Wednesday, 2 August 2017

Joining a directorship and having a life?!?!?!

I am currently 33 and just about to buy into an established equine practice.  I have been a salaried director for 2 years having joined the practice just over two and a half years ago with the intention of joining the directorship.  I have worked in 100% equine practice for most of my career (bar a short stint in mixed practice as a new graduate) and have always looked for the next challenge!!  Prior to joining my current practice I worked for four and a half years in a fantastic practice as an equine vet, but felt I had to leave as there were no directorship opportunities and it wasn’t particularly near my family.  I was reluctant to settle into life long term as an assistant, and 3 hours from my family home.  I have always been one of those annoying people who relishes the most difficult option in life.  I remember being told by numerous careers advisors that I should pick a different degree course to apply for as ‘nobody gets into vet school’ (which was true of the college I did my A Levels at), but all this did was spur me on to prove them all wrong.

Having achieved a certificate in Equine Orthopaedics and Advanced Practitioner Status in my previous practice I was then looking for the next challenge.  I decided to look for a job nearer my family and with more opportunity for progression.  I only applied for one job, met my now business partner and decided there and then that this was the right place for me.  The practice needed some modernisation, but I got on well with my now partner, we had a very similar outlook on things and she complemented my orthopaedic bias by being an Advanced Practitioner in Equine Medicine and an experienced stud vet.

Rather naively I thought moving to a new practice with a few more letters after my name would cement me into the practice team quickly and gain me a name with the clients.  This didn’t happen – I still spend time doing vaccinations, being rejected by clients for being new, getting complaints because I didn’t do things in the same way ‘xxxx’ used to.

Joining the directorship has been a HUGE challenge – possibly more than I was looking for.  At times I have gone home and cried after yet another staff member has moaned about lack of communication in the practice, or handed in their notice when we are already short staffed.  The clients have been critical at times too, some of the long established clients have complained about my bedside manner and disliked the new practices adopted (not least that we now insist they pay their bills…).  I have come to the realization that you have to expect everything to be slightly falling apart all of the time – there is always someone complaining, someone leaving, someone off sick, some difficult case that has been pushed in your direction.  I am getting better at leaving it at work and trying to relax in my own time, but it is much harder once the buck stops with you.  I now get to fret about the practice finances, staff members, cars, equipment, H+S, practice standards inspection, accountants and a whole load of other stuff that never even crossed my mind when I was just a vet.

On the whole though I am enjoying it, I am now in a position where I can make decisions – hopefully to the benefit of our team and the business.  I am enjoying learning new skills (last week I learnt how to do the till rec after someone in accounts decided the best time to retire at short notice was when someone else in accounts was on holiday) and find the prospect of growing the business exciting.  I take great pride in every letter of thanks, every favourable Facebook post and tweet, every client who tells me how much they like one of our vets or nurses.  I am slowly winning round some of our long standing clients, but I think it will take time.  Being a director does not fast track you to the top of their ‘favourite vet’ list – you have to clock up years of service like everyone else.  

In terms of work life balance I am finding it hard.  I am writing this on a Tuesday evening several months after I was asked to write it because of lack of time.  I have been on CPD courses learning about putting all your tasks into categories and spending time doing the important but not urgent things – I fail at this mostly and spend lots of time doing urgent unimportant things!!  I am constantly worried about neglecting my friends and family by working too hard, so try to cram lots into my weekends off.  I have managed to maintain some rules from my life as an assistant – I still switch off my work phone when I’m not on call (though my colleagues have my private number my clients don’t), I vowed to take every single day of my holiday allowance every year and my allocated TOIL and so far, I have.  I try to exercise a few evenings a week and spend time with my other half.  I get up earlier so that I can ride my horse before work – meaning I can start the day with something enjoyable and not immediately be greeted with problems (this plan back fires if the horse throws me off which has happened a few times….).  Overall I think becoming a director has been the right choice for me, but it is a lot of work and stress which I don’t think you can appreciate until you make the jump.  My advice would be to find a practice where you get on well with the other directors – they will be your partners – the rest of the team are important but your fellow directors are the people who need to have your back.  I would probably suggest working in a practice a bit longer than I did before taking the plunge, it has been hard to gain the clients trust and loyalty at the same time as the staff, if I had more years of service under my belt I wouldn’t necessarily of had to do both at the same time.

Tuesday, 13 June 2017

Bullying with some positives

Be nice…sounds simple doesn’t it? But why does it seem so difficult to find a job in academia where people are simply pleasant to each other? Having experienced several years of upset within my own workplace, I have started to question, is being nice enough?

I’ve worked in academia and in private practice both in the UK and abroad. Is there more bullying and negative behaviour in academia? I don’t know, but what I can say, is that based on my experiences, it certainly feels so.

One would hope that academia would be full of like-minded professionals, keen to advance the boundaries of veterinary medicine. Unfortunately, the reality can be one of an environment tarnished by interpersonal disagreement, professional rivalry and immense stress and loneliness. Behaviour that would not be tolerated in private practice seems rife in the university setting.

I have witnessed bullying, some of which was extreme, go unreported, or worse still, be ignored by heads of department and by human resource staff.  Have I been guilty of turning a blind eye to such negative behaviour? Unfortunately, I have. I’ve fallen into the “Be nice Paradox” and smiled, gritted my teeth and walked away, trying to be the grey man, to blend into the background, to avoid being the next victim and to stay out of trouble. Do I regret this? Every day. Never more so than when I look at my children and I feel like a hypocrite telling them to always stand up to bullies….something I have failed to do.

It is easy to start out as idealistic, but it only takes a couple of failed attempts of seeking help for people to simply stop trying and to ignore the problem. I once tried to discuss an issue with a head of department to be told that if I took the matter further he would “make life very difficult” for me. Is it any wonder that we have problems when we have with attitudes like this from leaders? As vets, we seem used to just getting on with things and never want to trouble others with our problems for fear of looking weak. Surely, when a problem becomes bad enough that it is reported, it should be taken seriously?

In a profession diseased with high rate of depression, burn out and suicide, we really need to be mindful and to watch out for our colleagues. I am so tired of seeing friends and colleagues either burn out and become disillusioned with the profession after years of bullying or those who perpetuate the problem and become the bully that they once despised.

In my experience, the people who tend to survive in such a toxic environment are those who take a back seat from the office politics and get on with their job as an individual as much as possible. Certainly, this can improve quality of life for the individual, but is this really the way we should be working? Shouldn’t we be tapping into the potential of teamwork to give the best quality of care to our patients, while pushing the boundaries of research and clinical expertise?

Is it as bad as it sounds? It can be, but as with any job in our field, there are some wonderful colleagues out there. Certainly, I have had the privilege of working with some outstanding members of the profession and some of my closest, most treasured of friendships have been made at work. Indeed, it is often easier to socialise with colleagues as they are the very people who never mind when dinner reservations are delayed or cancelled because of a blocked cat or a GDV and they are the people who will truly understand when you need to offload the stresses of a difficult surgery or euthanasia. To be so bold as to paraphrase Dickens, it can be the worst of times, but it can also be the best of times. We are after all a profession of caring people who just want to please people and improve quality of life of animals.

Perhaps we need to stop trying to simply be nice and instead try to be brave, to promote a zero tolerance approach to bullying, to stand up to bullies and to lead by example.

Thursday, 1 June 2017

Bullying and survival in academia: is the female-female divide bigger than the male-female divide?

For those vets working in academia, the priorities between teaching, research and running clinics have always been hard to balance. Universities tend to swing between putting research first when the Research Excellence Framework (or, Research Assessment Exercise, as it used to be known), is on the horizon; and then swing in the opposite direction when the Teaching Excellence Framework (formerly, Teaching Quality Exercise), becomes the focus. Despite teaching bringing in the far greater income, “research”, however, remains the measure of a University’s excellence; and despite what most mission statements say, research lies at the heart of the ‘measured’ success/prowess of a university and drives HEFCE funding allocations.

So how does a vet, employed as an academic, fulfil obligations to perform research to the highest standard, attracting multi-million pound grants on a regular basis, yet simultaneously maintain a clinical commitment, usually with an out-of-hours on-call requirement, and all this with a heavy teaching load? There is no simple answer, as most of us aren’t Superman or Wonder woman. And for some, their mere survival in academia is fraught with jealousies, back-stabbing and plagiarism. If there’s one thing for certain, you need eyes in the back of your head and a very very thick skin to survive and thrive in academia. There is no room for sensitivities; and not much for high morals or a conscience! Those that climb the academic ladder tend to assure their position by trampling on those around them, usually after using them as leverage. And once at the top, most will then withdraw the ladder, effectively stopping others joining them. The Hubris syndrome is common indeed and bullying, from the top-down, is rife, despite most institutions having ‘policies’ to supposedly guard against such behaviour.


Although the press is full of woe regarding the male-female divide in terms of wages, most universities don’t do so badly on that front, especially those applying for Athena Swan recognition – but there’s still room for improvement as there are still fewer women in the highest positions than men. However, the most noticeable battles, and usually of the bullying type, appear to be between women, especially between those at the top and those aspiring for promotion. It seems such a shame that after fighting for equality in the work place with their male colleagues, women seem to be fighting most amongst themselves. Perhaps now is the time that they should take heed of this, examine themselves in the mirror, and stop the bullying?

Thursday, 20 April 2017

Suicide

Nobody heard him, the dead man,
But still he lay moaning:
I was much further out than you thought
And not waving but drowning.

Poor chap, he always loved larking
And now he’s dead
It must have been too cold for him his heart gave way,
They said.

Oh, no no no, it was too cold always
(Still the dead one lay moaning)
I was much too far out all my life
And not waving but drowning.

Stevie Smith


I attended funeral about 3 months ago. A family member who killed themselves.

The dogs, frantic through the night, found him first, then his son. Just imagine.

We stood in the rain, a community of working people, heads bowed, in suits too big or too small, around a fresh grave with hot tears.

He wasn't a strange man, or a desperate man. Just a man lost in day to day banality and finally lost in his mind.

And I was angry. Not with him, with him I felt nothing but an aching pity I couldn't have reached out to him at that unGodly desolate hour and given him peace, but with the people who said "I'm not surprised."

"I'm not surprised!?" Because you saw the mental and physical deterioration that resulted in such a violent and tragic end when you could have stepped in?

"I'm not surprised" because of the situation or the work, his position or the circumstances he found himself in?

"I'm not surprised" because it's considered normal for a hard working man in a stressful and lonely position to take his own life and allow his family to find his bloody remains mixed with a muddy yard?

I'm still angry.

Then I received news a couple of days ago about a vet I taught. Dr K God bless you. He ended his life.

Also alone, in some dark place he could only find one way of escaping.

I recall him as a jolly person, always willing to participate. I don't know what happened, only that he was found alone. He was buried this morning surrounded by a huge number of people.

A few weeks ago I lectured at SEVA and was lucky enough to be invited to the evening dinner where I sat with several final year students. One lady I spoke with carried the nervousness I could only ascribe to social anxiety and the excema on her forearms and tic of trying to conceal her scratching belied something I feared may become more ugly with the exposure a young graduate is faced with from day one and which only grows with increasing responsibility.

I spoke with her for little more than 45 minutes but slept fitfully that night wondering what my duty as a fellow colleague should be, or whether my observations were aberrant and even offensive?
I've always been astounded by the trail of tragedy that follows veterinary medicine in its literal wake. Depression, alcoholism, family break ups, injury and suicide. It is so common place that it is met with the "I'm not surprised" dismissive and idiotic "the show must go on."

If anyone is reading this and is in that place. The place where your thoughts are not your own, where the next day envelopes you in fear, where the need to escape may trickle in ideas of death. We know that it hurts, that you are not alone and that at last help is there. In Vetlife, in MindMatters, in the Samaritans, in AA, in a call to a colleague or a friend, on a knock on the door of a neighbor. I only ask and beg that you never allow anyone to utter the words "I'm not surprised."

If you need to talk to someone, Vetlife Helpline is avaialble 24 hours a day. Call: 0303 040 2551 or email via the website: http://www.vetlife.org.uk

Ben Sturgeon

Monday, 3 April 2017

A reply to Booze

I am really surprised at how few responses there are to this blog. Yes, it is about alcohol, but it is also about the need we equine vets have for support and compassion from both within and outside the profession.


Thank you to the author of the blog for sharing your story, which is painful to read, and no doubt worse to be part of. I’m sure that you are a good equine vet – and certainly good enough - because you obviously care very much about your patients, clients and professional standing.


What is it that is missing from the veterinary profession that makes this is such a common story? I know others who did not manage to extricate themselves from the downward spiral and ultimately paid with their lives. Depression, loneliness, isolation and then liver failure. Sadly, far from being supported, they were actually ridiculed and left to struggle alone.


Most of us want to be the best we can be and strive to achieve this. Unfortunately in too many practices there seems to be an element of competition rather than collaboration between individual vets. I was lucky enough to realise that there were times when I needed to bounce ideas off a colleague or receive specialist advice so we developed a network of friends who had expertise in different areas and we could phone for advice at any time. So often all it takes is a 2-minute phone call in a moment of uncertainty to allow one to proceed with confidence. Caring and sharing with a few moments of one’s time . . .


Things don’t always go perfectly and our work is never over as there is always the next difficult case. Thankfully the profession is recognising the importance of looking after mental health with its increasing programme of ‘mindfulness’. But awareness and empathy have to come from within practices. Could it be that with the corporate ‘takeover’ vets will have time to look after each other? Perhaps the remaining independent practices will consider this a priority. Thirty four years in equine practice has been a privilege and at the age of 60 I am not planning to retire. If I had my time again I would not change my career path but it would have been nice to have more support at times along the way.

Sue Devereux

Friday, 10 March 2017

Is work killing you and your patients?

Irrespective of disease presentation and progression the ability of a clinician to make an accurate diagnosis and implement appropriate treatment is paramount in outcomes and prognosis. Most veterinary work requires out of hours work or shift patterns and the equine veterinary surgeon is arguably most likely to experience and undertake a multiplicity.

Our photo-periodic health or circadian rhythms are entrained by the paired suprachiasmatic nuclei (SCN) of the anterior hypothalamus which regulate a host of diverse physiologic processes from sleep, behavioural activity and appetite, through to hormone and steroid production and function, hepatic activity and renal excretion. Interference of these rhythms are associated with many pathological conditions; simple disturbances of sleep or in sleep quality results in excessive daytime sleepiness is referred to as “chrono-fatigue” or “Shift Maladaptation Syndrome,” however, increasingly more significant conditions such as cancer, metabolic syndrome, cardiovascular disease, diabetes, depression, arthritis and asthma have been recognised. The effect of shift or night work has been demonstrated for example, to effect gene expression at the level of the SCN and influences release of various hormones, protein products and cytokines. To take mental illness as an example; chronic stress as experienced by emergency or regular night work has been shown to reduce Brain Derived Neurotrophic Factor (BDNF), which provides feedback from the periphery to the SCN, and a link between chronic stress and BDNF levels with anxiety and depression in people has been demonstrated . Whilst the incidence of cancer among veterinary surgeons in general is unknown, the incidence of depression and mental disorders is above national averages.

Furthermore and importantly, to improve the clinical prognosis of any patient, the ability of the clinician, especially those where work is out-with normal hours, and almost by definition of a stressful nature, to maintain objective and rational cognitive decisions is vital in allowing correct diagnosis, implementation of appropriate therapy and avoidance of medical error. Unsurprisingly, cognitive function is most efficient when well rested. Whilst fatigue can occur independently of sleep deprivation, for example during high stress periods; it often arises due to the nature of equine veterinary work and can lead to error. Diagnostic error can be categorized into 3 major groupings: no-fault, systemic and cognitive. No fault errors occur when disease is silent or atypical, systemic errors are attributed to system failures but it is in the human-factors and individual characteristics influencing cognitive and affective behaviour and decision making that is most influenced by day/night influence or chronobiology. Under conditions of stress, including fatigue, the manner in which a clinician differentiates and implements diagnostic or therapeutic protocols depends and is determined by a variety of factors and it is the summation of these factors which leads, hopefully, to one or a limited number of cognitive dispositions to respond (CDRs) and a diagnostic and therapeutic protocol (Figure 1).

Image

Figure 1: CDR determining factors and actions. From Henriksen et al (2005). Advances in Patient Safety: From Research to Implementation 

As highlighted there are a number of determinants of CDRs but they largely fall into 3 groupings: ambient conditions, past experience and impact of affective state, and arguably all three can be influenced by chronobiology. For example; temperature, activity level, motivation and other variables that may affect clinical performance are influenced by diurnal phase in many individuals. Premenopausal women may be subject to infradian mood variations, circannual influences such as winter darkness can exert a negative influence on affective state, and the circadian dys-synchronicity that results from shift work, common in equine veterinary medicine, can predispose to depressive-like symptoms. These various influences are collectively referred to as affective dispositions to respond (ADRs) and compromise cognitive control and therefore the efficacy of clinical decision making (Table 1): 

Table 1: Potential Chronobiological Influences on Affective Dispositions to Respond

 1. Specific affective biases in decision making 

2. Endogenous affective disorders within the clinician 
•  Depressive disorders 
•  Anxiety disorders 
•  Manic disorders 

3. Emotional dysregulation in clinicians 
•  Unconscious defences, avoidance, anxiety 
•  Emotional involvement or detachment 

Adapted from Henriksen et al (2005). Advances in Patient Safety: From Research to Implementation. 

Long hours of work, sleep deprivation, stress and accumulated sleep debt are common in the equine veterinary workplace. Generally, the longer people stay awake, the sleepier they become and their cognitive and psychomotor performance is impaired reaching its nadir between 3-4 am when cognitive performance is the equivalent of being intoxicated. This brings in to sharp focus veterinary actions to perform intricate surgery, or make life-influencing decisions, during those hours or, perhaps suggesting that postponement to daylight hours is preferential.  

There has long been an association between sleep deprivation and medical error, and was found to have the greatest impact on diagnostic error with interns making substantially more serious errors when they worked frequent shifts of 24 hours or more than when working shorter shifts. This was supported in later studies which also identified additional effects including a higher predisposition to road traffic accidents, a highly relevant finding for the ambulatory vet. 

Interestingly people are recognized as demonstrating different chronotypes, with their sleep-wake cycle to the light-dark cycle differing between individuals. This is generally expressed as “larks” for early chronotypes and as “owls” for late ones and can be quantified perhaps suggesting the possibility of selecting people more suited to certain shifted roles. 

Whilst a number of chemical aids have been used to alleviate fatigue and psychophysiological performance their effects were limited and more work needs to be directed at management with preventative strategies and protocols implemented to reduce the potential for diagnostic error addressing both CDRs and ADRs.  These may include heightened metacognition, simulation training and development of cognitive forcing strategies but could just as well be asking for a few more hours in bed. 

 Ben Sturgeon




Wednesday, 8 March 2017

How do you know you exist?

The short answer is you don’t. But is very clear that each of us tends to have a robust experience and sense that “I exist.” In the latest Veterinary Record (180(7):165) a study is presented examining the potential benefits of exercise in stress relief. You can almost certainly predict the results and whilst I in no way belittle a novel approach, I believe it goes far deeper than a simple biological saturation with endorphins.

I was asked, in an interview, several years ago, why did I think vets, including myself, undertook extreme sports during their down time? I answered it was because of their type A personality but knew that answered nothing other than incorrectly associating cause and causality.

Interestingly there is a neuropsychological condition called Cotard’s syndrome, where people are convinced they do not exist. It has been shown that in such people, brain scans demonstrate that activity in the area of the brain associated with internal awareness is low. Down even to levels seen in people who are minimally conscious and so creating a perception of non-existence.

In the deeply claustrophobic world of depression, a plight suffered by many and seemingly increasing numbers of vets, there is often a feeling of non-existence. A living state of existence without value, existence without recognition, existence without self.

I know that going for a run, no matter how endorphin inducing, does little to remove this core feeling, and it is in my view crass to suggest to a sufferer to “go for a run.” Extrapolating from Cotard’s however suggests that by creating a vivid perception of our body and its various states, our brain also generates the feeling of existence of self, a vital sense of worth that may aid in a simple but vital step toward improvement.

But is not just perception of our bodies, it could be perception of spaces, of environments, of countryside, of people, music, art, food, science, dance….. Anything that reawakens the mind and person to their existence as a vital and necessary human being. Whilst the need for recreation and escapism will always exist, whilst exercise is a valid aspect of therapy, don’t forget or ignore that the variety of life may be all you need to remember and remind you that you do truly exist.

Ben Sturgeon