Conflict is a word that most of us shudder to say and many of us prefer to avoid at all costs.  In a survey published by DVM360 in 2013, 51% of veterinary team members said that “most of us avoid conflict when we can but engage in difficult conversations when necessary.”  So, for something that is so commonly avoided, why would it ever be considered a good thing?  The reality is that conflict is inevitable.  It would be impossible for a veterinary team to function without any differences in clinical knowledge, work approaches, values, opinions, or personalities.  So, it’s best to just accept that conflict will happen, it’s just a matter of when.  Having this mindset is important, because addressing and resolving conflict is imperative to team effectiveness.  When conflict is handled poorly, and the focus is on the people involved instead of the issue at hand, the team can become divided and patients can suffer.  Poorly handled conflict can also erode team morale.  However difficult it can be to handle conflict, avoidance is not the answer.  When people self-censor in order not to “hurt someone’s feelings” or “rock the boat”, disaster can occur.  This is referred to as artificial harmony and is the equivalent of team paralysis.  Team members become so reluctant to cause a problem by discussing a conflict that no forward progress is made.  Often so much energy is spent “walking on eggshells” or not “speaking one’s mind” that it distracts from providing appropriate client and patient care.     Team members must accept that conflict is normal and does not necessarily lead to problems.  While there will be some personal discomfort during the exchange of ideas, conflicts can often be resolved in a timely manner and with new ways of thinking stimulated within the team.  Allowing team members to express their opinion and be heard by their peers facilitates buy-in with decisions.  Even when the final decision is not the choice of every team member, they are often more accepting of the choice because their voice was heard.      Let me give an example of information conflict and how it can best be managed.  Information conflict involves differing ideas, views, and opinions (e.g., how to manage a case, what information to provide a client, when to perform renovations or software upgrades).  It can also involve a disagreement about the content of a decision (e.g., a newly hired team member).  While someone might not agree with the viewpoint shared by another team member or a decision that was made, it is best to engage in an open conversation that invites sharing of information and ideas in a non-confrontational way.  During these conversations, team members are urged to use arguments that are precise and as factually oriented as possible (e.g., reference to published literature or personal experience).  Arguments that persuade primarily based on emotion (e.g., I feel that my way is the right way) should be avoided.  If team members become defensive, they concentrate more on defending their point of view, rather than openly evaluating other views.  Defensive attitudes prevent team members from gaining new insight and understanding and create further divisiveness among the team.  When an argument turns into a personal win-or-lose “word war”, team members are no longer concerned with resolving problems rationally.   Instead, inquiry and accurate information must be shared in the hopes of demonstrating a desire to understand the other viewpoint and focus on factual information that could affect the situation and those involved.  Team members are encouraged to contribute what they know, feel, and value.  Team members must also be aware of timing by not wasting time or introducing issues when there is no time to work on them.  Time is a precious resource and should be regarded as such by all team members.  Open body language and open-ended questions are important so that team members feel encouraged to provide information freely.  Nodding heads, keeping an interested facial expression, and saying “that’s so interesting, tell me more” are good ways to get the most out of these interactions.  And most importantly, remember that failure to reach consensus is not an actual failure.  Two team members can disagree on the management of a case, but still come to understanding of each other’s reasoning and accept that there are many ways to manage different cases with pros and cons for every scenario.  So, the next time you find yourself disagreeing with a fellow team member or colleague, smile and say “that’s fascinating, I’d love to hear more.”  This will serve to enhance openness and collegiality within your team and prevent the artificial harmony that comes from silently walking away.  Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals.  She facilitates wellness workshops, boot camps, and retreats for veterinarians, technicians, students, and other veterinary team members.  To sign up for newsletters containing information regarding these events and veterinary wellness topics, please click here.  More information can be found at www.criticalcarevet.ca.        

I attended the Art of Leadership for Women conference last week and had the pleasure of listening to Tiffany Dufu speak.  Tiffany is the founder of a peer coaching company for women and an advocate for the advancement of female professionals.  She is also the author of Drop the Ball, a manifesto and memoir about adjusting expectations and enlisting the support of others to live a more meaningful and engaged life.  Tiffany was my favorite speaker of the day thanks to her authentic delivery, humorous anecdotes, and practical examples of how to let go of unnecessary tasks and recruit help from others.  Throughout the session, she shared what she referred to as “Tiffany’s epiphanies” and I felt so inspired by these wise words that I have decided to write some of them in this blog. Tiffany believes that life-changing events such as the birth of a child, a promotion at work, or a life-altering diagnosis can lead to what she refers to as “ball-dropping”.  To “drop the ball” means to “make a mistake, especially by failing to take timely, effective, or proper action”.  We’ve all been there.  Even those of us who have never had a child, been promoted, or had a life-altering diagnosis.  In my case, I hit the wall and felt utterly and completely burnt out.  I was no longer able to meet deadlines, adequately prepare for meetings, or reply to social requests in a timely fashion.  I was dropping the ball.  When this happens, Tiffany advises the following: 1)     Let go of expectations 2)     Get clear about what matters 3)     Engage another person’s help So, let’s break each one of these down further.  The first is about letting go of expectations about who we are supposed to be: whether it’s the perfect veterinarian, sole practitioner, independent practice owner, tenured faculty member, or hardest working associate.  And those are just the professional roles.  Many of us also have high expectations when it comes to our personal roles: being a perfect mother, supportive friend, responsible daughter, attentive sibling, fun aunt, and the list goes on…  Tiffany urges women to reflect on what it means to be a good (fill in the blank role) and where those expectations come from (i.e., TV, advertising, upbringing, peer pressure).  The important distinction is not what others think is important, but what you feel is most important to fulfill that role.  She even suggests writing a “new job description” for who you want to be in that role.  For example, I recognize that being a perfect veterinarian who knows everything about emergency and critical care is not possible.  Instead, my role in practicing veterinary medicine is to connect with my clients and colleagues in an authentic and meaningful manner and to practice emergency and critical care to the best of my ability.    The second part of dropping the ball is about getting clear on what matters.  Rather than thinking about what women are supposed to do, Tiffany urges women to get clear on what the best use of their time is.  She uses the example that when a request is received to do something months from now, to consider the following: if you could do it tomorrow, would you want to?  When I speak to veterinarians about the power of saying no, I often say: if it’s not a heck yes, then it’s a no.  So, when you think about how you want to show up in your life and what is most important to you, feel empowered to say no to the things that do not resonate.  For example, I am often asked to work emergency shifts, which I can do, but do not align with my passion for clinical teaching and critical care.  Therefore, while it can be difficult to say no, I am reminded that if I say yes, I will likely end up regretting giving up my time that could have been spent on something else that is more meaningful to me Finally, the last part of “dropping the ball” is about soliciting help.  As veterinary care providers, we are so used to helping others, that we often resist or do not recognize when we would benefit from receiving help.  There is a certain vulnerability in admitting help is needed and sometimes the ego can be bruised when we realize that we can’t do it all.  However, Tiffany argues that delegation can be life-saving and can free up time for the most important things in our lives.  For example, as an entrepreneur I started my business thinking I could do my marketing, web design, accounting, etc. all on my own.  Not surprisingly, this led to a tremendous amount of stress and unhappiness when I realized that these were not strengths of mine, nor anything I wanted to spend time on.   So, in recent years I have been able to delegate these duties to other (much more qualified) professionals and it has brought me a tremendous amount of relief and happiness in knowing I can focus my time on the parts of my work I am most passionate about.  As veterinarians, I encourage you to identify what is most important to you in the roles that you fulfill, what the best use of your time is in order to focus on what you are most passionate about, and how you might delegate some of the less important tasks to others in your life, so that you can drop the ball directly into the hands of someone just as capable.   Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals.  She facilitates wellness workshops, boot camps, and retreats for veterinarians, technicians, students, and other veterinary team members.  To sign up for newsletters containing information regarding these events and veterinary wellness topics, please click here.  More information can be found at www.criticalcarevet.ca.        

As a specialist in emergency and critical care for small animals, my job is to manage the most intensely ill dogs and cats that are presented to the veterinary hospital.  Examples include a dog that is hit by a car, a cat in congestive heart failure, a cat having an asthma attack, or a dog with a twisted stomach, among many other case scenarios.  Each of these situations is unique in terms of the disease pathology, systemic consequences, treatment options, and prognosis, but there is one unifying thread: all these pets have an owner (aka pet parent) with them who must decide whether and how to proceed with the recommended veterinary care.  And a question that pet owners often pose to me in these situations (the one I generally dread answering) goes something like this: “Doctor, if this was your pet, what would you do?”  I am avid follower of all things Gretchen Rubin (author of The Happiness Project and Happiness at Home) and regularly listen to her podcast Happier.  During one of the episodes about making a difficult decision, Gretchen’s “happiness hack” was to pose the question “If you were in my situation, what would you do?”  There is no doubt that this question is a powerful one because it forces the person being asked the question to remove their “professional” or “academic” hat and put on their “human” one.  Often this question garners insight or responses that were not shared during the initial exchange of scientific or logical information and can offer a sense of comfort to others.  I must admit to being in situations when I have posed this question to other people.   Whether I was looking for advice as to how to manage a difficult case or make a difficult decision, this question has been incredibly helpful for me and has given me relief in knowing that what I am considering doing is indeed what someone else who I trust would also do in my situation.  But I can also remember situations when I asked this very question and received an answer that did not align with my current line of thinking, leading me to question whether I was making the wrong decision or whether I should be doing something else.  And this is precisely why I cringe when owners ask me this question.  While some situations in the veterinary hospital are relatively cut and dry: for example, a dog has a bowel obstruction and needs surgery, if the surgery is delayed, the bowel could perforate leading to a much more critical and life-threatening scenario.  Other situations are much less clear: for example, a dog is diagnosed with bowel cancer and options include performing surgery, administering chemotherapy, or electing palliative care to provide pain and nausea relief.  In that situation, there is no right or wrong answer and what I might choose in that situation if it were my own pet could be completely different than what another person chooses.  When asked “What would you do if it was your pet?” there are so many things that make answering that question quite complicated.  For instance, my financial situation could be different, my mental band width to manage a sick pet long term might be different, my circumstance at home (i.e., my schedule, support system, living arrangement) might also be different.  All these factors are personal and affect the decision and ultimately determine what is best for that owner and their pet.  Because the bottom line is that it isn’t my pet, I’m not in that situation, nor can I presume to know all that affects that owner’s decision, so I would much rather leave that decision up to the owners who I firmly believe must make the decision that they feel most comfortable with.  That said, there are veterinary care providers out there who will gladly answer this question and take pride in doing so.  I posted a poll on my professional Facebook page a few months ago asking: “Do you answer the question when asked by clients ‘What would you do if you were in my situation?”.  More than 50 veterinarians and technicians responded, and the results revealed 2/3 said yes and 1/3 said no.  Those who wrote comments acknowledged that there are many factors to consider such as whether the owner has pet insurance, the evidence / research to support the options provided, other specifics regarding the owners’ situation, and ultimately what the owners’ goal is for their pet (e.g., longevity vs. quality of life).  Some also said that rather than saying what they would do, they share the options and then explain how they would advise a family member in that situation.  I’ve learned that the most important thing for me to acknowledge in these situations is that the owner is clearly struggling with their decision and to determine what I can do to help alleviate their stress in making the decision.  Sometimes asking the questions “How can I help you make this decision?”, “Tell me what it is that is holding you back from making a decision”, or “What do wish for most in this situation?” can help to uncover where the sticking points are and provide me with a way to help them talk through it without me making the decision for them.    Having been in situations before where I made a decision because someone else told me it was what they would do (and later having regretted that decision), I think the most important thing that we can do is to help pet owners come to the decision that they are most comfortable with on their own, but with compassion and patience.  Ultimately, I tell owners that no matter what their decision, they will be supported and often that allows them to breathe a sigh of relief and embrace their choice. Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals.  She facilitates wellness workshops, boot camps, and retreats for veterinarians, technicians, students, and other veterinary team members.  To sign up for newsletters containing information regarding these events and veterinary wellness topics, please click here.  More information can be found at www.criticalcarevet.ca.        

An Executive Report published this month in the Journal of the American Veterinary Medical Association shared the results of the Merck Animal Health Veterinary Wellbeing Study – appropriate timing given that May is Mental Health Awareness month.  The authors of the study wanted to survey a large group of veterinarians by way of random sampling to gauge the prevalence of serious mental distress among American veterinarians.  This contrasts with a previously published and widely publicized Center for Disease Control (CDC) study that was based on voluntary responses to a survey published online, which could have produced biased responses given that those with an interest in wellbeing (and potentially struggling with their own mental health) might have been more likely to respond.  Goals of the Merck Animal Health Veterinary Wellbeing Survey included quantification of the prevalence of mental illness among US veterinarians in comparison to the general population, identification of groups of veterinarians at highest risk for mental illness, and identification of factors that affect mental health among veterinarians.  The survey recipients were chosen from a random sample of 20,000 email addresses obtained from the American Veterinary Medical Association’s database of currently working US veterinarians.  Mental health was assessed using validated numerical scoring systems and compared to results of previous studies assessing the mental health of the general US working population.  More than 3,500 usable survey responses were obtained and were statistically assessed to ensure they represented the currently working US veterinarian population. Approximately 1 in 20 veterinarians reported experiencing serious psychological distress (e.g., feelings of nervousness, hopelessness, or worthlessness).  This represents 5.3% of respondents, which is not significantly different from the general US population who report a 4.7% prevalence of serious psychological distress.  However, the responses varied dramatically depending upon the segment of the veterinary population.  Specifically, younger male and female veterinarians (< 45 years old) had a higher prevalence of severe psychological distress compared to the same-aged general population, and single veterinarians had a 9.3% prevalence of serious psychological distress compared to veterinarians married or in a relationship (4.5%).  Serious psychological distress was also increased in association with a higher number of hours worked per week, working evenings, or working more or fewer hours than desired.  The prevalence of psychological distress was also more common among veterinarians working in clinical practice but was low to nonexistent for those working in food animal practice.  Survey results also confirmed that finances have a large impact on the mental health of veterinarians.  Respondents with student debt (regardless of the amount) and those dissatisfied with their financial situation had a higher prevalence of serious psychological distress.  But perhaps the most concerning finding of the survey and the reason why Mental Health Awareness month is so important, is the lack of treatment for mental illness and the stigma that persists among veterinarians who are struggling.  Like the CDC survey published previously, just half of veterinarians with serious psychological distress in the Merck Animal Health survey were receiving mental health treatment.  Of those veterinarians, 40% were receiving treatment for depression and 30% were receiving treatment for anxiety or panic attacks.  Unfortunately, employee assistance programs (EAP) offering treatment for mental illness were rarely cited (14%) by veterinarians with serious psychological distress, and only 16% had accessed other web-based resources (e.g., Veterinary Information Network). One factor that probably impedes veterinarians who need treatment from receiving it is the perception that help not available.  Only 46% of veterinarians with serious psychological distress agreed with the statement that “mental health treatment is accessible”.  Additionally, 60% of those veterinarians disagreed with the statement that “people are caring towards others with mental illness”; similar to what was revealed by the CDC study and confirmation that stigma causes veterinarians to hesitate seeking mental health treatment.  Considering these findings, it is imperative that veterinarians struggling with serious psychological distress have better access to mental health resources and feel supported by their peers.  The study authors urge any veterinarians who are experiencing psychological distress to meet with a mental health professional or social worker to develop a plan to mitigate stress and enhance their mental wellbeing.  They also suggest that those struggling with student debt consult with a certified financial planner to manage debt and expenses within their current income.  Finally, they implore employers to provide time off for mental health or financial planning appointments and to consider providing EAP that includes mental health support. While its comforting to know that veterinarians, in general, do not struggle with mental health any more than the average American, many veterinarians do need support and must have access to assistance.  To download a list of resources supporting veterinarian mental health and wellbeing, please click here.  And if you or a colleague of yours is struggling, know that there are many people who deeply care about others with mental illness and want to help.           Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals.  She facilitates wellness workshops, boot camps, and retreats for veterinarians, technicians, students, and other veterinary team members.  To sign up for newsletters containing information regarding these events and veterinary wellness topics, please click here.  More information can be found at www.criticalcarevet.ca.        

Technology is a necessary evil with the work that we do as veterinary care providers from keeping medical records to maintaining our practice’s online presence and communicating with clients and team members.  If it weren’t for technology, we would not be able to remain connected to lifelong friends, distant family members, and colleagues worldwide.  However, there is no doubt that technology has negative effects on our lives as well.  The feeling of constant connection can create a sense of anxiety around not being able to truly disconnect from work, thereby increasing stress, interrupting in-person interactions, and impairing productivity.  There is research demonstrating that even the presence of a phone sitting next to you can impair focus and disrupt conversation.  Additionally, there is research to suggest that social media decreases wellbeing by increasing feelings of jealousy, insecurity, and depression.  It is not uncommon for mental health providers to advocate that people experiencing anxiety and depression close their social media accounts to reduce the negative consequences of constant comparison.      Research also shows startling statistics when it comes to the amount of time spent in front of screens, whether it be the TV, computers, or smart phones.  In addition to the detrimental effects on mental health mentioned above, increased amounts of screen time have been associated with a higher risk of physical health concerns, as well as bigger odds of dying young.  This is probably because while a person is engaging in screen time, they are sacrificing time that would be spent participating in more healthful events such as exercise, time outside, or other self-care activities.  If you find yourself unable to disconnect by turning off notifications, closing your lap top, going 10 minutes without checking your phone, or binge-watching Netflix, you might consider trying these ten tips for limiting screen time to boost your wellbeing.  Turn off notifications such as buzzing, beeping, vibration, or flashing lights to decrease unnecessary interruptions.  If a notification does go off, pause and consider whether it could be of importance before interrupting your activity to check your phone.  Make a point to put away phones during meals, social gatherings, and family functions.  Decide when it is appropriate to check email, scroll social media, or send text messages.  Set boundaries around the use of technology for work when not actually working.  Ensure that expectations regarding checking email, being accessible by phone or text, and responding to non-urgent messages are clearly understood and followed.  Consider removing your work email account from your phone to limit the desire to check work-related messages during time off.      Decide how much time you’re willing to allocate to the use of technology outside of work.  Consider the activities you like to do during your downtime and the amount of time that you have outside of working hours.  Once you fill your downtime with exercise, time outdoors, family/pet activities, self-care, and sleep, the rest of the time should be the maximum available dedicated to screen time. Consider downloading an app like “Moment” or “Quality Time” to track the amount of time spent online or on social media sites and ensure that you are not missing out on other activities due to endless scrolling and screen time.  Try “batching” screen time rather than checking the phone, social media, or email repeatedly throughout the day.  Limit yourself to a certain amount of time a couple of times each day and even set an alarm to let you know when your screen time is up. Pair screen time with healthy activities such as exercise or stretching.  For example, only watch Netflix while on the treadmill or only check your phone while doing squats or lunges.  Take a digital detox by allocating time during which you take a break from technology.  If you do not need your computer while on vacation, leave it behind.  If you can go on a walk and leave your phone at home, then do so.  Other tactics to limit screen time include turning data off, using airplane mode, or turning off the phone altogether during periods of the day to prevent messages and notifications from coming through. 10. Be intentional when using technology to avoid watching hours of mind-numbing Netflix episodes or scrolling mindlessly through social media feeds.  If you find yourself in a fog and not focused on the screen in front of you, redirect your attention or purposefully switch to a different activity.  Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals.  She facilitates wellness workshops, boot camps, and retreats for veterinarians, technicians, students, and other veterinary team members.  To sign up for newsletters containing information regarding these events and veterinary wellness topics, please click here.  More information can be found at www.criticalcarevet.ca.