Sending Clients on Guilt Trips

(originally published in Veterinary Forum: February, 2001)

Sometimes we veterinarians feel so strongly about our role as animal advocates that using guilt to prod reluctant owners into accepting certain treatments seems like a caring thing to do: “I realize that medicating Skippy’s ears is a chore,” Dr. Marcroft politely lectures Mr. Safford. “But you waited so long to bring him in, it’s going to take time to get that infection under control. You don’t want him to suffer any more, do you?” Admittedly Dr. Marcroft might feel a surge of righteousness as Mr. Safford hangs his head in shame, but will the veterinarian’s guilt trip take her patient where she wants that animal to go? The answer to that is a rousing, “It depends.” Depending on the animal, its problem, and the owner it may, but it may not.

In general, guilt works best when used to motivate clients for a relatively short period of time. Stung by Dr. Marcroft’s criticism, Mr. Safford vows to make time in his busy schedule to medicate Skippy religiously. Like many people, he believes he can tolerate any inconvenience caused by the treatment process for about 7-10 days. He also sees this and any sacrifices associated with it as a fitting atonement necessary to repent for his animal-related sins. Owners who must juggle work and family obligations can usually rearrange a week’s worth of activities to accommodate any treatment without too much difficulty. “It’s a hassle,” they admit. “But it’s our own fault for not realizing that the cat was ill.”

However, even when guilt appears to work, we need to keep few points in mind. First, even if owners do procrastinate or make mistakes that caused their animals what we consider avoidable harm, the fact remains that they did seek our assistance. Unlike many other animal owners in Dr. Marcroft’s practice area, Mr. Safford did call and make an appointment, did show up for his appointment, did accept Dr. Marcroft’s recommendations for diagnosis and treatment of his pet’s condition, and did pay for all this. Consequently, while Dr. Marcroft might not consider Mr. Safford a good candidate for pet owner sainthood, does he really deserve to be treated like a good candidate for pet owner’s hell?

Second, the guilt-dispensing veterinarian often bases his or her condemnation of a client’s behavior on what may amount to little more than a collection of impressions gathered during a 15-minute office call. Consequently, that clinician’s evaluation of the situation exists in a relative vacuum that includes few details of the circumstances that contributed to the animal’s condition. As such, it carries little weight. Although Dr. Marcroft personally might believe that nothing should keep an owner from seeking medical attention for their animal at the first sign of a problem, others might not share that opinion. For example, Mr. Safford might consider the unexpected death of his wife, the loss of his job, or his son’s tragic accident a valid reason for not noticing when Skippy began scratching his ear. Additionally, no matter how valid his reasons, he might feel uncomfortable sharing details of his personal life with the veterinarian just to defend his actions.

Aside from the problems associated with the shaky foundation that may underlie our attempts to make owners feel guilty, guilt also may result in negative feelings toward the veterinarian and the animal. This occurs most commonly if the treatment lasts more than a short time or if the owner encounters any difficulties during the course of it. When Skippy develops diarrhea, Mr. Safford wants to call Dr. Marcroft to see if the antibiotics she prescribed might be causing this. However, the memory of the judgmental veterinarian makes him hesitate: What if she tells him he’s over-reacting? What if she says he should have called sooner? No matter how he looks at it, Dr. Marcroft could find yet another reason to make him feel like a negligent owner. “Who needs that?” he asks his dog. “We’ll just hope your diarrhea clears up on its own.”

Needless to say, owners sent on guilt trips often reach a point at which they begin to resent the veterinarian who sent them there. One thought fills Mr. Safford’s mind as he struggles to treat Skippy’s problem without what he considers useful veterinary guidance or support: he will never take his dog back to Dr. Marcroft. “She things I’m negligent, hah!” he sputters indignantly to a neighbor. “If she really cared about Skippy she would have told me about any side-effects those pills might have!” His neighbor nods sympathetically and agrees that she would never take her animals to a veterinarian like that, either.

Although her use of guilt may cost Dr. Marcroft a client or two, Mr. Safford stands to lose his relationship with his animal as well as with his veterinarian. This occurs because the animal and its treatment may become synonymous with the veterinarian in the client’s mind. When Skippy spits out the antibiotic tablet for the fifth time or shakes ear goop on the new chair, his owner may take out any anger or frustration related to the veterinarian on his pet. “Knock it off!” he shouts as he grabs the dog’s ear roughly. “It’s her fault I have to do this to you, not mine!” Startled by this unfamiliar owner response, Skippy slightly curls his lip and the human-relationship perches on the edge of a downward spiral.

All in all, objectively analyzing how and why we use guilt in the treatment process may lead us to view this practice in a new light. True, in the short run sending clients on guilt trips may make us feel self-righteous and like a defender of poor helpless animals who can’t speak for themselves. However, as long as we must depend on owner cooperation and commitment to successfully treat their animals, using empathy and compassion rather than guilt to fuel the treatment process may result in a much smoother and more efficient journey to good health for all involved.