Suicide: a compound problem

The perennial topic of comparative suicide rates in different professions came up this weekend at my course.

I am in a group of nurses, lawyers, doctors, dentists, and midwives. Over lunch one of the doctors brought up the comparative suicide rates for the professions represented at my course and, as is well known, vets top the list by some margin. The usual well-worn reason of easy access and knowledge to the instruments of suicide came up.

I say “well-worn” because it doesn’t hold much truck with me.

I don’t know how to get hold of the information in the first place, so this is said from a position of consideration rather than information, but I’d like to know the relative methods of suicide employed and what each of the victims had been doing before they did the deed before I dismiss such an appalling state of affairs as quickly as to say “it’s because it’s easier for us”.

A closer look

I don’t think it’s that simple or that nice an answer, and I think that both those who have ended their own lives and those who are at risk of it deserve greater scrutiny.

Yes, it is easier to get your hands on the materials; pentobarbitone is in great supply, being accessible in huge amounts, and we all have the knowledge and the skill set to make sure it is delivered in lethal amounts rather than just ending up in A&E with a headache. Insulin was another method mentioned, though I don’t know if anyone has actually used it in that way. Opiates are readily available too.

I think this is a factor, but we need to look at why these people reach this position in the first place. I wonder if it is anything to do with the type of people in the profession and the way the profession works?

Best of the best

Veterinary undergraduates are the elite of school leavers. High grades and years of dedication are needed just to be considered for a place at a British vet school. Getting through vet school is no easy feat either, though most manage it. Undergraduates are taught to a very high standard and leave vet school having been taught their craft by some of the best in the world at their disciplines.

Where to go from here? You can go back to vet school and climb the academic ladder. Competition for training places is intense, and as the training scholar staff list at most UK vet schools reads, the competition is international.

I openly admit I tried to get in to numerous clinical training scholarships. Some didn’t even bother informing me of rejection for weeks after the appointment had been made..!

So, in general practice, one then usually has to make one’s own way. If you are lucky you’ll be allowed to learn and practise in a practice that does things resembling the way you are taught. If you are unlucky you can be mired in a place devoid of enthusiasm riven with personal politics and awash with steroids and amoxicillin.

Covering it up

Stress is often covered up in a somewhat “macho” way and can come in many forms; vets are not shown respect by the people who work with them; vets are the fee-earners in veterinary practices with long and arduous training and yet are often ordered about and treated with comparatively little respect (in my experience).

Vets become vets to fix animals and alleviate pain illness and suffering. Vets are employed by practices to earn money by selling stuff. Monetary targets can often be set, compounding the feeling of being regarded as a salesman rather than a skilled professional.

It has also been shown that a source of stress to people, and particularly intelligent professionals, is a lack of control over work done. Vets, particularly employed vets, have little control; their appointments are made for them, they have to grind through this list daily, and annoying clients cannot be “fired” unless you own the practice, and in my time I have met only one practice owner willing to get rid of annoying clients. It is rare for vets to be able to pick what they do in a day’s work. Days off are rare. Vets also usually work the whole day but watch other members of staff coming and going through the day.

The profession is very poorly paid. To start off with new graduates are comparable or better off than new graduates in other professions, but the others (doctors, lawyers/barristers, dentists) all overtake vets after a few years. As a GP doctor I would be earning double or triple what I am now, and have fairly minimal on-call. As a consultant I would be able to earn much more working both on the NHS and privately. Not an end in itself but it beats being hard-up, particularly with children to bring up.

What’s next?

Then after a few years the vet will probably start to think “what now”? Start to get extra qualifications? Own a practice? Locum and travel? Boredom can cloud one’s judgement and ideas for what to do next.

Extra qualifications are expensive; I was bluntly informed by a previous employer that my studying for the CertZooMed would not be paid for by the practice and would not result in any change in my employment terms (read pay or leave allowance there!).

I started to pay for it myself but the costs of the courses, books, fees and so on were so crippling on my salary that I had to face the fact that this was a poor business decision on my part!

This is also still quite a “macho” profession where total dedication to the cause of the practice is expected and assumed and anyone who, say, doesn’t want to attend meetings out of hours is thought to be less worthy in some way.

Postulation

Contributing to this is the ever-present bogeymen of unhappy owners, negligence, and the RCVS, the latter is a particularly personal and, I argue in a later blog, unfair bogeyman.

I postulate, and this is just a thought, not an opinion, that the high suicide rate in this profession is a compound problem and it includes ease of access to the materials, but is aggravated by disappointment and disillusionment, and the effects being a vet has on home life and relationships as well.

These are going to be compounded with the influx of new vets the new vet schools are going to bring, as well as pressure from overseas. Even all these may not be enough to push people over that edge, but they will all contribute I think.