Thursday, May 26, 2011

Veterinary medicine in an information age

This month marks the twenty-first year I have been a veterinarian, and August will be twenty years since I bought my practice and became a solo practitioner. The changes in the profession during that time have been amazing. In my class at Auburn University College of Veterinary Medicine, the class of 1990, we were the first class where the women outnumbered the men-just barely. Now there has been a huge shift towards women in the profession. I remember going to visit colleges during my senior year of high school and the inevitable comment from faculty and advisers when they heard I would be a pre-vet major was "Oh, I hear they're starting to let lots of women in!". At the time I bought my practice, I believe there were two other female practice owners in Northern Ky. Guess that makes me a bit of a dinosaur!

And in more ways than one! When I was a high school student, we went to the NEW high school- Scott High, in Taylor Mill. We were the only group to go on the "five year plan"- we started as eighth graders so the seniors could stay and finish out their time at Dixie. One of the big exciting things about the new school was that it would be the first one to offer computer math. Now, I was definitely on the biology/science track so I didn't take it, but I still remember my friends carrying their cassette tapes that they wrote their programs on around! It was REALLY new technology when 5 inch floppies came along! During vet school, the school had one computer and the only time I remember using it was for some sort of self taught program in our respiratory physiology class. I did sometimes help out over the years at a business my family owned for a while, and spent a little time on one of the old original Apple computers that was in use there.

After graduation I went to work at a practice in Indianapolis and shortly after I arrived they computerized. At that time very few practices had computers, and those that did used them mostly for invoicing, but we went with a system called PSi where all of our medical records were computerized as well. I had NO computer experience, but did have a semester of typing in high school and ten years of piano lessons, so I got to be quite quick on the keyboard and figured my way around the program pretty easily.

When I bought my own practice the following year, I really missed our computer system and in late 1992 I purchased the same system for my own clinic. I had never owned a computer before and was excited when boxes and boxes of equipment came- all with strict instructions NOT to open them until the trainer arrived for three days of staff training. Yeah, right! I opened them up and managed to figure out how to set one up because I just couldn't wait to install a computer game I had bought called "Life and Death". (if you want a good laugh, click on the link for a short video to show you what this game looked like! It involved running tests on (human) patients, making a diagnosis, and taking them to surgery. The graphics were EXTREMELY crude-black, white, red and turquoise were the only colors, but it was a fun game. The only problem was, after I loaded it on the computer ALL of the clinic software vanished. Uh Oh. The night before the trainer arrived, I uninstalled the game, put everything back in the box, and feigned ignorance (ok, not a good plan, but it was a plan!). It took him half a day to figure out that somehow I had created a new partition on the hard drive (the game ran on DOS, while the computer system was Xenix based- which all was Greek to me). He did manage to get it fixed and up and running and I must have confessed my transgressions at some point, because he set up a separate DOS partition for me to run the game and a few other programs. At that time, we were using the old monochrome monitors with green type, there was ONE store in Northern KY that sold a little bit of software and computer supplies, but otherwise you had to drive to Comp USA up in Tricounty-45 minutes away, at least. Windows 3 or 3.1 had just hit the market and a lot of programs still used plain old DOS.

Around this time, the news was full of stories about the "information superhighway" and how it was going to revolutionize everything we did; but like most everyone I knew the whole concept made little sense to me and I could not visualize WHAT it would do, much less how it would work. One of the employees at that tiny little N KY computer store told me that you could get FREE internet access through Northern KY University and told me how to get set up, which I promptly did- free dial up access! I wasn't exactly sure WHAT to do once I had it, on my lovely little green and black monitor, but I had it! (and I had to shut the whole system down and restart it to open the DOS partition each time I wanted to use it as well!). Somehow I found out about email lists about obedience training and soon I was staying at the clinic until the wee hours of the morning reading posts from big time and little time trainers all across the country about various training issues. I learned a TON from those early lists. But soon I wanted more...people were starting to talk about "web pages" and my computer just didn't have the capability to look at those, so I ended up buying an ingenious little invention called "Web TV" that hooked up to my TV at home and allowed me to surf the internet on my giant old console TV from the comfort of my couch. Wow.

Before too much longer, I upgraded at work and was able to join Compuserve and make use of a new program started by the AVMA. NOAH, or the Network of Animal Health, was one of two veterinary computer networks that started about the same time. NOAH had various forums including those for canine and feline medicine and general chat, and was mostly populated by general practitioners. I was soon hooked and as a solo practitioner found being able to go to my colleagues, sometimes thousands of miles away, was invaluable. It was the beginning of a new era, and I read each and every post and learned a lot of information, both practical and academic.

Eventually NOAH was outdone by its competitor, VIN, the Veterinary Information Network, which I believe initially was started on AOL if I remember correctly but now is an independent entity. It is a privately owned enterprise started by Paul Pion, a boarded veterinary cardiologist and the man who discovered the link between taurine deficiency and dilated cardiomyopathy in cats- a disease I have never seen in my practice career thanks to his discovery which enabled the pet food industry to begin supplementing all cat food with taurine.

I have been a member of VIN since 1995. VIN is more formally organized than the old NOAH, with a separate "folder" or forum for just about any specialty you can imagine, as well as general chat, veterinary issues, humor, and even politics. Each specialty folder has its own staff of board certified consultants, which read and answer each post, usually within 24-48 hours. It is possible to post radiographs, photos, and videos. For a solo doc, the ability to get input on a case quickly is invaluable. Whether the consultants help to steer you towards a totally different course than what your first impression was ,or just comfort you with the input that they think you have covered all of the bases, it is a great relief at times not to have the feeling of going it alone. However, it's actually not even necessary to post your own case in many instances because you can often find the answer first by simply searching the board archives and the rest of the VIN resources.

In addition to the message boards, there is also a current drug formulary where I do almost all of my checking on drug doses and contraindications; an extensive searchable database that includes not only the board messages but many journals and conference proceedings, and a nifty little program called the Associate. How I wish I had had that when I was a new grad! The Associate allows you to plug in breed, clinical signs, and lab abnormalities and generate a list of possible diagnoses along with what percentage (and exactly which ones individually) of your symptoms fit the diagnosis, and then gives you a brief, thorough summary of that disease, how to diagnose it and treat it. This is a GREAT program to have when you feel like you're missing something, you have an oddball case that doesn't fit the profile, or your clinical signs and labwork are just not adding up. It helps to remind you to think of the less commonly seen diseases or those that you may not see in your area.

Vin has made me feel like I'm no longer flying solo; at times I have gotten input at 3 am on a case going bad from one of the best emergency clinicians in the country logging on during downtime hundreds of miles away. In an age of information explosion, there is no way to stay on top of every development in every field and be able to pull the best option for my patients straight from my head every time. However, with VIN and other technology, even if I don't know the answer, I can find it and find it more quickly, with less effort, and a more thorough result than ever before.

Despite all this technology, though, my BEST tools in practice are still my eyes, ears and hands. The art of a good physical exam and a knowledge of what "normal" is, both generally and for each individual patient, will never be made obsolete by progress. I still try to keep in mind what Dr. Cheryl Harris, one of our local, very skilled veterinary oncologists once told me;
"When I see "WNL" (abbreviation for "within normal limits") on the chart, I know that an awful lot of the time it stands for "We Never Looked". I try to keep that in mind and remember to do a good, thorough and thoughtful physical exam and history on each patient; after all, "garbage in, garbage out"- the technology is only as good as the information we feed it and our observation skills!

1 comment:

  1. Enjoyed this a lot. I was in one of the early computer programming classes. I remember programming on one old computer and then waiting half the night for the campus mainframe to PRINT my documents. You had to go to a separate building to pick it up. LOL.