Why can’t we all just get along?

I’ve noted a particularly disturbing conflict within my profession I thought I would take the opportunity to address publicly. My goal in doing so is not to fuel fires, but rather to open up dialogue between the two sides and see if we can’t redirect some of the hostility towards more productive measures.

The subject of my interest is the ongoing “dispute” between the goals of veterinary specialists and general practitioners (GPs) of veterinary medicine. It’s something I’ve only become attuned to as a working professional, and never considered during the inception of my career during veterinary school and residency.

I’ve seen countless examples of veterinary specialists who are quick to blame GPs for poor referrals, poor record keeping, poor case management, and “overstepping” their boundaries. GPs are equally verbal about their unhappiness with specialist’s egos, their persistent “stealing” of cases, lack of providing follow up, expense, and inaccessibility.

The bitterness isn’t pervading, but it’s sour enough to damper at least a portion of each of my workdays, some more significantly than others.

No soul would argue the fact that GPs and specialists alike share the same passion for our profession. We chose this path not only because we love animals, but also because we love science and medicine. We each knew how difficult attaining admission to veterinary school would be and we each reveled with our first (and in some cases only) acceptance to school.

We all grew from the same seeds planted in the dark and quiet lecture halls of our respective universities. We suffered together in the sticky trenches of gross anatomy, and shared in the joys and nuisances of clinics. In the end, we each pursued varied avenues of the same profession, working in different geographical and socioeconomic areas, with some of us working as GPs and some of us pursuing further training.

We hugged vehemently at graduation. We promised, and successfully managed, to keep in touch. And we now find ourselves sharing the joys and nuisances of marriage and parenthood amid our lives as working professionals. So why, if our foundations are so solid and deep-rooted, is there such palpable hostility between the two sides?

We are taught as children that there are two sides to every story. In considering this, I know that what I can’t see as a veterinary specialist is how GPs are scheduled to see so many more cases per day than I am, back to back, in rapid-fire succession. The pressure of this must be so immensely draining.

I know that despite being a dog or cat’s oncologist, I will never have the same bond with that pet as their GP does, as they were the most integral part of their healthcare from their very first puppy or kitten exam through the illness that brought them to my exam room. Their need to maintain contact and be updated stems from a place I could never begin to comprehend. There are these and a thousand more miniscule factors, whose magnitude projects larger than I could ever consider, that make the job of a GP so taxing.

What the GP will never see is the frustration on an owner’s face when their pet arrives to see me and I have no records to indicate to me why they are there because they were not sent ahead of time. They will not understand that faxing over a biopsy report with no signalment or history or descriptive information and expecting a detailed reply as to the “next best steps” borders on malpractice. They cannot see that sending a case to see me to “get the protocol so my vet can do the treatments at their hospital because it’s cheaper” is invariably infuriating.

The rationale from GPs, that owners “hear what they want to hear” or “don’t have the money to spend on referral hospitals,” starts to wear thin to us specialists when you consider that the price of a referral is nominal, and could provide owners with the information they need to make a choice, even if that choice is to do nothing.

Likewise, the gritty abrasiveness of specialists who complain about poor referrals or speak badly about GPs who send cases without adequate records, or mismanage cases without knowing the full details of what truly transpired in the exam room, needs to stop.

This is not to say that gross negligence on the part of either party should be ignored. If a GP makes a glaring error in prescribing an incorrect chemotherapy dose, I am obligated to point out their error. If I fail to return a phone call in a timely fashion, or if I speak in a condescending manner to a GP, I deserve to “lose” the potential referral. But neither of the above mentioned arguments are helpful for either side or for our profession as a whole.

We can be frustrated with each other, but we also need to remember that we do not walk in each other’s shoes. I could never do what a general practitioner does. In fact, I realized very early on in veterinary school that I would never attempt to do so. I know it is beyond my capabilities. Nor could a GP do what I do on a daily basis. As such, I would argue that we need to co-exist peacefully and productively, with each side recognizing our limitations and our talents.

We all entered the profession from our passion and love of animals and science. It seems we could all do with putting our egos aside and keep in mind the real goal: promoting and maintaining the health and wellness of our patients. On that, we’re still all on the same page.

Just as we were on day one of Gross Anatomy.

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3 thoughts on “Why can’t we all just get along?

  1. Eugene L Moore says:

    Dr. Intile,
    Thank you for this insight into some of the internal troubles of veterinary medicine. Coincidentally, my wife and I have been scratching our heads for months now over a related theme as it pertains to veterinarians in general.
    Interestingly enough, we Ph.D. doctors have the same exact problem in communicating with vets, whether in general practice or specialty. Your blog post resolved the mystery substantially. It is just a practice-wide standard of being non-communicative, egotistial, disinterested, etc. That is not to say that the whole of your community is this way, but by my rough estimates, 95% or more fall into the “I can’t be bothered” category.
    We all have very busy lives. I am a research scientist at La Jolla Institute for Allergy and Immunology. I am trying to advance the field of veterinary oncology to the level of personalized medicine-an advance that many vets claim they would like to see. Yet when I contact a vets office, I am often brushed aside by a veterinary assistant or clerical staff. I can safely and proudly say that in my community of scientists, we do not engage in this practice. Yes, I am very educated, very talented, and very busy. I still answer my emails within 24 hours most of the time, if not sooner. It’s just the respectful thing to do for fellow professionals. If I contact a University professor, researcher, or post-doc, I am guaranteed a response, usuallly a thoughtful, polite, intelligent response. Not so in your profession and it leaves a rather bitter taste.
    So it is comforting, on the one hand, to know it is nothing personal, that you all experience the same thing. On the other hand, it explains why advances in your field come so slowly. I have been trying to get lymphoma samples for over two months now. I have put out requests to many oncologists and other veterinarians. To date, I have received none. In my daily practice I coordinate the receipt of human clinical samples from all over the world with no difficulties.
    Thankfully, there are two or three vets who have agreed to send samples and I would love to name them here as they are fantastic-genuninely interested in our work and what it means to veterinary oncology.
    If a veterinarian contacts me, I will never brush them off to a tech or clerical staff, it is just disrespectful. At some point I may publish a list of those who have these practices in hopes that it will make them more mindful of how their actions affect others.
    I have the deepest regard for what all of you do.. As you say, I cannot do what you do. You cannot do what I do (I usually get the glazed over look when I describe the technical aspects of my work, but thats ok that’s why we specialize).
    So my plea to the veterinary community is not only show more respect to each other, but also to the scientific community who seeks to improve what you do.
    For the record, you have been very responsive to us and for that I truly Thank you.
    Eugene L. Moore, Ph.D.
    http://www.transcribDx.com

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  2. pam956 says:

    In my area of the country, there were no veterinary oncologists ten years ago.I suspect the same is true in most parts of the country unless you live in a very large metro area or very rural area. Don’t you think it would help if the oncologists and other specialists would make a concerted effort to meet the primary care vets in their respective areas and educate them as to what they offer. Also how the “ideal” referral is handled? Everyone – pet, pet owner, primary care vet and specialist would benefit.

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    • jintiledvm says:

      Absolutely – I think this is so important to do. As a specialist, I’ve tried to do exactly that – give CE lectures on Lymphoma or MCT or OSA – the common cancers primary care doctors are seeing and let them know what is useful for a referral and what isn’t. It doesn’t always go over well though – I struggle against a tide of primary vets who are stuck thinking referral = owners have to spend a lot of money and so they do the treatments themselves, or offer referral, but tell owners “you could go there, but it will just cost you more money” I know that’s an oversimplification, and I’m saying exactly what you are saying. Both sides need to make a concerted effort to meet more in the middle rather than making assumptions. It’s not east, but as you said, everyone would definitely benefit from this.

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