How do veterinarians die?

How do veterinarians die?

Veterinarians are a professional group with an exceptionally high suicide rate. They are four to eight times more likely to end their own lives than the general population. What is the reason behind this?

REASONS OF THE PHENOMENON
Veterinary studies take a long time and require sacrifices. Getting in is not easy and high demands are placed on the candidates. According to Halliwell and Hoskin, this may be associated with increased susceptibility to suicide in the United States of America. In the US, in order to apply, A levels are not enough. The requirements are a bachelor’s degree in life sciences, an essay accompanied by a recruitment questionnaire and documented volunteering in veterinary institutions or animal foundations. The final decision is made on the basis of an interview with the committee. In Poland, admissions are based on the secondary school final exam alone. Points are calculated digitally. There is no psychological examination whatsoever. Many candidates have misconceptions about veterinary studies. They cannot estimate clearly how much time and effort the university will require. The career decision is sometimes influenced by family pressure, possibly because the student cannot get into medical school. Veterinary students tend to be overworked, face unclear expectations from academic teachers and become home-sick. These factors contribute to anxiety disorders and depression. In 2016, we conducted a study with 584 veterinary students from all over Poland. 23.1% admitted being diagnosed with mood disorders and 14.6% were diagnosed with anxiety disorders. A packed and difficult curriculum and the competition can prevent veterinary students from developing emotional intelligence and social skills, and lead to low resistance to stress. They do not learn the so-called key competencies, such as cooperation and group work. They often put science before other spheres of life. They are in the rat race, constantly competing with each other. The first surgery on a living animal, according to research, triggered negative emotions in 63% of students. All this is just the prelude to the complex problem I’m addressing in this article.

Difficult start
Veterinary studies take a long time and require sacrifices. Getting in is not easy and high demands are placed on the candidates. According to Halliwell and Hoskin, this may be associated with increased susceptibility to suicide in the United States of America. In the US, in order to apply, A levels are not enough. The requirements are a bachelor’s degree in life sciences, an essay accompanied by a recruitment questionnaire and documented volunteering in veterinary institutions or animal foundations. The final decision is made on the basis of an interview with the committee. In Poland, admissions are based on the secondary school final exam alone. Points are calculated digitally. There is no psychological examination whatsoever. Many candidates have misconceptions about veterinary studies. They cannot estimate clearly how much time and effort the university will require. The career decision is sometimes influenced by family pressure, possibly because the student cannot get into medical school. Veterinary students tend to be overworked, face unclear expectations from academic teachers and become home-sick. These factors contribute to anxiety disorders and depression. In 2016, we conducted a study with 584 veterinary students from all over Poland. 23.1% admitted being diagnosed with mood disorders and 14.6% were diagnosed with anxiety disorders. A packed and difficult curriculum and the competition can prevent veterinary students from developing emotional intelligence and social skills, and lead to low resistance to stress. They do not learn the so-called key competencies, such as cooperation and group work. They often put science before other spheres of life. They are in the rat race, constantly competing with each other. The first surgery on a living animal, according to research, triggered negative emotions in 63% of students. All this is just the prelude to the complex problem I’m addressing in this article.

VETERINARY AND HUMAN MEDICAL PROFESSIONALS
The professions of doctors and veterinarians have much in common. They are equally required to be committed, have an impeccable ethical thinking and high social sensitivity. Professionals of both fields work under time pressure, at a dizzying pace and often overtime. University education is free for both groups. However, the training of these professionals holds certain differences. After their university studies, doctors continue as residents, and get paid for their work. Veterinary graduates, on the other hand, need to find a way to take paid postgraduate trainings and attend conferences and courses. Specialized residency programs for veterinarians are not available in Poland. The costs of broadening one’s knowledge and running a business are high. Health and life are at stake. Both groups have high risk of suicide compared to the general population. An estimated 19% of veterinarians have thought about taking their lives and 9% has attempted suicide. Veterinarians might have a higher risk of committing suicide than doctors, though the topic certainly requires further research. The team of Vetnolimits conducted a study in 2018 with 637 veterinarians from all over Poland. 21.4% of participants claimed having planned suicide, 12.6% occasionally and 3.6% often have suicidal thoughts.

PSYCHOLOGICAL PORTRAIT OF A VETERINARIAN
Who is a veterinarian? Often, an extremely ambitious and neurotic person with unrealistic expectations towards themself and their coworkers. These features increase the risk of mental illness. Excessive perfectionism can be a root of illnesses like depression, obsessive-compulsive disorders or
eating disorders. According to two independent studies, only about 50% of veterinarians would choose this profession again. Many of us take work home. They will not go to bed until having solved a clinical riddle or found answers in the literature to questions tormenting them. Their private conversations usually revolve around work as well. Many veterinarians consider work their only interest.

RISK FACTORS FOR SUICIDE

When searching for the risk factors for suicide, stress immediately springs to mind. The group that faces the highest levels of stress is young, inexperienced doctors, especially women. Hence, depressive disorders, anxiety disorders and burnout are extremely common in this profession. Veterinarians work long hours, often outside the designated office hours. They often choose to overtime when an animal’s life is at stake. Other times, medicine is powerless and despite their willingness and commitment, veterinarians are unable to help. As high as 80% of British doctors perceive their work to be stressful. Veterinarians working with small animals or mixed practices report the highest level of stress. Anxiety appears at an early stage of learning. In our 2016 study with almost 600 students, almost 90% admitted feeling completely unfit for work-related stress. To make matters worse, cyber-bullying causes an enormous tension. More and more frequently, owners do not mince their words. They challenge doctors online, sometimes threatening to destroy their reputation or even to take their lives. Strong emotions can make customers unpredictable and their actions can be unpleasant. Many doctors cannot cope with this. Unfair competition is worth mentioning as well: fake Google or Facebook accounts can be created and used to spread rumours and negative reviews in groups or forums. Doctors are unable to do anything about what happens online.The powerlessness creates a negative atmosphere and makes veterinarians distrust one another.

The ability to communicate with customers is another risk factor. Veterinarians need strong interpersonal skills. A veterinary surgeon not only has to examine, diagnose and treat animals. They are also required to provide information on the results to owners, so that they can make decisions about further treatments. The information is often devastating for the owner. We might tell them that the disease is incurable and that it is the last night of their pet. Owners often wait too long before turning to a veterinarian. Even if it is too late, they might insist on fighting until the last moments. Many of them underestimate the work and the sacrifices of the doctor, and pour their despair on the professional.

For veterinarians, it is difficult to see when the owner is not committed to the animal. They face dishonesty due to lack of trust. Pet owners tend to force unreasonable solutions or hold doctors responsible for the animal’s condition. In other cases, they refuse to take any action due to their lack of financial resources. All these circumstances are a burden for veterinarians that can decrease their commitment, and make them indifferent towards sick patients.

CONFRONTATION WITH HUMAN ATTITUDES

Veterinarians are aware of their capacities: over the years, veterinarians in Poland have gained access to excellent specialists, modern methods and medicines. No wonder they find it frustrating when the animal could get proper care but the owner has no willingness or money to go through with the treatment. Even if they could help, circumstances interfere – leading to professional burnout. Let’s see some typical scenarios veterinarians face in their everyday practice. “It is only an animal, it is not worth treating it. I have no money for this.” “I love him so much, I cannot watch him suffer. Please put him to sleep!” Euthanasia can be the owner’s answer even to the first health problem of the animal. Veterinarians have to patiently present the available options and encourage the owner to start the treatment. However, if we fail to convince the owner, they will go to the next veterinarian, until one of us gives in and performs euthanasia. We see that animals are not always treated as family members. Some owners are neglectful: they don’t take their pet to the veterinarian regularly, maybe only once in a few years for vaccination. It is heart-breaking for us to see that the animal, now diagnosed with a chronic disease in an advanced stage, would have had a chance to live longer, if had the owner reacted on time.

ACCESS TO LIFE-THREATENING MEDICINES
Death is a part of this profession, after all, veterinarians carry out euthanasia. It sounds brutal but we are, in fact, accustomed to it. Some of us even stopped being emotional about it. It is believed that performing euthanasia can disrupt the perception of death and the value of human life. It might enable self-justification, hence suicide can seem like a rational solution. A study conducted on a small group of veterinarians showed that 93% accept human euthanasia as well. We are one of the few professional groups that have an access to euthanasia drugs and psychoactive substances. Sadly, a large number of veterinarians end up using these to end their own lives. Kelly and Bunting reported that the conscious intake of such substances is the most common form of suicide in the veterinary profession: 76% of men and 89% women choose it.

ADDICTION AND EXCESSIVE DRINKING
Predisposition to addiction is another risk factor for suicide. Surveys conducted by the American Veterinary Medical Association’s Journal of the American Veterinary Medical Association showed that as much as 73% of respondents had a colleague at the veterinary clinic who was suspected or
known to be addicted to drugs or medicine. An addicted staff member can be a seemingly well-functioning employee. Most of the drugs are kept in a place with limited access to guests. In large, crowded clinics, monitoring the inventory of all drugs, 24 hours a day, is difficult. On-call workers can take advantage of this and there is scope for abuse and addiction. Veterinarians in the UK admit abuse of alcohol, ketamine, benzodiazepines, opioids, drugs (cannabis, heroin, cocaine and ecstasy) and nitrous oxide. Veterinarians are estimated to consume more alcohol than the rest of the population and almost 7% of them are drunk at least once a week. Our survey this year showed that 28.6% of physicians drink alcohol or use psychoactive substances practically every weekend, and 16.3% admit to doing it several times a week.

ISOLATION AND STIGMATIZATION

Veterinarians prefer to work with animals rather than humans, as their choice of profession shows. Working alone can cause isolation from society and exacerbates the risk of depression. Independent work in private practice increases the chances of medical errors. This is particularly true for graduates who find themselves in a new environment, often working without supervision and the opportunity to consult an older colleague. This results in severe stress and can be an important factor leading to suicide.

Mental illnesses are still stigmatised. They are recognised as a sign of weakness, especially in educated people. As a result, veterinarians do not seek professional help. Suicidal thoughts often develop – practically everyone knows or has heard about someone who is no longer among us. Young men are particularly vulnerable to suicide. In Poland, the access to psychiatrists is limited. One can be on the waiting list for psychotherapy of the National Health Fund for as long as 2 years. There is a social stigma attached to mental health problems and seeking the help of a therapist, hence people are reluctant to do so. The pharmacotherapy of depression is demonized. Private therapy is expensive (115 euros a month or more). The struggle of asking for help aggravates the situation.

(LACK OF) WORK-LIFE BALANCE
Helping animals generates strong emotions. Veterinarians are usually not prepared to cope with work-related stress and to handle difficult customers. During their studies, they don’t learn how to deal with the death of an animal and professional failures. No one explains how to look after their own mental health. The well-being of the professional is underestimated and is not captured in the syllabus, unlike in Western universities. Veterinarians work in a hectic pace. They sleep too little and have no time for private life. This endangers their physical and mental condition. They tend to take work home. They cannot separate their professional and private life, which makes them feel lost and exhausted. A medical profession can be unpredictable. There are moments when we do not know how to keep an emotional distance from failures and calmly analyze them. Our faith in positive outcomes is shattered, our self-esteem drops, and the quality of our work decreases. Professional mistakes can provoke or intensify suicidal thoughts. The persistent tension and overload leads to compassion fatigue – a rough phenomenon we have covered in our previous articles. Compassion fatigue might manifest itself in a loss of emotional control when communicating with clients or co-workers, in a decline of productivity or a reluctance to perform professional duties.

FACTS ABOUT SUICIDE
Depression is referred to as the disease of the 21 st century. It is estimated that about ⅔ of people who committed suicide had suffered from depression. Every year, close to 800 000 people die due to suicide in the world. Someone who mentions committing suicide is often really close to the decision. Such signals must not be ignored. Suicide attempts increase the chance of death due to suicide. Traumatic events are rarely the direct trigger of the decision. Most often, the individual experiences a long-term bad mood beforehand. In our next article, we are going to cover the signals
that may indicate mental health problems of veterinarians, and the ways to help them.


AUTHORS: DVM MARTA RYMARCZYK, DVM NATALIA STROKOWSKA

7 Comments
  • Basia
    Posted at 10:30h, 14 October Reply

    Artykuł jest napisany fantastycznie. Szokuje, wyzwala emocje współczucia, empatki,złości. Faktem jest ,ze własciciele będący w gabinecie nie jednokrotni e pid zostawia ją na lekarzy suchej nitki. Ale są też naodopikuńczy którzy walczą na słowa z lekarzem bo to oni sa ze zwierzakiem w domu i lepiej wiedzą co mu służy . Na pewno nie dieta. Faktem jest , ze właściciele sa trudniejsi niż rodzice malych dzieci. A lekarzowi czy personelowi pomocniczemu nie ufają . Bo ten chce wykrasc z portfel a jak najwiece j kady. Spotkałam sie w ży c iu z nieuczciwymi lekarzami. Ale jest ich mało i trac z pacjentow na rzecz kolegow z leprzym , uczciwszym podejci e m do pacjentow j ich właścicieli. Zaszokolawo mnie to , z e tak szybko nadtepuje wypalenie lekarza weterynarii. A czy ktos zastanowił sienad tzw personel d m pomocniczym,?, technik weterynari stoi obok lekarza razem znim przeżywa chorobę zwierzaka, choc nie podejmuje dec co do leczenia z braku kompetencji to tez jest narażony na stres. Też denerwuje sie gdy właściciel przychodzi za późno i oczekuje cudu. Czeżkoe stydia ,cieżkie życie, ale wszędzie sa chmury i slońce na usiechnietych pyszczkach.

  • Lina
    Posted at 20:48h, 14 October Reply

    Super artykuł! Zabrakło mi jedynie aspektu jak źle wpływa na nas konkurencja między kolegami pracującymi w jednym teamie, faworyzowanie przez szefów pojedynczych osób z zespołu czy przekraczanie granicy szef-pracownik przez pojedyncze jednostki, co negatywnie wplywa na samoocenę pozostałej części pracowników. Jestem w kolejnym gabinecie i po raz kolejny spotykam się z analogiczną sytuacja. Mam nadzieję, że ten zawód będzie na przestrzeni lat zmieniał się na lepsze dla ludzi, którzy poświęcili dla weterynarii bardzo wiele.

  • Marta
    Posted at 21:54h, 22 October Reply

    Dokładnie, to to to… Bardziej mnie to dołowało niż ogrom obowiązków. Najgorszy był pseudozespół. Uśmiechają się do ciebie w przerwie, a jak cie nie ma w pracy plotkują, i donoszą bzdury do szefostwa, by tylko podminować drugiego lekarza a samemu zyskać jakieś chore punkty u szefa…
    Teksty w stylu “przyzwyczaj się”, “musisz zostać po godzinach, taka praca, my już jedziemy i ktoś musi zostać”, “jesteś najmłodszy/najmłodsza w zespole, nie licz na święta z rodziną”, “jesteś najmłodszy w zespole, twoim obowiązkiem jest mycie toalety, żebyśmy my tego nie musieli robić” , “jeśli nie mówię, że zrobiłeś coś źle, to masz się cieszyć że nic nie spieprzyłeś” itp. itd. Zamiast się wspierać w obrębie zespołu wbijają sobie kosy pod żebra przy każdej okazji.

    • Natalia Strokowska
      Posted at 21:49h, 24 October Reply

      Bardzo mi przykro to czytać. Brzmi jak “fala” w wojsku. Takie traktowanie może całkowicie zniszczyć poczucie własnej wartości i stosunek do pracy. Z komentarza wnioskuję, że to już były zespół. I całe szczęście!

  • Ramka
    Posted at 08:19h, 26 October Reply

    Jeszcze możnaby dodać, że ludzie mają wyobrażenie o lekarzu weterynarii jako o osobie, ktora kocha zwierzęta i poświęciła im swoje życie zapominając o tym, że większość z nich ma też swoje rodziny, przyjaciół hobby i w momencie kiedy lekarz odmówi z jakiś powodów przyjęcia pacjenta po godzinach pracy bo pies rzyga od dwóch dni, ale w sobotę o 21 to już naprawde jest apogeum to właściciel obsmarowuje lekarza gdzie się da. No i stałe teksty typu “ale wy bierzecie za to pieniądze? Przecież niesienie pomocy zwierzętom powinno iść z potrzeby serca, przecież kochacie zwierzęta”

  • Polskie Towarzystwo Suicydologiczne – Biuletyn Polskiego Towarzystwa Suicydologicznego październik/listopad 2018 (nr 5)
    Posted at 10:27h, 08 November Reply

    […] i trudnościami na co dzień. Również o problemie samobójstw we własnym zawodzie pisze w świetnym artykule lekarka weterynarii Natalia Strokowska – zwiększone ryzyko wśród weterynarzy jest znane […]

  • klient
    Posted at 15:53h, 08 May Reply

    Przykro mi to czytać i smutno, że autorowi trzeba przyznać rację. Przykre i niesprawiedliwe jest to, że my – właściciele zwierząt – w dużej mierze możemy przyczyniać się do powstawania niektórych dramatów lekarzy weterynarii. Bo mało co niszczy ambitnego człowieka tak, jak złe słowo, krytyka, zniesławienie. A jeżeli trafimy na człowieka ambitnego, perfekcjonistę który bardzo stara się pomóc? Wystarczy zajrzeć na dowolny portal z opiniami na temat poszczególnych przychodni. Od dawna pisze się i mówi, że my, Polacy, lubimy sobie ponarzekać i trudno nam dogodzić. W dobie internetu widać to dobitnie wszędzie tam, gdzie ludzie publicznie i najlepiej anonimowo wyrażają swoje opinie. Czasami kilkadziesiąt pozytywny opinii potrafi przyćmić kilka tak złych, że aż trudno uwierzyć. No bo zwierzaka nie udało się wyleczyć i trzeba było uśpić, bo diagnoza nietrafna, bo badań za mało albo badań za dużo, bo drogo…

    Niestety emocje potrafią skutecznie utrudnić korzystanie z rozumu. To widać. Jak więc uciszyć swój smutek, silne emocje, poczucie straty, ciągłe pytania w stylu a co by było gdyby… Najlepiej komuś przywalić kamieniem, czyż nie? Przecież udowodniono naukowo, że odreagowanie złych emocji przynosi ulgę. Jak najlepiej odreagować? Najlepiej spektakularnie, żeby na przyszłość nas popamiętali. A skoro nie wolno przywalić komuś fizycznie (bo to karalne) to przynajmniej dowalmy psychicznie, mentalnie, moralnie. Lekarzowi udało się wyleczyć nas albo naszego zwierzaka – dajemy 5 gwiazdek i wychwalamy pod niebiosa. Lekarzowi, który bardzo się starał ale odniósł porażkę, albo nie miał szansy bo choroba nieuleczalna – dajemy 1 gwiazdkę i jedziemy po nim najgorszymi emocjami. Często nawet uogólniamy i potępiamy wszystkich lekarzy z danej przychodni, choć niektórzy nawet nie widzieli na oczy nas albo naszego pupila. Tacy jesteśmy jako ogół – choć wciąż nie nie brakuje ludzi mądrych i dobrych. Ktoś mi kiedyś powiedział cyniczną i smutną dykteryjkę: “nie rób nikomu nic dobrego, to nie spotka cię nic złego”. Jak dobrze, że mimo wszystko wciąż jeszcze są tacy, którzy chcą leczyć nas albo nasze zwierzęta.

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