Mental health issues, alcohol and drug abuse, a high incidence of stress and suicide, excessive staff turnover rates, and a failure to adapt to the increasing demographic dominance of women. These are all serious challenges facing the veterinary profession in the UK. And they require urgent attention. Yet veterinary medicine often obscures the messy, complex, ambiguous and uncertain reality of practice.
The largescale 2015 survey of vet students and graduates by the British Veterinary Association and Royal College of Veterinary Surgeons sheds light on the levels of dissatisfaction. Despite their considerable financial, emotional and intellectual investment, 10% of vet graduates leave the profession every year. More than half consider a change of job. Only 46% say they would choose vetting as a career again.
Many suffer considerable anxiety, depression, doubt, and tragically in some cases, suicide. Much has been written about the potential causes of this. A lot of analysis points to the “types” of people who are recruited into vet school (over-achieving perfectionists). But the Royal College of Veterinary Surgeon’s code of conduct places the onus on vets to “take reasonable steps to address adverse physical or mental health” issues.
Certainly, the struggle to manage the complex problems that come with being a vet relates to individual characteristics or “private troubles”. But these are too pervasive not to be treated as public matters. Our three-year study involving 75 interviews and numerous observations of equine, small, and large animal vets, suggests that these problems cannot be resolved through individual resilience and coping mechanisms alone.
Rather, there are wider issues at play, starting with training. This is shown by the fact that just 34% of vets that had graduated five or more years ago, think their degree had prepared them very well.
In our interviews, we found that people’s insecurities and anxieties get tangled up with extremely high expectations of the perfect self and their expertise, that are embedded within the culture of the profession. Vets, and their clients, tend to attach themselves to an unrealistic world view of rational science and medicine as a panacea for all ills.
Based on certainty, predictability and control, these ideals may be partly understood by the way scientific knowledge is portrayed in the media and taught in schools – as simply “objective”, with a clear separation between right and wrong answers. Despite attempts to broaden their curriculum, veterinary colleges reinforce this attachment to science with a heavy focus on clinical skills. Expertise gets viewed largely as a technical accomplishment.
One consequence of this is to encourage vets to accept impossible demands placed on them, by their practice, clients, the media (such as programmes about “super vets”) and their own idealism. While the allure and comfort drawn from faith in scientific and objective knowledge is understandable, it creates an illusion of control that is routinely contradicted in practice.
When the people we spoke to experienced the inevitable uncertainty and failure that comes with practising medicine, many were shocked and struggled to reconcile these contradictions.
The limitations of science – particularly in relation to certainty and predictability – tend to go unacknowledged in veterinary practice. This leaves many vets pained by the occurrence of what they see as failures. Rather than acknowledging the limitations of medicine that can never fully deliver on its promise, vets will tend to blame themselves.
Of course, we are not suggesting that vets do not make mistakes, or shouldn’t be concerned about them. But this tendency to translate anything that has not gone to plan into their own incompetence, creates a set of circumstances that are ripe for constant rumination, doubt and potentially destructive narratives of self-blame.
In considering whether practice ever makes vets perfect, some discovered that their anxieties reduced with experience. Others did not. Many outside our study will already have left the profession due to issues such as a lack of support and confidence.
One necessary way of dealing with these problems is for individual veterinary practices and educators to address, or at least minimise, the tendency for vets to interpret failings as their own lack of perfection, or inadequate knowledge. Instead, it would make sense to be more explicit about the limitations and uncertainties surrounding the job that vets do. Once these are acknowledged and accepted, anxiety and doubts about failure would inevitably recede.
This, however, demands humility and courage from the profession as a whole and individuals within it, to debunk some of the myths surrounding certainty and expertise. This is no easy task. All too often expertise is conflated with ideas of strength, infallibility and an invulnerability that pervade our culture in general, and veterinary practice in particular.
It is not enough simply to teach young veterinary surgeons about resilience and coping. This merely disguises these public matters by transferring the responsibility for failure from the profession back onto the individual. And this will only intensify the doubts and anxieties that vets seem already to have in abundance.