Ouch! Just reading that line makes your blood boil, doesn’t it?
If you’ve been in clinical practice for any length of time, it’s likely you would have heard this accusation, or a version of it.
Hit a nerve
These kinds of comments tend to hit a particularly sensitive nerve with most vets – and it’s not hard to see why.
The reality is we dedicate our lives to helping animals, often pushing ourselves to the edge of breakdown for comparatively low wages. We really want to help our patients, but situations out of our control often force us to do things that are counter to our caring natures.
Accusing us of “just being in it for the money” could not be further from the truth, right?
Well, yes and no. The thing is, those comments are not entirely unjustified. To some degree, it is about the money.
Rather be elsewhere
We would often prefer to be doing something else than be at work. Yes, we are fortunate to have a career that most of us care passionately about, that allows us the opportunity to do what we set out to do: to help. Most of us would still do the same kind of work, even if money was not a part of the equation – but maybe not quite so much of it?
When I’m there on a Saturday instead of with my family, or I’m there at 3am instead of in my bed, I am unashamedly there because of the money. If I fail to charge appropriately for my work, I will lose that job I love and have no money.
So yes, unfortunately, the money does matter.
Brutal honesty
Being honest with myself about this has gone a long way to assuage the feelings of guilt and anger that invariably threaten to overwhelm me in these kinds of conflict situations.
I’ll often openly agree with clients when they accuse me of being money-driven: “Yes, you are right, and you are justified to be angry, but at this point, it IS unfortunately about money. I prefer to help my patients, but right now we’re both limited as to what we can do by your financial situation. That is the reality. Now let’s see what solutions we can work on.”
It’s hard to keep arguing with someone who’s agreeing with you.
This doesn’t necessarily make them happy, and it doesn’t make them like me, but it leaves no further room for argument and allows us to move towards a decision (and, not too infrequently, once the client realises they can’t guilt me into free treatment, the money will miraculously appear).
Client communication is an important part of being a vet, as building a rapport and gaining their confidence will allow them to trust you.
I would encourage all young vets to practice this skill whenever and wherever they can, and develop their abilities from the feedback.
Communication
My year was the first at the University of Queensland in Australia to have any formal lectures and practicals on client communications, and I cannot tell you how underrated this crucial course is.
In fact, I’d argue having good client communication skills is just as important as knowing the science behind veterinary medicine itself.
You can know every veterinary textbook off by heart, back to front, and be the top graduating student of the class. However, if you are unable to build a rapport with your clients and gain their trust within the first three minutes of a consultation, they may still decline every diagnostic investigation and treatment you recommend, and seek treatment elsewhere.
Complaints
Gerardo Poli during his graduation.
Client complaints are every vet’s worst nightmare, and what is the number one reason for a client complaint? Mis-communication. Therefore, it is vital everyone practices their own communication skills.
For some of us, this isn’t innate and second nature, and that is perfectly fine. Knowing your weaknesses means you can work on them. Communication skills are something that can be learned and enhanced over time.
I encourage every student to go into as many consults with clinicians as you can, observe what the vets do well in and watch out for things not so well received. It doesn’t have to be just learning from the vets, either – you can learn a lot from observing nurses’ and receptionists’ interactions with the clients, too.
Practice on your peers, friends, family, lecturers, vets and nurses, and get them to give you feedback.
Clients often panic when they think their pet is having a seizure and can skip over vital information.
Often, what an owner describes as a “fit” may actually be syncope, collapse from anaphylaxis or internal haemorrhage (for example, neoplasia), a vestibular event or a behavioural condition.
True seizures
True seizures can be divided into two groups:
Generalised (grand mal) seizures, which involve both cerebral hemispheres and result in loss of consciousness, incontinence and muscle activity.
Focal/partial (petit mal) seizures, which originate from a focal region in the brain. These can also result in alterations in consciousness, but more typically only manifest in the form of repetitive twitching or limb movement.
Once you have established the owner is likely describing a true seizure, there are many important questions to ask to narrow down your differential diagnoses and treatment options.
The important questions
So, as part of a thorough history, always ask:
Was the pet conscious during the episode?
This will help to determine whether the seizure was generalised or focal.
How long did the episode last?
Status epilepticus is when a continuous seizure lasts more than five minutes or when the patient has not recovered fully before another seizure occurs. This can result in severe secondary brain injury.
How many episodes has the pet had in the past?
Epilepsy is the condition of recurrent seizures. This can be further classified as primary and symptomatic epilepsy, with symptomatic being secondary to an underlying cause (such as head trauma or a brain tumour).
How close together were the episodes?
Cluster seizures are when an animal has more than two or three episodes within a 24-hour period.
If a patient presents first time with a cluster, this carries a poorer prognosis in dogs, but has no influence in cats.
Clusters are generally an indication for commencing long-term management.
How was the pet before and after the episode?
Seizures often come with predicting (pre-ictal) and recovery (post-ictal) events.
In the pre-ictal phase, the patient may act strangely (for example, agitated or clingy) and may vomit.
Alterations in consciousness prior to a seizure usually indicate an intracranial cause.
The post-ictal phase can last anywhere between minutes and days, and animals are usually disorientated and/or lethargic. They may also appear blind.
Has the pet demonstrated any other strange activity recently?
For example, if an animal has also been circling to one side, you can start to predict the location of the lesion.
Cats more commonly present with partial seizures compared to generalised – this is seen as stereotypic behaviours and bursts of activity.
Has the pet been exposed to any toxins or chemicals?
Seizures caused by toxins (such as snail bait) generally do not stop and start, but are continuous.
In the next part of this series, we will look at differential diagnoses for seizures and highlight the differences between dogs and cats.
Owners love their animals and want the best for them, but despite seeking and spending money on veterinary care, they frequently fail to follow their vets’ instructions when it comes to medication.
One 2003 study1 found owner compliance with vet instructions in 64% of cases, suggesting something is going very wrong.
Common reasons given by owners include:
lack of trust in the clinician
failing to remember everything in the consultation
confusion and misunderstanding the treatment plan
lack of perceived value in treatment or health improvement
ability to administer treatment effectively
Ensuring effective communication
We need to empower our clients so they can adequately follow our instructions and help bring their pets back to health. Here are some things you can try.
Empathy
Owners who feel their concerns have been listened to are far more likely to follow veterinary advice; build a working relationship based on trust. Even something as simple as “this must be hard for you” goes a long way.
Reflective listening
Summarise what the client said and relay it back to them, to be on the same page. “So Fluffy started vomiting two days ago and now she’s not eating, is this correct?”
Ask them to reflect back
Asking clients for their understanding of the situation is particularly useful. It is surprising how much information can be lost due to information overload.
“We just went through a lot of information, just to make sure we are on the same page, do you mind telling me what your understanding of the situation is?”
Outcomes assessment
You need to make sure the owner’s expectations and concerns are listened to and addressed. Make sure this translates to practical outcomes and specific treatment steps for the owner, and involve clients as much as possible.
“Can I ask, what concerns or expectations you have?” This is an open-ended question that asks clients to say what they are thinking.
Make sure the clients are able to administer the medications to their pets.
Avoid bombarding clients with information and write pertinent instructions down.
Provide a typed discharge summary containing the key points or have a notepad and pen in the consultation room so you can write down key points and provide it to them (keep handwriting legible).
What the practice can do
Team work
Get the entire practice team on board with compliance protocols; everyone needs to change how they interact with clients to improve compliance overall.
Follow up
Follow-up calls with clients to see how treatments are going and also to see if they have come across challenges that resulting in reduced compliance.
Keep records
Track the current levels of compliance > implement changes > track compliance again and see if changes were effective.
Set realistic goals
As an example, once a month the team could reflect on what they’ve done differently, practice reflective listening skills to sharpen communication skills and develop solutions to problems that have arisen.
No I in team
Veterinary medicine is all about teamwork – not just within the practice, but with your clients, too. Without teamwork at all levels we simply can’t provide the exceptional care for our patients we all want.
If we make it a team priority, the patient is the one who benefits from all our efforts.
Christmas is a great time for family gatherings, but this does not necessarily mean it is a great time for pets.
In fact, it can often be the opposite, with veterinary clinics seeing a major increase in patient numbers that come through the door.
One common emergency we see at the emergency hospital during the festive season is dog fight and bite wounds. As vets, we have a duty of care to educate pet owners during this time, so they – and their pet – have the best Christmas possible and do not end up in the emergency room.
Why do dogs fight and bite at Christmas?
Usually during the festive period, family or friends increasingly gather to celebrate. Whether it is people coming into their home, or them being taken to someone’s home, this can be confusing and cause anxiety levels to rise.
When a family member or friend brings a new pet into the house with an existing pet, it creates competition for food, space, affection and attention – and this can lead to dog fights. Even usually mild-mannered pets can easily feel threatened by a new pet entering their territory, and may lash out.
Increases in noise, people, decorations and general chaos during the holiday season can cause stress and anxiety. For dogs protective of their domain and the people in it, this can be a difficult and uncertain time.
Children not used to pets, and pets not used to young children, can also be a dangerous combination. Dog bites are a common injury sustained by children during the festive period and it could often be avoided.
Solutions
Although dogs are part of the family, it is important owners understand leaving their dog at home when they go to a festive gathering is not leaving them out, but protecting them and making sure they are more safe, comfortable and happy.
If hosting a party, owners can shut their dog in another room away from the chaos and noise – they will be grateful to have a peaceful space. This is a must for a dog already prone to stress.
Children and dogs should not be left alone and should be monitored at all times. If the dog starts to show signs of anxiety and stress, it should be taken somewhere it feels comfortable and calm.
Owners can take their dog to their vet for a behavior assessment. Anti-anxiety medications could be considered in extreme cases, but this would be a last resort.
Communicating messages
We can educate pet owners in the lead-up to Christmas in many ways. We can offer thoughtful, engaging and informative advice and guidance.
Some ways to communicate festive dangers to pet owners include:
infographics
videos
social media posts
posters in the hospital or clinic
blogs
email campaigns
discussing the dangers at check-ups and appointments
newsletters
flyers
special calls to clients with an anxious pet
education events, such as how to manage pets and children
Establishing client rapport is paramount to any consultation. Without client rapport, trust is difficult to establish and clients are less likely to follow your recommendations.
Tip #1: Never forget to greet the pet.
We have seen a good deal of negative publicity regarding veterinary surgeons in the media, so now, more than ever, we need to build that trust from the moment the client and their pet walk into the room.
Here are 5 tips to help you build rapport:
Never forget to greet the pet. This should come naturally to most of us, but if it doesn’t, do it often so it becomes a habit.
Ask open-ended questions that enable you to get to know your client and their pet. This will help you understand more about how their pet fits into the client’s lives and helps you understand their situation. Use more focused, close-ended questions for getting specific details later.
Listen! Listening skills are very important. Try not to cut the client off and listen to their concerns. There is sometimes a disconnection between what you think your client’s concerns are and what they really are. If you are uncertain what their main concerns are, then ask.
Empathy. We can sometimes forget what it feels like to be on the other side of the examination table. Place yourself in your client’s shoes and remember they love their pet enough to have brought it in to see you, and are counting on you to help get their pet better.
Be honest, sometimes you don’t know what is going on. By establishing rapport, you can work together with the client to develop a plan that is best for their pet.
According to PDSA [PDSA Animal Wellbeing (PAW) Report 2022], rabbits are the third most popular pet in the UK behind dogs and cats. With an estimated 1.1 million pet rabbits in the country, that’s about about a tenth of the population of pet dogs and cats, which hover around the 9 to 10 million mark.
So, if the pet ratio of dogs/cats:rabbits is 10:1, why isn’t this reflected in our teaching? Despite rabbit populations being endemic to the UK for more than a thousand years, they always seem to get lumped with guinea pigs and the cold-blooded pets like lizards and corn snakes when it comes to textbooks or university curriculums.
I can confidently say my education on rabbit physiology and medicine has been dramatically less than 10% of what I’ve received for small animal medicine. Perhaps this is why many vets, especially new or recent graduates, feel more confident handing off any rabbit patients to the resident “expert” of the practice or even referring to an exotics specialist, rather than seeing it themselves.
Accessibility
It’s a sad truth that the less convenient education and health care are to access, the less people will reach for them. By extension, the less veterinary practices that advertise care for rabbits (and other exotics), the less rabbits are likely to be registered at a practice and receive regular preventive care.
For example, as a native to the land of Kent, I only know of two or three practices that would call themselves “exotic specialists” and I know that, for a lot of rabbit owners, traveling half way across the county to visit one of these few practices would not be practical or plausible. Perhaps this is why, according to PDSA reports, at least 11% of pet rabbits receive no preventive health care, including vaccinations.
Rabbits are a social species that has evolved to live in groups, not alone.
Education
The value of a veterinary consultation is not simply to talk through clinical signs or address a flea outbreak in the home, it’s a chance for owners to discuss management issues or to ask for general advice. When rabbits aren’t brought in for routine consultations, then discussions about their diet, husbandry and behavioural needs don’t get to be had.
Some vets are already worried that the development of an annual rabbit haemorrhagic disease (RHD) booster rather than biannual is going to dramatically reduce rabbit welfare by halving the number of times these pets receive a clinical exam.
Welfare
Of course, like all “exotics”, there’s the argument to be made as to whether these animals are suitable pets in the first place. Personally, I feel that this is a moot point for the time being.
The fact that more than 50% of pet rabbits are housed by themselves with no companionship speaks volumes about the lack of knowledge the general public possesses on how to care for these animals. However, with more than a million of them currently out there, they’re not going away anytime soon.
The best we can do as professionals is educate our clients so welfare can be maximised as much as possible… and that starts with educating ourselves. I hope that in the near future the landscape of the veterinary degree can shift to better reflect the current demand for exotic vets – or at least rabbit vets.
Idiopathic acute haemorrhagic diarrhoea syndrome (AHDS) – previously known as haemorrhagic gastroenteritis – remains the one disease where constant debate exists as to whether antibiotics should be used as part of the standard treatment.
The logic behind using antibiotics to prevent bacterial translocation is sound, and if AHDS is truly initiated by Clostridium species or their toxins then the use of antibiotics can be justified.
However, no knowledge exists of the true frequency of bacterial translocation in AHDS patients and conflicting evidence supports Clostridium being the initiating cause of AHDS in dogs.
Together with new data indicating the use of antibiotic therapy in aseptic AHDS patients did not change the case outcome or time to recovery, the benefit of using antibiotics must be weighed against the very real risk of selection of antibiotic resistance and other complications associated with inappropriate antibiotic use.
In this blog, we will explore the evidence against the use of antibiotics in AHDS.
Cause unknown
AHDS is characterised by an acute onset of vomiting (of less than three days’ duration) that can quickly progress to haemetamesis, and severe and malodorous haemorrhagic diarrhoea, accompanied by marked haemoconcentration that can be fatal if left untreated.
AHDS is a diagnosis of exclusion; other diseases (such as canine parvoviral enteritis, thrombocytopenia, hypoadrenocorticism, azotaemia, hepatopathy, neoplasia, intussusception, intestinal foreign body and intestinal parasitism) must be ruled out by a combination of medical history, vaccination status, complete blood count, serum biochemistry, coagulation times, diagnostic imaging and faecal testing.
Small breed dogs – in particular, the Yorkshire terrier, miniature pinscher, miniature schnauzer and Maltese – have been found to be particularly predisposed. On average, the affected dogs were young (a median of five years old).
The cause of AHDS is still unknown. Clostridium perfringens and its toxin has been incriminated as being the initiating cause; however, conflicting studies have refuted this claim. It is also difficult to determine whether overgrowth of Clostridium speciesis primary or secondary to the intestinal injury.
Virus theory
Another theory is viruses may have a role in AHDS’ aetiology. At this stage, only single agents had been investigated. It is possible a novel agent not yet been tested is the cause of this syndrome, or possibly the syndrome is the result of a very complex interaction between multiple organisms or their toxins.
For the aforementioned reason, no indication exists for the use of antibiotics to treat for the underlying cause.
Another argument behind the use of antibiotics lies in the fact most idiopathic AHDS patients have several risk factors for bacteraemia.
Necrosis of intestinal mucosa, leading to the disruption of the gastrointestinal mucosa-blood barrier; adherence of significant numbers of bacteria to the necrotic mucosal surfaces that increases the risk of bacterial translocation; significant hypoalbuminaemia indicating substantial loss of mucosal epithelial layer; splanchnic and intestinal hypoperfusion, leading to reduced intestinal barrier function; and microbial dysbiosis all contribute to an increased risk of bacterial translocation.
Although bacterial translocation has the potential to lead to sepsis, the true incidence of bacterial translocation needs to be established in idiopathic AHDS patients, as well as their influence on the outcome of the patients.
Antibiotic requirement
Use of unnecessary antibiotics not only disrupts the protective mechanisms of a normal intestinal microflora, but also the real risk of post-antibiotic salmonellosis and Clostridium difficile-associated diarrhoea.
Multiple studies have suggested antibiotics are not required in the treatment of aseptic idiopathic AHDS patients.
In a prospective study of bacteraemia in AHDS dogs by Unterer et al (2015), the incidence of bacteraemia of patients with idiopathic AHDS was 11%, compared to those of healthy controls, where it was 14%.
Transient bacterial translocation to mesenteric lymph nodes occurred in 52% of dogs undergoing elective ovariohysterectomy (Dahlinger et al, 1997), and confirmed in studies by others (Harari et al, 1993; Howe et al, 1999; Winkler et al, 2003), where portal and systemic bacteraemia was reported in clinically normal dogs.
As long as the immune system is competent, and the functional capacity of the hepatic reticuloendothelial system is not overwhelmed, the body is usually effective at eliminating organisms from the blood.
This is reflected in the Unterer et al (2015) study result, where – regardless of the bacteraemia status – all idiopathic AHDS dogs survived to discharge.
In another prospective, placebo-controlled, blind study by Unterer et al (2011), idiopathic AHDS patients were either treated with amoxicillin/clavulanic acid for six days or a placebo, and no significant difference occurred between the treatment groups concerning mortality rate, duration of hospitalisation or severity of clinical signs.
They concluded, without the evidence of sepsis, antibiotics do not appear to change the case outcome or shorten the time to recovery.
Negative impacts
The negative impacts of inappropriate antibiotic use are undeniable – especially in a time where resistance has become a worldwide public health concern.
Use of unnecessary antibiotics not only disrupts the protective mechanisms of a normal intestinal microflora, but also the real risk of post-antibiotic salmonellosis and Clostridium difficile-associated diarrhoea.
With evidence all pointing against the use of antibiotics as routine treatment of aseptic idiopathic AHDS, next time you are about to reach for antibiotics, I urge you to reconsider. Although it has taken some time to adopt and requires clear communication with clients, all vets should feel comfortable not using antibiotics for AHDS patients.
If you don’t come from a “horsey background” (like me) then the equine side of the vet course can feel a little overwhelming.
From a different number of ribs and guttural pouches to the inability to vomit, horses have an abundance of clinical differences to our smaller patients, and so (quite rightly) often need to be studied in their own right, much the same as with farm animal medicine.
Clinical aspects aside, the world of equine also comes with a wealth of nomenclature that seemed to me, at first, like a second language. A disease called “glanders and farcy” was a particular favourite equine term of mine, as it sounds deceptively quaint despite in fact being an incredibly serious and often fatal notifiable disease.
For these reasons, in all honesty, I was a little apprehensive of my first equine clinical placement – most likely not helped by a distinct lack of large animal clinical EMS up until that point (thank you COVID-19).
As it turns out however, the two-week placement became one of my favourite so far. So, for those of you with it still to come, here are a few things I wish I’d known going in…
Time to smell the hay
Small animal medicine can sometimes be fast paced, and patients can come and go in a blur. With 15-minute consults and a lot to pack in within that time, there sometimes just aren’t the opportunities for students to ask questions or for advice.
On the other hand, equine and large animal medicine placements are often a little less patient intensive, affording students the opportunity to really dive into each individual case, rather than losing track of how many they’ve already seen that morning.
The drive between clients can also provide time for asking questions, filing in your case logs for the last animal, and reading up on the next.
Communication, communication, communication
Depending on the client, of course, a lot of call outs will involve a certain amount of time standing around the horse with the client waiting patiently at the reigns.
Dentals, in particular, can take a surprisingly long time and while in small animal practice the vet can typically just stick the radio on, plonk on a stool and get to it, that might seem rather rude with the animals owner standing right next to you. Being able to hold a conversation with the client, whether its about their animal or just the nice weather we’ve been having, is a skill that can sometimes be sidelined in favour of clinical competencies.
Making conversation can also be extra difficult if you’re trying to be clinically competent at the same time – and this is where multitasking comes in, as vets will often have to engage with the client for more than an hour while performing tasks on the animal that a smallies vet would probably take a dog out the back to do.
As a student, spending long periods of time with a vet and a single client is a great opportunity to practice client engagement and communication. If in doubt, and you’re left alone with the owner while the vet runs back to their car, try asking about their animal (how long they’ve had it, if it’s their first, and so on). We all love gushing over our pets, and it goes a long way to show enthusiasm instead of the vet coming back only to find the two of you staring in silence at the grass.
When you’re not feeling 100% on your catheter placement or blood sampling, it helps to have something big to aim for. This is where horses come in…
It’s almost like they’ve gone out of their way to be the perfect injection-giving training wheels, with jugulars like drain pipes and large obvious muscle bellies for you to grab in one hand and pop a needle in with the other. Once you’ve mastered the horse IV and IM, it’s only a matter of sizing down.
My main takeaway from this placement was a reminder not to shy away from practising things that don’t come naturally, or aren’t your favourite thing in the world. There’s no point practising the things you know you’re best at, for the sake of feeling good about succeeding in something you already knew how to do.
You’ll feel much better after that initial leap out of your comfort zone, when you succeed in something you couldn’t do before.
I’m only a few short weeks into my final-year rotations at the University of Bristol’s Veterinary Referral Hospital, but I already feel like I’ve learned a lot:
DOPs aren’t as scary as I’d built them up to be in my head.
It does get easier to navigate your way around the hospital with time (and trial and error).
There are quite a few differences between first-opinion and second-opinion practice that I’d never really considered until now.
Budgets
The gift that is the NHS can certainly make us blind to the costs of routine medical procedures. Something as simple as an ultrasound, blood work and a couple of days’ hospitalisation can amass a bill that’s simply unaffordable for a lot of pet owners.
I’ve seen a lot of cases reach the end of the road due to lack of funds, when the answer (or potential answer) was frustratingly simple, but just too much money. The reality of referral practice, however, is that if your patient has made it to you in the first place, there is likely a higher budget to play with than the average consult.
When you’re on a certain rotation, you find yourself doing the same diagnostics every day, so it’s easy to lose track of the value of the drug you’re administering, or the probe in your hand. I think my group and I honestly balked when the cardiology team told us the cost of a standard echocardiogram at the end of our week where we’d been observing between 6 to 10 a day. Of course, it’s still important to keep costs low wherever possible, but it’s been interesting to see how larger budgets and insurance policies are broken down.
Seeing small animal CTs, echocardiograms and neurosurgeries for the first time was an amazing experience, but I do need to keep reminding myself that the proportion of my future patients that will go on to have these sorts of procedures is incredibly small.
When you’re learning in a veterinary hospital, you’re constantly surrounded by leading experts in the field of everything under the sun, and sometimes it’s hard not to feel like a monkey with a stethoscope. Usually, in first opinion, there’s an assortment of different strengths throughout the practice – one vet may have intercalated in neurology and behaviour, while another may has done more CPD on exotic animal medicine. These differences are an asset to every practice and make team working an essential and valuable commodity.
In a referral setting, these “strengths” are often extended to actual specialisms, where the vets are not only actively involved in research in a particular field, but see only animals in a certain category of illness. The need for teamwork, however, is just as paramount here – if not more so!
After working in cardiology for a week and beginning to feel like I didn’t know anything, I can tell you that it was very refreshing to have the head of another department pop their head through the door and ask what on earth was going on with their patient’s heart. When they also didn’t know the actions of all the drugs I’d been painstakingly trying to commit to memory for the past five days, that too came as a wave of relief.
Client communication
Good communication and patience come hand in hand. If you’re delivering bad news to a client or talking them through a complicated diagnosis or treatment plan, that takes time – and although the average first opinion consult is only 15 minutes long, I’d say that, rather oxymoronically, there’s more time to deal with difficult situations in that scenario than in emergency referral.
Of course, first opinion sees it’s share of emergencies as well, but for the most part vets see a disease present slowly over time and are able to prepare their clients accordingly.
In the past couple of weeks, however, I’ve seen referral vets have to delicately balance client communication with the urgency of life-threatening conditions. Sometimes there are mere minutes to intervene after an animal enters the hospital, and vets must be very diligent and considerate when explaining this situation to an owner who may not yet grasp the severity. Owners have to have informed consent at all times, and to be prepared and supported in the event of any potential outcomes, but the sooner an animal is triaged and either treated or prepped for surgery the better.
I think that this is where the truly brilliant vets really shine. To have compassion and humanity at the forefront, with animal welfare and haste also in mind, takes a lot of mental and emotional gymnastics. I’m honestly in awe of every vet I’ve seen both in the past few weeks and over my years seeing practice who’s had to deal with a crisis on both the animal and the human end.
As of yet, I’m unsure if my career will lead me to first opinion or referral practice, but I can appreciate the similarities and differences between the two – despite us all starting out in the same place.
