The previous post wrapped up with tips to help you build confidence, keeping in mind that we’re not focusing on confidence just for our own sake – we’re using confidence as a building block towards building trust with our clients.
Remember, why would your clients trust you if you don’t trust yourself?
The next trust-building tool is Competence. If you want someone to trust you with his or her pet, he or she needs to know that you know what you’re doing, right?
But more exists to competence than simply showing that you know your stuff – it’s also about knowing that you know your stuff, which, of course, leads back to last week’s topic of confidence.
Competence breeds confidence, which will make it easier for you to try new things and learn new skills, which, in turn, will lead to even more competence. More feedback loops…
Here are some practical ways to use competence as a tool for perfect consults.
Show competence
Your clients want to know you are good at your job before fully trusting you.
The problem is, they don’t get to see you shine once you leave the consult room, so you need to make sure you demonstrate competence in your dealings with them.
This means making sure you know how the practice software works, know the vaccination protocols, how to confidently examine their pet, how to give an injection… the basics we mostly take for granted.
If you appear to be a bumbling buffoon with the simple things, clients will presume you’ll be the same where it really matters.
Talk about how competent you are
Don’t be afraid to talk yourself up a bit. You can sell yourself – whether it’s your own skills, or your clinic’s – without being arrogant. For example:
“I have a special interest in skin cases, so I’m confident we can make a big difference here.”
“We see a lot of these cases, and we have high success rates.”
“Dr X, who will be doing the surgery, is one of the best in the business.”
Develop competence
It’s much easier to feel like your good at something when you are actually good at something.
Resist the default of the aimless drift towards mediocrity – “Jack of all trades, but master of none.” Pick something – anything – and spend a bit of time polishing your skills in it. The manky ear, in-house cytology, behaviour, treating seizures, reading radiographs, dealing with angry clients, fixing canaries… anything.
Distinguish yourself by becoming a “mini-specialist” in something, so that the next time one of those situations arises you absolutely smash it.
Others will see this. Your clients will see it. People will acknowledge your skill and, maybe, praise you. Someone less skilled may start deferring to you the next time they have a similar case.
These things will light up all those feel-good social centres that our minds have evolved for, which will give you a massive confidence boost. Which, as we just said… have I mentioned feedback loops?
The next part look at the final C needed to establish trust with your clients.
Either way, as a student with a passion for both fitness and animals, I was initially intrigued. But I can’t help but have concerns for whether this practice is beneficial for all members of the class.
Five freedoms
Usually applied to the context of captive animals, the five freedoms can really be utilised to evaluate the welfare of any animal outside of its natural habitat (which, technically, every dog is).
These being freedom from pain and disease, stress, discomfort and hunger, as well as freedom to express normal behaviour.
My main concerns when it comes to puppy yoga would be stress, hunger and disease.
If classes run back to back, younger animals that require more frequent feeds may miss out on vital mealtimes, and there’s always the worry some puppies included in these classes are too young to be removed from their mothers. Ideally, no puppy should be removed from the dam or weaned before eight weeks of age. In larger breeds, puppies can appear older than they really are, and some breeders or yoga studios may be motivated by profits to use pups that are slightly shy of this age limit.
The danger here is that puppies don’t typically receive vaccinations until they’re eight weeks old, and if puppies from different litters are introduced when their mother-derived immunity is lowering, diseases can be transmitted very quickly. Most vets wouldn’t advise mixing a puppy with other dogs until at least two weeks after its second vaccines (at around 12 weeks old) to allow adequate immunity to develop.
In regard to stress, anything new or novel can be stressful to a puppy (or any animal for that matter). Loud noises, strange smells and lots of new people all at once can also be very overwhelming and scary to puppies that are yet to be properly socialised.
Socialisation
The socialisation window for puppies is from when they are roughly one to three months old. During this time, the animal’s perceptions of the outside world and its stimuli are being shaped by its experiences, and once that window closes, it can be more difficult for biases towards certain stimuli to be changed.
Since the majority of puppies used in yoga sessions are between two to four months old, on paper, the practice sounds like an excellent opportunity for animal lovers to exercise and unwind surrounded by adorable puppies, with the added benefit of those puppies being socialised to grow up more well-rounded and well-behaved pets.
Unfortunately, however, socialisation is not an exact science, and while it is incredibly beneficial to introduce puppies to lots of different things during their socialisation window, it does not mean flooding them with lots of stimulus all at once.
This is the really tricky part, because what counts as “overwhelming” to one puppy may be completely manageable to the next. Some animals may find a room full of new people and smells incredibly exciting, while others need to be introduced to new people one at a time, with plenty of opportunity to withdraw from the experience if needed.
It can also be impossible to predict what type of puppy you have until you place it in that situation. While a lot of behavioural aspects in our pets can be traced back to environment and genetics, every animal is unique, and just because a litter comes from docile, friendly and outgoing parents, doesn’t mean the offspring will share the same traits.
Ensuring every puppy’s experience of a yoga session will be adequate from a welfare perspective would take a very knowledgeable and conscientious screening process that some businesses may not know how to or be able to provide.
Yoga “pants”
I feel that puppy yoga is probably far from a black and white picture, with the level of puppy welfare and attention to their needs varying from practice to practice. For this reason, I think it’s definitely a good idea to do your research before booking a session – whether you’re a vet or not – to make sure you’re happy with where the puppies come from, if the establishment is aware of vaccine records (and so forth), and if the puppies are given adequate opportunity to rest and retreat from engaging with the customers if they wish.
In the same way that in the veterinary profession we are now seeing the outcomes of puppies raised during the pandemic lockdowns, we may soon see the influence of puppy yoga in the next generation of pets.
At the end of the day, it’s up to the individual consumer to decide if the practice is for them, or if ethical puppy yoga is a bit of a stretch…
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.
Euthanasia is a big part of our work as veterinarians. Working in an emergency setting, it is something I have to face on every shift.
It doesn’t get any easier no matter how many times I have to do it, but I have fine-tuned my approach over the years so each euthanasia process runs as smoothly as possible, with minimal additional stress to both patient and client.
This month, I will talk about taking care of your client.
Communication is key
Euthanasia is a big part of our work as veterinarians.
The most important aspect of taking care of your client in this difficult time is to make sure you really focus on communicating clearly, effectively and, most importantly, with sincere empathy.
First, I listen to their concerns, and why they have made the difficult decision to euthanise their pet.
Quality of life decisions can be a very grey area, and sometimes what you think may be manageable as a veterinarian can be a huge quality of life concern for a pet owner.
A prime example is osteoarthritis in older dogs. You may assess them as being clinically well except for some difficulty walking, but the client sees their pet every day and notices the struggles they go through.
Euthanasia is a difficult conclusion for them to come to and, in most instances, I will defer to the client when it comes to assessing the quality of life of their pet.
Quality assessment
One way I help clients assess their pet’s quality of life is by asking them about a few aspects of it, including:
Can your pet do the things that make them happy?
Do they spend more days sad, depressed and ill compared to the number of days they are bright, happy and eating?
Is your pet in pain? Is this pain manageable?
Confirmation
Once a client has expressed they want to euthanise their pet, I always try to confirm three things:
That they have actually decided to euthanise their pet. I frame the question like: “So, my understanding from our conversation is that you have made the decision to euthanise Fluffy today?” Sometimes, when you ask this question, the client reveals they have not actually come to that decision yet, which means you will need to backtrack a little and guide them through the decision process again.
Whether they would like to be present for the euthanasia.
How they would like us to handle the after care.
I also always try to manage all documentation and finances before the euthanasia so the clients will be in a position to leave immediately after the procedure, meaning they can begin to grieve rather than have to do paperwork. The only exception to this is when the patient is in a critical condition, meaning euthanasia cannot wait.
Explaining the process
Try not to perform the euthanasia in your consult room or in the main treatment areas – if you have a private room for euthanasias, that is the most ideal. This is important especially if the client comes back in the future with another pet or a new pet. They often find it difficult to walk into your consult room and be reminded of the euthanasia of their beloved pet.
I like to give clients some time to spend alone with their pet to say their goodbyes in private. When I come back into the room, I start by explaining the process of the euthanasia, covering the following things every single time:
Euthanasia is an overdose of an anaesthetic agent
The process is quick – 10 to 20 seconds
It is completely painless
The pet doesn’t close their eyes afterwards
The pet can have a couple deep breaths and muscle tremors
The pet can release their bowels and bladder (especially important to warn of this if the clients want to hold their pet)
Lastly, if their pet came into the hospital in shock and obtunded, where I have fluid resuscitated them, meaning they are now more bright and alert, I warn the clients that despite their pet looking better, the underlying disease remains the same.
Once the euthanasia is performed, I again ask if the client wants to spend a little more time in private with their pet. Finally, when the client leaves, they typically will say “thank you”.
Whatever you do, do not say something like “my pleasure” or “you’re welcome” like you would for a vaccination consult – this is a natural response, but would be a terrible faux pas. I simply say “I’m very sorry for your loss. Take care for now and let us know if we can help in any way”.
Next month, I will talk about taking care of your patient throughout the euthanasia process.
Every vet has their niche, speciality or personal interest. I think I’m slowly finding that mine may be located somewhere in the gastrointestinal (GI) system; as the daughter of an endoscopy nurse I like to think I’m following in the family footsteps.
I was really enjoying my lectures on the topic until we reached the point of hiatal hernias.
The unfortunate cognitive dissonance of veterinary medicine is that the more interesting or objectively “cooler” the case, the more likely it is often incredibly sad from the perspective of the patient.
Vet geek
In this case, I personally was finding the concept of a sliding hernia pretty “cool” (don’t judge, I’ve been out of the game for a year and I’ve missed nerding out over-vetty stuff), until I learned that the majority of brachycephalic dogs suffer from the condition.
The mechanism behind this being that, in an effort to breathe through an actively collapsing airway, a brachycephalic dog can effectively create such a negative pressure that it sucks its stomach through its diaphragm and into its thorax.
The worst part of this is that it’s suspected the majority of cases are subclinical (or, at least, subclinical to the owner), as the main clinical signs associated with nausea, such as drooling and lip smacking, are characteristic of short-nosed breeds anyway.
Less love?
I wonder if a pilot finds it impossible to enjoy a flight? Even if you stuck him in first class with a martini, the Friends box set, comfy slippers and a sirloin steak on the menu, would he be able to switch off, or would he find his mind focusing on minute turbulence? Would he keep checking the altitude, or picturing the cockpit, wondering: “What on Earth is going on up there?”
Along a similar vein, by the time I finish vet school I wonder if I will ever be able to truly enjoy a dog in the way I used to? If somebody had presented me with the fluffiest, most adorably friendly puppy in the world the day before I’d started first year, I’d have been ecstatic – I may even have passed out from happiness.
Not just a puppy
Now, don’t get me wrong, I’m never NOT going to love being handed a puppy, but it’s not just a puppy anymore.
Has it been vaccinated?
Was its mother healthy?
Did the breeder socialise it effectively, or will it forever have a fear of bearded men in funny hats?
Is there a cleft palate behind those tiny teeth?
Are there worms lurking in that adorable pot belly?
It’s like my subconscious races to take a history in every animal – even if they’re not a patient!
Natural versus artificial selection
As a constant reminder of my disturbing lecture notes, while tutoring GCSE biology I regularly cover the topic of “natural versus artificial selection” with my students. This includes covering the staggering feet of man’s journey over the past 1,000 years to convert the wolf into anything from a small bear to something that fits in a handbag.
Each time I teach this topic I find myself fighting the urge to be overly pious, knowing no exam will ever ask them to list the ways the pug is destined to a snorting existence or why the dachshund can’t jump onto his owner’s lap for fear of shattering his spine.
I feel including that sort of thing in the syllabus could certainly go a long way – and perhaps the best way to promote healthy dogs is with re-education from the ground up. But is that my responsibility? More importantly, is it the responsibility of vets in general?
Flawed from birth
With some owners (especially breeders), mentioning any predispositions or hereditary conditions of their dog is akin to attacking their personal brand.
Some people are “dog people”, while some are very passionately and unequivocally only “pug people” or “sausage dog people” or “golden people” – and it’s generally a struggle not to cause offense when telling an owner their animal is slightly overweight, let alone that their pride and joy is genetically predisposed to be flawed from birth.
The frustrating thing is that if owners knew the risks to their particular pup then prophylactic management could really make a difference to these animals’ lives.
Not walking brachycephalic breeds on hot days, keeping the weight off of larger dogs to take the stress off of their joints – prevention is always better than cure, and if we can’t prevent the breeding and purchasing of puppies with a gene pool so shallow only a gnat could drown in it then at the very least we should be aiming to prevent suffering and promoting comfort.
Balancing act
The danger, as always, is that if you tell an owner what they don’t want to hear too many times, they won’t come back. So, the balancing act lies in maintaining the client-vet relationship so as to ensure animal welfare, while not being too pious or condescending.
This is equally important in day-to-day life. Being able to switch off is a must for any professional to maintain mental health, yet it’s sometimes hard to stay quiet when your friend mentions their aspiration to own 50 sausage dogs.
My question for you is, does a vet ever stop being a vet, and is a dog ever really just “a dog”?
The decision of whether or not to get a new pet is an important one, but the decision of where to get it from might be more important.
Volunteering for two weeks this Christmas at a cattery has really made me believe we, as a society, need to undergo a significant evolution in terms of how we approach buying our furry friends.
Every year, thousands of dogs and cats kept in rescue shelters are euthanised because they never manage to find a new home. At the same time, according to Government estimates, 560,000 puppies are born in the UK each year, at a minimum.
Changing attitudes
As a second year vet student with little experience as either a breeder or a dog owner, I recognise I have little position in which to tell people where to purchase their pets. But if our attitude to pet buying remains unchanged, this self-perpetuating issue will only continue – in fact, with dog and cat ownership on the rise, it might get worse.
We appear to prefer the new to the old when it comes to pets, in the same way that, given the choice, most people would opt for a brand new car over a second-hand model.
We also seem to be very blinded by the ideology of our favourite breeds. Pure-bred animals make up a very tiny percentage of shelter occupants and are also often the first to be adopted.
Domino effect
Most sheltered animals are there because their owners couldn’t cope, changed jobs, moved abroad or even passed away. The animals that never make it out of shelters aren’t necessarily aggressive, undisciplined or even unfriendly, it’s simply because they don’t match up to our idea of the perfect dog – which, to me, is truly heart breaking.
So many advantages exist to adopting from a rescue shelter, for starters you kick off a really positive domino effect by not only creating room in a shelter for another animal to be taken in, but by educating your family and friends to an option they may never have fully considered, potentially leading to more adoptions.
The process will also be less expensive than buying a pedigree puppy or kitten and you have the added bonus of knowing you are both changing and saving an animal’s life.
Happy and healthy
Even if you do decide to go with a breeder, you can still look out for animal welfare by buying from one you trust and is properly licensed.
You can help to validate the health of the puppy/kitten by asking to see the mother – if she seems happy and healthy this is a good indication of the same for her offspring – and ensuring the animal you are taking home is fully vaccinated and treated for worms.
By buying from recognised and responsible breeders, rather than puppy/kitten farms, you are still helping reduce the number of animals that needlessly end up in welfare and to move towards a future where shelters never have to put a healthy animal down.
As me and my (non-vet) partner sat down for a rare mid-week breakfast together, I made an offhand comment about “having” to vaccinate 15 puppies that day.
“What do you mean ‘have to’?” was his response. “Most people would love that, and you get paid for it.”
I considered this – and, while I’m more of a kitten person than a puppy person, who doesn’t love puppies? It‘s the little things like this we, perhaps, take for granted.
Sharing the joy
All too often, as vets, we focus on the negatives: the long hours, on call, the stress of trying to keep to time when everything goes belly up, the emotional strain, the difficult clients, surgical complications, mystery cases with unanswered questions… the list goes on.
In the midst of it all, while we‘re able to show enthusiasm during the puppy or kitten vaccine consult, sharing the owners’ joy is soon forgotten when it is swiftly followed by a few challenging consults or clients.
At the end of a couple of stressful working weeks (for a number of reasons), I found some peace having formulated a plan for a couple of complicated medical cases and finally convincing a difficult client to get on board with a particular treatment.
It’s easy to get wrapped up in the vet lifestyle – researching cases when you get home at night (and even when you don’t), not being able to sleep because, subconsciously, you’re trying to work out the best course of action for one of your patients.
Rattling off the list of procedures or appointments for the day will just seem the norm to other vets, but take a step back and remove the “vet blinkers” and actually think for moment about what we do.
If you talk to any non-vet friend or family member about your working day, they often show seemingly exaggerated enthusiasm or squeamishness. It’s tempting to brush this off, but it’s usually genuine. From their perspective, our “normal” work can be fascinating.
Everyday heroes
We may not be saving lives in a dramatic fashion every day (or maybe you do), but, as vets, we get to help a number of animals on a daily basis and, as a result, their owners.
This can be done in what feels like the smallest of gestures sometimes; as much as we may resent the notorious anal gland appointment, what that actually involves is giving a poor dog (or cat) almost instantaneous pain relief.
While I don’t think any vet will particularly enjoy an anal gland appointment, my point is to look at the bigger picture: what may be mundane to us does actually make a difference to the individual – our day-to-day routine work is far more interesting than a lot of other jobs.
Let it go
Being a vet is mentally and physically draining at times, but no day is the same and we will always have stories to tell.
So, if you’ve had a bit of a crap week (or haven’t), take a moment to think about what you’ve actually done in the past few days and enjoy the good moments – whether that’s the puppy vaccination or draining the really satisfying cat (or, in my case, cow) abscess. Then think of the clients who have been thankful for your help (even those who don’t show it) and let go of the bad moments in between.
It’s surprising how much we rely on the internet and associated technologies. In fact, you don’t quite realise how much it helps until you find yourself without it.
I experienced a weird widespread internet fault. I’m not sure if it was localised to to my geographical area, but, for a few hours, neither my mobile data would work on my phone or the internet on the practice computers (although I’m not sure if they were just being their usual painstakingly slow dinosaur selves) – even the clients were commenting there seemed to be a data blackout.
Regardless, it made my consulting morning surprisingly more challenging.
First appointment
Repeat aglepristone injection for mismating
I go to check the protocol as I know the timings are different to when given for pyometra. The BSAVA app crashes four times on opening before I accept defeat and find a bound copy of the formulary.
I then realise things are listed by drug name rather than brand name and draw a blank. I try to open the NOAH website on the consult room PC, but this inevitably crashes the internet browser. Of course it does.
Suddenly the name aglepristone is dragged from the depths of my brain and I leaf through the formulary once more. That wastes nearly the whole appointment time before I even manage to find the drug, draw it up and give it.
The computer freezes while trying to print consent forms. Luckily it’s a fairly straightforward admit for fluids/treatment and the client knows the drill. I hand over to the ops vet and leave her to work out doses.
Third appointment
A transfer from the out-of-hours provider
After skim reading the long history (that consists mainly of numerous phone calls back and forward as to whether the owner could get the collapsed dog in the car), I finally get to the point and call the client in.
The dog is bouncing and back to normal, apart from a stonker of a heart murmur. Cardiology is not my strong point and after a lengthy discussion about starting medication, and much faff flicking through the compendium trying to remember various side effects, I manage to convince them to trial medication.
Fourth appointment
Vaccination
Yay, no formulary needed.
Fifth appointment
Medicine check
One client thinks her dog has gained weight since being prescribed a particular medication. I highly doubt this is the cause of weight gain, but say I will quickly (or not so) check the data sheet.
I reach for the NOAH Compendium (when I manage to locate a paper copy) rather than the formulary, because I can’t for the life of me spell the active ingredient. On skim reading the page, can’t find anything about weight gain or appetite, but it’s not as clear cut as the lovely “clinical particulars” or “contra-indications and adverse reactions” tabs on the website. I close the book.
The client seems to be in a rush, but wants to discuss lowering the dose (are you serious? Could you have not said that while I had the page open?). I flick through and eventually find the page again, and work out the dose as they’re practically running out of the door.
Sixth appointment
Pregnant bitch
The owner asks about worming and once again I leaf through the compendium to find the protocol, only to realise we don’t have that formulation in stock.
Of course I’ve shut the book – but, before I find the right page again, one of the fantastic receptionists has materialised a bottle from somewhere and is flashing the data sheet in front of me for reference.
Seventh appointment
As she had no internet, Jordan turned to the NOAH’s Compendium for guidance, with varying results.
Dog bitten by a ferret
Small wound, possibly infected, but the dog is very wriggly. I prescribe Amoxyclav – one of the few things I instinctively know the dose of – and meloxicam (definitely no books required to work out that dose).
Eighth appointment
Puppy diarrhoea
Can you give young puppies probiotic paste? Back to the book…
It’s not listed in the compendium, and the box doesn’t indicate a minimum age – normally I would check the product website… Sigh. I search for the other vet to ask what feels like the 100th stupid question today. So it went on…
No time to lose
The point is, I didn’t realise quite how much using the internet on my phone sped up my consults. A 10-second search on an app turns into a couple of minutes leafing through a book for a drug dose. When your consults are only 10 minutes, that extra couple of minutes in each one adds up and very quickly I found myself getting behind, and, therefore, more stressed.
I can’t retain numerous drug doses in my head – or at least don’t trust myself to rely on memory for many of them except the most common ones – so maybe this dependence on technology is more of an issue for new grads than more experienced vets who seem to be an encyclopaedia of drug doses.
I was thankful this hadn’t happened on a large animal day – as someone with a terrible sense of direction, I would definitely have been stuck in the middle of nowhere with no Google Maps to get me home.
You’ve done it – five long years of hard work and study have paid off and you’ve graduated as a fully fledged vet. Welcome to the veterinary community.
And it is just that – a community of people who’ve all been there and had a first day as a vet. You’ll find that everyone (meaning more senior vets than you, which is basically any vet) is happy to offer what I consider “well-being” advice, such as “don’t be too hard on yourself, you will make mistakes” or “don’t be afraid to ask if you don’t know”.
Now, while this sort of advice is true, I don’t think it’s practically helpful for getting you through those first few weeks. No matter how much positive encouragement you receive from other vets, you will probably still be terrified for your first day/week/month.
Having been there only a year ago, I have some practical tips and tricks to help get you through the day during those first few weeks:
In-practice consultations
Make sure you know where things are kept in the consult room, so you don’t have to open every drawer in front of the client to find the syringes on your first consult.
Likewise, familiarise yourself with the drugs in the dispensary. At uni, you learn drug names, now you’re in practice you will have to learn the brands.
Make a note of the vaccination protocol used at the practice and the most common recommended flea/worm treatments (such as those on the pet health plan, if your practice has one).
Note down anything you may want to look up quickly, particularly premed doses. Depending on how your practice works, nurses may draw up premeds and have vets check before giving them, which can sometimes just be a waft in the vet’s direction for assertion – don’t panic and agree just because you don’t know what the dose is off the top of your head.
Keep a health plan or puppy/kitten package leaflet handy for when clients ask about them.
The stethoscope is one of the most useful tools for allowing yourself time to think without the client bombarding you with questions.
ALWAYS leave something essential outside of the consult room (a thermometer, fluroscein or tear test strips, for example). This gives you an excuse to leave the room have a flick through a book or ask another vet (don’t do it too many times in one consult).
If it’s something you want another vet to look at, most owners respond well to getting a second opinion. Alternatively, take photos “for comparison” then go and show another vet (be careful here – you need permission from the owners and check your practice policy regarding GDPR. You may be okay to use a work phone/camera, but not a personal one).
If you want to remove the animal from the owner – either to get another vet to look or for thinking space – ask if you can go and get a nurse to help restrain.
Being on-call/farm visits
Open things before your first equine/farm visit (gloves, lube, etc) to avoid awkwardly trying to rip open boxes while the farmer is waiting.
Save dropped pins on Google maps or your satnav for your main farms or big equine clients. Again, work within GDPR, which may only allow this on work phones.
Make a cheat sheet for the car detailing drug doses for the most common things you use on farm – to avoid the inevitable mind blank resulting in an inability to do simple mental maths while staring at the bottle of Pen and Strep with the farmer staring at you. I made one for a 300kg/500kg/750kg size horse for quick reference.
If you need to call a colleague for advice while on farm, make an excuse to go back to the car. I would go to examine the animal first with minimal kit (just a stethoscope, for example) then, if necessary, make a call when I had to go back for a thermometer or relevant meds.
Make a note of who to contact regarding out-of-hours, door codes and alarm codes – and make sure you have practice keys.
Be prepared to be tired. It doesn’t last forever, but working as a vet is very tiring to begin with – don’t make too many plans for week nights or weekends for the first couple of weeks to allow you to relax when you get home.
Have a pocket-sized notebook and pen at all times, and hold on to that pen for dear life. Pens have a habit of wandering in vet practices.
Take a look at one of my previous blogs on language (Fake it ’til you make it) for some handy phrases to help assert your ability when you don’t really have a clue what’s going on.
Have a couple of books handy for quick reference when you need a memory jog. I use 100 Top Consultations in Small Animal General Practice and Gerardo Poli’sThe Mini-Vet Guide for small animal, but I hear good things about the “Nerdbook” as well. For equine, I find the Handbook of Equine Emergencies great for quick reference on the go, along with the SaundersEquine Formulary.
Make lunch in advance to start with. It may be that you always get a lunch break, but sometimes things are manic, so ensure you have food to keep you going.
Take part in any work social activities and get to know your team – it will make the working day much more fun if you get on with those around you.
Book a holiday for three months time. You will need it.
Handy resources
Make use of the vast range of apps and websites out there. Here are some I found really helpful:
BSAVA app for the formulary (it’s quicker to search drugs than flicking through the paper formulary).
BEVA apps – which features drug doses, certain procedures and joint blocks.
NOAH Compendium – there isn’t an app (at the moment), but the mobile version of the website works well. Open the NOAH website on your computer before a consulting session starts – practice computers are notoriously slow and I guarantee it will freeze when you’re desperately trying to do a quick search for doses while the client is waiting.
Vet Calculator for various calculations, particularly the heart rate counter.
While the word “survive” carries negative connotations about veterinary practice (and I have previously discussed how this sort of language can be harmful), I do think you feel like you’re firefighting in those first few weeks.
There’s no doubt it is a steep learning curve, but I’m confident you’ll come out the other side and thrive on the challenges of being a new grad.
Good luck and enjoy finally being able to say you’re a vet.
As I discussed in my previous blog post, if you are a boss, partner or practice manager, it’s important to consider whether your practice is suitable for a new graduate, before taking one on.
Perhaps you’re considering taking on a new grad for the first time, or maybe you’ve employed them before, but are struggling to attract candidates for your job vacancies – or it might be your new grads are leaving you after a short spell of employment.
If any of these apply, or you’re simply looking for inspiration on what you could do to offer support to new grads, I’d like to offer some suggestions from the new grads themselves.
Friendly face of support
Every new graduate looks for “support” in his or her first (or, in my case, second) vet role, but what exactly does that look like?
By far the most important aspect of support is communication – we’re all different, and the key to a great working relationship with a new grad is asking him or her the kind of support wanted or needed, and discussing how you can provide that.
This should also be considered a fluid, flexible conversation that continues through the first few months of employment – the rate at which a new grad gains confidence and experience will vary due to individual personalities, but will also greatly depend on caseload.
If your practice doesn’t see many cats, your new grad’s first cat spay might not happen for several months, and you can’t just assume having performed a lot of other surgeries, he or she will be fine to just get stuck in, when he or she may never have used a flank approach before.
On the contrary, some new grads can be dangerously over-confident, and that’s where your clinical and character judgement will be vital in ensuring the safety of their patients.
It can be a very delicate balancing act between pushing a new grad to improve, and not letting him or her charge in all guns blazing without the right skills.
Suggestions
The answer is not straightforward – no “one size fits all” new graduate induction plan exists – but a number of areas can be considered to help your new grad settle in.
I’m not suggesting you action all of them, or even that they’d all be suitable for every new grad or practice – they’re just ideas to think about.
Provide a booklet with practice protocols – for example:
vaccine protocol
neutering advice (ages)
treatment protocols for common ailments (as a starting point)
what should be included in estimates for operations
Order uniform or name badges and have them ready for the first day. It may seem trivial, but it symbolises being part of the team. Being asked 10 times a day who you are, or “are you new here?” gradually chips away at what little confidence you have as a new grad.
Have him or her spend a morning on reception to learn how to book appointments and other tasks, to get used to the computer system.
Put a nurse or receptionist in consults with the new grad to help him or her navigate charging for consults, saving notes, making up estimates and so on.
Have the new grad observe some consults or accompany other vets on call-outs to help him or her grasp how the practice runs and to introduce some of your regular clients.
Allow the new grad to pick up consults from a general list at his or her own pace.
Book out double appointments for the new grad initially, then shorten these as he or she gets more confident – and, therefore, faster.
Always have a more experienced vet available (in the prep room, perhaps) to answer those quick questions while the new grad is consulting. He or she need not be twiddling his or her thumbs, but, if performing procedures, ensure your new grad knows he or she can pop in and ask without feeling like an inconvenience.
Decide on a maximum length of time for a consulting block and allow breaks for the new grad to catch up or have five minutes to gather his or her thoughts.
Assign a formal buddy or mentor within the practice (not the boss) for him or her to go to as a first port of call for any problems – clinical or non-clinical.
Provide regular constructive feedback – we don’t know if we’re doing okay unless you tell us!
Have formal scheduled progress review meetings to let the new grad discuss any issues in a fair manner (the boss informally asking “how are you doing?” in front of half the staff will not always elicit an honest response).
Have a working list of procedures or cases your new grad wants to gain experience in so all staff know to try to involve him or her if they get one in. Similarly, have a list of procedures he or she is happy to do alone (and an expected timescale) so reception staff don’t book in three bitch spays on day one.
Supervision for operations – ask your new grad whether he or she wants someone scrubbed in, either in the same room or just within shouting distance, for different procedures.
Have goals for the new grad to work towards without pressurising him or her.
Show the new grad respect. Don’t undermine him or her in front of clients, even if he or she is in the wrong – better ways of addressing it exist without shattering the new grad’s confidence and credibility.
Take on board any suggestions the new grad may have in practice discussions – he or she will have the most up-to-date knowledge, and it can be a huge confidence boost to have your ideas taken up.
Try not to put your new grad to the bottom of the pile for holidays. In fact, some bosses almost force new grads to book a holiday after two months because they know they’ll need it.
Give the new grad a Christmas at home (or at least the choice of doing so). Nobody wants to work at Christmas, but is it advisable to have a stressed out new grad – who will likely still need backup in December – on call for the busiest “my dog’s eaten the Christmas pud” poisoning fest of the year? He or she will have likely moved a long way from home and will be particularly lonely at this time of year.
Have formal second on-call in place for as long as the new grad needs. Don’t assume he or she will be fine after six months – this will vary greatly depending on caseload.
Making a difference
From discussing our varying inductions and levels of support with my university friends, by far the most important thing is just being patient and friendly – even when it’s crazily busy.
Taking 30 seconds to answer a question will make a huge difference for the new grad, rather than letting us spend ages unable to find the answer in an ancient textbook.
If you take an interest in your new grad’s learning and development, rather than just employing us for cheap labour, you’re already heading in the right direction and your efforts to welcome us into the profession will be greatly appreciated.
The process is quick – 10 to 20 seconds
