Dr Liesel van der Merwe is a small animal medicine specialist. Send her your questions: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Dr Liesel van der Merwe

In veterinary practice, as a general practitioner and as specialist veterinarians, we are often confronted with constraints to providing what we perceive as the best care for our patients.

Historically we are taught that we should provide the “gold standard” of care and anything less than that is second rate. But we live in a real world, and we all know how situations differ between people, families, pets and even across time.

Access to veterinary care is a complex problem that sits at the intersection of many societal factors including income inequality, access to transportation, language and cultural differences as well as the spatial distribution of veterinary care providers.

Unless veterinarians take these factors into account and formulate treatment options to manage them, then we will be falling short of the standard of care we should be providing. By considering and contextualizing patient treatment options we will improve animal care at a population level even though we may not be providing perceived “gold standard of care” to each patient.

I have mentioned in previous columns how the veterinary profession is experiencing a mental health crisis with depression and burnout frequent occurrences. Part of this is due to our intrinsic nature and one of the other factors is our feeling of failure or frustration when unable to provide gold standard of care to all our patients. The expectation of some clients for gold standard care regardless of circumstances is also an additional stress.

Tailoring patient care does happen every day in practice – each intervention is tailored to individual client and patient needs. So what is new? The concept of tailored care versus pushing for the gold standard is becoming a focus point of discussion in the veterinary field.  This is because we have made such advances in diagnostic and treatment options that what we have available on a routine basis is vastly different from 25 years ago.

Even I as a vet have seen the anti-inflammatory red phenylbutazone pill change into a myriad of much safer options. There has been a veterinary medical revolution in the last 30 years. We have to be able to select what to apply to each patient from all that is now available.

The term “spectrum of care” refers to the wide range of care options veterinarians can provide. Practicing across the spectrum of care involves tailoring care options based on contextual factors, such as client goals, abilities, and resources, as well as patient, veterinarian, and practice factors, while considering available evidence. We, the client and the vet, also need to realise that there is a limit to how we can tailor a treatment option without it becoming too risky and causing harm to our patient.

In the real world contexts are infinitely variable. Constraints and affordances differ between primary general veterinary practices and referral hospitals and by species of patient. Even within these categories, there are always differing animal factors (age, temperament, general health and environment) and human factors (resources, capabilities, preferences or circumstances of the owner, vet and veterinary clinic). 

Animal and veterinarian welfare could be better served by considering what the most appropriate management options are for each case, rather than there being an assumption that maximal, gold standard care equates to optimal care.

If the default aspiration is an idealised gold standard and this cannot be met, then this may cause feelings of shame, guilt, anger or dissatisfaction in the owner and the veterinary team, thus contributing to workplace stress

Veterinarians need to be clear, and not be ashamed about offering an approach to clinical care that recognises the diversity of situations we encounter, and clients must understand and not be ashamed by the choices they need to make. We live in the real world where the availability of money and time count.