More than one way to kill a vet
An inside story on stress and suicide in veterinarians
Death is like an automatic teller machine – available 24/7. Veterinarians, as much as their counterparts in human medicine know this only too well. But except for the obvious meaning – that a life-threatening emergency can come knocking at any moment – there is a more sinister aspect to this statement. Death does not only stalk your patients; it can crawl under your own skin, insinuating itself into the deep recesses of your mind, to start singing its siren song when your resistance is at its weakest.
Melodramatic? Maybe so. Yet few people are aware of the darker side of veterinary science, the other side of the smiling animal doctor image. Take it from the horse’s mouth: being a veterinarian in private practice must rate as one of the most stressful jobs.
Yes, a neurosurgeon is under severe stress. Yes, a policeman is under stress. So are pilots and businessmen and professional golfers. So what makes a veterinarian’s position so different?
One aspect of the answer is time, those same twenty four hours a day, seven days a week, 365 days a year that most private practitioners call their working hours. In some of the bigger cities there are all-night emergency centers, but for most veterinarians life means being shackled to their after-hours telephone. This might sound simple, but consider a life where no social event, no meal at a restaurant, no movie or shopping trip or digging in the garden is done without the fear of an emergency call interrupting. Not even a trip to the bathroom is totally free. Yes, take a relaxing bath, go for a walk with the dogs, but don’t you dare leave that cell phone behind! Like a chained dog you are yanked back every time you dare to go beyond the set borders of time or distance.
Add a few friends and family members to the picture and you can end up with some really strained relationships. Dad’s seventieth birthday? Sorry, guys, I have to tend to Mrs. X’s cat that has swallowed a bee. Romantic dinner with the new boyfriend? Hold the dessert, someone’s dog is running a fever.
If this walk of life was on a wide and even road, it might have made a difference. Instead it is a never-ending and nerve-racking tightrope walk.
It is unfortunate that in a variable science like biology, where one and one does not always make two, the results of getting a wrong answer can be so devastating. While there is mostly a general guideline, a golden mean, there are no hard and fast rules. Nearly everything is variable, from the symptoms of a disease and the constitution of the individual animal to the medication and dose needed for treatment. Veterinarians are often presented with novel cases that did not read the proverbial book and for which they have to make decisions based on common sense and gut feeling as much as pure proven science. Make the wrong decision at the wrong time and you’ve had it. An animal can’t be rewired or panel beaten or given a new engine. The end comes all too easily. To err is human and often fatally so.
Ever since graduating I have felt that all other vets must be more skilled, more knowledgeable, more experienced than me. After more than a decade in private practice, surely helping thousands of animals, but failing a good number, I somehow still believe this. Is it because no-one else is willing to own up to failure? Is it because articles and seminars (created, by the way, by experts in their chosen fields) exude the message that “of course you still remember the anatomy of the tongue bone and the exact dosage of medication for sarcoids in horses”? The high expectations of clients and the ease with which they switch to your (more skilled, more knowledgeable, more experienced) colleague around the corner at the first sign of indecision about a diagnosis, does not help.
What makes it worse is that even if you keep your balance on that tightrope of life and death, even if you do make the right moves, you don’t always win. Treatments fail, death happens. Learning not to feel responsible for every failure is hard. A dog that has been run over ends up on your examination table gasping for its last bloody breath and expires within minutes. Why couldn’t you save it? Why did you fail the traumatized client in his hour of need?
This is another factor then. As if a veterinary professional’s own sense of failure is not bad enough, he has to deal with the owner’s grief and often anger. Unfortunately, this is where the golden snake of finances rears its ugly head. In a crisis it is easy to commit yourself to do everything possible for your pet. Just save her life, doctor, I don’t care what it costs! When the life isn’t saved, the costs do not go away. While people seem happy to accept this where human patients are concerned, it is not the case with their animal friends. So either they just don’t pay, they badmouth you to everyone they meet or they lay a complaint with the Veterinary Council. That is a subject all on its own, but let’s sidetrack onto money first.
The degree in veterinary science requires seven grueling and expensive years of study. It deals not with one species as in human medicine, but with at least seven. It equips a graduate with knowledge to be not only a general practitioner, but also a surgeon, anaesthetist, radiologist, obstetrician and more. Add to this the cost of equipment, medication and facilities. For some reason pet owners tend to think these services should come cheap. After all, it is just an animal you’re dealing with, isn’t it? It isn’t.
While a stud bull might be valuable only for its material worth, a dog or cat is usually an honorary family member. Which means that emotional involvement is inevitable. Since few would argue that money is not also an emotional issue, this creates a potent and dangerous mix for the veterinarian to deal with. The problem is – it is his or her bread and butter, their means of making a living.
No human patient will be admitted to a private hospital without laying sufficient money on the table. Refuse to treat an animal emergency because the owner “forgot his purse at home” and you’re liable to be convicted of unprofessional behaviour. Trying to get hard-earned money out of bad debtors adds another straw of stress to the camel’s back.
In some instances, one should be able to charge even more – for danger pay. Surely no vet escapes the dog bites, cat scratches, angry bulls or rearing horses that go with the territory. Being asked to treat or even just examine an aggressive dog, straining at the leash to get at you, while the owner tells you with a grin that he (the dog, not the owner) has just bitten the gardener, does not make for relaxing entertainment. When you do eventually get near enough to make a tentative diagnosis, they usually let go the moment you stick a needle in the monster’s backside. Sue them for physical and emotional damage? You must be joking.
The other side of the coin looks no brighter. Many vets practise in constant fear of a misstep that will bring about the ultimate stress – being called before the Investigation Committee of the South African Veterinary Council (SAVC) after a complaint by a client. While one realises that the SAVC has a duty to investigate every case, to ensure a certain standard of veterinary service is maintained, the complaints are often misguided or just plain malevolent. Even if found not guilty, it is not an experience the vet is likely to forget. And while the guideline of what constitutes unethical or unprofessional behaviour is always measured against what “the reasonable veterinarian” would have done in the circumstances, this imaginary person is sometimes an idealistic image of a white-coated individual of outstanding skill and knowledge, the top-of-the-class standard that all envy but few attain.
If this is then such a stressful job to be in, there must be ways to cope with it. From personal experience I know that these are few and far between. In a one-person practice you just do not get away from the stressors unless you switch off the phone and leave town. Which is easier said than done. Standing in as locum for a colleague away on much-needed leave, one of her regular clients tells me: “But she can’t go away! I thought vets can’t go on holiday. They have to look after our pets!” Indeed. 24/7, like all self- respecting ATM’s.
Stress-counselling specifically for veterinarians has for many years been available in other countries, for example Australia and New Zealand. A suicide group has even been formed with veterinarians as qualified counsellors. The Veterinary Defence Association (VDA) in South Africa has recently made available the services of an Australian counsellor to its members. And so we come to the aspect hinted at in the beginning of this article.
Stress by itself is already an efficient killing machine. Add to this the fact that a vet on a daily basis deals with problems all too easily solved with quick and painless euthanasia – whether because of insufficient funds for treatment of a pet or behavioural problems like urine marking or even just because the owner is moving to a smaller property. The possibility of solving one’s own problems in the same way, crops up uninvited. With enough high-schedule drugs within reach to kill an ox or two, this could be a temptation in times of trouble that is just too hard to resist.
In an article on stress in the veterinary profession, professor Ken Pettey, a lecturer at Pretoria University’s Faculty of Veterinary Science, relays information from a 1993 UK report listing occupations in order of Proportional Mortality Ratios for suicide. Veterinarians topped the list, with three times the expected number of deaths from suicide. The situation in New Zealand is very similar. One wonders what South African statistics would show.
It is even sadder when final year students already start cracking under the responsibilities of their clinical year, as evident from a recent letter in the Veterinary Faculty’s newsletter. Maybe the faculty needs to rethink its criteria for selecting students. Being an A-grade academic with a passion for animals does not necessarily make you the best person for the job. Some form of psychological testing might save a naturally sensitive person from breaking down after years of expensive studies or building up a successful practice.
I guess what I’m trying to do, is to smash the image of the all-knowing, ever-friendly, always-available veterinarian and to replace it with something more realistic. More human. Yes, they are professional people. Yes, they do love animals. But they are not perfect by far. And when life has nothing more to offer than unlimited chances to put your foot wrong and the resultant judgement by your clients, your colleagues and yourself, the happy-go-lucky James Herriot-story gets a nasty twist. Unless the veterinary profession gets a bit more user-friendly, I can not truthfully recommend it as a career to any bright-eyed animal loving child.
Dr. David Carser from the VDA:
“There can be no doubt that veterinary practice has become more onerous and stressful and that veterinarians practice in an environment of high expectation and demand … When a client feels that a vet did not live up to their expectations, they may seek recourse by lodging a complaint of unprofessional conduct with the statutory controlling body … who is obliged by law to fully investigate all complaints made against veterinarians. Most of these bodies have powers to discipline, suspend or remove the veterinarians registered with them from their rolls.
“The Veterinary Defence Association provides advice and assistance to its members in all of these circumstances. The VDA is acutely aware that complaints of unprofessional conduct create significant stress, whatever the outcome … Our members experience a wide range of emotional, physical and even behavioural symptoms, which in many cases, interfere with their professional and even personal lives … Many have expressed a desire to move to another place, to immigrate to another country, to reduce the size of their practice or to leave the veterinary profession completely and, sadly, some have actually done so.”
From VDC News, Oct. 2005
Prof. Ken Pettey on stress:
“Many new graduates feel overwhelmed by practice; dealing with clients, long hours and feelings of inadequacy. [They] often blame themselves for the death of patients … Financial responsibilities accumulated from student loans and setting oneself up in practice also contribute to depressive illness leading to self-medication through drug or alcohol abuse.
“Veterinary graduates face a lifetime of stress peculiar to the profession. More can be done at the undergraduate level to give people the skills to cope. The University of Sydney Veterinary School has planned a new curriculum … Years four and five will include lectures from psychologists. In the USA, some veterinary schools have full time psychologists included in the staff compliment … Students must be taught how to recognise signs of depression in themselves and arrest it before they hit the downward spiral.”
From “Stress”, published in the SA Veterinary Association’s VetNews magazine.
© Ilse van Staden 2006
Death is like an automatic teller machine – available 24/7. Veterinarians, as much as their counterparts in human medicine know this only too well. But except for the obvious meaning – that a life-threatening emergency can come knocking at any moment – there is a more sinister aspect to this statement. Death does not only stalk your patients; it can crawl under your own skin, insinuating itself into the deep recesses of your mind, to start singing its siren song when your resistance is at its weakest.
Melodramatic? Maybe so. Yet few people are aware of the darker side of veterinary science, the other side of the smiling animal doctor image. Take it from the horse’s mouth: being a veterinarian in private practice must rate as one of the most stressful jobs.
Yes, a neurosurgeon is under severe stress. Yes, a policeman is under stress. So are pilots and businessmen and professional golfers. So what makes a veterinarian’s position so different?
One aspect of the answer is time, those same twenty four hours a day, seven days a week, 365 days a year that most private practitioners call their working hours. In some of the bigger cities there are all-night emergency centers, but for most veterinarians life means being shackled to their after-hours telephone. This might sound simple, but consider a life where no social event, no meal at a restaurant, no movie or shopping trip or digging in the garden is done without the fear of an emergency call interrupting. Not even a trip to the bathroom is totally free. Yes, take a relaxing bath, go for a walk with the dogs, but don’t you dare leave that cell phone behind! Like a chained dog you are yanked back every time you dare to go beyond the set borders of time or distance.
Add a few friends and family members to the picture and you can end up with some really strained relationships. Dad’s seventieth birthday? Sorry, guys, I have to tend to Mrs. X’s cat that has swallowed a bee. Romantic dinner with the new boyfriend? Hold the dessert, someone’s dog is running a fever.
If this walk of life was on a wide and even road, it might have made a difference. Instead it is a never-ending and nerve-racking tightrope walk.
It is unfortunate that in a variable science like biology, where one and one does not always make two, the results of getting a wrong answer can be so devastating. While there is mostly a general guideline, a golden mean, there are no hard and fast rules. Nearly everything is variable, from the symptoms of a disease and the constitution of the individual animal to the medication and dose needed for treatment. Veterinarians are often presented with novel cases that did not read the proverbial book and for which they have to make decisions based on common sense and gut feeling as much as pure proven science. Make the wrong decision at the wrong time and you’ve had it. An animal can’t be rewired or panel beaten or given a new engine. The end comes all too easily. To err is human and often fatally so.
Ever since graduating I have felt that all other vets must be more skilled, more knowledgeable, more experienced than me. After more than a decade in private practice, surely helping thousands of animals, but failing a good number, I somehow still believe this. Is it because no-one else is willing to own up to failure? Is it because articles and seminars (created, by the way, by experts in their chosen fields) exude the message that “of course you still remember the anatomy of the tongue bone and the exact dosage of medication for sarcoids in horses”? The high expectations of clients and the ease with which they switch to your (more skilled, more knowledgeable, more experienced) colleague around the corner at the first sign of indecision about a diagnosis, does not help.
What makes it worse is that even if you keep your balance on that tightrope of life and death, even if you do make the right moves, you don’t always win. Treatments fail, death happens. Learning not to feel responsible for every failure is hard. A dog that has been run over ends up on your examination table gasping for its last bloody breath and expires within minutes. Why couldn’t you save it? Why did you fail the traumatized client in his hour of need?
This is another factor then. As if a veterinary professional’s own sense of failure is not bad enough, he has to deal with the owner’s grief and often anger. Unfortunately, this is where the golden snake of finances rears its ugly head. In a crisis it is easy to commit yourself to do everything possible for your pet. Just save her life, doctor, I don’t care what it costs! When the life isn’t saved, the costs do not go away. While people seem happy to accept this where human patients are concerned, it is not the case with their animal friends. So either they just don’t pay, they badmouth you to everyone they meet or they lay a complaint with the Veterinary Council. That is a subject all on its own, but let’s sidetrack onto money first.
The degree in veterinary science requires seven grueling and expensive years of study. It deals not with one species as in human medicine, but with at least seven. It equips a graduate with knowledge to be not only a general practitioner, but also a surgeon, anaesthetist, radiologist, obstetrician and more. Add to this the cost of equipment, medication and facilities. For some reason pet owners tend to think these services should come cheap. After all, it is just an animal you’re dealing with, isn’t it? It isn’t.
While a stud bull might be valuable only for its material worth, a dog or cat is usually an honorary family member. Which means that emotional involvement is inevitable. Since few would argue that money is not also an emotional issue, this creates a potent and dangerous mix for the veterinarian to deal with. The problem is – it is his or her bread and butter, their means of making a living.
No human patient will be admitted to a private hospital without laying sufficient money on the table. Refuse to treat an animal emergency because the owner “forgot his purse at home” and you’re liable to be convicted of unprofessional behaviour. Trying to get hard-earned money out of bad debtors adds another straw of stress to the camel’s back.
In some instances, one should be able to charge even more – for danger pay. Surely no vet escapes the dog bites, cat scratches, angry bulls or rearing horses that go with the territory. Being asked to treat or even just examine an aggressive dog, straining at the leash to get at you, while the owner tells you with a grin that he (the dog, not the owner) has just bitten the gardener, does not make for relaxing entertainment. When you do eventually get near enough to make a tentative diagnosis, they usually let go the moment you stick a needle in the monster’s backside. Sue them for physical and emotional damage? You must be joking.
The other side of the coin looks no brighter. Many vets practise in constant fear of a misstep that will bring about the ultimate stress – being called before the Investigation Committee of the South African Veterinary Council (SAVC) after a complaint by a client. While one realises that the SAVC has a duty to investigate every case, to ensure a certain standard of veterinary service is maintained, the complaints are often misguided or just plain malevolent. Even if found not guilty, it is not an experience the vet is likely to forget. And while the guideline of what constitutes unethical or unprofessional behaviour is always measured against what “the reasonable veterinarian” would have done in the circumstances, this imaginary person is sometimes an idealistic image of a white-coated individual of outstanding skill and knowledge, the top-of-the-class standard that all envy but few attain.
If this is then such a stressful job to be in, there must be ways to cope with it. From personal experience I know that these are few and far between. In a one-person practice you just do not get away from the stressors unless you switch off the phone and leave town. Which is easier said than done. Standing in as locum for a colleague away on much-needed leave, one of her regular clients tells me: “But she can’t go away! I thought vets can’t go on holiday. They have to look after our pets!” Indeed. 24/7, like all self- respecting ATM’s.
Stress-counselling specifically for veterinarians has for many years been available in other countries, for example Australia and New Zealand. A suicide group has even been formed with veterinarians as qualified counsellors. The Veterinary Defence Association (VDA) in South Africa has recently made available the services of an Australian counsellor to its members. And so we come to the aspect hinted at in the beginning of this article.
Stress by itself is already an efficient killing machine. Add to this the fact that a vet on a daily basis deals with problems all too easily solved with quick and painless euthanasia – whether because of insufficient funds for treatment of a pet or behavioural problems like urine marking or even just because the owner is moving to a smaller property. The possibility of solving one’s own problems in the same way, crops up uninvited. With enough high-schedule drugs within reach to kill an ox or two, this could be a temptation in times of trouble that is just too hard to resist.
In an article on stress in the veterinary profession, professor Ken Pettey, a lecturer at Pretoria University’s Faculty of Veterinary Science, relays information from a 1993 UK report listing occupations in order of Proportional Mortality Ratios for suicide. Veterinarians topped the list, with three times the expected number of deaths from suicide. The situation in New Zealand is very similar. One wonders what South African statistics would show.
It is even sadder when final year students already start cracking under the responsibilities of their clinical year, as evident from a recent letter in the Veterinary Faculty’s newsletter. Maybe the faculty needs to rethink its criteria for selecting students. Being an A-grade academic with a passion for animals does not necessarily make you the best person for the job. Some form of psychological testing might save a naturally sensitive person from breaking down after years of expensive studies or building up a successful practice.
I guess what I’m trying to do, is to smash the image of the all-knowing, ever-friendly, always-available veterinarian and to replace it with something more realistic. More human. Yes, they are professional people. Yes, they do love animals. But they are not perfect by far. And when life has nothing more to offer than unlimited chances to put your foot wrong and the resultant judgement by your clients, your colleagues and yourself, the happy-go-lucky James Herriot-story gets a nasty twist. Unless the veterinary profession gets a bit more user-friendly, I can not truthfully recommend it as a career to any bright-eyed animal loving child.
Dr. David Carser from the VDA:
“There can be no doubt that veterinary practice has become more onerous and stressful and that veterinarians practice in an environment of high expectation and demand … When a client feels that a vet did not live up to their expectations, they may seek recourse by lodging a complaint of unprofessional conduct with the statutory controlling body … who is obliged by law to fully investigate all complaints made against veterinarians. Most of these bodies have powers to discipline, suspend or remove the veterinarians registered with them from their rolls.
“The Veterinary Defence Association provides advice and assistance to its members in all of these circumstances. The VDA is acutely aware that complaints of unprofessional conduct create significant stress, whatever the outcome … Our members experience a wide range of emotional, physical and even behavioural symptoms, which in many cases, interfere with their professional and even personal lives … Many have expressed a desire to move to another place, to immigrate to another country, to reduce the size of their practice or to leave the veterinary profession completely and, sadly, some have actually done so.”
From VDC News, Oct. 2005
Prof. Ken Pettey on stress:
“Many new graduates feel overwhelmed by practice; dealing with clients, long hours and feelings of inadequacy. [They] often blame themselves for the death of patients … Financial responsibilities accumulated from student loans and setting oneself up in practice also contribute to depressive illness leading to self-medication through drug or alcohol abuse.
“Veterinary graduates face a lifetime of stress peculiar to the profession. More can be done at the undergraduate level to give people the skills to cope. The University of Sydney Veterinary School has planned a new curriculum … Years four and five will include lectures from psychologists. In the USA, some veterinary schools have full time psychologists included in the staff compliment … Students must be taught how to recognise signs of depression in themselves and arrest it before they hit the downward spiral.”
From “Stress”, published in the SA Veterinary Association’s VetNews magazine.
© Ilse van Staden 2006
