THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved.
In addition, a possible way forward is suggested; however, there is rarely a cut-and-dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Taking a full lunch break’, was submitted and is discussed by Anne Fawcett and Juliana Brailey. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue.
The series is being coordinated by Steven McCulloch, a practising vet with a PhD in the ethics of veterinary policy. It aims to provide a framework that will help practitioners find solutions when facing similar dilemmas.
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Anne Fawcett teaches veterinary ethics and professional practice at the University of Sydney.
Juliana Brailey is currently completing her final year studies in BVSc at the University of Sydney. She has recently completed her BSc(Vet) and has a strong interest in the mental health of the veterinary profession and animal welfare.
Taking a full lunch break
Your veterinary school incorporated teaching on self-care, resilience and mental health in the curriculum. You join an experienced veterinary team and rapidly learn that in this workplace, taking breaks is frowned upon. When team members do sit down for lunch, one of the practice partners, a well-respected senior colleague, will jovially prompt them to return phone calls, write up records, chase up results or see walk-in appointments. When a team member replies that he or she will attend to the task ‘after my break’, the partner jokes that ‘you millennials have it so easy. I didn't get to this stage in my career by taking long lunches’. No one in the practice seems to take a proper lunch break during their shift.
Issues to consider
This scenario is common in practice. Members of the veter-inary team are expected to respond immediately to the urgent needs of patients and clients and the timing of breaks may be contingent on the nature of one's caseload. The definition of what constitutes an urgent task varies.
Nonetheless, employers must be mindful of work health and safety regulations that dictate the nature and lengths of breaks per shift, and ensure staffing levels allow for this. Breaks are generally required to allow workers to eat, rehydrate and rest, reducing fatigue and stress.
The evidence is clear that time saved by skipping a break can be detrimental in the longer term. A regular lack of meaningful breaks can have negative consequences on individuals, with potential negative consequences for patients and clients. For example, dehydration of just 2 per cent of bodyweight can impair physical and cognitive performance. Dehydrated medical staff performed poorly in short term memory tests (El-Sharkawy and others 2016). Even short periods of fluid restriction leading to a 1 to 2 per cent loss of body mass reduced subjective perception of alertness and ability to concentrate (Maughan 2003).
While there is little data directly reporting on about the impact of the wellbeing of veterinary clinicians on the welfare of patients, there is literature documenting an association between physical and mental stress in farmers and poor animal health and welfare (Farm Animal Welfare Committee 2016).
Veterinarians who exhibited signs of stress, including those who threw instruments and those around whom staff felt they were ‘walking on eggshells’, stressed out veterinary support staff, impacting their health, leading to negative economic implications for staff (Foster and Maples 2014).
Veterinarians and nurses suffering mental health issues may have compromised or limited ability to care for animals, or recognise and address animal welfare problems.
Possible way forward
One helpful approach is virtue ethics, based on the cultivation of reliable, morally relevant character traits in individuals. Beauchamp and Childress (2013) list virtues as important for medical professionals – compassion, discernment, trustworthiness, integrity and conscientiousness. Virtue ethics emphasises personal development and the importance of role modelling. In promoting health and wellbeing of animals to clients, we should be role modelling good healthcare practices ourselves.⇓
In this case, the conscientious veterinarian would appreciate the potential consequences of the current workplace culture. The compassionate veterinarian would understand that compassion is a trait not reserved simply for patients and clients, but for colleagues and oneself also. Under this framework, appropriate self-care, including refuelling and taking breaks, is a moral obligation of the virtuous professional.
Discussing the importance and evidence for taking meaningful rest with the senior colleague, emphasising the potential negative impacts of failing to take breaks on patients and clients, may prove persuasive. Identifying and empathising with that colleague's own pressures establishes common ground. Role modelling the benefits of taking a break, perhaps inviting the senior colleague for a short walk during a lunch break or sharing a healthy meal, may help convince him or her. If s/he is not convinced, gently and consistently protecting one's time during breaks, by confirming that non-emergency tasks will be attended to later, is likely the best option.
The virtuous veterinarian recognises that he or she has a choice, even when it doesn't seem like one exists. One can choose to continue not to have breaks because the work and experience is more important (although the evidence suggests that work will be negatively impacted), or one can decide to address the issue because it will impact oneself and others negatively. The authors strongly support the latter option.
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