It was my first day at work. I was nervous as heck, keen to impress, and desperate to prove to myself I could actually function as a veterinary surgeon (and, ideally, without writing my car off in the first week, which is what my university mates had voted me the person most likely in the year to do).
My new boss, David, was a tall, world-weary middle-aged vet with wire-framed glasses and hair that appeared to be trying to escape his head. As I peered nervously down the list of morning consultations, he approached, straightened his glasses, attempted vainly to flatten his wandering hair, and raised an eyebrow at me.
“Right,” he said. “What do you think it means to be a vet?”
Well, this was an interesting way to start the morning. Couldn’t it have been a Star Wars question?
“Erm,” I said. What would sound most impressive? “Well. I think really it’s about helping…”
My voice tailed off as David starting shaking his head sadly.
“Okay,” I tried again. “It’s about… er… doing the best for the anim…”
“Compromise,” David interrupted. “Being a vet is about compromise.”
“Compromise?” This didn’t sound like any of the lectures I’d had.
David nodded. “Let me give you an example,” he said. He looked at the waiting list. “Right, there’s a client coming in this morning with a dog with diarrhoea. Say you look at it and decide it’s got gastroenteritis. The client wants antibiotics because she knows that clears diarrhoea up. What do you do?”
“Well,” I said, deciding it was time to show off my knowledge. “The vast majority of enteritis isn’t related to an infection; not a bacterial infection, anyway. So, I’d recommend feeding a bland diet for a few days. Quick return to eating is better than starving because the enterocytes…”
David nodded quickly. “Brilliant. Textbook answer. You know what happens then?”
“The client comes back the next day to see me and tells me their dog is no better. She wants antibiotics. I give them to her. Her dog gets better, and she’s very pleased with me. She also tells me the vet she saw yesterday didn’t know what he was talking about. I’d rather that didn’t happen. The dog is going to get antibiotics anyway. If we cut out the middle-man then I won’t have quite so much work to do, and clients will like you better.”
“I know what they teach you at university, Nick,” David said, not unkindly. “The science. Now it’s time to learn the art of veterinary medicine.”
There was a saying at university – a nugget of wisdom, filtered down from those intrepid souls that had passed before us: taking your final exams is like taking your driving test, but starting work as a vet is like learning to drive.
At university, I was taught by specialists in their field – certificate and diploma-level surgeons, medics, anaesthesiologists, pathologists, radiologists, anatomists, and so on. In my early years of vet school, most of the tutors weren’t vets at all. In my later years, they were often the sort of vets who, in their biographies (printed, as they were, at the side of academic papers or articles in Veterinary Record) usually had a sentence that read something like “…after a short period in general practice, they returned to university to study…”, which couldn’t help but make me wonder how much they had enjoyed their “short period in general practice”.
The upshot of all this high-level expertise in my training was that I left university with a head packed full of the symptoms and treatment of rare and exotic-sounding diseases such as Key-Gaskell syndrome, myasthenia gravis, tetralogy of Fallot, and leishmaniasis, but with no training at all on what I was actually supposed to do when I was faced with a cat fight abscess, or a sprained leg, or a dog that’s vomiting a bit but not a lot, or any one of the dozens of different common conditions I would be faced with multiple times a day in general practice.
It meant that, for me, every new consult was accompanied by a tiny sinking feeling as I mentally flicked through my notes, still jammed in my head from final exams, came up blank, and had to start again, working from “first principles” (basic knowledge of anatomy, physiology, pharmacology and pathology) to come up with the best plan. Or (and honestly rather more often) looking back over the notes and doing whatever the last vet did until I had a bit more time to think about it.
David had been in the business long enough to realise consulting was, to some extent, a performance. He knew as well as I did that antibiotics didn’t cure diarrhoea in most instances, but he didn’t believe they did any harm, and he knew the dog was probably going to get better whatever treatment was given. The client just needed the confidence to think their dog was going to get better. He had been trying to tell me, as gently as he could, that all my high-minded ideas of best practice and best medicine weren’t going to survive contact with the clients.
The problem, of course, was that David was wrong about something. Antibiotics can cause harm – any drug can, if you’re unlucky – and overusing them could mean that, very soon, we wouldn’t have any antibiotics left to use. I wanted to do the right thing for the clients, but how could I square that with the fact that it wasn’t always the right thing to do for the animals?
I needed to find a way to practise the medicine I wanted to and keep the clients on my side. I quickly discovered David was right – it wasn’t possible without compromise. And there was a problem, because of the way I was trained. Every little compromise – every time I avoided a blood sample because the owner couldn’t afford it, and instead treated for the most likely condition, and every time I gave in and gave steroids for itchy skin because “the last vet had done it” – pricked at my conscience. This wasn’t the logical job I had been expecting.
We don’t leave university well-equipped to break the rules we’re taught, even though we have to do it every day. There are three competing forces when you’re consulting:
- the textbook “correct” way to do things
- the way the owner wants to do it
- the thing that causes least suffering and risk to your patient
In rare, happy consultations, all these forces align perfectly. The rest of the time you’re compromising one for the other. And because we’re never taught anything about this, when we do it, we feel like bad vets. Imposters. I felt it for the longest time. I’m getting there now. Sometimes – and far more often than we’d like to admit – compromising is the best thing we can do for our patients. Learning to be okay with that is a big part of learning to be okay with being a vet. Let’s admit it. We’ll all feel better.
My classmates were wrong, by the way. I didn’t write my car off until my second year in practice.