can use so that together we can craft environments of workplace thriving in the veterinary profession.

Cyndie Courtney:

I just want to say anyone who's lucky enough to have a conversation with Josh, you will see that this man lives what he teaches, and you'll feel that meaning and that validation in a single conversation. So also mutual fandom here.

Josh Vaisman:

Thank you, Cyndie.

Mary Schwartz:

It's always great when there's a lot of mutual admiration going around. I'm super excited to have you both on. I love approaching things from that data driven scientific point of view. And oftentimes when you have conversations with veterinarians, the first question is, but is there a peer reviewed study on that? It's helpful to have that in your back pocket, especially when it comes to things like workplace wellness and human behavior, for sure. Today's episode is surrounding, we'll call them toxic clients, difficult clients, those fractious folks that have the special note on their appointment notes that is written in code so that everybody knows that are going to be difficult when they come in.

How can you start out by training your staff to deal with these clients, not only the actual interaction with the client, but for their own wellbeing? What are some tips and tricks they can use in dealing with difficult clients, to keep themselves happy and psychologically safe?

Cyndie Courtney:

I guess I'll kick it off, which is, and I think you guys hit on this last week a little bit when you were talking about toxic team members, which is that we want to do some perspective taking. There's this wonderful term that I love to introduce people to called the fundamental attribution error, which is this idea that we have a psychological bias, which says that when we look at somebody else's behavior and we want to come up for an explanation as to why they're behaving that way, we're prone to explaining it by saying that's who that person is. We think it's their disposition, when it's usually more of the situation than we think. When that person comes in and they're super frustrated, it might be more because they have a new puppy and that's driving them crazy and up the wall and they're really exhausted rather than the fact that they're just a jerk.

So sometimes we leap too quickly to that jerk shortcut. Sometimes taking a step back and even just teaching our teams that that's something we're prone to doing and getting in the exercise and actually practicing perspective taking and saying like, hey, what else might be going on with that client? Why might we behave that way? And getting out of that tendency for us to even label people and to say, this is the difficult client. Maybe we are saying instead, this is how someone has behaved in the past. This is a behavior that we've found challenging or problematic, or we don't necessarily want to see again, but not necessarily labeling the person or trying to define them in that way.

Josh Vaisman:

What I love about what you just said, Cyndie, is that you took this very natural and normal bias that we all have. I've started to think about, by the way, this is just an aside, but this word bias, I've actually started to think of that as brain features. This is a feature of the human brain. It actually serves a really wonderful purpose. Being able to quickly make attribution and categorize things can be of benefit. And in the highly complex social interactions that we have every day, sometimes they lead us a skew. And what I love that you've just done is you've taken this feature of the human brain and you've been able to parse out that we can think about these interactions with people as who they are, or we can think about these interactions with people as how they're behaving.

And that feels like such a subtle little thing, but oh my gosh, it changes the perspective and it changes the way that we're likely to respond to that situation in really, really powerful ways and empowering ways. Because if we're trying to change a person, we're probably just going to feel like that's an impossible task. But if we're trying to alter behavior, well, we all know, every one of us has been involved in training a dog or a cat or a bird or some other creature. We know we can do that. And that's actually a pretty empowering stance to be in.

Mary Schwartz:

We even see pets train their parents to give them more food. Certainly human training is very, very possible. It's one thing to perspective take. It's one thing to make that leap. I think it's an entirely bigger challenge, a bigger jump to now diffuse a situation with someone who is actively frustrated, upset, angry. What are some ways that we can, A, genuine by using perspective taking? Because obviously if you're not genuine, that's going to come through. But B, how can we start to wind that person down a little bit and really get to the core of what their problem is?

Josh Vaisman:

I'm going to throw something out that will be an oversimplification that Cyndie will probably be able to make more robust for all of us. I think that if we can find a way to lean into what I think of as cognitive empathy. That's just another fancy way of saying perspective taking, but trying to include that person in the perspective taking. And it's reaching out in a way of trying to get to some level of understanding. Now I specifically put that word cognitive ahead of it because I am not looking for emotional empathy in these situations. I think we do that way too much as it is that this is my personal take. We tend to be empathic people in this profession. It's a caregiving profession. And practicing that level of empathy, really truly getting to the same emotional state that somebody else is, or at least feeling their emotional response, can be really beneficial in some areas in life.

It can also be incredibly psychologically expensive. And if we're doing that all day, every day, we're we're going to run out of steam. But I think that cognitive empathy is something that we can absolutely do. It's not forgiving or allowing, It's not condoning the way that somebody's behaving. It's not excusing the impact that their behavior is having on us. It's absolutely accepting the way that you're treating me right now is hurtful and I don't like it. And I'd like to understand how we got here, because I feel like if I can understand how we got here, maybe I can help us navigate beyond it. If we can open up the lines of communication, Cyndie, I can see that the situation with your dog today and how long things have been taking, I can see how much that's upset you.

Can help me understand a bit more about how this has happened and how it's impacting you, so maybe we can talk about ways to work through it? That's a way to get to that cognitive perspective taking that that allows that person to be a part of that conversation.

Cyndie Courtney:

I might take a little bit of a different direction and get into some of the nitty gritty of what I do. And I love Mary that you talked about our pets training us, and even Josh, you talked about this ability to leverage some of those skills we have in the animal profession to then how we work with people. Because I think we do this all the time. You mentioned Mary, the fractious people, right? Well, we deal with fractious animals all the time. So how do we start applying these skills to people? Well, I think the first thing that we often do when we're dealing with fractious animals is we get ourselves in the right head space. We've got to calm ourselves down first before we can encounter this person who's in a difficult head space. I call it my kiddies in head space when you want that calm cat.

You can't go and handle a fractious cat if you're super stressed out. Nobody's going to be safe. You got to take that deep breath and get yourself into a good place. And we know that somebody else being upset and emotional with us, our brain registers that as a physical threat. It uses the same parts of our brain as the classical pain matrix. Our brain is like, this is bad. To some degree we've got to shut our own amygdala off first. And so naming what you're going through and saying, it's okay, I'm feeling stressed and that's normal because this other person is upset, can give yourself some empathy so you can calm down first. And then I think using, again, some of those same skills, thinking about your body language, thinking about not responding and reacting at that slave level of threat that other person is responding is something that's really, really helpful.

Mary:

I think Josh hit on curiosity. Just that intention to understand is a really helpful tool to just say, hey, using those history taking skills that we have. Tell me more about what's going on there. Tell me what's happening. Getting that understanding and empathy and treating somebody equally is really, really helpful. Understanding, just like when we're dealing with a fractious cat, you do not have to keep pushing. You can stop, You can say no. Sometimes deescalation requires taking a step back. And some really good things to do with humans that we don't necessarily have to do with animals is connecting in that moment and saying, hey, this is really important to me so I know that I want to be able to think about this a bit more rationally and I'm feeling a little defensive right now. Can we regroup, say in a day and talk about this a little bit more?

Being able to take a step back and not talk to each other when everyone's screaming at each other can be really good for everyone. But making sure you connect with, hey, this is important to both of us, are some of the just logistical skills that I think are really helpful in some of those moments and I hope will serve some of the folks listening

Josh Vaisman:

If I can play off of that a little bit. These are fantastic. I think what's sort of underlying a lot of what you're sharing, Cyndie, is I think oftentimes where we run into trouble with this is that we're conflict avoidant. And so that avoidance part takes over and we don't prepare for it, because we think that we can just of avoid it at all costs. But it does inevitably happen. And certainly over the last probably three, three and a half years, it's happened more than in the past. We're not going to actually be able to succeed in completely avoiding these kinds of interactions. Let's prepare for them. I love all of the things that Cyndie is sharing there. Those are all tools that you can prepare for in advance, when, not if, when I have an upset client, what's going to be my go-to sort diffusing and calming tactic?

Maybe for me it's going to be, when I get somebody, Mary comes in and she's like raging pissed and I'm standing in the lobby listening to her, my first tactic is going to be, hey, can we go step into this exam room so I can give you the attention you deserve? I can think about that now when I'm not in front of an upset client, I can write that down and plan. That's going to be my first step. My second tactic will be, if that doesn't work, then I'm going to take a breath and say to Mary, I recognize that you're upset, I'm feeling upset now too, and I don't feel like I can help you in the way that you deserve. Like to use the language that Cyndie just shared, can we revisit this later in a phone call? Can we connect tomorrow? Whatever it might be.

But pre-planning those tactics can make them a lot easier to access when your amygdala taken over and you're having a very normal and healthy reactionary response to a perceived threat in your environment.

Mary Schwartz:

And taking that space gives them time to calm down as well. You might find an entirely different person on that phone call the following day than you did that day standing in the clinic, getting them out of the environment that's upset them, giving them a chance to breathe, maybe get some sugar in.

Josh Vaisman:

Yeah, right.

Mary Schwartz:

A little bit of Southern. But it's huge. Changing up the environment itself can make such a big difference. And one of the things that I want to call out that both of you guys talked about was really listening and acknowledging what that person is going through. I think active listening is such an important skill, but it can be a difficult skill too, because it can come across as patronizing sometimes. How can we perfect that skill? How can we work on that skill so that we are empathetically and actively listening, but we aren't making somebody feel like we're just regurgitating what they said at them?

Cyndie Courtney:

I personally go back and forth on this. I hear, and I've found different things work with different people. For some people actually literally using the exact same words that they have used actually does work really well, saying, I hear you are just so frustrated. And putting some emotion into the words that you are hearing them say and matching them emotionally, not exceeding their emotions, but matching them emotionally can really help. For other people, especially if that first attempt doesn't work, rephrasing can help. Or sometimes even getting at the underlying need that you think might be driving that emotion saying, if I had been in a situation where X, Y, and Z had happened, if I had come in and I'd been waiting the whole day for my dog to be seen and I got here at five o'clock and found out that they still hadn't been seen, I would be super frustrated and upset.

Being able to connect with the experience that someone is having and the needs that they have that are connected to their emotions can sometimes hit that extra level and help them feel heard.

Josh Vaisman:

I totally agree. I think that's incredibly insightful advice. I hear, Mary, what you're saying, when some of us have this thought or maybe even experience that active listening, just sort of retorting back what people said might come across as I'm mocking you or something of that nature. In my experience it's really pretty rare. If we can prepare ourselves for, when somebody's at that level of tension, when somebody's that anxious or upset, they're not in a rational place in their mind, they're reacting. They're reacting to a situation in which they feel they have been harmed, some need has gone unmet. And if we go into a conversation or an interaction with somebody that's in that place thinking that we're going to have the right words or the right response to immediately diffuse them, is setting ourselves up for failure.

An example that I can share of this, I remember I tell this story frequently in talks that I do. I had this experience with a client of ours, and you can't tell on camera here, but I'm not exactly the world's tallest human being. I'm like five foot nine when I'm wearing good thick shoes. And this client was thoroughly off with us, to the point where he had come in, sternly asked the front desk to print out his entire medical record history for his dog that he had been coming to this hospital for 25 years. He had a ton of records. And then requested to speak to the owner before he switched practices. You can imagine how upset this guy was. I walk into the exam room to go talk to him. This man is like six foot three, he's towering over me. He's standing in the middle exam room. I reach out my hand to introduce myself. He does not shake my hand. He just launches into a tirade, angry, red face, standing over me, wagging his finger at me, raging pissed off.

And of course my immediate response was defensiveness. And I had to try and find a way to calm myself. I'm using these breathing exercises. He finally gets done with his tirade and I did what Cyndie suggested to do. I said, I'm hearing these things. This is what you've shared of me. I can see how that would make you so upset. Help me understand what might be a path through this. And what he did was he launched right back into the same tirade. You're damn right I'm pissed off. And then he started saying the same exact things. When I share that story with people, with audiences, I watch their facial expressions, because a lot of times they'll be like, you just got done telling me that active listening's going to help, and now you're saying this guy is just as pissed off and still yelling at you.

Hold on a second. 10 seconds, not even 10 seconds later, he sat down. That was a physical change. A physical change. This man was standing over me. He was saying a lot of the same things, but he sat down. I mirrored him. I sat down in a chair in front of him and leaned forward and kept listening. The pace slowed down, his volume slowed down. And while he was repeating a lot of the same things that he was saying before, he started telling me more. And you see what had happened was, this guy had lost his wife three years prior. Nobody, I didn't know that, I'd only been at the hospital a year and a half. They didn't have kids. This dog was their kid. And when he lost his wife, he had become obsessed with the care of this dog because losing the dog would feel like losing his wife again.

Of course, none of us knew this, but to us it looked like he had become one of those clients. The high maintenance, like you said, the one that you put the coded message and the pims that only pops up internally and doesn't print out on the medical records. So everybody in the hospital knew this guy was the high maintenance client and we had grown tired of his needs. His neediness. His perception of that was we didn't care enough about his dog and damn well he was going to go find somewhere that would. Giving him that opportunity, just using that reflective listening and standing firm in his response for just long enough for him to calm himself down, opened up to have that conversation. And now we got to this level of understanding. That man remained a client at our hospital. We were able to get him to a new doctor who was a lot better suited to his sense of need and it all worked out.

I guess I would say that don't come away from this conversation today thinking that Cyndie or I or Mary or anybody's going to give you that one thing that's going to just turn it all around every time. That's not how conflict resolution works. You've got to prepare yourself to stand in the face of it, as uncomfortable as it is for long enough for it to set in.

Mary Schwartz:

That's an extremely powerful story. I think it is interesting, the underlay that the dog was his and his wife's kid, I don't think anybody would hear that or understand it and not immediately have their heart go out to this widower. You just need to get to that bottom layer and figure out what's driving the need and how it can be helped. There are always going to be on occasion those clients that there is no underlying need or the underlying need is unreasonable and cannot be met. When do you make that call? When do you say, I think that what you need is not something we can provide.

Cyndie Courtney:

I think to some degree there's a set of boundaries. You have your boundaries for your individual organization as to what is okay and what is not okay. And you try to be as flexible as you can within those boundaries and beyond that you know you're not. And that is going to be a little bit different for every practice. For some practices, a single time that somebody yells at a team member, for some practices that's enough and they say, okay, you're not here anymore. I think there are certainly quite a number of more practices that are going to talk to somebody, give them a chance to explain themselves and then say, okay, let's move on from here. Many times they'll also say like, hey, could you please apologize for that team member? I think for me what I'm looking for is what's okay to us? Does that match with what's okay to the client?

Because we've all been in a place where we have done something that we knew was not okay. I think the point is, do we recognize after the fact that it was not okay and we work to make it right or does this client still think what they did was okay and they're going to keep behaving in that way that is outside of our boundaries. I think another thing that's important to think about, and hopefully we'll get to talking a little bit about too is, when we're helping protect our team, how clear are we about those boundaries ahead of time for those clients? And if you sit down and you talk about what are our values as a practice, what is important to us, it's going to be a lot clearer what those boundaries should be.

There was an amazing technician, Chelsea and I, goodness, I meant to grab her practices name, hopefully Mary will let me put it in the show notes, who talked about when they set out a client code of conduct, they sat down and looked at who was their A client and what did their A client look like. And they actually worked backward from that and said, what do we want our clients to look like? And then worked backward from that to figure out what kind of behaviors they did not want. I thought that was genius.

Josh Vaisman:

I love that.

Mary Schwartz:

I love that. That is amazing.

Josh Vaisman:

That's incredible. Wow. What a great resource. I will add to what Cyndie is sharing there and say that I've become a big fan of two statements. I'll start with the latter and go to the former. The latter is sometimes we have to liberate people from our mutual discontent. Sometimes there's just no way that we're going to be able to cross that bridge. However, I feel very strongly that we shouldn't jump to that until we've given them the gift of the opportunity for self-awareness. And the simple truth is that a lot of us, when we get into this very narrowed, limited brain reactionary, amygdala driven state, we just don't get the impact that we're having. We're feeling this need to have ourselves heard and have some need be met, and we're acting in a way that it's a bit of a fool.

And all of us have done it. All of us have done it. Everybody on this call has had an experience like that. We've all had moments in our life that we look back on a bit sheepishly and very embarrassed by and wish that we could have taken it back. And so giving people the opportunity to take it back first is important. So to play off of what Cyndie was saying with the boundaries, I'm a big fan of, if somebody's really acting in a pretty rational and hurtful way, establishing a boundary along with that empathy, along with that active listening. Cyndie, the things that you're saying right now to me feel very hurtful. And when you don't take my feelings into consideration, it's really difficult for me to want to take care of you.

Now I can see that you're upset. I can hear what's happened, You've shared this with me. I understand why that would upset you. Can we talk about a resolution here. And giving people that, establishing that boundary, I'm not going to tolerate being treated this way and I'm here to help you. That's a gift of the opportunity for self-awareness. If somebody's still pushing hard or pushing harder at you at that point in time, well yeah, then maybe you have a decision to make on if this is somebody worth trying to diffuse.

Cyndie Courtney:

I think we should all have the opportunity and our clients should have that opportunity in order to create that psychologically safe environment, we should have that chance to make a complaint and to express our opinion. And that should be okay and we should be able to do that respectfully. Where we get to places where it's not okay is when we're either using violence, when we're trying to coerce somebody into doing one thing or the other, or when we get to a place where we're using contempt. We basically believe that we are better than the other person and we're expressing that. And while we can't police somebody else's brain, there are also those physical symptoms we start to see like the rolling our eyes.

Often there are phrases we tend to hear in veterinary medicine that we recognize frequently, that we can start asking clients not to use. Like, can we both agree that we're not going to talk about who's willing to pay for what in terms of the care of this animal as a signal of who cares about this animal? Those are some signals. If I may, I just want to again mention Chelsea Jankowski at Family Pet Health Center in South Bend, Indiana is the one who has those insights into the client code of conduct.

Speaker 4:

So cool.

Mary Schwartz:

That is amazing. I also want to point out something about what Josh just said, which is really important, which is how you phrase things. If a client is in your face yelling at you, if you just yell back, you can't treat me like this. It's true, 100% true, but it's a very different way of approaching it than to say, what you're saying right now is really hurting me and it's hard for me to help you when you are actively hurting me. I think that it's really important to include the way you might want to phrase things in that action plan we talked about earlier for how you're going to handle these situations. Because in that moment, your emotions are going to be so high that your gut reaction is just going to be like, you can't talk to me like this. Get out.

I think that's a really important shout out there. Now, what is the effect of these kinds of clients on our teams? How can we keep our teams safe? And the process of developing a client code of conduct for me seems like a natural outcropping of a solid culture and something that every team member should be able to act upon. What do you guys think?

Cyndie Courtney:

I dork out on this data, it's my bread and butter. My favorite study is one out of Israel actually. This is a placebo controlled study, which I think is fascinating in this area especially. But they took two NICU teams and they were in a training simulation, but they exposed one of the teams to rude feedback from essentially the parent. They had this, not an actual baby, but in the training simulation. And they either got rude feedback or neutral feedback from this parent. And they found that the teams that had received rude feedback did significantly worse on their diagnostic and treatment performance, especially because they weren't communicating as well and they weren't sharing information or they weren't sharing the workload with each other as much.

And so I think a lot of times we know that there's an emotional cost and we know that even that there's that physical cost to us of having these negative or toxic workplaces. We don't necessarily think of is that there's also this cost to our patients and it's real, it's there. And we have actually some really good, sometimes even better science to support that than we do some of these emotional and physical costs. What is a little frustrating is that a lot of times incivility and rudeness, the incivility and rudeness for both clients and team members get slumped together. So it's a little bit hard to parse out. And the data specifically from our field is more on the line of focus groups and surveys.

It's not super solid, but we do have at least some information out there that suggests exactly what you'd expect, that people who are experiencing incivility or client complaints are seeing negative emotions, stress, they're feeling more depressed, they're disengaging from clients or withdrawing from clients and that they're feeling more inclined to leave the veterinary workforce altogether. So if you want your team to stay, you probably want to protect them to some degree from these kinds of behaviors. And the good news is, in those focus groups, they're saying that having the support of your team does seem to be one of those mediating factors.

Josh Vaisman:

That's awesome. I love listening to you talk about data. I really do.

Cyndie Courtney:

Josh and I are data dorks. We love research.

Josh Vaisman:

We are definitely data dorks. A bit on the sort of informal or subjective data side. I've been talking about this particular topic with veterinary professionals throughout our community for the last two and a half or three years now, as we can imagine since on onset of the pandemic in certainly beginning in mid 2020 and onward, we hear more and more about challenging client interactions. And so when I do these talks, we use a digital polling tool. It's an anonymous polling tool and we ask everybody in the audience, generally speaking lately, do you feel like you've been having more, less, or about the same difficult client interactions than in the past? And pretty unequivocally, 99.9% of the time people are saying, that column of more is the tallest column by far. It's not unusual for me to have a group of 50, 60, 70 people and they all say more. We're definitely experiencing it more.

The next question that I then ask them is, if you're being honest with yourself and you can take a step back and take a global perspective, for every one of those difficult client interactions, how often do you have a good client interaction? And again, the vast majority of people say, actually, if I'm really being honest, the vast majority of the interactions that I have on a day to day basis are at least pleasant, if not good. And so my takeaway from that you might think is, okay, just look on the bright side, things aren't that bad. That's not the takeaway, that's not the message. As Cyndie, just very, very eloquently shared with us, every one of those interactions that is hurtful has a distinct and deleterious impact on the individuals involved in it, both primarily and secondarily, it's not just the person who's listening to the screaming client, it's everybody else on the team as well.

That's real. And that impact because of a negativity bias or negativity feature, if we're going to use that language today, that feedback is likely to stick longer. It's going to take a lot longer for it to dissipate and disappear. The response from it, the reaction from it. That's all real stuff. I'm not trying to dismiss that. Think that there are two things that we can do to help protect the wellbeing of our team. Number one, empower them with these kinds of skills. Let's make this a core part of what we do. Let's create action plans for how we will handle these situations and let's see what we could do to tailor it to each individual in the team. Maybe you've got a Cyndie Courtney on your team and you feel very good that Cyndie can really handle most of these head on, but maybe Josh actually needs to be able to defer that to somebody else, and let's give him the language and the tools and the support to be able to do that.

So that when those inevitable difficult interactions come up, we've got at least enough skills to handle them better than we have in the past. And then secondarily, let's use that untapped resource, that untapped resource that is the majority of our clients who actually really like us, who really appreciate us, who have so much gratitude to share and we just aren't giving them enough opportunity to do so. That is a resource that can fill the resiliency cup that makes it a lot easier to deal with those inevitable, normal, difficult ones that come up. Let's give those good clients more opportunity to share with us how they appreciate us and why they appreciate us. Let's literally ask them. I think it would be great if at the end of every appointment we asked every client, thank you for being your pet in today. Here's your invoice Just really quick before you leave. Who helped you today? Or how have we helped you today? Or I've noticed that you've been here before. What keeps you coming back?

Let's just ask those kinds of questions and see what responses we get. Because every one of those good responses, man, that's going to give us fuel to make those difficult ones a little more tolerable.

Mary Schwartz:

There's a really interesting, the Gottman's who do marriage and relationship research, is that where you were going Dr. Courtney? I love it.

Cyndie Courtney:

I was not going there next, but I do love the Gottman's.

Mary Schwartz:

Okay. The Gottman's are fantastic. I've read through one of their books recently and one of the things that stuck out to me is that by actually connecting with people, your partner in this instance, but in this case, like you said, Josh, your clientele and creating more and more good experiences for yourself, it makes the bad ones easier, and you draw on those good experiences in the bad moments, which makes them less impactful, shorter in length, things like that. Advice that applies not only to your interaction with clients but also maybe significant relationships in your life.

Josh Vaisman:

Yes. Yes.

Mary Schwartz:

We're helping everyone's problems today.

Josh Vaisman:

We're helping everybody do that.

Cyndie Courtney:

Absolutely. They actually, just fun fact, they have something on the Gottman blog called the sound relationship workplace, where they basically translate all the great gottman relationship stuff into workplace stuff. It's amazing. Mary, you had mentioned as well, can we translate this into the client code of conduct pieces and how do we use that? If I may touch on that. I think, again, getting to this values piece and saying how can we almost be preventive? How can we stay ahead of this for our team? Both having a plan for how we're going to respond to this, but also what can we do prevention wise in a way. If we know that there are common areas of frustration for our clients, are there things that we can do to stay ahead of these conflicts even happening in the first place?

I think the first thing is to even just set client expectations and to say, hey, here's what we would like from you when what are those most common areas of concern for us? Things that we would either like clients to start doing, things we would like our clients to stop doing, and can we put together a document that talks to clients about, hey, here's that positive request. If you think of that, what we want them to stop doing first, give them a replacement behavior. Just like if you were training a dog, it's a little harder to tell them to stop barking. It's a little easier to train them to sit quietly on their little mat, right? So if you think of a don't, turn it into something they can do. And then we also want to think about, what are those things that that clients are hoping for from us?

A lot of times bad behavior comes from clients feeling stuck or trapped. A story I like to tell with his permission is when my mother was pregnant, there's some confusion about whether it was me or my brother, but my mother was having a very severe gallstone attack while she was pregnant and in severe nine out of 10 pain and nobody was coming to help her. And my dad got increasingly, increasingly more furious, scared, concerned, and he had no idea who he was supposed to talk to or when somebody was going to come and help him. And when he would tell this story, he would tell it was some pride that he went and he found a doctor and he dressed that doctor down. Well, if we don't give people passive least resistance to address their concerns, we end up with an explosion.

It's like that fractious animal who feels trapped in a corner, they're more likely to bite because they don't have a path of escape. So let's think about those things that are frustrating our clients, say when it comes to costs, do we have it posted really, really clearly on our website, what our payment policies and options are? I've seen practices that have it right next to the appointment button. It's the payment options buttons, right next to it. We know 80% of complaints that go to veterinary team members are concerning costs. We can't make our services free, but we can help narrow that gap a little bit. Concerns around availability, concerns about professionalism. And also whenever we ask something of our clients, so if we're really frustrated about clients no showing for their appointments, are we willing to hold ourselves to a similar standard?

Even if it's not going to be exactly the same. If timeliness is something that's important to us and we say we'd like you to let us know 24 hours in advance if you can't make your appointment, what are we going to give on our end as far as timeliness? Can we at least let clients know that if you have an urgent care appointment that's not an emergency, we will work you in the same day. Or even just explaining to people why you have that timeliness policy. So doing something to show that the reason you're asking for these things is because of a shared value and not just because you have the power to do it. We often underestimate how scary we are to our clients. We have power and knowledge that they do not have and they can feel very, very small. And when they feel small, that is also often when they're more likely to lash out.

Let them know what their rights are in your hospital and you may end up with less conflicts that comes out of negative emotions and fear as well.

Mary Schwartz:

Absolutely. I think that's something we lose sight of so quickly and so easily. When you have all of the knowledge and you use it every day, it just seems so normal to you. But every client that walks in your door doesn't have any of that knowledge. And that's scary. Increasingly, we're seeing that people are seeing pets as part of their family and not just an owned animal. They are a cherished family member

and this person is coming to you with no control or knowledge over their pet's health and the length of their life.

Cyndie Courtney:

People often don't know their own medical rights even in today's age. And so they don't necessarily know about things like their right to informed consent or their right to decline care. And in human medicine they even consider it a right to know what the hospital's policies are, so that they can be in compliance with those policies. How often are we letting clients know on a regular basis what our policies are about no-shows, what our policies are about payment? Are we making sure that clients really know what those are?

Josh Vaisman:

That's awesome. I love what you were talking about. You were saying something along the lines of if we're going to ask something of our clients, like timeliness, we're going to expect you to be on time. What are we willing to give as well to meet that? And I was thinking to myself, wow, I never really thought of it this way, but I feel like what you're saying and I agree, is a request without the willingness of reciprocity doesn't feel like a request. It feels like a demand. And people who are told what to do don't tend to respond so well. We also have another feature of our brain called reactance and we tend to dig our heels in and then when things really go bad like what your father experienced, we go and we dress people down.

I'm almost wondering if with the client code of conduct, it would be nice also to have a client bill of rights attached to it as well. This is what we expect of you and this is what you can expect of us. So there is that sort of reciprocity.

Cyndie Courtney:

I have some templates out there, and usually I have it set up as exactly what you said, what you can expect of us, what we expect of you. They sometimes urge caution on the rights and responsibilities language. Because sometimes that can imply legal obligations that we might not necessarily imply. Because the veterinary client patient relationship is often an at will legal entity, right? I'm not a lawyer, so I will encourage folks to go seek out appropriate legal counsel to that end. So if you do provide clients with this, I wouldn't necessarily recommend having a signature line on it, Because we don't want to imply a contract where one doesn't exist. But yes, absolutely. I even recommend folks structure it as a table so they can see exactly where there's what we expect of you, what you can expect of us.

And this was actually inspired for me by my local hospital, had a rights and responsibilities document that made it very clear that you were getting something and you were giving something and those match that you were expected to be kind and respectful, but you could also expect kind, respectful treatment in turn.

Josh Vaisman:

That's great.

Mary Schwartz:

Is that template something folks are readily able to access, Dr. Courtney? Or is it something that we can link in the show notes for folks to check out?

Cyndie Courtney:

The template unfortunately is not, I think that one's gated with AAHA. But AVMA did post a relatively good article that is available for free in their AVMA news and that we can definitely go ahead and post in the show notes and it does a pretty good outline of that full presentation.

Mary Schwartz:

Great. Perfect. We will make sure to get that in there so that people can access that. Before I let you both go today, I just want to add a super easy peasy question at the end. It's going to only take a moment. Now the internet adds a layer of complexity to this. So now we have people who can post from behind a screen and it feels way more impersonal and it's way easier to be mean or sometimes outright cruel in these comments and reviews that people leave on hospitals. How can teams respond to those in a way that's professional and upholds boundaries and continues to support their staff and their staff's wellbeing?

Josh Vaisman:

I will tell you personally I vacillate between how I feel about this. I'm really curious to get Dr. Courtney's thoughts on this. I go back and forth between feeling like I'm just not going to engage with any of that. I challenge anybody to tell me about a time when an argument was successfully settled through a Facebook post. I just don't see the value in it. And engaging in it is for me I'm personally going to struggle to let go of hurtful comments online targeted at me, especially when they are not steeped in any level of truth. I am going to struggle to let go of them far longer if I actually engage in the conversation. To me it seems like the lesser of two evils to just be like, that sucked. That person is ridiculous and I'm not going to engage. That's one side of it. And then the other side of it is, I think there's enough of it happening now that maybe there is some value and standing up for ourselves.

And so I do see, I run in a lot of circles with practice managers and I do see a shift. To me it looks like a lot of practice managers are taking an active role in responding to some of these posts and I'm softening on my stance against that now. I guess I would encourage if you do feel that you have to respond, for whatever reason, write your response and then take 24 hours before you click send. Come back to it 24 hours later, reread it and challenge yourself to ask, if I was a regular Joe on the street that came across this post and read this person's lash out and this organization's response, how would I feel? And if you feel pretty darn good about it, then maybe you can send it. And if you feel like, I'm not sure what that person would think about this, then maybe you want to rethink it or edit it at least. I guess that's my advice. But I'm dying to hear what Cyndie has to say about this.

Cyndie Courtney:

As a good veterinarian I know when to refer. I know there are some really great experts on this and I got to tell you. Dr. Caitlin DeWilde, The Social DVM has just put out a book that has two whole chapters to help you with this.

Josh Vaisman:

That's great.

Cyndie Courtney:

All of chapter 11 of her book, Social Media and Marketing for Veterinary Professionals is online reviews. And she has a whole chapter 12 on cyber bullying. It's a very, very helpful resource I think that helps people both figure out some of these emotional pieces, but also some of the logistical pieces, especially if things start spiraling out of control. Because they can get really bad and really scary really fast. I think it's helpful to know what some of those resources are. I think one of the best pieces of advice she has there is wherever possible to take it offline. Figure out if you know that client, who that person is, if you know who that patient is, see if you can bring it to a higher fidelity medium. So can we get them on the phone?

If you cannot, then you definitely probably want to respond in at least some way that may be saying, hey, we take your concern seriously, can we talk about this offline? So trying to take that in a different direction. If they still fail to engage with you, then potentially outlining your desire to engage and address this concern in a way that's in line with your boundaries. But again, that hasn't been possible. She talks a little bit about how to some degree, at a certain point, the audience is not this client, because to some degree, if this client wanted to fix the problem, they would engage with you. At some point the audience is anyone else who would be reading this review. And the goal is to show your personality as a practice and your willingness to try to address the concern in as professional and civil way as possible. I think there is potentially a lot of value to that. I think that's my long short answer.

She also has some really great resources. I think just as Josh has said, trying to get that positive feedback regularly, but also to monitor for potential concerns before they arrive. How often are we soliciting the concerns? Or even if you're trying to build a code of conduct and you want to know what is it that we're doing that clients wish we could stop doing? How often are we actively doing a focus group or are we looking at feedback from every single client to say, what could we have done better today? Or would you recommend us to a neighbor or a friend? Why or why not? So figuring out that information ahead of time so that you can address it. I know it can be scary to potentially open yourself up to criticism that way, but it can be a lot scarier to end up on the receiving end of one of these things blowing up in your face later down the line.

Mary Schwartz:

Well I want to thank both of you so much for your time today. This has been a really engaging conversation. I'm sure we could keep going for a lot longer, but we'll call it quits for now. Thank you both very much.

Josh Vaisman:

You bet. Thanks for having us.

Cyndie Courtney:

Thank you so much for having us.

Mary Schwartz:

I'd like to thank Josh Vaisman and Dr. Cyndie Courtney for being our guests on today's episode, as well as you our listeners. We appreciate your support and hope you'll subscribe to our podcast, Simple, Interrupted on your favorite podcast app, and share it with your fellow veterinary colleagues. This has been a co-production of Evergreen Podcasts and PetDesk. Learn more about PetDesk and how we're helping clinics guide their clients to better care at petdesk.com. A special thanks to the PetDesk team and to all of the veterinary professionals out there. Thank you for all you do for our pets as well as our evergreen production team, producers, Leah Haslage and Nijah Golliday and audio engineer Gray Sienna Longfellow. I'm your host, Mary Schwartz. Thanks for listening.