After the previous post on surgiphobia I received an e-mail from a concerned pet owner wanting to know whether she should change vets. Reading about my lack of surgical competence in my first years of practice struck fear into her heart. She was now worried her twenty-something vet would maim her new kitten during her spay next month. I guess I opened that can of worms so now it’s my job to start stuffing them back in — not that I’m sure I can…
Before we proceed, let me first offer: Do you want the blue pill or the red pill? If you prefer the red pill hit the back button now. If you’ve chosen the blue pill, read on…
The reality of clinical practice is revealed by the word 'practice.' My understanding of this concept was finally realized when I read a great book written by a human surgeon, Atul Gawande, called Complications: A Surgeon's Notes on an Imperfect Science. In it he describes how he and other surgeons commonly botched procedures at the outset of their careers. He details how this early 'practice' of medicine is a basic tenet of physician training — and what the medical professions accept as a cost of doing business (for otherwise doctors would never learn).
Not only does 'practice' apply to young medical professionals, it also affects us throughout our entire lives. After all, would you want a vet to treat your pet if she didn’t learn new procedures every year? Medicine is constantly changing and to keep up means learning something new every single day. But that means Fluffy gets the short end of the stick as she deals with my inexperience when I wire her fractured jaw in a new way.
This may seem unacceptable. You are paying me to fix — not to learn. Consider, however, that when I practice each and every case is essentially a novel learning experience that makes me a better clinician. It doesn’t matter whether I’m fresh out of school or thirty years out. If I do my job well, I will always be learning and trying new things. And most of my learning won’t come from the safety of a dimly lit conference room — it’ll come, in a sense, at Fluffy's expense.
Having just scared the bejesus out of you let me now tell you how I handle these situations. Whenever any new procedure (or medication regimen, for that matter) carries significant risks, I will always inform you of your choices. Informed consent is an ethical imperative in any medical environment. I’m not required, however, to tell you whether I`ve ever undertaken said procedure or regimen before.
At least in our hospital's case -- we always will. In fact, we will always offer you the best specialist first. Only then will we offer you our own services with caveats related to our skill set, equipment, etc. But we`re not required to — not really.
This grey area is where you might prefer Fluffy not fall. Your twenty-something vet? I don’t know her. Maybe she’s done 400 spays by now … or maybe just four. Is Fluffy more at risk if your vet is less experienced? Of course she is. And the same is true for human physicians.
Would you want a resident doing your child’s open-heart surgery? Probably not. But residents do tricky first-time surgeries every day.
Studies show that human surgeons would only rarely let residents practice on their family members. But resident-based care is a fundamental part of medicine -- even in the finest institutions in our country.
Vet medicine is no different. Doctors don’t spring fully formed from their schools of origin. We have to learn. And the truth is, if we told you every time about how few "X" procedures we’d done you might never consent to give us the opportunity to learn how to do it.
Does this mean you should forego treatment when you know your vet has little experience? I think enthusiasm and a basic drive to practice good medicine beats experience in most cases. Most recent grads have a strong desire to do everything right, whether it's their first time or their fortieth. I`d much rather deal with an inexperienced perfectionist than an experienced practitoner`s potential attitude of complacency and boredom with respect to their career.
Despite my honesty, (indeed because of it) perhaps I haven’t done a very good job of capping that can of worms. However, I’d rather be frank about what we do than deceive you just to assuage your fears. What can I say? I’m a blue pill kind of girl.