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The following equation is one of the most useful I have ever discovered: Stress = uncertainty x urgency Or put another way ‘stress = doubt x deadlines’. This equation helps explain much of the unseen causes of stress in practice. In on order to set a sound basis for well-being in practice we need to manage the unseen variables that psychologically drain us on a daily basis as much as we try to raise morale using ‘perks and parties’. My post discusses how veterinary practice frequently includes both of these 2 variables, where they come from and what we can do about them.

The potential for stress frequently includes uncertainty and urgency and veterinary medicine has plenty of both. We feel uncertainty about what is causing symptoms and whether our treatment will work. We perceive ‘urgency’ with respect to the ticking clock when trying to resolve any illness, with the more acute and / or the closer to the brink of death, the greater the urgency, coupled with the urgency of time pressure to meet all the clinical, client, colleague and personal ‘demands’ required of us. I honestly believe that the single most useful way we can manage the ‘urgency-variable’ during consultations is to have a consulting system that allows you enough time! In my opinion 10 minute consultations are obsolete in modern veterinary practice. I openly and actively encourage new graduates not to join a practice that either does 10 minutes or says ‘we’ll allow you doubt slots until you are up and running’. In my opinion 10 minute appointments are never, ever, ever a good system. Ever! Not just for our own well-being but for clinical effectiveness, client satisfaction AND financial productivity. (I have never known a practice regret the commercial decision of making the switch up to at least 15 mins). In my opinion, moving away from a 10 minute appointment system is the single biggest stress-reducing thing practices can do to enhance their team’s well-being.

And...the single most useful way we can manage the ‘uncertainty-variable’ during consultations; Formulate a differentials diagnosis list! Only about 25% of the vets I observe in consults verbally express a differentials diagnosis list to the client. A differentials list acknowledges uncertainty BUT contains it. It articulates what is “possible and probable”. Many vets assume that clients expect them to know exactly what is wrong with their pet after a history and exam. This leads many to over-commit to a ‘definitive diagnosis’ without adequate information or they say they ‘don’t know what’s wrong’…which, whilst an honest expression of the doubt they are quite rightly experiencing, sends the message to the client: I haven’t got a clue either about what’s wrong…or about veterinary in general!

Personally, I don’t think you should be allowed to graduate vet school unless they can clearly articulate the “possible and probable” causes of the most common symptoms in the core species we work with…. otherwise we are no better than a Google search of “Why is my dog / cat / rabbit / cow / horse / iguana…doing such’n’such?” Whilst Google is quicker than us at hypothesising what is ‘possible’ via its millisecond searches lacks the sense of ‘probability’ that a practitioner should have. I am afraid to say that because differentials are not being drilled at vet school nowadays (it was when I graduated in 1995) many vets just skip this step of the consultation and jump straight to “I think we should try scuh’n’such treatment or we should run some bloods (without clearly specifying what they are looking to rule out or rule in). This increases the chances that the ‘trail of logical thought’ as to why we treated for this suspect or tested for these suspects, gets lost in both the vet’s and the client’s minds when cases do not resolve with treatment or tests come back as ‘normal’. Cue uncertainty and doubt (leading to self-doubt...tune in next week for more on this) in both the vet and the client’s mind and hence stress!

However, by the way….I also feel equally as strongly that we should NOT be allowed to graduate vet school if we claim to be certain of our diagnosis solely based upon sensory information (sight, touch, sound, smell…taste!). Veterinary consultations are not some exam test whereby we are expected to get the right answer first time, every time. The purpose of a consult isn’t even for us, alone, to boldly make the decision as to what should be done. The purpose of the vet in the consultation is to make sense of symptoms, offer ‘plausible and probable’ explanations about why they exist and options to proceed; either to rule out or confirm suspects or to treat the most probable suspect. Facilitating this decision making process involves managing the uncertainty in our mind and the client’s mind....and facilitating the reaching of a consensus between us and the client about a fair and reasonable way to proceed....that both parties can live with...both now .....and in the future, come what may! (The hallmark of consensus is a decision that both parties can live. Seeing decisions made during a consultation as ‘a consensus’ is very different from seeing decisions as the vet made the ‘right or wrong’ decision.) The VDS have told us for years that 80% of their cases relate to mis-communication. This is a classic example of that; vets need to realise that clients are much, much less likely to ‘blame and complain’ when things don’t turn out as expected if the vet has learnt the art of how to facilitate reaching a consensus whilst working in uncertain circumstances.

So, we need to teach vets that uncertainty exists and not to be afraid of it but instead they need to learn how to contain it. We need to learn to recognise it and know how to deal with it like any other scientific investigation by formulating hypotheses (ie differentials) and then ‘testing’ for evidence in support of them (either an appropriate diagnostic test or a response to treatment….which could often occurs despite our intervention!)

Next week I will discuss how vet often and unwittingly allow this inherent doubt (ie uncertainty) of veterinary practice to become ‘self-doubt’, often concluding they are feeling doubtful because ‘I’m not good enough’ as opposed to realising the situation is inherently doubtful. ie most vets confuse the cause of uncertainty is a lack of knowledge or ability.