The real gold standard is an individualized client relationship

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In a perfect world, all animals would receive the gold standard of veterinary care. In reality, many clients cannot afford the highest level of care for their pets. The results of a 2018 survey conducted by the Access to Veterinary Care Coalition¹ found that 28% of pet owners experienced a barrier to care in the past 2 years, the vast majority of which were financial barriers, across all types of veterinary care.

Ryane E. Englar, DVM, DABVP, joined dvm360 Live!™ to discuss the concept of spectrum of care. Englar leads the clinical and professional skills curriculum at the University of Arizona College of Veterinary Medicine and is the author of several textbooks, including Common Clinical Presentations in Dogs and Cats and Performing the Small Animal Physical Examination. Her current research projects focus heavily on examining how clinical communication drives relationship-centered care. Englar shared with host Adam Christman, DVM, MBA, how veterinarians can learn to offer options of care on a spectrum that best meets client needs and expectations.

Empathy in communicating care options

Christman pointed to rising costs with inflation and supply chain issues leading to medicines and supplies being on back order for long periods of time. He asked Englar about the importance of recognizing challenges these issues present to clients and how veterinary teams can empathize with pet owners.

“I think that our clients need to feel heard, respected, valued, and understood,” Englar said. “There’s nothing worse than when we’re standing in that room and the client wants to do everything and can’t.…It’s gut wrenching.” She explained that clients may not be able to articulate that they can’t afford to give their pets the best care possible, and so clinicians must treat clients with empathy and “unconditional positive regard” while reserving judgment. She said that in these situations she communicates clearly with the client that she understands they wish they could do everything for their pet, but they can still work together to consider the path forward that best helps their animal.

The gold standard vs spectrum of care

“The gold standard has a place in terms of pet care and safety, because we want to make sure we’re not assuming clients do not want to proceed with certain options,” Christman said. “But the question then becomes, ‘What is the best?’ Who defines that? And should our client have a say in that?”

Englar agreed that clients should have a say, and she added her perspective: “Spectrum of care is really looking at an acceptable continuum of options to give our clients.” She said that veterinarians often view it through a financial lens, but she reminded the audience that spectrum of care is about more than whether clients can afford a certain treatment. Client expectations also play a part. For example, she said, the owner of a pet with a brain tumor may want to prioritize quality of life over surgery or radiation therapy. Defining what is best in this situation requires communication between both parties and may have nothing at all to do with money.

“I think that we...lose sight sometimes of each other in that mix,” Englar said. “And for years, we had that paternalistic view of medicine, that doctor knows best, that we call all the shots, and we were very comfortable with that. And now we’ve moved into that relationship-centered care where our client is a partner…which means we have to actually work hard to understand them.”

Reference

Access to veterinary care: barriers, current practices, and public policy. Access to Veterinary Care Coalition. December 17, 2018. Accessed September 9, 2022. https://trace.tennessee.edu/cgi/viewcontent.cgi?article=1016&context=utk_smalpubs