Kristina Kiefer

“I need help, please.” This is one of the hardest things I’ve had to learn as a veterinarian. It’s taken monumental work, but it’s paid enormous dividends. And from what I’ve witnessed, it seems to be a skill that our profession really struggles with. It’s another one of those features I believe we have been selected for, and conditioned to be terrified of admitting. I see it repeatedly in students on their clinical rotations. Afraid to admit they don’t know the answer. Worried about asking a clinician for help. Basically, admitting imperfection. And I feel it carries over a lot into our medical practice. Owners expect us to know all the answers. Practice owners expect us to see all the patients, complete all the medical records, thoroughly document phone conversations, and show up the next day eager and happy to do it again. We have been trying to do and be all the things for so long in order to get where we are. But most of us are reluctant to open our mouths, afraid we’ll inconvenience someone else, or be looked upon as anything other than a hard worker. 

My first lesson was a hard one. Super fresh out of school, not more than a couple months into an internship, nervously collecting recommendations for a residency application, and on the overnight emergency rotation. A case came in, referred for a pyometra. The patient was pretty bright; the pyo was open. She came with minimal diagnostics, but had a drip of purulent material from her vulva here and there. I examined the dog, and formulated an estimate for diagnostics, emergency surgery and appropriate therapy. It was, of course, after 10pm. The owner took one look at the estimate and flat out told me it wasn’t an option. Being an intern, I had no authority to change prices, and minimal experience in what was “OK” to start whittling down. I had offered standard of care, and excellent care. I offered Care Credit. “Nope.” I suggested borrowing from friends or relatives. “Nope.”  I offered referral to other practices, which I knew to be cheaper. I offered antibiotics and surgery at the rDVM the next day. I gave all the options I knew. The owner took the antibiotics and left, peaceably, but of course not happily.

Next thing I know, a relative of the owner is calling the clinic, demanding to speak to me, and screaming at me about how I have given the dog a death sentence, and I am a horrible veterinarian and human being. They threatened to sue me. They threatened to take me to the board. After calling 2-3 more times, screaming each time, they finally informed me they had found a “better” veterinarian, who would do the procedure that night, for half the cost. Great. Fantastic for the dog. Not so great for me. I pre-emptively called and left a message for the Hospital Director and CEO, and was haunted throughout the night by visions of my dismissal from my internship and a screeching halt to my ambitions as a specialist. I fretted the whole night. I stayed late from my shift, to meet the Hospital Director and explain in person, that they should expect a phone call from an irate customer. Nowadays, being a more a seasoned veterinarian, I can confidently state that I took way too much ownership for that client’s anger. (Please note, I can also identifies ways I could have better managed the situation- learning- it’s my favorite.) They were the ones who hadn’t spayed their dog. They were the ones that chose to do something after hours, in an emergency situation. They refused the financial options I gave them. They were the ones who had created the entire situation, from start, to finish. But, in my little intern brain, I had failed.

The Hospital Director had one question for me after I regurgitated the whole story. “Did you ask for help?” My anxiety ridden mind came to a screeching halt. 

“Help?” I asked lamely. “Like, help making the estimate? I’ve had several of these cases, and this was not different from any of those…” He shook his head.

“Help to manage the angry client? Everyone was dealing with critical cases, and the client I actually saw wasn’t angry…” 

He shook his head again. “I mean, did you ask one of the senior clinicians if they would do anything different, before the client walked out the door?” I sat quietly for a long, awkward moment. Asking for help hadn’t crossed my mind. I wasn’t uncertain about the care needed. I wasn’t uncertain about my recommendations. I’d handle dozens of cases similarly. I’d watched mentors handle hundreds of cases similarly. I hadn’t felt helpless or incompetent, at any point. Asking for help had never crossed my mind. For the record, I’m pretty sure the outcome would not have been any different if I had asked for help, but I was mortified, when it was pointed out to me, that the thought of getting help had never even flitted by my consciousness.

I do not consider myself an arrogant person, nor do I feel like I have a tendency to overstep my capabilities. Most people would describe me as “humble”, and “teachable”. And yet reaching out wasn’t even in my consciousness. I started paying attention from that moment forward. How often we do (or don’t) ask for help. And I became even more alarmed. It’s. Not. Natural. It has to be a very deliberate and courageous action for the average veterinarian to ask for help. And I think it’s one of the contributors to our tragic losses of colleagues by suicide. We haven’t set the standard that asking for help is normal, natural, or necessary. We have created a culture of self-sufficiency, all encompassing competence, and shame at the thought of needing help. Realizing we don’t need to do this alone is an incredibly powerful skill. Learning that there are others willing and ready to support you, is liberating. And getting outside perspective can be the most direct path to learning and expanding your strengths. 

So, here goes. I need help, please. I need help creating a culture in our profession that asking for help is OK. That it is powerful. That the strongest among us rely on others, in order to be their best. Your willingness to ask for help and creating an environment where it is a strength could save another colleague’s life. It might even save your own. Help, please? 

Related material:

• Slaying the Savior
• Book Rounds: Well Being
• Book Rounds: Feedback: The Science and Art of Receiving Feedback Well- even when it is off base, unfair, poorly delivered and frankly, you’re not in the mood
• Stuck in My Head
• Help, me please- I’ve been thinking about suicide.