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Helping Ourselves Part 2

Helping Ourselves Part 2

The second big concerned raised by respondents in the “Time for Change” survey was a lack of support from when things do wrong. Things will go wrong from time to time, it is inevitable, and it is important that there is a supportive environment to understand why things went wrong and what can be done to stop the same thing happening again. 

In previous posts, When Things Go Wrong and Mindfulness in Clinical Governance I have looked at the importance of a developing a non-judgement approach and a “no-blame” culture. These create a safe environment to look at issues in a reflective manner.

This process is vital for veterinary practice to develop. We must look at how we can improve the quality of service that we deliver to our clients for their pets. I would encourage the profession to ensure that a robust Quality Improvement programme is in place in all practices, there is plenty of information on the RCVS Knowledge website which can be used and adapted for individual practice use. 

Members of the profession will benefit by feeling able to talk about mistakes and cases where there has been an unexpected outcome. If we continue to feel that we need to be perfect or that we cannot talk about problems we become more stressed, we put more pressure on ourselves by setting unrealistic expectations, we become more anxious about making a mistake and our ability to practice effectively suffers.

Practices will benefit by ensuring that treatments and recommendations are effective, and when they are not steps can be implemented to improve. With regular discussions areas of weakness and strength can be identified in all members of the team. Areas of strength can be shared and areas of weakness can be strengthened through mentoring and CPD. 

Our clients and patients will benefit through the practice of Quality Improvement as our clinical skills will develop.

By adopting the process of Quality Improvement we will show our clients that we take their concerns seriously and that we are proactive in taking steps to improve the level of service that we offer. This also has the potential of improving the trust between the public and the profession.

It may require something of a culture change in many practices to embrace the idea the mistakes can happen and it is important to discuss them, but it is only by allowing free discussion and accepting that it may be necessary to change existing protocols and adapt to new information and circumstances that we can develop.

Helping Ourselves

Helping Ourselves

I have been reviewing the results of my “Time for Change Survey” and they are similar to a number of similar surveys. One of the major causes giving concern to respondents is dealing with owner’s expectations, so how can we manage this?

I firmly believe that the key to success in managing owners’ expectations is communication. 

If we start with a “non-judgemental approach” we can create an environment where we don’t jump to conclusions, we listen to what our clients are telling us and are better able to understand their concerns.

If we then use the techniques outlined in “the mindful consultation” we give ourselves time to fully examine our patients, formulate a treatment plan and discuss this and the costs with our clients.

I am confidant that these steps will improve the service that we give our clients which will instil confidence in them which in turn will improve compliance with our advice. This will also give us time and space to appreciate the gratitude that our clients have for us and for us to appreciate the good work that we are doing, and will be in a better position to manage the expectations of our clients and ourselves.

I appreciate that this may sound like a simple solution to a big problem, but sometimes we lose sight of how we can make things better for us. Give it a try and see how you get on!

My Story

&me aims to encourage senior people within the healthcare professions to come forward with their stories to show that we all have mental health, and that a mental health problem does not exclude people from achieving leading roles in healthcare. I have previously shared my story at the Wellvet Weekend and more recently at the BSAVA congress as part of the Mindmatters stream and am now presenting here.

I qualified as a vet in 1985 and have spent my entire career in small animal practice in a variety of practices including the charity sector, a 2 vet practice, a large multi-branch practice and the corporate sector. I have held a number of positions from assistant to clinical director but throughout my career I have found the stresses of everyday practice difficult to deal with. I particularly found being on-call very difficult and had a constant feeling of not being good enough and that every other vet knew more than me and was more skilled at everything. However, I felt that it had been my choice to become a vet and that there was nothing else that I could do and just had “to get on with it”.

For me “getting on with it” meant accepting the stresses as normal and my coping strategy was to try to supress emotions. I ignored the fact that I did not feel happy but took on more responsibility in my professional life thinking that was what I should do but all it meant was that I experienced more difficult situations and more stress. I was also increasingly anxious and my mood was low, but it is only now that I recognise this. Even when I consulted with my GP and found myself crying during the consultation, not knowing why, I still did not recognise that I was depressed.

When you do not address stress, when you suppress emotions, when you do not recognise the warning signs your body is giving you it is inevitable that something will give. For me it was finding myself shouting in a consultation, pent up emotions and stress have a tendency to burst out in unexpected and inappropriate anger. It was at this time I realised that I needed help. It had only taken me 25 years to come to this realisation.

So, I went back to the GP who got me to fill in the questionnaire that is used to assess levels of depression. I scored well, but in this test the higher the score, the worse the result, so perhaps the first lesson in recognising perfectionism is not a good thing. I was prescribed medication, signed off work and was recommended to undertake talking therapies. Fortunately, I had health insurance and there was a Priory hospital close to home and took the decision to get myself referred there.

After an initial assessment my psychiatrist recommended three half day sessions as an out-patient. I was asked how I felt about group therapy. I had no idea how I felt about group therapy but approached treatment with an open mind putting myself in the hands of the experts and see what happened. Group therapy was interesting, as I listened to other people’s stories I thought “you thought that?”, “you do that?”, “that’s not going to be helpful”. But as I reflected on what I was hearing, I realised that I did the same things and I was able to recognise problems in others but not in myself. 

Talking therapies are surprisingly tiring, at the end of the sessions I was exhausted, but I stuck with it and did my homework which was lots of self-reflection and understanding my unhelpful behaviours, how thoughts affected emotions and in turn mental and physical health. Through the combined treatments of cognitive behavioural therapy and mindfulness I learned how to monitor my thoughts and recognise they are just thoughts and how to recognise the voice of my inner critic who would constantly tell me that I was not good enough, that everyone else knew better than me and that my opinion was not worth a thing. Over time I have learned to ignore my inner critic which has increased my confidence and self-esteem and opened a whole new world to me of new opportunities. I am getting more from my professional life, and genuinely feel that I am a better now than I ever have been. I also have allowed myself to explore other interests as well, particularly in producing fine art photography and poetry, and this creative outlet perfectly balances my work life. 

I do not believe that I am cured of depression and anxiety, but with the toolkit mindfulness has given me I can ensure that I remain in remission and get more out of my life now than at any other stage. So if you are feeling low and cannot see how things can improve ask for help, it may be the best thing you ever do.


&meLive Mind Matters at BSAVA

&meLive

Yesterday, along with 2 other colleagues I presented my story of how mindfulness has helped my mental health and has made me a better vet (and a better person) at the BSAVA congress. The session involved us sharing our stories followed by a Q&A session chaired by Lizzie Lockett, CEO of the RCVS.

The session was well attended and I was humbled by the number of people how said how helpful my presentation had been and how it resonated with them. I will share my story in a later blog, but today I would like to share a few bullet point take home messages.

  • Mental health issues affect 1 in 4 people BUT, being a vet does not mean that you will be affected.
  • However, mental health issues are common within the profession
  • Every individual member of the profession has their part to play in improving the mental health of the profession
  • We are talking more about the issues which is fantastic
  • We must ask for help if we are struggling and Vetlife is available to all 24/7. Please use this resource.
  • Now we are talking about the issues, we must make changes

I feel strongly that there are some simple changes that we can make which will really help.

  • Create and open, non-judgemental environment where everyone can discuss issues.
  • I would suggest that by having regular meetings based on the RCVS Knowledge Quality Improvement resources will play a vital part in this process. It will create a blame free culture where clinical issues can be discussed and when handled sensitively it will identify where there are any issues that need to be addressed in a supportive manner.
  • Put structures in place to manage the workload throughout the day which includes regular breaks and lunch/meal breaks, 15 minute consultations and managing operation lists sensibly.
  • I believe the above points will go a long way in improving our clinical care, our health and our overall service to our clients and patients.

As I said above, we all have a responsibility to take ownership of our mental health, we must not fall into a victim culture as a profession where we think that mental health issues are inevitable and that we are powerless to avoid them. There are good resources to make use of especially the ones above and the Mind Matters Initiative and with everyone making use of these I believe that the profession will flourish.

The Stories We Make Up

The Stories We Make Up

Perception is an individual experience of the world we live in. It is based on the information that we gather through our senses which is interpreted by our minds. This interpretation is based on our past experiences, our values and our biases which are unique to each of us, so how we perceive the world is unique to each of us. This process results in our minds creating stories about the situation in front of us which is only based on limited facts. These stories are thoughts which result in us making judgements and jumping to conclusions that have little basis in truth. 

Mindfulness provides a useful tool to monitor these stories and ask ourselves “where do these thoughts come from?”, “do I need more information to come to the correct conclusion?”, “what information do I need?”, “am I letting my biases influence my judgement?” and so on. This is of particular importance in our interactions with clients and making clinical decisions. It is too easy to make decisions based on limited information, we may think, “this client cannot afford treatment”, “this client does not want investigation for their pet’s problem”, “I have seen this before so do not need to investigate the problem”. 

The stories we make up can get us into trouble, we end up making assumptions, jumping to conclusions, taking shortcuts and miss vital information. If we take more time to gather more information our interactions with colleagues, clients and patients will be more rewarding. 

Here are links to videos exploring these ideas;

Helping to find solutions

Thirty-seven percent of vets in the UK are actively considering leaving the profession (Vet Record 10/11/2018 pg 550). There is a lot of dissatisfaction within the profession and a great deal of complaining about how poor the woking conditions of vets are. However there is little in the way of solutions being offered. I would like  to use this survey to start the process of finding the solutions to the current state and help us all to get more from being a vet.

The survey is anonymous and will be open for 3 months.

The survey can be taken here

 

Time for Change

Time for Change

 

A fundamental concept in mindfulness is to stop “doing” and start “being”. I think that this concept is particularly important in our profession, we spend most of our lives in the “doing mode” thinking about “how are we going to get through the ops list”, “are we ever going to get through the consultation list” etc. We always get through the day in the doing mode, but we do not recognize what we have achieved other than making it through another day. Then we start to question what we have done, “have we missed something”, “could we have handled a situation better” and so on. This mode of living is draining, constant concern about how we are going to manage, playing and replaying “what-if” scenarios in our minds depletes our resilience. With resilience drained we are susceptible to the negative thoughts that are never far away; “I am not good enough”, “I hate this job”, “I am too busy”, “I’m never going to get through all this work today” and so on.

The alternative is the being mode of living. In this mode of living we maintain awareness of what we are doing at that moment and not getting distracted by all the “what-if?” scenarios in the doing mode. This allows us to fully experience each moment so in the case of our professional lives we are able to listen more attentively to our clients, concentrate on our clinical examinations, evaluating our findings, creating problem lists and treatment plans. When we are operating we do not get distracted and perform much better than if we were trying to hurry or take shortcuts because we are worried about what we are going to do next. In the being mode we are also aware of how we are feeling and how we are reacting to situations, we are also more aware of how our patients are reacting and are more empathetic with our clients.

Developing the being mode allows us to get so much more from our lives and by practising the techniques in this blog, especially the mindful bitch spay and the mindful consultation you will get so much more from being a vet.