With the benefit of experience in veterinary practice and a social work perspective, if I were to start out all over again as a new or recent veterinary graduate there is a lot of advice and guidance I would give myself:   Don’t beat yourself up if interactions with grieving clients don’t go well. There are lots of reasons why interactions with psychologically distressed clients dealing with loss don’t go well: the time constraints of practice; all the things we are expected to get done in the space of a consult; charging accordingly for our services and time. These, taken in whole, do not foster a formula for success. Anger, fear, regret and guilt are common emotions associated with the impending or actual loss of the animal relationship, and any one of these emotions can negatively impact on our interactions with grieving clients. Often it is not personal, but it is hard for it not to feel personal. Each client has their own unique complexity and vulnerability associated with the animal relationship. Animal companions are often a significant source of social support and create a sense of meaning in people’s lives. Ideally, a psychosocial assessment is required to gain an in-depth understanding of the nature of this relationship. A psychosocial assessment is best obtained by someone with specialized training and expertise. The professionals who perform this role in a human hospital setting have the benefit of making an assessment without the responsibility of also diagnosing and managing the patients’ medical problems. In veterinary hospitals the veterinarian often fills the role of multiple medical disciplines. The intensity of what is expected to be achieved by veterinarians and support staff in a regular day of veterinary practice was one of the biggest standouts for me after spending time in the human hospital setting. Discussions about end of life with clients are not easy. Veterinarians who report feeling comfortable with supporting grieving clients tend to have years of experience with a reliance on gauging of clients’ emotions based on intuition. It is particularly challenging when you are under stress and just starting out in practice to also expect to be in tune with a client’s emotions and to be able to pick up on subtle cues. The grief veterinarians experience associated with patient death and the impact it has on mental well-being is also worthy of recognition and validation. The intense, fast-paced nature of veterinary practice and frequent death of animal patients leaves little opportunity for veterinarians to process emotions. Veterinarians can experience grief associated with the attachment developed with our animal patients, particularly those in our care long-term. Additionally, grief can be vicarious as a consequence of identifying with the loss experienced by clients. Veterinarians also experience grief associated with unmet goals and aspirations when not successful in treating an animal patient or when it unexpectedly dies. This grief can become disenfranchised if not recognized and validated by our peers, contributing to feelings of isolation and a decline in mental wellbeing. The sadness, guilt and regret that can be experienced in the course of veterinary practice is worthy of validation and support from a trusted professional or peers, either within or external to the practice. It is important to dedicate time and resources to working through our own grief. Give yourself and your colleagues permission to take time out for themselves to express and process emotions. Take the time and courage to reflect and learn when cases don’t go well and use this as a source of meaning for our work and to honour those patients no longer with us. Grief is a journey and needs time to heal. Grief is not something veterinarians can fix for clients, but we can provide them with resources and link them up with people who can support and walk alongside them during their grief journey. Veterinarians certainly play a role in supporting clients and validating the grief experience, but for the sake of the veterinarian’s well-being it is important that this burden is shared.  Each client and the relationship with their animal is unique, and offering a broad range of supports creates choice to cater for individual preferences. Clients who are socially isolated can be particularly vulnerable and benefit from participating in grief support groups which offer a safe and non-judgmental space for bereaved pet owners to share their stories and coping strategies with others while allowing their feelings to be validated. For some clients memories of strong emotions such as anger and guilt relating to end of life events may mean that an external support group may be preferable than returning to the veterinary practice for that support.  Even clients who appear to be doing “okay” should be provided with brochures or communication with details of resources including individual counselling and peer support groups (either face to face or online). We are not privy to our client’s current circumstances or future events and sometimes the loss of a significant relationship can be the precipitating factor for revealing an underlying mental health issue or complicated grief.    There are benefits to getting to know and building relationship with counsellors and professionals who work in the area of grief and mental health. It helps to instil confidence when referring clients to someone with whom you are familiar. Clients can also be informed in advance about practicalities such as wait times and costs.  A willingness to explore with curiosity about how both we / ourselves and our clients might benefit from counselling or grief support groups cultivates a healthy work culture. Psychological distress associated with grief is normalised when we or our clients reach out for help. There is justification in veterinarians and veterinary staff having access to similar but tailored resources to help manage their own grief associated with the death of an animal patient. As there are limitations to the capacity of veterinarians to support grieving clients, opportunities to network and collaborate with other professions specifically trained in the area of grief support or with specialized knowledge in end of life (e.g. hospice and palliative care) should be encouraged. Strive to seek a healthy balance between taking care of the emotional needs of clients and the emotional needs of yourself. It is difficult to be present for clients if we are emotionally depleted. The responsibilities and professional obligations associated with being a veterinarian require repressing of grief emotions to maintain professional composure, however it is healthy and normal to express emotions of grief that are experienced as part of their day to day work

The benefit of experience in veterinary practice and a social work perspective ... Sometimes unique life experiences create ‘light bulb’ moments. For me, this experience was changing role from veterinarian to social work student on placement in both a human hospital / community setting and child protection agency. These placements were undertaken in communities in which I had previously practiced as a new graduate veterinarian, and another where I currently work as a casual sessional veterinarian. Curiosity coupled with my involvement in research as an academic and social work student led me to delving into the topic of grief and veterinary practice. More recently, my periodic work in the veterinary practice setting (without ongoing case management responsibility) has enabled me to experience fresh insights into grief experienced by both clients and veterinary staff members. Most new veterinary graduates have minimal preparation, training, and ongoing support for managing the grief of clients or the grief they themselves experience as part of working in a veterinary practice. Traditionally it’s simply thrust upon them as they enter into veterinary practice. My recollection of starting out as a new graduate was that of the ‘sink or swim approach’ where skills for supporting clients tended to be self-taught and based on a combination of intuition and practise. This experience was not unique to me. Approximately 4 years ago a survey was conducted of veterinarians practising in the same state in which I have worked throughout my career. Just over 85% of respondents reported that most of the skills they use when relating to grieving clients were self-taught.1 Additionally, just over 85% of the veterinarians from the same survey also reported having experienced grief at the end of an animal’s life. This validated the significance of my own grief experience working as a veterinarian in private practice.  While 40% of respondents reported that their physical / mental health had been impacted by dealing with client grief and end of life issues, this same survey1 also found that none of the veterinarians had personally accessed support services (e.g. help-lines, professional psychological services) for help with the stress of dealing with client grief and end of life issues. Interestingly, approximately 80% of survey respondents thought that providing grief support resources would be useful and that providing support for grieving clients was time consuming.1 However, just over 10% of the vets in the study surveyed reported offering contact information for pet loss support groups or someone trained in supporting owners with the grief process.1   Reflecting back on the first 20 years of my professional career and working in practice, I never fully appreciated the significance of the grief that can be experienced by both clients and veterinary staff. I was immersed in the hustle of my full-time work in a busy veterinary practice. I was also unaware of the value or availability of support options for dealing with grief. If only I had been aware of these tips for new and recent graduates. As a veterinarian I recognize that we play a significant role in supporting clients through their pet’s end of life experience. This can be a significant source of job satisfaction for veterinarians. It needs to be recognized, though, that supporting the mental health and wellbeing of clients in the context of the animal relationship does call for a multidisciplinary approach.   Reference: 1. Dow MQ, Chur‐Hansen A, Hamood W, Edwards S. Impact of dealing with bereaved clients on the psychological wellbeing of veterinarians. Australian veterinary journal. 2019 Oct;97(10):382-9.