5/14/16 Edit: This post is two parts: mental health statistics in veterinarians, and veterinarians’ experience of adverse events. My writing about the stress and distress that can surround complications isn’t meant to imply that complications are the cause of veterinarian suicide, but rather that they are a predictable, and predictably stressful event that veterinarians encounter and that we aren’t generally taught how to handle. For some people, these events contribute to the anxiety, depression, and self-doubt that may also be impacting their overall mental health, and for some people, adverse events are a reason to leave the field or the profession.
Veterinarian wellness and mental health have received an increasing amount of attention recently within the profession. Veterinarians overall appear to be no more at risk for mental illness than those in the general population, but certain subgroups of veterinarians—young, female veterinarians, and those who work alone rather than with others—are at higher risk than other veterinarians for suicidal thoughts, mental health difficulties, and stress (Nett et al., 2015; Platt et al., 2012). While there is no published data about mental health specifically in spay/neuter veterinarians, shelter veterinarians do appear to be at higher risk for serious psychological distress (Nett et al., 2015). Further, many shelter and spay/neuter vets are young and female (White, 2013) and work apart from other veterinarians, placing them in a higher risk demographic. The suicide rate published for the veterinary profession is approximately four times that of the general population, and twice that of other health professionals (Bartram & Baldwin, 2010). While no one is certain of the reasons for this, most authors propose that it is due to a combination of personal characteristics, feelings of stress, and having medical knowledge and access to medications.
Any veterinarian who is experiencing anxiety, depression, thoughts of suicide or other mental health problems should seek the care of a health professional. The AVMA is developing wellness tools for veterinarians available here. Other resources that could be useful are Vetlife, a UK resource for veterinarians, and this site hosted by the Washington State Veterinary Medical Association.
Complications and Stress
Performing surgery can be stressful, and events that occur while in surgery can increase the amount of intraoperative stress experienced. Unlike workers in other industries in which the safety of others is at stake, surgeons are not typically trained in stress-management or how to mitigate the effects of stress on surgical performance (Arora et al., 2010). In the past few years, there has been some research on human healthcare providers, including surgeons, and their reactions to and thoughts about adverse events (see an article by Luu et al here and a book by Sidney Dekker here), but I couldn’t find any research specifically looking into veterinarians and our reactions to adverse events and how we cope with them.
So, I’m currently conducting a research study on spay/neuter veterinarians and adverse events. The purpose of this research is to explore the experiences and reactions of spay/neuter vets after serious adverse patient events (serious, life-threatening complications or death) related to spay/neuter. I am interested in the ways that veterinarians react to these events, the ways that we talk about them, think about them, and cope with them. My hope is that this research will give us tools to support each other, our clinic or shelter staff, and ourselves as we deal with adverse events. Understanding as much as we can about how spay neuter veterinarians react to and process adverse events could be a vital piece of making continuous improvements in the care that we provide. I’ll share results here on this website, as well as any information about presentation or publication of the results as they are available.
Meanwhile, here are some thoughts on dealing with complications from the existing literature on human practitioners:
All veterinary practices experience perioperative complications and deaths. In high volume spay/neuter, the high volume of surgeries performed means that, even in clinics with exceptionally low mortality rates, some perioperative deaths will occur. Perioperative deaths can lead to feelings of guilt, responsibility, and self-blame, as well as grief and sadness (Luu, Leung, & Moulton, 2012; Luu, Patel, et al., 2012). When a patient death occurs, fear, grief, or self-doubt can make it difficult to continue with the day’s scheduled surgeries, but the schedule of many spay/neuter and shelter clinics makes it difficult or impossible to interrupt the work schedule for debriefing and time away.
Candid discussion of deaths, errors, mistakes, and mishaps can be taboo in medicine: surgeons often have the expectation that they should perform flawlessly (Wu, 2000). In spay/neuter practice, there appears to be more open discussion of complications and near misses than in many medical fields; however, spay/neuter veterinarians may still benefit from increased discussion of early recognition of danger, errors, decision-making, expertise, and error-recovery (Patel et al., 2011). For those who work in facilities without access to peers, electronic listserves are a resource to allow communication with other spay/neuter surgeons. Spay/neuter veterinarians may also benefit from training in the skills needed for performance while under stress.
References:
Arora, S., Sevdalis, N., Nestel, D., Woloshynowych, M., Darzi, A., & Kneebone, R. (2010). The impact of stress on surgical performance: A systematic review of the literature. Surgery, 147(3), 318-330, 330 e311-316. doi: 10.1016/j.surg.2009.10.007
Bartram, D.J., & Baldwin, D.S. (2010). Veterinary surgeons and suicide: A structured review of possible influences on increased risk. Vet Rec, 166(13), 388-397. doi: 10.1136/vr.b4794
Luu, S., Leung, S.O., & Moulton, C.A. (2012). When bad things happen to good surgeons: Reactions to adverse events. Surg Clin North Am, 92(1), 153-161. doi: 10.1016/j.suc.2011.12.002
Luu, S., Patel, P., St-Martin, L., Leung, A.S.O., Regehr, G., Murnaghan, M.L., Gallinger, S., & Moulton, C.-a. (2012). Waking up the next morning: Surgeons’ emotional reactions to adverse events. Medical Education, 46(12), 1179-1188. doi: 10.1111/medu.12058
Nett, R.J., Witte, T.K., Holzbauer, S.M., Elchos, B.L., Campagnolo, E.R., Musgrave, K.J., Carter, K.K., Kurkjian, K.M., Vanicek, C.F., O’Leary, D.R., Pride, K.R., & Funk, R.H. (2015). Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among us veterinarians. Journal of the American Veterinary Medical Association, 247(8), 945-955. doi: 10.2460/javma.247.8.945
Patel, V.L., Cohen, T., Murarka, T., Olsen, J., Kagita, S., Myneni, S., Buchman, T., & Ghaemmaghami, V. (2011). Recovery at the edge of error: Debunking the myth of the infallible expert. J Biomed Inform, 44(3), 413-424. doi: 10.1016/j.jbi.2010.09.005
Platt, B., Hawton, K., Simkin, S., & Mellanby, R.J. (2012). Suicidal behaviour and psychosocial problems in veterinary surgeons: A systematic review. Soc Psychiatry Psychiatr Epidemiol, 47(2), 223-240. doi: 10.1007/s00127-010-0328-6
White, S. (2013). Prevalence and risk factors associated with musculoskeletal discomfort in spay and neuter veterinarians. Animals, 3(1), 85-108.
Wu, A.W. (2000). Medical error: The second victim: The doctor who makes the mistake needs help too. BMJ: British Medical Journal, 320(7237), 726.