Practice Management

Setting Boundaries: A Lifeline for Equine Veterinarians

By Adam Marcus

The practice of equine veterinary medicine can be emotionally taxing. Research shows feelings of depression (https://beva.onlinelibrary.wiley.com/doi/10.1111/evj.14467) run higher in equine practitioners than in other veterinarians, and roughly half  (https://bi-animalhealth.com/equine/articles/survey-results-show-equine-veterinarians-struggling-with-wellness-burnout) of equine veterinarians say they’re concerned about their personal welfare.

As Laura Garrett, DVM, explained at the recent meeting of the American College of Veterinary Internal Medicine, in Louisville, Ky., one way to maintain at least a modicum of equanimity is by effectively setting boundaries with clients. Doing so doesn’t mean being uncaring or abrupt, according to Dr. Garrett, who is a clinical professor in oncology, the coordinator of communication training, and head of specialty medicine at the University of Illinois College of Veterinary Medicine. But establishing clear expectations can help preserve professional and personal equilibrium.

Garrett discussed a handful of communications skills that can help veterinarians navigate challenging client interactions, reduce stress and ultimately provide better care.

The Power of Being Heard: Reflective Statements
One of the most powerful tools in your communication arsenal is the reflective statement, which show attentiveness. But instead of a formal “what I hear you saying is,” Dr. Garrett suggests a more natural approach: “So, you’re worried about [client’s concern].” “A reflective statement shows you heard them, and they can also correct you if what you heard is wrong,” she said.

This immediate validation has another benefit: it prevents clients from escalating the situation by reverting to what Dr. Garrett called the “lizard brain”—the reactive, emotional part of the mind—where things can get heated in a hurry.

Navigating the Consultation: 4 Essential Communication Skills
Beyond reflective statements, Garrett underscored 4 additional skills can significantly enhance interactions with clients:

1. Pausing: After asking an open-ended question, resist the urge to fill the silence. Give the client time to formulate their answer. This simple act respects their thoughts and encourages more detailed responses.
2. Signposting: Clearly outline the plan for the appointment. “First, I’m going to do a physical exam, then we’ll discuss treatment options.” This opening sets expectations and minimizes interruptions. For front office staff, she said, the opening might be, “I’ll take your information, then you’ll wait in the lobby, and then the technician will call you in.”
3. Chunk and Check: When delivering information, break it down into manageable “chunks.” Instead of an overwhelming monologue, present a small piece of information, then pause and “check” for understanding or questions. This method ensures information is absorbed and allows for two-way conversation.
4. Asking Open-Ended Questions: Don’t assume you know what is going on. Instead of making accusatory statements—‘you behaved so terribly last night, you’re fired,’ [say] ‘Okay, tell me about your side of the experience,’ ask for their perspective,” she said.

These questions foster curiosity and a collaborative approach to problem-solving, she added.

De-escalating Angry Clients: Control with Empathy
Dealing with an angry client can be particularly stressful, Dr. Garrett noted. The natural instinct might be to tell them to “calm down,” but—as in other human relationships—this approach almost always backfires. Instead, she advised focusing on these strategies:

• Match Intensity (delicately): While you shouldn’t shout back, avoid an overly soft, undermining tone if a client is yelling. Match their rate of speech and volume to show you’re taking their concerns seriously.
• Change the Angle: When a client is confrontational, subtly change your body angle away from a direct face-to-face confrontation. A slight turn can diffuse the intensity and encourage them to adjust their posture, often leading to a calmer interaction. “This isn’t always about connecting; sometimes it’s about maintaining dominance,” she said.
• Be Setting: “Setting a boundary is not telling someone what not to do, because that is only going to trigger them more. It’s what you’re going to do if a condition is not met,” Garret said. Instead of saying, “You can’t talk to me like this”—which invites defiance—state what you will do if the behavior continues. For example, “I’m not comfortable with this language. If it continues, I will end this consultation.”
• Empathy, Not Apology: Saying “I’m sorry you are so angry” is not true empathy and can sound passive-aggressive. Instead, use phrases that validate the client’s feelings without taking responsibility for them: “I can see you’re upset about this. Tell me more.” or “I hear that you’re upset. What can I do to help?”
• Address Underlying Emotions: Anger is often a secondary emotion. “When someone goes off the rail angry, they really may be scared or worried,” Dr. Garret said. Sometimes, simply asking “What can we do to address this?” can prompt them to consider solutions, or even realize their anger is unproductive.

These boundary-setting principles also apply to protecting your staff from abusive clients, Garrett said. If a client is consistently rude to technicians or students, intervene. Start with empathy for the client’s situation, then calmly state the boundary: “If this behavior continues, we will ask you to seek care elsewhere.”

And be as clear as possible about the nature of that offensive behavior. Describe what a camera would record, not an interpretation, she said. Instead of saying “You’re abusive,” say “You turned your back on the technicians,” or “You speak very quickly and loudly.” These kinds of statements avoid arguments about intent and focus on observable actions, she said.

Using these core skills allows clinicians to focus on clients—even when those clients are upset or difficult, Dr. Garrett said. “You can de-escalate them, and then you’re going to be able to be successful in working with them. And they will be kinder, too.” MEV