A take-home truth from a recent paper I read was “Death is a rare and serious, but predictable consequence of performing surgery”. So if death (or other major complication) are predictable, why are we so affected by them as veterinarians, and why is there no or little training at Veterinary School as to how to manage emotional wellbeing, when things go wrong?!?
A recent and excellent paper gave me some insight into this: "Veterinarians Emotional Reactions and Coping Strategies for Adverse Events in Spay-Neuter Surgical Practice". White 2018.
There a few factors that determine a veterinarians resilience to complications i.e. how well we bounce back. And let me just say this - no-one wins if we don't bounce back.
So why are some vets able to move past adverse events, while others are deeply affected for months or maybe years. Some veterinarians even leave the field or won't perform surgery again.
Seemingly, there could be 4 factors. I will discuss the findings of the paper "Veterinarians Emotional Reactions and Coping Strategies for Adverse Events in Spay-Neuter Surgical Practice". White 2018, then try to comment on my own personal experiences in the following posts.
1 - LEARNING -
Vets report that technical learning helps them move past adverse events. Not only does this learning help future patients, it also helps with your own emotional wellbeing. This is not the same as stewing over any mistakes, it is about up-skilling and actively seeking to increase technical competence.
Personally, I couldn't agree more. It is only now that I look back, I can see that any adverse outcome I felt could have been due to a technical error I made, I have determined categorically how to help prevent it from happening again. This was a combination of visiting referral practices (I did this for years prior to my official residency training), researching the complication in journals, asking colleagues for tips etc. This has always been my approach, and maybe in hindsight, it was part of my being resilient (I'm far from perfect, but I am definitely resilient).
Experts believe that failing to learn from an event can be a constant source of anxiety. It is also empowering to know you can reduce the risk of an adverse event from happening again, when equipped with a new skill or knowledge.
Video - Me teaching at a VetPrac Orthopaedics Workshop. I have always been a supporter of VetPrac - they are well-organised, practical workshops that are an excellent opportunity to
2 - Having perspective and appraisal.
Putting the event into perspective is helpful. Our work benefits hundreds of animals - Therefore, being able to put a single event into some sort of frame of reference, was found to be common amongst resilient participants. It helps vets to have conversations with colleagues who understand, and can give this perspective. It is not about minimising the event itself, but the reframing of the event in a person's mind.
Personally - I had an amazing boss once that somehow managed to put things into perspective for me one day when I was struggling. I can't remember how she worded it - it wasn't exactly 'there are people starving in 3rd world countries', but it was something that made it click inside me, that there were worse things in the world than not being able to get an IM pin through the centre of a tibial fracture. Holding 'perspective' isn't about not caring, or not improving - it is about not letting one error/complication/struggle overwhelm you with negative thoughts about being a failure.
3 - Support and collegiality
Talking with others helps determine the long-term impact of the event. This can be to family and friends or other veterinarians. For some vets, specifically speaking with colleagues is key.
My personal recommendation to vets, is to be part of collegial groups. It is good for practices to actively encourage participation for their vets in groups where possible. I feel it is better to debrief in person, versus debriefing on social media. Social media 'debriefs' can be largely supportive in the right groups, but some comments can be destructive. Where possible, talk with someone you trust or admire. My view has always been that there should be lots of people whose opinions you shouldn't care about, and often these people can be found on social media (sorry, I know I should be an advocate for social media. Basically, log in and read my posts then log off ;)
Receiving support in the workplace is also important for vets. It should go without saying (however you would be surprised!), that an environment that values learning and avoids shaming and blaming, is obviously more conducive to creating resilient vets.
4 - Emotional learning - This refers to knowing and learning what to expect from yourself and your emotions. This knowledge 'i.e. it is normal for this response' can be protective over time. With some vets, this is a conscious, deliberate skill acquisition.
Personally, I have learnt that in terms of protecting your own mental health and wellbeing, the best way to do this is with 'deliberate skill acquisition' versus leaving it to chance and seeing how you might fare. For me, this has been something I have developed on over years - I have learned skills from reading, from performance psychologists, from health retreats and talking with colleagues and friends.
Can I finish with this line, which I feel was brilliant "Death is a rare and serious, but PREDICTABLE consequence of performing surgery”.
PREDICT that you will, at some stage, encounter a complication from surgery that will shake your core. LET it shake your core, KNOW that this is a normal response, LEARN from it and develop skills, TALK to people and remember that YOU are responsible for your resilience. Bounce back, stronger and more prepared than you ever have been.
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