Embrace The Anal Gland!
There has been much discussion recently about the dissatisfaction and drop-out rates among vets, especially those early in their careers. In more more less every debate I see the phrase ‘nobody wants to be expressing anal glands and vaccinating all day’ and suggestions that we somehow need to select less ‘high achieving’ individuals to universities, lest they become disillusioned by such menial tasks, especially in first opinion practice.
What finally irritated me enough to write an article in defence of all us slaving away at the coal face of disease prevention and body cavity expiration was seeing, in quick succession; an advert in the national veterinary press from an ECC employer implying that emptying anal glands is somehow beneath a veterinarians skill and then reading a final year student on Twitter dismissing a career in first opinion practice because ‘over 30% of consultations are preventative health’ and as he was more keen on ‘ good clinical work-ups than client communication’, he saw his future in referral clinics only.
Clearly I can’t get too riled at the naivety of someone who has never been in practice and obviously there are people for whom ECC work represents a blessed relief from the mundane (although I have expressed emergency anal glands out-of-hours, being a criticalist doesn’t preclude you from those succulent sacs!) but when we put these incidents together, along with the many others I come across, I believe it represents a pernicious denigration of first opinion practitioners and our role in the profession.
Perhaps a more pertinent question for the student is how he reached his conclusions in the first place. Could it be that our venerable centres of veterinary education, staffed as they are by academics and diploma holders, hold a less than flattering view of the bedrock of the profession? And if they do, is this what is contributing to the, seemingly growing, dissatisfaction of the newly graduated? Are they already conditioned to view routine consultations as boring and unchallenging? Do they believe they can only truly apply their skills and knowledge in a referral setting?
Is there an emphasis on referral level diagnostic and procedures in teaching at the expense of what is truly relevant to a newly graduated veterinarian? Maybe things have changed since I was at university but I certainly remember sitting through hours and hours of step-by-step spinal surgeries but just a single afternoon on dentistry.
I have no idea (Indeed, I recently did some tutoring at Nottingham University and was impressed by the emphasis placed on realistic ‘real world’ limitations to diagnosis , including cost implications, in the teaching sessions) but I am hearing anecdotes like the ones above more and more.
I also wonder if an increasing lack of good quality EMS placements in general practice is an issue. (Destined only to get worse with the rampant ambitions of some universities, desperate for a piece of the veterinary education cash cow) Without the opportunity to spend significant time in clinics and see the many and varied skills of the first opinion vet for themselves, is it any wonder graduates are entering this profession without a realistic idea of what they will be able to achieve?
What is so wrong with expressing anal glands anyway? It gives our patients immediate relief from a very painful problem, it is potentially an opportunity for us to educate about diet or lifestyle and is generally viewed by clients as nothing short of miraculous!
And vaccines – are they not the single more important medicine we prescribe? They have saved countless lives and are an annual opportunity to assess the health and welfare of a pet. Without their yearly booster, how many would come in only at the end stages of a disease process, given the average owners famed inability to recognise issues?
Maybe we in general practice should hold ourselves responsible in some ways as well for not seeing these skills as valuable and, indeed, skilful. Sure, we all view boosters as a good way to catch up in a busy consulting period, but let’s celebrate the ability we have to fully examine an animal, question it’s owner, make small talk and administer an injection without it flinching (Chihuahua’s excepted!) all within 10 minutes or less.
It is true that life in first opinion practice can be stressful, tiring and difficult but it is also rewarding, satisfying and fun! And, in my experience, most of the frustrations are as a result of clinic management and support rather than the clinical work itself.
One more thing; if I need to refer a patient, I will actively chose a colleague who has spent a significant portion of time in first opinion practice . I find they are better with my clients (one still needs to be a skilful communicator in the ivory towers), more respectful of budgets, and more aware, and forgiving, of the limitations of general practice, than those who left the coal face as soon as they could.
First opinion veterinarians are the forefront and the backbone our profession. We are the primary advocates and protectors of animal health and welfare. We do an incredible job, make a huge difference to our patients and work in teams of equally awesome people. Our caseload extends from the preventative and routine, to the unusual, complex and challenging. None of it is boring, and all of it is vital. Also, we have the potential to extend our, already enviable, abilities in a myriad of directions encompassing practically every aspect of medicine and surgery without ever having to leave the clinic.
As general practitioners, we must realise and celebrate these qualities and make sure that every new generation of vets do as well.