Mental Health

How the Four Agreements will make you a better veterinarian

Up until my late twenties, I was someone who took everything personally. It didn’t matter whether it was an angry stranger who cut me off on the highway, or a coworker snapping at me for no apparent reason. No matter the cause, I let these fleeting moments send me into a tailspin and I’d carry negative emotions with me for the rest of the day.

As I moved into my clinical year of veterinary school, followed by an internship, I quickly realized this quality would prevent me from being an excellent veterinarian. How could I focus on medicine if I was too fixated on a few angry words that were said to me? I knew I needed to find a way to let this go. Fortunately, I stumbled upon the book The Four Agreements by Don Miguel Ruiz. Below is a summary of his philosophy, and how applying it to veterinary medicine has transformed the way I practice.

1. Be impeccable with your word.

We have all experienced a gossip-laden work environment. If you’re fortunate enough to have avoided this, think back to middle school: one kid makes a negative remark about another kid. You could stand up for the person being bullied or you could stoop to the level of person doing the bullying. I wish that most people could confidently say they would do the former, but the reality is most will be more inclined to gossip and make negative remarks about others once the instigator sets the tone. Not only do we then think it is okay to speak poorly of others, but it is almost as if we fear rejection from the group if we don’t say something in alignment with the initial insult.

Gossip begets more gossip. Negativity begets more negativity. It is a vicious cycle, and one that is difficult to break—especially in a workplace where this has become the norm. If a coworker makes derogatory comments about an owner or their peers, it sets the stage for others to do the same. This is especially true if you are in a position of leadership. Your team looks to you for guidance and they will mimic both your actions and your words. So if you speak poorly of others, you’re essentially endorsing your colleagues to do the same.

Don Miguel Ruiz makes an important point that being impeccable with your word is not just about speaking kindly of others, but also speaking kindly to yourself. As veterinarians, we are driven by our intense desire to succeed. This drive is what got us into veterinary school, through the rigorous curriculum and helped us pass national boards. Once we are out of school, success has a different definition. It might be correctly diagnosing an obscure autoimmune disease, performing a successful resection and anastomosis, or simply putting a smile on an owner’s face. When these things don’t happen, we spiral into a dark hole filled with self-critique.

It is easy to become plagued by our doubts and fears. But what good does negative self-talk do? It is not only detrimental to your own well-being, but will begin to permeate into those around you. So be impeccable with your word. This agreement requires discipline and self-awareness, but it is simple: speak kindly about others and to yourself.

2. Don’t take anything personally.

This particular agreement has been the biggest struggle for me, but it also had the most positive impact on my life when I learned to implement it effectively. In our field, there are many instances in which we may feel personally attacked. It could be that a coworker is having a stressful day and speaks curtly with you. It could be a frustrated owner blaming you for the high cost of treatment or what they perceive to be poor medical care. It is so easy to let yourself drown in the emotions of others, to take on the burden of their hardship, and to make it all about you.

Hands down, the most important thing I have learned as an emergency veterinarian is this: it isn’t about you. It is about the fear of their animal is sick. It is about whether to pay the mortgage or pay for emergency surgery. It is about the guilt that a bottle of Advil was left out for a dog to consume, or the back door was left open and the cat ran out into traffic. I’m not saying it’s easy not to either get defensive or completely shut down when someone yells at you—it is hard to keep your head above water. If you can pause, take a breath, and say to yourself, “This isn’t about me,” then you have won 99 percent of the battle.

Furthermore, separating yourself from the situation allows you to refocus your client’s emotions. Instead of getting defensive, say something along the lines of, “I understand that you’re scared about Fluffy’s health and I know the cost of treatment is expensive. My goal is to alleviate your pet’s suffering in any way possible and I want to find a way to communicate with you so that we can reach that common goal.” Once their feelings are addressed, you can bring the focus back to the most important thing, which is making a plan to help their animal.

The next time someone gets angry with you, whether it is in a hospital setting or as simple as someone cutting you off in traffic, just remember it isn’t about you. Don’t take it personally.

3. Don’t make assumptions.

We have all been guilty of this. We assume someone doesn’t care about their pet because they waited days after the onset of symptoms to have them evaluated by a veterinarian. We assume someone who didn’t vaccinate their pet won’t be able to afford treatment. We assume a client is angry with us when really they are angry at the situation or simply worried about their pet.

Sometimes, these assumptions are correct. But guess what? More often than not, they are completely wrong. Making an assumption is essentially allowing yourself to create and believe a lie. Moreover, placing these assumptions on people sets the stage for conflict. And most importantly, it detracts our attention from the main goal, which is helping the pet. If you focus only on the fact that you assume someone doesn’t care about their pet, or you assume they don’t have the financial means for treatment, then your focus is taken away from the medicine. Let go of the assumptions and approach every case in the same manner. If it does turn out finances are tight, then you can adjust your treatment plan accordingly. But don’t go into something expecting it to turn out a certain way, because that is a surefire way to set yourself up for conflict.

4. Always do your best.

There isn’t much to elaborate on here, it is pretty straightforward. But I think one of the biggest take-homes for me is we should be able to look back on our days and confidently say we did our best work. That doesn’t mean no mistakes were made; rather, it means you took the time to ensure you did the best you could for your patients and your clients.

Sometimes doing your best means having to redo a procedure, or take an extra set of radiographs, or have a long conversation with an owner. As long as you can reflect on your work and be proud of it, then you know you’ve done your best.

If you’re trying to do your best but running out of steam, it might be time to take a few days off and reignite your energy. Never be too proud to say, “Maybe I didn’t do my best today, and that means I need to take care of myself.” Your patients, your clients, and your own health will thank you in the end.

Dr. Kerri Nelson is an emergency veterinarian and medical director at Veterinary Emergency Group and will be opening their new hospital in Denver this summer. She is currently pursuing certification to become a Pet Loss Grief Recovery Specialist through the American Institute of Health Care Professionals, and is passionate about helping owners through the process of losing a beloved companion. Outside of work, she is an avid marathoner, equestrian, and skier. She recently started blogging about her experiences with burnout, grief, and compassion fatigue.


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