Monday, June 20, 2011


Had to take a moment to comment on an article in the June 15 issue of JAVMA. There is a very nicely put together article criticizing the role of corporate freebies given to veterinary students throughout vet school as well as to veterinarians and physicians written by a lawyer who is (or was at time of submission) a second year vet student at Colorado State. This is what happens when lawyers go to vet school...;)

In all seriousness, she had many good points but I have to refute from a practical standpoint. Had we not received free or very cheap pet food, there is no way I would have been able to afford to feed my kids. Additionally, the free lunches, dinners, etc. often provided made many of us actually eat a meal when we might not have done so otherwise. To eliminate this would be another step toward making veterinary a privileged profession only available to the elite people who have money or a spouse or parent to support them. There is already enough politics out there that limits admission to many worthy folks while allowing admission of people who really don't deserve to be there. Speaking for myself who grew up on the "wrong side of the tracks" in a family with a very low income due to having my father pass away when I was extremely young and who paid for my entire education through scholarships, grants, and student loans (NOT parent loans, by the way), I for one appreciated any help given.

The author makes a valid point that gifts can influence later recommendations and that the meetings, lectures, etc. are biased. While this is true, I always walked into the corporate sponsored lectures with that prior knowledge therefore listened with an even more critical ear than usual and, believe me, I am very critical probably in part due to my natural cynicism. This exposure as a student can but benefit when one reaches a private practice job in which the boss prefers not to pay for good CE hours and forces at least some of the hours to be through local chapters that are, guess what, corporate sponsored events... Additionally, I viewed the food as a chance to get a personal working knowledge of the different companies and availability. Now, when an owner asks me if the food works or is palatable, in most cases I can actually say I have used it for my cat or dog and this was my opinion. This is one reason that I have a personal preference for Purina HA versus Hill's Z/D for allergy dogs; I tried both on mine.

I believe that a better approach than eliminating this practice would be to better educate students on how to critically examine evidence and make a non-biased decision. Realistically, this practice is something that everyone deals with on a daily basis in real life - wouldn't it be better to learn how to handle it while there are mentors available to question and from whom to learn? Oh, but I forgot, to teach students to critically examine evidence would be to expose those clinicians who are deficient in their knowledge, etc.

It took me a while to recognize that those who laughed at my questions, blew them off like I was asking something stupid, ignored them entirely, or handed me a pat answer really didn't know what they were talking about and didn't want to admit it. I had the privilege of working with many great clinician's in vet school as well as a few during my other experiences since but my absolute favorite by far was the man whose lectures were beautifully put together, took the time to find a way to connect, and who responded to my first weird, out there question to him with "I don't know; why don't we look it up." This describes a person who is secure enough to admit they don't know everything (who does?!?!?) even to a (gasp!) underling such as a lowly student. This is in direct contrast to the other type that I previously described who are definitely too insecure to admit a lack of knowledge or confidence in front of a student.

Perhaps it is partly my nature that makes me take this stance on this issue. I'm admittedly a questioner; always have been, likely always will be. I'm sure I drove mom crazy with the endless string of "Why's" throughout childhood. I even remember playing softball in high school and failing to run home when the coach told me to because it made no sense to me. Much like Smalls in The Sandlot, I think too much, never really fit in with kids or people of my own age group, and am not great at just letting go and having fun. Needless to say, I got pulled out of the game after that but the coach knew me well enough that he also took the time to explain his reasoning on why to run. Unfortunately, I still have not developed that trust in anyone just to blindly run when told hence I don't blindly trust just because someone said so; even if it is a boarded specialist. I probably drove many of them crazy as well with my questioning and looking things up that I was told just to verify that it was truth...

Anyway, I do not disagree with the points in the article I just disagree with the solution. It's time that we really advocate evidence based medicine in vetmed. (I did a great presentation on this last year; I'm not sure that it went over that well with the folks listening but I had a blast doing it and used some of my more sarcastic cartoons to help illustrate the point.)

On other topics, my brother is still in a mess. He got his wife out of jail and 4 (!!!) days later they were both arrested for drug possession. He seems to rationalize that it is ok because the drug they are using is "technically" legal in his state. It doesn't matter that they both are killing themselves slowly by using it. The whole problem started after they had a really bad car wreck about 17 or so years ago. Due to their injuries, they were placed on prescription pain medication, slowly began to abuse it, then reached for illegal substances, and it has escalated from there. He's trying to play the guilt trip on mom to get him out and he's really good at it. I hope she stands strong because at least he is in out of the heat with food, water, shelter, and hopefully no drug availability. It's so sad seeing them throw their lives away; their kids won't even associate with them at this point.

The herd is doing well overall (big sigh of relief!) and I'm working on being intentional about spending more time with each of them, especially the geriatrics in the group. I still don't have an answer on my poodle but am looking into atypical Cushing's. Not that I'd treat it yet if it is that but I'm really a type A driven personality when it comes to finding answers and explanations. I liked the suggestion about age related changes, too. Maybe it's a combination of things; I'm comparing him to my Cocker/Poodle that passed away a couple of years ago at 18 and he's not really quite like she was (definitely a cognitive dysfunction syndrome) but does show some similarities. Abdominal ultrasound was boringly normal but I do caveat that at this point I have to rely on a human ultrasonographer to do scans since we do not have a machine and it's not really kosher for me to take the probe from her (besides, he turns into Cujo if I don't hold him...) to do the exam.

Have done some self diagnosing again and determined I'm definitely dealing with some major compassion fatigue as well as some burnout. Partly disillusionment factors in ranging from the disappointment of not obtaining the surgery residency that I worked so hard for primarily due to politics and very much because of the reluctance of many clients to allow me to practice good medicine. As a quick example, I recently repaired a cherry eye (prolapsed third eyelid gland) in a Beagle. He's being brought in tomorrow for my boss to remove the gland because the owner is not happy, it was not the same as before and doesn't look as good. It was a huge prolapse and had some inflammation; she has not given it time to heal or allowed me to even re-examine it to see if there is anything else that needs to be done. I cannot bring myself to remove the gland since it was beaten into my head that doing so is akin to malpractice due to the association of development of dry eye after removal (I'm also really enamored with eyes, therefore it is a double whammy to try to talk me into doing something I feel is wrong.) but that is what my boss was taught and he is no convert or lover of eyes... What's the point in trying to do it right? Not that my driven self would be able to do differently but it is very frustrating!

At work, my boss has hired 2 teenagers, 18 and 19, to do the kennel in the afternoons and to work as a receptionist. I hate running a nursery. They don't listen to me and he hasn't helped by undermining any authority I have in front of them. I've lectured, explained, yelled, griped, and pleaded for the same things over and over. One of the worst is the importance of maintenance of a proper medical record. INK. DON'T SKIP LINES. NO INAPPROPRIATE COMMENTS. ETC... What do I get last Friday?? 2 lines skipped followed by presenting complaint "boobs too big, tee hee =)". Dead serious. Another recurrent issue is to completely fill out rabies certificates. I even took time to write down in 2 places the vaccine info but it still fails to appear in the appropriate place. But, at this point, they sign my boss's name all the time anyway so... I told him it was amazing how many vaccines he does when he's out of the office.

The other issue at work (besides the ongoing ones) is the controlled drug log. I've inherited the problem and it is making me more crazy than usual. The few people that have access refuse to cooperate and short of myself pulling up and recording all drugs used, I have no solution. Couldn't do that anyway since I'm not there every day. The boss hints about my working more since we are very busy with the advent of summer but, although I could certainly use the money only barely stretching paychecks to pay student loans and other needs, I just don't know if I can physically and emotionally handle it right now. Besides, he wants me to be there but doesn't want to pay for my time.

That's about all that is new for me. I've been trying to find a way to send a kitten to CantSpell to make her feel better and smile a little but haven't found a way yet. Maybe airmail...hmmmm.

Planning a fun post about Guess and Maybe but need to get a picture first to help illustrate. Hopefully in the next few days I can get it done. Also working a lot on my cartoons which are a major source of stress relief. Have considered posting them before but have not figured out how to post and maintain legibility. Need a better computer guru than I am, I guess.

For now, I must go because I have more than plenty to do that I'm putting off for a little bit...Me? Procrastinate?? NEVER!


Krissy Wood said...

I'm a veterinary student and I totally agree with your position on health care vendors, we just got our pet food and any other free goodies taken from us by our university's new health-care vendor policy. We can't receive anything that cost over $5, but must pay what the public would pay. Just not cool. I feel "educated" enough to make my own product decisions!

Yonka said...

I see how free product can be manipulating... But how is it any different from having a good sales rep!? I won't lie, I am bias towards hill's pet food because of how wonderful their customer service is!

----Side Note To Author:----
I have been working in a small Vet Clinic for 1.5 years now... I am simply a certified dog trainer working as an administrate assistant. I don't share any of the same responsibility as the technicians/assistants and vet... but I see everything they must deal with and well... when days like today happen... I am desperate to find insight from someone dealing with the same issues...

I just want to thank you for posting your stories. You are a very entertaining writer and I have enjoyed reading over your blogs! I look forward to reading your new postings :)