Chocolate, tea and respect

I’m getting old. I can see that. People greet me not by saying “you look great” but by saying “you’re getting greyer”. The worst part of that is not that it’s rude, but that they seem to think it’s funny.

I’ve been in this profession a long time, and I have seen quite a bit. My favourite type of CPD or article to read in a journal is also the rarest: “ten tips for successful…”

And so, in a break from my usual rants, I’m going to impart brief bits of advice for colleagues and the profession as a whole. I’m writing them down as they randomly occur to me throughout the month of September.

I hope they are a bit different from the usual “don’t x-ray their wallet” and “they don’t care how much you know until they know how much you care”. They are necessarily brief.

1. 

   Receptionists are the most important people in the practice. They are also the most undertrained, underpaid and under-appreciated. Some practices seem to think you can have anyone at reception, but it takes a lot of experience, training, intelligence and initiative to be a good receptionist. They can also make your life easy, or hell if you annoy them.
   .
   I once had to return to my place of work during time off to buy some wormer for my dogs. I walked into reception and there was a bit of a queue, so I sat down opposite reception. I was ignored for 45 minutes before anyone spotted me, saying “I didn’t know that was you!” – a familiar face in an unfamiliar place should have attracted attention, but no-one looked at me for all that time.
   .
   Reception isn’t just booking appointments and passing on queries and messages, it’s managing the whole experience of being in the vets for the client. What’s worse is it happened to me again.

2. I once read “fifty tips for emergency medicine” and the two most valuable and memorable tips were “when did you last cuddle your patients?” and “if it’s just plain weird, think neurological”.
3. I once had an interview for a clinical teaching job at the Royal Veterinary College. It was a bizarre experience for more than one reason, but one of the questions asked was: “If you have one sentence of advice to pass on to the next generation of vets, what would it be?”
   –
   I thought a second or two and then said: “Have the patience to let your brain figure it out, and your actions to work”.
   .
   Something I have found very useful is admitting a patient with strange clinical signs, or where the diagnosis is in question, and just watching them. Walk them around, watch them in the kennel, watch them go to the toilet, and so on. I have solved quite a few head-scratchers that way, just by spending time with a patient.
4. If a client is having difficulty making the right decision, leave the room. Even giving them five minutes – to check another patient, squeeze some anal glands, or whatever – reduces the pressure on them and lets them think.
5. Caffeine isn’t the answer, but it can help. Night work is very demanding for all sorts of reasons, not least the “thinking straight at 3am” thing. Caffeine works much better if you haven’t had it recently, so save it for when you need it. Water, squash and fruit juice are better for your stamina than caffeine at that hour, and you can still get a snooze when you need it. Caffeine also has a “comedown” phase and a crash effect in many people.
6. Common things happen commonly… to other people. Keep the weird stuff in mind. Patients can also have more than one condition at the same time!

7. 

   Nurses are absolutely essential to a vet. You simply cannot do your job without them doing theirs. Chocolate, tea and respect.
   .
   It takes a lot of love and willpower to get out of bed every morning to do a dirty, dangerous and (all-too-often) boring job for far less than the national average wage. They can also make your life hell.

8. Keep it simple. The fewer medications and the fewer doses needed, the more likely the animal is actually to get them. Obvious, but it needs saying.
9. Omnicompetence in the profession is necessary. In 1996 I was editor of the Journal of the Association of Veterinary Students (JAVS). I got to rub shoulders and argue the toss with many of the prominent leaders and personalities of the profession at the time at conferences because, all too briefly, I was invited along because I was a “somebody”.
   .
   At the BVA congress that year I argued hard with someone who really should have known better because they were (and are) prominent in the “One Medicine” fad*. I was arguing that omnicompetent veterinary graduates were necessary. This was partly in case there was a national emergency (for example, an outbreak of foot-and-mouth disease that could quickly overwhelm the cattle vet population), and partly because principles learned in one field can be applied in another.
   .
   His reply, and I quote, was: “Ha. You can’t hold on to that, we haven’t had FMD in this country for more than forty years”.
   .
   Quite apart from that, knowing about other species’ medicine helps others. It is only recently that the impact of ventilation in hospitals has been emphasised, something we’ve know about for decades in cattle medicine. Calf pneumonia and barn ventilation, rats and their respiratory diseases, and respiratory infections in human hospitals are all more similar than most people think.
10. When making estimates, make an honest estimate of how long it will actually take you to do the surgery. Then double it.
    .
    It’s a weird thing, but most people do it… they underestimate how long something will take by a factor of about a half. A similar thing I’ve noticed is that most people (clients) can’t estimate or remember the length of time an animal has been showing a sign if it’s greater than a fortnight – they will default to saying “two weeks”.
11. Lawyers and doctors may initially seem the most intimidating clients, but they are usually the best.
12. Don’t tape your giving sets in distal to the carpus.

13. 

    With regard to wildlife: euthanasia is a much underused treatment modality. Broken wings, cat bites or just too thin? Seriously consider euthanising them. You should be sure you can fix it to proceed.

14. Learn a few local anaesthesia techniques. If something is in severe pain, these will help where other things can’t.
15. Insurance is not a bottomless pit of funding for a case. All have limits and everything you do eats into that, so keep that in mind when considering your next steps – and…
16. Don’t be afraid of referral. Early referral often saves money for the client – RCVS certificate holders and specialists often save money overall because a case gets progressed quickly.
17. Learn to love medetomidine and atipamezole. Don’t be afraid of acepromazine and boxers. Diazepam is a much underused drug.

Well I hope that different tack has proved at least thought-provoking!

* I call “One Medicine” and “Evidence Based Medicine” fads because they are statements of the bleeding obvious rather than revolutions in thinking.