staging.vettimes.com

Tag: mental health

EMS: life, death and lost holidays

EMS is something I haven’t touched on too deeply, which is odd considering how much of a vet student’s life it takes up.

For those not familiar with the term, EMS stands for extra-mural studies: work experience conducted outside of university term time.

Each vet school organises its EMS slightly differently, but at Bristol we’re required to complete a total of 12 weeks preclinical work experience over the first two years of our course (“preclinical” essentially meaning anything from shadowing a vet nurse in practice to shovelling manure in a stable). It’s basically to get everybody up to speed where animal handling skills are concerned, regardless of individual animal backgrounds. Levelling the playing field as it were.

As a second year student, this is the world I’m living in and, since I completed roughly 12 weeks of work experience to get into university in the first place, as you can imagine, EMS has become a big part of my life, and roughly a third of this year‘s summer holidays.

Pros and cons

There are highs and lows to every aspect of uni, but it can be difficult not to let the sheer volume of extra work that needs to be done get to you. Vet students, after all, have some of the highest numbers of contact hours among their cohorts, up there with medicine and dental students, who are also required to carry out extra non-curricular work when the majority of the student body are taking three or four months off.

But it’s important to remember there’s a reason for it, and although you’re not yet aiding diagnoses or learning neutering techniques, preclinical EMS teaches you a lot of skills you’ll need to have by the time you first step into practice, such as patience with and confidence around animals.

It can also help prepare you for the harder aspects of the job, and that’s really what I want to address here.

“Preclinical EMS essentially means anything from shadowing a vet nurse in practice to shovelling manure in a stable,” explains second-year vet student Eleanor Goad. Image © Nigel Baker / Adobe Stock

There at the end

Working on a farm for any decent period of time will allow you to become familiar with two things: life and death.

Death is a part of the veterinary career that’s easy enough to understand as a concept, but far more difficult to teach in practice; vets face the death of patients regularly enough that their mental health as a profession rivals that of human medicine for being so staggeringly low. In my mind, it’s definitely an area of our education that could be improved upon, but the trouble is it’s so difficult to do.

For example, I have been volunteering at my local practice for almost seven years and yet I have never seen an animal euthanised. This isn’t for lack of opportunity but, rather, a case of respecting the owner. I’ve had to leave many a consult once the bad news is broken, regardless of the level of training because, quite understandably, having your animal euthanised is a very personal and emotional experience that you wouldn’t want a stranger observing – especially one with an open notebook and poised pen.

The (other) problem with death

The trouble is, giving patients the space they want and deserve might not be in their best interest in the long run – especially if it goes on to produce a generation of veterinarians who’ve never seen euthanasia until a whole three or four years into their training.

Nobody wants some trainee hovering over such a private and, often, devastating moment – I know I certainly wouldn’t – but if the procedure is to be done with the same level of maturity, professionalism and understanding as it demands, this takes observation and learning, like anything else.

This is one of the reasons why I think EMS plays such a vital role in shaping young vets outside of the lecture theatres and in the real world.

Perfectly placed

My latest placement is on a pig farm, and despite being one of the most enriching and enjoyable weeks I’ve completed so far, it has hit me, emotionally and personally, in way I had not anticipated.

I’ve spoken before about how working with livestock intended for human consumption is different from working with cherished pets (and it definitely is), but an animal is still an animal and, especially when you’re starting out, it can be difficult to acclimatise to the professional separation the job often entails.

That said, I’m incredibly glad for my experiences over the past week and in every placement I’ve been lucky enough to visit. Farmers and veterinary professionals alike offer up so much of their time and experience to help you improve your own skill set in ways you never even knew it needed. You grow in ways you didn’t expect and your opinions change a little bit each day in light of everything new you learn.

On paper, EMS might sound like a lot of lost holiday time and long days of manual labour but, in reality, you only get out what you put in. And what you get out is often invaluable.

July 22, 2019
Managing from the inside – what next in a personal medical crisis?

This article is written for vets and non-vets – and perhaps both groups will get different things from it.

I would prefer not to be prescriptive about the lessons I think can be learned from it, but instead invite you to take from it whatever naturally occurs to you.

It is written with the benefit of five years’ self-analysis and memory degradation, which is perhaps why I am able to ascribe meaning to some of the raw emotion a vet or VN may feel if grief is in the present or more recent past, but also may explain why you find some of your own experiences are missing from this account.

It is also personal to me, and may not chime with other members of my profession, although, when I have used my experience to help close friends in the past, I believe it has helped them.

Sudden haemorrhage

Five years ago, my mum had a sudden brain haemorrhage and immediately became comatose. My dad telephoned me to say what had happened, and that medics were loading her into an air ambulance and taking her to hospital. I was at work, but was given immediate leave to go to the hospital.

I remember being numb for about five minutes, then starting to cry in the car on the drive there. I arrived a long time before the air ambulance as, unbeknown to me, the medics had taken an hour to stabilise my mum before they could take off. Eventually, I saw paramedics unload her on a trolley. They had covered her completely with a blanket, which I now realise was to shield her from the downdraught, but at the time I thought she was already dead.

They were also not running, but moving in a calm manner – which, of course, is the safest and most effective way to behave in an emergency, but it increased my worry. It was as I would have done when a dog or cat was carried into the surgery collapsed, but it was difficult, as a family member, to understand.

At that moment, I had a visceral experience of an outpouring of grief – something I would not experience again for three months. Once I had gone into the hospital, and been told my mum was being stabilised and wasn’t dead, I became calm and entered my professional mode.

Family communication

I barely cried over the three months of my mum’s treatment, but instead took on the role of communicating relevant history with the doctors and translating their communications back to my family. I had the support of my wife, who is also a vet, and sister, who is a midwife, but often was the only one able to attend.

Of course, I was giving emotional support to my family, too, but did so almost with sympathy rather than empathy; it was like I wasn’t being affected by the situation. I felt embarrassed when friends would offer me support or ask after my well-being, and usually deflected on to talking about dealing with the suffering of my family members in the situation.

In the veterinary profession, we suppress our own feelings so we can carry out tasks efficiently and care for patients. We do this to a greater or lesser extent, but all do it to some degree. This is not something unique to us – I’m sure doctors and nurses, other emergency services and military personnel also have to do this. This professionalism is sometimes misunderstood by the public, who confuse it with coldness.

Not so long ago, I was venomously accused of “not even liking dogs” by a client when I failed to react with drama to her dog squealing when it received its vaccination. In fact, since this all happened, I have found it much harder to suppress emotion. I have even cried at the emotional back stories on MasterChef, only stopping when tears turn to laughter as my wife affectionately takes the mickey out of me.

I tend not to cry at work, but often have that feeling of tears queueing up behind my eyes, and the worry I will not be able to hold them in when I am carrying out euthanasia – particularly if I have been treating the animal for a while, or have learned something about the owner’s life and personality.

Emotional awareness

Members of my generation are often called millennial snowflakes due to our emotional awareness and perceived lack of resilience.

My instinct is, as the world and society have become broadly less oppressive (it may not seem like it, but read Factfulness: Ten Reasons We’re Wrong About the World – and Why Things Are Better Than You Think by Hans Rosling), we have developed the freedom and confidence to question everything – as well as the tools, such as the internet, to do so. This has led to widespread discussions about feelings and an increased introspection by most individuals.

My own experience is with an increased understanding of self comes the freedom to allow one’s emotions be. Perhaps, at the moment, this self-awareness is leading to an increased incidence of mental health issues, or perhaps it may just be that in the past we were less aware of what people were going through. However, as our knowledge, understanding and mental health medications improve, the empowerment of people to think and talk about their feelings will lead to better outcomes.

I am sceptical we are heading into a mental health epidemic, as is widely reported. Perhaps we simply understand the importance of addressing mental health to a greater extent. To put it another way, perhaps a greater number of normal emotional states for human beings are being medicalised than in the past and, therefore, coming under the banner of mental health.

An element probably exists of mental health stakeholders unconsciously presenting an overly gloomy view of the future to secure investment. Whatever the true picture, no stigma should be attached to any mental health issue – the answer is not just to toughen up and suppress feelings.

Poorer prognosis

During the three months my mum spent in a coma, it became increasingly clear to me the prognosis was becoming poorer. The doctors were tactfully trying to convey this and seed the idea into conversations with my family, but, naturally, they focused on the more positive appraisals by the nurses looking after her, who were trying to give us comfort.

They were, in their kindness, telling my family about positive signs she exhibited. In one incident, the nurse held my mum’s hand to inject into the cannula on the back of it, and mum’s fingers curled slightly. However, I knew this was the natural reflex to pressure on the palm of the hand and meant nothing in terms of conscious muscle control.

Often, pet owners over-interpret positive signs in the overall picture of their health and we, as vets, often have to be the bad guys in conveying the true picture. I took on this professional responsibility with my own family in nipping their positive interpretations in the bud and giving them the true picture of mum’s health, as I saw it. While, overall, I felt this was the right thing to do, at times I doubted myself and worried I was being arrogant in extrapolating my veterinary knowledge into the field of human medicine.

In truth, few things are certainties in medicine, and vets have to do their best to consider the whole picture and give owners the ability to make informed decisions. Unfortunately, at times we are asked by the owners to give more than the facts, and offer opinions as to what the likely outcome may be – often without having been able, for one reason or another, to gather all the diagnostic information we may require.

Veterinary judgement

If our judgement results in a decision to euthanise, and no conclusive postmortem is carried out, the vet has to live with that decision without necessarily knowing if he or she was right.

This relationship with euthanasia became relevant to the story of my mum. When anaesthesia was reduced and she had moments of waking from the coma, she was in a vegetative state. She also had many other pre-existing health issues: severe OA, obesity, diabetes, depression and stress.

I was also aware she was in an intensive care bed and her care was costing more than £2,000 per night, with only limited resources available in the ward and the NHS on the whole.

I felt, perhaps, my mum was coming towards the end of her fair chance to show improvement and her continued care was denying someone with a better chance of recovery the care he or she may need. I did not tell my family members the decision they should make if we were to be offered the Liverpool Care Pathway (the next nearest thing to euthanasia in people), but did explain how I felt and the reasons behind my opinion, and I think I had some influence on my family’s collective decision to ask the doctors to take that route after three months.

One of my sisters had difficulty facing up to the decision when the rest of us had decided, and it was me who gently helped her reach the same decision as the rest of us. This weighed heavily on me – no certainty in the situation existed. Although several doctors had indicated the poor prognosis, one said he had once seen someone come out of a coma after two years and recover “some function”.

I felt it was pragmatic, even if I was wrong about my mum’s chances of eventual recovery, to allow her to rest in peace. Visiting her every day was taking its toll on my family and I didn’t want that to be drawn out for months or years, and affect their health and well-being.

Scientists… but humble

As scientists, we like facts and evidence, but we are also humble enough to acknowledge the small amount of uncertainty that almost always underlies any scientific knowledge. We have to rely on the best available evidence, and that is the right thing to do. However, when the consequence is the extinguishing of a human life, sticking to those scientific principles is emotionally tough.

When my mum’s ECG monitor flatlined 36 hours after starting the Liverpool Care Pathway, I had my second visceral outpour. I cried uncontrollably for 10 minutes, but not in sadness – in relief. My whole family and mum’s friend had been gathered around her bed for hours talking while her breathing was becoming heavier.

The Liverpool Care Pathway is such a slow process in comparison to euthanasia and I believe that option has now been taken away from people, extending the end-of-life period for many patients. That night, we had a family meal and exchanged memories of my mum. I remember it as a really happy occasion.

Certain triggers would make me cry over the following 18 months or so and, for me, that was the real period of grieving. Once I could have no further influence on improving the situation, my own feelings became more prominent.

I got married five weeks after my mum’s passing, but became moderately depressed after that happy period. I regret the way I behaved moodily at home, but my wife was nothing but supportive of me during that time. Perhaps this was a side effect of having suppressed my feelings during the period of my mum’s illness.

When my wife’s mother was ill the following year, I don’t feel I supported her as well as I could have done, as I was still suffering from this grief hangover. However, despite the personal difficulty that was contributed to by my “veterinary approach” to the situation, I am still glad I approached it in this way.

Emotional intelligence

Vets and VNs are some of the most emotionally intelligent and strong people in society, and many of us may be able to deal with situations in a similar way. I feel, overall, I provided support to my family and that gave me a sense of purpose, despite the personal toll it took.

I hope my experiences will help inform the way the public interacts with the veterinary profession and help my fellow professionals better analyse their own role when they come up against difficult personal situations.

I hope they can use this to either decide to let themselves off the hook and put their professional skills to one side, or use their veterinary emotional skills to aid their family, as I tried to do, but with the additional understanding of the potential consequence of that approach.

Whichever approach you take, use your support network and look after your mind.

March 13, 2019
Stress: your nemesis or superpower?

As a veterinary student, I’m certainly no stranger to stress.

There’s a running joke within my friend group that “diamonds are made under pressure”, which helps us all to feel a little better when the pressure on ourselves begins to rise.

But, whether it’s a coursework deadline or juggling my work-load with my social life, there’s always something going on in the back of my mind like an internal, manic hamster wheel.

Duck feet

I’ve grown up wanting to be a vet. This obviously came hand-in-hand with an admiration for those in the veterinary profession – and the medical field as a whole.

Saying that, I don’t think my younger self was ever fully able to appreciate all the time, energy and exertion that went on behind the scenes. When you’re greeted by a medical professional – whether at your local GP or veterinary practice – the (hopefully) calm and collected individual you meet across the desk is only one half of the story.

You know the popular analogy of a duck, peaceful and composed on the water’s surface, but frantically kicking underneath? Well, you can be sure, 9 times out of 10, there’s some heavy paddling going on behind every good doctor or nurse that you meet.

We’re in this together

I really don’t think it matters what kind of medicine you practice or study – human or animal – it all comes with its fair share of stress. There’s a reason my course and my future career are commonly associated with poor mental health, and it’s sad how careers that do so much good have the potential to cause such harm in the process.

I think this really highlights the importance of “clubbing together” in the work place, whether that’s the university common room or the staff room of a first opinion practice. Medical degrees, along with the jobs they lead to, are demanding – there’s no getting away from it. But there’s no reason we have to do it alone.

#bekind

A little bit of kindness goes a long way, so if you see a colleague or fellow student struggling – even though you may have a lot going on in your own life – maybe try to ease their load a little, and one day they will return the favour.

If you make sure to be kind to yourself and have a good work-life balance then stress can be your superpower, rather than your downfall. It can be a great motivator if you don’t let it get on top of you and keep you focused on your goals through all the distractions life can throw at you.

To be honest, no matter your profession, course or lifestyle, stress is inevitable. It’s how you cope with it and what you choose to do with it that counts, and, ultimately, helps you grow.

March 7, 2019
All work, no play

Christmas is almost here, which means a much-awaited and deeply longed-for break from the 9 to 5 pattern of university life. The holiday period for Bristol students is starting a little later than normal this year, so, naturally, my friends and I are counting down the days until we get to retreat to the festive comforts of home.

This is my second Christmas coming home from uni and I remember the same time last year being quite a culture shock; the jump from student accommodation and rationed toilet paper to a house that is too hot – though you never believed there could be such a thing – and surprises in the form of presents rather than re-timetabled lectures and unexpected

deadlines.

Post-Christmas examinations

“It’s important to engage with whatever holiday traditions your family takes part in, and not lock yourself away behind your bedroom door with only text books and highlighters for company.”

Over it all, though, loom the post-Christmas examinations, which can’t help but make the season a little less jolly.

This is when all students must learn to juggle enjoying the well-earned rest and respite as well as finding time to work, a skill that vet students will likely have to draw on for the rest of their careers.

The task is not an easy one – ever since GCSEs kept me inside, revising on sunny summer days, post-holiday exams have been a bane of mine. It can also feel quite unjust and confusing when your university and lecturers both tell you to “have a relaxing holiday” and “take some time off”, but still expect the same quality of work you’ve been producing all term.

The same demand is made of most students, veterinary or otherwise, but for those who are also trying to fit two weeks of work experience into the bargain – such as my, perhaps foolish, self – the challenge and strain on time management become greater.

Staying motivated

Treading the line between work and play can be a daunting prospect, especially at a time when all you want to do is kick back and enjoy yourself. Staying motivated is really important. Being back home can feel like living in a whole other world, and it can be easy, especially if you live miles away from your university, to forget exams really do exist and are around the corner. On the other side of the coin, it’s important to engage with whatever holiday traditions your family takes part in, and not lock yourself away behind your bedroom door with only text books and highlighters for company.

Exams aside, and as patronising and impossible as it sounds, it is important to take some down time over the Christmas holidays with your family and friends. Mental health can take a dive during exam periods and working endlessly isn’t healthy. Of course, it’s important to study for those tests, get good grades and be the best that you can be – and if your joy stems from doing that then great.

But, at the same time, if you’re miserable because you have no time to spend with important people or to clock off then what is the point? It’s also important to recognise if you’re not at your best mentally, your capacity to revise is going to be low; so taking breaks isn’t detrimental to your studying, quite the opposite.

I love what I study, so a small break from learning recharges my batteries, but also makes me itch to start learning again. A work-life balance is a part of every course and every career, and it’s important to find something that works for you.

December 22, 2018
Being a millennial vet

Millennials are stereotypically considered lazy, entitled and always wanting something for nothing. And having previously discussed the many advantages of employing new graduates (and, therefore, millennials), this sort of labelling angers me.

The choices our generation makes are not due to lack of work ethic and naiveté about the future, but rather a reflection on the hand we have been dealt by society.

Recent statistics show the average baby boomer had to save for 3 years for an average-sized house deposit in comparison to the predicted 19 years it would take for millennials to do the same. By the age of 30, the number of millennials still renting is double that of their predecessors in “Generation X”.

At my age, my mother owned a house, had her first child (yours truly) and had been married. I can’t even comprehend the possibility of being able to afford one of those things at this stage in my life, let alone all of them.

We may prioritise our meagre disposable income in different ways, but, despite all the jokes, our love of avocados and lattes are not the reason we can’t afford to get on the property ladder. (For the record, I can’t stand avocado).

Unyielding abyss

It is excruciatingly impossible, says Jordan, to save enough in today’s financial climate to even consider a house deposit. Image © zimmytws / Adobe Stock

It is excruciatingly impossible to save enough in today’s financial climate to even consider a house deposit, while pouring money into the unyielding abyss of renting.

One of the biggest snags in the rental black hole is the deposit and associated agency fees. Shortly after leaving university, I had to magic £1,500 out of somewhere to rent a place close to my first job (and that’s a lot when your bank account hasn’t been above zero since you started uni).

Six months after that, I was faced with having to do the same again because I quit that job.

As vets, we bang on about being happy, having a supportive first job and leaving if it’s not right. That’s all very well, but what if you’re trapped financially?

I didn’t give much thought to my financial situation at the time because I was too unhappy to carry on. While I think it was ultimately the right decision for my mental health, I would carefully consider my situation before doing it again – two months of no salary left me in a very vulnerable position, and if it had been much longer, I would have been in serious trouble.

Luckily, I was offered accommodation for my second job, which was an enormous help, taking the burden of having to find a deposit again off my mind. This is one of the benefits of being a vet as a millennial – very few other jobs would offer a house as part of the package.

If you have to repeatedly uproot and keep forking out for rental deposits every time your circumstances change, it’s easy to appreciate how quickly you can find yourself in a mess.

And for me and my classmates, this is while holding down a respectable job with supposedly “good pay” for someone of the same age. But is the pay all that “good”?

Non-vet friends

My non-vet friends earn varying amounts dependent on their careers or jobs, but these certainly include plenty of non-professionals earning far more than me. However, multiple factors need consideration here.

Those who didn’t go to uni have six years of “work experience” and climbing their respective career ladders more than me. Those who did go to uni have a two or three-year head start, which is significant in certain industries.

While it’s understandable they have had more time to progress in the world of work, that doesn’t entirely quieten the resentment at having put so much money, blood, sweat and tears into a professional degree without the remuneration to reflect that.

And while we may have a decent starting salary in comparison to other graduate roles, we are very quickly overtaken.

The ceiling salary of the GP vet is a much-discussed topic, with an increase in salary seen early on, but thereafter very little difference is seen, despite further years of experience. In the current financial climate, the traditional partnership route becomes less and less tangible for the millennial veterinary graduate.

I struggled to be approved for a credit card, and with the very real possibility of never owning a house, I wouldn’t dream of asking for a loan for the kind of money needed to buy into a practice – and I think I’d be laughed out of the bank if I tried.

For my generation, the type of career, and therefore salary progression, is just not what it has been for previous generations.

Enjoy life in present

Perhaps this is why we value work-life balance more than our predecessors – for them, they worked hard in their early careers because there was a light at the end of the tunnel, being partnership.

Many of my millennial colleagues don’t even consider that as a possibility, with many of us not really knowing what we want to do long-term career-wise, and so we take each day as it comes, not just trying to survive, but striving to enjoy life in the present.

Millennials are all in the same boat – still young adults driving battered cars with bleak property-buying prospects. Image © Deyan Georgiev / Adobe Stock

It deeply upsets me that vets are still perceived as rich money-grabbers. I am not a rich vet, I’m just a millennial, struggling to make headway in an economy set up to put young people on the back foot.

The difference between me and my desk-bound friends, however, is I have the privilege to do a job that I love, and while it comes with all manner of stress, it’s worth it for being able to care for someone else’s beloved pets.

At the end of the day, though, millennials are all in the same boat – we’re still young adults driving battered cars with bleak property-buying prospects.

We didn’t choose to inherit this situation. We’ve drawn the short straw in the birthdate lottery, so all we can do is live the millennial lifestyle and enjoy our lattes and avocados.

May 3, 2018
Breaking away from a vet’s diet of fast food

A while ago, I wrote about anorexia in vets… the stripped down, bare meaning being the clinical sign of “not eating”. As a student, I witnessed vets on placements routinely forgoing lunch or existing on a diet consisting entirely of Pot Noodles or fast food – one vet I shadowed had either a McDonalds or KFC on four of the five days.

Then, I could appreciate the lack of time and energy for cooking, but still couldn’t imagine being able to stomach so much junk food. I could not understand how you could work effectively and remain healthy while pouring so much crap into your body – and, of course, you can’t!

Isn’t it ironic that part of our job is to advise on diet and nutrition for clients’ four-legged friends, yet we don’t take our own advice?

Realisation dawns

Image © miketea88 / Adobe Stock.

As a student, there would be rare occasions I wouldn’t get lunch until 4pm or would just order a pizza through tiredness (or, more likely, from being hungover). But, on the whole, I had a pretty good diet. I exercised a lot and was organised enough to make lunch 90% of the time, so I was never stuck without food.

Yet now, as a new grad, I totally get the unhealthiness; it’s not really a matter of choice, but more a matter of pure exhaustion.

I found myself going without lunch on numerous occasions, mostly due to being stuck on farm all day TB testing, but sometimes due to being swamped with surgeries. Having not been able to stop for food all day, my first exploratory laparotomy was done after inhaling a cupcake – not the most nutritious of lunches.

24/7 shopping

There have been weeks I have consumed more takeaways or McMuffins than I am proud of, purely down to a lack of time and effort. I’m too tired to shop for food, or cook it, and I don’t want to spend all weekend meal-prepping for the week ahead, which is what my more organised, student self would have done.

It also doesn’t help that shops close early on a Sunday in England. I was definitely spoilt in Scotland, where 24-hour opening actually means 24 hours, 7 days a week.

If I cooked like I did when I was a student, my day would literally be work, cook, eat, sleep. But, to be honest, it’s not much better anyway – more like work, pick up takeaway, eat, sleep.

Maintaining a work-food balance

I do manage to get out on the bike at weekends, but not during the week, and as a former gym frequenter at uni, it gets to me sometimes that I’m becoming seriously unfit. Perhaps the answer is to get up early and go to the gym before work, but that’s not in my nature… I tried early running once, and all it did was make the day feel really long by 9am.

Mental health and well-being are constantly in the veterinary media at the moment, and, while I can empathise with my colleagues who lead the lifestyle of fast food, I’m not condoning it. This is no way to carry on. We need to try to achieve an acceptable work-life balance and, at the very least, a good work-food balance, which is something I am apparently not very good at yet.

I’m told it gets easier. Whether that means you get over being so tired all the time or just get used to it and somehow manage to power through, I’m not sure, but I hope it does – and I hope I find the energy to improve my diet.

December 1, 2017
New vet schools are not the solution

We’ve barely had a day of news in the past year that didn’t include Brexit. Yet, do any of us really know what the real consequences will be?

Within the veterinary profession, specific factors are undoubtedly going to be influenced by Brexit, even if we don’t know the extent of these yet. They do, however, include a great deal of legislation on welfare and meat hygiene, but also the future of the UK veterinary workforce.

It has been suggested the proposed coalition of Keele University and Harper Adams for yet another UK vet school may help boost numbers of veterinary professionals in the UK post-Brexit, especially when it is suspected we may be facing a shortfall.

I disagree.

Not a new problem

Is training new vets going to be of detriment to the health and well-being of those in the profession already? IMAGE: GianlucaCiroTancredi/Fotolia.

Yes, the veterinary profession has a shortage of experienced veterinary surgeons right now, but this was the case before the EU referendum was even in the pipeline – SPVS, for example, called for veterinary surgeons to be added to the UK’s shortage occupation list in 2015.

Sure, post-Brexit, it is likely to get worse – for example, the uncertainty surrounding the whole situation is (anecdotally) already seeing some of our EU vets searching for jobs overseas and leaving. This isn’t just “vet news” either – the BBC (despite the ambiguous statistics quoted) also recognised the effects of Brexit on the veterinary profession in an article this week.

But opening new vet schools isn’t the answer. For example, there is increasing awareness in the veterinary profession of the importance of mental health and a resultant expanding of the resources available for those who are struggling.

We also frequently hear buzzwords such as “compassion fatigue” and “burnout”, which we need to do more about.

My point is: we need to look after our current vets. This would prevent them getting tired and fed up, and ultimately leaving the profession – or, at least, leaving a clinical practice role.

Sold the wrong idea?

The Voices from the Future of the Profession report produced by the BVA/RCVS Vet Futures initiative in 2015 stated 50% of recent graduates thought their working lives did not meet their expectations. This disillusionment, set among a feeling of being undervalued, overworked and lacking a good work-life balance (something I’ve written about at length) leads to vets turning to other careers before they have a great deal of experience – this is what should be addressed.

We need to focus on the well-being of the vets we have instead of luring even more school leavers into a profession they have false preconceptions of.

More new graduates will not solve the problem – and this is coming from one. They will simply dilute the profession and struggle because there are less “experienced vets” to mentor them and help them hone their skills and knowledge. Ultimately, a large proportion of these will become stressed and leave within a couple of years – the vicious cycle is thus complete.

Teaching tussles

On a vet school level, irrespective of Brexit, this announcement is too not welcomed. At Glasgow, I have met clinicians that have chopped and changed between vet schools because there aren’t enough experts willing to teach, resulting in a bidding war between the universities.

We now have nine vet schools across the UK and Ireland. The Aberwysth-RVC programme (for which updates on their plans were announced earlier this week) and the Keele-Harper Adams course are only going to add fuel to that fire. Where are we going to suddenly magic up so many more diplomats and EU specialists to teach? Or, for that matter, clinical skills and first opinion teachers?

Couple-of-years-qualified graduates aren’t going to have the same breadth of experience to prepare students for a variety of surgical or clinical scenarios – they are not an adequate substitute.

Reasoning questioned

Is it simply a case of money, as Jordan claims?

The plans for new vet schools is not about saving the profession, nor is it about Brexit. It is down to academic institutions seeking high-achieving school leavers to attract more undergraduates and gain more funding.

It is ludicrous a university can just decide to open a vet school off its own back and threaten the resources of current vet schools, which include teaching staff and the availability of EMS placements, especially since many of the new course models (Nottingham, Surrey and the two proposed courses above) do not have their own teaching hospitals and, instead, use external practices.

It is true the new courses will be monitored and analysed once they have an intake of students to assess whether the graduates will be allowed to practice as veterinary surgeons, but by then, it’s too late.

There needs to be regulation to prevent it getting to that point, for the sake of the profession and the disillusioned school leavers applying en masse to these new courses.

July 30, 2017
It’s good to talk…
The issue of poor mental health in the veterinary profession as a whole is becoming more recognised, and has sparked the launch of initiatives such as Mind Matters and Vetlife’s helpline service. But what about vet students specifically?

Despite not being selected for the sports teams she tried out for initially, Jordan (mounted) got on to the riding team during her second year at Glasgow.

When I was applying for vet school, I remember numerous people told me the hardest part is getting in… well, they lied. Having now spent five years at Glasgow, I can’t even comprehend why they would spread that awfully inaccurate myth.

My first inkling this oft-repeated phrase was totally unfounded came during one of our first lectures where my entire second year of A-level physics was summed up in an hour – and the pace only continued to pick up from there.

Difficult beginnings

Along with the personal struggles of moving away to university (in my case, 300 miles from home), not being selected for the sports teams I tried out for and the social pressures (feeling I had to take part in things despite feeling exhausted and wanting to sleep), it was hard.

I also had a sense of emptiness – having worked my entire life towards getting into vet school, once I got there, it was like: “Now what?”

I began to wonder whether veterinary was really the right career for me and, in the first term, seriously considered leaving.

No alternative

One of the main things that kept me there was the simple fact I didn’t know what I would do instead. I took my car back with me after Christmas, which helped with logistical issues, and started an evening creative writing class that gave me the opportunity to get away from vet school and vet students every so often.

By the summer of first year, I still wasn’t convinced I would stay. I hinged my fate on exam results, deciding I wouldn’t have the motivation to resit them because my heart wasn’t in it.

Jordan and the team of volunteers with Bolivian NGO, Comunidad Inti Wara Yassi.

However, I passed, and bundled myself on to a plane to South America to undertake some EMS in the Amazon rainforest. My time in Bolivia was incredible and rekindled a long-forgotten passion.

After that, my vet school experience shifted massively. I suddenly loved being a vet student – I got on the riding team, became more involved with the social side of vet school and continued my love of writing through getting involved with the Association of Veterinary Students.

I was the definition of the “work hard, play hard” vet student, but it was all about balance – the negatives of being a vet student were being outweighed by the positives.

Serious doubts

I still wasn’t particularly enthused by the course and merrily carried on because I was coping. Besides, a veterinary degree didn’t have to culminate in a veterinary career.

Every exam period was a rite of passage to get to the next year. Before Christmas, one year, we had nine exams in eight days – I think I averaged two hours’ sleep a night that week, but we got on with it. Everyone moaned together and everyone came out the other side, one way or another.

Nobody is immune – even at later stages in the course, those students who were high achievers and never seemed phased by anything started having doubts – serious “I’ve been to discuss where my degree stands if I drop out now” doubts.

By fourth year, I’d reached a level of acceptance that, since I’d got this far, I may as well carry on.

A sense of equilibrium

I started final year rotations absolutely terrified, but took comfort in the shell-shocked looks reflected in my classmates’ faces on the first morning of medicine rounds in the small animal hospital. We were all in the same boat.

Yet, finally, I found my stride; I have absolutely loved final year. For the first time in five years, I didn’t regret my life choices and found myself thinking “this is exactly what I want to do”. I was fascinated by medicine and felt a real sense of achievement of actually doing things for myself, such as taking consults and performing surgery.

Again, some of my peers hit their “walls” during final year, but we got them over it.

Another nugget of advice “they” tell you is final year will fly by. That one, I’m afraid, is not a lie – I can hardly believe I’m sat here with 12 months of rotations behind me, already facing finals and job applications.

All in the same boat

Jordan eventually “found her stride” during final year rotations.

Everyone has a wobble at some point and thinks “why am I doing this to myself?” The important thing is to remember other people are probably feeling the same way.

Mine was very early on, when everyone else seemed to be loving life, and I felt so alone. I felt like I would let my family and friends down if I dropped out, so felt too ashamed to say anything. However, when I eventually voiced my feelings, it transpired a lot of people were thinking the same.

A lot of support is out there now, which can be accessed in different ways. Each university will have a formalised counselling service and many vet schools now have a peer support system in place – this has been a huge success at Glasgow.

Meanwhile, Vetlife offers confidential telephone support to vets and vet students alike if you need an impartial, anonymous ear.

Feelin’ good

Glasgow recently held “Feel Good February”, a month of events and activities to raise awareness of these services and promote good mental well-being around the vet campus, part of which involved defining the problem at Glasgow specifically.

The Glasgow University Veterinary Medical Association revealed the results of a survey, which showed:
- 62% of current vet students felt stress had a negative impact on their everyday life
- 89% felt it was normal to feel stressed during a veterinary degree
This normalisation of stress can lead to students feeling they should be able to deal with it, but that the inability to cope will not translate well to life as a vet. It’s a very tough course for a number of reasons, including the workload that was described by our professor, Ian Ramsey, as “savage” in an STV interview.

However, this perception students should be stressed leads to an inability to speak out, for fear of seeming weak and “not cut out” for veterinary.

So worth it

I cannot imagine where I would be now if I hadn’t carried on with my veterinary degree. I’m so grateful friends and family supported me through everything and I made it to the point of starting a veterinary career knowing wholeheartedly this is what I want to do.

If you’re thinking of dropping out, please talk to someone – I can guarantee they’ve felt the same at some point. And if you’re having a particularly tough rotation or coming up to exams, power through and help each other – it’ll be worth it in the end!
April 15, 2017
Eating disorders and the veterinary profession

The general public associates the word “anorexia” with the eating disorder characterised by refusing to eat to lose weight, which, in human medicine, has the more specific name of “anorexia nervosa”. As vets, we use the word the term “anorexic” in the slightly different sense of being a clinical sign our patients exhibit – defined as “a lack or loss of appetite”.

Is the veterinary profession practising what it preaches when it comes to nutrition?

When referring to vets themselves, however, these definitions blur together a little, but I believe many vets frequently exhibit clinical signs that may or may not be part of an eating disorder.

While there is a lack of hard evidence or figures for eating disorders within the veterinary profession, it is estimated 10% of UK veterinary students suffer from eating disorders (not limited to anorexia nervosa), which is higher than the figure for the general UK population, which sits at 6.4%. (vetlife.org.uk).

Another branch

We are all made very aware of the mental health statistics and suicide risk of vets, and eating disorders are another branch of that tree.

Despite the lack of evidence to back up the theory, based on anecdotes alone, I’m willing to bet eating disorders, or even intermittent “anorexia” (the clinical sign), are more prevalent in qualified vets than the general population.

I’ve lost count of the number of times I’ve been on EMS and spent the entire day in the car with the same vet, going from call to call and not seeing them eat once.

I’m probably on the other end of the scale; I tend to get indigestion and heartburn from excess stomach acid production if I don’t eat regularly enough, so I tend to stress about the next time I’m going to eat (which turns into a vicious cycle because those symptoms also develop as a result of that stress). Therefore, I always try to ensure I have a packed lunch so I never get caught out.

On the road

Veterinary professionals on the road can often find themselves picking up fast food, which will be of long-term detriment to their health.

The number of ambulatory equine or farm vets who don’t appear to carry food in their cars is astounding.

They often rely on getting time to stop for food – which, inevitably, results in them not eating for the whole working day or picking up unhealthy fast food or snacks, which isn’t really much better.

When discussing my observations with fellow students, many of them have similar tales, and the problem is not limited to ambulatory practice.

While many vets and nurses in small animal practice will have a slightly more routine structure to their working lives, there’s always the odd mad day, week or month when they just can’t seem to grab a minute to supply their digestive system between consults, surgeries and emergencies.

Despite my own claim of always being prepared to avert such situations, sometimes they’re unavoidable.

I’ve found myself a few select times during rotations when I’ve been so rushed off my feet, trying to get everything done or see clients, that I haven’t eaten lunch until well after 4pm. Then, it’s likely I’ve got to that stage of being “past hungry”, but, as it is at that point I normally get headachey and feel a bit weak, I force something down despite not really wanting it any more.

Can’t or won’t?

Now, there’s a subtle difference between anorexia (a “lack of appetite”) and physically not having a chance to eat despite the grumbling in your stomach and the agonising knowledge there’s a pretty decent lunch waiting in the fridge in the next room – but it’s a fine line.

If a client has been waiting 20 minutes for you already, surely another two won’t hurt while you inhale a sandwich? Are vet staff just too busy to eat sometimes or are they not finding the time themselves? No matter how stressed and busy you are, you should still be able to satisfy the basic human right of being able to eat.

I believe the problem of the profession not eating properly is a combination of possible eating disorders, stress related anorexia and the working environment.

Take responsibility

Finding time to eat is crucial, says Jordan, for the health of both the profession and its patients.

I have previously expressed my opinion of the poor work-life balance within the UK veterinary profession, and ignoring rest breaks that are a legal requirement in almost any other field – while not entirely to blame – certainly doesn’t make it easy for vets to look after themselves.

On the other hand, vets need to take personal responsibility for their own health and find time to eat during the working day – if you don’t look after number one, you won’t be providing optimal care to your patients.

As much as skipping one meal might seem like a short-term solution to helping a patient that little bit sooner, it will be at the detriment of your clinical ability in the long term.

Evidently, this is not a clear cut problem and, as such, there’s no fix-all solution.

However, I think vocalising these issues is a good starting point if we wish to become a more healthy, sustainable profession in the future.

November 2, 2016
Change for the better

The UK veterinary profession is suffering.

While a documented shortage of graduates does not exist as in previous years, significantly less fuss has been kicked up about the announcement of the new Aberystwyth-in-conjunction-with-RVC vet school, compared with the opening of the Surrey Vet School in 2014.

Surrey vet school: a bolt from the blue?

Is this because we knew Aberystwyth was in the pipeline so are not shocked by the announcement, or has the profession kept quiet because we do need more vets?

The problem is not a lack of graduates, but a lack of “experienced vets” and a shortage of vets staying in the profession after a few years of graduation.

This begs the question: why?

The simple answer is, as shown in last year’s “Voices from the future of the veterinary profession” survey conducted by Vet Futures, the profession, in its current state, does not meet expectations of those entering it.

Essentially, we feel undervalued, underpaid and overworked, and lack a sense of life outside veterinary.

Undervalued

The profession has an image problem, in many respects. It is becoming more commercialised, not just because of corporate takeover, but because clients expect more.

We seem to be moving away from the respected professionals who have dedicated their lives to helping animals and, as such, are praised for performing little short of a miracle in medical and surgical feats, and towards the providers of a service that, if not absolutely perfect and costs next to nothing, will only be complained about and bad-mouthed to other customers and competitors.

Sadly, the economic climate has caused much scaremongering, bringing vets to the absolute disposal of the pet owner for fear of losing clients and, therefore, not being able to balance the books.

I feel very strongly part of the reason our services are so undervalued is the NHS (See Jordan’s July 2014 blog post, “I Blame the NHS“).

The everyday person has no concept of how much medical procedures, diagnostics and therapeutics cost. I’ve done the research – prices for private medical care are found fairly easily, but NHS costs? Nigh impossible.

So how can we blame the public for not having a clue how much a radiograph costs? The public perception of veterinary in this country needs to change and I don’t think it will without transparency on human medical costs in conjunction with our veterinary ones.

Overworked

“I struggle to see how many full-time vets’ hours fall within the legal limit,” says Jordan. Image © alarts / Fotolia.

Depending on the kind of practice you’re in, or going into, the relative feeling of being overworked will differ. I realise my points won’t apply to every practice in the country and this is sweeping general opinion on the UK profession as a whole. However, I struggle to see how many full-time vets’ hours fall within the legal limit.

The legislation is complex, with loopholes in the Working Time Regulations 1998 (WTR) possibly allowing certain practices to skirt round some of the “rules”, such as the designated 11-hour consecutive rest break in each 24-hour period and the minimum 24-hour rest break in each 7-day period.

On-call work is difficult to classify, but, in essence, the signing of a workforce agreement (probably as part of an employment contract) means the employee is agreeing to to provide out-of-hours cover that impinges on these designated rest breaks.

Some final year rotations at university I know are well beyond the limits set by the WTR (although the legality is sketchy since we’re not employed while we’re students).

“It’s not a nine-to-five job,” was a comment given with regard to rotation hours. That’s tough love: you’re going to be worked into the ground when you qualify, so you may as well get used to it now. But why? Why can’t veterinary be a nine-to-five job? It certainly is in other countries.

The profession is changing and I really hope this is the kind of change that comes about nationwide. With the increasing popularity of outsourced out-of-hours cover and shift work, why can’t a vet clock off at 5pm, enjoy some exercise, cooking, social activity, whatever and come back to work refreshed the next day ready to put in 110%?

Achieving work-life balance

We have numerous talks at uni about mental health awareness and the importance of work-life balance. But how is it possible to achieve a work-life balance if you’re working from 8am to 8pm and, even on the nights you’re not on call, you essentially only have time to grab something to eat and sleep.

What kind of life is that?

“It’s all very well lecturing us on being conscious of having a work-life balance, but what if it is beyond our control?” Image © DOC RABE Media / Fotolia.

It’s all very well lecturing us on being conscious of having a work-life balance, but what if it is beyond our control, as in so many cases?

I know for a fact, if the profession remains stuck in its ways, I will become just another statistic and leave the UK, if not the profession entirely, within a few years.

Don’t get me wrong, I have loved my rotations so far and the sense of fulfilment when I’m actually getting a handle on things is excellent, but I know I will resent my job if it does not allow for some enjoyment outside of veterinary.

But will it ever change? I think something has to give soon, or the profession will find itself in dire straits before long. How would change come about? If we wait for one practice or chain to provide a great work-life balance and rely on the trend to catch on, I think we’ll be waiting a lifetime. But what if the regulations changed?

I don’t really want to talk about Brexit (I’m sure a little piece of me dies inside every time that word is uttered), but the potential change to employment law (which has mainly been derived from the EU) could allow for changes specific to medical professions to protect us from “burnout”.

Overtime pay should exist in the veterinary world, as it does in any other “normal” job, allowing for those maniacs who want to work 24 hours a day to do so at their leisure (or those who need the extra cash), but not at the detriment to those who don’t wish to. Working out a vet’s base salary as an hourly basis is just depressing. And it shouldn’t be.

I keep hearing phrases such as “the profession is changing” and “it’s an exciting time”. I genuinely hope that is the case and we become the progressive generation we like to think we are, and drag the profession kicking and screaming with us into the modern world of enjoying life outside veterinary and moulding our careers around our lives – not the other way around.

July 30, 2016