Trust Yourself

Jonathan Madara, UPenn

Experiences

      It seemed to be a straightforward ER case: an indoor/outdoor cat with tags had bitten the patient on the right carpus approximately 5 hours prior to presentation. The owner of said cat had slammed the door in the face of the presenting client when the cat was returned, with no mention of rabies vaccination status. I watched the intern, resident, and attending clinician assess the patient with keen interest, eagerly awaiting the confirmation of my treatment plan: Clavamox for the penetrating bite wound and a rabies booster. However, the resident’s concerns did not match my own. We should see if the patient is up-to-date on tetanus vaccination. No interest in rabies. Surprised, I waited for the attending to correct the omission. It was not to be. Rabies is not really a concern in our area. I was shocked and confused. I quietly mumbled if a rabies booster could be considered anyway. We’ll have to call the city health department. I was concerned, disappointed, upset, but mostly…exhausted. My wrist was throbbing from the bite. I wanted some Clavamox for my cat bite. And at 11:30pm on a Saturday night, I just wanted to go home.

I’d like to say that I indignantly gave the attending a piece of my mind. I’d like to say that I defended my knowledge of the severe local prevalence of rabies and demanded to speak with an administrator. I’d like to say that I believed strongly enough in my veterinary training to correct the attending at my university hospital. I’d like to, but I cannot. I balked; I deferred to the man in the white coat. He must see bite cases all the time in our area. Surely they take rabies seriously here. It’s the university ER. Maybe it’s not as prevalent in our region as I thought…

As any current veterinary student can attest, we learn a thing or two during our medical training. We memorize anatomy and life cycles, practice surgical techniques and client communication skills. We learn more information in four years than some individuals learn in their entire lifetimes. But at the end of the day, it is all useless trivia if you do not use it to inform your clinical decision making. That night, five hours into my ER visit for a cat bite that I should have been smart enough to avoid, I forgot that lesson. I lost my faith in the training I’d received. I deferred to the man in the white coat, because he was a physician. Even though I knew he was wrong, I let myself believe that his statement was based on more accurate medical information than my veterinary training.

Twenty-one days after that ER visit, with an official recommendation from my city public health department, I started my rabies post-exposure prophylaxis. Almost a year later, the experience has been one of the most important and unexpected of my veterinary education. We learn many things in veterinary school, and while none of that information qualifies us to practice medicine on human patients, we don’t need to ignore or forget that information either when it comes to our own healthcare. Our medical knowledge is broader than any other medical training on the planet. We are valuable partners in the maintenance of human health. Do not be afraid to speak up for yourself based on your veterinary expertise. Use your training to inform your clinical decision making. Most importantly, do not forget to trust yourself, even (or especially) if a superior bombards you with incorrect information. It may be the most essential lesson I have learned in my veterinary education.