As a veterinarian, you will frequently find yourself helping clients through difficult decisions. 

• Is it time to euthanize my pet?
• Should I pursue this expensive treatment for my pet?
• Which treatment approach is best for my pet’s disease? 

These are just a few examples, but you will likely see many others.

Clients faced with difficult decisions will often ask for your help and support. Even though the decision is fundamentally theirs, your words and actions can help them arrive at a decision that they can be at peace with.

Step 1: Give your client the opportunity to involve others in the conversation

As soon as you realize that a difficult decision needs to be made, ask the client if there’s anyone else who should be involved. If there is a spouse, parent, or child that needs to weigh in, it is best to bring them into the conversation early. 

If possible, try to schedule difficult conversations when everyone can be present. If that isn’t an option, maybe the absent family member can participate via speakerphone. Involving others from the beginning is typically more productive than trying to catch them up after conversations have already taken place.

Step 2: Give your client the facts

In order for clients to make an educated decision, they need to know (and understand) their options. While you may have heard the advice that you should “offer Plan A and then shut up,” that isn’t appropriate for every situation. In some cases, you may need to walk clients through all of their options, including the options that you would consider undesirable, and fully explain what each of these options means.

For example, let’s say you’re dealing with a client that can’t decide whether or not to treat their newly-diagnosed diabetic dog. Obviously, the best option is to treat. If they’re reluctant to treat, however, what are their other options?

One option is to euthanize the dog at the time of diagnosis - this may be unnecessary, but certainly would minimize suffering. Another option is to monitor the dog at home for worsening of clinical signs, then euthanize. If the client wants to go this route, they need to understand what quality of life parameters they should be monitoring and be committed to euthanasia when their pet’s condition declines.

The final option is to leave the dog untreated and wait for it to die on its own. If the client elects this option, they need to understand what their pet’s decline will look like and what their pet may experience during that decline. I think we would all agree that the last option is a crummy one, but some clients need to hear and understand all of their choices before they can commit to a course of action.

Putting all of the options on the table, even the bad ones, can help clients start crossing things off the list and working towards a reasonable solution. 

Step 3: Give your client the chance to ask questions

After discussing options, it’s important to ensure that the client understands everything that you have discussed. Encourage them to ask questions. These questions may be related to what you have said or may be seemingly unrelated, but the goal is for the client to feel comfortable in their understanding of the scenario and their decisions.

Step 4: Give your client tools, if applicable

In many cases, outside resources can help clients make difficult decisions. 

If a client is debating whether to proceed with aggressive treatment for a particular disease, online support groups can help them connect with other pet owners who have been in a similar situation. Hearing “real world” experiences may help clients in a way that research-based facts and statistics cannot.

If a client is struggling with a decision about euthanasia, pet quality of life scales can help. There are a number of different quality of life scales available online. (I personally like these Quality of Life Scoring Tools.) Additionally, asking clients to track their pet’s “good days” and “bad days” on a calendar can be helpful, by providing a visual representation of the ratio of good days to bad days.

When I have clients that are really struggling with a decision, especially the decision to euthanize, I’ll sometimes present the following scenario: 

“Think ahead to 5 or 10 years from now. You know Fluffy won’t be with you any more at that point, regardless of what you decide right now. But, when you look back on your time together and this particular situation, which option are you LEAST likely to regret? Some clients regret that they kept their pet alive for too long, while others regret that they weren’t more aggressive in their treatments… which next step is most likely to help you minimize regrets?” 

While I certainly don’t use that approach with every client or in every situation, I have found that it provides clarity for some people. Thinking towards the future helps take some of the emotion out of the situation and helps people think more clearly. 

Step 5: Give your client time 

Unless you’re working in emergency medicine, the majority of client decisions are not extremely urgent. Encourage clients to take their time when making high-stakes decisions. You might step out of the exam room for a few minutes, giving clients time to discuss amongst themselves or make a phone call. You might encourage a client to go home and “sleep on it.” Either way, encourage clients to take some time to arrive at a decision. 

Remember: It’s not your decision

It’s important to remember that big decisions are ultimately up to the client. All you can do is provide the appropriate information, answer questions, and provide resources as appropriate. You can’t make these decisions for the client. You can’t feel guilty if the client delays arriving at a decision. And you definitely can’t feel guilty if a client arrives at a decision that is different from the one that you would select. 

In order to minimize your own risk of compassion fatigue, it’s important to realize that all decisions are ultimately the responsibility of the client.