Resilience and Compassion Fatigue
Our emotions are powerful assistants, but dangerous masters.
Compassion fatigue occurs when we become too involved in our cases that our emotions are affected beyond the consult room to the point where our own reserves are eaten away. The result is either switching off (becoming unemotional and disengaging), or emotional breakdown (where it all becomes too much), both of which are very damaging to ourselves, our relationships and our careers.
As a vet student, I was lucky enough to be taught by Peter Jackson, legend in the fields of reproduction and large animal medicine. I am now privileged to work alongside him at Wood Green the Animals Charity, where he is one of the veterinary trustees. His compassion towards patients always struck a cord amongst myself and fellow students. His subtle tones whispering “Cush, cush chicken”, to a stressed-out cow never failed to settle them… and the students observing him. I asked him to write a blog on how he maintained such gentle compassion after a lengthy career. The answer… professional resolve and peppermints!:
AVOIDING COMPASSION FATIGUE
“As a teenager I remember very clearly visiting the local doctor about a painful elbow. In those days doctors had open house surgery with no appointments. The doctor didn’t look at me as I went in but said ‘Sit down. Tell me your name, address and age. Now, as quickly as possible, tell me what’s wrong with you!’
Perhaps my doctor had compassion fatigue. It’s easy to develop it as you fight against the clock in a ten – minute consultation with a complicated case history. Your conscience reminds now or later that you have rushed your clinical examination and have been a bit impatient with your client.
If you feel compassion fatigue coming on think about why you became a vet. Most of us decided to be a vet whilst at primary school. We wanted to help sick animals and perhaps to be like that clever young vet on TV. We struggled to get a place at vet school, sat countless exams and eventually graduated. On admission to membership of the RCVS we said “I PROMISE AND SOLEMNLY DECLARE that I will pursue the work of my profession with integrity and accept my responsibilities to the public, my clients, and the RCVS, and that, ABOVE ALL, my constant endeavour will be to ensure the health and welfare of animals committed to my care.’
We became members of the veterinary profession and as such we must behave at all times, whatever the pressure, in a professional manner. Our clients expect it and our patients deserve it. A quiet few words as you handle and examine your patient and a friendly word with the owner set the tone for a good consultation.
I worked for many years in general practice where pigs formed a high proportion of our farm livestock. Often arriving at a farm or smallholding there would be a note on the piggery door. “Peter – third sow on right, off her food and piglets hungry please leave note – please write clearly.’ You quickly learned to be stealthy with pigs doing as much as possible without disturbing them. Stroking the sow’s udder and speaking quietly to her you can perform your clinical examination including looking at the feet whilst the sow lies happily there. Far better than shouting ‘Come on get up let’s have a good look at you.’ Have a look at the piglets in their creep. Pick one up by a hind leg to reduce the chance of it squealing. The sow has diamond – shaped elevated lesions on her back and a very high temperature. You quietly give her a s/c penicillin injection as you rub her udder again and tell her she’s a good girl. She doesn’t notice the injection.
As you go out you write a little note ‘Bill, Sow has erysipelas, have injected her and will call again tomorrow. Can we discus vaccination? Peter.’ You write carefully as you remember Bill saying ‘You vets don’t half write badly Peter. I don’t expect to be able to read it ‘cos you vets and doctors always write in Latin don’t you?
You suddenly see another note on the inside of the door. ‘Peter while you’re here can you have a look at the old cat – it’s in the kitchen. She’s got a bad eye. Oh and we found a couple of dead chickens this morning can you do a PM please.’ Your planned timetable of visits is compromised but you dutifully look at the cat and the deceased chickens You radio the office asking them to tell your remaining calls you are going to be at least 30 minutes late. You have a peppermint, take a deep breath and remember to be professional.”
May you be happy as a pig in muck throughout you career!
Different career experiences, written by vets who have learnt along the way. This page is a work in progress – email us with your story if you think it may be of help to colleagues. Alternatively, the Veterinary: Stay, Go, Diversify Facebook community has career profiles and comments from vets in diverse roles.
Working for a feed company
The following blog was originally posted on the Vets: Stay, Go, Diversify Facebook page and has been reproduced here with kind permission of the author. It provides an insightful look at the pros and cons of work outside practice within a large company.
“Having been in my current role as Vet and Equine Nutritionist at a feed company for just coming up to a year I thought some feedback for others considering such a career move from practice or elsewhere might be useful.
For: Working for a big(ish) company has its advantages – training in everything from sales and negotiation to presenting and excel to vet and nutrition CPD. Plus any memberships, registrations, subscriptions or anything else I need are paid for without quibble. Reasonable pay (circa 40-45k) plus benefits and car. Good support, regular appraisals and an emphasis on development.
And the role itself: massively varied with control of your own diary- mix of yard meetings, office meetings, business-to-business collabs, research and advising, teaching, lecturing and organising internal and external CPD. You need to have a commercial interest because any role in the commercial sector has that focus, obviously, but this is a great opportunity to develop your skill set and enough practice to gain some confidence – in proposals, pitches, negotiating, managing and setting budgets and targets, working fast and efficiently (doesn’t come naturally to me!), customer interaction and support, and even marketing, promotion and PR; what works and what doesn’t. There’s a lot do! And pretty much, if you have an idea or interest that you can pitch successfully internally (logistics, investment and returns etc) you have the opportunity to run with it and make it fly which is pretty cool (worry about pressure of making the predicted returns on it later…!). The prospect of working internationally – I currently advise where required from the UK because we have staff elsewhere but there’s definitely the option for more travel in this type of role.
Against: the hours (45+pw plus driving time, usually averages out at a 12 hour work day), driving (500-1000 pw though would depend on where you live and specific role of course), staying away (1-4 nights a week, every week, averages at about 2 pw, with the odd weekend night unavoidable). Sales chat! Quite a time waster. Some internal meetings inevitably end up with a lot of it however. The inefficiency of endless internal admin and reports which divert from doing the actual job – quite similar in other companies and similar roles probably but I have little to compare with in the commercial sector. It is certainly much more than in practice. The inefficiency of a larger company – gaining approval for plans or investments from multiple departments can take a very long time and if you don’t shout loud enough can miss the boat on whatever opportunity you were working on as a result which is frustrating. This is a very competitive sector, which is good sometimes and bad at others! Makes for quite a pressured work environment. There’s positives and negatives to working with big yards – they can be variable to work with, some great and others less so (as vets in practice will know about as well of course).
Overall, this is a great role to broaden and develop your skill set which is increasingly important in the inevitable changes in work force requirements in the future. Whether this role will even be relevant?! But it has been a step in the right direction to develop further after leaving practice. I was certainly not expecting to use my clinical knowledge and skills to the extent I have and having left practice rather demoralised it has reminded me why I wanted to be a vet in the first place, which is quite a relief! I won’t be staying in this role for much longer for the reasons stated above (the driving mostly) but it has provided a good focus for what to do next and, importantly, some great opportunities and contacts for future roles.”
Mentoring – One aim of the Vet Futures initiative (pg38) is to create an intra-professional mentoring scheme. Some pilot schemes are currently underway (e.g. University College Dublin, click here for info). Would you like to take part in a mentoring scheme post graduation? Have your say on our forum
The Vets Christian Fellowship offer an informal mentoring scheme to provide support to members.
If you have connected well with a vet during EMS, or a fellow student a year or two ahead of you, you could request they provide you with peer support when you graduate.
What are your views on mentoring? Do you think it would be helpful? Necessary even, especially in relation to the PDP phase? Have your say on our forums.
Rumination is an entirely detrimental waste of time with no benefits for anybody. Mistakes are inevitable, but if we learn from them and move forward better and stronger then everybody gains. There are hidden dangers to ruminating; adverse effects on both physical and mental health. Click here for more information
Thrive Global have a good blog on How to Fight Negativity and Kickstart Self-Worth
Psychology Today has a couple of great blogs on ruminating. Here’s an excerpt from one:
“Replaying conversations in your head or imagining catastrophic outcomes over and over again isn’t helpful. But solving a problem is.
Ask yourself whether your thinking is productive. If you are actively solving a problem, such as trying to find ways to increase your chances of success, keep working on solutions.
If, however, you’re wasting your time ruminating, change the channel in your brain. Acknowledge that your thoughts aren’t helpful, and get up and go do something else for a few minutes to get your brain focused on something more productive.” Read the full article here for great information on how to stop yourself from worrying.
Why do they not listen? Or worse, why do they appear to listen and then do the complete opposite of what was agreed in the consult? Is it us or them? Our communication, or their hearing??
DEALING WITH DIFFICULT CLIENTS – read this great blog by clinical psychologist Dr. Joanna Cates, with some practical tips for disarming and working with awkward owners.
PATERNALISM VS PARTNERSHIP – recent work suggests the typical paternalistic way of communicating, which the professional-client relationship lends itself to, does not foster a sense of empathy or teamwork.
We need to MOTIVATE clients by the way we speak to them. Here’s an excerpt from a recent paper from the farm animal dept. at Bristol University:
“future communication training may need to incorporate methodologies that foster a mutualistic approach as the backbone of practice rather than a useful aid. For example, one such evidence-based methodology widely adopted in the medical and psychological sciences is Motivational Interviewing (MI). MI practice is not just defined by a set of verbal skills cultivating empathy, collaboration and support of patient autonomy, but by an underpinning philosophy of compassion, acceptance, partnership and evoking (eliciting client ideas, rather than imposing) that act as a mindset to guide practice.”
The VetFutures project is also looking into communication and how to develop this area: “by working in partnership with clients, vets are better positioned to convince them of the value of preventive services”.
I had just had E-NOUGH of revision. 6 years of jam-packed timetables, then a 6 week block at the end with nothing but grim revision… I was stir crazy by the end of the first week, and threatening to quit! My brain just couldn’t hack the monotony of cramming day after day.
So, I broke up my day:
6am: wake up, revise with a cup of tea for a couple of quiet, productive hours. Phone off!
8am: stop, eat a good breakfast, chat to housemates for half an hour
8.30-11am: revise. Phone off!
11am: Enough! No more! Can’t hack it any more!!! Stop for half an hour and make a revision super smoothie. Half an hour of chilling with social media.
11.30am: cycle to vet school library and revise until 1pm. Phone off!
1-2pm: lunch with the library crowd. Preferably outside. Often followed by a nap for half an hour in the sun!
2-4pm: revise in the library. Phone off!
4-5.30pm: go for a run / do some exercise of some form then cycle home, shower
5.30-7pm: final bit of revision. Phone off!
7pm: make dinner. Sit on sofa with housemates, watching utterly mindless television. Big Brother… Real housewives… Eastenders….
10pm: bedtime, utterly relaxed and brain able to process all the information from earlier.
It worked for me… although I later learnt that anyone in the library after 8pm became part of the mutual massage club. They would take it in turns to massage each others’ shoulders and neck. Missed a trick there!
Other friends decamped to coffee shops. Some went home to their parents. I went up to the Lake District to a practice where I’d seen lots of EMS… I sat and went through their X-ray library and went out on calls for a break… I even did my first solo cow C-section during my revision period. I learnt more there than I did in the library.
The day before my first exam I went for a deep tissue back massage at 2pm and did no revision afterwards. It was a great decision – I was fresh and relaxed for exams, and had much better perspective.
EXAM SUPER SMOOTHIE I created this in my final year (what else do you do when you’re supposed to be revising?!). It was the perfect psychological boost in the middle of the morning when my enthusiasm was starting to wane. Tastes like chocolate milkshake. Contains caffeine. Is healthy. What more do you need?
1 ripe banana (too ripe to eat so it’s super sweet!)
1 shot of espresso, or 1 teaspoon of instant coffee granules (optional caffeine kick)
1-2 rounded teaspoons of cocoa powder
Squirt of honey (start with a small squeeze and test the sweetness – you might need more if your bananas are still at the edible stage of ripeness).
Some milk – how much depends on how thick you like your smoothie.
You’ll need a smoothie maker, but mine was a £10 handheld stick one from a supermarket, so it doesn’t have to be fancy.
Try adding a handful of porridge oats for a tasty breakfast
Add a few drops of vanilla essence to add a bit of sweetness (optional), or vanilla yoghurt (adds a bit of rich creamy taste)
Like it colder – more like a milkshake? Simply peel and freeze your spotty old bananas in a bag and break them into the smoothie maker straight from the freezer.
Milk variations – soya, almond, or try it with coconut milk (I’ve never done this… let me know if you do!)
Make up your own and post below – I graduated over a decade ago and I still make this smoothie as a pick me up… but I’d love to try your alternatives.
How do you survive exams? Read a blog from an exam sick final year. Or click HERE for a great blog from Student minds
Exam tips – learn to think like a vet, rather than regurgitate a load of facts for an exam.
Study Aids: super smoothie recipe, super-naps (research shows coffee and a nap is better than coffee or a nap to recharge your batteries).
Client Communication – Our ability to do the job we trained for depends entirely on our clients, yet we’re taught precious little on how best to engage with them. Click HERE for resources on improving your client skills… and consequently your ability to vet effectively.