I’ve barely updated this blog over the past 5 weeks and there are a ton of reasons for that. I had a three week vacation which I spent with my long-distance girlfriend, I moved out of my dorm and into my friends’ house, I’m trying to make the most of my last year in Michigan with my friends, and I’ve started a new rotation: Primary Care. Unlike with every other rotation I’ve written about, I’ve had a hard time coming up with snarky things to say about Primes Cares. I think that’s because I genuinely enjoy it.
Here at Michigan State University CVM, Primary Care is considered one of the easier, more laid back rotations. It basically mimics the environment that most of us vet students will be working in: an 8 – 5 small animal general practice. Most appointments are annual wellness exams and vaccinations. We run heartworm tests, prescribe flea and tick preventives, and do a lot of physical exams. We also see new puppies & kittens, ear infections, unexplained vomiting, diarrhea, masses, and all the other things that general practitioners deal with every day.
The way appointments work is that after us clinical students take a history and physical exam, we figure out what we need to do for our patients. We may come up with a tentative prescription for antibiotics, suggest certain blood tests, request radiographs, list what vaccines are patient is due for, etc. Once we have a plan, we present our case to one of the doctors.
Not the actual case patient, Ryan! Just…do something normal for once.
The doctor listens to our suggestions and then does their own physical exam on the animal. After that they’ll make any necessary adjustments to our plan, sign off on the necessary forms, and let us do the rest. When the patient and owner leave, we write a discharge that will be emailed to them that night. This means unlike the quickly scribbled notes or single-paragraph summary of a case you’ll do in a regular clinic, you spend a half hour or more writing up every aspect of the visit. We type up every bit of the animal’s history, all the physical exam findings (“Ain’t doing right” or “Completely Normal” don’t cut it), describe every treatment and medication prescribed, and sum up the visit and explain to the owner in laymen’s terms what exactly is going on with their animal. It’s a long and tiring process to do this for every appointment, but at least it really helps the owner understand what they paid for and is a great chance to do some research on things that relate to your case.
So why do I like this rotation so much? For one thing, we’re really treated like we’re doctors. Every clinician I’ve presented to has really listened to my ideas on how to proceed with the case, and they don’t make me feel bad if I’ve made a mistake. As I said before, I also love dealing with the clients. It’s also been great being exposed to a lot of the nuances we’ll have to deal with in the real word: trying to persuade clients that a test is necessary, going over estimates, how to leave a message on a client’s phone without blabbering like an idiot. (Pro tip, it helps to actually know the hospital’s number the client should call back at.)
“So Fluffy’s heartworm test was negative. That’s good because, uh, she doesn’t have heartworm. So if you have any questions, just give us a call at…just give us a call. Okay buh bye.”
Pretty much my first five voicemail messages.
If there’s one thing I’ve realized I really needed to work on (and am grateful for this rotation giving me practice with), it’s trying to sell clients things. I wasn’t poor growing up, but I wasn’t middle class either. Our pets never went to the vet, we went on one vacation my whole life, and getting a car for my sixteenth birthday was beyond laughable.
I asked for DVDs of Futurama. I got the first season, i.e. the one with the least episodes.
As such, I have a hard time recommending tests and preventive treatments to clients because I couldn’t have imagined my family ever paying for them. Back when I was on soft tissue surgery, I wanted to shake clients and ask them how they could afford $2,000 for surgery on their dog. Don’t they need that money for food or children or food their children? I was able to resist that impulse, but I’m surprised I didn’t get reprimanded during my first week on primary care. I’d offer a vaccine which was all but required for dogs and then say, “But it’s $20, so we could probably do without it.” I’d recommend a heartworm test but follow it up with, “It’s $43 though, and your dog’s on preventives, so maybe it’s not necessary?” I’ve gotten better at recommending tests and saying this is in the best interest of your pet, but I still can’t help but be blown away that people go for it.
One other interesting thing I’ve experienced during this rotation is that I don’t want to leave. I have never, ever been a gunner in my other rotations and was, in fact, a borderline case dodger.
I quickly learned that if you walk around carrying a clipboard, looking furious, and randomly hitting walls, people will think you’re too busy to give you more cases.
But for whatever reason, I just want to do stuff on this rotation. I spent a lot of time in previous rotations blogging and working on my second novel, but over the past few weeks I just haven’t had the urge to write much. That means if I’m not at the hospital, I’m just screwing around on Reddit or something. The end result is me feeling like I’m wasting my time. The fact of the matter is I’ve spent nearly every spare moment over the past three years doing something: trying to revive Jimmy Neutron, entering script contests, writing a novel, studying…something! Just sitting at home day after day watching TV makes me feel like shit. So since I haven’t felt like writing, that means I shift that energy into the vet world. Plus, this rotation is all about what I’ll actually be doing in a year, so I feel I should learn everything I can.
The worst example of this was the past Thursday and Friday. They were slow days, so the lead doctor told half of us to work on Thursday and half to work on Friday. That meant we all should have gotten a day off. I worked on Thursday, and at the end of the day we found out Friday would have more appointments then we thought. Our doctor asked one of us to be on call for Friday, and I volunteered. She told me I might have to come in at 10 the next morning and should be out around noon; I just decided to show up at 8 and stayed until 4:30.
The doctor in charge just kept getting more confused as to why I was there; apparently she kept asking my friends why I wouldn’t leave and kept saying, “If I give you a day off you should take it.” I’m pretty sure she thinks I’m clinically depressed; whenever she asked why I was at the hospital I just said, “It doesn’t matter,” or, “I don’t know what else to do.”
“What’s the point…we do it and then what? Poof, we’re gone. Nothingness, emptiness, we’re all just dust in the wind.”
I’m sure having this attitude in a professional environment will have no repercussions of any kind.
I’ll balance it out next week.
As much as I like Primary Care, though, there is one thing I want to let pre-clinical vet students know. It is not a completely accurate mirror of what you’ll do in general practice. Appointments routinely take more than an hour when in real life they’ll be a half hour or less. Sometimes they creep past four hours! That’s because every test and treatment requires a ton of waiting and paperwork. Whereas getting radiographs takes five minutes in a clinic, in our hospital it can easily take more than an hour. Because of that, each student only oversees 2 – 3 cases a day on Primary Care. So if you want to a general practitioner, I strongly urge you to set up at least one externship at a normal clinic. I really wish I’d done this and am trying to set one up for my last semester. If you want to be a GP, I think it’s important that you get an idea of a how a clinic really runs and how fast-paced it is.
So that’s primary care. If you don’t mind waiting a ridiculous amount of time to get prescriptions signed off or radiographs done, you’ll have a lot of fun. I’m really looking forward to next week; we have a group of undergraduate students who are interested in veterinary medicine coming in to shadow us. I’m one of the two students in my rotation who were chosen to lead them around and teach them about vet medicine. I love teaching and doing community outreach stuff, so I can’t wait to get back to work on Monday. The week after next I’ll be switching over to my first large animal rotation; I’m not quite as thrilled about that. I’ll try to sport a good attitude and will let you know how it goes.
Unless I die, which is the most likely outcome of working with horses.