I must admit, I feel exhausted… which isn’t good for the beginning of a new academic year. It’s my own fault. I gave myself a week’s holiday a fortnight ago, but things have just been too busy to take much time off. Look at my Instagram – with a new case each day – and you’ll see how eye emergencies just keep turning up!
Yesterday’s emergency was an elderly Jack Russell Terrier with cataracts, uveitis and glaucoma, while the day before was a Shih Tzu with a laterally strabismic eye and a dilated pupil. Now, I know what you’ll say – a simple case of oculomotor nerve palsy, surely? Except the dog was blind in the same eye due to an atrophied optic nerve. So that makes it a trickier diagnosis – and it’s those cases that keep me going.
While a morning’s worth of corneal ulcers and dry eye are simple to deal with – a matter of pattern recognition that doesn’t take me much brain power – if you don’t see eyes every day it’s much more difficult. And that is the whole reason for the Instagram profile, so you can see a new eye case each day with some discussion around it. Cases which perplex me are more tiring as they require some serious thinking, but they keep ophthalmology interesting for sure! It stops exhaustion from becoming burnout.
One of the questions I ask applicants for veterinary medicine at St John’s is how, after getting A*s and As in their A-levels (or maybe it’s 8s and 9s now) and spending six years learning the intricacies of veterinary science, the students think they could cope with days of cat bite abscesses, dog vaccinations and the occasional diarrhoeic gerbil? Won’t they get bored? It’s interesting to hear their answers. Many say that there will always be interesting cases to see. Some say that their aim is to care for animals whether they have routine complaints or rare ones, while a few say that while a condition might be routine for the vet, every case is of concern for the owner and it’s that bond between client and pet that we ought to be concentrating on. I do like that response. At 17 or 18, though, lots of applicants are focused on their love for the animals with a smattering of passion for science thrown in too. Only a few seem to think much about the owners. But gosh – at 18 years old 40 years ago, I don’t remember mentioning anything about owners or their concerns at my interview so I can hardly expect applicants to know, can I?
While a condition might be routine for the vet, every case is of concern for the owner and it’s that bond between client and pet that we ought to be concentrating on
Of course, veterinary medicine is quite as much about being able to interact with owners, be they rat fanciers or sheep farmers, as it is about the science behind what treatment option to choose or what diagnostic step to take in a particular disease presentation. And for sure we have client communication skills classes for our students, but they take up a tiny proportion of time compared with the lectures on basic sciences or clinical skills. Where are the students to get their training in talking to owners? While they’re doing their extra-mural studies (EMS), of course! For starters, seeing us and how we interact with clients is key in them developing their own communication strategies. There are acknowledged methods to help. The Cambridge-Calgary model integrates 71 skills (or so Wikipedia tells me – I must admit I haven’t counted them all up!) from eye contact and empathy, to summarising and asking about owner’s views and beliefs. But reading a paper on what to do in a consultation is nothing compared to seeing it being done well.
The vet who first drew me to veterinary ophthalmology, John Heath in the 608 Vet Group in Solihull, was a past master in communicating with clients. “You should be able to come up with your diagnosis in a minute or two”, he used to say. But the owner is paying for much more than that – so chatting to them about their pet, their children or his own favourite Warwickshire County Cricket Association was key! Those were the days, nigh on 40 years ago, before five-minute consultations and computers in consult rooms. John’s quiet, calm empathy was second to none, with a winning smile and an infectious chuckle. Things that no textbook or lecture could impart and could never be summarised in a set of steps but moulded themselves to whatever the client needed. Well, I say “client” but those people who brought their pets to John’s clinic were never seen by him as clients with the underlying emphasis on providing a service they paid for, but rather friends who could be helped.
John’s quiet, calm empathy was second to none, with a winning smile and an infectious chuckle. Things that no textbook or lecture could impart and could never be summarised in a set of steps but moulded themselves to whatever the client needed
You might say that this is viewing the past with rose-tinted glasses but even so, I think we need to get back to that way of seeing our part in benefitting the welfare of animals and their owners… and our own welfare too. Seeing our practices as places where we help friends and their pets, rather than businesses where we make money out of veterinary services, is a sure-fire way of ensuring we don’t feel burnout, even if every day is not a little exhausting!