Bad behaviors from clients and customers are not unique to veterinary medicine; it is going on everywhere and there are lots of industries reporting bad situations with their businesses, with customers, with reviews, and with their teams. The veterinary client patient relationship, or VCPR, is the basis on which we pretty much function in veterinary medicine. The American Veterinary Medical Association (AVMA) has defined the VCPR for both the client and the veterinarian. There is a reason the client comes before the patient in the VCPR. They do have a more important role in this relationship than we sometimes lend credence to, especially when they are frustrating. In veterinary medicine, we are always reminded patient care is the most important job, but really, without the client care, we cannot ever get to patient care. Firing bad clients is never fun, however, it is necessary at some point during most veterinary careers, unfortunately. On a few occasions there were lines in the sand drawn, then crossed and the leadership team in my practice had to make difficult decisions. It was emotionally taxing and aggravating in the moment, but better for the practice overall. The number of clients I had to fire over my 15-year career was very minimal compared to the stories I am hearing about now. The numbers are shocking when most of us on leadership teams used to be able to count on one hand the number of clients we have had to sever relationships with. Following along on social media and seeing all the articles on client interactions with veterinary professionals has really been disheartening over the past two years, and, sadly, it seems to be worsening. It really does feel like it is “us versus them.” Our veterinary client relationship should not be this way; the path to work with them again in order to provide excellent patient care for their pets is getting impassable. How can we accomplish this if it is us versus them instead of us aligned with them? Making a definition The AVMA shared a policy that, while tagged as “under review,” still shares important information about the VCPR and how it is defined on the veterinary side. It is called the Principles of Veterinary Medical Ethics of the AVMA; in particular, Section 7 stands out: “A veterinarian shall in provision of the appropriate patient care except in emergencies be free to choose whom to serve with whom to associate and the environment in which to provide veterinary medical care.” (For more, see “Section 7 allows severing.”) Client expectations For the longest time, we trained clients to believe veterinary medicine was an immovable object. We had to do the things we were doing because we had to do them. They accepted this fact, and we had a working agreement. Veterinarians were not unethical in the tests or recommendations in general more entrenched in “This is how we do it, this is how we have always done it.” Then, in the past two years, we were abruptly required to make some drastic pivots in order to stay in business and continue to deliver patient care. This showed our clients we can, in fact, change, and the systems in place are movable. So, now we have confusion and potentially some distrust. The clients are confused. They do not know the rules, what to expect, and, honestly, they are different from place to place. I’ve experienced this myself. Do they require a mask? Do they not require a mask? Am I allowed to go in with my pet? Or do I have to wait in my car? How much time do I have to take off work for this visit? Can I work from my laptop or phone while waiting in my car? What are the expectations of my time? The list goes on. Lack of easy answers to these client questions creates a lot of confusion, which leads to embarrassment and anger. When you mix this with our extremely tired teams, overworked and battered from abusive, cranky clients, it is a powder keg waiting to explode. This is how we have cultivated the us versus them mindset. I bet if we did a show of hands, we would not be shocked to find how many of us have dealt with cranky clients, which was made possible by a lack of communication in some form. Bad behaviors from clients and customers are not unique to veterinary medicine; it is going on everywhere and there are lots of industries reporting bad situations with their businesses, customers, reviews, and teams. We are not special in this behavioral environment. We do, however, have an opportunity to make things better for ourselves, our teams, our clients, and ultimately, our patients. Let’s get into some of the things that we can do and some things we should probably consider before we pull the trigger. Sure-fired ways to address the situation I have seen a few techniques from various practices that have had mixed results. If you have done any of these, I’m not saying you’re right and I’m not saying you’re wrong. I’m playing devil’s advocate and sharing what I have seen. The outcomes of these techniques have been across a few different retellings from practices. Approach 1: Posting a sign in the window telling clients, as well as anyone who passes by to be nice and that abusive behaviors will not be tolerated. Pros: I honestly have not seen a whole lot of negative outcomes specifically tied to this approach. In some cases, it seemed to align the clients with the teams in a sense of empathy because of the wear and tear the teams were facing. Clients would leave comments for support and affirmation for the practice. Cons: The tone used in this type of signage on the practice, whether it be concise and professional, or snarky and sarcastic, may have unintended consequences. Defaulting to sarcasm when we communicate is most often seen and felt as passive aggressive. It’s what we do when we want to get our point across without taking a strong stand or being confrontational. The practices with clearly stated policies or mission statements that have made a point to include their expectations of the treatment of their team is a meaningful statement and not easily taken as a joke by a client. Approach 2: The open letter to clients posted on social media channels. Pros: Oh man, reading some of the letters penned to address clients has been so cathartic for me. As a veterinary professional reading from the sidelines, I can only imagine how it feels on the front lines. In business, you are taught the customer is always right and behaviors should be tolerated to protect revenue. So, telling clients how it “really is” must feel great! These open letters outline client behavior issues you will not tolerate, and the “why” of the boundaries you are setting. Again, this has gotta feel good. Lots of clients and fellow veterinary professionals have shared their support and love for the practices along the way. Cons: Unfortunately, I have not seen this go over as well as hoped. I follow lots of practice pages and the response from clients who respond to this type of letter is often defending their own behavior. They point out what the practice did to earn those negative reviews. So, it doesn’t stop the behavior; it opens the door for further negative conversation—online no less. While no one wants a bad review, it’s wise not to get into a back and forth with clients online. I’ve also seen an increase in negative reviews specifically outlining some of the things causing the angry client interaction. These include additional wait times, lack of information on pricing, and poor communication from the veterinarian about their pets. Proceed with caution when typing up an open letter; this can be akin to “throwing rocks when you live in a glass house.” Read it from the angry client view and what they may say to counter your points. Remember to pause before hitting “send” to be sure you are committed to your declaration living digitally forever. I certainly do not intend to offend anyone reading this if you have done any or both of these approaches. I want to share some of the negative outcomes I have seen personally so they can be considered when making the decision of how to communicate behavioral expectations to clients. Prevention A preventive step before we have these behavior issues is to have a set of guidelines in place that helps us determine when we need to fire a client. In the moment when we are emotionally charged is not the time to be making procedural decisions about client relationships. We may be harsher and quicker to act in an emotionally charged situation that we have been personally involved in, at least compared to a situation that maybe has been retold to us from a team member. How likely are you to be as angry or ticked off by a bad client interaction that you experienced personally compared to one that your receptionist was telling you about? So, herein lies the rub, without having policies in place and team members trained on what those policies, we have a chasm that can be opened, and good teams can fall through them. We’ve all seen it, owners accused of only caring about the money and tolerating abusive behaviors from clients. A behavior policy will help teams expect the outcome when the event happens. Then assumptions about motives are less likely to take on a bigger more nefarious form. Your state will have a practice act that dictates how veterinarians can terminate their relationship with their client. Individually you’ll have to look that up to see what the specific guidelines are for your state and the steps that must be taken in order to terminate a client. In some cases, the reasons why may be outlined as well. I shared the AVMA guidelines earlier on to give you an idea of where to start when building your practice policy on client behavior expectations and what you will and won’t accept on behalf of your team. Team members who are verbally abused and demeaned on a regular basis will not stick around. There is no dollar amount you can pay in exchange for this kind of treatment for your teams. Patient care is traditionally thought of as job one, but the people delivering the patient care should be priority one. If the team is afraid, stressed, abused, exhausted, fatigued, suffering from signs of PTSD, or burnout, then patient care is now on the bottom of the list, and basic emotional survival has now become job one. I have worked in practices that were run by the clients, and we never knew what set of rules we were following or enforcing that day. Worse yet, we also had those special clients who each had their own set of rules, because “that’s just the way she is” or “he doesn’t mean it in that way, he’s a good client.” On the flip side, I have also experienced working for a practice owner who would take a belligerent client into a room and tell them what they are doing to the team is not appropriate and will not be tolerated. I have seen him turn these clients around totally and kept them coming back to the practice. He wasn’t mean or aggressive, he just outlined what would and would not be happening when it comes to how his team is treated. I encourage you to create your practice policy regarding client behavior expectations right now, today. Start training it, today. Pre-teach all your expectations to your team during their onboarding phase when they are new hires. Continue this training throughout their career with you during staff meetings, not only during and after altercations with clients. Model your expectations so your clients and your team can rely on you to support them and defend them if necessary. Consistency is vital to building trust, but can be difficult at times. I encourage you not to back down on what you are willing to accept from clients regarding their behaviors when it comes to protecting your team. There is comfort and safety in a boss who will protect their most valuable asset. That is where team loyalty is born. SECTION 7 ALLOWS SEVERING The AVMA’s Section 7.1 goes into further explanation of whom the veterinarian will serve and in particular their freedom of this choice. This section reads as follows, “Veterinarians may choose whom they will serve. Both the veterinarian and the client have the right to establish or decline a veterinarian client patient relationship and to decide on treatment. The decision to accept or decline treatment and related costs should be based on adequate discussion of clinical findings, diagnostic techniques, treatment, likely outcome, estimated cost, and reasonable assurance of payment. “Once the veterinarian and the client have agreed the veterinarian has begun patient care they may not neglect their patient must continue to provide professional services related to that injury or illness within the previously agreed limits as subsequent needs and costs for patient care identified the veterinarian in client must confer and reach agreement on the continued care in responsibility for fees if the informed client declines further care or declines to assume responsibility for the fees the VCPR may be terminated by either party.” Rhonda Bell, CVPM, CCFP, CDMP, is founder and co-owner of Dog Days Consulting, a social media and brand management company. She spent 15 years as a practice manager working the day-to-day challenges of the veterinary practice and experienced firsthand the stresses, joys, communication dilemmas, and wonders of working in veterinary medicine. Bell now dedicates her work and energy to helping practices succeed online and to coaching team members with the skills that will hopefully prolong their careers.
