Thursday, 22 December 2011

Always two there are...a master, and an apprentice

It's been a pleasant few weeks at the practice.

Actually, now I come to think of it, that's a bit of a fib. It's been a teeny bit horrible, what with the pre-Christmas busyness and the usual set of 'clearout' euthanasias - but one of the things that has made it a little more enjoyable is the presence of a couple of vet students seeing practice with out.

Ah, vet students. They all look so young, fresh and excited. Makes me quite nostalgic for my student days, and all the things that will never come again - pound a pint nights, Oasis versus Blur, my hair...happy days. I can almost smell the formalin from the dissection room (if hte aforementioned formalin hadn't already sizzled most of my sense of smell away)

Vet students are nice to have around for a number of reasons. Firstly, they're a lot more interested than the typical stand in the corner and look bored work-experience types - probably because they're thinking 'Oh my God I actually have to do this job in a year or so and I have absolutely no idea what I'm doing!' (Don't worry, vet students. I've been doing it for ten years and I'm still not entirely sure either).

Secondly, it's nice to have some company in the consulting room, partly to share some of the strange experiences we have in there (see previous blogs for details), and party to be able to talk medically with someone. Maybe this sounds a bit feeble, but nice as it is to talk to clients and try and explain to them what you think is going on in simple terms, it's also nice to be able to talk to someone who can understand medical terminology, and follow your clinical reasoning. Well, if nothing else, it makes me feel clever (unless the student asks me a question that I don't know the answer too, but I usually brazen that out by telling them to clean my table, or put up some drugs, or as a last resort faking a fainting episode)

The enthusiasm they have is a little infectious too, and reminds me why I wanted to do this job in the first place. I genuinely do love animals, but I also love medicine, and am fascinated at what a complex, wonderful machine a living creature is. It's nice to be reminded of that from time to time, and to talk to someone who feels the same way, without the jaded cynicism that comes from ten years in (I suspect) any job.

For every Jedi, though there is a Sith, and the Yang to the Yin of having a vet student watching me consult is that I'm suddenly very aware of my own consulting skills. Fairly soon into the surgery, I hear myself saying for the fourth time in a row 'Now, the reason I gave that cat an injection of steroids is...'

Steroids are powerful anti-inflammatories, which probably relieve more suffering than any other drug I have in my arsenal. They also have many other effects upon the body, and so using them is a bit like the medical equivalent of using a cluster bomb. Lots of things other things will get hit, but you'll probably get the job done. They are regarded with horror, fear and loathing by veterinary colleges, and students (like me) have it drummed into them to avoid falling into the trap of using steroids at every available opportunity. They're a bit like the Dark Side of the force - quicker, easier, more seductive. And very cheap, to boot.

To me, however, and to many vets in practice, steroids' reputation amongst more academic members of our profession as the drugs of Satan himself is somewhat overstated. Yes, you get side-effects, but these effects are predictable and, for the most part, reversible. One of the more serious side effects, particularily in cats, can be diabetes - but this is rather rare, and I always explain the risk of this to clients. I can think of many cases of mine that would have had to have been euthanased years ago if it wasn't for the anti-inflammatory and itch-relieving power of steroids.

All this I can justify to myself...except when I have a vet student with me, who can't help but notice that I keep reaching for the same bottle on the shelf.

It's not just steroids of course. It's all the little things that you find yourself doing 'just to be on the safe side' - the things that you know probably aren't necessary but you just want to be sure. Things like giving antibiotics for diarrhoea in dogs, or for cystitis in cats. You know you probably don't need to, don't want them coming back tomorrow, and another vet doing it, and you looking stupid for not doing it in the first place.

(The antibiotics issue is, actually to me, a more serious point that the steroids. Vets are as guilty as anyone else (well, more so than doctors, less so than farmers) of the overuse of antibiotics. Bacteria are getting wise to our antibiotics pretty fast, so we've got to try and be more responsible over their useage - but perhaps that's a topic for another blog)

So, I raised this as a bad thing about having vet students at the practice - but it isn't, really. It's a little like watching yourself on video - you're suddenly unpleasantly confronted with all the weird things you do that you weren't even aware you were doing.

As you get older as a vet, there's a certain arrogance that creeps over you - you've seen most things that can happen at least a few times before, and you've got a fair idea of what's going on with a patient within the first few minutes of a consultation. It's the common things occur commonly principle - sure, this animal that is presented to you after collapsing out on a walk -might- have myasthenia gravis...but it's probably just sprained its leg - because the leg sprainers will outnumber the myasthenia cases by tens of thousands to one.

The trick, when you reach my level of experience, is knowing when to listen to those little alarm bells ringing at the back of your head that tell you something isn't quite right here - it might appear to be a normal gastroenteritis, but it seems a little too pale, or a little too sore in it's abdomen, or just...just not right. It's the difference between giving a shot of steroids, or admitting immediately for a blood sample, x-ray and intravenous fluids. It's very easy just to slip into the steroids-every-time-because-you'll-be-right-nine-hundred-and-ninety-nine-times-out-of-a-thousand. I can feel myself of the brink of this 'old-vet' approach. teetering on the tightrope, ready to fall from experienced professional to, essentially, a knowledgeable amateur. It's my duty to my clients, and my animals, to avoid that slippery slope! This is part of the reason that I'm studying for my certificate in advanced veterinary practice.

Which is why vet students making me squirm as I reach for the steroid or antibiotic bottle once again is a good thing. It makes me question exactly what and why I am doing what I am doing, and what the consequences could be if I'm wrong. And, If nothing else, my excuses will get more finely honed!

So thank you, Laura and Jess, for making the last few weeks more enjoyable, if slightly harder on the brain!

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