Day in the life of a Village Vet
Life as a vet is never dull. Sometimes I wonder how I manage to get through a week!
It never fails to amaze me the things that I have to deal with on a daily basis. It has made me think a lot about how I make decisions both at work and at home. I was also fascinated by a journal article I read about how vets make decisions. This stuff has really been playing on my mind.
For a long time I have pondered how it is possible to move between so many different types of patients and cases and still generally make the correct decisions. Is it that often, it is obvious, or is it something that only certain people can do. I have certainly worked with indecisive vets (or over decisive vets!) and this really doesn't instill confidence. I think a lot of it has to do with pattern recognition, or certainly things that don't fit normal patterns, but it is the speed of change that interests me. We can all know what to do with an acute trauma case. It is no different to first aid in people, but what about less obvious things.
On a given day I might go from advice on training a new puppy, to diagnosing dental disease, to a referral for an eye problem, to vaccinating a healthy pet, to a complicated medical case. If I am operating, I might go from delicate eye surgery, to extracting teeth, to x-raying or scanning a dog to interpreting lab results. All of these and many more can come in quick succession and all need important decisions to be made. I think I am lucky that my brain can compartmentalise and move on. Make a decision, leave it and move on to the next thing. Add to that management issues like clients not paying their bills, staff related problems and trying to run a business and you can see why I need to make quick decisions. I see it outside work as well and I have to work very hard not to let it frustrate me. Once I have made a decision, I rarely go back and reconsider unless new information comes about. I know it sounds a bit arrogant, but it keeps me sane!
The thing that has really interested me is that I have always felt that I use my gut feel a lot. These days, veterinary medicine is trying to follow human medicine by practicing what is called evidence base medicine. That means, treatments should be based on the best available evidence of clinical trials. I truly believe in this, but I worry greatly that as a profession we are running before we can walk. Human medicine has a vast array of information gathering that is then assimilated into decent evidence. In veterinary medicine, there is very little in the way o evidence gathering from general practice. All of the evidence really comes from either academic institutions who are seeing a very small group of complicated referral cases or from drug companies who obviously have a vested interest. Where does this leave experience and gut feel?
For example, cat bite abscesses. There is some evidence out there that antibiotics are not indicated for these nasty infections. Over the years I have seen so many of these that I know instinctively which ones need a quick clean and which ones need aggressive flushing and antibiotics. I cannot think it is ethical to leave a cat with a painful infection because evidence gathered somewhere suggests it. By the same token, am I wrong to use my gut feel? Does this fly in the face of evidence based medicine? I think it does, but I am not willing to stop being a vet this way. I know my own limitations and am willing to say when I am wrong, but if I am to get through my crazy busy days, I have to continue using instinct and rapid decision making. A recent article in a vet journal I read discussed gut feel used in decision making and it made me feel that at least I'm not the only one. I think there is a happy medium somewhere, but until evidence is clear and unbiased, I will continue to struggle a little.
On a different not I have some lovely pictures to show you. The first is so far a happy story. Nellie, our practice cat at Southgate has become a blood donor. The picture shows me drawing off blood from her and thankfully the cat she gave blood to is doing really well at the moment. Thank you Nellie!
The next one is a very cute 10 week old Chihuahua puppy with sadly a broken leg. He has had a tiny plate put on to fix it and is healing well.
And lastly, an unusual cat's paw. I have seen many cats with extra toes (witches cats!). This is called polydactyl, but I have never seen one like this with 2 claws growing out of the same digit. Crazy! I never stop seeing new things in life.
Vilage Vets Winchmore Hill