The presentation above is a recorded version of the same one delivered at the 2018 VR Voice ‘VR in Healthcare Symposium’ held at Harvard Medical School, Boston, USA.
Please follow the link below to access a PDF version of the full paper from the above presentation, including the results of the survey conducted on the experiences and awareness of VR and AR within the veterinary profession.
Click link below to access paper
What a great day checking out the VR/AR Association startup zone at #IOTX in Dubai. Great ideas, great products, great people, such as Shujat Mirza (VR/AR Association Dubai Chapter President) & Clyde DeSouza (VR Filmmaker) – Spherical Image – RICOH THETA
AWE (Augmented World Expo)
- Seeing how much bigger the event has become, even over the last three years. One could really get a sense of VR and AR starting to be embraced by the mainstream and the energy during the event certainly felt like it had been etched up a notch from the previous year.
- Getting to speak. I was one of several speakers who took to the stage on the Life track and thoroughly enjoyed being able to deliver my vision of where I see VR in Veterinary currently standing and where I see it going in the future. I believe I am correct when I say that I might have been the first veterinary surgeon to speak at the event so representing the veterinary profession in such an exciting and rapidly advancing industry was truly an honour.
- Checking out Lllama Zoo’s HoloLens dissection experience. Charles and Kevin from the company had made the journey down from Canada and both my friend, Deborah, and I were privileged enough to be given a live demo of their augmented reality canine dissection tool, using the Microsoft HoloLens. With each of us wearing a headset, we were both able to see a high resolution holographic image of a set of lungs and heart floating in midair and move around it viewing it from different angles, remove layers and learn about the specific anatomy of this part of the body. The image quality was superb and I was not aware of there being any flicker or issues with the hologram staying fixed in position. A very compelling demonstration and a real glimpse at the future of anatomy teaching in vet and medical schools.
VR in Healthcare Symposium (VR Voice)
Mixed Reality & Virtual Reality
In 2016 I was fortunate enough to be at one of the conference parties where someone happened to have two Microsoft HoloLens headsets and was demonstrating them to the small crowd of curious nerds that had gathered around him. Well, I was one of those nerds and before long had the pleasure of donning one of the sets and so was introduced to the wonders of true mixed reality.
Much like a small welding mask, in both look and feel, the HoloLens is essentially a set of transparent screens that sit in one’s field of view by means of the headstraps that keep the device in place. Whilst not especially comfortable and certainly not something anyone is going to ever be in a rush to wear out in public on account of looking, frankly, ridiculous, the experience that it delivered was compelling. With the use of a simple gesture, specifically an upward ‘throwing’ movement, a menu popped into view suspended perfectly in mid-air and crystal clear as if it were right there in the real world in plain sight of everyone around me. Of course it wasn’t and the only person able to see this hologram was me. Selecting from the menu was as simple as reaching out and ‘touching’ the desired option and within seconds a holographic representation of the Earth was spinning languidly before me. I could ‘pick up’, ‘move’ and otherwise manipulate the item in front of me as though it were a physical object, and if I did move it, for example off to the right, out of my field of view, that is precisely where it remained and where I found it again when I turned back round. The human body application was similarly cool, as I was able to explore the various layers of anatomy through interaction with a highly rendered hologram. Whilst comical for onlookers not wearing a HoloLens, as I appeared to apparently be pawing away at thin air like someone suffering a particularly lucid acid hallucination, the thrill of what I was actually seeing and engaging with myself allowed me to ignore my daft appearance.
What are the medical education applications for such mixed reality technology? Whilst holographic visual representations of anatomy are, at first, a magical phenomemon to experience and a pretty cool party piece, it is the fact that mixed reality sees realistic holograms merged, or so it appears to the user, onto the real world, in contrast to virtual reality, which replaces the real world experience with an entirely digital one, that lends itself to unique educational applications. Anatomy instruction by being able to accurately overlay and track in real-time deeper layers onto a real-world physical specimen, enabling students to understand the wider context in which various anatomical structures sit is a far more compelling and useful application of MR than a simple floating graphic. Similarly, surgical training involving holographic overlays onto a real-world, physical object or combined with haptic technology to elicit tactile feedback, offers the potential to deliver programmable, repeatable, easily accessible practical training with minimal expense and zero waste on account of there being no need to have physical biological specimens.
Imagine: a fully-functional and resourced dissection and surgical training lab right there in your clinic or home and all at the press of a digital button. Imagine how confident you would become at that new, nerve-wracking surgical procedure if you had the ability to practice again and again and again, physically making the required cuts and placing the necessary implant, being able to make the inevitable mistakes that come with learning anything new but at zero risk to your patient. Being able to step up to the surgical plate for real and carry out that same procedure that you have rehearsed and developed refined muscle memory for, feeling the confidence that a board-certified specialist with years of experience has, and all without having had to put a single animal at risk – that’s powerful. That’s true action-based education at it’s most compelling and it is a future that both VR and MR promises.
I predict that the wide adoption of graphically rich, immersive and realistic digital CPD programmes, through both VR and MR, will result in a renewed engagement of professionals with CPD training and ultimately lead to more confident, skilled, professionally satisfied and happier clinicians. I, for one, know that were I able to complete practical CPD by simply donning a headset and loading up a Vive or HoloLens experience from the comfort and convenience of my clinic or home, all whilst still being able to interact in real-time with colleagues both physically present and remote, my CPD record would be bursting at the seams. That has to be a great thing for the profession, our clients and society in general.
You’ve done it! Five, or even six, years of lectures, practicals, placements, projects, rotations, deadlines, exams, and, of course, a whole lotta fun and here you now find yourself. Graduating, finally, as a fully qualified vet. Hoorah! It is most certainly the end of a MASSIVE chapter in your life and the start of, some would argue, an even BIGGER one. Now I don’t profess to be the font of all wisdom or to be able to bestow upon you the ultimate guide to be awesome as a new vet – to claim to be so would be both horrendously arrogant and plain wrong – but what I can offer to do is pass on a few tips that I have learnt – often the hard way – along the path from newbie vet to older, more grizzled vet with less hair than I started with.
- Take some time off after graduation/ finishing vet school – I remember loads of people in my year rushing out and starting work the very minute they got their paws on that degree certificate only to hear many of them state later that they wish they had taken more time off post-graduation to just enjoy, well, being free. Free from the stresses of studying, revising, being examined and assessed all of the time, free even from competing with one another, which admit it or not is exactly what we do throughout university – it’s in our ‘high achiever’ DNA. Save for taking a sabbatical between jobs, which many vets do after a few years, often to travel the world before ‘finally settling down’, this is one of THE best opportunities to just kick back, relax and take some stock of what it is you have actually achieved over the past half a decade. Granted it is getting more competitive in the veterinary job market and, true, loans do need to be paid off but we have not yet got to the tragic state where ALL the best jobs will have been snapped up immediately and student loans only actually start getting paid back once you are earning over a certain amount (other loans, such as professional development loans, may, it is fair to say, come with different repayment terms but generally speaking there isn’t as much of a pressing imperative for you to rush out and jump into the frays of work that you might imagine). So simply ENJOY!
- Be selective about your first job – this kind of follows on from tip number 1 but is something that too many new grads forget, or just don’t even consider. Jumping into the very first job that is offered to you may well get you practicing, and thus earning, faster BUT it is a really smart long term career move to ensure that you accept an offer from the very best job that you can attract. This doesn’t simply mean the highest paid. No. What it means is picking a practice, a team, a culture in which you will be more likely to thrive as a new grad and grow and develop into the top veterinary surgeon that you surely have the potential to be. Regardless of what you might feel, or believe, immediately post-graduation you are not the fully formed product. Nay! You are, or certainly should be, ‘day one competent.’ There is a reason that you are expected to complete the PDP (Professional Development Phase) after graduation and that is because there are still loads of things you will NOT be anywhere close to fully competent at doing. And thats ok. It’s normal. It’s expected. So, with this in mind I am sure we can agree that accepting a position to run a solo branch clinic as a fresh-faced newbie with little to no support or meaningful guidance from the older, more experienced vets, does not necessarily lead to a smooth learning curve towards year one competency. What it almost certainly does guarantee is the mother of all baptisms of fire and if you are the kind of person who feels that they learn best by jumping into the ring and just start swinging, or find the whole ‘Sink or Swim’ philosophy appealing then a sole-charge position may be the one you do want. My first job, whilst being part of a larger clinic and technically not 100% solo, did see me mostly based out in one of the group’s satellite clinics, where we had a more limited set of diagnostics tools, a piss-poor surgical set-up and probably THE worst X-ray machine and processor ever that made me actually hate any case that required an X-ray to be taken (that’s a lot of the standard caseload!). Whilst I coped, relying on what I did know, what I could pick up along the way from books, online and colleagues, I know now that I would have developed into a far more competent, well-rounded, omni-skilled vet – and, if truth be told, enjoy my job more – had I spent my really formative years working in a truly multi-vet environment, with high clinical standards, equipment and staff to meet them. Well run practices that think long-term recognise the true value in developing their new grads properly and invest time and resources into them. They will often reap the rewards down the line when that same new grad starts, as second nature, to work cases up properly, fully utilising a range of skills and knowledge to maximum effect for their clients, patients and the clinic. So it might take a little while to find this kind of practice but trust me, it is worth the wait. The alternative, which a lot of people opt for, whether they actually realise it at the time or not, is to take one of the first jobs offered, struggle for the first year and then quit, moving to another clinic, often a little more jaded about being a vet. And that is just sad. The other reason to really be selective is to ensure that you also choose somewhere where you’re going to enjoy living. Having a good salary doesn’t make up for living somewhere crap!
- Sign up to SPVS to get the annual veterinary salary survey, and READ IT – make sure you actually enter the veterinary job market knowing your market worth and start your professional life on the best footing you can. For many of us the very idea of negotiating our salary, including ‘perks’ or extras such as the level of CPD allowance, is more terrifying than a 3am GDV (only marginally, mind) and most new grads will simply not attempt it, instead just accepting what is offered. It is rare that you will take a salary cut as your career progresses, unless you change to a part-time position or change direction entirely thus dropping down several rungs on the old career ladder, so why not do yourself a favour and try and start a little higher up the greasy pole? Knowing what the market generally says you are worth paying via salary surveys is a good starting point in any job hunt. Whilst we’re on this topic it wouldn’t be the worst idea in the world to maybe use some of that post-graduation downtime to read some good books on subjects that might not seem immediately relevant but that will actually pay dividends many times over. Books on topics such as negotiation, sales and basic psychology are not only interesting reads in their own right but will equip you with some highly valuable soft skills that can be applied to job hunting and can make your transition into a working professional smoother and more productive.
- Be Confident of Your Worth – this naturally follows from the previous point but relates more to knowing why we charge what we do for our services and having the faith in your, and your profession’s, worth to avoid apologising to clients for it. It is a fact that you will be made to feel time and time again that you are a member of a “money-grabbing” profession who simply cares about profit over animal welfare. This charge, often spat at you when you are feeling at your lowest ebb, will come from clients who may well be frustrated, for whatever reason, legitimate or otherwise, but who have zero real appreciation for what it costs to provide top-class medical care and the fact that YOU are ridiculously highly trained and DESERVE to be paid reasonably for your skills, knowledge and service. I am as guilty as anyone of starting out in this game withering under these kinds of baseless attacks and finding myself nervously, awkwardly apologising for our prices being “expensive,” before feeling under pressure to cut costs, discount and generally acquiesce to unfair pressure. I have since developed a much tougher skin and fully appreciate both my worth and the worth of the profession, and of the wonderful service we provide. Business fact: without profit there is zero incentive to keep a business running, and veterinary clinics are no different. Having a building, medicines, surgical facilities, a skilled and dedicated team that is on hand round the clock to ensure animals, and their owners, have access to superb healthcare, does not happen by magic. Someone has to pay for it. If you believe that you should practice simply for the love of it then that is all well and good – go and work for a charity – but if you value the investment that you have made in your own training and the value of the service we provide then do NOT be bullied into apologising for what you do and what you charge to provide the service that you do. Of course some people will find the Gold Standard of care prohibitively expensive and may not have the luxury of insurance, or any other variation on the theme of not being able to meet the costs involved. We are, as a profession, sensitive to this fact and that is why as a professional you should be prepared to discuss all of the available options, including referral to charities, looking at less pricey (but often less effective) treatment options or, in the event of ‘treat or the animal suffers’ cases, offering euthanasia. As hard as it will be to remember this fact, it is NOT your fault or responsibility if the owner in question does not want to entertain any of the other options offered and still insists on the Gold Standard but without wanting to pay. You are not a money-grabber. You are not a bad person. You are not disinterested in animals. Quite the contrary – every one of us could have gone off and earned multiples of what we do in different industries and probably with less stress. You simply have confidence in your own worth and that of your profession. It is worth noting at this point that the vast majority of the clients you meet will appreciate and value the good work you do. That cannot and should not be understated.
- Be nice to nurses – well, you should be nice to everyone, obviously, but especially nurses as they very much hold the power to make your life as a vet, and especially a new grad, either awesomely awesome or miserable. They will know loads of super useful things way beyond the academics of being a vet, such as how to actually, safely hold a cat for you to examine, blood sample or the like without sustaining injury, and will be able to let you in on those little tips and tricks that are specific to the clinic in which you actually work and that can help to smooth the flow of the work-day. Aside from just being a decent person, polite, respectful and all that obvious stuff, you might find that mucking in and making the odd round of teas or actually cleaning out that shitty kennel that you happen to be the first person to see, rather than walk past and pretend you didn’t, will go a long way to ingratiating you as a genuine member of the team. In fact, just remembering the old adage “behave as you would want others to behave towards you” is a simple way of putting it.
- Develop interests/ a social life OUTSIDE of work – one of the biggest culture shocks to most new vets is the fact that we all go from being part of a pretty sizeable family, getting to see your mates every day, to often finding that you live miles away from both them and your family. Throw in the inevitable stresses that accompany starting work and the fact that you are now professionally responsible for what you do, plus lengthy working days and it is easy to see how one can quietly slip into a bit of a social rut or depressing cycle of ‘work-home-bed-work.’ Ensuring that you have an interest, hobby or social outlet outside of the clinic and that can serve as a healthy outlet for the stress et al of a vet’s working life will keep you sane, balanced and happy. Vets have an alarmingly high rate of depression, alcoholism (often started at vet school if my observations are any guide) and suicide, with the fact that the job can be quite isolating and lonely on a lot of occasions. Coupled with the sudden change in circumstance from being part of a big, social group of like-minded people to being out there in the world on your own can contribute to a deleterious cycle. Whether it be sport, or music, or art, or a whole host of other activities and interests, please do either continue to pursue them or develop one as soon as possible after moving to your new home.
- Treat yourself when you get your first salary payment – there is no sweeter feeling than being able to buy yourself something that you’ve always really wanted and that you can now afford. A big TV? A new car, perhaps? Or a holiday? Whatever it is that you will truly enjoy splurging on now that you can afford to enjoy doing so when you get your first payslip. It’s wonderful and screams out “I have arrived!” Savour the feeling of spending power and throw caution to the wind before you have to become all grown up by moving onto more responsible attitudes to your money.
- Save & Start a Pension – yes, yes, I know. I have actually typed those words and have instantly turned myself into a granddad in your eyes! Well, if thats the price I have to pay for offering really good advice then so be it. And it is awesome advice. Probably some of the best advice you will ever get. As much as you will not want to think about it the inescapable truth is that you will age and you will eventually want to do such things as retire, or maybe buy a house, or get married. You know, the kind of things that old people do but that you will end up doing too before you’ve had time to realise it. I am sure that you want to have a great standard of living when you finally stop working – I know I do – and that the likelihood of there even being such a thing as a state pension by the time we get there is pretty much zero. As such, you NEED to make provisions for your latter years and the truth is that the earlier you start the sooner you can begin to take advantage of one of the most powerful forces there is: COMPOUNDING. I won’t go into an in-depth definition of what compounding is here – you can Google it – but suffice to say that it is awesome and can be the difference between you eating baked beans everyday as a pensioner or living the good life. The key with compounding is time and so the earlier you start saving, and especially contributing to a pension scheme, then the more you will benefit from it. Establishing good habits – and we all know that saving IS a good habit – early can quickly lead to them becoming just that: habits. As in something we do without really giving it much thought. As in automatic. If you’re anything like me then without making a conscious, early decision to put aside a certain, fixed percentage of my salary automatically and regularly, I would probably just feel it burning a hole in my pocket and be the proud owner of even more Apple products than I already am! The fact that a set amount just disappears out of my account as soon as it lands in there and goes towards something with long-term benefit to me, means that I essentially do not even miss it because it was as if it was never really mine anyway. As such, my monthly budget is based on what I keep and it is amazing how I have adapted to this smaller amount quite happily. Having money saved regularly also means that should you wish to make a larger, discretionary spend, such as an awesome holiday, or maybe even need some ready cash in an emergency, it is already there courtesy of your good, early habits. That is incredibly liberating. So, start a regular savings plan as soon as you start earning and as much as it will feel like it is something that someone of your age has no place doing book an appointment to speak with a pensions advisor. (NB: I really, really wish we could change the word and use something other than ‘pension.’ It just has certain automatic connotations that I strongly believe serves to put young people off the very idea).
There are doubtless many more bits of advice that will see you sail smoothly from the life of an aspiring student to that of hard-working professional so feel free to suggest your own below. In the meantime, enjoy your success and good luck with whatever is next in this insane journey we call life.
Knowledge has never been so readily and easily available. It is instant, mobile and has the power to revolutionise how we operate as vets and work together with clients on their pets’ healthcare.
What is at fault is that we are generally POOR at knowing HOW to LEARN and critically appraise the quality and reliability of information, especially that found on the internet.
A classic example is that of dog breeding/ puppies. I saw a Pug owner the other night whose female had been ‘accidentally’ mated (there are no accidents in these situations as there is a widely advocated option known as neutering) and so we are now looking at said bitch being due to whelp in the next 2 weeks. The owner in question admitted that they had never had any experience of breeding dogs but had “looked online” and was alarmed to “learn” various things, all of which were quite frankly sensationalist at best and downright incorrect at worst. The advice I gave, in addition to dealing with the immediate issue for which the dog had been presented to me in the middle of the night, was to advise the owner – nay, urge the owner – to visit their nearest well-stocked book store, buy and READ a comprehensive guide to dog breeding, especially the sections pertaining to whelping and puppy care. Books are great in as much as they generally still do undergo some degree of review before publication and so it is less likely that the information contained is plainly wrong, in contrast to much of what can be found online with the universal ability for anyone with a connection, voice and opinion to fire their musings out into the world. Hell, I am one of those same people as demonstrated by virtue of this very blog! How can you be sure that what I write on here isn’t just a load of inaccurate bollocks? You can’t is the truth of it. The same goes for much of what is published online, especially that found on forums/ discussion boards and blogs. Therein lays the challenge and risk associated with relying blindly on “the internet.”
I was fortunate enough to benefit from a rigorous training in the importance of critically appraising information for reliability and so do feel that I am able to mix my information sources (online versus print, etc) relatively safely. Many, unfortunately, do not and in the veterinary profession we still hear “but the breeder said..” or “a website I looked at said this (completely fanciful/ sensational/ wrong) thing…” again and again. Our battle is becoming more and more against the swathe of half-truths and inaccuracies that swirl around in the electronic ether and set against a client base that is becoming generally less trusting and more questioning of what we do, which is not necessarily a bad thing in and of itself.
I love the internet and the educational power that it contains. From TED talks to online courses, blogs from recognised experts and amateur enthusiasts alike, to social networks and their power to engage in real-time conversations and information dissemination, the web is and will continue to be utterly transformative. It is vital, therefore, that in order to get the most value out of this precious resource people know HOW to LEARN, what information to accept and what to question and potentially reject. Part of our role as modern day veterinary professionals is more and more going to be as information curators and sign-posters, directing our clients and the wider animal-owning and caring population toward sources of information that will lead to sound healthcare decisions and outcomes. As old-fashioned as it may sound, books do still serve as a good place to start and this is why I often still direct my clients to their local bookstore.
“Virtual Reality was made for education.” I have no idea who first said that – can I claim it? – but I am sure it has been uttered countless times since and I assure you that it will be said countless times in the future. From feeling as though virtual reality (VR) was nothing more than a sci-fi promise of things to come yet never quite delivered to the current situation in which VR feels as if it is undergoing a true renaissance.
With the arrival of devices, such as the Vive, Oculus Rift and Samsung GearVR, that are finally capable of delivering truly-immersive, high resolution and, most importantly, non-nausea-inducing experiences that captivate both young and old alike, VR has arrived and the exciting truth is that we are simply getting started!
There are already creative, innovative and fast-moving teams working on sating the appetite for immersive content, with gaming naturally leading the charge, and 360-degree video experiences also offering many their introduction to the world of VR. This, however, is not where VR ends and it continues to excite me to see the educational promise that this technology offers and that pioneers in the field are indeed delivering on. Unimersiv, one such team, refer to the idea that whilst 10% of knowledge that is read and 20% of that heard is retained two weeks later, a staggering 90% of what is experienced, or physically acted out, is recalled. If that is indeed the case then VR, with its power to immerse users in any environment that can be digitally rendered, offers a hugely powerful educational tool. The fact that the big players in the tech arena, such as Google, are now taking VR seriously speaks volumes for how impactful it is predicted to be, and that I believe it will be.
Potential medical, especially educational, applications abound, with veterinary no exception. Whilst my interests in the technology are NOT limited to veterinary, it is an area that I have direct experience of working in and so where perhaps I am most effectively able to postulate on the future applications of a technology that IS, I strongly believe, going to shake things up for all of us. In terms of medical and science education, for example, work such as Labster’s simulated world-class laboratories, where students can learn cutting-edge science in a realistic environment and with access to digital versions of professional equipment. It may be digital and simulated but that does not diminish the educational power that such experiences delivers. I can see Labster’s technology inspiring a new generation of scientists to develop a fascination for the subject and ultimately help solve many of the world’s most pressing problems, such as the issue of antimicrobial resistance and the drive to develop new drugs.
So what about the potential uses for VR within veterinary? Well, perhaps some of the following….
- Dissection – Anatomical training without the need for donor animals/ biological specimens. More efficient, with multiple ‘reuse’ of specimens in a digital environment, leading to revision of key concepts and better learning outcomes, translating into better trained, more confident practitioners.
- Physiology – take immersive ‘journeys’ through biological systems, such as the circulatory system, learning about how these systems work, both in health and disease. Simulation of the effects of drugs, parasites, disease processes can be achieved, with significant learning outcomes compared to traditional learning modalities.
- Pharmacology – model the effects of drugs on various biological systems and see these effects up close in an immersive, truly memorable manner, thus deeply enhancing the educational experience.
- Surgical training – simulate surgical procedures thus enabling ‘walk-throughs’ of procedures in advance of actually physically starting. With advances in haptic technologies, tactile feedback can further augment the experience, providing rich, immersive, powerful learning environments. Surgeons, both qualified and training, could learn in a solo capacity or with team members in the digital environment – great for refreshing essential skills and scenario role-playing with essential team members. For example, emergency situation modelling to train team members to carry out their individual roles automatically, efficiently and effectively.
- Client education – at home and in-clinic demonstrations of important healthcare messages, helping drive healthcare messages home and driving clinic sales, revenue and profitability, and leading to more favorable healthcare outcomes and client satisfaction.
- Communications training – many of the issues faced in medical practice stem from breakdowns or difficulties in communication with clients or between colleagues. Communications training is now an integral part of both medical and veterinary training and should be extended to all members of a clinic’s team, from receptionists to nurses and veterinary surgeons. With the immersive power of VR and the ability to create truly empathetic experiences, it offers the perfect tool for communications training.
- Pre Vet School education/ Careers counseling – think you know what it means to go into veterinary practice? Can’t arrange a farm placement but still believe you have what it takes to pursue a veterinary career? Imagine being able to experience a range of VR simulations that guide you through a host of realistic scenarios faced by veterinary professionals, enabling you to make informed career decisions based on ‘real’ experience. It has been demonstrated that those who experience high-quality VR feel genuine empathy for those situations into which they digitally stepped. The power of this for making informed choices about future plans and for challenging preconceived notions about what it means to be or do something is compelling.
- Commercial demonstrations/ trade show experiences – custom-made VR experiences for showcasing new products and services to prospective customers, creating truly memorable and impactful campaigns. I for one look forward to VR becoming a mainstream component of company presentations at trade shows.
These are simply a snapshot of some of the potential applications for VR with most easily being applied in other, non-veterinary contexts. I look forward to continuing to grow my knowledge and expertise in this exciting area and welcome anyone who shares the same sense of wonder and optimism at the possibilities to get in touch.
Autonomy & independence – the camaraderie of working with other vets during the day is great and it is always good to have others to bounce ideas off. However, long-term the danger is that always being able to “check things” with a colleague can lead to a slow erosion of the ability and confidence to truly think and act independently. With night shifts, where it is usually only ever a single vet in charge, there are no others to check in with. Assessments need to be made and decisions executed based on what I believe to be best practice. If I don’t know something then of course I can, and do, check in with trusted sources of information but ultimately I am the one who has to decide and act on a variety of unique cases and clinical situations. Although it can be scary at times, such as my first night on that saw me presented with an aged Boxer dog that seizured pretty much continuously all night, the confidence that gradually comes from relying on your own ability to process information, apply knowledge and skill and ultimately make decisions and take actions that have real outcomes is empowering. For this reason alone I think that doing some night work is very valuable for all clinicians.
- Variety – we see and hear it all during the graveyard shifts, that’s for sure! From the full-on emergency requiring all hands-to-the-deck, to the varied hospital cases that seem to swing from one state to another almost by the hour, consults for ultimately simple complaints to downright bizarre calls, we do get variety in our lives. Often the main challenges presented during the night are the human ones, with the most unusual calls coming in, such as one we had at 2am from a lady concerned about whether her sister’s dog was in pain after having been neutered a couple of days ago. My nurse spoke for a short while with said lady before offering an appointment at which point she informed her that the dog was actually in Scotland! (nb: we are in Dubai!) Another classic night-time call is often from an owner who has been sitting on a pet health issue for the last week only to decide that now, in the wee small hours of the morning, is the time to seek advice and assistance and to then act surprised when the cost of being seen is pointed out to be higher than during the day. Just plain odd. Again, from a training in how to deal with people and communicate standpoint, night shifts are an invaluable learning environment. Either that or fertile anecdote-mining terrain for the next book!
- Free time – some nights are literally spent working for the entire time, such as the aforementioned fitting dog scenario, whereas a lot of the time things do tend to quieten down after midnight meaning that there is an opportunity to catch up with paperwork, do some CPD or even just indulge in some more light-hearted pastimes such as reading. As someone who is generally busy working on all sorts of personal projects, having the time to sit down during the night is one of the main draws of working these shifts. Of course there is always the risk that a call will come in or something will change with an in-patient, requiring you to switch attention, but generally it seems that there is time available.
- The filtering effect of the higher consult prices – it costs more to be seen out-of-hours, the reason being that our costs of providing a service overnight are higher than during the normal working day. The advantage of this fact is that it can, and does, serve as a very effective filter for those genuine emergencies versus those cases where the pet can either wait to be seen when the clinic is running with a full team and the real time wasters. It never ceases to amaze me how what is initially dialled in as a “real emergency” that simply “must be seen NOW” quickly becomes “oh, its okay – I’ll see how we go overnight and then see the vet in the morning,” once the cost of the overnight consult fee is made clear.
- Leaving as everyone else arrives – despite being tired and very much looking forward to hitting the sack, there is a satisfaction that accompanies being able to head out the door, past everyone else in the world who is heading in the opposite direction to start their working day. One might call it a sense of smugness.
- Time off – we touched upon this primary perk above, with the main point being that the reward for working a full week of long night shifts is an entire week completely off work. Brilliant!
Our bodies and brains just aren’t used to functioning optimally during the entire night and regardless of the amount of sleep one tries to get during the day it never feels as though it is enough, meaning that, for me anyway, I have spent the last week feeling somewhat jet-lagged. The worst periods are the hours during which I am actually writing this now: 2am – 4am, the real ‘dead of night,’ when every fibre of my being is screaming at me to close my eyes and just switch off. The evidence shows that the body and brain changes state during these hours, meaning that even the food we eat during the night is processed differently to if it was consumed during daylight hours. Increased long-term risk of developing conditions such as heart disease, diabetes and obesity are recognised sequelae. Although there are plenty of articles and sources of advice on how to “adapt” to night shifts, the truth is that you never really “adapt,” especially if you then adjust back to a normal routine. One of our nurses who works nights has actually converted to a pretty much permanent state of nocturnal being, continuing to stay up all night and sleep during the day even on her off weeks, so maybe she has managed to adapt over time but that is not something most of us would be happy to do.
- Try to get a little sleep directly before the first night on duty, even if it’s only a couple of hours of rest, preferably in the dark. You’ll still feel tired during the shift, especially during the very early hours, but psychologically I find it better than trying to go straight from being a ‘day-walker’ into being a creature of the night.
- Prepare some healthy, wholesome food to take in to work, preferably something you can heat up and have as a ‘proper meal.’ The temptation with night work is to snack, especially on the kind of crap that you wouldn’t normally indulge in often. Snacking on junk combined with the stresses of already being awake all night will gradually have a detrimental effect on your health. Eating decent food is one thing that you can control and giving your stressed body and brain the right kind of fuel will make the process so much less damaging in the long run.
- Take something to do during those ‘quieter’ periods. I always go into nights expecting to be busy all night, with any ‘free time’ ultimately being seen as a bonus. I find this approach much easier to cope with psychologically than going in expecting to have free time only to get all pissed off when I find that 1am emergency rocking up. Whether you take in some reading, a movie or some project work to do, having something on hand to focus on during the occasional lulls will help keep you awake and stave off the attack of the drowsies!
- Get in early so that you’re not rushing and feeling flustered before you start, especially if you then end up heading into a busy night. I personally like to arrive about 30 minutes before my shift, change into my work clothes actually at work and maybe even kick back for ten minutes before heading upstairs to find out what fun-and-games await me.
- Expect to feel tired at some point, even as you get further into the week. I have not had a single night over the past seven days where I have not felt the strong desire to curl up and sleep at about 2am. There isn’t really any way around it unless you choose to make use of stimulants such as caffeine, although I don’t recommend it as a) you simply end up elevating your heart rate, stressing your body at a time when every bit of it’s programming is telling it to be relaxed; and b) unless you process caffeine super rapidly you’ll likely screw yourself over for when it comes time to get your head down at the end of your shift. I do have a small coffee before heading in for my shift, as that would normally be part of my ‘breakfast’ routine, but otherwise I avoid caffeine for the rest of the 24 hour period.
- Try and get some rest, even if it does just mean a 15 minute lie down. The restorative properties of simply remaining still and allowing the brain to rest, even for short periods, is established. It’s unlikely you’ll get to actually sleep so I wouldn’t bank on it and besides, any more than a 30 minute nap usually results in feelings of sluggishness and confusion when you come back around, so the apparent advantages don’t really seem to materialise.
- Get a healthy breakfast, avoiding caffeine, and go through whatever morning routine suits you. I personally need about two hours to fully unwind from the shift, getting into bed by about 10am.
- Assess whether you’re safe to drive. Extreme fatigue has been proven to have the same effect on driving ability, hazard awareness and reaction speeds as drinking, so if you do feel super tired in the morning then do yourself a favour and get a taxi home. Crashing your car on the way back home would be a really shitty way to end a shift.
- GET SOME SLEEP! The bulk of the day should be given over to sleep, not to “getting things done,” as will be the temptation. Creating the right conditions for a decent sleep can help, from making the room as dark as possible or even wearing a mask, to turning the temperature of your room down a little. Even then, it is likely that you will not sleep as soundly, or for as long, as you would normally during the night but that is to be expected. I have aimed for at least 6 hours a day (10am to 4pm) and found that I have been waking naturally just before 4pm anyway. The first day of sleeping and then waking in the evening was odd and it took me a moment to remember what time of the day it was, which was a surreal, almost dream-like experience.
- Turn off distractions such as phones. You’re much more likely to be disturbed by various notifications, messages and emails pinging continuously as they hit your phone during the day, especially given that you’ll likely be sleeping less heavily than normal, so turning off any such notifications is wise. Obviously the one notification you will want to ensure you hear is your alarm call and it is for this reason that I personally choose not to use ear plugs.
- Get a good breakfast, as with any day.
- There are two techniques I discovered during my research that can aid in transitioning back to a normal day-centric routine:
- Sleep for a few hours (e.g. 10am to 2pm) and then get an early night later in the evening, with a normal return to daytime routine the following day. This is the tactic I intend to employ.
- Sleep through for 36 hours and write off the first day in order to start the following day on normal routine day mode.
- Expect to feel a bit out of sorts for a couple of days. Much as jet lag can leave you feeling a bit weird for a day or two after returning from a long-haul trip, coming off nights can feel the same. Not to worry though: it’s normal.
- Plan some awesome stuff to do during your time off and enjoy – you’ve earned it!
I had a cracker this week after apparently failing to remove every single tick off a dog that was presented to me during consultations. In spite of safely removing those that were found during the fifteen minute appointment on a very busy weekend consulting block, and both demonstrating safe removal and disposal whilst also clinically examining said dog and spending time imploring the owners to effectively treat their pets against ticks, including examining the environment to try and identify the likely source of the acute infestation, prescribing safe and efficacious measures and discussing the potential health implications of ticks for both their pets and them as humans, it was apparently all insufficient due to the fact that they had ended up having to remove further ticks at home.
I won’t go into why the complaint was just silly as it is basically a waste of good electrons but it is worth picking up on one of the daft comments made as part of their groundless gripe: “it almost seemed as though the vet was scared of ticks.” Brilliant!
On that point, however, they are correct. I am scared of ticks. Terrified. As should everyone. They are serious little parasites who can and do kill as a result of some of the horrendous diseases that they carry, and I am not only referring to pets here.
“I am scared of ticks. Terrified. As should everyone.”
The big concern with ticks here in the UAE is the risk of ehrlichia, and it is a disease that we sadly diagnose and treat – not always successfully – all too often. It is also a potentially serious zoonosis, meaning that we can contract it if bitten by an infected tick. This is why we preach about effective and regular tick control over and over again, sounding like broken tick-themed records. It is a serious business that sadly too many people do not fully comprehend. So yes, I am scared of ticks. I approach them with caution, removing them with care and the respect that a dangerous killer attracts, and it is exactly why it may well seem as though I am being ‘over-cautious’ in the consult room and why I implore owners to treat their pets AND to take home the means by which to safely remove and kill any further ticks that almost certainly will be found by the owner at home.
“The battle against ticks does not begin and end with the vet.”
At the end of the day all I can reasonably do as a clinical veterinarian is to do my best to deal, in the time reasonably allotted, with the immediate issue (ie the ticks that were found and removed) and both educate and equip the owners to do the correct thing by their pets. The battle against ticks does not begin and end with the vet; it is an ongoing battle that is best fought in a preventative manner at home and taken as seriously as the “terrified” vet seems to take it. The long-term health of both you and your pet may well depend on it.
For more detailed information on ehrlichia in dogs, click here.
Further information on ehrlichia in humans can be found here.