The cost of caring

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fatigueThe cost of caring can lead to significant health and psychological conditions, particularly for those new to the profession. Sue Nelson uncovers how to manage the pressures of the job.

Most vets get into the profession because they have a love of animals and want to help them. But the job description involves not only destroying countless animals each year, but also witnessing and addressing the abuse and neglect of pets and livestock and the trauma of injured wildlife. Vets are also frequently privy to the distress of their patients and the grief and anger of their owners. 

It’s a particular kind of stress and anxiety that not many other professions face with such grinding regularity, and it is called compassion fatigue. Also known as the ‘cost of caring’, compassion fatigue is a recognised psychological condition that can affect anyone in work that regularly exposes them to the suffering of others. It presents an emotional and physical exhaustion, leading to hyper-vigilance, irritability or poor concentration in the workplace, and social isolation, insomnia and impaired immunity at home. Unfortunately, it is exacerbated by the profession’s very calling—that is, the need to help others.

“Compassion fatigue can be triggered by an individual event, such as exposure to a cruelty case, or by chronic exposure to stressors in the animal shelter or veterinary practice,” says RSPCA ACT acting CEO Jane Gregor. “It can also be termed ‘vicarious trauma’, as we often see, feel or hear the story of the trauma patient, its owner or a colleague.”

Other factors, such as long working hours, isolation and a tendency for vets to be high achieving and competitive individuals, contribute to the affliction. Andrea Montesano, a partner at the Reservoir Vet Clinic in Melbourne, says it isn’t uncommon to continue working for an hour or so following a nine-hour shift.

Rebbecca Fisher, a vet who left private practice to work at a university with family-friendly hours, cites poor pay, long shifts, weekend work and the “endless emergencies” as some of the reasons she left—all of which compounded her compassion fatigue. Fisher says she knows of several colleagues who committed suicide because of the pressures of the job.

A recent study entitled “Workplace stress, mental health, and burn-out of veterinarians in Australia” examined the frequency of depression, anxiety, stress and burnout in vets, and compared this to the incidence of these problems in the general population. It found there were strong links between a career in veterinary medicine and poor mental health, particularly in younger women, who were most at risk. Burn-out comes quickly too—as little as five years after graduation. The report concluded that educators and employers need to be wary of these trends and to provide new ways to support graduates to ensure they can enjoy long, healthy careers.

“When I was at university there was not much support or lessons regarding grief, handling conflict and managing the client-vet-patient bond,” says Montesano. Fisher agrees, though she concedes it has probably improved for newer graduates. “There was only one lecture on grief counselling in my entire degree.”

Fisher says some of the hardest times were early in her career, before she became inured to the emotionally intense work. “When I tried my heart out and still lost the battle, when it was someone’s only or best friend, when I put down an elderly lady’s guide dog… When I euthanised Jair, a dog with prostate cancer in my first year. He couldn’t walk and I was crying so hard I couldn’t see the vein properly. Sometimes people just couldn’t afford the treatment and they were so ashamed about that…”

“It’s hard for me to say what is the hardest or worst thing I’ve seen,” Montesano says. “I have seen dogs with injuries such as a broken jaw which would appear to be inflicted by the owner, a cat that was thrown into a wall by an owner with a mental illness. Some of the saddest things are just assisting and guiding families and people through the loss of a much-loved elderly family pet. Children affected by grief are always very upsetting.

“As a younger graduate I would find it very emotionally challenging trying to assist pets whose owners were not bonded to them—the owners did not wish to spend any money on their pets that needed care.”

Some vets have difficulty preventing their work from creeping into their personal lives. “Staying professional and removed was the hardest thing. I got very close to many people,” says Fisher, who found she was increasingly doing pro bono work to try to stem some of the suffering she witnessed.

So how do vets continue to keep a clear head, strive for the best outcomes for their patients and maintain good mental health?

“Compassion fatigue needs not be a professional death sentence,” says Jane Gregor. “It is possible to cope and it is possible to heal from chronic compassion fatigue before we experience complete burn-out. But some vets may need to go on stress leave to fix this problem.”

According to the RSPCA, there are personal as well as professional strategies vets can adopt. “It’s important to look after yourself physically, get enough sleep, eat well and exercise,” says Montesano. “Emotionally, make sure you have a good support system around you, including non-veterinary groups.”

In practice, it’s important to support colleagues—debrief, but be careful not to share traumatic stories with unprepared or inexperienced colleagues (this is also known as ‘sliming’) who may take these experiences on board. Always provide a warning, and seek permission to share the information. 

Know your limitations: “As I have continued at the practice, I have come to realise that I cannot always provide the best treatment all the time due to restraints that owners put upon me. I see my role as informing my clients what is the best treatment for their pets and acting as the pet advocate to encourage owners to do what is required for the best interests of that patient,” says Montesano.

“I work in a very supportive veterinary environment and I get lots of support from my peers. Working alongside experienced vets in a caring environment helps. It’s good to have passion for your work. I found having sessions with a psychologist helped me, as did extra learning about grief.

“I think the best thing a young graduate can do is work on communication skills—if you can get communication and conflict management right then I think you can reduce a lot of compassion fatigue. Focus on what you do well and keep a file of thankyou notes to refer to when you feel you’re losing the battle,” she says.

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