Thursday, June 16, 2011

Some thoughts on disillusionment

Last night, I had a visit from a fellow blogger, Hermit Thrush. She just finished her 2nd year of veterinary school at Cornell, and naturally, we fell to discussing what she would do when she graduated. Our discussion got me to thinking long and hard about why so many veterinarians I know are unhappy in their jobs - nay, in the career of veterinary medicine itself. After talking about it with her, I came up with some reasons so many young vets are rapidly disillusioned (and better clarified some of the reasons I was so burnt out recently).

First, we are taught excellent medicine in veterinary school. We learn chemotherapy, MRI and CT scan, how to do biopsies correctly, how to submit histopathology, and every other advanced diagnostic technique that exists. What we don't learn? How to unblock a cat. How to deal with a flea toxicity patient. How to approach stabilization and surgery on a GDV. How to treat a simple cat bite abscess or laceration. How to triage ER patients in a busy ER. How to manage client communications. How to discuss money and how to handle patients with very limited (or no) funds. There is a huge, huge disconnect between academia and the real world.

We are taught black and white: for instance, NO STEROIDS for ANYTHING EVER without a clear diagnosis. Every suspected foreign body MUST have 3 view abdominal xrays. Well, what do you do when the owners won't LET you do any work-up? When they have $200 and an ill pet? Are steroids and/or antibiotics "wrong" then? Does every patient with a possible foreign body require 3 view abdominal xrays (at 2x the cost of just one xray)?

Much of the initial disillusionment comes from the initial realization that vet school is nothing like the real world. It has taken me the better part of the last 3 years to come out of the Ivory Tower mentality. To realize that there are multiple ways to do something, multiple right answers, and rarely wrong ones (although there ARE wrong ones). It was a shock and has lead to some of my greatest disappointments and unhappinesses. When people come to the vet school, they are there to spend a great deal of money, at whatever outcome. Not so in general practice and general emergency. Often, owners just want a pill to fix their pet. Sometimes I can provide it, sometimes not. But learning to accept the REAL world for what it is and not try to force it to conform to my ideas of perfect medicine has been an important step forward in my personal happiness.

I've also had to come to the realization that general practitioners have it hard, too. They work very long hours, are often astonishingly busy, and it can be very, very difficult for them to manage a complicated case like a DKA or IMHA. Learning not to judge the general practitioners so harshly, but instead being grateful that the patient is able to transfer for further care, has helped enormously. I used to get very angry at some of the stuff I saw done, but then realized these GPs are dealing with the real world too, trying to be realistic and do what they can for their clients. Does that mean there isn't true negligence or malpractice? No, but it means that I don't need to look so hard at the wrong things -but focus on the right things that were done and what I can do to improve the patient's care.

Secondly, we are never taught how to be good employees. How to work well with our colleagues, how to manage staff and technicians. We are taught no workplace skills at all. So we graduate, full of ourselves, our vast knowledge, and then go out into the real world with no idea how to function. Most of us suffer a great deal of friction in the first few years - dealing with clients, dealing with office managers, dealing with our colleagues and technicians. Learning how to manage people and how to be good to work with without being a push-over is a huge challenge. It is something that some veterinarians will never learn.

Lastly, and this is nebulous I realize, but I think with myself in particular, personal life satisfaction stems from work satisfaction. When I'm not happy at work, I'm not happy anywhere. It has taken a bit of attitude re-adjustment to realize that while I LOVE being a veterinarian, it is still a job. It is a special job with unique requirements, unique stressors, yes. It is still a job. Being pregnant has helped me to realize that I can leave my job AT my job and still be an excellent veterinarian. There is more to life than work.

Just some nuggets of un-wisdom from someone emerging from a period of very bad burn-out.


Megan said...

I agree 100%. I graduated vet school with a pretty good sense of how to interpret an ECG and an echo, how to put a patient on a ventilator during anesthesia, and how to monitor a dog with a multi-drug-resistant ear infection... but no clue what to do with a laceration, a newly-diagnosed diabetic, or a dog with chronic diarrhea whose owner doesn't want to go to endoscopy or surgery to get biopsies. Super frustrating, and I had a steep learning curve initially. How could schools start better serving those of us who will be going into "real world" practice?

Can'tSpell, DVM said...

Lots of very true things... espically the frustration about being taught very good medicine and not being able to do it when you're out, and about not being taught the "easy" things!

Anonymous said...

It's not "un-wisdom": Don't downplay yourself!!!! As someone at the very beginning of this career change (starting this fall), I very much appreciate hearing the stories of people ahead of me, whether it's one year ahead or 10 years ahead. I don't have as much time to figure things out (as a mid-lifer), so my ears perk up and I pay attention when I read things like this post. The better prepared I am to transition from 'academic' to 'practice', the happier me and my family will be.

So thank you for the post!

Robin Rankin said...

I'm starting pre-vet in the fall (also a mid-lifer) and I really appreciate the advice from those of you who are further along.

Thanks so much for your honestly :)

C. Todd Dolen, DVM said...

This is so on target! Thanks for sharing these observations. I think young vets and their employers need to read this!

I really enjoy your blog.

Anonymous said...

Discovering that general practice is largely routine, and boring, was a rude awakening for me. I wasn't well-prepared to deal with "social issues" of clients, either - everything from poverty to denial to low intelligence to mental illness. All of these issues impact good patient care but we're not taught how to manage these situations when we're on our own, with no university social worker or finance office (grant me the serenity... comes to mind).

Count me among those leaving clinical practice, even though I'm taking a financial hit. There's no reason to stay. I wish I'd gone directly to public health following veterinary school, but hindsight is 20/20.