Here’s the scenario: you are in general practice and you have a patient that needs surgery. It is not a surgery that you have ever done, nor do you feel comfortable doing it. You recommend referral to a specialist. The owners don’t have the money for the referral. In fact, they have about $800 to put towards this particular problem. What do you do? Do you try? Do you feel like you have to do something? Do you feel like if you don’t take a crack at it the patient will die and it will be your fault?

What if you just say no? What if you don’t have to do anything? Not doing surgery is acceptable. Not doing surgery may be better for all concerned. If the owner has limited funds, then they are choosing a more palliative approach and that is okay. You can help them with that however you feel is appropriate.

Now before you get your knickers in a knot and fire off some choice interwebs comments below about how a specialist should not tell general practitioners what procedures they can and can’t do, that is not what I am doing here. That is a quagmire that I do not wish to wade into. (I know that someone will say this in the comments anyway, please help those peeps by referring them back up here. Thank you. Don’t @ me.) Your own experience, training and aptitude should dictate what procedures you offer to your clients. What I am saying is that the person who decides what procedures you do or don’t do should be you, not a client who is leaning on you to do them a solid on the cheap. Honestly, no good can come of that and I think it is bad for you.

This feeling of “giving it a go” comes from our roots, from back in the day. It has that retro James Herriott vibe where everyone just gives it a nudge and sometimes it works out and sometimes it doesn’t, then everyone meets up in the pub while Lassie slowly bleeds to death in the barn and isn’t that a shame. It is not that time anymore. That old school feeling has the potential to be extremely demoralizing in the present. I believe this pressure to come up with something when clients are financially strapped is a major source of compassion fatigue, burn out and imposter syndrome that is hurting our profession right now. Also, if you suddenly come up with a bonus option that is the exact amount of money the owner says that they have, it gives the impression that veterinary medicine is really more of a barter system than anything.

In my experience, this approach does not usually result in a favorable outcome for the pet. Sometimes it actually makes things worse for them. Just as importantly, if it doesn’t work out, how are you going to feel? Likely you are going to feel like you failed and you are going to blame yourself. Think of the ulcer you are going to get when you try to do a surgery you have never done, you don’t have 24-hour care for the pet, so you turn yourself upside down to try to provide the care the pet needs and it doesn’t work out. Raise your hand if you have done this and it didn’t work out and you ended up in a fetal position in bed for a while, devastated that you hurt one of your patients and exhausted because you worked so hard on the case?

What if you want to practice and get better? Is that a reason to offer a cheap surgery option? Well, that is another ethical quagmire, isn’t it? I honestly don’t know how I feel about it, but I think considering what the patient would want and how they would feel about this is an important part of answering this equation that is not always considered. They really didn’t sign up for that. I tend to think practicing and learning is best left to teaching hospitals and CE courses, where there is someone there to teach you, somewhere that you can make mistakes without consequences.

If someone only has $800, then maybe surgery is not the right choice for their family and that’s okay. It has to be okay. Every animal deserves to be treated humanely and we are obliged to prevent suffering in our patients and treat them with dignity. Not every animal can get fixed or have surgery. That is honestly very sad, but we have to be okay with it because that is reality and we have to be okay with reality or we will go mad.

I challenge you to stop giving it a go. Set yourself up for success. Set yourself up to have the best possible outcomes for your patients by doing what you trained to do to the best of your ability. Keep learning and training throughout your career. Try to have whatever is the opposite of imposter syndrome. It doesn’t have a name yet, let’s give it one. How about poster syndrome? You got 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.


Sarah Boston, DVM, DVSc, Dipl ACVS

ABOUT THE AUTHOR

Dr. Sarah Boston is a veterinary surgical oncologist practicing in the Toronto area. She is also an author and her memoir, Lucky Dog: How Being a Veterinarian Saved My Life was published by the House of Anansi Press in 2014. She has published numerous scientific articles and book chapters, some of them good. She is the co-creator of the satirical online veterinary newspaper The Cageliner and an amateur stand up comedian. You can follow her on Twitter @drsarahboston


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