Do No Harm

I am reminded of an old joke: What’s the difference between God and a veterinarian? God doesn’t think he’s a veterinarian.

Before we deify ourselves and pontificate about how much we have made things better, we need to ensure that we haven’t made them worse instead. Do no harm. It should be easy. After all we all became veterinarians because we want to help not hinder, fix not destroy, help not harm. Unfortunately, even with the best of intentions, it’s not always that easy.

Veterinarians are not, in fact, God, or anything approaching it. For starters, we actually exist. And we’re human. And humans make mistakes. The trouble is when the plumber errs the toilet might rupture and flood the bathroom. When a veterinarian falters someone could possibly end up dead. How much worse it must be for the medicos who have to withstand the full fury of the victim’s family. Still, trying to explain to someone that you just killed their beloved pet, their million dollar racehorse or that endangered species is no laughing matter either.

I find it difficult to determine how much good I’ve actually done. I once knew a zoo keeper who judged the skill of a veterinarian by how readily they could take a blood sample from his animals, because this was something he could measure. Anyone can place a stethoscope on a chest and pretend to hear the heart, when all the while they are desperately trying to buy time because they actually have no idea what’s going on. But a blood sample or an anaesthetic dart fired at an animal produces a tangible result. Success or failure, for all to see. I wish it was that easy with diagnoses and treatments. How do I know that my treatment was successful? Many conditions resolve without intervention, or despite it.

It’s quite possible that up to 80% of the cases I have seen would have had exactly the same outcome regardless of the treatment regime I selected. Of the remaining 20% I like to think that half improved or recovered directly because of my treatment. Unfortunately the remaining 10% quite possibly got worse or died because of my intervention. Not a very cheery figure but then I did read somewhere that up to 60% of statistics are made up.

With such ambiguous outcomes is it any wonder that veterinary medicine has such a high attrition (and suicide) rate? There are some cases, mostly surgical, where I am convinced that I was a force for good, and I cling to these as justification for what I do each day, but there are probably just as many that cling to me where I just as obviously killed my patient. Fortunately it doesn’t happen that often and I always hope desperately that the post mortem will reveal some underlying pathology. So often it does not. I’m not sure how I manage to pick up the pieces, collect myself and carry on. I do know it gets harder every time it happens. I knew a colleague once who was a veterinary dermatologist. She chose that route because there are no emergencies in dermatology and animals tend not to drop dead unexpectedly from skin complaints.

I almost did not complete my veterinary degree because I knew that, as a new graduate, my skills would be found wanting and I would make mistakes, possibly with disastrous consequences. But I persisted, believing that eventually my positive outcomes would outweigh my negative ones. After over 20 years in the profession I certainly hope they have.

Dr. F. Bunny

 

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