Nonviolent Communication for Veterinarians

Man alive, being a veterinarian can be hard. Often, in ways you don't expect. It's tough being around animal suffering, and yeah, we don't get paid all that much for what we do. We get stretched thin and asked to solve a lot of challenging problems simultaneously, and the answers aren't as easy or definitive as they are on the thousand multiple choice exams that we took to get here.

But after the medical side is added up, often the most difficult part of my day is the people. Having 60-90 seconds during a CPR to talk about the odds of success (very low) and associated cost (very high) to a client who's only seen a 90% success rate and happy endings on TV is just... tricky. It takes skill. I don't know if that's a "soft" skill or not, but there's quite a learning curve, despite the token communication courses that everyone browses the internet during in vet school.

Presenting cruel reality to clients takes a toll, and owner frustration (at cost, at prognosis, at their stupid decision to pay thousands of dollars for a bulldog) often manifests as anger. Not general, directionless rage, but very pointed vitriol with the taut bowstring pulled opposite the folks in fur-covered scrubs.

Recently, I had a very upset client. Very upset. Without going into details, let's just say by the end of the day, half the front desk had torn out clumps of hair and were Googling the hours of nearby liquor stores. His/her/their ire was based on a misperception of events, and accusations of graft/incompetence/extortion/malpractice were lobbed. Half a dozen staff members tried to explain the situation in their own way, all of which failed to penetrate this individual's density (roughly the same as a piece of holiday fruitcake behind the fridge since 2007).

Fortunately, I inherited the case. I mean, fortunately for me. I love this stuff. Talking to pissed-off people gives me the same rush as sliding down the face of a big, roaring wave (that's 3-foot Hawaiian for me, btw). I can't believe I get a front row seat for the insanity. There's just something captivating about grownups throwing tantrums. Get me some popcorn, baby!

It's not (merely) sick pleasure. I actually think this might be the only aspect of veterinary medicine where I could possibly be above average. People know me as the crazy client whisperer. I want the super angry clients. Very few things at work are as fun as turning someone like that around. I'm fascinated with both psychology and communication, and I look at raging pet owner the same way a cowboy might at a bucking bronco: Let me on that thing!

I'm not claiming inherent mediation skills here, I'm no natural. I've got a secret weapon: Nonviolent Communication (NVC).

Okay, weapon is the worst possible choice of words. "Technology" is better, or just "tool" will work. No glowing LEDs or titanium alloys, though. NVC is nothing more than a way to communicate, albeit one you probably never came across if you grew up in a Western culture. I only encountered it a few years ago via a therapist. It's kind of a hard sell, so I initially brushed off the recommendation to watch a three hour long video from the 90's of a scowling, Mr. Rogers-type talking to an audience via a giraffe puppet. After getting pestered for about the fourth of fifth time, though, I finally watched the video.

And holy shnikes, does it work.

Marshall Rosenberg, the progenitor of this tool, claims that no matter the size or intensity of the conflict (up to and including brutal murders of family), NVC can resolve it in fewer than 20 minutes. I genuinely believe this, although I've never had to use it in such extremes. But it works great in the vet clinic, if you ask me!

The trick is, NVC is counterintuitive. Very, very, unfairly briefly, the core of NVC is that your problems are nobody else's responsibility. You're responsible for your needs, you can't get upset about somebody specific doing something or not doing something for or to you. In other words, you can (and should) get your needs met, but you can't make (or expect) any particular individual to meet those needs for you.

Here's the point: this way of thinking inures you to personal insult. When I'm talking to an angry client, and they say something terrible, I don't feel bad about myself. I need respect, but I don't need it from them. I can get respect from myself, I believe this is called "self-respect" or something like that in the medical literature, don't quote me. I re-frame the interaction, sticks and stones, baby!

My other need in these situations is figure out how to treat their animal, which is how I earn my living. I didn't wake up that morning needing people to be nice to me. I showed up at work to help animals. Their owners are necessary, because I need their consent and cooperation to perform those treatments. But sometimes the only thing in the way is an "a-hole" client.

Here's where the genuinely beautiful magic happens. When I tell myself that I'm not a greedy, incompetent, stupid and horrible person ("self respect"?), their insults fall flat. I become immune to attacks, therefore I don't need be defensive. I still want to help their animal, so I still listen to what they're saying because 10% of the nasty verbage might contain clinically relevant information. I wait until they're done and repeat back their concerns, to make sure I have them correct, without any judgement whatsoever in my tone. This has an absolutely remarkable effect on people, their rage fizzles and then sputters out. It's gone. I take their "violent" communication, drop my guard and let them punch away. I don't fight back.

It's gorgeous, like having a just-a-second-ago snarling cat purring on your lap. All done through this tool that I got from a puppet-wielding psychologist from YouTube.

The hard part is getting over that hill of personal insult. The easy part is finding out what the angry client wants. They want their pet to be okay. Whether it's unrealistic medical perceptions, unattainable cost of care, or something else, this is usually their goal. Sometimes it's more complicated, like with interpersonal family struggles or the guilt of wanting to be free of caregiver burden, but those aren't usually that hard to diagnose either. Just listen to them. Then decide on how you can help.

This does require some careful interpretation, you don't want to make them feel attacked (or embarrassed, or blamed). It requires patience and politeness ("I'm afraid I can't write off the entire bill and have the staff bow to you and kiss your boots, sir...") and some level of professional competence ("Unfortunately I don't think an ALT of 17,000 is related to the groomer's shampoo, ma'am..."). But we teach our kids to be polite, why not aim for excellence ourselves?

I know how horrible things can happen to animals. And I know not everything is affordable for people, especially as the prognosis tanks. The harsh reality of veterinary medicine can hit people like a dump truck. It's not hard to understand that. I don't think anyone intends to be an jerk. If you think that way, just remember than in their story, you're the jerk. NVC is about catching just a bit of empathy for that person, which is really why they're acting like that in the first place. It might be a childish tantrum, but kids throw tantrums in order to get something they want. You can either (1) give them what they want to make it go away, (2) get angry and deny them what they want, which usually makes them even angrier, or (3) calm down and listen to them. After understanding, communication can take place. The situation can be explained. A plan that meets everyone's needs can be formulated. Violence can be extinguished.