Rescuing animal doctors

Depression among veterinarians has been fairly common in developed countries with as many as 70 percent experiencing it at some point in their lives, and a sizable percent ending their lives when they are unable to cope with the “compassion fatigue” associated with the profession.

I hadn’t paid attention to this heartbreaking statistic till I came across a social media post by a veterinarian friend based in the US. Her 30-something colleague had died by suicide as he couldn’t bear to see sick and homeless animals anymore. My friend’s timeline was flooded with condolence messages as she herself tried to articulate her guilt at being unaware of how much her friend was hurting inside.

I then stumbled upon several studies and at least three books on the issue: Coping with Stress and Burnout as a Veterinarian by Nadine Hamilton, Victory Unleashed: A Veterinarian’s Tale of Thriving in a Profession Marked with Depression by Heidi Pulito and the most recently written Mental Wellbeing and Positive Psychology for Veterinary Professionals: A Pre-emptive, Proactive and Solution-based Approach by Laura Woodward. Woodward is fairly well known in India for helping set up VSPCA in Visakhapatnam to neuter and vaccinate stray dogs.

All three writers expose the dark and dangerous side of the veterinary profession and discuss compassion fatigue in detail. Compassion fatigue is a form of stress resulting from repeated exposure to traumatic situations and can give rise to a range of negative emotions, including anger, annoyance, intolerance, irritability, scepticism and cynicism.

According to Hamilton, “the suicide rate for veterinarians is almost four times higher than the general population across the UK, Australia, US, New Zealand and Canada.” She goes on to list long hours of work, frequent euthanasing of animals and financial issues as lead causes.

“Failure to cope with such stress upsets mental well being and can lead to serious emotional, physical, and behavioural issues. For some it leads to death,” Hamilton sums up.

On the other hand, Pulito offers ways to cope with this stress, apart from getting to the root of the problem. She writes that suicides by veterinarians are one of the highest rates of suicide out of all professions of the world. Her book speaks to “frustrated veterinarians” and she tells them how to combat their daily work challenges and conquer depression.

A 2023 study conducted by pet food brand Royal Canin confirmed Hamilton and Pulito’s fears. The study reveals that nearly 70 percent of veterinarians have had a colleague or peer die by suicide, and close to 60 percent have experienced work-related stress, anxiety or depression so severe it required professional help. The same study hints towards veterinarians leaving their profession due to a poor work-life balance: “A whopping 60.3% of professionals list this as the main reason why they want to leave, indicating a growing sentiment (or indeed, resentment) in the profession.”

How did we get here?

Woodward offers valuable insights into how-did-it-get-so-bad for the veterinarians? She blames the stigma around mental health conversations in veterinary circles and the profession’s never-say-no to a client approach. She identifies the main stressors as work environment, complications arising during the treatment of patients, and the inability to communicate well with clients.  

Woodword stresses the importance of soft skills to get through life. “As parents it is our duty to attach our children’s self-worth to more than just good grades or medals at football. Kindness is an achievement in kids too. So are empathy, self-regulation, resilience and the ability to be self-aware of our strengths and weaknesses,” she writes.

“…they get into vet school and the applause continues. They are seen as a whole and complete person because of their achievements and they believe it themselves. But at no stage has anyone stopped to ask if they have good social skills? Do they have empathy? Do they know how to fail or how to cope with failure?”

She observes that this cripping fear of failure results in the imposter syndrome, which results in severe depression and in the worst case death by suicide.

“It is exhausting learning social skills and empathy on the job and they suffer from depersonalisation and compassion fatigue. If only they had been taught these soft skills as a child or as a student,” she notes.

Veterinary care in India

When our beloved cat, Biryani, was diagnosed with chronic renal failure a few years ago we knew that her time was up. We tried to make her trips to the veterinarian over the next few months as comfortable as possible. And when we saw her gasping for breath one morning we drove her to the nearest private clinic and requested the veterinarian on duty to put her on oxygen – our final shot to save her. Reluctantly, he gave in, but to our utter horror, switched off the oxygen supply within 15 minutes. His duty was over and he needed to head home. He didn’t care about our pleas to save Biryani. We cleared the bill, an extravagant amount as Biryani was considered as an emergency patient, and headed home. On the drive back, Biryani left us.

If it had been a government facility or a fund-crunched animal shelter where dozens of animals are admitted and dozens more pass into another world unsung every day, I would have perhaps put this attitude on the poor doctor-to-patient ratio in our country and forgiven the veterinarian on duty for violating his medical oath.

More recently, when we took our senior cat Mr Bush, 13, to a private clinic, his blood work didn’t look good. We told the veterinarian to let him pass in peace (not euthanasia) as he was a senior cat, but the veterinarian did not agree. He pursued an aggressive line of treatment. One day, after a couple of injections were pumped in and another couple of medicines shoved down his throat, Mr Bush came home dead.

It was difficult to get over the manner in which the medicines were injected, often not by the veterinarian, but by his assistant, an unqualified “para-veterinarian”. The times when the paravet would struggle to find Mr Bush’s vein, the veterinarian would step in at our insistence. It hurts the way Mr Bush, the gentlest of cats, went, and I am not even taking into account the bills that ran into several thousand rupees.

In light of Hamilton and Pulito’s theory, and what Woodword suggests, I can’t help but wonder if these veterinarians are suffering from compassion fatigue? Callousness, heartlessness and functioning on auto pilot mode are symptoms of compassion fatigue.

They seem detached from their patients and their approach is impersonal and mechanical. To make matters worse, these clinics – which have mushroomed in every nook and corner of the city in the recent past -- are usually understaffed with unqualified assistants filling in for veterinarians while they are away.

The majority seem to be driven by the forces of commerce and they make pets undergo test after test even though these are not needed because the pet is slipping away. Pet parents are sometimes sent to the farthest corners of the city for x-rays and scans as these insecure veterinarians cannot have a colleague, who offers these facilities in the vicinity, steal their client.

One can argue that these tests are imperative for a diagnosis, but the staggering bills which make human medical bills seem meagre in comparison, are avoidable if there are enough clinical symptoms to show that the pet is dying. This is where a veterinarian’s judgement – and, most importantly, his medical oath “to use his scientific knowledge and skills to protect animal health, relieve animal suffering and practise his profession with dignity” comes into play.

Veterinarians at the receiving end

Of course, this isn’t a blanket statement for all veterinarians in India. I have known scores who are compassionate, secure and dedicated professionals. To be fair, pet parents are also at fault for not seeking prompt treatment or paying heed to the veterinarian’s advice. And when the case gets out of hand they call these professionals “thieves” behind their backs, if not to their faces. Social media posts about a certain veterinarian “killing” someone’s pet are also not uncommon. It is unfair to cyberbully them or write undeservedly negative reviews.  

Financial factors, long hours on the job, expectations of pet owners and exposure to trauma and dealing with deaths do take a toll on veterinarians and pet parents need to keep that in mind. Pet parents also need to understand that even veterinarians have bills to pay and it is okay to have requests for frequent discounts or a fee waiver turned down.

Depression and compassion fatigue

While, thankfully, one hasn’t heard of veterinarians dying by suicide in India, they too are probably experiencing the same symptoms that are confronting their colleagues worldwide.

Woodword points out that mental health talks have been taboo in this fraternity in the West, and this could be true for India too. Perhaps these veterinarians are unaware of their mental health given our collective levels of mental health awareness, the skeletal infrastructure available to address it, and the stigma associated with mental health issues.

Woodword’s book is a hands-on guide for these professionals. It is divided into six sections and offers valuable tools, including meditation, mindfulness, and positive psychology, to help grapple with mental challenges.

She has included her experiences while counselling patients struggling with anxiety, compassion fatigue, fear of failure, imposter syndrome, and grief in the book. Her advice to veterinarians is to be prepared in advance about the hurdles they will face in their careers to cope better.

What we need are support groups where veterinarians and pet parents can thrash out contentious issues. This will unburden the veterinarians and make it easy for pet parents too. That said, veterinarians should do their best to not turn this noble profession – as many seemingly have – into a business venture.

Lamat R Hasan is an independent journalist. She lives in New Delhi.