If someone asked me, "What has been the greatest change in Veterinary practice in your career?" my answer would be either;
- The dramatic increase in scope of veterinary options
or
- The changing expectation of pet owners.
The increase in treatment and diagnostic options has made it challenging when trying to guide an owner through the process of deciding what is the right option for their ill pet. The option list can be bewildering, especially when it is underscored by the uncertainty inherent in medical problems.
The changing expectation of pet owners has been just as dramatic as the advances in veterinary medicine and surgery. Most of us keep our dogs inside now. Our cats sleep on our beds. Their daily activities feature heavily on our social media. Their lives are woven into the planning for our own in a way that was unheard of only 15 years ago. Understandably this elevates our expectations when they get sick. We are often advised, “They are a family member” and the hopeful expectation is that they will be treated equivalently.
So how do these changes relate to the “right” decision? Making sure we provide all the options has made the choice for owners more difficult. The higher expectation on the vet to get it right, has made offering an opinion more difficult for the vet. Add to that the need to balance an owner’s available funds and the increasing cost of veterinary services and you wonder how decisions are made at all.
One option for the vet is to comprehensively offer all options including their pros and cons, impartially then leave the decision to the owner. This is the approach that our professional standards body would recommend. It is what our insurers would advise. It is the safest option. And in my opinion it is the same as relinquishing the very basis of being a GP. I find it unethical and immoral. I will sometimes tell veterinary students that if that is the style of practice they wish to aspire to, they should become a specialist. And whilst that remark is somewhat tongue-in-cheek and absolutely not intended to be an insult to my specialist colleagues, it does highlight, what is the role of a GP.
I’m not sure there is a “right” answer but the closest I can get to in my consulting room is when;
- The owner reassures me that they understand the uncertainty associated with disease and it’s treatment. This gives me the freedom to break their overwhelming task of making a choice, into more manageable subset of options.
- I give a shortlist of options of what is the best next option. This way I can limit the number of complicated options and add others as we work through the problem over time.
- We merge my opinion based in experience and their opinion in regards to money and what they think they would like to happen to their beloved pet and we make a decision.
I would love to design a study to answer how often this approach results in the “right” decision. Is it 90%, 50%, 100% of the time? I am certain it is not 100%. I’m pretty sure it’s better than 50%. But truthfully I will never know, because the “right” decision can’t be measured by how often the patient gets better or the specialist agrees with a diagnosis.
The “right” decision can only be measured when an owner looks back, sometimes months or years in the future and reflects, “We did the best for us”. And that will never happen 100% of the time.
Dr Matt Costa
