I am opening my talk with the following Zen saying, 'Unless we change direction we are likely to end up where we are heading' I accepted the invitation to be a guest speaker here today because my aim is to place emphasis on stress in the veterinary profession. Hopefully I can be an influence in bringing about awareness and suggesting ways of changing the direction many veterinarians too often find themselves heading--to a life where stress takes over and has negative consequences on the life of these individuals. Firstly though we must realise stress is part and parcel of all our lives and that some, what we term 'positive stress' is essential to enhance our motivation and boost our ability in carrying out many activities. However it's when stress has the reverse effect and is experienced over a prolonged period of time that the pressure begins to manifest itself in human suffering.
Richards 1989, defines stress as 'the three way relationship between demands on a person, that person's feelings about those demands and their ability to cope with those demands'. Today I'm speaking specifically on the negative aspects of stress. I'm sure researching causes of stress in any profession would produce an endless list of potential stressors, but the most common factors likely to cause stress usually includes the following:
Working conditions--this might involve working under time pressure, using poor, outdated equipment, unclear or unreasonable expectations from employers, bullying and conflict, lack of influence in area of work and no prospect of promotion.
Secondly, relationship problems and family issues--where circumstances experienced outside of work are so difficult they impinge upon the person's working life also.
Thirdly, health issues--chronic pain or poor health make holding down a job quite a burdensome experience.
Finally, financial difficulties--money worries can be extremely stressful, particularly when the incoming wage is unsatisfactory to keep the bills paid. Additionally in this day and age there is more pressure on people to 'get rich' and live a life of constant entertainment and gratification.
Nevertheless, I think it's fair to say that further to the above mentioned stressors, the veterinary profession can admit to having much more distinctive potential stressors of its own. Primarily (as pointed out by researchers such as professor Richard Halliwell, former president of the Royal College of Veterinary Surgeons, Brian Hoskin of the Veterinary Benevolent Fund, and Voracek) the college requirement to be a highly intelligent and gifted individual and the demanding nature of vet school all contribute to a highly stressful experience in training--further exacerbated according to Austin Kirwan, chair of the Vet Helpline, by the 'culture shock' of moving from university to work in the isolation of small practices out in the country.
Workload, and the requirement to be on call at all times, night calls, weekend work and the busy spring calving and lambing are considered by most vets to be a huge contributor to stress and this was clearly revealed in a small study I carried out on vets in the south east. It is my belief that the situation is further fuelled by the stringent laws attached to medicines, when a simple case of sore feet in a sheep must be seen and diagnosed by the vet, with most farmers perfectly capable of this knowledge themselves. In busy periods for farmers and vet alike, this time wasting for the more urgent, life saving cases heightens frustration, with each bearing the blunt of the other's agitation.
Veterinary practice in more recent times has experienced the development of a new source of stress referred to in an article by Anne Tynan in the Australian Veterinary Journal--the importance of the human animal bond has significantly increased, placing pressure on vets in their care and treatment of animals and having to assist clients' grieving for lost pets. Having little training in the area of grieving clients and trying to be sensitive whilst working against the clock, leaves it extremely difficult for any vet to perform professionally under such strain. As stated by Nic Blaney of the Society of Practising Veterinary Surgeons, being obliged to offer veterinary service at all times during emergency situations is a big responsibility and burden to carry.
Numerous others have looked at the stresses of the veterinary profession with each drawing similar conclusions. For example Juliet Cazer (2002) claims many vets can identify with being stretched to capacity and beyond it. There is undeniable evidence to suggest the veterinary profession can become life-threatening for those who are unable to deal with the different sources of stress says Jeyaretnam and others. Connolly (2003) writes in the words of Dromey (1992), practice is taking a dreadful toll on vets' lives with many feeling locked in their jobs. A stressful, often solitary grind up against the clock, Ian Herbert of 'The independent' reminds us. Dr. Dianne Gardner of Massey University, New Zealand carried out a research study on stress in the veterinary profession and found multiple sources of stress. She revealed there were six main headings containing forty-seven subsidiary sources of stress. Included in the six are:
1. Workload--for example excessive task demands, over work, long pressurised day.
2. Client issues--such as unreasonable, demanding, critical, unreliable clients, client grief, poor pet discipline, and financial.
3. Interpersonal relationships--like staff problems, lack of support, errors, communication etc.
4. Work outcomes--meaning unsuccessful and difficult cases.
5. Work constraints--this proved to be quite a big one with paperwork, bureaucracy, poor conditions and equipment, audits, isolation and lack of career advancement being a sample of the stresses suggested.
6. Finally other stresses, taking in weather, travel, risk of litigation, personal risks, work-life balance, family issues and so on.
Furthermore the various health hazards attached to the profession pertain to intensify stress. Diseases such as brucellosis, leptospirosis or Weil's disease, toxoplasmosis which endangers the unborn foetus in pregnant females, the risk of serious injury from handling larger animals, infections, and braving the elements in severe weather all pose a threat to the health and well-being of veterinary professionals. If contracted, brucellosis can have a lifelong effect on one's health leading to severe bouts of depression. Dr. Virginia Richmond of the Veterinary Surgeons Health Support Programme and Dr. Richard Mellanby, a vet and researcher at Cambridge University pathology department have found the veterinary profession attaches a huge stigma to mental health problems in the profession. Therefore with little help available, alcohol and drugs frequently become the chosen remedy to alleviate suffering. Sadly this is the case with many vets--plunging themselves into a vicious circle of short term psychological relief from alcohol and drugs to longer term mental and physical impairment resulting from continuous using. Incidentally the situation isn't helped by the fact that vets have easy access to drugs such as ketamine and other lethal animal injections.
Changing the Situation
So is there anything can be done to change the situation? Well one could be excused for concluding the picture looks quite bleak and indeed it seems that way, but sometimes even simple straightforward changes can make a huge difference. We know it's not in our power to alter the demanding nature of the profession: animals get sick--timing doesn't come into it, the bureaucracy, legislation, risk of litigation, plus health risks are all part of the job. However the key lies in our approach to any given situation, therefore education has to be the starting point. I would suggest building personal development and self-care classes into the veterinary curriculum. One hourly class per week shouldn't disrupt the educational programme too much, yet has the capacity to change the course of life for veterinarians for the future. Communication skills, interpersonal skills, time management, prioritising, self-care and physical well-being, stress management, creating self-esteem, receiving and giving support, sharing duties, promoting team work, conflict management, assertiveness skills, etc are all evidently useful topics. Their significance and value are very obvious to us all but the vast majority of us are unskilled in implementing them in our lives.
I am presently visiting veterinary practices in my area and surrounding counties, letting them know I'm available as an outlet if they need somewhere to turn in difficulty. I have included a small survey study on what vets themselves would suggest to improve their situation. The surveys returned so far have all been favourable towards an educational programme. Some have suggested final year: others--when a few years in practice; and others have said anytime. Personally I would be in favour of beginning in year one. This would show young graduates the relevance of their personal care and that the veterinary profession is serious too about the care and well-being of workers as well as animal welfare.
Another area where vets could make changes is the competitiveness of practice, guarding clients from neighbouring vets. This attitude is detrimental to good practice: jealousy and harbouring grudges are now added to the fray, where the amalgamation of smaller practices would make proper sense--instead of having five or six one and two person practices in the same locality resenting each other. More off-duty time would become available, duties shared, expertise and knowledge passed on, isolation reduced, less night-time work, travel minimised, disruption of meal time lessened, and much more. I understand personality clashes could cause difficulties, but that happens in all situations. Almost certainly careful planning, outlining of roles and positions, and clearly indicating what's acceptable to the organisation would reduce the incidences of such an occurrence.
The concern of remuneration and pricing being lower than comparable professions has been mentioned to me on occasion as problematic. True and all as that may be, I don't want to explore that route here. Money must not colour the truth or draw attention from the real problems facing the veterinary profession. The reality is the vast majority of people are stressed about money, some of it justified and some of it not. Money circumstances are totally personal and sometimes our obsessions with wealth can leave us unable to differentiate between how much we want and how much we actually need.
My final point however relates to the disturbing findings of many researchers, that the veterinary profession worldwide has the highest suicide rate of all professions--being four times higher than the general public and double that of doctors and dentists. These are alarming statistics and cannot be ignored. I implore all involved with the profession to take stock. What messages are being sent out to members of this occupation? Although a long established and highly successful service, veterinarians cannot allow success over shadow the fact that real people are working tirelessly behind the scenes to achieve this result. Placing the profession on a pedestal is to be absolutely and completely discouraged, as such an environment leaves no room for vulnerability. Instead it serves to pressurise many into ignoring their internal battles in an attempt to prove they can handle their problems on their own. Everything possible must be done to encourage vets to speak out, seeking help rather than hiding their distress. The shame element many have attached to personal problems needs to be extinguished for people to feel safe. Confidential, non-threatening, easy accessible conditions must be made available on a continuous basis, so nobody falls short of help when they seek it. Counselling is an option here. Treatment for depression and substance abuse can also be incorporated into counselling, particularly if help is sought early. Early intervention with cognitive, behaviour therapy--based on our thoughts, the feelings that follow those thoughts and the resulting behaviour can save sufferers from spending time in residential settings to deal with their depression and substance abuse.
I urge all veterinarians to take steps in self-care when necessary, and realise how valuable your life is. I conclude with the wise words of a proverb and hope the message is received loud and clear by all: 'He that is ill to himself will be no good to nobody.'