An expert generalist: reflecting on 30 years in practice
Having just completed my 30th year in veterinary general practice I have been prompted to reflect on my career in primary care. I am occasionally called upon to speak to local groups, which usually gets me thinking about my motivations for joining the profession in the first place. And I wonder whether current school leavers share any of my inspirations and aspirations.
I grew up on a Yorkshire Dales hill farm but, unlike my brothers, I never wanted to be a farmer. Much of the work on a hill sheep and beef farm can be dull and repetitive, albeit in a glorious setting. Visits from the vet were different. If it was a big brucellosis test that took all day, the conversations were different. If it was a difficult calving, I saw my father and brothers take a back seat to let the expert work. Vet students would flood the Dale at lambing time and then the pubs would be full of young people often from very different backgrounds from mine who were bright and funny and interesting.
I wanted to be a vet because I could join this fellowship that seemed so exciting but was still connected to and held in very high regard by the community I was raised in. (That was not universally true of all students in the 1970s.) My exposure was exclusively to Liverpool students and they seemed to have a ball, so off I went.
On qualifying and heading with my peers for practices all over the country, my recollection is that we were excited and a little apprehensive but not in the least frightened. I wonder why we were not more anxious, when it is clear to me now how inexpert I was. I think in part it is relative. What we knew, which seems very thin compared with the new graduates I encounter now, was much greater than the general clientele and also greater than any information they had access to.
"I wonder whether current school leavers share any of my inspirations and aspirations"
We embarked on problem solving, often from first principles, the only evidence being our tatty notes and the textbooks we carried with us or which sat on the practice shelves. It was an adventure into the unknown and even in failure we were often thanked for doing our best. I recollect virtually no negative feedback from clients in the Shropshire community I was inflicted on, and we were given considerable credit for attaining our professional status as vets through the necessary study.
Work in primary care has become progressively more difficult as expectations have justifiably risen. At the time same, unquestioning respect for professional status in general has diminished, after repeated scandals and disappointments that have fuelled an explosion of scepticism.
We are called upon to justify our judgements in advance much more often now and we presume we will be held to account for the outcomes.
Attraction of general practice
There is a continuity within the team that makes up a private practice. Some people come and go and that is to be expected, but some stay and put down roots that anchor the business in the community. Among my proudest outcomes from running a small business is seeing members of the team develop. In some cases, I have watched them leave school, train, start work and develop into integral players, along the way getting their own homes and starting families that grow around us.
We also get to build relationships with clients whose parents remember our predecessors and whose children become our new clients. We can choose – to a degree – the level of expertise that we wish to develop, both among the team and personally, and the spectrum of services we want to offer. In my own case, I have stayed in a blue collar, semi-rural area that is not served by any charitable outlets.
I cannot deny that trying to provide veterinary care to everyone, no matter how willing or able to pay to support the overheads, has been very trying at times but, on balance, I don't think I would have wanted it otherwise. I can still get great satisfaction from problem-solving on a shoestring, a reminder of my earlier days in practice.
A sad feature of recent years has been the demise of local veterinary associations in some areas, mine being one of them. When I joined the profession, it was where a considerable amount of the interaction was centred. With fewer opportunities to meet and chew the fat there is a danger of becoming preoccupied with our own local concerns and drifting into isolation that can be so dangerous.
Becoming actively involved in what gets called veterinary politics was my way of countering isolation. I don't really like the term veterinary politics – most of the activity is about mutual support, which holds the veterinary fellowship together. Only in my brief period as a BVA officer did it involve any significant activity that could really be called political.
"Generalists like us truly manage the entire cycle of birth, rearing, decline and death and that is the privilege and the pleasure"
I have never actively pursued any special interest within practice and it has been reassuring recently to see greater recognition of the value of the expert generalist as discussed in the recent viewpoint article in Veterinary Record by Stephen May (May 2015) Interestingly, when I have talked to students and recent graduates, I have come to realise we do develop a specialty as we support generations of clients. We become expert in managing the later life stages of their animals and particularly euthanasia, which almost invariably falls to the general practitioner. I firmly believe more animal suffering is alleviated by good counselling around, and management of, euthanasia, than in any other area of specialisation. I understand that we cannot call ourselves specialists, but if you do not become expert in managing patients and clients through the end-of-life process you will never achieve satisfaction in general practice, regardless of how good you are at anything else.
Generalists like us truly manage the entire cycle of birth, rearing, decline and death and that is the privilege and the pleasure.
I have helped run an independent business with my colleagues and our team now for over 25 years. Although that independence can be a blessing and a curse, overall I have found it a hugely positive experience.
We have been able to decide what level of return we wish to see from our investment in both money and time. We have taken on extra staff to improve time away from work. We have chosen our level of community involvement, supporting local events and activities. We have tailored our range of services to meet our clients’ needs but also to create work we enjoy. We are currently redesigning and updating our entire practice, more with a view to providing a nicer place for us all to work than necessarily getting a cash return. We have to manage all our own headaches between us. It is a measure of the sort of working community you can develop over time, with a consistent philosophy, that I can walk out of the building for a holiday or a weekend and never give it a thought until I walk back in.