I’m on vacation this week. To free up a little extra time, I thought I’d "recycle" one of my favorite posts from last year when I was blogging on the Daily Vet. If you’ve already seen it, take the day off with me; if not … read on.
All Creatures Great and Small … what a great book. So were the rest of James Herriot’s works that gave us a glimpse into the life of a country veterinarian in the middle of the last century. I won’t say that Herriot’s books are the reason I became a vet (I hope I’m not as dewy-eyed as that), but I sure did love reading them over and over again when I was a child.
I’m sorry to report that James Herriot is dead. Not the man himself; James Alfred Wight (his real name) did in fact die in 1995. I’m speaking of the all-things-to-all-patients lone veterinarian. Sure Dr. Herriot had colleagues he could consult with when necessary, but when the phone rang, it was he, and he alone, who was expected to handle whatever fate had dealt him, which led to the oftentimes hilarious anecdotes he included in his books.
This is not veterinary medicine today, however. Yes, in the rural parts of our country you still can find veterinarians who have practices that are not all that dissimilar to Herriot’s, but they are a dying breed. Veterinary medicine has just become too multifaceted for one person to hold all of the information in his or her head that is necessary to effectively treat all the ailments that can affect multiple species. It’s not that we have more diseases to deal with these days, it’s that veterinary medicine is now more like human medicine, with such an array of complex diagnostic, medical, and surgical options available that we have to rely on specialists, support staff and, more than anything, teamwork to get the job done well.
I know some owners hate this move towards specialization in veterinary medicine, but if you want the best care for your pets, this is the price that needs to be paid. Vets in general practice are still the closest things to a "Jack of all trades" that I know of. They’re pediatricians, dentists, surgeons, internists, and much more, but many are starting to limit their practices to a few, or only one species (e.g., the growth of cat-only practices). Modern general practitioners are also much more willing to refer difficult cases to board-certified specialists in dermatology, neurology, surgery, internal medicine, ophthalmology, oncology, etc., when they feel like they are getting in over their heads. Pet owners should think more, not less of their primary care veterinarians when referral is mentioned as an option.
I found it interesting to read that the human medical profession is dealing with similar issues. Dr. Atul Gawande gave last year’s commencement address at Harvard Medical School. I encourage you to read the whole speech as it was printed in The New Yorker. It’s a fascinating and insightful look into the challenges facing both veterinarians and human medical doctors today. Here is a snippet to get you started:
We are at a cusp point in medical generations. The doctors of former generations lament what medicine has become. If they could start over, the surveys tell us, they wouldn’t choose the profession today. They recall a simpler past without insurance company hassles, government regulations, malpractice litigation, not to mention nurses and doctors bearing tattoos and talking of wanting "balance" in their lives. These are not the cause of their unease, however. They are symptoms of a deeper condition — which is the reality that medicine’s complexity has exceeded our individual capabilities as doctors.
The core structure of medicine — how health care is organized and practiced — emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves. One needed only an ethic of hard work, a prescription pad, a secretary, and a hospital willing to serve as one’s workshop, loaning a bed and nurses for a patient’s convalescence, maybe an operating room with a few basic tools. We were craftsmen. We could set the fracture, spin the blood, plate the cultures, administer the antiserum. The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.
I am reassured to learn that veterinarians aren’t alone in their struggle to become members of "pit crews" rather than lone "cowboys," as Dr. Gawande puts it.
Dr. Jennifer Coates