A KICK ASS Interview: Discussing the Pressures with Dr. Salvador
KICK ASS VETS was very lucky to have Dr. Salvador join us to talk about life as a new graduate! Originally from Stockholm, he moved to Australia and studied at the University of Sydney, graduating with a DVM about 6 months ago. During university he worked initially as an animal assistant and then moved into a nursing position. He is now a full fledged veterinarian working in a busy small animal practice.
An Uncomfortable Experience:
Responsibility can be scary, and the sudden feeling of pressure when you are “the one in charge” and things are “for real” can be overwhelming.
When Dr. Salvador and I were working together we had a case of a very very sick cat with a peritoneal-pericardial diaphragmatic hernia. Due to owner finances the options for this kitty were either euthanasia or surrender with Dr. Salvador and I attempting the surgery. In order to try both try to save this kitty, and to get Dr. Salvador some real-life experience as what it’s like being “the one in charge,” I made him be the primary clinician on the case. I wanted him to have the experience of working through a case, on his own, but with the support of having back-up standing right beside him.
“I do very much remember that time. It was a really good experience… because it was the first time that I felt that ‘this was for real’ and it was my responsibility.” Dr. Salvador shares that as he was making that first incision, he starting “feeling all of this pressure that I had never experienced before.” He felt light-headed and had to take a break. That experience helped Dr. Salvador realize that he wasn’t a student anymore, and it’s now real.
Going from student to veterinarian is a huge responsibility shift, and this is a huge emotional experience that cannot be explained, studied or memorized… it just has to be felt. And until you are in that position, you really cannot know exactly how you will feel, or how your body will react. Having a visceral reaction, whether it is feeling faint or feeling panicky, sweaty, heart racing, crying, whatever… is NORMAL. This is something that I think most, if not all, vets go through at some point or another.
Dr. Salvador has forgiven me for putting him through that experience as he felt it was a very useful learning experience. “Since then I’ve had unexpected things happen in surgery, and having that experience helped me maintain my calm.” Dr. Salvador describes that rush of adrenaline, when your heart starts going crazy, after you have something happen in surgery like a dropped pedicle. Until you have that experience, and until you have that full responsibility in your lap, you cannot know how it will feel, or how your body will physiologically react to those experiences. For new graduates, knowing this is a NORMAL reaction, and a normal feeling, is vital. It doesn’t mean you are weak, unprepared, incompetent, or not able to go on. It’s a physiological response and very quickly you will train your body out of it!
Nurse to Veterinarian Transition:
Dr. Salvador was surprised by how he felt with this transition, and it caught him off guard. When referring to the emotional sensation, he shares that “even though I have been in hospitals and am familiar with how they run, there was still that [change in feeling of ] responsibility. That is a big thing that when you work as a nurse, you just don’t have the same amount of responsibility.” Dr. Salvador felt that due to his nurse experience he would ‘already know’ what it meant to be in charge of cases, but was absolutely surprised by how that role change also changed his emotional reaction.
Nurses that become vets have a HUGE advantage clinically in terms of skills and exposure to cases. However there is the down-side of getting used to being able to rely on the vet on duty, and being used to the safety net in terms of responsibility. This leads a lot of vets that started as nurses/techs, feeling a bigger shock than classmates when they are suddenly the ‘doctor in the room.’
“We have to make so many decisions so quickly sometimes” is the sentiment and feeling behind Decision Fatigue that Dr. Salvador faces on a daily basis…and it’s harder for new graduates because each decision takes more brain power.
Decision Fatigue is when the quality of your decisions deteriorate after a long session of having to make multiple decisions one after another. This is a massive factor in veterinary medicine, because you are often doing 2 or 3 consults at one time, jumping between rooms while waiting on one diagnostic test or another, while nurses are asking you questions about other patients that are either in hospital or on the phone. You are often fielding 10 questions at once. For new graduates especially this can be incredibly stressful because every little question takes 100% of your brain power, and you just cannot have 10 x 100% brain power!
“We have to make so many decisions, so quickly sometimes.” Dr. Salvador shares his struggles and experiences with decision fatigue, and how your brain has to juggle so many different things at the same time. This is an aspect of clinical practice that he just wasn’t exposed to in school.
As you become more confident with your medicine, and as you have the same scenarios occur over and over again, these decisions will become easier and less stressful, and your threshold of hitting this decision fatigue will be prolonged. However, there will be times when you are dealing with a very serious case, or are in surgery where you need to focus, and someone will ask you a question, and you just cannot sacrifice any of your current brain power on the question asked. It is OK to say “I can't think about that right now” to the person asking the question. This might mean they need to take a number and call an owner back about a question on the phone, or a medication or treatment for a less critical patient needs to be pushed for an hour. This is OK. When you have limited resources, whether that is staff, money, equipment, or BRAIN SPACE, the triage system kicks in and you deal with the most urgent, most critical cases first. Having a spot where staff know they can write down a list of questions or tasks, that you will address later, is also helpful!
And new graduates remember, it will get easier, but also it is OK that you need more brain power for ‘simple’ questions, that is part of the learning process! Everyone struggles with managing multiple cases at once. Practice will make it easier, but when you have a critical case, it’s OK to use 100% of your brain power on that case, and push other cases to the back-burner. Even experienced, specialized vets have to do this!
Paint By Number: Creating something beautiful doesn’t have to be done without help! Medical records are no different. Having a template makes your medical records beautiful.
A big part of being a medical professional is keeping records so that there can be continuity of care over time, and between different vets. There is a big difference as well between the records that specialists keep, compared to the records that general practice vets keep. This is a factor of both the complexity of their cases, and the time availability (of both the specialists and the interns writing their records!).
Dr. Salvador says this is “another thing that I have thought of a lot … [at school] we get taught gold standard, best practice, from specialists. We get taught to think in a certain way, and communicate and write medical records a certain way. When transitioning into practice… I found that the way I was trained to write [records] doesn’t always fit in a general practice setting when you have a limited time.” Dr. Salvador wasn’t expecting this drastic change of how to actually manage time.
KICK ASS VETS recommends TEMPLATES! Having templates for everything is helpful. Templates for surgeries, templates for records, templates for common procedures or discharge instructions. These are a huge help when trying to improve your efficiency and also help ensure you have consistency and completeness of your case management! Most software programs that clinics use will allow you to program in templates, but if you can’t KICK ASS VETS has a Template Medical Record that you can bookmark on your work computer.
Lacking Support from Support Staff:
How to manage unsupportive support staff without cutting ties can be a challenge… especially for “baby vets.”
Nurses and technicians can be invaluable resources to you, especially as a new graduate. They have clinical skills that will help you, and they have case management experience based on pattern recognition that will be accurate a lot of the times. However, the difference between a nurse education and a vet education is knowing the different differential diagnoses. Pattern recognition simply isn’t good enough as a vet. You have to think about, and making sure you are accurately ruling out all of the other possible causes of diseases. Also, you have to keep up to date with current medications, and implement changes to your practice with new knowledge.
This dynamic can be a huge difficulty for new graduates especially because sometimes nursing staff can feel they ‘know better’ than the ‘baby vets’. Dr. Salvador admits that he has had some struggles with support staff or colleagues having different opinions on case management, and at times not being supported because he is a “newbie.” He has hit resistance by staff to perform the medicine he wants to perform, which was what he was taught in school. He shares that sometimes he has to “assert his dominance” over the support staff and that is an uncomfortable thing to have to do.
KICK ASS VETS recommends trying to focus on education. When you have a particular topic that your teammates are resistant to, see if you can put on a presentation for the staff on that new drug, or new technique, or new approach. Show the team that you are motivated, educated, knowledgable and excited to perform up to date medicine, and that energy hopefully will be contagious to your team and help them adopt your ideas.
If there is a particular staff member that you are having difficulties with, that will not support you, is undermining you, changing your treatment plans, etc. sometimes you need to have a private conversation. KICK ASS VETS recommends to first try approaching that staff member privately and independently. Ask them for lunch and explain that although you greatly appreciate their experience and help, you really need them to respect your clinical judgements because ultimately it is your license and livelihood. Also, explain to the individual WHY you you are performing the medicine the way you are. Explain that you are happy to answer any question the individual may have, for any case, but you ask for support in return. Also, in emergency situations or in anaesthesia you ask that your team member perform what you are asking first, and ask questions later. Often, if you have this conversation you can win that staff member over by showing them you respect them, and by showing your confidence and knowledge. Sometimes there will be staff members that will just not respect your decisions, and in these cases you will need to escalate the issue to management/owners. However, you catch more flies with honey, so try having a private conversation first, and a little flattery goes a long way!
New graduates can’t talk about work without talking about mentorship! Especially in veterinary medicine, where so much of our learning is ‘on the job’ because 4 years of school just cannot possibly prepare you for every aspect of the field. Dr. Salvador has established a very good system with a group of classmates where they meet once a week to chat. “We’re all facing our own individual challenges at our new work-places.” Dr. Salvador shares a couple stories of what classmates are facing, but overall he chats about how “mentoring and support is a really big thing. Some friends [are] not getting support that they thought they were going to get.” He feels he is very lucky to have a very supportive clinic, but also strongly feels that “having another support system with people outside of your own clinic is really important.”
Talking Money With Clients:
“Something I didn’t realize was having the financial conversations with clients can be very very draining” and “having people unload their personal problems and dilemmas, and why they can’t afford treatment.” Talking money with clients is part of the job, and Dr. Salvador knew going into the career that this was going to be a big part of the profession. What he didn’t expect was the emotional stress of being the one in the room, having those discussions, and then having to recommend that clients spend their limited money when you know they are struggling financially. “You want to be there to do your job and help their animals, and you’re not always in the right mind-set to hear their story.”
There is a huge feeling of guilt when talking money, especially for new graduates because they don’t always feel they are ‘worth it’. It takes confidence, and practice, to recommend treatments and to feel comfortable not knowing the answer right away. Also, it takes time, and practice, and the development of an individual strategy, to deal with the huge emotional toll that owners place on vets on a daily basis.
Dr. Salvador feels that “financial planner, therapist, accountant and counsellor” should all be added to the list of difficult jobs that we have as veterinarians.
Dr. Salvador really identifies with the shirts that say ‘a Veterinarian is a cardiologist, anesthesiologist, internist, surgeon, etc’… but feels that financial planner, therapist, accountant, and counsellor should also be added to the list. The emotional strain of dealing with the humans attached to our patients, on top of the incredibly difficult medical aspect of the veterinary job, is frankly sometimes too darn hard!
KICK ASS VETS understands that part of being a vet is communicating with owners, explaining conditions, offering options, and working within a clinic’s budget and with their ideas and opinions. In school there are often practical sessions where actors play clients, and we are taught how to deal with the human component of the consult. However, these always focus on how we, as the vet, can support the human. There is incredibly little in our veterinary degree on how to manage your own emotions and feelings in these consults, and create boundaries, and how manage when you are placed in positions that are out of your depth. Dr. Ann has had clients that have used her as a support and counsellor for their alcoholism, or for their grief of dealing with family members with terminal illness. She shares that she is NOT trained to have these conversations, and feels incredibly uncomfortable in these situations. Support, and training on how to handle these conversations, and how to set boundaries, would be a welcome and needed addition to the veterinary degree program!
The immense amount of pressure, client expectations, emotional and financial stresses, can all make you feel underwhelming, or like you’re not enough. This fuels the amount of Imposter Syndrome we already feel. So… be KIND to yourself. FORGIVE yourself. And mainly, recognize that YOU ARE ENOUGH!
Forgiving yourself as a new graduate for not being an expert in every field, and for understanding the limitations that you can provide as a both a veterinary professional and as a human, is really important. Also, forgive yourself for not being comfortable, or not wanting, to take on the emotional stress of every single client! It is OK to want to be JUST a veterinarian! You don’t have to want to be the best friend of every client, and you don’t have to be the life coach for every owner. Your job, as a vet, is to provide knowledge, options, and medical interventions and treatments. But, beyond that, that’s it! It’s 100% OK to not be the therapist of your clients!
Dr. Salvador really feels this with his clients. It’s “this whole feeling of guilt, and feeling like you have to be emotionally available.” He also talks about the difficulty in presenting estimates when the owners have outlined cost constraints, and how it’s a real struggle. “I’m trying to work on this, and feel more comfortable.” Having the confidence to talk about money with owners, and to recommend best practice for the pet, is a real struggle for a lot of vets.
KICK ASS VETS recommends trying to separate yourself from financial component. You truly never know what an animal is ‘worth’ to an owner, and it isn’t your job to make those financial decisions for owners. Some vets will tailor their recommendations based on what they think their clients want or can afford. But, the reality is, you never know what your owner will want. Your job is to provide options, and then support the decision of the owner. There will be individuals that will mortgage their house for their pet, and others that would prioritize a trampoline (yes, this was a discussion a family once had in front of me…).
“This is the cost of care” is a useful line. And remember, you should be paid appropriately for your work, and that doesn’t make you a bad person. This means that clients have to pay for your services. You cannot change the fact that medicine costs money, and your education cost money, and as Dr. Salvador puts it: “it is what it is, I can’t change it.” You cannot change the fees, so learn to just present the information and then let the owners figure out their own financial decisions.
Leaving the room while owners decide is a good strategy as well. I will often say “I’ll give you a minute to discuss as a family, and then I’ll come back to answer any further questions you might have.” This gives clients time to breathe and think, while giving you an escape from the room and the emotion.
Also, don’t allow your pre conceived ideas of what is ‘expensive’ or not be put on the clients. By saying things like “I know it’s expensive but…” you are setting them up to think you are over-charging or that the intervention isn’t worth it. Instead, focus on the benefits of the test, and THEN give the price. “X-Rays are going to rule out the really scary things that mean we need to go into surgery now to increase Fluffy’s chance of survival. The cost is $200.”
Following this up with “Is this something you would like to, and are able, to pursue?” opens the door for clients to say “no, I can’t pursue that” so you won’t feel, or come off, like you are pushing tests. Owners prefer a clear recommendation, so give options but also clearly state what you recommend. This will earn trust with your clients, and be emotionally easier for you as you are just recommending the best option for patient care, which is your job!
Being A Vet Is Awesome:
“It is really tough but it’s also very rewarding, and I’m really happy overall” Dr. Salvador shares. He is very happy being a vet, and recognizes and is excited about the amazing aspects of the career. However, Dr. Salvador is realistic that there is room to improve, and is hopeful that as a profession we can try to tackle the less desirable aspects and improve on them.
Advice from Dr. Salvador:
1. When you have days off try to enjoy other things that aren’t vet related. “It helps a lot and makes coming back to work more enjoyable.”
2. Try and learn as much as you can from everyone in your clinic, nurses and vets. Even vets that do things differently, have conversations about why. These can lead to both parties learning a lot!
3. Try and get your record keeping down pat. A template worked well for Dr. Salvador. Templates help a lot with efficiency.
KICK ASS VETS is so grateful for Dr. Salvador for joining us and for being open and honest about his experiences. He has brought up a lot of really important points for new and experienced vets alike, that as a profession we can try to improve upon. Thank you so much for joining us and we wish you all the best in the future!
If you are a veterinarian or veterinary nurse, and feel that your story, opinion or experience might help others in the profession, or if you just want to share so that others in your situation can know how you managed, please Contact Us and we can arrange an interview. The more we talk, the more we share, the more we will grow together to improve this amazing profession of ours!