Dear Second Opinion,
I recently had a consultation appointment for a new patient with diabetes. The appointment was fairly routine and focused on optimizing glycemic control. We provided prescription diet samples and instructions to increase the insulin dose, and we scheduled a 1-week recheck.
Within 48 hours we received several emails (often within hours of each other) and phone calls from the client demanding to speak to me regarding additional questions. Although our clinic protocol advises it may take up to 48 hours to receive a response to emails and phone calls, this client calls until they are able to speak with a staff member when an email goes unanswered for longer than an hour.
I want to provide excellent care for this patient, but I worry this client has unrealistic expectations for communication and lacks respect for staff boundaries. I wish I could say this is the first time a client has acted this way, but episodes such as these have increased in frequency in recent years. Like most other clinics, our staff and resources are stretched thin, and I want to protect the mental well-being of our staff and avoid burnout.
How can I establish appropriate boundaries with this client while maintaining a solid veterinarian–client relationship and ensuring they are satisfied with patient care?
—Burnt Out Without Boundaries
Dear Burnt Out Without Boundaries,
With a client roster in the hundreds, even thousands, the demands for our time, insight, and compassion can feel boundless and acute. It’s easy to feel frustrated when a particular client appears to be especially demanding and acts impertinent when those demands aren’t immediately met.
There are steps you can take to balance your and your team’s well-being and provide excellent patient and client care. Following are 3 methods to help build boundaries with clients.
1. Turn Empathy Into Action
It’s clear you are an empathetic person, and empathy in action is what we call compassion. Research suggests intentional compassion in health care settings can increase compliance and reduce burnout. Overly demanding clients may be confused, worried, or even scared. First, you need to set a compassionate boundary-setting response, “I understand having a diabetic pet can be overwhelming. It’s normal to feel worried and afraid for our pets that we care so much about. This is a complicated disease, so you may think of additional questions after we talk. I want you to know that my team and I will walk this journey with you. We have a recheck scheduled next week; please bring all your questions to that appointment. What questions do you have for me right now?”
2. Coach Your Clients
Our definition of urgency often differs from what our clients feel. Many concerns can seem like an emergency, but we know they are not. We can therefore try to coach pushy clients into a healthier relationship. The next time this client emails then calls an hour later, take a couple of minutes to answer their question. Once they have calmed down, provide a gentle reminder of expectations, “I care about you and your pet. I also care equally for my several hundred other clients and their pets. In order to take good care of all of them, sometimes we have to address emergency situations first. Your question was important, but it was not an emergency. Remember, you can bring all your questions to next weeks recheck. For your next question, I ask that you take a moment to consider whether it’s an urgent matter or can wait for next week’s appointment.” A firm, respectful reminder is sometimes the nudge people need to get out of their amygdala (ie, feelings) and into their prefrontal cortex (ie, rational thoughts).
3. Rank Your Values
You mentioned the desire to balance team well-being with client care. These are both worthy values, but they can conflict with each other at times. I encourage you to facilitate a conversation with your team to explore what well-being and client care mean to them, as well as how these values relate and which has priority when they are incompatible. Allowing the team to have input and come to an agreement can help build healthy, collective boundaries.
It may not always feel like you’re doing enough, but you are! It’s clear you’re doing all you can to care for your patients and clients. Seeking advice and knowledge on how to protect your team’s well-being shows you care for them as well. I see you, and I bet your clients and team members do also.
Thank you for all you do!
Josh Vaisman, MAPPCP, CCFP