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Veterinary Suicide and Depression

In 2015, the first study addressing the mental health of veterinarians was published in the Journal of the Veterinary Medical Association. Through a survey, the authors found that veterinarians in the United States are more likely to suffer from psychiatric disorders, experience bouts of depression, and have suicidal thoughts compared with the general adult population. They also concluded that nearly one in ten veterinarians might experience serious psychological distress, and more than one in six might have contemplated suicide since graduation. Think about that. Approximately 16% of the veterinarians in the United States, which calculates to be approximately 16,000 people, have considered ending their life. This is frightening, sad, and unacceptable.

Many people are no doubt surprised by these statistics. We get to work with animals all day, how can it be so bad? For the small animal veterinarian, it’s not just treating healthy puppies and kittens all day, like some would like to believe. It’s the old dog with cancer, the young cat with heart disease, the puppy with a parvo virus infection, and the middle aged aggressive dog that would rather bite you than look at you. Add to that the constraints that owners contribute to their pet’s care including time, finances, and emotion, and you begin to understand why there is a problem. Pets, farm animals, zoo animals, wildlife, and their owners and care takers have always received empathy from their veterinarians. Now, veterinarians are the ones that need empathy.

Veterinary suicide and depression has received more attention lately. An article published in the Daily Oklahoman on Sunday of this week has undoubtedly made more people aware of this serious issue that the veterinary community faces. I have read the article, and I think it gets high marks for presenting the facts and statistics of this problem; therefore, I’m not going to summarize or critique the article, as you can read and interpret as you wish. I think our time with this blog would be better served if I state my thoughts on the topic, and provide guidance as to how you may be able to help. While I am writing this specifically as it pertains to veterinary medicine, these pearls of wisdom can easily be applied to just about every interaction you have with another living thing, whether human or animal.

1. Be aware. If you observe a change in someone you know, such as substance abuse or loss of interest in activities, ask them about it. Simply providing “talk therapy” has been shown to effectively reduce suicide risk.

2. Be friendly. If you are a part of a vet’s personal life outside of work, talk to them about something other than your pets. We are mothers and fathers, husbands and wives, and we have so many interests that don’t involve work or animals. Ask us how our son is doing in baseball. Ask how our husband is liking his new job. Ask us how we made the delicious dessert we brought to the church picnic. You can even ask us why it’s called a head of lettuce or why it’s called an ear of corn. Just don’t continually ask us for free advice.

3. Be kind. A recent study of human physicians showed that rudeness negatively affects medical performance. The authors found that rudeness affects the cognitive system, which then affects a physician’s ability to perform. Reversing these changes in cognitive function is out of the affected person’s control, which means that they can’t just get over it and move on. In a previous study, the same authors found that rude behavior from parents caused medical teams caring for infants to be deficient in all of the 11 study measures which included diagnostic accuracy, sharing of information, treatment planning, and communication. They also observed that the negative effects of the rude behaviors were present for the remainder of the working day. I would be shocked if a similar study of veterinarians yielded different results. So here’s your take home message: being nice may lead to fewer medical errors, and improved patient care.

4. Be gracious. Don’t take this statement as implying that you should heap lavish gifts on your veterinarian and their staff (though we love cookies and cake). All it means is just say “Thank you.” That’s it. You can’t imagine how much better a day goes when someone appreciates the hard work that it takes to do this job.

I lost a patient recently that had many problems including liver cancer and kidney failure. He was a great dog with fantastic owners who loved him dearly. He spent a lot of time in the clinic, which means that I spent a lot of time talking with his owners. When ending our conversations, his owner never failed to tell me “Thanks Dr. Reeds. We appreciate you.” This was such a small gesture from her, but it had such a huge impact on me. If she is reading this, I want her to know how much it meant to me to hear that.

5. Be prepared. Due to cost, veterinarians often have to offer care that is less than ideal, and in some cases substandard. It is already frustrating that we can’t save all of our patients, but the situations in which a pet can be saved but care is declined due to cost (or other factors), can take a serious toll on a veterinarian’s psyche. These situations are often when we hear “You don’t love animals! You’re only in it for the money!”

Fact: being a veterinarian is our job and how we earn a living. It shouldn’t be a surprise that we do this to earn money. That’s why you work and do your job isn’t it? We LOVE animals and the people that care for them. We (often) LOVE our jobs. We would LOVE to be able to provide free veterinary care for everyone. However, we also love putting food on the table, a roof over our head, keeping our student loans out of default, saving money for our kids’ college education, and putting money away for retirement. Veterinarians graduate with enormous debt loads, and have starting incomes that are a fraction of their human counterparts. Having someone tell you that you are only in it for the money is a punch in the gut. Being told this over, and over, and over again, is wearisome.

To help alleviate this issue, be prepared. Owning and caring for a pet costs money. When budgeting for your pet’s care, include the monthly costs for food and parasite preventatives as well as savings to be used in a case of emergency. I recommend having a minimum of $1000 dollars in a saving account for each animal that you own. This may not be enough to completely pay for a serious life threatening emergency, but it’s a start. Also, consider purchasing pet insurance. There are many different companies and options, and it is likely that one will be affordable and appropriate for you. 6. Don’t be a jerk (or insert other colorful word of choice here). We already talked about this above with #3, but this statement applies to the internet and social media.

Imagine doing your best to provide the utmost care for a patient, and then having a less than desirable outcome. Whether it is the fault of the veterinarian, or due to factors that are out of their control, it is difficult to deal with. Veterinarians also hold themselves to high, and sometimes impossible standards that make letting go of these situations tough. Now, imagine that veterinarian being attacked, or even bullied on the internet. Posting a negative review for a truly bad experience is one thing, but posting a diatribe about how the veterinarian doesn’t care, wouldn’t treat the animal for free, or is an overall horrible person because they weren’t able to work within impossible constraints is flat out wrong.

The rise of social media is a fantastic thing for veterinary medicine, and many other professions, as it can improve communication, knowledge, and visibility. However, some people use it for nefarious purposes. The anonymity of the internet and some social media sites make hiding behind a keyboard easy, and often means people don’t have to take responsibility for the harmful things they type. Once one person posts something negative, it is easy for others to develop a mob mentality and pile on the person/business. One of the more well-known examples of this in veterinary medicine is the suicide of Dr. Shirley Koshi. Dr. Koshi was the owner, and sole veterinarian, of a practice in the Bronx. A Good Samaritan presented a cat to her that was found in a local park and believed to be a stray. Dr. Koshi provided care for, and eventually adopted the cat, whom she named Karl. A few weeks later, a woman went to the practice to claim Karl as her own, as it was one of several the woman “kept” at the park. Without appropriate proof of ownership, Dr. Koshi refused to relinquish the cat to its “owner,” which prompted the “owner” to file a lawsuit, and organize demonstrations outside of Dr. Koshi’s clinic. The fight was also taken to the internet, in which people not even involved in the situation piled on the hate. Unfortunately, all of this led to Dr. Koshi committing suicide.

Veteriarian Depression and Anxiety

All of this is horrible, but hold on to your lunch, because this is where it gets sickening. After learning of Dr. Koshi’s death, the mob showed no remorse for their posts, and continued to pile on the hate. One post read “BREAKING NEWS.... BREAKING NEWS.... DR. SHIRLEY SARA KOSHI HAS BEEN REPORTED DEAD IN NEW YORK CITY. KARL THE CAT HAS BEEN FOUND.” Other posters commented “Oh wow. So happy for Karl!” and “Although I’ve never seen it, could the cause of death possibly be Karma?”

Now clearly this isn’t the entire story, but Dr. Koshi’s death isn’t the focus of this blog. This is just one example, out of thousands, of the pure hatred that some veterinarians have to deal with on the internet. No matter what the circumstances are, is behavior like this ever justified? How can anyone believe that this is an acceptable way to treat another human being?

So what can you do about this? Well, first, don’t be like these people. Second, counteract their negativity with positivity. People leave reviews that are either very positive, or very negative, with little in between. If you have a positive experience, leave a good review. If you see hate, speak up and set the record straight. We should all be doing what we can to be sure that a tragedy like this NEVER happens again to anyone.

Bee Kind

This isn’t a topic that makes for an enjoyable discussion, but it’s an important one that needs to be addressed. I know that learning of this issue may cause you to trust your veterinarian less, or even terminate your relationship. I strongly advise against doing that. Your veterinarian can be considered your pet’s second best friend, and we are strong advocates for their care and well-being. If you have concerns about this issue, talk to your veterinarian. Open dialogue will allow us to reduce the stigma associated with this problem and possibly come up with novel ways to combat it. If you have someone in your life who wants to become a member of this wonderful profession, have them talk to a veterinarian (or two, or three) so that they will understand what this life entails. The veterinary curriculum is ever evolving, and in the future, we will likely see the inclusion of information about self-care and dealing with the pitfalls and everyday stresses of the job. As a highly motivated, caring, and determined group of individuals, I have no doubt that veterinarians will be able to come up with ways to remedy this situation.

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