Handling Unethical Clients in Veterinary Medicine

Consider and discuss ethical dilemmas before they occur, and understand negotiating principles, to help you navigate these tough situations.
Author:
Publish date:
injection vet gloves barn

It is not uncommon for veterinarians caring for competition horses to feel pressured to give treatments that allow an injured or lame horse to perform in an event, or even worse, to be presented for purchase.

Ethics in the equine industry and equine veterinary industry have become an important topic as society has increasingly viewed animals as sentient beings capable of anxiety, fear and pain. Despite often limited knowledge of animal behavior or appropriate management, citizens have great power in moving societal approval of activities involving animals. 

At the Ethics Early Riser Session at the 2019 AAEP Convention, Dr. Camie Heleski led a discussion on "Social License to Operate," a concept encompassing the legitimacy, consent and trust that is required by the public for certain activities to continue. By using examples such as elephants in circuses, greyhound racing and bullfighting, all of which have lost their social license, the speaker brought forward the idea that certain areas of the equine industry are under threat as well.

While it is easy for veterinarians to agree that an activity like dog fighting is horrendous, an increasing number of people in society feel that way about horse racing, rodeo and even three-day eventing. Increased media coverage of injuries and deaths in the equine industry—for example, the Calgary Stampede, the “Big Lick,” the New York Times expose' of Thoroughbred horse racing, rotational falls on the cross country course—have made the sports we take for granted come under an ethical microscope. 

If those in the industry want equine sports to continue, we must all take a stand for the horse.

According to the American Association of Equine Practitioners (AAEP), ethical behavior is described as follows: “Professional ethics embodies the behaviors of honesty, integrity and kindness while obeying rules and regulations set forth with mutual respect for opinion and preservation of dignity in interpersonal relationships. The conduct should be in a manner that will enhance the worthiness of the profession. The ethical practice of medicine includes those remedies and treatments that have, as their short or long-term goal, the health and welfare of the horse.”

Our professional ethics are generally an extension of our personal values. Values are the core of identity of individuals and organizations—they are the principles, beliefs and philosophies that are held sacred. Individuals absorb their values from their earliest experiences in their nuclear families, and these core beliefs will shape them through their lifetimes. These are the personal truths that feel undeniable.

Core beliefs serve three very important functions in your life and in your practice:

  • Provide ethical guidelines and boundaries for your behavior.
  • Simplify decision-making, because if something is not in alignment with your values, decisions become much easier to make.
  • Resolve conflict due to values being the standard of acceptable behavior within your practice or your life.

The ethical guidelines from our professional associations, and scientific research findings to guide our treatment decisions, support us when ethical dilemmas arise. These pillars can be the foundation of the difficult conversations that follow.

Industry Pressure

It is not uncommon for veterinarians caring for competition horses to feel pressured to give treatments that allow an injured or lame horse to perform in an event, or even worse, to be presented for purchase. 

Sometimes the ethical question seems less profound, as in the case of being asked to “scratch” a lame horse from an entry for a reason that is untrue, or to dispense antibiotics for a foal with a fever and snotty nose, without an examination. 

At those moments, equine veterinarians might have a number of concerns. Will the client be angry if I refuse his or her request? Will I lose that person as a client and the income that he/she represents? Will the practice owner or my partners be angry if I lose this account? Will the trainer take away the work from the entire barn of horses if I do not comply? Could the horse or rider be injured as a result of the request? Could the patient have an adverse outcome? What will they ask of me next if I comply this one time?

Because situations frequently arise that offer ethical dilemmas, the best approach might be to think them through in advance and prepare for the conversation.

Ethics has been a hot button issue for newer graduates in equine practice, leading some to leave the profession. The approach of “the customer is always right” or “if we don’t do it, the next veterinarian will” or “we can’t afford to lose the business” can leave some doctors despairing of the lofty purpose of “serving the horse” that originally brought them to the long hours and hard physical work of equine practice. Having a forum for discussion and debate offers an opportunity for a practice to come to a collective decision about a uniform approach to unethical requests, and to support the concerns of all veterinarians.

If you work in a group practice, the variety of commonly occurring ethical challenges can be fodder for robust conversations among doctors at regularly scheduled meetings.

Conversations with a client requesting a service that the veterinarian feels is unethical is sometimes because of client misunderstanding or occur due to lack of client knowledge. It is important to understand the perspective of the client and why he or she is making the request.

To be sure you have listened completely, it is always a good idea to rephrase back to the client what you heard in order to check the accuracy of the communication.

Understanding the client’s objectives, reasoning and motives can help the veterinarian to make a judgement based on more complete information. Making a snap judgement without the benefit of the full story can turn a potentially positive conversation into an argument. Keep in mind that all people occasionally make mistakes or have lapses in their ethical thinking, so assume the best of people, and make that clear in your communication.

Conflict Resolution

Conflict resolution occurs through negotiation. Negotiation is defined as a process during which two or more parties attempt to resolve their differing interests. When it is collaborative and cooperative, sometimes negotiation allows the needs of all parties to be met. In that type of negotiation, there is a focus on what is found in common rather than on differences; on interests rather than positions; on meeting the needs of all parties; on an exchange of information between sides; and on considering innovative ideas.

In order to be a successful, both sides must build trust through honesty and integrity; have a positive outlook that sees abundance rather than scarcity; recognizes that others’ interests might have equal validity; be able to see the big picture; and have strong listening skills.

By facilitating a reciprocal flow of information, both sides gain understanding of the needs and concerns of their counterparts, leading to less extreme resistance and reaction. Identification of the other persons’ true objectives and desired outcomes can lead to recognition of common goals. This makes searching for solutions that meet both sides’ needs more successful and satisfying.

Individual Styles for Negotiation

Individuals have innate preferred negotiating styles. These include avoidance, compromise, accommodation, competitive and collaborative. By understanding one’s own preferences and being aware of the potential for others to have differing styles, a person can become more successful in difficult conversations. A cooperative approach is often more effective than a competitive one, so awareness of personal preferences can lead to better outcomes. 

Dr. G. Richard Snell, a professor at the Wharton School of Business, created an assessment tool for negotiation style, printed as an Appendix in his book “Bargaining for Advantage.” Results of this assessment reveal a preferred style of negotiation.

Those with strongly Accommodating styles have strong skills in relationship building and enjoy helping solve others’ problems, but can be vulnerable to competitive counterparts, sometimes placing more value on relationships than warranted. Those with weak Accommodation often focus on being “right” and have difficulty seeing other perspectives. Others often perceive them as stubborn and unreasonable, or uncaring about others’ feelings.

Negotiators that are predisposed to Compromising are seen as friendly and reasonable, but frequently grasp the first fair solution that presents itself, so are vulnerable to choices made without adequate fact-finding. Those low on Compromising often have strong principles and passion and are subject to standing on principle when common sense dictates otherwise. They can be seen as stubborn and irritating.

People that favor Avoiding dislike confrontation and will dodge all situations that lead to disagreement. This can manifest as diplomacy and tact, and those can be very helpful in tense negotiations, because conflict avoidance well-handled can bring reactive people to agreement. However, important information is often not brought into the open due to fear of the resultant difficult conversations. Those who have low Avoiding preferences have a high tolerance for assertive or even aggressive conversation. They are often thought of as lacking tact or being overly confrontational.

Those predisposed to Collaborating enjoy solving tough problems through negotiation and work hard to find a best solution. However, those people might fail due to their wish to build consensus and their vulnerability to competitive negotiators. Those low in Collaborating prefer a more controlled, detail-oriented process, and they might lose clarity and focus when they cannot dictate the result.

Negotiators who prefer Competing like to win, and they enjoy negotiating because it provides a contest. Comfortable in the combat of these conversations, their style is often dominating and can damage relationships. These negotiators often focus only on getting what they want, neglecting the intangibles of trust, relationships, etc. These are clients you might feel comfortable letting go. Those low on Competing value fairness and trust highly. Unfortunately, because they are seen as non-threatening, in some situations they will be at a disadvantage.

Take-Home Message

Despite your best efforts in negotiation, when conflicts in values occur between parties, a mutually beneficial solution might not be possible. In those cases, the effort to understand both perspectives and the willingness to have non-judgmental dialog can salvage a future relationship.

Two phrases that can assist in holding to your ethical position are: “I am the only one who can protect my veterinary license—without it, my career will be over” and “I simply cannot compromise my values.”

In addition, consideration and discussion of ethical dilemmas before they occur, and understanding negotiating principles, will help you navigate these tough situations. 

Resources

For more articles related to this topic go to:

AAEP-MediaPartner_1968x1100
AVMA-PLIT-logo_resized
BEVA-logo_3757x2100
WEVA-Logo-Dark-Background_1789x1000
NZEVA-logo_1100x1968

ISELP-logo_1100x1968

AAEVT-logo_2050x3667
neaep-mediapartner_1968x1100
epm-society-partner_1968x1100
Mexican-equine-vet-association-