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Tuesday, February 3, 2009

Something I didn't learn in vet school

In vet school, I was taught extensive anatomy, physiology, histology, pathology, and medicine in dogs, cats, ruminants, birds, and equines. I learned how to auscultate the heart, lungs, and digestive tract of all of these species. I learned how to treat IMHA, GDV, colic, conjunctivitis, Addison's disease, VPCs, and the ABCs of resuscitation. I learned how to make radiographic diagnoses, when to vaccinate animals, how to spay a cat, and how to remove a portion of a cat's small intestine.

What I was not taught was how to deal with career exhaustion, burnout, and compassion fatigue.

I blissfully entered the field sporting an invisible cape and hero suit on which "Super Vet" was emblazoned - at least that is who I wanted to be. Lo and behold I am not the superhero veterinarian I thought I was, but rather one who has come to question his future.

There are alarming statistics regarding career burnout in veterinarians. Vets are four times more likely than the general population to commit suicide. This is truly shocking. Please read the entire article here (I think the author went a little nuts about veterinarians' abuse of the drug ketamine, but I digress).
Why is this? Vets are typically happy-go-lucky people who have "the best job in the world," right? As pets become ever-increasing members of the family, the quality of their health and care must increase in tandem. This puts increasing pressure on veterinarians to perform, to heal, and to cure, added pressures to an exceedingly-high pressure profession.
Attesting to this fact, many vets are perfectionists, therefore a lack of "success" in treating veterinary patients and medical errors can lead to feelings of utter failure, lack of self-esteem, and eventual depression.

I was not taught that I would have to deal with eccentric and overly-demanding pet owners. I was not taught how to deal with the stress associated with such pet owners, difficult-to-manage cases, a physically demanding job, euthanasia, and grieving clients. I had to do this on my own. Self-taught, I believe I was only partly successful. I do, luckily, have other "teachers" to get me through this...
Given the statistics regarding occupational (mental) health in veterinarians, it is incumbent on veterinary schools everywhere in the world to sensitize veterinary students and prospective veterinary students to the many stress-related issues facing veterinarians today, these issues unfortunately eschewed by veterinary institutions.

I want to finally accept my limitations as a veterinarian, and as a human being so that my feelings of ineptitude and guilt can finally be extirpated from my being.


GoLightly said...

Great Post, Doctor.
I hear you, loud and clear.

I couldn't have become a good vet, even if I had gotten in. Tried twice, ran out of money. Marks weren't perfect. Being a high-school drop-out, I needed a few semesters to start learning how to learn.
I couldn't have handled the people and the stress. The animals are the easy part:)
That you did, and it's hard!!
Says a lot about you.
Would I trade places with you?
No, I know myself too well, now.

Working with the Oakville SPCA and the vets in Oakville sure opened my eyes. My experiences with horses also "learned" me.
Your thoughts should be made known to the Vet Schools. I've known great vets, and bad 'uns.
Of course you aren't perfect.
(Even me, but don't tell anybody)
Hang in there, you are needed, by the animals.
The medical profession is very well-known for burn-out.

Maybe go south, get some vitamin D??

I'm forwarding your blog link to my best friend, a DVM. She's nearing retirement age, and she's worked harder for that than anyone I know. Her health and her wallet took a severe beating. She got Hodgkins' in 4th year OVC. yeah.

It's got to be hard, being expected to magically fix an ailment in an animal with no vocal chords. With the owner staring, crying, screaming, whatever.

I can't imagine what goes through a vet's mind when presented with a grossly obese animal, and the owner clueless to the slow death they are perpetrating on the poor animal. What do you say?
Um, your pet is TOO fat!
Well, Doc, give me a pill for that.

Kudos to you.
Please, hang in there.
You're only human, after all.
People forget that, far too often.
Best of Luck.
If my business does go under, maybe you need a new receptionist?
Kidding, I know you're doing locum.

hang in.

DogsDeserveFreedom said...

My opinion? As someone who is Not a vet - but simply an extremely involved volunteer for a local no kill shelter?

You keep going the best you can. Change the world as much as you can in the way you want to see it go. Be yourself in every way possible.

Always remember ...

"I am only one, but still I am one;
I cannot do everything, but still I can do something;
And just because I cannot do everything,
I will not refuse to do the something that I can do."
- Helen Keller

Wishing you all the best.


Nicely dun said...

Thank you for the nice comment. I didn't realize people actually READ what I write...
(and the photo you commented on is from several winters ago, I just love his ears-they're always working like my own personal GPS)

I bet you're an excellent vet. I worked at a clinic while I was in highschool and it was difficult, even as a "kennel girl" to cope with the losses some of the clients had to face. One of the dogs that had come in, belonged to the uncle of a childhood friend...Needless to say he didn't make it. It's easy to say that while your job might be the best one ever, it certainly can be the hardest.
I'll be reading...

Y.L.G. said...

"Which way do I go?"

You don't have to make a choice.

It is possible (so I've learned) to still feel the joy of giving and helping in a way that allows you to be whole -

Acceptance; the first part of your journey you have done.

Stop beating yourself up. Stop tormenting yourself.

Regarding your last statement, thank you for being so candid; how excruciating hard to admit, but well done. Satan isn't coming to get you and you won't burn in hell. :) There is no failure here. It is what it is and you are what you are.

Veterinarian Medicine is a proud and respected profession; it is harder to get into Veterinarian College than Med School. The veterinary profession worldwide has the highest suicide rate of all, is an eye-opener. Having said that, did you know that it takes two classes of medical students every year just to replace the physicians who are lost to suicide?

Intrigued, surfing through the internet I found other related material that might be of interest.

"There is a need for more training in veterinary medicine so students and practitoners can know how to adjust while juggling the incongruent roles of healer and executioner. This work requires more than a mere sentimental love of animals. It's hard work which requires tremendous emotional fortitude and can drain resources physically, emotionally and spiritually. Hopelessness turns to rage and we begin to hate people and view others as incompetent. We develop a disdain for our patients, have no patience, no sense of humor and have not time for fun."

How truly sad, and please forgive me for saying this but you sound like you're getting there or are there. Not a good place.

Yes every pet comes with a person attached to the other end of the leash but instead of viewing them as "difficult people" why not view them as "different." Most people see their pets as children and their veterinarians as a kind of pediatrician.

I entered the "field of motherhood" planning to be supermom, super doggie mom, super wife, super everything and I was given 'Dr. Spock' to read and that was it. The Learning Channel or reality Nanny episodes on rearing children did not exist nor The Dog Whisperer or Animal Housecalls.

I didn't have the option of questioning my future - I accepted the fact that...I couldn't wear the 'cape' anymore.

Usually we are taught at an early age to care for the needs of others before caring for our own needs. The essence of our humanity is that we are deeply caring individuals, depleting our souls, striving to be the best, and trying to solve all problems. We give and give - empty the bucket - but never refill it because that wasn't part of the equation.

Sometimes all that compassion we feel and the causes we've dedicated to, can take so much out of us we don't have energy left for anybody else.

I know what compassion fatigue is.

I've tried to change by being detached, but that turned into callousness and I became mean, hard and angry. I have since found healthier ways and "still be me."

I am who I am, anything less goes against my nature - I'll still give the beggar on the street money even though I know he will use it for anything but food; I'll still take in strays; I'll still probably say 'yes' when I should be saying 'no' and I'll still be wondering why I got another puppy when they don't come with happy endings -

Ah..but you Dr. Cliff - get off the pity-pot ...look at your blog -there were joyous veterinarian moments - not all is doom and gloom.

There are so many support systems and materials to help you out. Here's something interesting -
Compassion Fatigue
Train the Trainer Workshop

You can be the one to mentor upcoming students, or share your knowledge; you seem to be a great diagnostician:) You can write a book, lecture, take other courses which you have.

There are still good and appreciative pet owners who value your expertise and compassion, and when things get rough - we're going to need your strength.

So lock up the ketamine - get over it- get on with it- and that's the direction to go:)


The Starfish, Author unknown

One day a man was taking a sunrise walk along the beach. In the distance he caught sight of a young woman who seemed to be dancing along the waves. As he got closer he saw that the young woman was actually not dancing, but picking up starfish from the sand and tossing them gently back into the ocean.

"What are you doing?" the man asked.

"The sun is coming up and the tide is going out; if I don't throw them in they'll die."

"But young woman, there are miles and miles of beach with starfish all along it -- you can't possibly make a difference."

The young woman bent down, picked up another starfish, and placed it lovingly back into the ocean, past the breaking waves.

"It made a difference for that one," she replied.

TorontoVet said...

Thanks, everyone. Nice words, filled with wisdom.
YLG, thanks for taking the time for your extensive post.
Despite my post, I still love the pets and the clients.

DogsDeserveFreedom said...

Just thought I'd let you know that Oakville Humane Society is having a compassion fatigue seminar. I just received the email about it. Don't know if it helps or anything. Sometimes it's nice to meet people who go through the same thing as you do.


Mortimer Lang said...

Hmm.. my partner went back to school a couple of years back to retrain as a vet. Initially, I was excited by the higher level of care I thought our pets would receive, and the accessibility to emergency treatments if things went wrong... but increasingly, I'm bothered by things like the number of dogs that would be put down by my partner, and how the relationship would perform should my partner fail to save our dogs... it's ... certainly not like how I thought things would be.

Jean said...

Dr. Cliff,

You were the most compassionate vet we could have had when our beloved Charley had to be relieved of his suffering. In hindsight, we should have let him go sooner.

You were very kind and dealt with my very upset daughter in the kindest way, Charley was her first dog and her first loss.

When our lil red pup, Rosie came along, spayed at 9 weeks, your dismay, humour and compassion also helped us get through what we thought was a major problem. She only needed antibiotics.

You are a charming and very competent vet, please keep on keeping on. The animals and owners love you. Well, most of us anyway! lol

Glad you're back in TO, the girls have missed you.


Jean said...

Dr. Cliff,

You were the most compassionate vet we could have asked for when you 'where there for our beloved Charley'.

We all knew that Charley needed to be relieved of his suffering, my guilt was that I loved him selfishly for a bit too long.

You were wonderful in how your dealt with my very upset daughter, Charley was her first ever loss.

I can never thank you enough for your help.

If I say we have a lil red doggie named Rosie, you'll remember us.

Welcome back to TO!

bethkate said...

Probably most of your clients deeply appreciate the work that you do but just don't say so, for a number of reasons including distraction, just not thinking about it, and ignorance ;) I think sometimes we forget that we're not the only ones who are sad when our pets die. I need to go thank my vet now....

SC said...

I completely relate!