Ahh, veterinary medicine. Look at it, stretching out over the horizon – so pretty. Look at all those referral centres.
Of course, I remember back when it was all fields. Back in my day, you could be a proper mixed vet, expressing anal glands with the lingering scent of cowpat on your fingers, and an MRI scan was a rare and exotic beast from human medicine.
That said, even in the distant mists of the last millennium, when I first picked up my stethoscope, things were changing. I spent my first four years in “mixed” practice, but this effectively meant I worked an almost entirely small animal day job, but occasionally got called out to pull one cow out of another, or to pop a uterus back in.
It made for a varied and interesting working life, but it did mean I got through rather more toilet roll than I otherwise would have done.
And that’s homing in on the point of this blog: generalism is hard.
New specialities
Our profession, as it ever has, is following in the footsteps of human medicine, in that it is becoming increasingly specialised – something I was strongly reminded of at this year’s BSAVA Congress.
It wasn’t so long ago we thought “medicine” was a speciality, but at many of the lectures I attended, the speakers would stop and say something like: “Now, I’m not a radiological oncologist, so it’s not really my field, but…” (for “radiological oncologist”, you could insert “endocrinologist”, “gastroenterologist”, “neurosurgeon” and many more).
Now, at this point, I’d like to clarify that I am not denigrating any one of these fields, nor suggesting they aren’t big enough to justify specialism – every one of them is. In fact, most of them are so big, sub-specialisms exist within them – and each is complicated, fascinating and, crucially, helping to improve animals’ lives and reduce suffering, which is what it’s all about.
However, you would be forgiven for sitting there as a general practitioner, looking at the letters after the names, and plaudits piled on the various specialisms, and thinking something lesser existed about working in general practice. It’s not said, it’s not even suggested, and I don’t think it’s even really implied, but nevertheless, you might infer from it all that specialism is harder, cleverer work than life in general practice.
Complicated concepts
As far as cleverer – well, working in a specialism is definitely far deeper than general practice. There’s so much to know in every field, and many concepts can be complicated and can easily slip out of your brain if you aren’t constantly wrestling them back in (acid-base balance, I’m looking at you).
You need to stay absolutely up to date with the new developments in your field, and in many cases, you need to be making those new developments – and that can be a scary and exciting place to be. Harder, though… well, it probably depends on the specialism, but when you’re a specialist, you have a comfort zone.
It’s an area you know a great deal about, and however complicated and messy that area is, there’s a reason the word “comfort” is in there. There’s a reason for those lecturers saying: “Well, nephrology isn’t really my area,” or why even I, as a humble resident in clinical pathology, will find myself (rightly) saying on the phone: “You’re probably better talking to an oncologist about that,” because he or she is going to have much better information on the current thinking about treatment of inoperable osteosarcoma.
Understand broad details
For general practitioners, though, their “comfort zone” is the entire remit of veterinary medicine. It’s true, no one expects them to know the fine details of each specialism – that’s why there are specialists – but to be a good general practitioner, you need to at least understand the broad details of them all; to understand the scope of them all.
In the space of a day, you will be dealing with endocrinology, oncology, immunology, orthopaedics, integumentary surgery, clinical pathology, bacteriology… that’s only scratching the surface of the ologies, and I haven’t even mentioned end-of-life care, euthanasia, grief counselling and social work.
“Jack of all trades, master of none” is often said disparagingly, but I personally think it is equally valid and equally (if not more so) important to specialism.
As well as having to have, as my boss would say, a “grasshopper” mind, leaping from discipline to discipline, the general practitioner is of vital importance to the client. A specialist is going to help a client through extremely difficult times, and maybe even deal with the loss of someone’s companion, but a good general practitioner will be the friendly face a worried owner can ask for advice and help up to, and including, the birth and death of their pet.
He or she is the client’s link to the massively expanded world of veterinary medicine – a good general practitioner knows when he or she is out of his or her depth, and refers the patient. Even once a client is referred, though, the GP will probably remain the point of contact and the voice of reassurance to him or her.
Changing face of medicine
I’ve said “good general practitioner” a number of times now because there are, of course, bad ones out there – I may have even been one myself.
Practitioners who don’t keep themselves aware of the changing face of medicine, and exactly what is possible; practitioners who refuse to accept specialists know more than them in a given field, and continue to “have a go” at things to the detriment of their patients’ welfare; practitioners who are just trying to get through the day, and have learned they can get away with a lot of bad medicine so long as they say the right thing to the client.
Being a good GP is hard. Attempts have been made to recognise it – although the CertAVP offered by the RCVS can lead to specialism, at its basic level it’s explicitly a certificate in general practice. Sadly, my experience of the general attitude of employers and vets is it doesn’t really count unless it’s in surgery, or dermatology, or something.
So I’m going to say it once again as someone who has, for the most part, left general practice after 17 years – general practice is hard. It may be the hardest thing of all in medicine. I think it’s time we acknowledged it.
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