Friday, July 22, 2016

Career identity in veterinarians and nurses

Dr Sarah Page-Jones.

Who are you and how do you fit into the world? If you are a veterinarian or vet nurse, your career is likely central to the answers to both of those questions. While that can be a huge strength, it can also be a weakness, according to veterinary management consultant Sarah Page-Jones BVSc CertSAS MBA MRCVS.

For example, it can make changing careers extremely challenging, if not impossible for some people. Dr Page-Jones knows about this first-hand. She had to reinvent her professional identity due to a physical condition.

Now a consultant in evidence based veterinary management, she is the co-author of an intriguing paper, “Career identity in the veterinary profession”, published in the Veterinary Record. The study raises some important questions about career identity in veterinarians and veterinary nurses.

Why did you become a veterinarian?

I became a vet because I had always been drawn towards animals and pestered my parents for a pet from an early age.  I don’t know where my love of animals came from, my family didn’t own pets and my Dad was a telecom engineer and my Mum a classroom assistant. But as I got older I started horse riding and by the time I was doing my exams at 16 I was set on becoming a vet and by then we had moved on from a succession of rodents to being proud owners of a cat called Chips!  It wasn’t easy to get into vet school because of my background but some very helpful vets and farmers allowed me to get the experience I needed and I was offered a place at Liverpool University in the UK.

How did you come to investigate career identity in the veterinary profession?

Congenital hip dysplasia meant that I had extensive surgery as a child and by the time I was in my 20s I had osteoarthritis.  I had to undergo further invasive surgical procedures in my early 30s but unfortunately I was left permanently disabled.  I carried on pursuing my love of small animal surgery on a part-time basis for a couple of years but then I had to stop clinical work altogether.  This led to me moving into a clinical managerial role and subsequently further away from clinical work.  I had always identified myself as a vet and the fact that I wasn’t one anymore meant that I had quite a bit of work to do to sort out who the new me was. 

My new professional identity is as a veterinary management consultant which I’m comfortable with and I’m really happy to have found a non-clinical role for myself within the profession, hence my interest in others’ career identities and my aim to increase understanding in this area and assist with identity related issues.

What is career identity?

The answers to the questions ‘who am I?’ and ‘how do I fit into the adult world’ tell us about our overall identity.  This relates to the kind of person we are in everyday life (at home, at work, with friends and family, in social situations etc.).  Furthermore our attitudes, values and beliefs underpin our identity and have a significant impact on it.  Our career identity makes up part of the whole so the questions become ‘who am I at work?’ and ‘how do I fit into the world of work?’ 

A very basic example might be “I’m a conscientious, competent and hard-working small animal first opinion vet who’s caring and empathetic with high moral and ethical standards working in a privately owned veterinary hospital.  I behave with integrity and believe in fairness”.

You state that "the strength of veterinary identity and feelings about what it means to be a veterinary professional cannot be underestimated." Why do you think this is so strong in veterinarians and nurses?

From my research it seems that many vets and vet nurses decide on their profession early on and stuck to it; in fact many participants were unable to remember a time when they were not partly defined by the profession. 
In this situation we grow up telling people that we’re going to be a vet or vet nurse and then that we are one and hence the formation of our identity through adolescence and beyond has a veterinary identity at its heart.  People that have done this tend to have great difficulty imagining doing or being anything else.  In this case it appears that the person’s professional identity also goes a long way towards answering the questions related to overall identity. 

This means that being a vet or vet nurse impacts who we are and how we behave in the whole of our lives, particularly in relation to our attitudes, values and beliefs.  When we say to others that we belong to the veterinary profession this is actually short-hand for explaining the type of person we are. 

You observe a number of potential advantages of this strong identity. What are these?

There are many advantages to a strong identity; it facilitates the development of a consistent, congruent and authentic self and the generation of meaning and social standing.  In this case people are very clear about who they are and how they fit into the world (and in fact rarely have to think about it since it’s virtually innate).  People who go through life wanting to be a vet or vet nurse, enjoy training for that occupation and then enjoy fulfilling veterinary careers are usually really happy and fulfilled individuals.

What are the potential disadvantages?

Unfortunately there are a few disadvantages with a strong identity, it certainly makes negotiating unexpected events, outcomes or socio-cultural changes that threaten identity particularly challenging.  An unexpected event could be something like my experience with disability and socio-cultural changes could be related to industry consolidation and corporatisation.   Vets and vet nurses usually move jobs to try to find an environment that’s compatible with their identity and avoid companies where practices and initiatives threaten who they are. 

A strong identity means that people tend not to contemplate changing who they are professionally to match the organisation, but as the ability to move to a different organisation becomes more difficult (due to fewer options) this may have to change.  This means that vets and vet nurses may have to begin experimenting with identity reconciliation where people change their career identity to fit with the organisation they are part of rather than working against it.  This will be a huge undertaking and is likely to cause profound internal turmoil for many as ethical dilemmas come to the fore and people continually question themselves as to whether management sales pressure is impacting their clinical decision making. 

What are the potential impacts on the psychological wellbeing of vets and 
nurses?

This means that those people who have to negotiate unexpected events or feel their identity is threatened by changes in the profession can struggle to cope and this can negatively impact wellbeing.  This is likely to affect more people as the corporatisation of the profession continues apace.  Another potential issue is that lots of us set very high standards for ourselves related to our underlying attitudes, values and beliefs and if we don’t manage to live up to these (in our own opinion) this can also be a cause of significant psychological distress.

Do you believe career identity is something we can manage in a way that can be adaptive, but not selling out one's principles?

I do believe we can negotiate questions of identity and become more adaptable but not without considerable effort from universities, organisations and individuals.  We have to begin teaching students with contemporary business in mind and assist them to cultivate a more flexible identity perhaps partly based on commercialism and interpersonal competence with altruism and social justice becoming less pronounced. 

Organisations have to work with employees to begin to understand their attitudes, values and beliefs and to work towards organisational and employee identity congruence in order that vets and vet nurses might consider aligning themselves with organisational goals. 

There is also considerable learning and work to be done by veterinary professionals, this might begin with the acceptance that ethical issues cannot simply be divided into right and wrong with businesses that seek to make a profit being wrong and we as caring professionals being right; it would perhaps be helpful to accept that ethical and moral standards exist along a continuum and will vary between organisations and veterinary professionals but that jointly working towards greater mutual understanding and compromise will provide universal benefit.

Thank you Sarah for your time and these insights! Details about Sarah's consultancy can be found here. 

Reference

Page-Jones, S. & Abbey, G. (2015) Career identity in the veterinary profession. Veterinary Record doi:10.1136/vr102784

Wednesday, July 20, 2016

Why the McHugh Report is worth a read

Don't be overwhelmed by its size. This report contains important lessons for anyone working with animals.

Earlier this month the Department of Justice released a very hefty report, documenting the findings of the Special Commission of Inquiryinto the Greyhound Racing Industry of New South Wales. This report is worth a read for so many reasons - apart from the fact that it prompted some remarkably decisive action on animal welfare from a State Government - so I’d like to explain why.

First and foremost, many if not most media commentators on this report have clearly not read it. In the age of “evidence-based” practice, medicine, and one would hope reporting, this is somewhat astounding. The investigation, led by the Honourable Michael McHugh AC QC, was wide-ranging, meticulous and detailed. It provides historic background and reviews current practice, including substantial changes to governance and practice by Greyhound Racing New South Wales. It contains answers to many of the questions journalists are asking in the wake of the report- many in the summary!

Secondly, this document tells a tale of marked failure of governance. While much of the focus has been – appropriately – animal welfare issues, the report documents how systemic organisational failures can encourage the cutting of corners when it comes to animal welfare. In this process it also highlights some weaknesses in our current animal welfare legislation and suggests improvements, explaining how and why these would make a difference.

Third, it documents incredible moral courage on the part of individuals in a range of contexts – including participants in greyhound racing, persons working within the regulatory organisation, and veterinarians. For example, one veterinarian who was actively discouraged from recording injuries and deaths of dogs – to the point where his forms were not accepted or discarded – continued to keep his own records in a diary. He set his own standards of what was required in his job and acted when he felt others – in his case a majority of others – were acting improperly. His records provided compelling evidence for systematic cover-up of injuries and fatalities on tracks.

Fourth, the investigation documents the rise of pseudoscience within the industry. While there are veterinarians who work with the greyhound industry, participants in general don’t think highly of veterinarians and rely on pseudoscience, including the services of “muscle men” who charge $10 for a consultation. The report reveals that their use was encouraged by the industry body. Treatments include the injection of unregistered substances, and practices such as blistering, sclerosing, pin-firing and needling of lame dogs, with evidence finding that these practices were not proven to help and much more likely to cause harm.

If you have an interest in animal welfare or work with greyhounds I strongly recommend reading this report. I hope that more politicians and journalists find the time to read it too - if not, at a minimum the summary (approximately 30 pages) is helpful and provides a decent overview, but there is so much to be found in the body of the report.

The report also foreshadows the genuine challenge now faced in rehoming greyhounds. There is no doubt this will be difficult – at very best the industry can rehome but a fraction of greyhounds, in part due to capacity of rehoming services such as the Greyhound Adoption Program but also due to a general lack of socialisation and habitation, combined with predatory aggression. This is not a quick process – greyhounds must be properly assessed and undertake a rehoming program to ensure they can be rehomed.

There are a range of ways that ordinary people can help.
  • Consider adopting a dog from a shelter. Greyhounds are expected to compete with order dogs for room in rehoming kennels. The more dogs – of any kind – rehomed from shelters, the better.
  • Consider fostering a greyhound in a rehoming program. This aids in socialisation and habituation, but also helps rehoming programs increase their capacity.
  • Donate to a greyhound rehoming program or animal shelter.
  • Organisations such as the Greyhound Adoption Program, Friends of the Hound, and Greyhound Rescue New South Wales are all working hard and will need ongoing support.
  • Volunteer with these groups.


The Australian Veterinary Association is supporting veterinarians impacted by the changes. Members can access their counselling service through the AVA web site.

Saturday, July 16, 2016

Considering adopting a greyhound?

greyhound collar, decorative collar
Greyhound collars at a recent adoption event.

The recent announcement to close-down greyhound racing in New South Wales is expected to lead to an increase in greyhounds needing foster and forever homes. Today Greyhounds as Pets (GAP) is hosting a massive adoption day in Wentworth Park, Glebe from 10am to 2pm.

It’s an opportunity to interact with greyhounds and for those interested in adopting a greyhound to have all their questions answered.

For details visit GAP here.


Friday, July 15, 2016

What is evidence based practice?

Evidence based medicine, evidence based practice, EVM, EBP
What is evidence based medicine and what does evidence based practice look like? Bosca is searching here for evidence of snacks.

What does evidence based medicine look like in practice? This was one of the questions explored by Dr Marnie Brennan, Deputy Director of the Centre for Evidence-based Veterinary Medicine (EVBM or EVM) and Assistant Professor in Epidemiology at Nottingham University, in Sydney this week.

Dr Brennan defines EVM as “the use of scientific (peer-reviewed) evidence, clinical expertise, owner and patient circumstances together”. Her analogy is that evidence is like a pair of glasses – if you put them on they may clarify things, but not always – so we sometimes need to put them on and take them off again.

We need to ask ourselves five questions:
  1. What is the question I am trying to answer? What do we not know?
  2. How do I find this evidence – where do I go? Databases? Journals?
  3. How do I work out if its any good? Can I trust this material enough to use it?
  4. Is it relevant to my practice? Relevant to this case?
  5. How did I do? What were the outcomes? Was this approach better or worse than the standard approach?

The big barriers to evidence-based practice (EBP) are time, a concern by some that it robs them of clinical autonomy (it doesn’t – we still need to exercise judgement), a concern that EVM yields a one-size-fits-all protocol (it can’t), bias in the types of evidence available (some research is more readily funded than other research) and concerns that evidence in veterinary medicine is generally non-existent or poor. But in the words of evidence-based veterinary dermatologist Hal Williams, “It’s better tolight a candle than curse the darkness.” (Actually those words are an old proverb but we like their application in veterinary dermatology, and to life in general).

So what does an EVP look like? This was the topic of much of our discussion, but our group agreed it would use
  • Some sort of clinical audit/benchmarking including analysis of case outcomes
  • Lots of continuing professional development
  • Case discussions
  • Journal clubs (effective journal clubs using structured worksheets)
  • Development of evidence-based guidelines/protocols
  • Review of same

Dr Brennan pointed out some great EVP resources available online, including Best Bets for Vets or this one on evidence based guidelines on cardiopulmonary resuscitation for vets which describes the process of developing these. 

Many veterinarians are using EVM without badging it as such, but it would be great to see these resources developed further and used widely, and more measurement of outcomes.


You can be part of the process by contributing to international research. Dr Brennan is working with postdoctoral researcher Dr Natalie Robinson to interview owners and veterinarians about booster vaccine consults. To participate, visit www.surveymonkey.co.uk/r/boostervaccinations - and remember this is for vets or clients. It doesn't take long (maybe 1/3 of a cup of tea worth of time?).

Wednesday, July 13, 2016

Health risks of being licked by a dog - why we need a one health approach

Capnocytophaga canimorsus, lick, dog, lick of death
Could a lick from a dog be life-threatening?

A recent case report in the British Medical Journal describes a rare and very scary disease in an older lady following a lick from her beloved Italian greyhound. News stories relating to this case have been bouncing around the internet so I thought I’d a) provide the link direct to the case report (always better to get it from the horse’s mouth - click the BMJ link above) and b) add my two cents.

The case describes a 70 year old woman, with some comorbidities (hypothyroidism, epilepsy and transient ischaemic attacks), who seemed fine until she was chatting to a relative on the phone.

Her speech began to slur. The relative, who was on the ball, called an ambulance. When they arrived the patient was slumped over the phone in a reduced state of consciousness.

She was admitted to hospital and they found hyponatraemia (low sodium) which was thought to induce the seizures. She seemed stable until day 4 when she became very confused, developed headache, diarrhoea and rigors, and later developed disseminated intravascular coagulation (DIC), deranged liver function and respiratory failure necessitating ventilation.

Blood cultures revealed Capnocytophaga canimorsus, a gram negative anaerobe associated with dog bites and scratches. The patient had not been bitten or scratched by her dog. But other studies have suggested that 60 per cent of cases were associated with a dog bite and 24 per cent associated with a scratch. 

The owner admitted she had been licked by her dog, so the authors conclude that the source of the infection was the owner’s own dog, via a lick, on the grounds that Capnocytophaga canimorsus was isolated from that patient and that it is a zoonotic organism. My understanding is that this conclusion is based on findings that C canimorsus colonises the mouths of dogs and cats.

And according to human microbiology specialists I’ve spoken to, that assumption about the source of the infective organism is probably correct.

So, what does it tell us? This case highlights a rare but serious potential complication of being licked by a dog. Those people without spleens and alcoholics are at a higher risk of sepsis, as are the elderly. All of us should be cautious.

Of course what is missing here is discussion about the dog1. As a veterinarian I’d have liked to have seen the organism isolated from the dog’s oral cavity, if just for the sake of completeness, and some discussion of its dental condition as well as diet. Could any steps be taken to reduce ongoing risk of exposure, if indeed the dog was the source? Is Capnocytophagia responsible for some of the rare cases of sepsis in companion animals?

Was the dental and periodontal health of the dog assessed? What measures could be taken to reduce the risk of exposure, apart from avoiding being licked by the dog? A recent UK study found that 9.3 per cent of dogs suffered from periodontal disease2. What we don’t know is whether regular dental scaling may reduce carriage of C canimorsus.

Another question, perhaps to be answered by veterinarians, is whether the patient’s comorbidities contributed to the licking by the dog? Companion animals may alter behaviour in response to owners, and may engage in licking or biting as an attempt to rouse owners with a reduced state of consciousness3.  In fact, licking behaviour was performed by 50 per cent of seizure response dogs when owners suffered seizures4. (It is important to note that while licking may be detrimental, seizure response dogs can save lives – in the previous study, one dog brought the cordless phone, another rolled the owner, who had a history of aspiration pneumonia, onto their side, and yet another turned off the electric wheelchair as several accidents had occurred during seizures).

Human animal interactions are complex, involving mutual benefit as well as potential risks to both parties. As a veterinarian I am occasionally asked by owners who suspect they have a zoonotic disease to euthanase the animal in question so that the risk is eliminated. For this reason I feel there is an ethical imperative to confirm the source of infection where possible.

Veterinary investigation of the role of the dog in this case with a veterinarian may help illuminate and reduce animal-based risk factors. This is an example of one of those cases where a One Health approach could potentially help humans and animals.

References
1. Speare R, Mendez D, Judd J, et al. Willingness to Consult a Veterinarian on Physician's Advice for Zoonotic Diseases: A Formal Role for Veterinarians in Medicine? Plos One 2015;10(8):8.
2. O'Neill DG, Church DB, McGreevy PD, et al. Prevalence of Disorders Recorded in Dogs Attending Primary-Care Veterinary Practices in England. Plos One 2014;9(3):16.
3. Seligman WH, Manuel A. The cat and the nap. Medical Journal of Australia 2014;200(4):229-29.

4. Kirton A, Winter A, Wirrell E, et al. Seizure response dogs: Evaluation of a formal training program. Epilepsy Behav 2008;13(3):499-504.

Monday, July 11, 2016

What is storm phobia in dogs and how is it treated?

Storm phobia, noise phobia, thunder, dog anxiety
Bosca loves lots of things, but one thing he really loathes is storms. He's not alone - many dogs suffer from storm phobia.

Do you live with a companion animal that suffers from a phobia? Storm phobias, especially in dogs, are not uncommon. Affected animals may display mild signs or suffer from extreme panic reactions and destructive
behaviour. Our family dog Bosca panics during storms and can become inconsolable, even trying to escape.

Later this year, the Australian VeterinaryAssociation Behaviour Interest Group (AVBIG) will host a webinar on storm phobias, discussing symptoms, comorbidities and management.

Elle Parker from AVBIG took some time out to give us the low-down.

What are the signs of storm phobia?

Signs of anxiety / stress / panic that occur temporally associated with storms or other phenomena that have become associated with storms (wind, rain, darkening sky etc). Most commonly dogs will vocalise, pant, pace, become clingy and attention-seeking. They may hide, cower, tremble, salivate, defecate or urinate. They may become unresponsive to commands and stop eating. Some will seek certain places in the home such as bathroom or bathtub. 

Is it usually accompanied by other fears and phobias, such as noise phobia, or is it more often very specific to storms?

Can be either.

It is VERY commonly part of a more complex or general anxiety disorder or co-morbid with noise sensitivity or separation distress. 

Some dogs seem to only have focal storm phobia with no other observed problems. 

Some dogs may develop storm phobia secondary to a trauma or fearful event - being outside when lightning strikes. 

Some are genetically predisposed and in some dogs it manifests in social maturity. 

How common is storm phobia?

I don't have an exact percentage figure for you but it is super common! Anecdotally it appears to effect almost a third to a half of the dogs I see in referral behaviour practice and certainly a few in every 10 I see in general practice.

What is the biggest misconception about treating storm phobias?

THAT ACP [acepromazine] SHOULD BE USED! 
Acepromazine is contraindicated in storm or noise phobia (or any other stressful event) because:
  • it increases noise sensitivity
  • it is sedative but NOT anxiolytic ie it blunts motor responses and perceptual appraisal but doesn't make the animal feel better - they are still just as afraid and stressed but less able to accurately perceive information or employ behavioural coping strategies. 


That owners should ignore the dog or refuse to comfort it. This is false.
The dog is behaving due to the underlying emotional response and the owner should do everything possible to improve the emotional state and make the dog feel better i.e. try to calm it down by reassuring it or giving it attention, soothing, words, praise or petting / massage. [Ed. This is really interesting as when I studied we were taught that comforting frightened dogs during storms “rewarded” bad behaviour and should be discouraged. I think this remains a common misconception.]

There is misleading information re if people comfort animals showing distressed behaviour they will reinforce the fear but fear is an emotion not a behaviour and thus cannot be reinforced. The only thing that makes an anxious animal feel better is the abating of that fear.

What are the key strategies veterinarians can employ to help clients with animals with storm phobias? (A lot of clients use thunder jackets- do these work?)

Thunder shirts are hit and miss, they seem to work really well for some dogs but make others more stressed. The dogs may need to be desensitised or counter-conditioned to them. Some dogs who do not tolerate tactile stuff may hate it. I also think that sometimes people misinterpret dogs being inhibited with them being calm (ie they freeze and reduce their motion and outward signs but are actually more stressed by the shirt).

Other strategies should include a multi-modal approach:
  • Adaptil
  • Psychotropic medication (Benzodiazipines's, Trazodone, Clonidine or a combination of these). Perhaps on top of a long-term baseline SSRI if the dog has more generalised anxiety issues [Ed. you will need to consult with a veterinarian before your dog commences any medication].
  • Behaviour modification: desensisation and counter-conditioning to low levels of noise on youtube or CDs
  • Management: trying to prevent or dampen auditory and visual stimuli that predict a storm (play background music, close curtains etc)
  • Create a Safe Spot or Zen Den [Ed. I think I need a zen den for me!]


How can vets find out more?




Thank you Elle for your time. Members of AVBIG can attend the webinar in September at no cost.

Friday, July 8, 2016

New South Wales Government Shuts down greyhound racing

greyhound puppy
We may be seeing more companion greyhounds in the near future.

UPDATE: Since this post was written, NSW Premier Mike Baird has addressed some misconceptions about the ban, you can read more on his facebook page here.

Yesterday the New South Wales Government announced that greyhound racing would be banned in New South Wales from 1 July 2017. The reason for the ban is the systemic abuse of the welfare of the dogs and other animals, notably the issues of “wastage” of greyhounds and also the widespread practice of live baiting.

Despite revelations about live baiting, the report found that senior officials knew about the practice but did nothing to address it. The "wastage" rate was estimated to be 50-70 per cent. The report found that "important sections of the industry have little, if any, interest in the socialisation of greyhounds" - something that not only impacts their welfare during their racing careers but also their ability to be rehomed.

And in terms of veterinary care, the review found that "many trainers appear to prefer cheap and sometimes painful methods of treating greyhound injuries instead of using the services of qualified veterinary surgeons."

A ban does not, of course, immediately solve the problems it seeks to address. There are dogs currently racing, and people who are financially dependent on them. The Government has committed to ensure the welfare of dogs as the industry is wound down, and to provide assistance for those losing their jobs in the process. 

There are many questions. Will this report prompt investigation of “wastage” in other animal industries? Will NSW be followed by other states, such as the ACT

As someone who treats some of the dogs that are “rescued” from this industry (and not all are suitable for rehoming), I believe this is a very positive step for animal welfare and an impressive stance by the Government.

The full report, and details of the Government response, can be accessed here (if you want a brief summary read the "fact sheet" or you can download the major sections below (nb there are also extensive appendicies).



Be prepared for some very heavy reading – there was a huge amount of evidence looked at in this enquiry.