Many Clinics Report an Increase of Toxic Clients, Contributing to Staff Turnover

by Kerri Fivecoat-Campbell

It’s happening in veterinary hospitals across the country: Clients are becoming exceptionally rude by harassing, berating, and sometimes even threatening staff. As a result, clinics are reporting they are “firing” more clients than ever before.

At Metropolitan Animal Specialty Hospital (MASH) in Los Angeles, California, Rebecca Baker, LCSW, lead veterinary social worker, described an incident that led to a client’s firing. Baker said the new client scheduled a sonogram for her pet, showed up a half hour early, and got into the line for emergency curbside service.

“She began yelling, swearing, and honking her horn at the other clients and staff,” remembered Baker. “We explained she needed to get out of the emergency line and go to the parking lot. She became even more angry and hit another client’s car trying to get out of the line. She went to the parking lot, got out of her car, and tried to bust down the clinic door, which was locked due to COVID protocols.”

Baker says they told the woman the clinic would not serve her at all and asked her to leave. “We told her we didn’t feel safe treating her pet or any others she may have.”

Elizabeth Maimon, DVM, MPH at AAHA certified Hills and Dales Veterinary Clinic in Kettering, Ohio, described a similar incident in which an angry client tried to intentionally run over a vet tech in the parking lot during a curbside service. “It was a client we worked into our schedule, and she was mad that she had to wait,” said Maimon. “When she was told we couldn’t see her right away, she tried to follow the vet tech into the building. When that didn’t work, she waited until she came back out, then tried to hit her in the parking lot and sped away.”

Maimon said the clinic sent the camera footage to the local police, but they declined to prosecute as the tech wasn’t harmed. Of course, the client was fired from further services at the clinic.

These are two examples of the extremely toxic clients that clinics are seeing more routinely in their practices. Marybeth Cline, DVM and owner of AAHA accredited Riverside Veterinary Hospital in Elizabeth, Pennsylvania, has been in business for 31 years and said rude, aggressive clients have always been a part of the business, but they are becoming more common. “There have always been those types of clients,” she noted. “Prior to the pandemic, I fired one or two clients per year. In the past two years, I’ve fired at least a dozen.”

Richard Glassberg, DVM, at Sunnycrest Animal Care Center in Fullerton, California, said toxic clients are in the minority, but they are becoming more prevalent, which has forced him to fire three in the past two years. Glassberg has been in business since 1968, and when asked the last time he fired a client prior to the pandemic, replied. “I think I fired one sometime in the ‘70s or ‘80s.” Glassberg added he fired a client last year just before the holidays. “She had my daughter-in-law in tears,” he said. “I didn’t fire her just because she was abusing my family, I just heard about it faster because she is family.”

Reasons for More Toxic Clients Are Many, but Center Around Pandemic

Alicia Artman, CVPM, a former practice manager with more than eight years’ experience, says there are many reasons clinics are seeing more toxic clients. “There were many situations of us getting yelled or cussed at for curbside service protocol, being booked out and unable to offer same day appointments or having to refer to emergency care, and periods of time when we were only scheduling essential services and not accepting new clients,” said Artman.

The pandemic has also caused a lot of financial stress on people who have lost jobs. “I think the most common issue is people arguing about their bill, especially if their pet passed away,” said Alyssa Pepe, LCSW, a veterinary social worker for AAHA-accredited Orchard Park Veterinary Medical Center in Buffalo, New York.

Frank Anderson, MD, a psychiatrist in private practice specializing in trauma in Boston, Massachusetts, said all service sectors are seeing an increase in toxic customers and clients since the pandemic began in 2019. “It is absolutely due to the pandemic; we are in a collective mental health crisis and it’s worse than it has ever been,” explained Anderson. “People are experiencing waves of trauma with this pandemic, and they are at their wits’ end.” Anderson noted he doesn’t personally know a mental health professional who isn’t completely booked.

Anderson said society has ridden the wave of the initial pandemic panic, waves of variants, the promise of the vaccine, deaths of people close to them, and then more waves that are currently infecting more people than in 2020. “It’s physiologically unsustainable,” said Anderson. “Our cortisol levels cannot tolerate chronic high levels of trauma and stress. There haven’t been enough breaks in this pandemic to allow recovery before the next trauma hits. Adrenal fatigue sets in, and people are just drained and fatigued.”

As a result, Anderson said, people take their frustrations, grief, and anger out on people in all service industries. Specifically speaking to the veterinary industry, he says pandemic isolation has also caused many people to become even more bonded to their pets. “Pets are the salvation for many people,” said Anderson. “If they are not getting attended to as owners think they should, it’s not surprising they’re lashing out.”

Setting Boundaries

Anderson is quick to point out that although he understands the reasons people are lashing out, it doesn’t make it right. “It’s perfectly fine to set boundaries and tell the clients it’s not OK to treat you or your staff this way,” said Anderson. “Setting a boundary is taking care of yourself and your staff and brings more power to the situation.”

Baker agreed that while she understands the stress and trauma clients are experiencing, “verbal abuse, threats, and hate speech should never be tolerated, especially in such a vulnerable population with vet staff having extremely high rates of suicide and exposure to primary and secondary trauma.”

Her clinic has contemplated several avenues to inform customers of the hospital’s boundaries, including requiring new clients to read and sign a code of conduct. “That was vetoed, but we are in the process of having a sign approved that will be posted at the door and in the clinic.”

The proposed sign that is in the approval process reads, “Welcome to MASH. We remain dedicated to providing excellent care for the dogs and cats of Los Angeles during the ongoing COVID-19 pandemic. During these extraordinary times, our staff are working harder than ever amidst unprecedented caseload and staffing shortages. We appreciate your patience and kindness. We reserve the right to refuse service to anyone.”

When Setting Boundaries Isn’t Enough, Training May Help

Artman, who left her job last summer due to the stress and resulting health issues that stress caused, said her previous employer did set boundaries, but there were enough abusive clients to wear on everyone. “Any client that uses profanity or yells at the staff was not allowed to receive services any further,” said Artman. “We had some very understanding and nice clients, but it was often overshadowed by those that weren’t so understanding.”

Cline noted that it is important to talk about and train the staff to deal with difficult clients. “They usually always go after the staff, not the vet,” she said. “When I walk in, they are typically calm and collected.”

Cline says they discuss incidents in their regular staff meetings. “We talk about what happened, how it was handled, and how we might improve,” said Cline. “There are a lot of reasons things like this happen.”

Glassberg said he has seasoned techs mentor new techs, and one of their functions is to show them how to deal with clients in a positive way.

Many times when a situation does arise, Baker said, a conversation gets out of hand as a result of a stressed or grieving client and also due to stressed, overworked staff. “Communication isn’t something that’s focused on in veterinary or vet tech schools,” noted Baker. “If a client is stressed and maybe grieving, they are emotional and the exchange between the two escalates.”

Part of Baker’s job as a veterinary social worker is to take the time to listen to the client, which many veterinarians and techs may not have time to do.

Baker’s hospital has also allowed her to provide continuing education in communication and de-escalation techniques. She is there to provide support to the staff as well as the clients. “I may be able to help bridge the gap in communication if a situation arises. I’m the conduit that allows staff to do their jobs effectively.”

Maimon doesn’t have a veterinary social worker on staff but said prior to the pandemic, she had a licensed therapist come in to conduct workshops in communication and de-escalation. She said she is also lucky to now have a licensed therapist as part of her staff who helps in such situations.

When the Situation Cannot Be De-escalated

There are times when a client’s behavior is so egregious that it simply cannot be handled. That’s when it is appropriate to fire a client.

“There is a line,” said Ivan Zakharenkov, DVM, president/CEO of Galaxy Vets in St. John, New Brunswick, Canada, a new company focused on helping the industry deal with compassion fatigue and burnout. “You and your staff are there to help and support the client. We, as vets, have also been taught that the client is always right, and that’s just wrong. The client isn’t always right. It’s always easier to find a new client than it is to find a new staff member.”

Pepe said her clinic has empowered staff the autonomy to walk away from clients. “We want them to feel comfortable in walking away, to call the police if they feel threatened, and do what’s necessary to feel safe,” said Pepe.

Other clinics escalates the situation to leadership staff on site or, in the cases of firing, to corporate offices.

Cline said she doesn’t feel it’s her staff’s responsibility to handle such clients. “It’s not their fight, so they are told to bring it to me or the office manager immediately, not after the client leaves,” she said. “Sometimes they just want to vent, and a person in authority can de-escalate by telling them, ‘We’re here to help you, we’re all on the same team, but you’re going to have to lower your tone.’”

However, if that doesn’t work, Cline said even as the owner of a small, rural clinic with a finite number of potential clients, she doesn’t have a problem asking a client not to return. “I might take more than I ask my team to take from them, but it’s all about protecting my team and making sure everyone feels comfortable and safe.”

Cline noted when a client is fired, they are never allowed to return. “One of the first clients I ever fired when I first opened tried to come back, and I told her she still wasn’t welcome, even decades later.”

It’s important to send a written notification that the client is no longer welcome, as well as a copy of the client’s medical records. Cline’s clinic sends both by regular and certified mail. “It is documented, and they can’t come back and say we didn’t send their records,” Cline explained.

When a client is fired, Cline said she is confident she’s made the right decision. “That level of disrespect goes further than just being rude,” said Cline. “We don’t play around.” 

Kerri Fivecoat-Campbell is a writer living her dream life in a small cabin in the Ozark Mountains. She shares her life with her rescued pack of dogs. She is the author of Living Large in Our Little House: Thriving in 480 Square Feet with Six Dogs, a Husband, and One Remote. You can see more of her work at kerrifivecoatcampbell.com.

Photo credits: DjelicS/E+ via Getty Images; LightFieldStudios/iStock via Getty Images; Jevtic/iStock via Getty Images

Tips from a Certified Veterinary Practice Manager

Sample Language for Firing Toxic Clients

by Debbie Boone, CVPM

Over my career in veterinary medicine, I had to fire a total of four clients. I managed for 23 years before beginning my consulting practice, and my largest hospital had 11 veterinarians. Lots of clients of all socioeconomic levels, varying emotional attachment to their pets, and a spectrum of levels of emotional intelligence (EI) walked through those doors. Yet only four behaved in such a manner that we asked them to not return.

In today’s world, managers are releasing clients to torment others at the rate of four or more a month! There seems to be a literal tsunami of bad behavior walking in the doors in practices all over the country. In addition, this phenomenon is not limited to the US; practices in the UK are reporting similar circumstances. WHY?

As someone fascinated by human behavior, I understand that two years of constant stress from major life changes, fear of illness, and societal disruption are taking a toll on the human psyche. Veterinary teams are working shorthanded and being forced to shift and change workflows that in the past were almost automatic. Our brains are exhausted and running on a short fuse.

Unless they are a sociopath, no one is enjoying this agitated state. So, when you have two stressed and twitchy humans confronted with a situation that does not meet the expectation of the client, chances are good that we are going to face an explosion. For those with high EI, these situations typically don’t get out of control. But when even those with high EI can’t manage these clients, it is time to say goodbye.

The first rule is always BE SAFE! Our bodies are designed to sense danger, and if you feel this person is going to possibly harm someone, it is time to call the police. You may state, “Mr. Jones, your behavior is making me very uncomfortable. I am asking you to leave our premises or I will be forced to call the police.” If the client does not comply, make the call and disengage.

If the client has been verbally abusive, you may ask them to filter their language. If they do not comply, it is time to send them on. “Mrs. Jones, we understand that you are unhappy and we would like to help you. However, since you continue to use harsh language, we are preparing your pet’s records and will ask you to seek care at a practice better suited to your needs.”

This same language can be used if clients are on the phone.

Other times clients should be fired because they insist on inappropriate care or on allowing a dangerous pet to be out of control to the point of harming other animals or people. In these situations, you may say, “Mr. Smith, although we are happy to help your pet, we must insist you follow our instructions. If we no longer have your trust, we understand but will have to prepare your pet’s records so you can seek another provider.”

Firing clients is never fun. But hopefully by training the team to have advanced EI, you can avoid incidents of client meltdowns. Sometimes we inadvertently say things that escalate situations rather than calming them. My favorite tip is to remember that humans are just animals at the top of the food chain. Most bad behavior is based in limbic brain fear-based reactions. Often these reactions come on the heels of a negative surprise. Blindsiding people is never a good plan, so push information out to clients beforehand. If we start to look at fractious people the same way we view a fearful animal, we may begin to give folks some grace.

Debbie Boone, CVPM, Fear FreeSM Certified, has worked for the veterinary profession for more than 30 years. After earning her bachelor’s degree in animal science from North Carolina State University, she began as a client care representative and quickly moved into hospital administration. Debbie has experience in the management of small animal, mixed animal, specialty, and emergency practices.