Friday, January 28, 2011

Stars burn brightest before they burn out...

My frustration cup once again runneth over. That didn't take long. Ha.

Without getting into specifics, I will try and explain. Being an emergency veterinarian is a lot like being a goldfish. You exist in your own little bowl. Unfortunately, the whole world can see into your bowl all the time. You have to deal with clients who have never met you and automatically don't trust you. Those clients come with their own veterinarians, who go over the records with a fine tooth comb to determine if everything was done perfectly "right" (as if there is such a thing). If you have to send a complicated case to the referral/specialty hospital, you have those specialty doctors and technicians poring over the records and everything you did.

Why is that a bad thing, you wonder?

In and of itself, it's not. There are many checks and balances as an ER doctor. Mistakes are much more visible, and it makes it easier not to repeat them - especially when everyone else sees them.

On the other hand, it opens us up to nit-picking from other veterinarians, other clinics, and clients. How I handle one emergency might not be how another veterinarian would have handled it and vice versa. Does this make me (or them) wrong? No. Does everyone see it that way? No.

I am beyond frustrated at the moment because I am still trying to learn balance. Keep in mind, I have only been out of veterinary school for 2.5 years. I work in a poor area in North Carolina, thus I see many people with very limited means. As a result, I am striving to find the ground between malpractice and "Ivory Tower" medicine. I still want to do everything exactly "right" - I want to check serial blood pressures on hospitalized patients, I want to monitor electrolytes, PCV/TS, and blood glucose at least once a day on sick patients, I want to make sure my diabetic ketoacidotic patients get exactly the kind of TLC and monitoring they need (which is expensive and involved). On the other hand, many people can't afford this.

I am afraid I have alienated some local veterinarians because I am doing the best medicine that I know how to do and that is not always a cheap thing.

It's so hard to learn balance - balance between doing what is "right" as I was taught in school and in textbooks and what is "best" for the patient (sometimes what is best for the patient is what is best for the owner's wallet). On top of that, I put enormous pressure on myself to be perfect. From the simplest dislocated elbow to the most complex polytrauma post-hit-by-car...I constantly question myself, my medicine, my abilities. I go back, review cases again and again, looking for the key that would unlock the mystery, give me answers, help me treat better. I spend hours on the Veterinary Internetwork (VIN), posting about cases I've seen, questions I've thought of. I read my journals. I talk to colleagues. I work when I'm not at work. I love my job. Yet I feel like I'm constantly failing...all the time, every day.

In short, I do everything I can to be better, and yet every day, I feel like a quack. My best friend told me that if you don't feel like a quack at least once a week, you're not doing your job well.

Sometimes I tell myself to just lighten the hell up, and don't take it all so seriously. Then I think of the anguished owners, the emotional euthanasias, the animals I couldn't save, and the look in their owners' eyes when I told them, and I realize that lightening up would be doing a grave disservice to my clients, my patients, and myself.

I need to find a bit of work/life balance. I'm joining the gym tomorrow. Sometimes I'm very afraid that my time in the veterinary field will be limited, because how can I keep going at this pace and not just burn out?


Anonymous said...

You're at the start of a long journey in life and as a vet. I like your dedication and insightfulness. Learning balance and how to take care of yourself now will go a long way to prevent the burnout and the compassion fatigue that can come with the territory.

Anonymous said...

I commented to you 12/24/10, and have nothing to add other than: take care of yourself, NOW. Focus on your life outside practice and develop effective coping skills. See if your local veterinary school employs a social worker skilled in working with veterinarians' burnout and compassion fatigue issues. Don't be like me; seek help before you hit bottom, 'cause I can tell you aren't even close to bottom.

Fi from Four Paws and Whiskers said...

I think this is common in ER medicine.
Why are you not doing regular practice?
You might benefit from spending time with the clients.
People first...
Your values might need adjusting. Ivory tower is excellent, but glad I am not paying for your work as I need to eat, live, repair my home, pay bills!
I guess the skill of selecting the right tests comes with time. Like can a doctor tell a person is having a stroke without doing an MRI?

Burnout, breakdowns, fatigue awaits you.
The work won't change.
You need to review your attitude. Professional yes, obsessive, no.
I found being a mother altered my priorities too. Not only in my workloads, but realizing that animals should not be put ahead of the needs of the family. Honest communication and talking about money is critical before thousands are spent.
Vets tend to be very poor at this!

Mary said...

Since I am not a vet, I can't completely understand what you are going through, but I'm glad you're going to go to the gym.

When my husband was deep in medical school/residency, I don't know what he would have done without running.

Hard physical exertion made a huge difference in his mental state, and I hope it helps you out as well!

Megan said...

I feel like 90% of my stress on ER is trying to figure out what to do when clients have no money. Then they get declined for CareCredit, and then they don't know anyone who might be willing to lend them money. Yes, it's terrible medicine to give SQ fluids and send a amoxicillin home with a vomiting puppy, but what else can you do when the owner can barely even pay for the exam? Once I have three or four cases like that in a row, I am so emotionally burned out for the night that I just want to go home :(

Then I go to awesome conferences like NAVC and learn about all sorts of crazy procedures and I come back jazzed up, only to remember that the majority of my clients can hardly do the bare minimum. Sigh.

I think they need to kick out some of the useless classes in vet school (parasitology?) and replace them with "How to Practice Medicine on a Shoestring Budget". Maybe if we start talking about it way back in vet school, it wouldn't be such a stressful thing to handle in practice?

Good luck with your new gym and finding some balance!

Nicki said...

From personal experience, you WILL burn out if you don't lighten up. You CAN'T take it all personally. You CAN't blame yourself for every case that didn't go well and you CAN'T save them all.

Are you still going to question yourself sometimes? Yes, but that's normal. You can't question yourself all the time though.

From reading your blog it seems you are a very smart, talented, competent vet-way better than I was at 2.5 years out! Just relax, you are doing a great job.

As far as the level of care you can provide, yeah, it's dictated by how much owners are willing and able to spend. Get used to it, offer the best and adjust from there.

If all else fails, find a new job in a different area or different clinic.

Good luck!

Anonymous said...

>>Why are you not doing regular practice? You might benefit from spending time with the clients.>>

I am a veterinarian who realized several years in that as you said, the job wasn't going to change - but what I hated most was spending time with clients. It was exhausting, even though I was well-liked, received plenty of positive feedback, and had many great clients. Actually, I found it harder to say "no" or even charge appropriately when the client and I had history. I was drained.

Now I am a different kind of veterinarian; I do not have any client contact, and am much happier. Mine is not the solution for all veterinarians in danger of burnout, though - just as working in general practice is not for everyone, either.

There's nothing inherently dissatisfying about emergency work, but the situations are certainly more intense, with less personal history to draw upon and more potential for mutual misunderstanding and disappointment.

I vote for self-care, now.

Anonymous said...

In response to Megan's comment:
"I think they need to kick out some of the useless classes in vet school (parasitology?) and replace them with "How to Practice Medicine on a Shoestring Budget". Maybe if we start talking about it way back in vet school, it wouldn't be such a stressful thing to handle in practice?"

Amen, sista! Fortunately our curriculum does a good job preparing us for client communication and dealing with stressful situations, but there's never enough. I suppose we'll have to learn via real experience, because there's no real way to teach these things, plus every case is different.

Anonymous said...

I second Fi from Four Paws and Whiskers' question: Why are you not doing regular practice? If you enjoy working with quality clients who really want the best for their pets, general practice (at a high quality practice) can be so rewarding. I love many of my clients as much as my patients. I certainly don't get bored. As vet blogger Dr. Shawn Finch says, "I love boring!" (ie. healthy animals with no serious problems). Best of luck to you as you explore your options.