The Art of Being a Veterinarian

A friend asked me recently if I would tell his daughter about being a veterinarian. He was hopeful she might be interested in pursuing a veterinary degree once she had completed her undergraduate studies in biology. She was very polite, but I could tell that she was not very interested. She seemed truly perplexed as to how doctors could ever figure out what was wrong with an animal. 

 

It’s true, there is an inexplicable art to being an accomplished veterinarian. Some of us, hopefully many of us, have that gift. When I was in school and first out of school I was fortunate to be mentored by people that fostered the skills of observation, thoughtfulness and patience that allowed me to make the very important observations that aid in diagnosing and treating my patients. However, there certainly was no formal training, no class or webinar (there was no web at that time!). Over the years I grew to appreciate that there were fewer new graduates that were embracing the art of our profession. Diagnostics, like blood work and radiographs, were what they relied on. Large veterinary hospitals grew even bigger and it appeared to me that there was a lot less time spent with the patient and less attention to the individual and how they ‘felt’. The time spent with the patient is where the most valuable observations occur that allow us to understand better what is ‘going on’ within our patients. 

 

Recently, I had the pleasure of attending the ABVP (American Board of Veterinary Practitioners ) annual conference. As I sat in the lectures throughout the weekend I began to appreciate that the art of our profession was making a resurgence, not that it had ever been gone, but now it is the main topic of lectures, conferences and webinars. 

 

One of the best examples of the advances in the practice of our craft is in the fields of pain management and anesthesia. You might think that it is pretty obvious when an animal is in pain. They cry and they don’t move or eat, right? This may be the case when they are in extreme discomfort. But our pets response to pain is influenced by many other factors, like fear and stoicism for example, even genetics. There are differences between individuals as well as differences between breeds and species too. I can not tell you how many times a client has told be that their pet, the one that is refusing to bear weight on an injured limb in the exam room, is not in pain. I usually ask them, ‘then why isn’t he using it to walk?’. Usually they see the error in their thinking. Even within our profession we have had difficulties with interpreting the level of discomfort and distress that our patients are experiencing. Pain management is arguably an area that our profession neglected at one time, because of inadequacies in our understanding of our patient’s pain and partly because the medications and tools that we had were limited. However, over the past 10-15 years we have made huge advancements. From Colorado State University School of Veterinary Medicine comes a useful publication that we use at our hospital. The ‘Pain Scale’ illustrates the appearance and behavior of a patient at varying levels of discomfort. They created these charts for both dogs and cats and for both in acute and chronic pain. We also have expanded that tools that we have available to manage our patients pain and we continue to expand out knowledge about pain and its management through continued research and education. Our profession has groups of board certified doctors that devote their energies to furthering our understanding of pain management, this includes the members of the International Veterinary Academy of Pain Management (IVAPM) and the American College of Veterinary Anesthesia and Analgesia. We utilize knowledge from human medicine as well as research conducted within our profession to identify new drugs and modalities of treating pets in pain. 

CSU-Acute-Canine-Pain-Scale.pdf

csu_acute_pain_scale_feline-(1).pdf

We also use knowledge of how pain affects people to try to understand if animals are in pain. Did you know that people that experience chronic discomfort will sometimes develop intense itching over the sight of the pain? I have certainly observed this in my patients. Cats and dogs excessively groom and chew over arthritic joints. Sometimes pulling hair out, just like they might if they were itchy. We have also learned that, just lie people, if surgical pain and post operative is not adequately managed patients can remain persistently and intensely painful. This continues well after the wounds have healed. Pain management is so much more complicated than attending to pain from an injury, but it is also avoiding the habituation of the nervous system. If habituation occurs, the nervous system will become trained to perpetuate the pain. A good example of this is that declawed cat that persists in limping years after the surgery even though all the wounds are healed. Fortunately, we rarely declaw cats these days and most of us utilize nerve blocks, anti-inflammatories and narcotics intra operatively and post operatively. These are all techniques that assist in avoiding both immediate and life long discomfort. 

Veterinary medicine has also embraced alternative therapies that are now commonly used in human medicine for pain management. We have applied the lessons learned with managing discomfort in people by adopting therapeutic lasers, physical therapy, acupuncture, and massage as viable techniques to relieve our patients discomfort. 

Assessing a patient’s stress level is a valuable observational tool as well. I think that most of my colleagues are more than capable of appreciating the signs of stressed dog or cat. These observations were valuable to us since they allow us to avoid injury. We have developed ways to restrain these pets safely, helping to avoid increasing their stress so we can treat them. However, now we recognize that minimizing their stress has  many additional benefits. More relaxed patients require less anesthesia, their blood pressure is lower, they heal more quickly and be generally more cooperative. At our hospital we have a separate ward for hospitalized cats, it is quiet and away from the noise and stressful commotion of dogs. We have stress reducing pheromones that we spray on blankets, cages and in our waiting room. Cages are insulated to decreased noise from neighboring patients. Our hospital emphasizes that value of minimal restraint. Forcing animals to do things and forcefully restraining them tends to heighten their stress. We also have a anti-anxiety medications and sedatives that we use readily to try to calm even the most anxious patient. 

 

I think there has always been an art to the practice of veterinary medicine. Frankly, I think that we veterinarians are a pretty talented, compassionate and intelligent group. I am very excited about not only the renewed emphasis on observation of the patient, but also the tools that we have been given to respond to these observations. 


Posted on November 29, 2015
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