I AM certainly no JK Rowling but a
good story teller is defined by his or
her ability to combine personal
experiences, stories from friends
and a vivid imagination in a
coherent and entertaining fashion.
One hopes not to
fail miserably so please
be gentle in your
opinions if reading
this is less interesting
than the latest
instalment of How to
watch paint dry.
The veterinary
profession is a privileged and
respected one and the
fallout from the recent
Panorama documentary
would likely not have
been as
underwhelming in any
other profession: we
operate so much on
the goodwill and trust
of the public. It is these
attributes which allow us the privilege
to self-regulate and to enjoy life in
practice – using common sense and gut
instinct alongside evidence-based
medicine and CPD in our clinical
decisions.
The profession is moving fast, like
a racehorse picking up its speed over
the last furlong.
Providing the tools
Veterinary education is no longer
focused on purely teaching disease
recognition and treatment and instead
incorporates understanding the
underlying aetiologies, its relationships
with other management practices and
providing recent graduates with the
tools to critically assess evidence-based
medicine more thoroughly.
It is also keen to install ambition
and drive to look at every case, even
those with “successful” outcomes to
improve management of the next
similar case and to ensure that only the
most appropriate diagnostics and
treatment strategies are used: just because it worked does not mean it was
best practice. Undergraduates are now
formally taught communication skills
and business: the importance of regular practice meetings to address
issues prophylactically, the importance of clinical and
financial audit and
appropriate marketing,
to name but a few.
We are all aware of
the issues we have:
high numbers of
recent graduates
leaving practice within
five years; a suicide
rate that is infinitely
worrying; the number
of recent graduates
who move practice
within the first two
years. In addition to
these are the issues
discussed recently in
the veterinary press:
the responsible use of antibiotics; the trade
union debate; animal ethics; and continued professional self-regulation.
Every episode of South Park starts with a disclaimer: that all characters,
stories and similarities are entirely
fictional and coincidental.
I will start my story like this in the
hope that as people read on they think
of a funny South Park moment and
guarantee at least one laugh, just in
case my attempt at story writing
doesn’t quite reach the dizzy heights of
Harry Potter! I should warn readers
that the last story I wrote was for my
AS Level English! So let’s explore these
issues through Alex, a fictional recent
graduate.
Different advice
Alex graduated from the University of
Springfield in 2008 and wanted to go
into mixed practice, even though his
father, who had been a small animal
vet, advised him differently! A trusting
recent graduate, Alex found the perfect
job: 50% companion animal, 50% large
animal, and agreed to start work
straight away.
The contract was agreed verbally
and at the interview Alex had been
very honest about the level of support
he needed. He remembered the SPVS
final-year seminar about getting a
written contract, making sure there was
adequate and appropriate support and
the importance of the work-life
balance.
He was quite happy the contract
would soon be provided and the
opportunity to develop would be
plentiful given the progressive nature
of the practice in preventive medicine, herd health management and regular
forums to discuss clinical protocols and
CPD.
The first few months Alex worked
were everything that could have been
imagined: the job was a 50-50 split,
support was available and the clients
seemed receptive and were even opting
for diagnostics they had previously
declined.
Alex was excited about the
upcoming practice forum where a new
idea for the treatment of diabetes
could be discussed before finding out
that only one of the monthly forums
had actually gone ahead in the last year.
Suggestion rejected
Alex decided instead, therefore, to
discuss this idea with the principal, “Mr
Skinner”, informally but unfortunately
the suggestion was rejected
on the basis that this was
“not how it is done
here”.
Alex, inquisitive in
nature however, had
been taught at university
to constantly try to
improve and develop
practice protocols to
ensure that they were up-
to-date and so was so
surprised at this
rejection. His EMS foster
practice had regular
forums and just how
valuable they could be
was clear.
Alex was a
conscientious vet and remembered the
highly animated lecture series received
from Mr Burns on responsible use of
antibiotics and the rational and
reasoned use of fluoroquinolones and
fourth generation cephalosporins.
Worried about the way these drugs
were sold over the counter to farm
clients, particularly for enteric disease
where fluid therapy is widely
recognised as the most appropriate
therapy, and without client education,
Alex also mentioned this during the
informal chat – again without success.
Disappointed, he continued to try
hard and develop but noticed a
significant deterioration in personal and
professional relationships in the
practice; it was not his intention to
criticise but instead to try and improve,
practising the principles and ideas that
Springfield had instilled.
Unfortunately, it seemed these
attempts to practice evidence-based
medicine had been perceived badly.
With this deterioration, Alex noted
more and more of the daily workload
became farm work. Each day, his
interest in equine work became more
unfulfilled and gradually work became
more work and less of the vocation all
vets enter the job for.
Many an evening Alex spoke with
fellow classmates who were in practice. They still loved their jobs and were
excited to go into
work, develop and
progress. Alex’s
workload was no
longer allowing the
desired work and,
worse still, clinical skills
and acumen were no
longer developing and,
for the first time in a
short career, Alex
became disillusioned.
Multiple situations
occurred where clinical
decisions were
questioned or not
supported and soon
Alex felt isolated and
unsupported. One day he was asked to anaesthetise a dog with
respiratory issues but when induced it
required a tracheotomy due to
complications. With no tracheotomy kit
in the practice, he turned to the
principal who cut down and placed an
E-T tube without preparing the site
with any clip or aseptic technique.
Nightmare scenario
During this very stressful event, Alex
needed a hand around the shoulder but
instead was shouted at for being
incompetent and left to deal with the owner, who was renowned in the
practice for being difficult.
Alex soon became the “nightmare
scenario” described in many a lecture
– feeling unsupported, isolated and
disillusioned. It was like being back at
school where he had been bullied. It
had taken years for the self-confidence
to develop and day by day it was
evaporating once again.
As a result, Alex
sought less advice
within the practice as it
would only heighten
the untrusting and
unsupportive
behaviour of the
principal; if nothing
else, Alex felt betrayed
that the progressive,
supportive practice
described at the
interview had
abandoned its
responsibility.
Relationships
suffered
Alex began to revert to
the “old-school” type; very serious
about work and less able to relax and
use the dry sense of humour
developed during university. Private
relationships suffered; Alex split from
his long-term partner met in freshers’ week and was suddenly five hours
from home and very alone, even
outside of work.
With no regular forum and the
complete failure of the attempted
informal meetings, Alex and the
practice became further and further
estranged; so much so that he felt
each clinical judgement was being watched so any
mistake could be used
in performance
reviews.
For the first time
he compromised
ethical and moral
responsibilities, using
antibiotics in a cow
with enteric disease –
just in case (Mr Burns
would have been most
disappointed!).
Eureka! Alex
remembered the BVA
legal advice line and
would be able to talk.
Unfortunately, the
practice didn’t provide
BVA membership and the student membership had run out
soon after graduation and so Alex
was alone again.
Alex had one good friend at
school who had returned to the states
for university. They had some issues just after graduation and
utilised the support of
the pro-active alumni who
had close links with the
undergraduate body.
Unfortunately,
Springfield’s prestigious
alumni association was in
a transition period of re-
inventing itself and as a
shy and retiring individual
Alex couldn’t lean on
anyone there.
Without any allies at
work and not wanting to
burden friends who were
doing so well in their jobs, Alex had
no one to talk to – if only there was
a trade union that could provide
support at this time!
Unfortunately, there isn’t one and
the privilege of self-regulation means
there is no external audit of
standards and attitudes. For Alex,
who had been in the position under
12 months, there wasn’t even much
protection via the law, unless there
was a suggestion of discrimination.
He felt isolated and alone with no
one to turn to, part of an
“unprofessional profession”.
Feeling bullied for wanting to
improve and demanding the
continued improvement in clinical
management of all cases, Alex lost self-belief and was no longer able to enjoy the job
or life in general. Quickly
he became depressed, work
was a chore and evenings
were spent drinking wine,
smoking cigarettes and
listening to Mozart.
Each evening was also
spent re-counting the
events and deterioration at
work, self-blame and
loathing developing more
and more. With no one to
speak to and feeling so
bullied and isolated, Alex became the statistic we all fear
hearing about.
Only then did his family and
friends realise the reason for the
distant attitude; and the colleagues
who had made work and life so
disheartening appreciate their failures
of responsibility and the lack of
professionalism in their behaviour.
Luckily, Alex is just a fictional
character and didn’t become a sad
statistic. I just hope this story
encourages all of us to be supportive
of our colleagues, be open-minded
and receptive to personal and
professional development.
Then Alex can remain in the
archives under “fiction” rather than
“documentary”.
