| EXTRACT – THE VETERINARIAN – Oct 2002 |
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THE PRESSURE OF PRACTICE Most jobs these days are stressful, but studies increasingly show the veterinary profession has above average rates of anxiety, depression and suicide. SONIA VASQUEZ speaks to the experts about the causes and symptoms of stress and depression in the practice. When Peter Hatch’s friend ruptured his carpal ligament while pregnancy testing cattle, Dr Hatch didn’t hesitate in moving into the flat on the premises and taking over practice while he recovered. Several weeks passed until about 11 o’clock one night, he noticed the surgery lights were on. I went in and found Chris* (not his real name) there Dr Hatch says. He was just sitting in the surgery. I asked him what he was doing and he said.” just thinking. After some time, Dr Hatch managed to coax Chris into revealing that he was “just thinking” about driving away with just his credit cards. He had the idea that he was going to keep going until his money ran out,”Dr Hatch says. I told him this isn’t making any sense, mate- you’ve got a wife and three kids”. We sat up until half past three in the morning trying to get to the bottom of this. It turned out that he’d had to have a carpal fusion, the result of orthopaedic incompetence over the previous 12 months. He’d been in enormous pain, he couldn’t work properly. There’d been an argument at home two nights before. and now he was thinking of just driving off. But Chris was the most dedicated practitioner I’d ever known. After a few hours talking that night, Chris decided to return home and attempt to work things out. Eventually he made a decision to sell his practice and leave the profession. The experience also transformed Dr Hatch. The next day I saw him and He’d slept very well. I hadn’t. Somehow I had disrupted his negative thoughts, but I was up all night trying to figure out what I had said that changed his mind from driving off with nothing to going back home,”Dr Hatch says. Making sense of it all Spurred on by these questions, Dr Hatch completed a diploma of counselling and has gone on to establish workshops aimed at educating veterinarians and support staff about disrupting negative thought patterns. He emphasises the distinction between clinical depression and the effect of irrational and distorted thoughts, both of which are nonetheless related. Often the problem occurs when people get to the point where they perceive that they can’t change anything. We can talk through that and change those perceptions,” he says. But what would he have done if Chris wasn’t able to engage in conversation on that pivotal night. What if he was clinically depressed to the point where words were ineffectual? All you can do for someone in that state is be with them, Dr Hatch says. They’re at an impasse, they are not ready to look and move on at that point. That’s when sometimes you have to turn to anti-depressants. Otherwise the idea is to try to understand the thoughts that are going on in someone’s head and to help them change them. Negative thoughts may be fleeting but they can be enough to cause a problem. All relationship breakdowns are related to dysfunctional thinking for example I can’t share my experiences with somebody”. That is a personal choice. A lot of the self doubt thing is determined by our response. For example, the graduate loses a dog under anaesthetic, and they doubt themselves after that. People need to dispute the thought that they have failed immediately, otherwise they will come to fear the next anaesthetic and forever on that fear and related anxiety remain with them. Dr Hatch and others argue that negative thoughts are easier to disrupt early, and that veterinarians can benefit from becoming aware of their personal needs, and the impact that their career and lifestyle may be having on them and their family. He blames lack of communication and interpersonal skills as a major contributor to negative thoughts and depression. Vets have to get such incredible marks every year at university you have to achieve, then after five years someone hands you a piece of paper and suddenly you’re a vet – without experience or confidence! You go out into the workplace and the boss often goes off and does his or her own thing. You haven’t learned to communicate with people effectively but you have to do it, Dr Hatch says. Dogged by depression The black dog, as depression is often referred to, affects more than 800,000 Australians each year – or one in five adults. Women tend to be affected more commonly than men (with a rate of 1 in 4 compared to 1 in 6). In the general population young women between 18 and 24 years of age tend to be most at risk of suffering clinical depression. A British study found veterinarians more than three times more likely to commit suicide than anyone else, particularly older, male vets working in rural practices, and young female graduates. Easy access to drugs and daily exposure to euthanasia were seen as possible contributing factors. Nicole Hyatt, a psychologist researching depression with Australian research group beyondblue, says several features of veterinary practice may combine to render vets and support staff vulnerable to anxiety and depression.< Practice especially rural practice is often very isolated, there is little opportunity for support and the level of contact is superficial, she says. Health professionals are also vulnerable to “care fatigue”, as their own needs are neglected while they meet the needs of others. Dr Hyatt says people too often refer to anxiety and depression as stress” implying the condition can be ameliorated with a break, allowing the practitioner to make a fresh start” This may mask the need for more effective treatment. Sometimes a break is just not enough,” she says. Is there something inherent in the vocation that predisposes vets to depression? Stephen Cutter, a small animal practitioner in the Northern Territory, argues there is truth in this notion. “The job often involves long hours. You are dealing with difficult clients and difficult animals, and there is a high rate of patient death. Even on a good day you never know when something extreme might happen – such as an anaesthetic death,” he says. “I think it would be a severe test of anyone’s personality and I think no matter who you are, there will be periods of depression. Whether
you can call it depression or not is a different question.” “Some pointed out that stress was an important part of achievement at high level, but clearly excess stress was potentially bad,” Professor Heath says. He also found 70% of respondents had trouble balancing their work and personal life; although this was lower for practitioners more than 60 years old. Older practitioners were less likely to be stressed by their work. Perhaps experience and age has allowed them to develop a more balanced lifestyle and outlook. Ultimately some practitioners realise their needs are not met in private practice. Some choose to leave the profession altogether, while others may change from full time to part time, in order to spend more time with family and/or pursue personal interests or further study. s
The cost of stress Employers should consider the occupational health and safety implications of depression, anxiety and stress, which are not insignificant. According to the National Workers Compensation Database, claims related to “mental stress” constitute 3.3% of claims lodged, yet the average cost per claim is highest, at about $13,000. The average leave taken due to mental stress is just over three months. This does not account for reduced productivity, physical illness and/or problems in workplace relationships preceding the claim, all of which compound the cost. The personal cost of depression is impossible to calculate. If untreated, practitioners suffering from depression may lose their personal relationships or their career, and studies have shown people suffering from depression are more prone to accidents than those who are not. Ultimately much of how we feel depends on how we respond to a situation. It is important for practitioners and others working in the veterinary profession to be aware that some aspects of the job do render us more vulnerable to depression. If we keep this in mind, support our colleagues and reach out early, we may be able to mitigate negative feelings when they do hit. What to look for Depression research group beyondblue says a person maybe depressed if, for two weeks or more, they have been feeling sad, down or miserable or they appear to have lost interest in things that they might normally have enjoyed. Behavioural signs include: withdrawal from social interaction or family and friends, loss of productivity; “anhedonia” or loss of pleasure in activities normally enjoyed, and the use of alcohol or sedatives. A depressed individual may become indecisive, irritable and may be overwhelmed by feelings of guilt, loneliness or disappointment. Colleagues may notice a loss of interest in projects or patients. Depression may be experienced as a loss of meaning or purpose. Physical signs include fatigue, lack of energy, illness (run down); insomnia; anorexia; weight loss; and headaches. Further information
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