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We are going back to our roots with this blog post and talking about something we are both SO passionate about: The Challenge of being A NEW VET.
Being a new vet brings up all sorts of feelings: excitement, terror, hope, satisfaction, and more! Get excited as we share our stories, situations, and feelings with you that will help to put this unique experience (and we mean unique ๐) into perspective! Think being a new vet is easy...think again.
๐ ๐จ๐๐ค ๐ ๐พ๐ผโ๐๐๐ ๐๐ฅ ๐๐๐ฅ๐ฅ๐๐๐ ๐๐ ๐๐ก๐๐๐๐๐ฅ๐๐ ๐๐ค ๐ ๐๐๐จ ๐๐ฃ๐๐....
The case was clear: The 2 year old dog ate a rawhide. Then, the dog started having diarrhea. Its temperature was 102.5 F, but it was also bouncing around my exam room and scarfing down Hillโs I/D happily.
Sounds like gastroenteritis, right? But as a new grad, my brain ran through every differential it could think of. Like, what if this was the early signs of a partial foreign body? I had seen something like that on one of my externships...
My mind was confused with all of the information I had learned in vet school and my fears of missing something because I was new. So, worried I'd miss something, I went into communicate all possible scenarios to the owner.
Letโs just say, that poor owner left so confused ๐คฆ๐ปโโ๏ธ.
So, what the heck happened?
Well, I let all of my vet school knowledge OVERWHELM me and as a result, I OVERTHOUGHT IT and GOT COMPLICATED. I made a mountain out a molehill with a simple case of gastroenteritis in a dog!
Ashley and I laugh about this now but all of the knowledge you have from school/NAVLE make you really book smart! But it can also interfere with your ability to analyze cases in a simple way! When new, you don't have a lot of experience to fall back onto, so you rely on all the book knowledge which seems equally relevant for each case no matter how unlikely the differential is!
Here are three things we find helpful:
โ 1 - KISS: Keep it simple stupid. Remember this and look for horses, not zebras.
โ 2 - Develop an Initial plan: This does NOT have to be perfect. Communicate it to the owner.
โ 3 - Develop a back up plan: If the initial plan doesnโt work, this is what you will do next. Communicate it to the owner to prep them in case things go differently.
Hope that helps! Share any similar stories โฌ๏ธ .
๐ฐ ๐๐๐๐๐ ๐๐ ๐๐๐๐ ๐๐๐๐๐ ๐๐ ๐ ๐๐๐ ๐๐๐๐ ...
A lot of these moments happened because I was not confident and did not know exactly what to say.
I struggled to take simple exam findings and transition into my differential and treatment plan.
Instead, I would get in the weeds and word vomit all the exam findings (important or not), and then discuss the 10+ differentials for each clinical sign. ๐
Sure, my internal medicine clinician in vet school would have been impressed with my knowledge retention. BUT, clients were left overwhelmed and confused. ๐ฅด
If you find yourself word vomiting, STOP, breathe, and restart.
Hereโs an example โ An 11 year FS Maltese presents for acute vomiting. Sure, on exam she has horrible dental disease, cataracts, and a few lumps and bumps. BUT the owner is not there for that today. You will overwhelm them if you dive into that rabbit hole today.
Instead, briefly mention those things and how we can address them at a later date (thatโs the GP in me...), but keep the focus on the vomiting. Explain the findings of the soft, comfortable abdomen and significant dehydration. This will help you with your differential list, staging of severity, and diagnostics. Mention a few things you want to rule out like HGE, pancreatitis, etc. and how your diagnostic will guide your treatments. DONโT word vomit the 10-15 differentials because it means nothing to the owner and just scares them.
Simple explanations are enough. Owners just want to know how sick their pet is and what will make them feel better. Donโt fall into the word vomiting trap! ๐คฎ
๐ ๐ค๐ฅ๐ฃ๐ฆ๐๐๐๐๐ ๐ฅ๐ ๐๐๐๐ง๐ "๐จ๐ ๐ฃ๐ ๐๐ฅ ๐จ๐ ๐ฃ๐" ๐๐ค ๐ ๐๐๐จ ๐๐ฃ๐๐...
I was the queen of playing "what-if" or of not following the whole hindsight is 20-20 advice.
There was that time I did not seen pericardial effusion on x-rays (to be fair...it was subtle).
Another time where I knew the client left very upset because they could not afford treatment, and then their cat died the next day.
And anotherrr time when I got into an argument with a staff member and felt poorly about it.
All of these situations are different. One is medical. One is financial. And one is personal. While they are all different, they all affect you the same way.
Each situation like this will weigh heavy on you as a new grad. You have not had enough situations to realize that all of these things are normal. We are human, and mistakes or difficult situations happen to everyone. Even though I know you still will...try not to take it home with you.
Here are a few ways I found helped me to go home and leave "work at work."
-- Vent or chat with a co-worker you trust about the situation. Getting it off your chest and normalizing it helps. Give yourself 10-15 minutes, then let it go.
-- Go home and immediately do something that gets that pent up energy out. For me it is blasting music and singing or working out. SWEAT IT OUT.
-- Journal about it. Sometimes it helps to just get it out on paper. I usually will write all my thoughts down, then crumble it up and can feel the weight come off me immediately.
No matter what it is that helps you...find something and do it repetitively. This is a habit you need to form. It does NOT come easy, but it will make you feel much better in your personal life and more fulfilled as a vet.
๐ธ๐ค ๐ ๐๐๐จ ๐๐ฃ๐๐, ๐ ๐จ๐๐ค ๐๐๐ ๐๐ฅ ๐ฅ๐๐๐๐จ๐ ๐ฃ๐.
This can happen very innocently and is a VERY common mistake of new grads. I saw it all the time and got feedback on this about many new grads.
Here's how it happens...
When you are new, your confidence is prettttty low. You self doubt everything you do and triple check all your decisions. How this falls into teamwork is that it can often lead to micromanaging.
My mistake with teamwork was that I micromanaged EVERYTHING. I remember one time an assistant I was working with was like "Dr. Gray, I got this...move on." It really hit me! I would hover over cases and check every step. This behavior leads to your staff being stressed out and feeling like you do not trust them.
Innocent as it was, it was taking away from other things I could have been doing. I could have been seeing the next patient, typing a few notes in my medical record, or even making a quick phone call to a client. THESE LITTLE MOMENTS MATTER! You need all the extra time you can get as a new grad!!
My best advice...trust your staff. Let them do their job. They are there to help you work as a team to take care of the patients TOGETHER!
๐ธ๐ค ๐ ๐๐๐จ ๐๐ฃ๐๐, ๐ ๐จ๐ ๐ฆ๐๐ ๐ ๐ง๐๐ฃ๐ฅ๐๐๐๐ ๐๐ง๐๐ฃ๐ช๐ฅ๐๐๐๐.
It was a simple diarrhea case: a 4 year old Labrador that had eaten an entire rawhide and then started having diarrhea. This was going to be a slam dunk!
Except...right before I walked into the room, my nurse told me the dog had a borderline fever of 102.4 F. "OH NO," I thought to myself. What if it is more than simple diarrhea? I don't want to miss anything!
So I walked in the room with NO plan whatsoever and just started word vomiting differentials, treatments, diagnostics, possible causes, etc.
Things like this came out of my mouth:
- "So to sum it up, it could just be simple diarrhea, but it could also be a foreign body, which we would need x-rays to tell us about or even the start of an infection because of the fever. Sometimes too, they can also have parasites. So, we have the options of doing a fecal, x-rays, and full blood work on him..."
- "OH, he vomited once a few months ago. That puts Addison's on our list too...."
- "Well, it sounds like there is a lot going on here..." (There wasn't, I had made it a lot.)
I still cringe thinking about how confused that owner was! ๐คฆ๐ปโโ๏ธ Later, I realized the dog had a borderline fever because it was so excited to be there!
So, now let's talk about how I would approach this appointment today:
Here is an example conversation this this owner:
"Since my PE showed your dog appears healthy and is feeling great, I would like to run a fecal first. Based on those results, we can discuss treatment options. If negative, I suggest we treat him conservatively to start with a bland diet (Hill's I/D), probiotic, and metronidazole, which is an antibiotic to rid the gut of bad bacteria, for presumed gastroenteritis from a bad rawhide. Gastroenteritis is inflammation of the GI tract and can happen due to a variety of reasons."
" I can't be 100% certain that is what caused his GI upset, but it seems to fit with the history and since he seems to be feeling great otherwise, I think this is a reasonable place to start before we dig in with more diagnostics. However, if at any point your dog has a poor appetite, vomiting, or isn't responding to the treatment plan, then he needs to come in right away for x-rays and blood work so that we can dig deeper."
After this spiel, ask the owner if the plan sounds ok and offer that if she is worried about him today, we can always proceed with either of these diagnostics today. Lastly, no more rawhides!
This response:
1- Lays out a clear and reasonable initial plan.
2- Lays out a clear back up plan.
3- Gives the owner the option to do more today, if they are worried.
As you can see, we have ALL been there VOTR fam! When you see vets like us out in practice today that seem like we "have it all figured out...," I can guarantee you we all still went through some of these new vet challenges of...
- making things more complicated than they needed to be
- word vomiting up WAY too much information
- struggling to "leave work at work"
- being bad at teamwork
- falling into the trap of overthinking simple cases
We are here to normalize these challenges. Every single new veterinarian will have their own because it takes time to transition your book knowledge to real world cases. It is easier said than done, but we promise each challenge is something you WILL overcome and become a stronger doctor because of it.
Your Vet Mentors,
Ashley and Monica
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