Knowledge-based practise

‘Man seeks to form for himself, in whatever manner is suitable for him, a simplified and lucid image of the world, and so to overcome the world of experience.’

                                                               Albert Einstein

 Studying at university is a unique, though arduous experience. I have always found it such a great nuisance that knowledge can only be acquired by hard work. Yet despite the rigour of university, most students find it a halcyon adventure, a period of escaping their parents’ demands and exploring their own individuality. It is a time when we can shrug off the yoke of classroom dictators who parade as teachers and discover the nuances of divergent learning, free thinking and radical opinions. Whether the polemic ideas which university students embrace can be blamed on the ennui of lecture halls, to hormonal changes or to the liberty which the campus eschews, one thing is certain - the mind of students change. Veterinary science as an undergraduate course is arduous enough to occupy much of the teenage needs to expend energy. Rarely do reactionary groups emerge from schools of veterinary science. They would be more socially active if they had the time and energy afforded by a less demanding course, such as the Arts. But that does not negate from the fact that students from every discipline begin to radically question everything they read and hear. Rather than being a detraction, this effluvium of psychic libido in students is what drives them to conquer their course. Redirecting energy that would otherwise be spent on the football field or in steamy Saturday night drive-ins, such students have what older people lack; an evanescence of curiosity intermingled with an appetite to conquer novel worlds. A layman’s dream may be to get laid, but a freshman’s dream is to freshen their understanding of why, how, when and where? Which is why any student who isn’t asking these fundamental questions is likely to falter in the Sahara of dry, unrelenting tomes, encyclopaedias and textbooks. No matter how interesting textbook writers try to make their case, they must be concise, factual, unemotional and therefore dull. One cannot compare the Merck Veterinary Manual to Dostoevsky’s Crime and Punishment. In scientific texts, there is no plot, only unending characters. There is no subterfuge, only counterpoising arguments. There is no romance, only anatomy. No dialogue, only diagrams. No teary conclusion, only bibliography. It’s little wonder why so few vets become writers.

The advantage of cut-and-dried study at university is that it prepares us for a clinical life. In 1998, a questionnaire was sent to graduates from all the veterinary schools in Great Britain and Ireland. Graduate students explained that they were generally satisfied with the course, but that there were some subjects they considered important in which the teaching and extramural studies had failed to provide adequate learning opportunities. Two subjects, small animal medicine and anaesthesia, were considered to be ‘very well’ taught, and extramural studies were considered to be ‘very useful’ for three subjects; small animal surgery, cattle medicine and cattle surgery[i]. Graduates are keen to continue learning and specialise after they graduate. They recognise that they have sufficient arsenal at their disposals to attack clinical practise. Though they lack the clinical wisdom that only comes with experience, their primal enthusiasm of finally getting their teeth into the stuff they have long read about propels them into the fields and consult rooms of general practise.

What students should know is that the best arsenal they have is and will be always be knowledge. University teaches us that scientific inquiry comes from first being suspect of something, then knowing it; first by suspicion then revelation. After spending five or so years at university perfecting the art of their science, they have to face what is to them an alien culture - being in business. From the day they graduate, they are employed for their knowledge and clinical skills. This is how they now make their livelihood. There is no impartial government stipend to allow them the luxury of absorbing knowledge ad lib. The rigours of practise insist they work for their income. It’s not as bad as it seems, but at some fundamental level, there is a paradigm shift in motivation. Before, knowledge-seeking was motivated by passing exams, or fear of failure or to please family. In practise, this motivation immediately mutates. We no longer get out of bed to study. We throw back the doona because we have a boss, bills to pay, clients to deal with and animals to treat. Though subtle, it is a demanding psychological transformation akin to a rite of passage. We suddenly realise that we are potentially a commodity in a service industry. Growing thorough this false idiom can be difficult. To reach the final realisation that we are more than what we know or can do and that we have value at a personal level is a task which requires considerable work to achieve.

Veterinarians in practise understand that one of the key challenges facing their business is managing knowledge and extending this knowledge to clients[ii]. This problem is no different whether it is a corporate bank or a small suburban veterinary practise. Veterinarians know that what their knowledge-base is why they are in demand. This does not mean that clients are there to use us. Considering the alternative sources of revenue in general veterinary practise, knowledge-based procedures (medicine and surgery) constitutes only 50-80% of income; the remainder being from marketing, merchandising, sponsorship, etc. From a broad base of learning and experience from university and into general practise, veterinarians have evolved two effective methods of treating their clients:   

Knowledge sharing has the advantage of informing the client of all pertinent information, giving them a sense of participation in the experience. The old-fashioned method of diagnosing a pet’s problem and giving the client medication without explaining what it is used for or why is an opaque method which can only lead to confusion, distrust, lower levels of client compliance and treatment success.

Curiously, the modern shift to knowledge transfer from black-box methods of client dealings has been largely driven by economic forces outside the realm of veterinary science. People are more knowledgable and have a higher expectation of understanding the service they receive and tend to question many things. The advantages of knowledge transfer are obvious; enabling client’s to make better informed decisions regarding their pet’s welfare and enhancing their use of the veterinarian’s services. The main disadvantages of knowledge transfer is that it requires a need for transparency of information and maintaining an up-to-date knowledge-base.

For modern economies, the main consequence of this evolution toward greater knowledge transfer between businesses and their clients is that the distinction between products and services becomes blurred. Commonly, products and services are now thought of as one single entity, ‘client offerings[iii].’ However, it is difficult in this economic environment to make a practise function as a service-only business. Refusing to participate in merchandising, marketing and promotions seems to limit client expectations and satisfaction. However, many successful veterinary enterprises adhere to the maxim that ‘there are riches in the niches,’ and become niche-market practises, such as accredited specialty practises or single-species practises. One of the critical problems with black-box services is that the client sees only the outcome. Thus the service becomes ‘commoditised’ and the client cannot assume that your practise provides this service any differently to another practise. Knowledge-transfer, however, relies as much on the process as the outcome, thus increasing the chances of client satisfaction, medical compliance, treatment success and client loyalty.