To fight contagious toxicity, write a code of conduct for clients and the clinic

With rudeness on the rise in the wake of the COVID-19 pandemic, some veterinary practices have posted signs such as “Aggressive behavior will NOT be tolerated” or “Zero Tolerance Policy: We do not tolerate inappropriate behavior toward staff.”

Better yet would be to come up with a one-page document outlining the rights and responsibilities of both clients and the clinic, said Dr. Cyndie J. Courtney, a consultant on workplace conflict. She spoke on “How To Write a Client Code of Conduct” on July 30 at AVMA Convention 2022 in Philadelphia.

Dr. Courtney is a small animal veterinarian practicing just south of Kansas City, Missouri, and founder of The Jerk Researcher. She describes herself as a recovering toxic team member, and she draws on experience and research as she speaks, writes, and consults nationally on conflict resolution in the workplace.

Illustration: Angry pet owner with an angry dog

Toxic behavior is contagious, Dr. Courtney said. When clients treat team members in a toxic way, team members are more likely to treat one another in a toxic way and to take toxic behaviors home.

A code of conduct outlines acceptable and unacceptable behavior. Dr. Courtney gave the example of her local human hospital, which has a patient bill of rights for what patients can expect from the hospital and patients’ responsibilities in turn.

To help identify and address the concerns of veterinary clients, Dr. Courtney said, some good resources are the AVMA Principles of Veterinary Medical Ethics, the American Animal Hospital Association’s Standards of Accreditation, and state veterinary practice acts. Also, it’s a good idea to have a lawyer assess any code of conduct.

Dr. Courtney said to keep the initial code of conduct to at most three things that the practice will ask of clients and three corresponding things that clients can ask of the practice. These things could have to do with topics such as payment structures, being a discrimination-free environment, or refraining from yelling and cursing.

For instance, if the practice wants to ask clients to be on time, it is important to let clients know that the practice will be respectful of their time and make its best effort in that area. In reality, appointments won’t always be on time, but the practice can make a commitment to tell clients when appointments are running behind.

“We want to show them that we are asking for these things because we value the underlying principle—not just because we can, not just because we have more power, not just because we can fire them—but because we care about the underlying principle, and so we’re willing to offer them the same thing that we are asking of them in turn,” Dr. Courtney said.

To format the document, a table can be used to allow clients to easily compare things side by side. A list is another format. Dr. Courtney usually recommends keeping the document to a single page.

She advised printing the code of conduct and posting it in visible places around the hospital, posting it in the “about us” section of the practice website, sharing it through email or a client newsletter, and briefly reviewing it with clients at an appointment—then giving a copy to clients and making a note in their record.

Dr. Courtney advised against including a signature line. The practice already can end the veterinarian-client-patient relationship at its discretion, and she recommended omitting a signature line to avoid an implied contract.

If a client violates the policy, remind them of it first. If the violations are flagrant or repeated, then end the relationship with that client.

“We all have the same interests at heart,” Dr. Courtney said. “We all want to help take care of these animals. And the more we can be on the same page, the more we can achieve those aims, and the less conflict we can have.”

A version of this article appears in the October 2022 print issue of JAVMA.