Sarah Boston, DVM, DVSC, DIPL ACVS

I am a veterinary surgical oncologist at a teaching institution. I’ve also spent three years in general practice and feel like I have a good relationship with my RDVMs (referring veterinarians), but recently, I read some things that have suggested some animosity between these two groups. And so, we decided to try to come together. Here are my top five things GPs can do to work with their specialist DVMs.

1. Records

Something that we all share is our hatred of records. They are time consuming and it takes even more time to get it right. The RDVM records that are sent with each case vary wildly in the quality of the presentation and content. Sometimes it is 40 pages of faxed records, in hand written, illegible chicken scratch that resembles the musing of a paranoid schizophrenic.

Sometimes it is a beautifully typed letter that is loosely in SOAP format, outlining the case with the signalment, history, physical examination findings, pertinent diagnostics, assessment and plan. When it is the latter, patient care is always going to be better because it is seriously hard to troll through years of hand written records with no direction as to what is pertinent to the current case. Please send something that you would be proud for the owner to see and read.

2. Be understanding when some tests are repeated

Please be understanding when we decide to repeat a diagnostic test done in your practice. There are several reasons why a specialist may choose to do this, but it is never a money grab or an intentional insult. It may be that enough time has passed that the bloodwork or radiographs may have changed. Or it may also be that the Xray machine in a specialist practice is better quality and a radiologist is going to read the Xrays or do the ultrasound. We may be making important clinical decisions based on these tests and feel more comfortable when we have them done in-house. There is also the possibility that your radiographs are not diagnostic quality. If our radiologist assesses that your radiographs are not diagnostic quality, I am bound the repeat them.

Instead of getting frustrated, call your friendly Xray machine rep and ask them to come out and help you get the quality of radiographs that you want. (Side note: back in the day when I was in general practice, I worked in a practice with a tanning salon in the same strip mall [so glamorous]. This was 1998, so the machine was old-school. If there were too many people tanning, it sucked power from our Xray unit and it threw all of our settings into disarray, making it impossible to get diagnostic quality films. So, I get it, there are challenges to getting great films – but life is better now, we have digital radiography and tanning salons are on their way out.)

3. Cut us some slack when we don’t call you right away with an update

We understand that you are anxious to hear about how your patient is doing, but please try to understand that it is not always realistic for us to call immediately. We honestly do our best, but all of our RDVMs feel this way and usually, we are running around all day trying to get our diagnostics done or in surgery. Most days, when I finally have time to sit down and call referring veterinarians, everyone is closed for the day.

I have had RDVMs demand twice daily updates on their patients. Please try to remember that all veterinarians are running crazy all day, whether they are specialists or GPs and most of the time, the lack of a phone call is simply due to a crazy day and we all have crazy days. Also, don’t be shy. If this patient is extremely important to you, please call us and we will find a way to connect.

4. Trust us

It is critical that you trust the specialist that you are sending your cases to. You need to trust that they are going to do the best for your patients and you need to trust that they are not going to throw you under the bus. If you have doubts on either of these fronts, I suggest finding another specialist to refer your cases to.  You also have to trust that we are all doing the best that we can and we are working together to give our patients the best care. Enough said.

5. Please call us if you euthanize one of our patients.

It’s a great sin to not let the RDVM know a patient in our care has died or been euthanized, and for good reason. In contrast, it is extremely rare that a RDVM calls me to let me know that one of our mutual patients has been euthanized.  This can put specialists in an awkward position when calling a client to check on their patient, or having staff call them to remind them about an upcoming appointment only to discover the patient is deceased. This can be very upsetting for the client and for us. Please let us know. We care about these patients too.

Also, from a purely academic perspective, this information can be very useful if we are doing a retrospective study and we need information on survival times and cause of death. Not as touching a reason for requesting this information, but this information can help to contribute to the greater picture of understanding some of the diseases that we all treat.

Whether you are a specialist or a GP, we are all veterinarians. Our lives and days are much more similar than they are different and there is much more that connects us than separates us. As a profession, we all have to give each other a break sometimes and recognize that this job is just really hard. We have to stick together.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Veterinarians are professionals that work with animals. Usually sick animals. There are often multiple body fluids involved. This creates a tension in us. How do I dress professionally, knowing full well that I will soon be covered in feces, urine, anal sac fluid (I don’t even know what this stuff is called), blood and/or hair?

Once, when I was in general practice, I was unblocking a cat (male cat, can’t pee, needs a urinary catheter placed ASAP) and I managed to simultaneously pass the catheter and release a jet of fluid from the cat’s anal sacs. Couldn’t really stop what I was doing due to sterility and finally getting the cat unblocked, so I just endured the stream of stinky fluid as it shot directly on to my neck and then streamed down my chest, settling in my nonexistent cleavage and bra as I worked. And I really can’t complain because when I tell this story to my colleagues, they always one-up me and tell me that almost the same thing happened to them, only the anal sac stream hit them in the mouth. The mouth. I quit.

One of my professors at vet school, a very old-school bovine veterinarian, used to wear a shirt and tie under his coveralls when he saw sick cows. I am not sure about what kind of pants, or if he wore pants. (I hope he wore pants.) I am not even sure if it was a real shirt versus a dickie-style shirt-collar and tie, but the overall appearance was very very profesh. For male veterinarians, it is relatively straightforward; if you want to look professional, wear a shirt and tie.

Our veterinary students are required to wear a shirt and tie on their clinical rotations. There is no doubt that it looks good, but it is important not to think too much about the particular tie. Most vet students do not have a wide selection of ties. It is also questionable whether or not they have ever cleaned their tie(s) or if they would know how to clean their tie(s). Their tie is peeking out between the lapels of their clean-ish lab coat, picking up bacteria everywhere it goes. It is a fashion forward fomite.

Female veterinarians have a whole other set of hurdles to contend with. There is no shirt and tie off-the-shelf uniform. The clothes that we wear at work need to be: comfortable, flattering, stylish, professional, female, machine-washable and hair repellant. Easy to change in and out of is also a plus if you are going in and out of surgery. So what’s a girl to do? There is the old-school female(-ish) vet uniform, that is often mocked, yet can not/will not go away. That is the white sneakers, mom jeans and airbrushed animal T-shirt or sweatshirt. This ensemble fits only 2 of the 8 criteria above, but it is a real favorite.

Some women just miss the mark when trying to dress professionally and land either in cocktail party or bar-girl outfit land, or even worse, frumpy middle-aged men’s business clothes for women land (complete with shoulder pads). It’s tricky.  I oscillate between different vet girl looks on a regular basis. Sometimes, I try to look nice and I wear my best working girl clothes (meaning professional clothes, not that I am dressed like a hooker, which is definitely a look to be avoided). Then I get frustrated because these clothes get ruined or cost a fortune to dry clean and I switch to dorky, but functional and washable dress shirts and slacks. Sometimes I give up altogether on civilian looks and wear the surgeon’s uniform, which also look like pyjamas, surgical greens. Then I miss fashion and I start the cycle all over again.

The other challenge to looking good is the general business of the day in the life of a  veterinarian. Most vets do not take time for themselves at work to do frivolous things, like peeing or drinking water. Actually, drinking water would just compound the problem, as adequate hydration can only lead to the need to urinate. No peeing also equals no looking a mirror for the entire day, so the mascara fail, food in teeth (assuming you had time to eat) or protruding booger go unnoticed all day.

Ignorance can be bliss in this scenario. It is also a good way to know your true work friends, the ones that let you know when you have a “puppy in the kennel” as they gesture to a nostril. I would say I am a bit inconsistent on the booger alerting front. I try hard to be brave and just let my colleagues know that they have a bit of a situation in their nez, but sometimes too much time has passed in the booger-laden conversation and bringing it up now would just make it worse because I have been staring at it the whole time. Sometimes I am just not strong enough.

Once you head in to surgery, it is a whole other set of aesthetic challenges. It is impossible to stay pretty in surgery. The surgical cap, which is made of a truly disgusting synthetic material that makes my skin crawl and does strange things to everybody’s hair, the face mask and the sweating, all conspire. Once you come out of surgery, you have mascara running down your already darkened eye circles, strange hair that will not/can not go back to normal, and you are just a little sweaty all over. If you are a cancer surgeon like me, you might also have blood splattered across your face. Everyone you see in the hospital will tell me about it, just in case I forget that I look like an axe murderer as I head up to the waiting area to tell my clients that their precious dog is doing just fine.

I think that the only reasonable answer is to have a glam squad waiting for you as you head into every appointment. Just like the glam squad on American Idol that keep J-Lo and Harry from looking too shiny. (Somehow beautiful Keith doesn’t seem to need any touch-ups on set, he just gazes dreamily into the camera while his besties get re-primped.) Until we have vet glam squads, our clients will just have to take us as we are, shiny, frazzled, disheveled, sweaty, tired and happy to get a little dirty taking care of their best friends.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Okay, first of all, I am not sure if this blog is going to resonate with everyone. It could be one for the neurotic geeks. People like me. The ones who have a lot of themselves and their identities wrapped up in being a veterinarian. The ones who want their jobs to be perfect. When it’s not perfect, we are disappointed, we feel let down by our profession and ourselves. We feel like we are letting others down too. Perhaps we even start looking for greener pastures. And this is, I think, one of the biggest challenges of our careers and possibly, of life. When do you accept that this job (insert other big life questions in here if you wish) is as good as it’s going to get, and when do you cut and run?

My first job after my internship was at a truly horrific small animal practice. It was beautiful on the outside. It even had a waterfall in the waiting area and a pavilion where you could buy overpriced pet goods, but it was all a façade. The owner was a bad man. He hit dogs who were misbehaving in the back and both his medicine and ethics were highly questionable. He would use the same surgical pack for multiple spays and neuters. When I interviewed for the position, I asked him if he wore a gown for dog spays, as I thought this was a good measure for the quality of practice. He said yes.

Unfortunately, he neglected to mention that it was the same gown and that he and his colleague would pass said gown back and forth between surgeries, mostly to prevent them from getting blood on their street clothes. So, we had irreconcilable differences and I knew it after day one on the job. I should have run away, but I was too naïve, too stubborn and determined that this must be my problem somehow and I needed to make it work. I am not a quitter.

Turns out, if you don’t agree with the boss and practice owner, something has to give, and that something is you. You get fired. I got fired six weeks in, just after a fascinating discussion about whether or not a surgical pack was still sterile after the fourth or fifth dog spay and if it is OK for your tech to eat a sandwich in the OR during surgery. It was a very dark moment in my young career.

Perhaps this experience scarred me into constant reevaluation of my job. I also think that academia might be the most classic place for thinking the grass is greener. There are some pretty big problems in academia. Let me list some of them for you (these are things I have heard): overworked, underpaid (most specialists in academia make half of what their private practice counterparts make), underappreciated, the administration never follows through on their promises, being asked to do more and asked why they haven’t achieved X, ignoring Y and Z, blah blah blah.

There is a constant flow of talent streaming from academia into private practice. Young specialists often become disillusioned and realize that getting paid double and a four-day work week actually is better than being a part of the future of the profession and “giving back”. They can move into private practice and give up a part of themselves that they identify with in exchange for a chance to retire earlier. This sets off another round of the never-ending game of academic musical chairs. One academic position comes open, someone moves, another one comes open at another institution, and so on, and so on.

The question is, how do you decide if you are happy in your job? I don’t think you can let your job or career alone decide this. However, most veterinarians identify strongly with their careers, so it is a major factor.  I don’t have all of the answers, but here are some things that I have learned in the past 20 years of vetting:

1 – Assholes are everywhere.

In every organization, there is a certain percentage of people that are complete dicks. Moving to get away from an asshole is a bad idea because you will just find a different asshole and it will take you a while to realize who the dicks are. If you can, try to manage your own dick(s). If you don’t know what I am talking about, please stay in your current job forever.

2 – Bullies are the exception to rule. 

 If you are being bullied in the workplace, this is an unmanageable situation and you need to find a way to change it. If your dick is a bully or a sociopath, it is not likely to be workable. You should try, but sometimes you do have to change jobs. Life is too short to be bullied. If you have insomnia and diarrhea more than you don’t have insomnia and diarrhea, this is a sign you need to make a change. Life is short.

3 – Are you stressed out all the time?

Starting your career is stressful and being a vet is stressful too. However, at some point, you need to feel like you are good at your job and that you’ve got this. If you are stressed all the time (see above, insomnia, diarrhea) it is possible that you need to make a change. You might even need to do something radical like move from a clinical to a nonclinical position or even get out of veterinary medicine altogether. (Side note, is it just me or has anyone noticed that the industry vets are winning?) Very scary stuff to consider, but compassion fatigue, working weekends, and getting yelled out by clients is not for everyone.

4 – Being a vet is really hard.

I don’t think that this can be overstated. We picked a tough profession. I think we need to give ourselves a break sometimes and try to work on ways to make being a vet more like being a normal person, but for now it is not. We are not normal. We don’t eat lunch, pee regularly, or have weekends off like normal people. Try not to obsess too much about the fact that you could have become a dental hygienist, drug dealer or hedgefund-douchebag and it would have been easier and you would have made more money. (No offense to the dental hygienists or drug dealers.) I don’t think it matters what kind of vet you are, there is some universal shitty-ness that unites us all. If it is just too hard, it’s ok. See #3.

5 – Love where you live.

I have moved a lot for work, which has been an exciting adventure in many ways, and I am grateful for this. However, it is important to keep in mind that you do need to love where you live so that you can enjoy life outside of work. This means many things to many people so you need to define this for yourself. Some people are great at finding things that make them happy anywhere they live, but if you really need something to make you happy – rural, city, mountains, ocean, heat, seasons, culture, like-minded people – make sure you try to find work where you can have access to this on your time off.

6 – Family and friends are a precious commodity.

I have always moved anywhere for the job. My parents were immigrants from the UK to Canada, so this was always part of my ethos. Also, I finished high school and vet school in Saskatchewan in 1996. At the time, the economy wasn’t great, so everyone left Saskatchewan (which is actually a huge shame because it is a wonderful place to live. You will have to trust me on this one.) So now my friends and family are scattered all over Canada, the USA and even further afield. I would love nothing more than to round them all up and make them all live in one place. If you have most of your family and friends in one place, recognize how precious this is and even if you wander a bit in your career, try to find your way back home.

7 – Look at Sarah’s job happiness formula.

Figure out what is important to you and try to get over 80%. You won’t get 100%, no one ever does. Look at the big picture. Try to examine if one factor is dominating in the numerator or denominator. It looks something like this:

Job X Money X People X Place (+/- Bully/ α )X100%    =  Grass Greenness

---

Dicks X Tough Hours X Commute X (Work Stress – It’s hard)

Never stop believing in your happiness. You worked too hard for this.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Veterinary Medicine, can I call you Vet Med? Great. Vet Med, are you okay? You are kind of freaking me out right now. Social media has been good for you in a lot of ways. Now you are blogging (case in point) and tweeting (@drsarahboston) and websites are happening and people are confessing their veterinary sins. Some of the confessions are unsettling. A lot of your feelings are bubbling to the surface.  I am glad that we are getting things out in the open. I really am, but it is a lot to digest. Vet Med, I am worried that maybe you are a bit messed up.

The term Compassion Fatigue was the first step in your coming out. That was about ten years ago. Now, instead of a rare syndrome that was something we needed to be aware could happen to us, it has become an epidemic. The new normal. Everyone in this profession has or has had compassion fatigue.

I am glad we are now aware of it, but I would rather that we find ways to avoid compassion fatigue in the first place. Sometimes I think we might actually have compassion collapse©. (see my blog on Compassion Collapse) We are also learning how to communicate better. How to deal with difficult clients. How to deal with difficult coworkers. How to manage conflict. It’s a lot of feels.

Compassion Collapse

If you take a look at the recent social media posts on veterinary medicine, most of it is negative. Most of it would suggest that we are in trouble. A lot of trouble. We are unhappy with our careers and our choices. The blogs that talk about compassion fatigue, setting boundaries, work-life balance, depression, mental health issues in our profession, and general workplace misery, are the ones that resonate with our people. We can’t get enough of each other’s unhappiness because it makes us realize that we are not alone. #CompassionFatiguePorn

I am trying to understand the root cause of this because I sometimes feel this acute disappointment in VetMed myself, and I have written some of these blogs (and I am writing one right now). The dream of being a veterinarian generally centers on helping animals as the primary goal, with a secondary goal of helping people. For some, these priorities might be the other way around, but they tend to be at the heart of what makes us vet and what connects us as a helping profession.

I think one problem is everything that gets in the way of that, such as finances, vexatious people, unsupportive colleagues, and, in general, human beings. Another problem is that when you are a child, nothing makes you happier than giving your life to animals. Who could want anything more than that?

Well, adults, that’s who. In the end, veterinary medicine is a job. Our lives need to be more than a job, even a great job. Who else has felt like you don’t have enough time to spend with your own animals because you are stuck at work, taking care of other peoples’ pets? My dog interrogates me with his nose every time I get home, and I feel that he is questioning why I spent time with all of these other dogs while he sat home alone. (Maybe that is just me.)

So Now What?

And so I am glad we are talking about our problems. Our profession has been a smokescreen of James Herriot and images of healing cute animals, which always invokes happy feelings. It is just that our days and those images do not always match up. I think the next step is trying to find solutions. I feel like all of this sharing has exposed a part of our profession that is really quite dark and ugly, and it takes us off guard.

So, is our profession fixable? I hope so. I think that we have some work to do. One important task is to lower expectations. James Herriot suffered from depression too. It wasn’t perfect being James Herriot. His stories are wonderful, but he also experienced the same stresses that we do today. It might be worse now because medicine and the demands of our clients have become infinitely more complicated.

Other parts of the solution involve our own self-care, setting boundaries and trying (really hard) to have a working schedule that at least tries to emulate that of a normal (ie non-vet) person’s work week. We also need to continue to embrace what is truly great about this profession and what connects us all as veterinarians. We care deeply, and we have the privilege of spending our lives with animals.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.