In school, they teach you the gold standard approach to pretty much everything. They expect perfection and set standards of care/sterility/diagnostics ridiculously high. They do this because they know that once you’re unleashed into the real world your skills will go downhill in some way. So the higher they start you at, the better chance you’ll end up still doing things pretty well.
Now, don’t get me wrong – I’m not suggesting the care your animal receives at your average general practice is somehow less than it should be. I’m sure it’s top notch, really. It would be completely unrealistic to expect a small animal general practice to operate in exactly the same way as an academic institution. We do the best we can.
There are also things I did in school that I’m just not expected to do now – I have technicians that do it for me, because it frees up my time to see more patients. As a student I was the grunt worker, now I’m the doctor I have my own grunt workers.
There’s also the fact that I spent hours learning about cows and horses and pigs, oh my…. and these species were included on my licensing exam, which I passed. Just two years ago. I wouldn’t recommend me to deal with any farm animal now. I have the base knowledge somewhere in my brain, and I know where to look for answers . . . but I haven’t had to think about large animal medicine in almost two years, and if you don’t use it you lose it.
I used to be able to take blood from a jugular with my eyes closed… I’ve only done jugular venipuncture maybe twice since I graduated. In school we only did jugular, with a scattered hind limb – fore limbs were saved for catheters only. Now I will try all four legs before I will resort to jugular. I also used to be super confident in my ability to get an IV catheter into just about anything. Now I do it so infrequently, if one of my technicians is available I refer to them – they’re faster and more proficient. If I do one catheter placement in a week, they do one hundred.
I sometimes lament my loss of skills. I know that I’ve gained new skills to replace the ones I lost – I was a slow and nervous surgeon when I graduated, now I’m confident and fairly well paced. And I’ve learned a lot about medicine and surgery I just didn’t absorb in school, or get a chance to really be exposed to. However, at 2am when I’m an animal’s only option for blood collection or catheter placement? I kind of wish I was as good as I used to be!
Of course, I know these skills are reclaimable. I used to work at a clinic where I did a lot of urinalysis. We learn how to do the microscopic exam at school, but we never really have to do it on rotation because the labs just down the hall. So I started to forget. Now I’m at a clinic that is short staffed as far as technicians go, so there are times in a day/week when we have no one to do urinalysis unless the doctor is comfortable doing it themselves. I have gotten myself back to that level of comfort with urinalysis, out of necessity.
The topic of “skills I’ve lost” is on my mind because at our last doctors meeting we were discussion placing IV catheters in all of our surgical patients. As I mentioned, we’re a bit short staffed. So there is a worry of the girls resisting extra work load… so it was mentioned that we, as doctors, could start placing our own catheters. I, for one, welcome the chance to rebuild my catheter placement skills. Sometimes I think it’s a sin how much I used to be able to do and am just not so good at anymore. Not even mentioning the stuff I flat out do not remember how to do. Thank goodness for the internet and instructional videos!