The saying goes “Primum non nocere”. First do no harm. Sounds very old, doesn’t it? Must go back to Hippocrates? Well, there are two problems with that. First, it’s not in anything that Hippocrates left us, and second, he would have spoken Greek not Latin. In fact, the phrase originates with the physician often called the English Hippocrates, Thomas Sydenham (1624–1689). Even that attribution comes from Dr Thomas Inman in his Foundation for a New Theory and Practice of Medicine from 1860. “We crouch under the cloak of Sydenham, and say, that our motto is none other than a translation of his Latin aphorism respecting a physician’s duties, ‘Primum est ut non nocere.’” Now, having never done Latin at school – my comprehensive school told me that if I wanted to be a vet then sciences were the thing to do, not classics – I can’t tell you what the “est ut” is doing there.
Anyway, non-maleficence – doing no harm – seems a good motto for life quite as much as medicine or veterinary medicine. You might ask why I am telling you all this. My aim in fact was to tell you that in my ambulatory service visiting veterinary clinics, far from doing no harm, much of the time I don’t seem to do much at all apart from owner reassurance!
Yesterday morning’s call was to a horse with an area of corneal oedema and a couple of focal cataracts arising from a trauma last year. The horse could see well and was not at all distressed. I was happy to say that I thought everything would stay much the same, nothing need be done.
Today’s first case was a lovely Retriever, a working dog for the deaf. Duncan’s owner was devastated by the finding from her vet of cataracts – would this be the end of his life aiding her? Thankfully the lens opacities were focal dots in the back of both lenses, nothing that would stop Duncan from seeing. Have a look at both cases on my Instagram feed @bow_teye if you don’t follow me already! Duncan’s examination took a few seconds and I felt rather awkward charging his owner for it – her relief was priceless, it was clear, but the cost on a minute by minute basis seemed to be nearly that of a premiership football player! But the practice I was working for had a defined charge and so the client happily paid up.
Next came a Husky Akita cross. His corneas were misty with a lipid deposit, a diagnosis of stromal lipid dystrophy, that again, took no more than a few seconds. Would this opacity cause a problem? I compared it for the owner with my rather grubby spectacles that I could happily see through as they were so close to my eyes. Such a demonstration might be seen as unwise given that I’m being paid to look at animals’ eyes – doing that through mucky glasses could be considered suboptimal! But the dog’s owners seemed happy with the comparison.
Our work as vets is quite as much linked with how owners view us, as whether we cure their pets. A bow tie and a slit lamp lead people to have confidence in me, even when all I’m saying is that “all is well”, not offering complicated surgical options or costly medications. And here’s the problem for a new graduate who may not be able to foster that confidence. How are we to instil that in our newest vets?
When I look at final year students at Cambridge now, I see a mix of what they were like at their interview six years ago and how they have developed since. I’m so proud of what they have become and, even though they might not see it as yet, how they are ready for work as a vet. This works because as a vet school we have just 60 to 70 students in each year so we can give them a really personal education, and one where they get plenty of experience talking to clients. Quite how other schools manage to educate several times that number each year is something I’ve yet to work out!