IMAGINE, if you can, seeing a dog, horse or a pig and not knowing what to do. For anyone out there in practice, no imagination is needed because we have all been there.
It is a fact of life as a working veterinarian that you come across cases where you just don’t know the answer. Whether you’re a new graduate, an experienced vet or a leading expert in your field, there is always a case which just doesn’t fit and doesn’t make sense.
There are also cases where you just don’t have the facilities to provide a high enough level of investigation or treatment and referral is needed in order to come to a definitive diagnosis; in my situation that would include cases such as surgical colic or more complicated lameness problems where the absence of a trot up and ménage is the major limiting factor in reaching an answer.
Practising in the area I do means I am fortunate to have some very good referral centres nearby and in the three cases where referral has been needed and plausible, I have been able to make a choice about where those cases were directed.
Not an option
There have also been cases where referral has not been an option: for example, last month I was presented with a dog which had been bitten and had severed its right jugular vein. You don’t ever have a lecture titled “Emergency surgery on a severed jugular vein” although I must admit that would have come in very useful just a couple of weeks ago!
In such a case, emergency surgery using basic principles of surgery and anatomy is the only option. Postoperatively, however, I did do some reading and sought advice on post
operative pain relief and the immediate management of a dog with only one intact jugular vein.
This advice was sought from the Small Animal Teaching Hospital at Liverpool where they were both prompt and helpful; in final year many members of staff made the assurance that “they were always there to help and we could always seek advice” – and that really was the case.
By providing the service they did, they made it all the more likely I would want to refer any future cases to a place I know is happy to offer advice even in cases where referral is not going to be an option.
On the other side of the experience tree, however, there are cases where advice/referral is sought and the process is not as good as the aforementioned case.
From the personal experience of both myself and several of my fellow ’09 graduates, we have been made to feel less comfortable asking for such support. As a general practitioner, the expectation is that you have a broad level of knowledge. It is not an unusual day for me or several of my colleagues to be presented with a calving, a colicky horse and a lame pig before spending evening consults seeing the wide variety of cat, dog and rabbit ailments we all come across.
The compromise of this is that you are “a jack of all trades and master of none”. For me at this stage of my career I am happy to see a broad range of cases and animals and continue to learn and develop as a veterinarian. The downside of this is, of course, that for more involved and complicated cases, we may not have the depth of knowledge and level of diagnostic equipment to reach diagnoses that are more easily reached by specialists in the referral centres.
Dermatological work-ups
Of course we all have areas in which we do have a more in-depth knowledge/interest within our respective caseloads; in my case, I have been doing a lot of more involved dermatological work-ups. Some get more involved in cardiology and others in equine lameness, to name a couple that spring to mind.
But as general practitioners we are dealing with a much broader range of conditions than those who spend their time in one aspect of one discipline. And as such it is our responsibility to seek advice when appropriate to ensure the highest and most modern approaches to individual cases.
Unfortunately, I have heard of situations where advice has been sought and has not been readily available from referral centres or where people have been made to feel unwelcome to seek advice from centres they would routinely refer to.
It seems a shame that on a few occasions, those who rely on referrals from the general practitioners seem to have forgotten that we have the demands of general practice and need a wider breadth of knowledge at the expense of depth of knowledge.
Disappointing
It is even more disappointing to hear of cases where those general practitioners have been made to feel mocked. We are all members of a privileged profession and as such we should act professionally and supportively of each other in order to cement the veterinary profession as one of the leading professions world-wide.
This must, of course, be supplemented with attendance at regular CPD and further private study. In addition to PDP and my LVI training, I have completed around 30 hours of CPD since graduating, some of which has been free and in the evenings outside of work.
Obviously it is my choice to spend some of my free time “working” but the benefits are evident already with my improved approach to small animal dermatology and neurology and my greater awareness of notifiable diseases such as West Nile Virus. It also ensures that the most current thinking about diseases is carried forward and implemented in general practice.
Dynamic world
The veterinary world is a dynamic one and can change in short periods of time and thus the RCVS is absolutely right when it highlights the importance of CPD for everyone, from new graduates to experienced vets, in order to not be left behind and practise medicine that has been superseded.
Much is made of the length of time qualified when it comes to experience in the veterinary profession. The most recent SPVS salary survey highlights that experience should not be based on how long you are qualified in a linear fashion but on how much you have actually experienced.
I believe that experience should be judged on the caseloads individuals have seen, the amount vets push themselves when it comes to reaching definitive diagnoses, the effort made to attend CPD and implement those lessons back in practice and the self-awareness to know when to ask for help from more qualified members of the profession and improve.
I would also like to think that referral centres remember to give back to those general practitioners who provide their caseload so we feel comfortable asking for advice and ensure that, when we do need help, we feel able to ask for it and maintain the high standards of care the profession’s reputation is based upon.
