More praise for being a general practitioner

Thank you very much to Meindl et al¹ for their commentary, “Never apologize for wanting to be ‘just’ a general practitioner.” Gaining acceptance to veterinary college is a challenge; graduating from veterinary college is a triumph. Going through veterinary college was the most humbling, exhausting, and awesome experience of my life. What struck me most though was not the overwhelming amount of material in the curriculum, but the often soul-crushing feeling of learning how much more I still did not know.

Given the extensive amounts of information and experiences crammed into 4 years of veterinary education, it is not surprising that imposter syndrome afflicts so many veterinary students and veterinarians. Imposter syndrome has been explained as “the inescapable feeling you don't deserve to be in the position you're in, because you know you aren't worthy of it. You know you're just making things up as you go along, and you actually have no idea what's happening.”²

Imposter syndrome can rob us of our confidence and undermine our work. What's worse is that it can be exacerbated when classmates receive accolades or appear to have friendlier relationships with professors who expound on their success.³

There is no easy answer or simple fix for people's feelings of inadequacy or not being good enough. Simply being made aware that not everyone who enters the veterinary field aspires to multiple certifications or advanced training may help, though. I am extremely happy for and proud of my classmates who were accepted into the internships of their choice, and I have the utmost respect for my colleagues who pursued specialty training.

But, as the adage says, every graduate has earned the same title: doctor. The profession thrives and grows because of everyone's gifts and talents. Never forget that all veterinarians—new and old—suffered through anatomy and para-sitology, whether that was 4 or 40 years ago.⁴

I am thrilled to be starting my career as a general practitioner knowing that I have an exemplary general practitioner as a mentor and that there are amazing specialists from whom I can seek help for the betterment of my patients and their owners. After all, who would refer patients to specialists, if not for general practitioners?

I hope all veterinarians have a deep sense of pride in the work they do, whether in general practice, specialty practice, academia, government practice, or any other facet of this diverse and rewarding vocation. And, I especially hope they never feel inferior because of the choices they made.

Kelly M. Hood, dvm

Virginia Beach, Va

Depression in veterinary medicine: a firsthand perspective

A lot of attention has been directed lately to concerns about mental health and well-being in the veterinary profession. Still, little is heard from those personally dealing with mental health conditions. As someone who has dealt with depression throughout their adult life, I wanted to offer my perspective on what depression feels like. I hope my writing helps increase others' understanding of depression and helps reduce the crippling stigma still associated with it.

I find that the most common—and devastating—misunderstanding is that a depressed patient is depressed about something. That's not clinical depression. Being depressed about something implies a normal mood response to a disappointing event or pattern of events.

Clinical depression is much more complex than that.

Clinical depression is a disorder characterized by one's mood not matching external events. It is not so much a feeling of overwhelming sadness as an inability to feel anything, except at the negative end of the emotional spectrum. Multiple factors contribute to depression, including stress and poor work-life balance. But stress and poor work-life balance don't cause depression. Healthy patients respond appropriately to these factors and can act to decompress. Depressed patients, or should I say I, when I am depressed, know what actions to take to decompress but still have no access to the full spectrum of emotions.

I have never gone skydiving, but I can imagine how terrifying it would feel to find, in the middle of a jump, that one's main and backup parachutes were both nonfunctional, even after having carefully packed and checked them. That feeling of having done all the right things, but to no avail, of continuing to descend despite everything one has done, is how I feel when in the depths of a depressive episode. What's worse is that on top of those feelings of fear and hopelessness is a feeling of guilt for being powerless to stop the inexorable descent. And depression lasts not for minutes, but for days or weeks and can even drag on into months and years.

Living with clinical depression can feel like being two people. There is the person we present to the world, and there is the person who lives inside. I recently explained to a friend that the summer we spent living in the same town during college was a time of difficult depression for me. He was shocked and said he was always inspired by how happy and upbeat I was.

This duality helps explain why the suicide of celebrities can be so shocking to the general population. These are people who have it all, who have achieved fame and fortune and want for nothing. What could they possibly be depressed about? The fact is, they are not depressed about something, they are ill. Suicide is the end-stage symptom of a disease that goes unseen unless self-reported.

Losing one of my veterinary classmates to suicide was devastating to me and a shocking wake-up call. It also taught me to reach out for help sooner, and I hold onto this lesson as the parting gift from a friend who could no longer tolerate this earth.

Here's the thing about depression: it passes. Eventually. We can't predict when, but in my experience and according to recent research, depression usually goes into remission. I had not heard health-care providers refer to remission of depression until the last decade or so, and I have found the term comforting. Remission suggests that although depression may feel like something we cannot control, it actually is something we can learn to live with and that can fade to a distant background.

As veterinarians, we all have stressful jobs. We are by nature individuals who care deeply about our work and set high expectations for ourselves. But we don't all experience depression. Techniques that have been discussed recently to improve mental well-being (self-care, stress reduction, positive thinking, maintaining a work-life balance, and letting go of perfectionism) are all useful and necessary for dealing with what is, at end, a difficult profession. But for those colleagues with depression, and especially those with suicidal ideation, the most critical thing we can do is talk to others and make ourselves heard.

Katharine Mertens, dvm

Boring, Ore