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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711171/
790 CVJ / VOL 54 / AUGUST 2013
Veterinary Wellness Bien-être vétérinaire
Burnout and health promotion in veterinary medicine
Brenda L. Lovell, Raymond T. Lee
Burnout is on the rise among the helping professions such
as human and veterinary medicine, and negatively affects
personal and professional wellbeing, and the provision of qual-
ity care to clients and animals. Even more significant is that
veterinarians are reported to have the highest incidence rate of
suicide among all occupations, and twice as high as physicians
and dentists (1). Indeed, 85% of American Veterinary Medical
Association convention attendees indicated that stress and
burnout (includes compassion fatigue) were the most important
wellness issues affecting the veterinary community (2). Seventy-
six percent believed that there were not adequate resources to
deal with wellness issues (2).
Much research attention is now being focused on the emo-
tional exhaustion component of burnout, as it has been increas-
ingly shown to be correlated with physical and mental health.
Progress is also being made to relate other variables such as
work/life conflict, and communications with burnout. A case
in point was our research study among Canadian physicians.
We found that having positive emotions and responsive com-
munications with patients reduced burnout, but when difficult
emotions were kept hidden or insincere, burnout increased (3).
Of the 3 burnout dimensions, emotional exhaustion contrib-
uted to symptoms of strain. We also found that less experienced
physicians reported higher stress levels than those who were
more experienced, and female physicians reported higher stress
than their male colleagues. Comparable findings are drawn
for veterinary medicine in which Australian female veterinary
surgeons and those with less experience also reported higher
stress levels (4).
Many clients regard their companion animals as cherished
family members; consequently, they have high expectations
that emotional and medical needs will be met (5). Recognition
of the human-companion animal bond is the very core of the
bond-centered approach for veterinary practice. It involves rec-
ognizing and responding to the unique emotional interchange,
in a way that benefits all of the participants involved (6). Thus,
good communication is likely to result in strong client relation-
ships, and an indicator of those more likely to follow treatment
recommendations (5–6).
To be engaging and responsive to clients often involves
intense and constant emotions, along with other forms of verbal
and non-verbal communications. This is no easy task, as the
skills needed to manage people and emotions, emotionally vola-
tile clients, and the feelings that arise from euthanization require
practice, time, and patience (4,7). This deep form of caring has a
potential to be a risk factor for compassion fatigue and burnout
if mental, spiritual, and emotional balance is not maintained (1).
Compassion fatigue then is the emotional burden that occurs
as the result of continued and excessive exposure to traumatic
events that patients and families experience (8).
How can veterinary practices provide
bond-centered care yet prevent burnout
and/or compassion fatigue?
Effective health promotion strategies need to be implemented
to reduce the risk factors for burnout and compassion fatigue,
and should include efforts from the organizational, practice/
collegial, and individual levels (7).
Organizations can provide resources such as lifelong learning
and continuing professional development workshops. Much can
also be done by the individual to develop the resilience and emo-
tional competence needed to keep compassion fatigue at bay (8).
Adaptive coping strategies are a key component of a health
promotion strategy. A problem-focused strategy involves tack-
ling problems that give rise to stress, and an emotion-focused
strategy works on normalizing feelings that arise from stress (9).
For example, emotion-focused strategies that Brenda frequently
uses are to listen to music, burn incense, enjoy coffee/tea, turn
on area lighting, stroke our pets, and walk outdoors, all of which
stimulate the senses and help to minimize harmful stress.
Some of the key points of this article were discussed at The
4th Annual International Conference on Communication in
Veterinary Medicine, Banff, Alberta, November 13–16, 2008.
References
1. Lawrence C. Shock central: Veterinarian suicides. 2009 Corralonline.
com Available from: http://www.corralonline.com/articles/article
080310152649.htm Last accessed June 12, 2013.
2. Carr GD. Veterinarians and potentially impairing illness. Insight
Magazine Sept./Oct. 2012. Available from: http://digital.turn-page.
com/i/80739/13:12-13 Last accessed June 12, 2013.
3. Lee RT, Lovell BL, Brotheridge CM. Tenderness and steadiness: Relating
job and interpersonal demands and resources with burnout and physi-
cal symptoms of stress among Canadian physicians. J Appl Soc Psychol
2010;40:2319–2342.
Independent wellness consultant, 1 Glengarry Drive, Winnipeg,
Manitoba R3T 2J5 (Lovell); Department of Business
Administration, University of Manitoba, Winnipeg, Manitoba
R3T 5V4 (Lee).
Address all correspondence to Brenda Lovell; e-mail:
brendalee.lovell@yahoo.ca
Use of this article is limited to a single copy for personal study.
Anyone interested in obtaining reprints should contact the
CVMA office (hbroughton@cvma-acmv.org) for additional
copies or permission to use this material elsewhere.
CVJ / VOL 54 / AUGUST 2013 791
VETERI NARY WELLNESS
4. Williams S, Davis H. Stressors in the veterinary profession. 2002. Board
Talk; Issue 12:12–13. Available from: http://www.vpb.nsw.gov.au/
Boardtalk/2002/aug2002/August2002_9.htm Last accessed June 12,
2013.
5. Dawson S, Fowler J, Ormerod E, Sheridan L. New perspectives on bond-
ing. The SCAS Journal; 2007:2–5. Available from: http://www.pat.org.za/
files/documents/New%20perspectives%20on%20bonding.pdf Last
accessed June 12, 2013.
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client-veterinarian bond on the care that pets receive. Vet Med Today:
Special Report 2008;232:531–540.
7. Cohen SP. Compassion fatigue and the veterinary health team. Vet Clin
North Am Small Anim Pract 2007;37:123–134.
8. Huggard PK, Huggard EJ. When the caring gets tough: Compassion
fatigue and veterinary care. Vet Script 2008:14–16.
9. Bartram D, Gardner D. Coping with stress. In Practice 2008;30:228–231.
... Moreover, apart from the financial and ethical dimensions of the conflict, there is also a conflict of interest that can be different for the animal and the client who pays for the treatment [5,14,31,32]. Undeniably, managing people and emotions in such complex circumstances requires practice, time and patience all at once [20]. Actions to resolve the conflicts peacefully are necessary, not only to satisfy the conflicting parties but also to prospectively avoid mental health disorders and related consequences. ...
... In addition, further research is required and more data must be collected to characterize and authenticate the root cause of the issue, i.e. the lack of training of the graduate. Thus, if the Veterinary School does not provide a curriculum corresponding to current demands, then there is a role for organizations that should provide resources such as lifelong learning and continuing professional development workshops in verbal and nonverbal communication and the maintenance of mental, spiritual and emotional balance of veterinarians [20]. ...
Article
Full-text available
Background The problems of burnout and the moral and ethical distress resulting from various kinds of conflict have been raised in the veterinary profession. However, their sources and inter-relationships have not been thoroughly recognized mainly due to the multidimensional nature of human interactions related to animal breeding, farming, welfare, prophylaxis and therapy. For the first time in Poland, an analysis of conflict and conflict-causing factors in veterinary practice has been conducted with the participation of veterinarians of various specialties and the owners of different animal species. Results Conflict in the course of work is most often experienced by young veterinarians. The problems associated with communication between veterinarians and animal owners and unforeseen random situations are the general causes of conflict. Approved Veterinarians were identified by animal owners as the most common professional group associated with the conflict experienced . Conclusions There is a lack of professional preparation by veterinary surgeons to cope with unpredicted stressful situations at work, resulting from an absence of appropriate educational input in this area. The animal owners do not understand the role and duties of Approved Veterinarians.
... 21,[24][25][26] There is also an influence on professional identity formation. 8,23,27 Closely integrated with these aspects, affect plays a key role in mental well-being and health; both the human and veterinary healthcare literature have identified concerns relating to stress and burnout in the profession, 21,24,[28][29][30][31][32][33] and the emotional consequences of errors. 9,34,35 In response to this, there is an emerging literature focussing on the development of resilience and strategies for emotional well-being. ...
Article
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Background: The transition to professional practice can be a challenging time. The Royal College of Veterinary Surgeons' (RCVS) Professional Development Phase (PDP) aims to support recent graduates through this transition, with graduates required to reflect on their experiences. This study drew on the concept of "lived experience" to explore the influence of affect (feelings, emotions and mood) on recent graduates' experience of reflective activity. Methods: Data comprised semi-structured interviews with 15 recent graduates from one veterinary school. Thematic analysis was used to explore the influence of three aspects of affect on reflective activity: affective valence (whether a chosen action is anticipated to result in positive or negative feelings), tacit aspects (such as tiredness) and perceptions of workplace mood. Results: Participants preferred to engage in activities associated with positive feelings. Tacit feelings, such as panic or tiredness, and perceptions of workplace mood, influenced how and with whom participants engaged in reflective activity. Participants often made different choices when reflecting primarily on affective compared to clinical aspects of situations. Conclusion: These findings suggest that acknowledging and understanding aspects of affect during the professional development phase has the potential to help the profession improve support for recent graduates.
... 29 30 Not being able to comfort an owner may result in stress for the FLP and contribute to psychological problems, unfortunately often reported in the veterinary profession. 31 Communication skills are necessary to be able to cope with these stressors. Confidence in being able to comfort owners was investigated in this study, to get some idea on whether veterinarians can be expected to be 'at risk' of stress relating to this matter. ...
Article
Background This study aims to investigate the perspectives of veterinarians in first-line practice on confidence and satisfaction regarding several important aspects of the description, diagnosis and treatment of canine patients with epilepsy. Methods A web-based questionnaire was used, focussing on general aspects of canine epilepsy, diagnostic tests, treatment and communication with owners. Results One hundred and two questionnaires were evaluated. No less than 73 per cent of veterinarians had performed euthanasia on one or more patients with epilepsy as the main reason. First-line veterinarians scored confidence on general aspects of epilepsy as 6 or 7 out of 10. Confidence regarding communication with owners was scored 7 or 8 out of 10. Conclusions This study provides insight into perspectives of Dutch veterinarians in first-line practice regarding canine epilepsy. Several results may provide reasons to adjust (pregraduate or postgraduate) education of veterinarians with regard to management of canine patients with epilepsy. Several factors (such as the importance of diagnostic imaging) may help specialists in the field communicate better with referring veterinarians so that first-line practitioners become better equipped in managing patients with epilepsy. These steps may then positively influence treatment results as well as care-giver burden for the first-line practitioner.
... There is an extensive body of literature documenting the serious emotional impacts of conducting or being associated with euthanasia among veterinarians, animal shelter staff, and animal rescue workers. Working in these fields, where euthanasia is performed frequently and may be seen as an unavoidable necessity, can erode the mental and physical well-being of staff, leading to compassion fatigue, burnout, and overall stress (Baran et al., 2009;Figley & Roop, 2006;Lovell & Lee, 2013;Scotney, McLaughlin, & Keates, 2015). While the average pet owner does not, of course, deal with euthanasia on the same scale as veterinarians or shelter staff, the ethical issues associated with making the decision to end the life of a companion animal remain. ...
... Indeed, having to face ethical challenges increases stress and burnout in veterinary surgeons and support staff. 35,36 These professionals, whose studies are oriented towards the care of animals, are continually faced with animal suffering, which is often underestimated on a social level. In fact, veterinarians can suffer more easily from severe compassion fatigue than physicians because they are not only responsible for animal care and end-of-life decisions, but they also have the power to perform euthanasia. ...
Article
The use of animals for educational and research purposes is common in both veterinary and human medicine degree courses, and one that involves important ethical considerations. The aim of this study was to assess the extent of differences between the knowledge and attitudes of veterinary students and medical students on animal bioethics, on alternative strategies and on their right to conscientiously object to animal experimentation. To this end, a questionnaire was completed by 733 students (384 human medicine students (HMS) and 349 veterinary medicine students (VMS)). VMS were more aware than HMS (72.2% and 59.6%, respectively) of the existence of an Italian law on the right to conscientiously object to animal experimentation. However, very few of them had exercised this right. Many VMS (43.3%) felt that animal bioethics courses should be mandatory (only 17.4% of HMS felt the same way). More VMS than HMS (81.7% and 59.1%, respectively) expressed an interest in attending a course on alternatives to animal experimentation. The data suggest the need for appropriate educational interventions, in order to allow students to make choices based on ethical principles. Fostering close collaborations between departments of human medicine and veterinary medicine, for example, through shared study modules, could promote the development of ethical competence as a basic skill of students of both veterinary and human medicine courses.
... 9 In veterinary medicine, women report more work-related stress, anxiety, depression, and burnout than men. [23][24][25][26] This observation is of particular importance, given that a recent study 29 revealed a higher incidence of psychological distress, including suicidal ideation and depression, in female versus male veterinarians. One of the most commonly reported stressors in that study was demands of practice, which could be interpreted to include involvement in AEs and NMs. ...
Article
OBJECTIVE To describe the sleep patterns, working hours, and perceptions of fatigue among veterinary house officers and to identify potential areas for targeted intervention to improve well-being. SAMPLE 303 house officers. PROCEDURES A 62-item questionnaire was generated by use of an online platform and sent to veterinary house officers at participating institutions via email. Responses were analyzed for trends and associations between variables of interest. RESULTS The mean age of respondents was 30 ± 3.7 years. Participants included 239 residents and 64 interns. House officers slept significantly less during times when they had clinical responsibilities compared to off-clinic time (6.0 hours vs 7.5 hours, respectively; P < 0.01). The majority of house officers reported working 11 to 13 hours on a typical weekday (58% [174/302]), and 32% reported clinical responsibilities 7 d/wk. Working hours were negatively related to sleep quantity (Pearson correlation coefficient, −0.54; P < 0.01), and perceived sleep quality was worse when on call ( P < 0.01). The majority of house officers felt that fatigue negatively interfered with their technical skills, clinical judgment, and ability to empathize to some extent in the previous 4 weeks. CLINICAL RELEVANCE Most house officers fail to obtain sufficient sleep for optimal cognitive function and physical and mental health. Working hours and on call may be important factors contributing to the sleep patterns of veterinary house officers, and training program structure should be critically evaluated to promote protected time for sleep.
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Serving clients since 2004, Colorado State University's Veterinary Teaching Hospital is the first and only program to offer a student-run pet hospice program. Under the supervision of faculty and staff advisors, student volunteers provide home hospice care to families who have a terminally ill pet. This article describes the history of the program, how it is organized, the roles and responsibilities of the students, the challenges of the program and future goals. This article seeks to serve as a follow up on the 2008 Journal of Veterinary Medical Education article on the Colorado State University pet hospice program.
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DAVID Bartram and Dianne Gardner give an overview of various approaches to coping in stressful situations, and describe a framework of practical and straightforward steps to assist effective coping.
Article
This study examined the extent to which job and interpersonal demands and resources are associated with burnout and physical symptoms of stress among Canadian physicians. Using the job demands-resources (JD-R) model, we predicted that demands would be more strongly related to emotional exhaustion and physical symptoms, whereas resources would be more strongly related to personal accomplishment and decreased depersonalization. The findings reveal that communication skills and emotional labor contributed to the explained variances beyond workload and work–life conflict (as job demands), as well as autonomy, predictability, and understanding (as job resources). The predictors were differentially associated with the outcome variables in a manner that is consistent with the JD-R model. Implications for physician well-being and improved patient outcomes are discussed.
Article
Although the term "compassion fatigue" is often used interchangeably with the term "burnout", they are two different concepts. Compassion fatigue stems from an overcommitment to work that involves caring for others and is considered by some to be a kind of secondary posttraumatic stress disorder. Because they often invest themselves deeply in the animals they care for, veterinarians, technicians, and other members of an animal health team may be particularly vulnerable to compassion fatigue. This article summarizes the current state of knowledge about compassion fatigue, describes its symptoms, and suggests ways to prevent or overcome it.
Shock central: Veterinarian suicides
  • C Lawrence
Lawrence C. Shock central: Veterinarian suicides. 2009 Corralonline. com Available from: http://www.corralonline.com/articles/article 080310152649.htm Last accessed June 12, 2013.
Veterinarians and potentially impairing illness Available from: http://digital.turn-page. com/i
  • Gd Carr
Carr GD. Veterinarians and potentially impairing illness. Insight Magazine Sept./Oct. 2012. Available from: http://digital.turn-page. com/i/80739/13:12-13 Last accessed June 12, 2013.
New perspectives on bonding . The SCAS Journal Available from
  • S Dawson
  • J Fowler
  • E Ormerod
  • L Sheridan
Dawson S, Fowler J, Ormerod E, Sheridan L. New perspectives on bonding. The SCAS Journal; 2007:2–5. Available from: http://www.pat.org.za/ files/documents/New%20perspectives%20on%20bonding.pdf Last accessed June 12, 2013.
Stressors in the veterinary profession Board Talk Available from: http://www.vpb.nsw.gov
  • S Williams
  • H Davis
Williams S, Davis H. Stressors in the veterinary profession. 2002. Board Talk; Issue 12:12–13. Available from: http://www.vpb.nsw.gov.au/ Boardtalk/2002/aug2002/August2002_9.htm Last accessed June 12, 2013.
Veterinarians and potentially impairing illness
  • G D Carr
Carr GD. Veterinarians and potentially impairing illness. Insight Magazine Sept./Oct. 2012. Available from: http://digital.turn-page. com/i/80739/13:12-13 Last accessed June 12, 2013.