It’s Good to Talk

It is good to talk.

The number of posts in social media by vets considering leaving the profession is a great concern. Common themes in these posts are lack of support, long hours, awkward clients, feelings of not being good enough and that “there must be something better out there”. I completely understand these feelings having been there myself, but before rejecting the profession that we trained hard to get into it is important to take time to reflect on what is happening.

First of all, please do not think that you are the only one feeling this way, you are not. Equally do not assume that others realise what you are feeling, no one knows what we are feeling unless we tell them. So, the first step is to talk to someone about how you are feeling and the areas that you are struggling with. Posting how you are feeling on social media may make you feel better because you have written your feelings down, but this is not the way to look for help as it runs the risk of validating your feelings and giving you the impression that what you are experiencing is what everyone is feeling, but this is only the views of a small number of people. I believe that it is important to write your feelings and worries down, it helps to understand what you are feeling and what you are thinking and makes it easier to talk to others. Talking to the right people always helps.

Too often younger members of the profession are left to sink or swim in practice. Practice owners may have put in place helpful resources, but they are seldom backed up with support in the practice and mentoring. I have looked at these areas in previous posts  and feel that they should be mandatory in practice, for the good of all. Ideally when one starts in a new job, be they new graduates or more experienced colleagues, a structured review and support plan is put in place. If such a plan is not part of the package, then perhaps it is best not to accept the position. As employees we are in a strong position to ask for support before taking on a new job and as employers, we need to be listening to what members of the profession need in order to be supported and developed, again for mutual benefit. The current situation where practices are finding it difficult to recruit practices is an ideal opportunity to address these issues.

If you feel that you do not have access to any support in your practice, talk to trusted family or friends. Talking always helps towards gaining clarity as to what is at the root of your feelings. Too often we bottle feelings up until one episode, such as an awkward client, an ill-advised comment from a colleague, or something that we would normally cope with releases all the pent-up frustration and negative thoughts that we have been suppressing and we explode in anger and lash out at whatever and whoever is nearby at the time. If you feel that you have nobody to talk too, pick up the phone and call Vetlife. Whatever you do, talk. It is only by talking that you will come to realise what you need to improve your life. It may be that you come to the conclusion that practice is not for you so you can look at what other avenues interest you either within or outside the profession, but equally you may realise that you really do want to stay in practice and that you need to change the job and not change jobs.

Talk to your boss, line-manager, your HR department, whoever is the most appropriate in your organisation and ask for support, ask to be assigned a mentor, ask a colleague who you trust to be a mentor. It is only by asking that we will make everyone else realise that we need (not just want) support. Get your employers on board by presenting what your goals are and what you need to achieve them. If your goals are a million miles from your employer’s then look for a practice whose goals are more in keeping with your own. I suspect that most members of the profession have the same goals as most practices, that is to be the best that they can be in their chosen profession and to offer the best care for our patients and owners. 

If practice owners continue to ignore the needs of the profession, then there will be a decline in standards and an increased dissatisfaction both within and of the profession. With support in place, the other commonly cited issues with the profession will be taken care of and the potential of talented people will be realised. We all have a part to play so let’s get talking.

Mentoring- A Companion on the Road to a Better Practice

There is no substitute for talking with colleagues about cases, clients and how we are feeling. It is how we learn how best to approach a case, how to communicate with clients and colleagues and how we develop an understanding of the emotional impact our work has on us. Our professional journey will, hopefully, be a long and fulfilling one, one in which we improve the lives of our patients and their owners, and it is vital that we have a trusted colleague to discuss our successes, difficulties, worries, hopes, someone to help us find the best road for us. This is why having a mentor is a must, not just for new graduates, but for all of us, whatever stage in our careers we are at.

Having the right mentor has the potential to allow us to flourish in our careers, to understand our strengths and weaknesses, to share and celebrate success and to find the right help for our professional progression. It is not enough to randomly assign a mentor to a mentee in a “box-ticking” fashion. Mentors must want to be mentors and they must have a deep interest in helping and guiding mentees. Mentors do not necessarily need to have formal training, and a guide to what being a mentor means can be viewed in this very useful guide from Manchester Metropolitan University; 

Having a successful mentor system in place will not only help the individuals, but it will also help to improve the performance of the practice as a result of improved management of cases and better communication.

In conjunction with regular, productive team meetings, mentoring will make sure that colleagues are supported and developed, the best practice based on the best current evidence will be provided to our patients and clients, communication at all levels will be improved, clients will feel more confident in the care that is being provided by the practice, and individual practices and the profession alike will flourish.

Team Meetings, a route to a successful practice.

In my experience the institution of regular, productive team meetings has met much resistance in practice. There are many reasons for this; they are not commonplace at this time, there is pressure to be generating revenue at all time, everyone in practice thinks that they are too busy to spend time in meetings, there is little guidance relating to veterinary practice on how to run meetings. This not an exhaustive list, I am sure that everyone reading this will be able to come up with a reason (or is it an excuse?) why meetings cannot be done. But regular team meetings are a vital tool in keeping every member of the team involved in the efficient running and improvement of the practice. Without meetings, leaders struggle to lead their teams, team members do not feel valued or listened to, team members have no idea of what direction the practice leaders want to take and if their values are compatible with their leaders, an “us and them” culture is created, there is no opportunity to learn what works and what is not working, and when there is an issue there is no structured approach to investigate and learn from it.

The first step that is required is the scheduling of a team meeting at a suitable time in the working day. A time when the consultation list tends to be quieter so the diary can be blocked off and the meeting scheduled into the diary for that day. This blocking of appointments must not be seen as taking time away from revenue generation, the benefits gained from meetings will be seen in a happier, more productive team, better work up of cases and better communication within the team and with clients.

An agenda must be made along the lines of 

  • A review of the last meeting including progress on any actions agreed on.
    • Clinical audits in which what has worked well and what has not, and what can be learned.
    • Discussion of any significant events in a “no blame environment” (to encourage an honest discussion of any difficulties that any team member is having).
    • Implementing, reviewing and modifying protocols.
    • Discussion of client feedback.
    • Agreement on actions required and assigning responsibility of these actions to the appropriate staff member. 

This agenda must be circulated to all team members well before the meeting. When everyone knows what is going to be discussed they can prepare their thoughts prior to the meeting. 

Approximate timings of how long agenda items will be discussed for can be made, and the meeting scheduled to last no more than 1 hour.

Suitable food and refreshments need to be ordered.

All team members who are working that day at the time of the meeting are to be invited. This may involve diverting phones to other branches during the meeting or assigning a team Diverting the phones to another branch or assigning a team member to answer the phone whilst the meeting is going on. It is important that it is not the same team member who is asked to answer the phone every time. It is also important to recognise that some team members will not be available to attend and it may be a good idea to alternate the day of the week that the meetings take place to allow for days off.

Stick to the agenda and timings. Have someone take notes which can be circulated to all team members after the meeting.

There are some resources available to help structure team meetings. The best one that I have found that is specific to veterinary medicine, all be it related to practice and America can be found at:

There are two items on the meeting agenda that I would like to talk about now, significant events and clinical audit.

A significant event is when something unexpected happened with a view to understand how it happened, what can be learned from the event and what measures must be implemented to prevent it from happening again. All the information and resources that are needed to understand significant events, how to log them, how to investigate them and how to discuss them with your team can be found at:

https://knowledge.rcvs.org.uk/quality-improvement/tools-and-resources/significant-event-audit/

To progress as an effective practice, it is vital that we learn the lessons that these events can teach us. This must be done in a “no-blame” environment, it is not a witch hunt, it is a process to allow us to understand all of the circumstances that led to the event, and to put in place processes that are designed to stop it happening again. Mistakes happen, unexpected results happen, what must not happen is that we fail to learn from them, and they are repeated. I strongly believe that having a structured logging, investigating and learning process in relation to significant events, a process that allows us to feedback to clients when appropriate goes a long way to making team members feel valued and clients to be reassured that we are committed to providing the best service to them that we possibly can. In turn this helps to retain both staff and clients which helps the practice grow and develop.

Clinical audit allows as to measure the success of our treatments and procedures. It is a tool that enables us to measure improvement of our treatments and procedures, which ones work best and most consistently. It helps identify what further training is required so allows more focussed CPD for our staff. It measures our performance against other practices in the country. All the information and resources that are required to understand and undertake clinical audit can be found at:

https://knowledge.rcvs.org.uk/quality-improvement/tools-and-resources/clinical-audit/

Clinical audits can be assigned to anyone in the practice, a process made easier if appropriate codes are set up in practice management systems, such as grades of post-operative complications, to enable quicker gathering of information, and so give an opportunity to any team member to be involved in the improvement of the quality of care that the practice offers.

Team meetings open and maintain channels of communication, provide and “no-blame” environment to discuss significant events, and to monitor and improve the quality of the services that we provide. They will boost team morale helping to retain staff members and facilitate their development. They will improve the service that we offer our clients, giving us material to present to them to show our commitment to offer their pets the best treatment that we can. All these are big wins for blocking off an hour a week in the diary.

A Road Map To The Future Of Small Animal Practice?

A Road Map To The Future OF Small Animal Practice?

The biggest hurdle to achieving the points outlined below is time. Meetings have a habit of being side-lined at the slightest hint that “we are too busy” and we fall into the mindset that meetings are not important with the result that we do not have the opportunity to discuss our concerns, learn from others, gather evidence that our treatments are successful. This increases the feeling of isolation and non-support that some feel, it allows anxieties and frustrations to build and eventually erupt in an inappropriate, and often detrimental, way. We become set in our ways, living by the mantra “it has always been done this way, and it always will”. 

This is a recipe for stagnation, boredom, frustration and dissatisfaction, all of which are prevalent in the veterinary profession at the present time. At least the profession is now talking more openly about the difficulties it is facing, I see little or no changes happening at the practice level to address them. At the risk of joining the current bandwagon, I suggest that we need a “roadmap” to outline the steps we need to take to reach a better place.

What is required?

An open and curious mind and a willingness to learn and to grow both individually and as a profession.

A workflow that includes;

  • Realistic consultation times to allow full examination of the patient and discussion of findings and treatment plans with owners.
  • Realistic allowance of time for in-patient procedures.
  • A 10-minute meeting when all staff have arrived for their shifts to keep everyone updated on what is happening today in the practice and who is responsible for what.
  • Mentoring with scheduled, regular one-to-one meetings to discuss progress and areas of development.
  • Time allowed to call owners with updates of treatment and investigation findings
  • Mandatory breaks through the day.
  • Scheduled time for practice meetings which need to include the following;
    • A review of the last meeting including progress on any actions agreed on.
    • Clinical audits in which what has worked well and what has not, and what can be learned.
    • Discussion of any significant events in a “no blame environment” (to encourage an honest discussion of any difficulties that any team member is having).
    • Implementing, reviewing and modifying protocols.
    • Discussion of client feedback.
    • Agreement on actions required and assigning responsibility of these actions to the appropriate staff member. 

There is no doubt that there are costs in time and resources to achieve this. To attain success, it is vital that meetings are scheduled and that they are structured as detailed above. We must be realistic that we are not going to achieve attendance by all members of staff at all meetings, but with proper minuting of the meetings, all staff can be kept up to date and involved in the growth of the practice. And it is the resulting growth and development of the staff and the practice that will improve the clinical are of patients, communication and support of staff members and clients alike.

In my next article I will look at the structure of clinical meetings and the resources that are available to help with clinical audits.

Creating Resilience

Creating Resilience

As mentioned in my last post, we all have a reserve of resilience to protect us against stress, anxiety and depression. This reserve is constantly being drained and replenished, but when the rate of draining exceeds the rate of replenishment we are at risk of succumbing to our negative thoughts of our inner critic. It is vital that we find ways of replenishing our resilience, and one of the best ways is to be creative.

Creativity gives us a time where we are not thinking of the stresses of work and life in general. This time is for us and us alone, a time when we can lose ourselves in the process of creating whatever we wish. 

Creativity teaches us that we are allowed to do things for ourselves. The end result is not important, but the process and the time spent is.

Creativity teaches us that we do not have to create a perfect result every time. We learn what works and what does not and that we are allowed to make mistakes, learn from them and leave them behind as we continue on our journey.

Creativity teaches us that it does not matter what other people thinks of our efforts. The pleasure, satisfaction and enjoyment that we derive from them reward us with a sense of fulfilment which in turn helps to build our reserves of resilience.

Creativity teaches us that if someone else enjoys the results we produce we get a buzz of satisfaction that boosts confidence and self-worth.

The lessons that creativity teaches us can be applied to all aspects of our lives. We can learn;

That by becoming absorbed in the task at hand we learn what is important to succeed in the activity.

That it is fine to make mistakes and to learn what works better.

That we will never please others all the time, but we must not be put off in our efforts.

That when our work is appreciated, we need to accept this appreciation and take it to our hearts.

When we learn these lessons and apply their teachings, we learn what works and what does not, our self-confidence improves and so too our self-esteem and self-worth and we build our resilience reserves, and so are less susceptible to listening to the voice of our inner critic. In fact, we can silence our inner critic in the face of the evidence of our achievements. 

Please find an outlet for your creative side, which we all have, and reap the rewards it will bring for your wellbeing and, indeed, to the wellbeing of those around you.

To hear from medical professionals who have found the benefits of creativity please visit crxeate

Depression, Anxiety and Mindfulness

Depression, Anxiety and Mindfulness

Depression and anxiety are common bedfellows, they originate from the same negative thoughts which wander in and out of our minds leaving their mark on how we perceive ourselves and our place in the world. These negative thoughts tell us that we are not good enough, that we are imposters who do not deserve praise or our position in the world. They lead us to become anxious, constantly afraid of inevitable failure and of being found out to be a fraud. This anxiety has a profound effect on our physical and mental health, it has a negative impact on our wellbeing, it stops us from developing and from enjoying our lives, it leads to depression. Depression creates more negative thoughts and wakes us more willing to listen to and to believe in them, so we become more anxious and less able to live our lives and so we become more depressed.

Negative thoughts are unavoidable, our minds are constantly working, it is easier to stop our breath than it is to stop our thoughts. Our minds create thoughts based on past experiences which are then used to try to attempt to make sense of our current situation, but they have no basis on the reality that we are experiencing now, in this moment. Those of us who are prone to depression and anxiety are easily led by these negative thoughts which results in the downward spiral described in the previous paragraph. We are not always conscious of these thoughts or what has stirred them into life, but we accept them as a true representation of ourselves and base or actions on them. 

Negative thoughts are pernicious, an ever-present inner critic berating us making it ever more difficult to interact with the world. All of us have some degree of natural resistance to the harmful effects of negative thoughts, but this resilience is eroded and if we are not careful it will be exhausted leaving us unprotected against the onslaught from our inner critic and in need of help. Unfortunately, our inner critics tell us that we are not worthy of help, so we do not ask for it and instead live evermore miserable lives, thinking that this is normal and just what we deserve. It is not normal, and nobody deserves this.

It would be flippant and disrespectful to suggest that we should just ignore negative thoughts and “get on with it”. If it was that easy there would be no one suffering from depression. Because of the insidious nature of the development of depression and our tendency to normalise the behaviours associated with it, we, more often than not, do not recognise that we need help. There is also a stigma associated with mental health issues despite advances made in making it more acceptable to speak openly about them. 

There is no substitute for talking therapy and anyone who is feeling depressed, or that they are not coping, or that there is no joy in their lives need to seek help. Asking for help is the most difficult step on the road to recovery, it can feel that we are failures if we cannot cope with what life throws at us, but remember that we only have a limited reserve of resilience. When you ask for help please accept all the support that you are offered and enter the process with an open mind and a willingness to listen to and to try the advice that is given. This is where mindfulness proves invaluable. 

Mindfulness techniques allow us to acknowledge our negative thoughts and give us an opportunity to examine them and question where they have come from. By developing an awareness of our negative thoughts and inner critics we stop them from sneaking into our minds unnoticed and lowering our mood and draining our resilience. By being mindful of our thoughts and emotions we can recognise when the new techniques that we are being taught in therapy are being helpful, and indeed what is not helpful for us. Mindfulness based cognitive therapy is perhaps the most powerful weapon in the battle against depression and anxiety, but this must be started with a properly trained practitioner, preferably under the guidance of a psychiatrist.

Once we are feeling better, mindfulness comes into its own in the prevention of a relapse. Initially it is hard wark keeping an awareness of our thoughts and emotions. We start to see what lowers our mood and this in turn allows us to develop better responses to these triggers. We cannot stop events from having a negative impact on us, it is normal to be sad, annoyed, angry and happy. With mindfulness we accept that all emotions are normal and that how we have reacted in the past to them may have been inappropriate, but now we can start to react to them in a more appropriate and beneficial way. And gradually the techniques of mindfulness become second nature to us and our lives become happier, more colourful and enjoyable, we recognise when our levels of resilience are getting low and what we need to do to replenish them. Mindfulness quietens our inner critics and allows us to thrive.

Embracing Change

Change

Change brings uncertainty, uncertainty gives rise to anxiety, anxiety can lead to lower mood and depression, low mood and depression makes it difficult to cope with change. But without change we stagnate, we do not develop, we don’t learn, we become bored and boredom makes us susceptible to low mood and depression. Change is also unavoidable, so it is vital that we learn how to cope with change and minimise its negative effects.

The first strategy is to accept that change will happen and that it is normal to feel some anxiety about the uncertainty that accompanies change. 

Secondly, have goals that are important to you. This is important as it gives an opportunity to assess how any changes fit in your journey to reach your goals. It also allows you to make changes that will help you reach your goal giving you control over changes, reducing the uncertainty they bring as they are part of your own plan. When changes are forced upon you take time to reflect on what impact the changes are going to have on you, giving a chance to formulate a plan for yourself which may be to embrace the proposed change or to make your own change, whichever fits in best with your plan to achieve your goals.

Thirdly, be true to your own values. When our values are uppermost in our minds we are less susceptible to uncertainty and anxiety, so when change happens we can base our response on if the change is consistent with our values or not. 

Instigate change yourself based on your values and goals, giving you more control of the process of change. By doing this we get used to change being part of normal life, and so when unexpected change happens the familiarity of the process of change will help us cope in a more positive fashion. 

View change as an opportunity to try something different, to learn a new way of doing things, to develop new skills and knowledge. 

Be mindful of what affects change have on you, are they positive effects, if so, go along with them and see where they take you. If the effects are negative or conflict with your values then make your own change to take you in a direction that is more compatible them and don’t worry about what other people think, it is more important to be true to yourself. 

By being true to yourself there is more certainty, less anxiety and more enjoyment in life. 

Make Time for Reflection

Mindful Minutes Expanded: Make Time for Reflection

As we develop our mindfulness practice the process of reflection becomes easier.

Reflection is vital for our personal, professional, emotional and spiritual development. Without reflection we do not learn who we are, what makes us happy, what success looks like for us, what lowers our mood, why things happen the way they do. Without reflection we drift from moment to moment, we stagnate, we get bored, we are more inclined to listen to our inner critics, we exist but we do not live.

There are many models for reflection, and a good place to start is by referring to Cambridge University Library’s Reflective Practice Toolkit at 

https://libguides.cam.ac.uk/reflectivepracticetoolkit/introduction

However, it is vital to realise that there is no formula that must be followed. What is important is to ask yourself the questions;

What happened?

Why did that happen?

How did it make me feel?

What could I have done differently?

These questions are easier to answer if we are living in the moment, paying attention to what we are doing and how it is affecting us both physically and emotionally. In other words, if we are living mindfully in the being mode.

The answers to the above questions will enable us to recognise what works well for us and allow ourselves to take credit for achieving a good result, and where our knowledge and ability are lacking allowing us to formulate a plan to improve and/or ask for help when needed. What will work for each of us and what we need to do to develop are entirely unique to us. Reflection allows us to gather evidence about why things happened so we can respond in a non-judgmental, appropriate and beneficial manner, which will help us get more from every minute of our lives.

Reflection is an opportunity to discuss how we are feeling and why events happened in the way they did with friends and colleagues.

Reflection is an opportunity for us to learn where our thoughts come from and to recognise that they are just thoughts and how these thoughts interact with our emotions and even our physical health.

Reflection gives us the opportunity to answer our inner critics negative thoughts by putting things into perspective, a perspective that is uniquely our own. With our perspective on the world around us based on facts we can react to our environment in a way that makes sense to us.

Reflection is a continuous process of review, exploring the questions of why? how?, and what? Modifying our behaviour on the basis of this exploration, reviewing the results of this modification and so on.

Modifying our behaviour helps to modify our thoughts. With the combined techniques of reflection and mindfulness we learn new behaviours which can lead to a more rewarding and fulfilling life. This is the basis of Mindful Based Cognitive Therapy (MBCT) a proven and powerful tool in the treatment of mental ill-health.

So, please, Make time for reflection.

With reflection we learn what works for us and what choices we need to make to improve.

Without reflection we tend to make choices that are a quick fix but not necessarily the best fix.

Reflection allows us to develop, both in our professional and personal lives. 

Mindful Minutes Part 2

Why is so much importance placed on breathing in mindfulness?

First of all, breathing is always available for us to focus our attention on. By practicing exercises such as the three-minute breath we can train our mind to concentrate on one thing at a time. By training our concentration in this way, we can start to pay closer attention to what is happening to us and more importantly how events are affecting us.

Secondly, our breathing is affected by our hormonal and nervous systems. When we are anxious or stressed our bodies respond without us being aware of what is happening. If these responses go unchecked, they will eventually have a detrimental effect on our well-being as stress hormones build up in our bodies. Our breathing is affected early on in the stress response, it becomes faster and more shallow. When we develop an awareness of this we learn to recognise the causes of our stresses at an earlier opportunity then we otherwise would.

This early awareness of our stressors is vital in our efforts to stay well. If the early changes that stress brings are left unnoticed and unaddressed, they will build up, but eventually they will become too much and we will end up being adversely affected by them. How we react in such situations will vary from individual to individual, but whatever the reaction it will be detrimental to our wellbeing. And if we have allowed stressors to go unnoticed when these adverse reactions occur, we are likely to blame them on the situation in front of us at the time, which is unlikely to be the true root cause of our discomfort. In this situation we are more likely to make inappropriate decisions which will lead to more stress.

An awareness of our breathing, and more importantly changes in our breathing patterns, will give us a profound understanding of how our bodies are reacting to any given situation. This understanding allows us to question whether or not these reactions are appropriate, and so we can develop plans to allow us to feel less stressed by these situations in the future.

The final reason for using breathing as an aid to concentration is the feeling of calm and peace that you will feel at the end of your three-minute breathing exercise. This is something to remember, a safe place if you like, a feeling that you can return to at any time where your mind is relaxed and quiet, where you can let thoughts wander off wherever they will go without following them and being distracted by their random associations, a place where you are truly you.

Mindful Minutes Expanded Part 1

Breathe

Just as it is fundamental to life, breathing is fundamental to the practice of mindfulness.

We cannot help but breathe, but we are most often unaware of our body’s effort involved in moving air in and out of our lungs. This is unfortunate as our breathing can give us an indication of our emotional state which in turn can help us understand how we react to particular situations. When we are calm our breathing is relaxed and efficient, as is our body. When we start to get stressed our breathing rate tends to increase and becomes shallower as the sympathetic nervous system kicks in releasing “stress hormones” into our blood. So how can an awareness of out breathing help us in our practice of mindfulness?

The first exercise in mindfulness practice is the “Three Minute Breath”, a simple but powerful skill which can be used anywhere, anytime to restore calmness and allow us to react more appropriately to a situation. 

As we start our mindfulness practice it is best to set aside a time and place where we will not be disturbed for a few minutes and give yourself permission to have this time to yourself, it is important. Sit comfortably on a chair, feet flat on the floor and hands resting on your lap. Close your eyes and bring your attention to your breathing. Watch as your body moves air into and out of the lungs. No conscious effort is required. As you sit watching your breath you will notice thoughts popping in and out of your mind. Do not allow these thoughts to distract you, let them wander off wherever they may go, don’t follow them, they are unimportant. If you find that thoughts are distracting you, bring your attention back to your breathing. Watch as your breathing finds its own rhythm. As you practice this exercise you will start to feel a calmness spreading throughout your mind and body. Be aware of relaxed state of your body and the quietness of your mind and remember this feeling and then bring your attention back to where you are sitting, noticing sounds and when you are ready, slowly open your eyes. Take a moment to sit quietly and feel the effect of this exercise before resuming whatever tasks that you are doing that day. 

For the best results practice the Three Minute Breathing exercise twice daily to begin with. Do not expect anything from the exercise, just accept whatever you notice. If you start off with the thought of a specific goal you will become distracted with thoughts such as is what I am supposed to feel and notice? Am I doing this correctly? What is the point of this? If you accept that whatever happens happens then you will reap the benefits of this exercise more quickly and begin to notice the benefits it can bring to everyday life, which I will discuss in my next post.

Take care, stay well and don’t judge.