Most dinosaurs were made extinct by a meteor strike millions of years ago. However, if you’re looking, you may occasionally see one in your practice loitering near a bottle of dex or long-acting amoxicillin, or even, in some extremely well-preserved specimens, reaching for the dry-cow tube after the end of a cat spay. At this time, the focus of everyone will be on the impending heresy of all that is holy in modern antibiotic use, while few will register that the operation will have been completed in under 20 minutes with minimum fuss and stress.
I write in jest as someone old enough to be if not a dinosaur, then possibly an early mammal and as someone who has worked with plenty of older vets using dry-cow tubes at the end of a cat spay.
We have had a few conversations in the practice recently that made me consider the sometimes diverging trajectories of a vet’s experience and knowledge. I vaguely remember some parable about buckets – when you graduate your bucket of knowledge is full but your bucket of experience is empty. Then as you go through practice the knowledge bucket seems to leak but the experience bucket fills up as the years go by. By the end, some people’s knowledge bucket seems pretty empty and it is their experience bucket that gets them through the day. This is not ideal, but nor is being a recent graduate with lots of knowledge and no experience, where every consult is a new scenario. John Wyndham wrote, “knowledge is simply a kind of fuel, it needs the motor of understanding to convert it into power”. I think we can add “and experience” after the word understanding, and read “power” as meaning clinical acumen and success.
John Wyndham wrote, “knowledge is simply a kind of fuel, it needs the motor of understanding to convert it into power”. I think we can add “and experience” after the word understanding, and read “power” as meaning clinical acumen and success.
There are many courses and much support for the new graduate, but there is not much for the older vets. The RCVS has made this process of gaining experience and recording it mandatory for new graduates, but as yet there is no equivalent for the ageing practitioner other than doing the 35 hours of CPD a year. Why does this make a difference? Take these three conversations from this week, all involving me, who has been in general practice for 24 years and done 10 years of some referral work.
The first was with a very longstanding client, and she was discussing her little old dog. He had been born, about 12 years ago, with a congenital defect of his distal urinary system and tended to make a bit of a mess peeing. But he and the owner managed OK. As a pup, he ended up being referred on for the best gold-standard corrective surgery to sort him out. I was vaguely aware of the case at the time, but did not know what was being done in detail, nor the timeline of referral, etc. The owner collared me in the car park, as they do, explained his problem and asked me casually what I would do if it were my dog. After establishing that he was, more or less, managing, I sagely said, “Well, if it ain’t broke, don’t fix it” and scuttled off to lunch. Wind forward 12 years and the owner said, “Well, I wish I’d listened to you. It cost me 10 grand and didn’t work and he ended up exactly how he was before – which was fine anyway.” I assured her that the vets only wanted the best for her dog, which she understood and appreciated at the time, and now.
The second was a simple gold-standard versus good-enough treatment debate. I had seen a cat with a complex fracture for which I did an estimate to repair in-house. It was, I have since found out, on a national level, relatively cheap. However, as I walked out to the car with the owner, I could see that fixing the cat’s broken leg was, to her, valued more than the value of her car. I mentioned this to the vet involved and we discussed whether we should offer referral for gold-standard plating or just get on and fix it. In the end, of course, we had a frank and open discussion with the owner about the options and costs, including amputation. But we avoided a knee-jerk response that everything should always go for the maximum treatment.
The last conversation was with a young nurse who had commented to someone else in the practice that she had a concern about the running of the ops morning. She observed that as we were very busy (again), due to unforeseen circumstances we briefly had two dogs on the X-ray table. The care and treatment of neither dog was compromised and was not in question, but we had indeed found ourselves in a sub-optimal situation for a few minutes. This situation started me thinking about how we need to have an open practice culture in all practices, which can permit criticism.
The many thousands of my peers and I do not want to become dinosaurs, and we need to be able to be criticised. But we also need to be able to criticise the constant drive for doing the most we can all of the time and have our experience listened to
No one likes being criticised but I feel that, as an older vet and partner, it is essential that people can criticise. The many thousands of my peers and I do not want to become dinosaurs, and we need to be able to be criticised. But we also need to be able to criticise the constant drive for doing the most we can all of the time and have our experience listened to. If you work with older vets get them to share some of their overflowing buckets of experience, and you, in return, can pass on some of your most up-to-date knowledge. Then, between us all, we will be able to practise with great power.