Handling Rejection

Host: Hello everyone, hello Natalie, and welcome to the veterinary business podcast, your ultimate resource for developing a successful veterinary practice in Korea. I'm Dr. Peter Weinstein, one of the co-hosts of the veterinary business podcast. On this podcast, we bring you insights and expertise from industry leading doctors, experts, and thought leaders. And sometimes they're all wrapped up into one. We cover a wide range of topics, including practice management, marketing strategy, leadership development, HR best practices, and much more. Whether you're a practicing veterinarian, a practice owner, a practice manager, or a student studying to be a veterinarian, this podcast is tailored to help you navigate the unique challenges and opportunities in the business of veterinary medicine. Every listener of this podcast is welcome to visit the website at www.v veterinarybusinessinstitute.com for additional resources and tools to support your growth. And remember, you can subscribe to our podcast

Host: of all of the podcast platforms, iTunes, Google Play, Spotify, and any other platforms that are out there. Today, I'm excited to welcome our guest, Dr. Natalie Marks, and today is all about handling rejection, which I don't do well. So let's jump in. And before we get started, Natalie, I wanted to take a minute to tell us about yourself, tell the listeners about yourself, I know you, they don't, how did you get into the veterinary field and, you know, take a few minutes to give us the Natalie 35,000 foot overview. Sounds great. It's so good to be here with you, Peter, and certainly with all the listeners. I started out in that med, sort of one of those traditional, I never wanted to be anything else, grew up in a small town in northwest Illinois every day at my best friend's horse ranch after school. And thought, this is the life I'm going to work on draft horses forever and ever. And this is all I'm going to do. And I did that for a very, very blink of an

Host: eye in my career until I realized, I'm not sure I can necessarily have a family in kids and a solid body coming out of this long term, at least back then. So after veterinary school, I practiced for five years in Atlanta, had a fantastic mentor who really shaped a lot of, I think, my detective work and clinical skills. New, I wanted to own my own practice that wasn't going to happen where I was, came back to Chicago and ended up buying the practice that I owned for many, many years with my business partner. And after quite some time of being a practice owner, which I absolutely loved, I realized that our degree really affords us this unbelievable flexibility and freedom to not just be that one trick pony, no pun intended, and simply be a clinician or a practicing clinician and in business owning clinician. So started doing a lot of teaching, investing, entrepreneurship, working with organized medicine. And so I've worn quite a few hats over the last

Host: seven to eight years while still practicing. And that I think has been incredibly enriching, not just from my network and certainly all the wonderful, I think, just humans, right? We're not just veterinarians and technicians and CSRs, but just humans that we have in this industry. But also to see the reach that our industry has on the whole world, what we can do, just as one person to influence where this industry has headed, but how we influence other people. But I think as we talk about today, I kind of was like, I don't want to be the person that's associated with clinical rejection podcasts, Peter. But it's actually an area that I have a lot of out and have really, I think, taken for granted that I've been able to sort of find my own place and being able to not just tolerate rejection, but out of bounce back from rejection in practice. Because we get it a lot. And I think one of the things that we can certainly start with,

Host: as I know you're incredibly passionate about education and educating our students, right? Is we never learned how to handle a client who says no, right? Like when we, when at least when I came out of school, I thought I like walk into the exam room with my superhero white coat on and I would say, okay, Mrs. Jones, here is the diagnosis. Here's everything we need to do. Here are the additional tests I need to do. This is how much it costs. And then every client would just say, oh, thank you so much. Of course, I'm going to do it. My pocketbook is open. My pen is here. Do whatever you need. You're the best person ever. I can never thank you enough, right? A little dramatic, but you get my point. That is not reality. And did you ever learn about rejection in veterinary school when you were there? I only learned about rejection in my grades by my faculty members, and they rejected some of my, my answers. That's, you know, it's interesting.

Host: We're going to get dive deep into this discussion of rejection. But I want to go back a little bit with your history, because you do, I think some of you're messaging about flexibility is extremely important. I think you and I have both reconfigured ourselves a number of times in our careers. You're as being a little bit shorter than mine. But I think this opportunity for flexibility and to have options is an important message as well. You know, we've, you and I both sold practices. We've gone through that seller's change from that standpoint. But I love the messaging regarding flexibility and options. And I love the fact that you had a great mentor. So I think those are two extremely important messages that are out there. And I think that they do lead in nicely to this discussion on rejection, because hopefully, with mentoring, your mentor helps you address that. And with flexibility and resilience, which is a big factor in veterinary medicine,

Host: we learned how to deal with rejection that not only comes from clients, but it comes from other resources as well. I mean, many of our students were like myself rejected and I hate to use that term, because it just feels so strong. Turn down by our first efforts to get into veterinary school. And I would, I would fathom a guess that I was rejected twice when I asked people to go to the problem. So, you know, we've had our share of rejections in life, and I don't think we're ever prepared for it. So before we dive into the clinical side of it or the veterinary side of it, it is, you know, we learning how to accept no as a person is probably as relevant as learning had as anything we do, because we all take it so personally, don't we? Yes. In some much more intensely than others. And I, you know, I did a column on this, and I did a lot of research kind of thinking about not just, as you said, clinical rejection, but just what happens to us with as much compassion

Host: fatigue, and we'll just say potentially people on the road to burnout in this heavy weight in our industry of people dealing with challenges of anxiety and depression. And just a lot of the sort of, we'll just say, umbrella, I hate to call it just mental illness, but mental health challenge, right, that we have, that we face. How do people that aren't in the best head space handle a no, whether it's a no in practice, whether it's a no at home with a partner or spouse, your children, your parents, your friends, a job application. And, you know, so I was looking into a lot of this, and there's a really prominent psychologist guy, Winch. And he said, rejection is the most common emotional wound there is in daily life. Like we think about rejection, it seems like you said, so big that word, but we face rejection literally every day, even in these micro burst moments. And I think we don't often realize that those compound, maybe the first small

Host: one, you know, somebody doesn't let you into, you know, you're trying to merge and somebody cuts you off, but doesn't let you in, right? They rejected, you're like, I got a little minute of road rage, and I moved on, but that certainly sets the tone for your next interaction, right, throughout the day. And so I think there's a lot of things we need to think about with rejection, and you mentioned it's not just from clients, but also from other people. But we often also, incorrectly, reject ourselves. Like we perceive situations and feel that it's rejection. And actually, it had nothing to do with rejection of us. If we as humans so often take rejection incredibly personally, when most of the time, and I think then studies, they say, anywhere from 78 to even 92% of the time and some of these clinical studies that have been done, it had nothing to do at all with the person being rejected, but the person rejecting, right, had some factor that was creating them to not agree with the statement,

Host: or activity, or movement, or whatever that person is doing. And so we take that so personally, and unfortunately, those do compound and build. And if we don't address them in the moment and learn healthy strategies of how to, we'll talk about this, but sort of distance ourselves from the personal attack that we might perceive as happening. But take a step back in that and try to understand why might this person be reacting this way, that often can reset that moment into one of collaboration or understanding or acceptance versus what we perceive as rejection. Yeah, I mean, this in rejection of former feedback, and from that we can learn. I mean, what happens way too often is that we take every former feedback in a negative fashion, but our body is an entire feedback mechanism. I know you, uh, you're a runner, at least I saw you come on your way out going to run one time and recognize you. And I get on a bike or I go to the gym.

Host: And sometimes our body gives us feedback that this is as far as we can go. But we don't reject our bodies for giving us feedback. And I think you, um, you know, this global discussion of feedback is really about, excuse me, about rejection is really learning about how to ask a better question, about how to present it differently, and how to present it so that we don't take it personally, because I think you're absolutely correct. I am the worst. When somebody, when I don't get what I want, I want to throw a temper tantrum. And we do that in sometimes we do it overtly and sometimes we do it covertly. So I think the research that you did is spot on, and I think it needs to have further conversations beyond what we're going to have today. Can you let everybody know where to find the column that you wrote, because since this is an audio podcast and not a visual, you can't hold up the graphic and where can they find the column? It's actually in the today's veteran

Host: business magazine. So this year, 2023, um, and I want to say a sector where it should but don't quote me, we can certainly get back to that. All right. So sometimes, towards a second half of this year. So let's talk about the specifics of rejection in the veterinary field. And, um, so besides clients, there are others who might say no to, right, to you, um, as a veterinarian owner, as an associate, or even a staff member who might listen to this or as a student. So who is this, this pool of people that might give you an answer that you're not looking for? Well, if we step out of the exam room, right, so we have other associates, you're discussing a case, they don't agree. They reject your recommendation, right? So other colleagues, team members, certainly your family, right, and friends, and your inner circle, um, people in the industry that may not be in your close circle. So you reach out for an award, or you want to be nominated for

Host: a position on a council or a board, or you're going up to, um, as a student, you're trying to get an internship, or your first job, or, you know, there's so many situations where it's incredibly brave to put yourself out there. Um, and certainly, I think there are, there are people that are more fearless than others in trying to really go for their dreams. But in that bravery, we have a potential consequence of rejection, right, and I think there are some people who are incredibly cautious, and they wait that possibility, very heavily, and it keeps them from pursuing a lot of opportunities that might be out there, because they are unsure of how they would handle that response, that feedback. Whereas others go, you know, head first into the deep ends, and it's only after that if there's an incidence of rejection, that they maybe hadn't even prepared themselves a little bit for that possibility, and that can really shake them. So I think we have most people

Host: earned in the middle, right? We're aiming for perfection here, which is not you enough, you certainly, I mean, I'm right there with you with taking things personally, and it's something we have to actively work on, but most people are on those extremes. They're either a little too cautious, or they fly by the sea to their pants, and then the consequences afterwards are often pretty challenging to sort of navigate, but we know that interestingly enough, which I think this is so cool, that everything that we've learned in the last seven years, now that fear anxiety, stress, the fear of free movement, everything around low stress handling, just the importance of the amygdala, right, in the animal brain, which includes us, is it's really, I think, so parallel, and so interesting to know that when they have, when psychologists and psychiatrists have done brain scans, and looked at people who have had a recent rejection and looked where their brain

Host: lit up, it's the exact same center in the amygdala that lights up with pain. So it's not surprising, right? We're all scientists, we get, we get, we want to understand the physiology of this, it's not surprising that when we experience rejection, it feels truly like a wound, because we're lighting up the same center of our brain that experiences physical pain. And so I think often when people go through a rejection, and we all have those friends, right, and family members, like I'm totally fine. We know they're probably not totally fine. We know physiologically, their brain is not totally fine, and I worry about those people the most, because I feel there are the ones that have put up that wall and have sort of compartmentalized or tried to compartmentalize that emotional wound of rejection, and there are the ones that I think, you know, especially if I have team members that are like that, that go through significant rejection or significant painful

Host: episodes, and all of a sudden, you know, they're going about their business like nothing happened. I check in on those people a lot, because to me, they're the ones that really do need to have some outlet, but have not had a trusted circle or do not feel a vulnerable or comfortable or brave enough to talk through that, and that's what we need more of in this industry, in my opinion, is people like you and me and our colleagues to be vulnerable and talk about our, you know, our rejections, talk about our cases that went wrong, talk about those difficult clients that didn't make you feel great on that first, and you didn't have that first witty response to get back and kind of say the exam, we, everybody has those, and the more that we can share those, I think the more that we can hopefully touch some of the people who don't feel confident enough yet to share in how they feel during a rejection. Yeah, and I would suggest that the veterinary field and the schools need

Host: to start to look at helping the students who don't get in, better handle that, because we may actually turn people away from the profession in general, because the feedback is not a positive feedback loop, it's a negative feedback loop, and I would also suggest, and I had this discussion with my students a couple of weeks ago, that we use a lot of negative feedback in our education process, almost to the detriment of positive feedback, we don't do enough of that, and and so once you get into a professional curriculum, why do we need to have grades? Why don't we look at a past fail system? Why don't we look at, for those people who need or are motivated by the grade, that's fine, they can find out what their grade was, but for those who are motivated by the knowledge, why should we penalize them by saying they got a B, and kind of categorize people, and I think, so we really need to look at this throughout the process, and we can take this all

Host: the way back to elementary school as well, but I think we need to think differently about this, by the way, I think the amygdala not only reacts to the same way with rejection, but it reacts the same way to change. Yes, and so we're a profession that has a problem with the amygdala, because it's lighting up all the time, because we don't deal with change well, and we don't deal with rejection, well, from that standpoint. So this is a great conversation to have that can go on forever. Let's narrow it down really to the veterinary field a little bit, and maybe do you have suggestions? I know you've worked with veterinary students and you've worked with staff members. How can people set themselves up to get a yes? Is there something that people can do to prepare to prepare before they go in? Yes. And so let me leave it. How can you set yourself up to get a yes? Well, I love that question because we're already starting down that positive feedback

Host: loop, right? We're framing our mind to not be worried of the no, but to achieve the goal of the yes. And I guess I want to see three quick things on that. The first is, is remember, most rejection is rooted in fear. And especially if we're just talking about the exam room, which I think that's this is a good focus to start. We're talking about the exam room. Many of our clients come in with some element of fear. They're worried what they're going to find out on our pet. They're pet. They're worried about a diagnosis because they just had a personal diagnosis and they're scared to death. Their dog or cat has the same thing. They're worried that they're going to be shamed because they didn't rush the teeth every day or they forgot to come in for the dental or didn't give all the men's, right? They're worried they're not going to be able to do the care. They're worried they're not going to be able to afford the care. There are so many factors

Host: that play a role in the fear of a client being able to say yes, completely out of our control. So I think the first thing we need to do is to remind ourselves that rejection is rooted in fear for us, for other people. And we know what fear does, right? A fear reactive dog is not a happy dog to be around and a fear reactive cat is the same way, a fear reactive human, a no is a bite, right? So I think we have to, if it's easier to think of it in that frame of mind, I think it is than I'm able to reframe how I enter the exam room. So the first thing is I remember that and it's incredibly important to be a student of human body language. We have spent so much time now, which I'm glad, but learning K9 and Feline body language and what they're saying to us through that, but we spend such little time understanding what the human body language, not just the client, but our own is communicating, you know, upwards of 96% or more of how we communicate

Host: is through our body, not through our voice. And so are we setting up the exam room again for that positive interaction? Are we walking in and being eye level with the client, not above them? Are we walking in at a comfortable distance to the client? Are we approaching them and understanding what their initial body language is saying? Are they crossing their arms already? Are they constantly looking at their phone when we walk in? Are they already teary-eyed and we walk in with this home? Mrs. Jones, which obviously is not the cadence or certainly tone we want. So understanding body language, I think is very, very helpful. The second is we have to get away from one directional discussions in the exam room. Instead of this, I am veterinarian, here what I'm going to say and we just wait for the yes, we have to think and I really hope that we all go to shared decision-making exam room strategies. I always say, as you see right now, I don't

Host: live without my Starbucks in my hand. That's like my little wooby blanket, but I always think about my exam room is I'm in there with my cup of coffee. My client is across the table with their cover coffee. We are in a casual warm environment. I want them to know I'm the medical advocate for that pet in the exam room. They are the medical advocate for that pet at home. We have an equal role in contributing to comments and thoughts about what the treatment plan is. My job is not to achieve my goal for that pet in the exam room. It took a long time for me to understand that. My goal is to get as much informed information to that client and to understand what that client school is for that pet and to help them achieve that goal. That is my job in the exam room. So when I explain it that way and I say, I am, I could get the great diagnosis and prescribe everything if you're not giving that at home. If you're not monitoring the improvement,

Host: if you're not bringing that pet back when they're not doing well, I'm useless, right? So it has to be shared decision-making and I think that in itself sets us up for more guesses than knows because the first thing we're asking that client is what is your goal? Why are you here? Not in an obviously not accusatory. How am I here? How can I help you? What do you want to see happen with this pet? And then the third thing that we need to do beyond that is to understand clinical empathy. We all, I think, every time I lecture, I always ask people, you know, who is the most empathetic profession? And everybody's like, of course, we are, right? Veterinarians, we're like the royalty of empathy in this world, right? This is all we do. All we know. But I think what we have to understand is that clinical empathy is different. So there's three important things about clinical empathy. And I want to make sure I get these right. So three things

Host: that will set you apart from this compassion fatigue. I have nothing left because I give all my empathy out to my clients and my team and my family all day long. And then at the end of the day, I'm just empty, right? So clinical empathy is having the ability to understand the client's perspective, right? So that's their emotions and thoughts and beliefs and what their circumstances and my. And then having the ability to communicate that understanding back to the client, right? So active listening and say, what I hear you saying is blank blank blank. And then having the ability to act on the understanding in ways that's helpful for the patient and the client, nowhere in there is helpful for us. So what that means is, do we have to agree with the client? No. Do we have to hear a client say, oh my gosh, you know, my spouse died a month ago, my life's upside down. We don't have to nor should we say, oh, I totally understand what you're feeling. Because of course,

Host: unless it happens to you, you won't. But what we need to do is say, I understand that you're on a limited budget and you want to do what's best for your pet within that budget right now and your hope is maybe later this year will be able to investigate further. Is that what I'm, is that correct what I'm hearing and that client is going to either confirm or deny, right? And then you take that and you say, so my goal here is to help you reach that goal. That's why we're here. What's why we're here together as a team? What that does is it allows you to preserve that so important piece of you, which is your compassion and empathy, so that you can give that out when it's needed in your personal life, but still being a warm and clinically empathetic clinician in your professional life. Because the thing is we aren't getting empathy back, typically from our clients, right? Once in a while we might, but typically we don't get that back. So for us to replenish that, we have to be able to feel

Host: enough, again, warmth and compassion inside that hasn't all been given out, and typically inappropriately. So I hope that to the listeners out there who are saying, oh my gosh, like maybe a light bulb's gone off and said, you know what? I can show clinical empathy, which we know from human studies is what patients want. They want clinical empathy. This is not a made-up term. This has been studied in human medicine, and we know it's been translated now into some veterinary studies, especially out of CSU. So we know clinical empathy works. But I think it's important to say this is what preserves you. We walk in, we have our tone, we read body language, we have shared decision-making, and we demonstrate clinical empathy. And if we can do those and practice those with a mentor and get active positive feedback and areas of opportunity to work on, you can be much more clinically successful in the exam room, but get that bucket filled

Host: without giving, giving, giving. So what I'm hearing is we need to be more of a rainbow than black and white. You need to go in with a full pallet of colors to paint the picture, and I think in sometimes we are so algorithm-driven that it's a yes or a no, and we really need to have more collaborative and cooperative and compromised options, whether it is Plan BCD, the entire alphabet, because if you go in, you can't be rejected when you have other options. You can only be rejected if you have only one option from that Yeah, and I love that because that plays very well into how a lot of us older, but our neurons were trained, which is the gold standard of care. So we set ourselves up for rejection, because we walked into every exam room, black and white, thinking that the client in there was going to immediately agree to all of the variables associated with the gold standard of care. And if they

Host: didn't, for whatever reason, not only did the client feel bad, right? It could go guilty, they can't afford it, or that's not the choice in our body language suddenly sunk, right? What am I going to do? They're not doing the standard of care. But then we feel as clinicians like, oh, I can't do the gold standard of care for this patient. I'm such a bad vet, right? So then that this horrible cycle of negativity in that exam room festers, and then we, because we a lot of us have not been trained to teach spectrum of care appropriately, right? Then we don't have the really safe, warm segue to transition into other options, because we've said, this is the standard of care, and then we sat there and waited. But instead, now we have to say, well, I guess we can try this, which is just an awful feeling for both parties in the room, right? So I love what you're saying of coming in, first, knowing the goal, right? So if the goal of the client says, look,

Host: you tell me my dog needs to brain transplant Norway. I'm getting the first private plane. I'm flying there. That's me, right? Okay. I'm going to help you get that goal. But there are clients that are going to walk in and say, I have $25 till next week, and all of you just told me all these things are going on with my dog, what do I do, right? So we help them prioritize and we give them options. We paint with all the different colors, and we let the client, again, the medical advocate for that pet at home, play a role in the collaborative decision making, because what we have to understand and what we have to accept, I think, most importantly, as veterinarians and technicians and every professional out there that works with families, is that this is not our pet, right? This is not our family member in the exam room. The client gets the privilege of making the decision of what happens, and they should. We are there to be their advocate and to assist them,

Host: getting there, giving them informed decisions, and with our knowledge guiding them along the way, and spectrum of care means that standard of care, this gold, silver, bronze, all these levels of need to just go out the window. It should just be care, right? It should just be care. This is what this client wants for the care of their pet, this is what this client wants for the care of their pet, and we need to take that judgment off and say, you know what, I'm here as your advocate to help you reach your goal for your family member. It's interesting, I've got so many different things I want to tap into, but number one, the Mayo Clinic was developed with collaborative care and integrative care in mind, and one of the members of the team, besides the doctors and nurses, is in the human health care side, is the patient and the patient's family. I think we sometimes get confused between our roles as veterinarians because we have not only a patient but a client,

Host: and a client tends to be transactional, and we have to recognize that. The Mayo Clinic is you're really talking about a lot of what the Mayo Clinic and how the Mayo Clinic was developed going back over 160 years. Also, there's a book recently, and I don't know if you saw the AVMA economic forum, but the book Compassionomics, which was about compassion and human health care, and the financial benefits of compassion is all about listening. We got to shut up and listen. We got to ask the questions. We got to hear what the client, in our case, or the patient and human health care face is saying what their family is saying, and we have to take and integrate all of that in the decision-making process, which is really difficult in a field that has always been about black and white to look at more choices. It's like, damn, can't this be a true false test instead of a multiple choice test? Well, actually ladies and gentlemen, it's an essay test,

Host: and you're given a blue book and you're given an hour or half an hour or 20 minutes in the appointment room, and you can't answer it true false or multiple choice. You have to write an essay. And so I think all of what you're saying is spot on, and I think it's a direction that we need to work in terms of teaching. I think it's a direction we need to work in terms of mentoring, and I think it's going to take people like you, sounding the bell, to start to move things in that direction. It's going to take a heck of a lot of role playing, and the sequence I'm going into is it's not just about the doctor, too. Isn't it of going to be important for the doctors to teach their team, how to be a part of this collaboration as well? Yes, absolutely, right? Because energy that we receive from others affects us, and energy we give to others affects them, right? It's that energy doesn't lie. And when we, if we are, let's say practicing,

Host: right, managing rejection, and practicing, setting ourselves up for yes, and practicing shared decision making, and all the things we're talking about today, and none of our team is doing that. Well, and we've all been there, right? So let's say where we have a dog that's scheduled that may have some notes about reactivity, and your team member walks in first to get a history, and the pet parent immediately says, oh, no, no, no, no, this is my dog doesn't like women, my dog doesn't, you know, what are my dog doesn't like people in pink shirts, or whatever it is, which is again out of fear, right? We remember rejections out of fear, so there's something there worried that their dog's going to misbehave, their dog's going to be reactive, whatever it is, or they're, you know, embarrassed, right? Because maybe they didn't manage some of these behaviors early on, or they didn't take good recommendations to see behaviors, whatever it is. But then

Host: that person who is your team member, all of a sudden comes running out, right? And human responses to say, blah, and just event about that client. Well, do you think that the associate veterinarian who is going to go into that room is going to necessarily be framed for, yes? No, now all of a sudden they're primed to say, oh, this client's in a bad mood, this client's going to, you know, yell at me because I had the wrong notes or whatever it is. So it, it just spirals out of control. One thing that I think I want to share that is a really easy thing to teach everybody on your team to get started is the power of a breath. I used to think this was very hokey, but I've been listening to a lot of research podcasts when I walk and I run about just what our brain has the power to do, and especially through breath. And so if we take, and this is from Daniel Aiman, he's like a leading psychiatrist and brain scientist and physiologists and he does a lot of work

Host: on looking at how can we really maximize our brain capacity and memory, but also response, right? How can our brain change our physiologic response? And one thing that they looked at is if we take a four-second breath in and hold for a second, and an eight-second breath out and hold for a second, we change from a sympathetic nervous system, right? So the fight or flight cortisol, I'm going to attack you. I'm all that's not in this, you know, road rage will mode to a parasympathetic nervous system in just that breath. So even just saying if suddenly a client has a reaction, you're on the phone as a CSR and the client starts with a reaction. Whatever that is, for you to take, just that those few seconds take a breath in for four, hold it, and a breath out for eight, and hold it, your response will instantly be different, even just from one breath. So I think it's critical for us to start thinking about what are micro pieces of information and education that

Host: are practical and actionable that our teams can start doing, because just simply putting your body into a parasympathetic state, calms you, why it's your brain, your gut is appropriate and start in steps, giving you that nauseous feeling, right? I mean, you stop sweating, your muscles relax, all of the things that you need to be able to think about what is my next statement. And I always did this, and I know we want to talk a little bit about those online reviews, right, because social media is a huge component of rejection, I think, as far as how we perceive both professionally and personal rejection, but anytime somebody writes a negative comment or rejected kind of phrasing online, the first thing you want to do is take that breath and not instantly go into combat mode, because we know that just is fuel on the fire, and that's not going to get us where we want to be both from that relationship with that person, but also within ourselves. Wow, we could spend an hour

Host: just unpacking that, but let's let's, I think that the ability to understand the difference between react and respond is huge. I think we are a reactionary tend to be, and I think that taking a deep breath or stepping away is something we don't do enough of because we do react. I have punched walls, the wall always wins. I've thrown things, but you'll notice that neurons never throw expensive things. And so, and I, because, and I think I do that, because I feel it's a, I'm personally being rejected. And I think part of the conversation that we need to recognize is that when somebody says, no, they're not rejecting you. They are rejecting the premise of whatever the conversation may be. Give a bigger problem if they're rejecting you. That was the problem. But I think this, this conversation has to be demonstrated from the top down, and some of our top type A leaders, if we have them, in our practices, I meant the leaders,

Host: not the type A. We have plenty of type A's. But I think this is an extremely important message to get across to the leadership within practices, the managers, the owners, the veterinarians, especially, that how you demonstrate your response to your team will help them create the appropriate response versus reaction to your clients. You agree with that? I totally agree. There was a really interesting study that was done looking at veterinarians and their ability to listen. Not just an exam room, but let's just say to a team member who's come up to you with a concern or a problem, or, you know, you've got a rep that's in, or, you know, somebody that you're interacting with. And they found that on average, veterinarians interrupt in 15.2 seconds, right? Which at first I was like, that's not. That's crazy. That's impossible. And then I thought, wow, I think that probably is. And if we just go back to the, let's just go back to your

Host: example of a leader, right? So, leader in the practice, and one of the team members comes up with a concern about another team member, right, and private. We are fixtures where detectives who want to solve problems. So, at the heart of us, we're trying to do this, but we're also, most of us, our people, please,ers. So, we have no time. We're typically, you know, wearing multiple hats. We're trying to solve a problem quickly, and we want people to be happy. So, what do we do? We hear a couple words. All of a sudden, our mind goes while we jump in and try to solve the problem. That does two things. One, it really is not validating that we are willing and want to listen to our team. All it says is, I'm going to talk over you, and so let me just fix it and sweep it under the rug. But two, often we are reacting, not responding. And if we practice that breath during the listening, we set our set our brain into that calm, parasympathetic state,

Host: while we're taking this in, and then having that calm, peaceful response back, which, again, with that empathy, clinical empathy is saying, what I just heard was blah, blah, blah, blah, blah, blah, blah, to make sure we, again, are acknowledging we heard it and we heard it correctly, and we have the facts to respond appropriately. We will also get that really nice collaborative work environment where we have mutual respect, and we have the trust and, again, that active listening so that people feel heard. That is a huge reason, so many are leaving the profession, is that we do not allow every team member to feel heard and to feel empowered, and they feel rejected. They don't feel important, they don't have that value, they don't have this empowerment to continue to achieve other goals that they might have because we haven't taken the time to hear their goals or ask their goals. We've just rejected them with sort of this,

Host: another thing I talk about are these silent expectations, which often lead to rejection. I was very guilty of this when I was a brand new practice owner. I had been an associate for some time at the same practice I bought. I didn't really talk to people as I should have about what does that transition look like between, I was an associate joking around and all of a sudden that next Monday, I'm the boss. That's a hard transition. I had all these silent expectations of what I thought at everyone should be doing in their roles, but I never once asked them and I didn't want to say what I thought my expectation should be because I didn't want to come off as quote unquote, the bitch now, that's owning and the person, the practice owner who's going to be suddenly we were friends, but now I'm your boss. That backspired on me horribly when I first started because people then when they didn't meet those expectations, even though they didn't know what they were,

Host: there was a lot of tension there until I realized just like with our clients, when we are compassionate and direct and set everything out on the table so there's collaboration, people have the ability to respond and say that's not my goal for being here and I can say well that was my goal for being here, how can we meet in the middle, but that also when we had these everybody has silent expectations. We're not great about putting those out there, but the more that we can say, you know, I expected that for this project, this is what we were going to accomplish and let everybody have their feedback and from the beginning say, okay, now let's delegate this out, everybody knows their goal, everybody has something passionate about their place in this project. We did that for fear-free's hospital certification and it was awesome. It was such an awesome way to get everybody from different teams involved in places that they wanted to be.

Host: Everybody knew, it was all out on the table, everybody knew where they needed to go and we didn't have reactionary meetings. We had meetings where there were responses, call responses, and discussions so that we knew everybody was on the same page. Well, I wish we had another hour to talk, but we don't, so we've got a few more minutes, but this first of all, in human health care, the time for a doctor interrupt is between 11 and 18 seconds. So veterinary medicine is right in the middle of that as well. Hearing is something we don't take the time to do. It goes kind of like, got to take a deep breath and I think we need to learn how to shut our mouths. And we also, I'm just like you, I want to solve the problem. Why? Because it's a lot faster if I do it than somebody else solving the problem. So we have a lot of these issues from that standpoint. How can you take your messaging and expand it from one article

Host: in TV being today's veterinary business to a more global audience that needs to hear it? What are your plans to take your messaging to a larger audience? Well, I think the best place for us to start with this is the students, right? The future of our industry, they're able to understand the reality of the exam room, the reality of practice, and how they can best preserve their longevity by some of these helpful tips. For me and my practice, when we had a new graduate, whether it was a technician, associate, paraprofessional, whatever team member it was, who came in with this beautiful new energy and light and excitement, we always would gravitate to at least hear what that was, right? That can be in this infusion of newness and a step in the right direction for change. But I think for just as we've been talking about, right? People can reject this idea of what we're talking about today pretty quickly, out of fear and change, and it's going to

Host: be painful. It might cost money to train people and time. There's a lot of factors that say, nope, nope, I'm going to reject it. So what I think is really important about this is that it's microsteps, right? That these are like taking a breath. That is something actionable and free that literally everyone can do. You just got to practice it. It'll change things immediately in your practice. So I hope to continue to work with students and write columns and do more with industry on these micro bursts of education that are practical and real and everyone on your team can do because like you, it's a team approach. It can't be one veterinarian leading the charge and everybody else sort of hanging on for dear life, but not feeling that they have an active role in the change. So I think we should change the cliche from how do you need an elephant to how do you need to know if the answer no and it's one bite at a time. Love it. Because I really do think it's

Host: going to take baby steps. The the crawl walk run sprint marathon because change in this profession is a marathon, but we want to institute it as a sprint and that's when things fail. Natalie Marx, I could go on with this as you know for an extended period of time. We'll have to reconnect and continue the conversation, especially as you get deeper into this. I concur the students are our answer. I think they can set the future. Thank you for your time. Thank you for your insights. I appreciate your willingness to come on and share this and I do think it's an extremely important message and I'm all over it. You have a cheerleader here. Any final words of wisdom for our listeners? Well, I want to encourage everyone to think about what we've talked about from the very beginning, which is your own flexibility. If you are in a rut, if you like like I did, had the impression that if I don't clinically practice full time, right? I'm going to be rejected

Host: by the industry because I'm not a practicing veterinarian full time. I want everyone out there to think about how can I instead of thinking that way embrace my own goals, my dreams, preparing, again, just like we talked about for the exam room, preparing sort of what does that journey look like? What mentors can I look towards? But what is another challenge that I can face and achieve and make a difference? And again, be equally, if not more, valuable at times without feeling the rejection that all that we have is clinical practice, right? There's obviously the core of us is preventive wellness and certainly my many, many, many, many, many years of clinical practice are near and dear to my heart. But I think many of us hit a point where we think, is there something else that I can do and yes, there is? Peter and I are definitely examples of reinvention and recreating and just rejuvenating yourself and your dreams and making again

Host: more of a different difference for the industry. So please reach out to us if you're listening and thinking, I think I'm time, it's time for reinvention for me because it's a wonderful journey and it doesn't stop. Thank you so much Dr. Natalie Marx for joining us today and talking to us about handling rejection, by the way, I think I fit into the category of a reject. I also want to take a moment to thank our listeners. We appreciate each and every one of you. We can't do what we do without you. If you like our podcast kindly share it, share it with your colleagues and friends on social media, positive social media. Also, please don't forget to leave us a review on your favorite podcast, but form your reviews will help other doctors and practice owners to find us. Until next time, keep striving for excellence in making a positive impact in the lives of your patients and your pet parents and the veterinary community, wishing all of you an

Host: amazing week ahead. Thank you so much.