Doctoral candidate Sydney Waitz-Kudla joins Dr. Andy Roark to discuss her recent peer-reviewed publication on securing lethal means for suicide in veterinary practice.
WARNING: This episode discusses suicide and the means for suicide. Listener discretion advised.
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LINKS
Sydney Waitz-Kudla on LinkedIn
Uncharted Veterinary Conference 2023
Dr. Andy Roark Exam Room Communication Tool Box Team Training Course
Dr. Andy Roark Charming the Angry Client Team Training Course
ABOUT OUR GUEST
Sydney Waitz-Kudla, M.S., received her BA in psychology from Vanderbilt University in 2015. She spent two years at the Vanderbilt Kennedy Center and two years at the University of Southern Mississippi as a Project Manager before coming to Auburn in 2019. Sydney is a fifth-year student in the AU Clinical Psychology Program and Presidential Graduate Research Fellow. Her current research is focused on means safety intervention and suicide prevention for veterinarians.
Sydney loves to travel and has lived in 8 states across the US. She has two dogs named Kiwi and Mango and has been riding horses for over 20 years.
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome, everybody, to the Cone of Shame veterinary podcast. Guys, I am your host, Dr. Andy Roark. Guys, I’ve got a good episode today with my friend, Sydney Waitz- Kudla. She is here presenting her newest research. Which is on what veterinarians are actually willing and able to do about suicide. This is a suicide episode, just go ahead and give a quick warning if that’s upsetting to you. Or, and we don’t get too deep into it. It’s not a graphic episode, but we do talk, pretty, pretty candidly about suicide in the vet profession. And so, if that’s upsetting, this is probably a good episode to skip. I think this research is really important.
It’s great to think about what’s possible. I love to have conversations about how we can fix problems. I think it’s also really important to be pragmatic of what are people able to do? What are they willing to do in their practices? Because those are the changes we could actually start to make. And so Sydney has done some outstanding research and I link to it in the show notes and everything.
We get all up into it. But, but that’s, that’s what we’re talking about. So guys let’s, I’ll let her take it from here. Let’s get into this episode.
Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast. Sydney Waitz-Kudla. How are you?
Sydney Waitz-Kudla: I’m good. How are you doing, Andy?
Dr. Andy Roark: I am really good. It is so good to see you. You and I have known each other for, it must be almost five years now. It’s been a few years. We’ve known each other. I I met you through, Dr. Tracy Whitty and her research that she was doing on suicide prevention and things like that. And you are, for those who don’t know you, you are a fifth year doctoral candidate at the clinical psychology department at Auburn University.
Correct?
Sydney Waitz-Kudla: Yes, under, and Tracy is my mentor.
Dr. Andy Roark: Very nice. And you specialize in suicide prevention research. And you have a new article that came out in JAVMA. I got to be a co-author on the article, although I did very little for that accolade. But hey, I’ll take it. I’ll take it.
But it was lovely to be included. I love the research that you’re doing. I think suicide prevention and veterinary medicine obviously is extremely important. Mental health and wellness is something I’m really passionate about. I really liked the, the article that you put out.
It was titled “Securing Lethal Means for Suicide”, and it was a sort of a survey article on veterinarians, and it was all about lethal means for suicide. And so let me just go ahead and pause here. And can you give me kind of an overview of the research and kind of what you set out to try to look into?
Sydney Waitz-Kudla: Yeah, and I will say too, I feel like, honestly, the consultation that we were able to get from you, just discussing all of the different ins and outs. We like Tracy and I both have been doing research in this area, but we’re not veterinarians. We don’t know what it’s like to be a veterinarian.
And so having those contacts within the veterinary community is so important. I also think that you were a vital part of us being able to get all of our participants. So thank you for all of the things that you did.
Dr. Andy Roark: I love to support where I can. So that was, but you’re doing great stuff.
Sydney Waitz-Kudla: Thank you. And so, basically what we were doing is we know, from Dr. Witte’s 2019 study, something that she found was essentially that pentobarbital is one of the primary methods utilized by veterinarians for suicide. And so, that was actually the year that I came into the program and we said, okay, this is a problem.
And I came in saying, I want to start working towards finding a solution to this problem and saving veterinarians’ lives, how can we prevent suicide so that then we can help improve the mental health of the veterinary community. And so what we did is we kind of had to start from the ground up because there is so little research on veterinarians and suicide.
And so, what we were doing is we did a focus group study. Basically taking veterinarians from a variety of different specialties and talking to them about, “Hey, we know that pentobarbital is a primary method utilized by veterinarians. What do you see as the reason why?”, and what we saw across the board and something that, at least when I’ve discussed it with, other veterinarians hasn’t been surprising is that it’s easy access to that drug. And so, we’re approaching these focus groups with the mentality of, okay, we know that this is a problem. And so, what would veterinarians be willing and able to implement in their workplace to potentially save the lives of themselves or of coworkers?
And so that was kind of the main goal. Was investigating what to them feels like it’s not going to stop them from doing their job, but would create barriers such that. If they were suicidal or if someone else in the practice was suicidal, they wouldn’t be able to access that drug or suicide, which falls into mean safety research and is a big push in the like suicide research community right now.
Dr. Andy Roark: I love that you do this because I remember beating the drum. We talked about Four Eyes Save Lives and I was, I’ve been a big advocate for means for means safety and means control. And I really do think that we can do a lot for suicide rates for veterinarians through control of substances that , that are used for suicide.
And then Tracy Witte put out this great paper that really supported that premise. And so, obviously I like that a lot because I was very much sold on that. And I was like, I really, this is what I see. And this is. This is, this all makes sense to me and all fits together.
And so I really liked that a lot. And so I remember her article came out, and the research came out and I was shouting it from the rooftops and I was like, this is guys, we need to pay attention to this. And there were a lot of people who listened. But I have to tell you, honestly, Sydney, I was surprised at the amount of pushback that came back from that saying, but I can’t do that in my practice.
And, this doesn’t work for us or we need to be able to move too fast. And again, I’m not saying that those people were incorrect in their assessment. It was just. It was not one size fits all. And there were a lot of individual concerns and a lot of people had very strong beliefs about what was possible to do and what was just not going to work in their practice.
There were a lot of people who were like, I’m a solo practitioner. I’m the only one who’s here. Or I do, I’m a large animal practitioner and it’s me and my truck by myself. And I have these limitations on access to lethal medications. And it was funny because I was surprised to get such pushback and it still made sense.
And so I, what I really like about the research you’re doing is starting to dive into that and saying, okay, moving past the idea that this is important. What would actually work and what are the barriers to having something that actually works there? So so yeah start to unpack for me what you found. What were your takeaways?
As far as the roadblocks and the things that people were willing to do
Sydney Waitz-Kudla: Yeah. And so I think that is actually a really important. point that you make talking about, it, you were one of the people that kind of came up and said, Hey, this is a possible solution. The Four Eyes method, having two people necessary to open pent up arbitral storage. And something we were talking about, even when we were creating this study was okay.
Andy received all of this pushback. So we need to investigate why. And also is there a solution that could work for folks? That the Four Eyes method wouldn’t work. And so, that was a lot of that conversation. And something that I know we also talked about as we were finalizing that publication is okay.
What about the Four Eyes method? What about having two people and something that we talked about and something that came up in those focus groups was essentially that. Even though that is such a good idea in theory, it was almost that of all the solutions that we discussed, that was one of the ones that for as many benefits that people talked about and for as many times as people said, I could do this, just as many people said I could not do this for the reasons that you mentioned, there are solo practitioners. There may have be times that they are the only person at their practice. They might not have even. A practice manager that is working at the front.
It’s just them or large animal practitioners that they sometimes are going in the middle of the night to. An animal and it’s just them and the truck and the animal. And so, to say, “Okay, on the one hand, could it be that, there is a solution that would work kind of across specialties, or is it that we need to have different solutions for different specialties?”
And it was something that, we really approached it saying it could be either of these. And I think I approached these focus groups saying it could be either way. What that allowed us to do is that when I talk to veterinarians and we used an iterative process that as I went through the different focus groups, sometimes we would talk about.
Here’s something that some people have mentioned. Does that seem feasible to you? And talking about, you know, what might work for different populations. We had a variety of focus groups, some of which were small animal vets, some of which were mixed animal vets and large animal vets and equine vets. And those were kind of our three big populations were a small animal, mixed animal, and then large animal and equine since they usually have similar barriers.
We did put those equine and large animal together, and then we had a variety of focus groups that had people from multiple different specialties as well as academia or government lab, animal, medicine, and those sorts of specialties. And so what we found is that across. Specialties, folks were really willing to implement adding an extra lockbox specifically for pentobarbital. So what this would be is that either within the storage for other medications or separate from that storage, there would be a lockbox that remains locked at all times, except when euthanasia is being conducted with the idea being that. What a lot of folks talked about is that okay, I need to go in and out of drug storage all day I can’t have that cabinet locked all the time because I’m so busy.
I have so many patients coming in I can’t be having to go back and forth and back and forth all day. And so talking about okay If we had pentobarbital specifically locked something that you don’t need to access all day, every day, and that was only unlocked when you needed it for your job. Is that something that you’d be willing to implement? And across the board we saw that folks “yes” and at least more so than anything else. And we also saw at post test that, by and large, most people said that would be something that they’d be willing to implement. And we had some folks that said, it was lockbox, an extra lockbox for pentobarbital, and then nothing.
And for the nothing, it was folks that already had really secure storage, already had something like this in place, and they said, okay, I wouldn’t add anything additional because I already have something similar to this.
Dr. Andy Roark: Yeah
Sydney Waitz-Kudla: That was really cool to see, just that this was something that worked across specialties.
And I think that kind of the two main barriers that came up for that method, that would be something that we would really need to take into account on a practice by practice basis is that for some folks, they said either, I just don’t have a lot of space, which especially came up for large animal vets because they are working out of a truck. It might be hard for them to find a separate place in that truck or a place within the cabinet they already have to put that extra lockbox, but is something that they were really willing to do. When we discussed, okay, mean safety does have a basis in research. We do know that this is something that is effective for preventing suicide.
Then we started to see veterinarians saying, okay, If this is something that you can say “it, it will likely work. It’s really something that could be helpful for preventing suicide. I am willing to give it a shot. I’m willing to figure out how to do it.” The other thing that came up, but I think is also something that would just need to be taken into account as far as when might it be important to keep this in mind, when might this be something that comes up is situations in which an animal might be in an emergency situation and that extra two, three, four, five minutes that it takes to unlock the extra lock box, it’s this cost benefit analysis of, is it worth that extra five minutes of suffering for that animal? And something that I think came up in our conversation in the manuscript is that’s something that, would there be more utilization of sedation in those situations using a drug that would be in that regular cabinet to make sure that dog or that animal, whatever animal it is, isn’t suffering.
And then having that extra few minutes that the animal is in a better state to access that pentobarbital and then conduct euthanasia. So those were the conversations that kind of happened, but something that was, even though we had all these conversations about barriers, which I think is really healthy because we need to discuss what barriers might come up before we can implement something.
At the same time, it was really good to see that after the fact, when we asked them at post test, what would you implement? That was something that came up time and time again, as I would add an extra lockbox or, even adding a time sensitive lock that it would take, they basically put in a code or something like that, and then it would take a few minutes before they could unlock the pentobarbital storage.
Dr. Andy Roark: Oh interesting. I like that a lot.
Hey guys, my favorite time of the year is coming up. It is the April Uncharted Conference. Guys, April 18th through 20th in my hometown, Greenville, South Carolina. The Uncharted team and I we’re putting on the show. This is the conference that I started with the gang in 2017. If you’ve never been to an uncharted conference, it is not like anything else you have been to it is all about Active learning.
It is all about collaboration, working together. When I set out to build the Uncharted conference, I built it to be the conference that never ends. I built it to be jam packed full of new ideas and fun ideas. I built it to take those conversations that you have in the hallway, which are actually the most valuable part of a veterinary conference, and put them center stage.
This is all about connecting. Getting to know people who were running businesses, who were leading teams, who were making things happen. I want you to leave inspired. I want you to feel like everything is possible. I want you to have tons of new tools in your tool belt. I want you to have tons of new friends and new connections who are enjoying vet medicine, who like it, who are like, this is a great profession, and I’m excited to explore more.
Do new things, make waves, and have an impact on my community, on my clients, on the patients that I see. Those are the people who come to Uncharted, and so if that sounds like you, and you’re like, God, I need those people in my life, come on to the April Conference. This April is called Chaos Island. It’s Standing Out in a Sea of Noise.
This is all about refining your brand voice, your practice voice for effective communication. That’s with clients. It’s also going to be with teams. I always like to weave strategy and running teams effectively into what we do. A lot of you are seeing a drop in your client numbers. A lot of you are starting to see open appointment blocks that you did not see in the past.
Guys, we anticipate this. We saw it coming in our uncharted community, and we are going hard in the paint to get your appointments full up again, keep you busy. Make sure that your clients know the importance of what you do and they get their pets in to see you and they’re happy to see you. We’re always talking about making sure that you have the right clients for your practice and how to get those people, how to make, how to make your life better. How do we enjoy practice more? How to make your team enjoy practice more. A lot of that comes down to the messaging that we send, how we communicate, how we train, how we set up for success. The battles that we choose to fight and the battles that we don’t choose to fight. All of those things are going to be things that we are focusing on.
So if you’re like, man, I want to hang out with that type of person. I need a dose of positivity. I want to fall back in love with vet medicine. Also, I like talking to clients. I like working the exam room and being effective. I like marketing. I like thinking about who we are as a practice and what makes our practice special.
This is the conference for you. Also, this is going to be the last one we have in Greenville, South Carolina for a while. And a lot of you guys have been coming to Uncharted conferences for a long time. A lot of you love it. Some of you met the people that you married at these conferences.
Some of you have met the best friends you have in the world in these conferences. We’re going to go away from Greenville for a while and it’s going to feel different and it’s going to be fresh and fun, but also I think it’s going to be a little bit poignant. when we leave the nest, and so I do expect this event to sell out, and early bird pricing is going away, early bird pricing, it wraps up on January the 17th if you’re coming and you know you’re coming, and grab a spot before the 17th, because that’s when early bird pricing ends.
So I’ll put a link in the show note to get y’all set up and registered. If you’ve never been to Uncharted before, man, this is going to be a great one. I’d love to see you there. I’d love to shake your hand and welcome you to the tribe. So anyway, guys, let’s get back into this episode.
Was there anything that you were really surprised by? So you’re getting this feedback, you’re doing these focus groups, you’re having conversations. Was there anything that just you were not expecting going in?
Sydney Waitz-Kudla: So I think that. A lot of it really made sense as far as what we were expecting when we were going in. I think that the one thing that I didn’t expect just as far as it was a, a good surprise was that I didn’t expect that the research backing up mean safety would have such an impact on veterinarians willingness to implement extra protocols. I think that I come from working with populations that aren’t scientists. And so it was something that as soon as it started to happen, we knew it made a lot of sense. Veterinarians are medical professionals, they listen to research, they’re really receptive to research. And so bringing up a lot of this research that is really important and has shown that mean safety can be really effective and really can prevent suicide.
Just seeing that quick shift that information caused in veterinarians’ opinions and tone was something that was really nice to see and something that I think really made us see, okay, this is how we can get that buy-in, get that willingness to do something that could make a really big impact.
Dr. Andy Roark: Yeah I liked that a lot. One of the things I was surprised about starting to have conversations and when we started talking about Four Eyes and things like that I was amazed at how many people, I guess that lived experience carries a lot of weight with people.
And I was surprised at how many people were like, “Andy, that’s never been a problem, you know, or just, I’m, I am not concerned about my own safety. This is not anything that I can imagine myself ever wrestling with,” and I think that’s probably genuinely true for those people. I think the benefit of the research was to be able to say, I understand you feel this way.
Here’s data driven proof that other people don’t necessarily don’t feel that way. And you know, I really believe that veterinarians are generally as we’re stereotyping a large group here, but I do think it’s true. I think veterinarians are very compassionate people. And so I think that the research sort of illustrating the fact that other people have this concern and or have this problem.
I think if you can show that to veterinarians, it definitely seemed to make an impact in the way they think. So I think that’s probably the most useful part of the research as a part of this really meant a lot to me. Sydney, where do you think suicide research in veterinary medicine goes from here?
Sydney Waitz-Kudla: So that is actually where we get into what we’re doing next. You know, just kind of brief overview is really investigating, okay, how can we present this in a way that might be you know, might help veterinarians say, okay. Yeah, this is something that is a good idea. And really figuring out. Okay. I know when I have a long focus group discussion with veterinarians we do get that willingness and so now it’s okay, how can we get this willingness? How can we portray what we want to do? What means safety is in a way that veterinarians have that buy in. You know the future kind of looks into what can we implement? You know, I know we talked about that. We know that a lot of veterinarians are willing to add an extra lock box for pentobarbital storage.
And so now it’s saying, okay, how can we discuss this as a protocol that could be implemented and then hopefully further down the line is seeing if we talk about it, is it something that veterinarians do implement in their workplace? Are there additional guidelines that would be necessary to put into place just as far as legal things to be able to add those extra protocols in the workplace, on a national scale?
What would we need to do, figuring out what is the red tape what, allows us to really disseminate this information. And then also do we see that once we tell veterinarians across the board, you know, okay, this is something that could be really helpful if we are able to get that buy in, do we then see that they actually implement it in their workplace?
If so, great. If we start to see that this becomes more of a cultural change. That’s awesome. And if we don’t see that kind of implementation on the back end of talking about this as an additional protocol to implement, what do we need to do additional to help get that actual implementation piece? And I will say, too, that something that you mentioned just a little bit ago, as far as veterinarians saying, “I, I’ve never experienced this. I don’t think I ever would experience this” is that was a smaller, but also, I think, pretty significant part of our findings from this study was that. When we asked veterinarians, their reasons for which they would be willing to add an additional lockbox or add additional protocols for pentobarbital storage from pre test to post test, we really saw a relatively low number of folks who said, I’d be willing to do this for myself. Like, my own safety would be a reason I’d be willing to do this. It was pretty low at pre test after we talked about it in the focus groups, pretty low post test. But, when we asked about for the sake of your co worker’s suicide risk, would you be willing to implement an additional lockbox or other protocol for pentobarbital storage, we saw that at pretest, they had some willingness to say, okay, if it was for someone else’s, suicide risk I’d be willing to do it.
And then at post test, we saw a significant increase in the number of folks who said, I’d be willing to implement this for the sake of my coworkers. And so that’s something too, that we have in our mind as we’re discussing next steps as far as how do we, you know, not only talk about how veterinarians can keep themselves safe, but also others.
And I’ll be interested to see, as we go down that line, how we can get that extra buy-in from folks that do work by themselves. Or, do work by themselves out of a truck are solo practitioners and, how can we also get that buy-in from them without having a one and a half hour conversation about mean safety?
Dr. Andy Roark: That absolutely tracks with the experiences that I’ve had talking to veterinarians about this over the years like that, that totally it’s, it’s just nice to see that bared out because just anecdotally that was, I felt like I was having that conversation again and again, it was always just interesting to me how little traction there was around, “Hey, this is for your benefit”. ” like, Eh, I’m like, I’m good”. But, there was much more interest in keeping other people safe. And I just, I don’t know, I think that maybe speaks, it speaks a little bit maybe to the personality of veterinarians. I think that’s interesting. I do think that there’s some weird ties to our culture and sort of our, our self identity as veterinarians there. So anyway, I think that’s really interesting. Sydney are there any resources that you are really big on right now that you wish that more people knew about?
Sydney Waitz-Kudla: Yeah, so one of the initiatives that I’ve been a part of since it started was Lifeboat by NOMV, Not One More Vet. And so that is a peer support anonymous resource for veterinarians. It is essentially veterinarians providing support for other veterinarians. And it’s something that you can sign up for. If you go to lifeboat.NOMV.org, I believe, and then.
Dr. Andy Roark: I’ll put a link to it in the notes. Yeah.
Sydney Waitz-Kudla: Awesome. And so that is something that if you are struggling as a veterinarian with mental health, and you really want to talk to folks that understand that’s a really great resource for those veterinarians. And additionally, if there are veterinarians out there who say, “Wait, I want to be supporting my peers, my colleagues, then they can also sign up to be companions and be the supports for other veterinarians.
Dr. Andy Roark: No, I love it. I’ve had some I’ve had some guests on recently. Lifeboat has come up a couple of different times. I said, I’ll put a link to it in the show notes so people can learn more. It’s a wonderful program. I am super happy that I love that you’re involved with it. I’m super happy that the NOMV group is putting it on.
It’s just I don’t know. It’s, it makes my heart happy to know that it’s out there and people are doing that work. Sydney, thank you so much for being here. I really appreciate your time. Where can people find you if they’re really interested in your research and they want to see when you’re publishing in the future where, where can people connect with you?
Sydney Waitz-Kudla: So as of right now, the best place to find me is on LinkedIn. And so if you search my name, you can find me. And then additionally, the paper that we just published is coming out in JAVMA in the ‘Journal of the American Veterinary Medical Association’. And so, keeping an eye on that paper or that publication and then additionally keeping track of me on Google Scholar or anything like that is where you can see a lot of my publications.
Dr. Andy Roark: I will set up links to all that stuff as best again, down in the show notes so people can find it and and keep up with you. So anyway, thank you so much for being here, guys. Thanks for tuning in and listening. Take care of yourselves, everybody.
And that’s what we got. Guys, I hope you enjoyed it. I hope you got something out of it. Thanks to Sydney for being here. Thanks for you guys for listening. Like I said, it’s a heavy topic. It’s an important topic. It really is. I want to keep our colleagues safe. Um, I want this to be a profession where people flourish.
And we need to look out for each other. And so anyway, that’s why we keep coming back here and just seeing what we can do. I love this episode because it’s actually talking about what can we do? What’s on the table? What are things that are actionable? How do we feel about this as a professional?
What are we, what steps are we willing to actually take? And so anyway, I think these conversations are really worth having. So thanks for being here and participating. Guys, take care of yourselves. I’ll talk to you later. Bye.
