Q&A with 6 of the Outstanding Winners of the 2022 AAHA Award for Proficiency in Primary Care

NEWStat posed three questions to six of the 27 fourth-year veterinary students who received AAHA’s 2022 Proficiency in Primary Care Award for demonstrating outstanding clinical proficiency in veterinary primary care. AAHA presents the award each year in collaboration with the Association of American Veterinary Medical Colleges’ Primary Care Veterinary Educators. All fourth-year students attending a veterinary college with an AAHA-accredited teaching hospital are eligible.

Brooke Appleton, Tuskegee University

Brooke Appleton.jpgWhat led you to focus on primary care?

My experience prior to veterinary school led me to focus on primary care for small and large animals. I worked at a small, mixed animal practice prior to veterinary school in an area where we saw pets and owners from all walks of life. In doing so at that clinic, I had the great opportunity and challenge to interact with all different types of patients and pet owners. I saw how important the primary care provider is for being an advocate for a pet's whole health and wellbeing.

A pet's primary care provider is usually the first and sometimes the only veterinary interaction that a pet and their owner may have in life. Primary care providers are on the front lines of pet health. We are the patient's advocate for their overall wellbeing and health care. We provide the client with the necessary information about surgeries, treatments, preventative care, and behavioral issues. We create a bridge between pet owners and veterinary specialists when a need arises for specialized veterinary care or procedures. We are there with a tissue or words of comfort when a client is sad and fearful about their pet's care.

Clients’ opinions of the veterinary world come mainly from their interactions and experiences with a veterinary primary care provider. So as a primary care provider, I want to provide my clients and my patients with a good experience, thus opening the door to building a strong client relationship. This allows me to advocate for my patients health and wellbeing in all aspects of life from preventative care, surgery, dental procedures, behavioral problems, disease treatments and managements, and more. I enjoy being a primary care provider building strong client relationships so I can provide great veterinary care for all my patients because at the end of every leash is a person not just a pet.

Where would you like to be and what would you like to be doing five years from now?

I am not sure exactly where I would like to be in 5 years having only just started my veterinary career this year. My goal was to become a veterinarian and 13 short weeks ago I did so. Now I am figuring out my next goals. I do know I want to give back to pre-veterinary and veterinary students to show them that a fulfilling life and career lies ahead for them too.

What have you learned from one or more of your patients in primary care? Be specific!

I have learned that no two patients, clients, or appointments are the same. One sneezing cat is not the same as the one in the next room. The owner of one heartworm-positive dog is not like the one you saw in the last appointment. Each of my primary care patients teaches me to be adaptive and attentive to their individual veterinary needs.

Desiraye Paredes, University of Tennessee College of Veterinary Medicine

Desiraye Paredes.jpgWhat led you to focus on primary care?

I have always had a passion for veterinary medicine and honestly only ever grew up with dogs or cats. So as soon as I was able to put myself into the veterinary medicine world as a technician, I fell even more in love with small animal primary care. I love how every day can be different and how much of a difference you can make for one life.

Where would you like to be and what would you like to be doing five years from now?

In five years, I would love to be working in a small animal general practice back home in Dallas, Texas. Hopefully with my own home at this point with my two cats and future dog. What have you learned from one or more of your patients in primary care? Be specific!

One thing that I have learned is how common things happen commonly. I’m always worried as a new veterinarian that I would over analyze everything and reach for diagnoses that are very unlikely. I had a case where a 2-lb yorkie came in for very vague signs, such as lethargy and inappetence. This yorkie had always been very small according to her owners no matter what they would feed her. On presentation, her blood glucose was checked which revealed it to be very low. When she came into my care, I automatically thought of insulinoma but found out that instead of just looking at her low blood glucose that I needed to look at the big picture. She was very small compared to the rest of her litter mates and it turns out she was a prime candidate for a portal systemic shunt. This again made me realize that I need to look at the big picture. It can sometimes reveal the most common thing that is going on.

Emily Lieuwen, University of Saskatchewan, Western College of Veterinary Medicine

Emily Lieuwen.jpgWhat led you to focus on primary care?

As a veterinary student working in private practice, I had many mentors with long-term clients who had been coming to them for ten years or more. I saw the trust and value in these relationships. It made me want to create these experiences for myself in the future. For this reason, primary care has always been an interest of mine. I believe developing lasting and meaningful client relationships is as important as the medicine I practice. I genuinely enjoy connecting with my clients and developing a rapport with them. I like being able to meet their pet at their first puppy or kitten visit and then grow with them over the years as their needs change.

Where would you like to be and what would you like to be doing five years from now?

At the end of the month, I will begin a year-long Master of Business Administration program. A goal of mine is to become a clinic owner. While I’m not sure it will happen in the next five years, I hope to one day open a low-cost clinic somewhere in Western Canada and work towards removing some of the barriers to accessing veterinary care. My clinic would also provide emergency boarding for little to no cost. There are very few social supports in place for those with pets who are experiencing events such as homelessness or domestic violence; I would love to be part of the solution to bridging this gap and facilitating the opportunity for people to remain with their pets.

What have you learned from one or more of your patients in primary care? Be specific!

The most important lesson I have learned from my patients in primary care is the importance of the human-animal bond. Regardless of age, gender, race, ability, or socioeconomic status, my clients tend to all have one thing in common: they care deeply for their animals. I have seen first-hand how their animals have positively affected their lives. I have had a client stop smoking because they learned their cat had asthma and second-hand smoke was exacerbating the condition. I once learned that a client had sold his only vehicle so that he could afford to pay for the surgery to fix his dog’s fractured leg. I have seen complete strangers from polar opposite backgrounds connect over the shared experiences of having a new puppy. I believe through caring for animals, we can begin to recognize our common humanity.

Note from Emily: I live, study, and learn on Treaty 6 territory and the Homeland of the Métis. The First Nations signatories of Treaty 6 are the nêhiyawak (Cree), Dene, Nakota, and Anihšināpēk (Saulteaux). I acknowledge my responsibilities as a treaty partner and settler to foster and build respectful and reciprocal relationships with the original peoples and lands of this place.

Jacob Lake, University of Wisconsin-Madison School of Veterinary Medicine

Jacob Lake.jpgWhat led you to focus on primary care?

Prior to veterinary school I had a broad interest in surgery and anticipated I would end up pursuing an internship with an eventual surgical residency to follow. During my surgical rotations in my clinical year, though the surgeries I observed were fascinating and varied (bilateral complete pinnectomy, ventral slot surgery, neoureterostomy, medial glenoid tubercle stabilization, to name a few), I noticed there wasn’t a lot of follow up or rapport built with the patient or client. These patients were presented for advanced surgical cases, but beyond a few rechecks they didn’t come back because the surgeries were a means to an end.

Things were drastically different on my primary care rotations. These patients kept seeing the same DVM; the clients and DVM had formed a friendly relationship over the years, and the clients trusted the surgical recommendations from the DVM as being the next appropriate treatment for their pet’s health. My professional interests shifted toward wanting to build that relationship with patients and clients over time, to know and feel a personal attachment to the patient under the drape. There is also a lot of opportunity to explore surgical interests and CE training as a general practitioner. Primary care was the only rotation I voluntarily repeated, and it’s now where I’ve found my home in practice.

Where would you like to be and what would you like to be doing five years from now?

I am incredibly fortunate that the place I want to end up in is the same place I’ve lived the last 11 years. I fell in love with Madison, WI, when I first moved here to earn my undergraduate degree back in 2011. It was only natural that Madison became the place I’d start my job search after finishing veterinary school. I’ve found myself in a wonderful small animal clinic as a general practitioner, and I could see myself remaining here five years from now, too. I hope to eventually refine my skills as a surgeon to offer more advanced options to clients when referral isn’t feasible.

What have you learned from one or more of your patients in primary care? Be specific!

Some of the most dramatic and fulfilling changes have come from prioritizing fear-free practices with multiple patients I’ve seen. I love that some dedicated owners have taken it upon themselves to rescue animals from horrible living situations or have chosen to adopt older animals with specific housing requirements. With these often-unknown past histories for our pets and patients, it becomes imperative to practice compassion, empathy, and patience to ensure every patient receives the care it deserves. I’ve been learning that building firm boundaries around managing a patient’s fear, stress, or anxiety is not easy, and there are clients that will feel you are wasting their time. But I’ve also been learning that there are just as many clients who can see the difference in their pets and are so appreciative of the additional considerations of care.

Jessica Garafolo, University of Guelph Ontario Veterinary College

Jessica Garafolo.jpgWhat led you to focus on primary care?

One aspect of being a veterinarian that I really enjoy is connecting with my clients and forming a long-term bond built on trust and communication. Being a primary care physician allows me to have more frequent visits with my patients and clients throughout the year to catch any medical issues early and keep checking in on how my recommendations are going. It also allows me to understand my clients on a more personal level. I like that I can influence many aspects of physical and mental health from a general standpoint and am more than happy to refer when I feel that cases could benefit from focused specialty care.

Where would you like to be and what would you like to be doing five years from now?

I am just at the very beginning of my career and willing to explore all options of where my DVM training can lead me. I am still undecided on my ultimate career path, but I could see myself working in primary care five years from now. A personal goal would be to become more proficient with companion exotic animal medicine.

What have you learned from one or more of your patients in primary care? Be specific!

I have learned that it may be best to warn owners before lifting their pet’s gums to show them the pet’s teeth as they can be quite shocked at the level of tartar hiding right in front of them! I have also learned that clients find it really funny when you recommend that Fido go on a strict diet while hand feeding him a full jar of liver treats during your exam.

 

Ross Pillischer, University of Pennsylvania School of Veterinary Medicine

Ross Pillischer.jpgWhat led you to focus on primary care?

Coming from a clinical background of primary care veterinary medicine before veterinary school, I have always had a great appreciation for the value of primary care. Routine preventative care has such a significant impact on the health and welfare of the animals we care for, it is hard not to focus on this aspect of medicine when considering our role in animal health.

Where would you like to be and what would you like to be doing five years from now?

As a Veterinary Corps Officer in the United States Army, it is certainly difficult to say exactly where I will be and what capacity of veterinary care I will be providing (as there are so many different avenues). What I can say is that I look forward to the challenges ahead and will continue to do my best to keep both animals and people safe through the skills I have developed over the years.

What have you learned from one or more of your patients in primary care? Be specific!

Through primary care I developed an appreciation for the significance in subtlety. The ability to assess and frequently reassess patients allows you to pick up on subtle changes that may otherwise be missed. Many of these findings have proven to be clinically significant - and it was early detection, diagnoses, and therapeutics that made all the difference.

 

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