What makes a good vet?

Re: What makes a good vet?

Mark Hedberg — Sun, 19 Jun 2011 21:17:18 GMT

There's a bit of ham in all of us, I'd suspect. (I read that somewhere but I simply can't remember where...)

Re: What makes a good vet?

mariette asselbergs — Sun, 19 Jun 2011 20:16:46 GMT

[quote user="plantagenet"]

Hmm...... just thinking after that mention of Darwin, didn't he base his theory precisely on the fact that he recognised patterns, amongst the beaks of finches and many other examples. Does this make him a good scientist?

[/quote]

Yes he saw the patterns but others had seen these things before. It was Darwin's genius (creative, artistic mind?) to propose a theory for the mechanism of evolution: Natural Selection. To prove or disprove this mechanism for evolution was then again the job of the logical hard working disciplined scientists......

Mariette

Re: What makes a good vet?

mariette asselbergs — Sun, 19 Jun 2011 18:13:42 GMT

It just occurred to me that there is another important aspect of being a good vet, at least it helps greatly. And this is also an aspect of "the art of veterinary medicine". This is the art of the performance. Technique alone is not enough. It helps if it is also a good show. Take your way of working with aggressive or scared animals, taking blood from a huge fierce bull, replacing a dislocated joint, passing a nasopharyngeal tube in a nervous horse or placing diagnostic anaesthesia injections to find the site of lameness. Part of the art of vet science is in the way you do things. No science involved, technique yes, but also the nowadays maligned James Herriott example. Some vets are great performers, many are just too modest maybe?

Re: What makes a good vet?

plantagenet — Sat, 18 Jun 2011 17:55:41 GMT

Re: What makes a good vet?

Cailyn Brown — Sat, 18 Jun 2011 05:34:21 GMT

[quote user="Richard Fox"]

Hmm - Yes I think knowledge is one of the most important criteria about being a good vet - In my experience many vets are just concerned with treatment knowledge and fail to grasp that attaining a suitable diagnosis is actually quite important?

[/quote]

Hey Richard

You are right

For each and every field you need to have the specific knowledge. But there is some other factors also which makes a person best in that field. These are experience and a good money. Experience helps a young person to decide if a work area is likely to be what he wants. Specifically veterinary technician, and veterinary medicine students should know beforehand whether they are comfortable with animals or not. Otherwise in long run it might lead to dissatisfaction. One of my undergrad friend while working part time with a private vet clinic only realized that he wants to make a career as veterinary technician. He did the distance course from a reputed university and is now earning a healthy salary. I think following article can give an idea about the income of a vet tech. http://veterinariantechnician.org/salary-information-for-veterinarian-technicians/ So now he has knowledge, experience and is getting awesome rewards also. All these things are giving him a job satisfaction and motivation to become a good vet. Anybody here wants to give any comment on this is heartily welcomed.

Thanks

Re: What makes a good vet?

mariette asselbergs — Fri, 17 Jun 2011 18:38:44 GMT

At this year's Hay Festival Paul Nurse the Nobel biologist and President of the Royal Society gave a lecture (on Milton and Darwin) during which he explained his view on the role of artists in science. In his view scientists use the discipline of the scientific method to constantly challenge "scientific knowledge". But then you have a number of findings, often conflicting and confusing, and it is in the creation of hypotheses, explaining your findings, that you may get great help from the creative, artistic mind, thinking outside the box and not in the paradigm or pattern of the present day "best practice". I found that extremely helpful in sort of reconciling the two, and I think it is in the same way the art and the science of vet medicine works in combination. They are not conflicting or in contrast, although both can be used in a sloppy way with exclusion of the other.

(Friday end of week meditation .....

Mariette)

Re: What makes a good vet?

Hannah Wynne Richards — Fri, 17 Jun 2011 15:57:05 GMT

In an ideal world veterinary medicine would be a science. Richard is a pathologist, so a 1st opinion practitioner has already selected owners who want a scientific aproach (are prepared topay lab fees ) The same applies in referral practice,where only patients with affluent (insured ) well motivated owners are presented, so a strictly scientific approach is possible

In 1st opinion practice, it's a mixture of science and art We use a scientific approach when allowed to do so Often owners can't/won't pay for diagnostics beyond a stethescope and thermometer, sometimes won't pay for more than 1 examination,so the art comes in deciding on a therapeutic approach which covers most of the possibilities

Re: What makes a good vet?

Richard Fox — Thu, 16 Jun 2011 09:26:56 GMT

Very much agree Alex!

Re: What makes a good vet?

Alex Gough — Thu, 16 Jun 2011 08:44:56 GMT

I guess it's sterile if it won't change what anyone does. Personalyl I find it interesting. Practically speaking though, you probably need a combination of pattern recognition and problem oriented approach, depending on circumstances. A pattern recognition is going to be vital to getting through a day of 10 minute consults, but a problem oriented approach is going to be needed for those cases that don't respond as expected, or don't fit the pattern.

Ultimately, which ever method you use, the most important thing I think is having a long enough differential list, and then using tests where appropriate to narrow the answers down, at least to a point where it makes a different in your management or prognosis.

Alex

Re: What makes a good vet?

J G Wray — Thu, 16 Jun 2011 07:29:32 GMT

[quote user="Richard Fox"]In my experience many vets are just concerned with treatment knowledge and fail to grasp that attaining a suitable diagnosis is actually quite important?[/quote]

This comment reminds me of one of The Lost Opportunities of my time in practice. A few years ago when Defra were in one of its phases of interest in disease surveillance in farm animals they asked for tenders for a suitable system to be adopted. NADIS was there, still is, although it's looking to leverage something else entirely now. However, NADIS is a practitioner dependent pattern recognition system and Defra went with a VLA driven approach and look where we are now.

As I recall BSE was initially recognised because of abnormal pattern - determined by farmers and firstopinion practitioners - which subsequently went on to more sophisticated diagnostics. I also recall a paper which showed, in the late Nineties that the correlation between diagnosis by experienced practitioners on clinical signs and PM diagnosis was of the order of 90% - that's not quite the same thing as "common things are common".

JGW

Re: What makes a good vet?

Evelyn Barbour-Hill — Wed, 15 Jun 2011 22:39:37 GMT

[quote user="alex gough"]It's on slide 6.[/quote]

Oh, that. He calls those three things "challenges". That's how you might miss things if your pattern recognition wasn't good enough. I dare say you'd miss things with any method if you weren't good enough at it.

[quote user="alex gough"] Take a case I saw a few years ago - a middle aged dog with hypercalcaemia and all its lymph nodes very enlarged. Easy, right, lymphoma. No need to biopsy. But actually there are other things on the differential list.[/quote]

Ah. It's not pattern recognition in itself that would lead to the missed diagnosis. What would lead to the missed diagnosis would be being unaware of the differential diagnosis. Possibly too - I don't know - inability to recognise a subtly different pattern.

As Jim Pinsent drummed into us, what you need is a little list.

Actually, I think this analysis and classification and dispute over diagnostic approach is rather like all those wranglings over approaches to ethics: useful to undergraduates to get their thinking methodical, jolly interesting to talk over while taking in a Campari, but ultimately a sterile debate.

Re: What makes a good vet?

Alex Gough — Wed, 15 Jun 2011 17:35:57 GMT

It's on slide 6.

Pattern recognition relies on experience. My understanding is that generally younger vets will rely on problem solving and older vets on pattern recognition, probably because pattern recognition is easier if you have experience, but harder if you don't. Both have pros and cons, but it is easy to miss unusual to rare things if you just go with the pattern. Take a case I saw a few years ago - a middle aged dog with hypercalcaemia and all its lymph nodes very enlarged. Easy, right, lymphoma. No need to biopsy. But actually there are other things on the differential list. And those biopses and further tests showed the dog had idiopathic granulomatous lymphadenitis causing the hypercalcaemia (I should have written it up - the first case in the literature was reported the following year). The dog was cured with steroids, instead of being PTS in the consulting room or started on chemo.

I wonder if pattern recognition and problem solving are akin to the increasingly recognised head versus gut ways of thinking (a gut feeling about a risk for example is a quick and dirty way of getting an answer when you need to react fast, the head analysis might be slower but is more likely to be accurate). There is a good book on that subject called Risk that I am reading at the moment.

Alex

Re: What makes a good vet?

Evelyn Barbour-Hill — Wed, 15 Jun 2011 16:40:21 GMT

Well, that's a nice presentation for undergraduates on how to organise their thinking. If they can plough through it without being bored silly.

I can't see anything there about disadvantages of pattern recognition, but never mind.

It seems I've been doing "SOAP" all these years and never knew it.

It reminds me of the fictional character who, when it was explained to him what prose was, exclaimed "To think! I've been writing prose all my life and never knew it!"

Re: What makes a good vet?

Hannah Wynne Richards — Wed, 15 Jun 2011 16:40:09 GMT

The 2 best veterinary surgeons I ever met were Jim Pinsent and Leslie Hall-both in their 50s when I 1st met them,so immensely experienced, but both still up to date, enthusiastic and dedicated to animal welfare-perfect role models

Wynne

Re: What makes a good vet?

Arlo Guthrie — Wed, 15 Jun 2011 15:58:37 GMT

[quote user="alex gough"]There is a nice powerpoint presentation that summarises the risks with a pattern-recognition approach, but I can't seem to copy the link.[/quote]

http://www.vetmed.wsu.edu/dc/facilitators/DC-docs/2010_POMR%20intro%20for%20DC.pptx

(with a link to a ppt, right mouseclick the link and select 'Copy Shortcut')

Re: What makes a good vet?

Alex Gough — Wed, 15 Jun 2011 15:34:17 GMT

[quote user="Arlo Guthrie"]

I'm now picturing you in a few hundred years time, ringing your local bookstore: "Do you have a copy of Differential Diagnoses in Small Animal Medicine? You DO?! My name? Er, yes, it's ..."

[/quote]

My name? Yes, its Mr Pages. L. O. Pages. :)

Re: What makes a good vet?

Alex Gough — Wed, 15 Jun 2011 15:33:09 GMT

There is a nice powerpoint presentation that summarises the risks with a pattern-recognition approach, but I can't seem to copy the link. If you want to find it. google "pattern recognition versus problem oriented" and click on the problem oriented medical record, on the first page, 9 links down.

Re: What makes a good vet?

Evelyn Barbour-Hill — Wed, 15 Jun 2011 14:55:26 GMT

[quote user="alex gough"]"It is also quite interesting how many diseases are found because new graduates with comprehensive DD lists didn't know they shouldn't be looking."[/quote]

I believe it is true that the first recognition of swine vesicular disease was when a senior and very experienced veterinary surgeon looked at the lesions and said "This is not foot-and-mouth disease"

[quote user="alex gough"]The problem-oriented approach ensures that these uncommon conditions are not overlooked.[/quote]

So does the pattern-recognition approach.

Re: What makes a good vet?

Arlo Guthrie — Wed, 15 Jun 2011 14:15:14 GMT

[quote user="alex gough"]Someone once wrote, in their introduction to a book called Differential Diagnosis in Small Animal Medicine, published by Wiley in 2007, and costing only £33.24 from amazon (delivered free in the uk):[/quote]

I'm now picturing you in a few hundred years time, ringing your local bookstore: "Do you have a copy of Differential Diagnoses in Small Animal Medicine? You DO?! My name? Er, yes, it's ..."

Re: What makes a good vet?

Alex Gough — Wed, 15 Jun 2011 13:31:27 GMT

"It is also quite interesting how many diseases are found because new graduates with comprehensive DD lists didn't know they shouldn't be looking."

Someone once wrote, in their introduction to a book called Differential Diagnosis in Small Animal Medicine, published by Wiley in 2007, and costing only £33.24 from amazon (delivered free in the uk):

"It is this author's opinion however, that it is possible to place too much importance on probabilities and how common a condition is. The newly qualified veterinary surgeon will often look for the rare but exciting and memorable condition they learned about at college, while the experienced practitioner will often remind them that "common things are common", and suggest they restrict their investigations only to commonly encountered conditions. The ideal approach is probably somewhere in between. Although it is self-evidently true that common things are common, it is also true that uncommon things are encountered relatively often. To take a hypothetical example, if a common problem is caused by common conditions A and B with a frequency of 80%, and by rare conditions C to Z the rest of the time, with conditions C to Z occurring with equal frequency, then each individual condition C to Z will be responsible for the problem approximately 0.9% of the time, making each individual condition quite uncommon. However,1 in 5 presentations of this problem will be caused by an uncommon condition, and so uncommon conditions will be commonly diagnosed, provided they are looked for. The problem-oriented approach ensures that these uncommon conditions are not overlooked."

Alex

Re: What makes a good vet?

David Mills — Wed, 15 Jun 2011 12:58:14 GMT

[quote user="J G Wray"]

Really? I think it's a manual skill, rather like painting, as in painting and decorating, where the end is the return of function and form as close to normality as possible, over and over again, converging on the same point .

[/quote]

Agreed. Certainly not scientific though. A technique.

[quote user="J G Wray"]

What we do is recognised by the man in the street as a science.

Not a popular view with some, no doubt, but I don't see too many degrees in Veterinary Arts coming up soon to shake my thinking.

[/quote]

Hardly scientific evidence. More artistic anecdote.

[quote user="J G Wray"]

The "Art" stuff is a conceit...This stuff about "art" just confirms how up themselves some vets are and is an extrapolation of how vets define how good they are.

[/quote]

A confusion of arguments. Art may be a label that you object to - fair enough, I agree it isn't the best. But the concept is describes is still valid: a vet is no more scientific in his everyday work than an airline pilot - they may both have intimate scientific knowledge but the application is not contained within or entailed by the science. I agree that some vets use it as a conceit for undefinable unjustified greatness in their own eyes.

[quote user="J G Wray"]

So long as the "Artists" keep up their (scientific) veterinary knowledge, the attribute most valued by the clients, then their conceit will probably do no harm to the patients and will, by default, maintain clients' confidence - probably.

[/quote]

As the thread began, the divergence between vets' and owners' expectations or values may be harmful. But bending ourselves to owners' lay expectations of the profession is a dangerous road in some circumstances (obviously not the upkeep of knowledge). Increasing awareness on the clients' side of the fence of veterinary artistry (unlikely to change, well, ever) is a more fruitful path.

What the survey shows, if nothing else, is the effectiveness of VDS communication skills. But how many problems arise through unrealistic expectations, from the man in the street, thinking veterinary medicine is a pure science and vets as scientists?

Re: What makes a good vet?

Richard Fox — Wed, 15 Jun 2011 09:10:50 GMT

Re: What makes a good vet?

Bob Russell — Wed, 15 Jun 2011 08:01:32 GMT

Now I can read the fine print it is more than a little scary that some people did not consider knowledge about veterinary medicine and surgery at all important!

It seems I can get rid of this pretence to having a likeable personality now and be a rude b**tard! Oh but perhaps I need to shower more!

Re: What makes a good vet?

Louise6732 — Tue, 14 Jun 2011 21:09:12 GMT

[quote user="Evelyn Barbour-Hill"]

The table also revealed to me that I may need to purchase a magnifying glass in order to read VR in future.

[/quote]

Priceless!

Re: What makes a good vet?

Michael Woodhouse — Tue, 14 Jun 2011 20:38:40 GMT

[quote user="Evelyn Barbour-Hill"]The table also revealed to me that I may need to purchase a magnifying glass in order to read VR in future.[/quote]

There's a lot more of this article on the VR site, including more analysis and big graphs