The acute abdomen, the philosophy of surgery, and why we need to look after our doctors

A gastrointestinal foreign body in situ - one of the most common causes of an acute abdomen in the dog. Not so much in human adults.

Have you ever wondered if your doctor has had a decent sleep, or a proper and nourishing meal? It was a question I was unexpectedly confronted with last week when a very close human family member was admitted to hospital with an acute abdomen. It became rapidly apparent that this was a surgical condition.

Due to a series of unfortunate events, the surgery was delayed. Patient X was meant to be transported to a larger hospital, but this didn’t occur due to the patient transport staff member calling in sick. As most surgeons know, at some critical point, time is bowel. So it was concerning that the surgery – scheduled for the morning – was not going to be addressed until late in the evening, when the on-call surgeon had been working constantly on critical cases and hadn’t had a break, and Patient X had been enduring discomfort for 48 hours. Free abdominal fluid had been detected on ultrasound.

To the team’s credit, everything went well. Patient X is recovering (I am so used to veterinary patients that I was shocked that I was able to converse with Patient X on the phone post anaesthesia. I wish our patients could call us and tell us things like “my throat is a bit sore from the ET tube” or “this pain relief is working really well”, or Whatsapp a cheery hospital selfie. It must at least be helpful to be hospitalised in a facility staffed by members of one’s own species). And no, it wasn't a foreign body but an obstruction which occurred secondary to an adhesion which occurred secondary to a previous surgery. (Disappointingly, at least for me, there was no surgical photo). 

The following day, when the surgical registrar called to update me, he was amused that I asked him if he’d had some sleep. But I was serious. We need to look after our health care professionals.

The French vascular surgeon Rene Leriche, in The Philosophy of Surgery, wrote that “The best surgeons are those who are able to maintain their fitness and comfort during the long-lasting jobs” back in 1951. (He also wrote that “Every surgeon carries about him a little cemetery, in which from time to time he goes to pray, a cemetery of bitterness and regret, of which he seeks the reason for certain of his failures” – an important acknowledgement, but somewhat concerning to recall when you know the patient, and you know there is a correlation between hypoglycaemia, hypohydration and errors).

I digress. It’s important that doctors are not overworked, are well-supported, take decent breaks, eat nourishing food and get recharging sleep. In an article last week in The Conversation, Professor Alex Broom put it succinctly: “Doctors who feel better will make fewer mistakes and solve problems faster.” (Read the full article here - he also makes the point that stressed doctors are less motivated to participate in continuing education, yet “participation in continuing education improves professional practice, and, crucially, patient outcomes”).

The Australian Medical Association lists some excellent resources on its website, many of which are just as relevant to veterinarians and nurses too. You can access those here.

We need to look after those people that look after others. In terms of vets, we’re working on The Vet Cook Book which should be published later this year. This is designed to promote collegiality and conversation but also provides some helpful resources – and recipes. You can follow the facebook page. 

Fortunately, and thanks to excellent care despite many challenges, patient X is doing well, having been discharged home for cage bed rest (without an Elizabethan collar).

In other news, an exhibition which opened on June 9 highlights the plight of victims of domestic violence and their companion animals. This looks like an amazing initiative and worth seeing.

If you’re in Sydney, SAT reader Kerry shared this info about doggy degustation events (obviously not for the canine on an elimination or prescription diet).

Are you considering changing jobs or even careers in 2017?

Is the grass greener on the other side?

Are you considering changing your job, or even a career change? Do you just want to change up your workplace? The New Year is a time for reflection. Recent research has shown that some veterinarians feel trapped in their current role, which can cause stress in itself. Jenny Moffett, is a veterinarian who has had her own career change, and has put together a short online course for those wondering what their next career move should be. She took some time over the break to talk to us about her career, why veterinarians change jobs and even careers, and what are the barriers to change. .

What is your day job?

I am founder of SkillsTree, a company which uses training and coaching to help healthcare professionals develop both personally and professionally. I spend about half of my time on the conference trail and running workshops, with the rest carrying out private consultancy work and 1-on-1 coaching. Whatever I’m doing, though, I still refer to myself as a veterinarian; it’s important that we recognise that there’s a wide range of veterinary career options outside of clinical medicine.

What prompted you to develop the Veterinary medicine: Where To Next? course?

At SkillsTree, we have noticed a recent trend of increasing career dissatisfaction amongst veterinary staff. These observations have been backed up by widely publicised studies such as the Vet Futures report, which suggests that around half of recent veterinary graduates say that the career has not matched their expectations. And there is a real shortage of experienced veterinarians and veterinary nurses in the UK right now. So you have to ask: “Are people leaving the profession because they just can’t see a way to improve the situation they are in?” From a coaching perspective, we can help individuals to identify the challenges they are facing at work, and explore ways to improve their circumstances. However, not all veterinary professionals have access to 1-on-1 coaching - there can be financial barriers, or maybe they are not yet ready to share their ideas with another person. “Veterinary medicine: Where to next?” was intended to be a low-cost, self-guided course for veterinary professionals who feel they are ‘stuck’ in their career, or are looking for a new challenge.

Why do veterinarians change careers?

There are many reasons why veterinarians choose to change careers, or take a different path within their own profession. Many of us choose the profession at a relatively early age - why would we expect the career to still be a perfect fit for us five, 10, 20 years out from graduation? People make a career change when there are sufficient push-pull factors. If clinical medicine is no longer a good fit - say if our family circumstances change, or we lose a sense of ‘meaning’ in what we do - we may feel ‘pushed’ out of the career. Similarly, we may be ‘pulled’ towards new opportunities, e.g. taking up position as a clinical director or setting up a new business.

What prevents veterinarians from changing careers?

We know from research that veterinarians have a strong sense of professional identity, and that many feel ‘inseparable’ from the career in which they work. And it’s hardly surprising; many veterinary staff have wanted to work with animals since a very early age, they have made considerable sacrifices to enter the profession, and they often feel a strong sense of ‘belonging’. When you combine this with the financial difficulties associated with greater levels of student debt, it can be difficult to turn your back on a relatively stable career.

We often hear about burnout in the veterinary profession. How do professionals find their mojo again?

We know that burnout is an occupational hazard for veterinary staff. And it’s important that we recognise and address the signs of burnout before it happens - prevention is definitely better than cure. It’s a bit of a cliché, but we do need “put our own oxygen masks on first”. It’s tempting to put our lives outside work on hold until the workload lessens/ rota changes/ children get a bit more independent, but that simply doesn’t work in the long term. Investing in social relationships, getting exercise and learning new things outside of work can often, paradoxically, be the key to enjoying our work more, or finding out what we need to change.

Thank you Jenny. You can find out more about “Veterinary medicine: Where to next?” at http://skillstree.teachable.com/p/vetcareers, or more about 1-on-1 coaching with SkillsTree at www.skillstree.co.uk

I enrolled in Jenny’s course as a fee-paying student and found this a useful program. Things I liked about the course included the distinction between goals and values (and how to work out what yours are), and the variety of resources that Jenny has pooled together including interesting articles, self-guided exercises and practical advice. The good thing is you can pace this yourself, so I spread it out over a few weeks.