Bigstock Veterinary medicine has gotten very good at telling everyone what we stand for: Evidence-based medicine. One Health. Antimicrobial stewardship. Client-centered communication. Spectrum of care. Diversity of voices. Independent clinical judgment. We’re perhaps less accomplished at actually doing some of these things than we’d like to think we are. This isn’t meant as another catalog of veterinary medicine’s sins. We’ve got enough people telling us what’s wrong with our profession (myself included). Instead, consider this a list of things we already know how to do—and could probably start doing tomorrow if we could get out of our own way long enough to think things through a little better. 1) Stop doing things we already know we shouldn’t be doing Let’s start with the low-hanging fruit: antibiotics. We pride ourselves on our “One Health” mindset, but don’t blink when prescribing doxycycline to almost every kennel-cough patient that enters our practice. We still reach reflexively for metronidazole in dogs with uncomplicated acute diarrhea. Somewhere, right this second, a cat with dysuria is almost certainly either getting cefovecin or going home with amoxicillin and clavulanate potassium. The guidelines aren’t especially ambiguous anymore, yet antimicrobial stewardship still sometimes seems to mean “culture when convenient, prescribe when not.” That suggests a broader problem: We need to get better at unlearning our habitual behaviors. Veterinary education understandably emphasizes acquiring knowledge, but practice requires something harder: periodically questioning what we’ve been doing for decades and asking whether the evidence has somehow moved on without us. Consider: Are we still giving perioperative antibiotics reflexively for clean surgeries? Are we still treating subclinical bacteriuria simply because an analyzer said so? Are we substituting empirical antibiotics for cytology and culture when an infection is recurrent, deep, or otherwise deserving of an actual diagnosis? Are we treating a laboratory number instead of the patient? Speaking of testing … Why do we keep ordering diagnostics on our “standard panel” even when we know (if we stopped to consider it) the results wouldn’t change our plan. Ironically, I find we tend to skip one or two cheap tests with findings that could totally change our approach, and that’s usually because we’ve already blown the client’s diagnostic budget on the pricy cookie-cutter panel our practice prefers we submit. 2) Make ‘spectrum of care’ something more than a conference phrase We’re getting much better at acknowledging there’s rarely just one medically acceptable way to treat a patient, but our hospital procedures haven’t necessarily caught up. We’ll happily spend physical, intellectual, and emotional capital in an exam room before spending some more of it devising a plan. After all that work, we send in a technician to “go over the estimate.” When the client declines half of it or simply gets overwhelmed by the dancing numbers and decides to leave, someone at the front desk hands her an AMA form. So, what exactly happened to the veterinarian during the most consequential part of the medical decision? Veterinarians should explain estimates when they require medical prioritization. That’s not the receptionist’s job. It’s not even primarily the technician’s job. Deciding what we can safely remove from Plan A to create a medically defensible Plan B—or C—is practicing medicine. That’s the definition of our job and what “spectrum of care” means. A signature on an AMA most certainly is not. Other places policies can interfere with humanity: Mandatory deposits delivered as ultimatums instead of incorporated into a medical conversation. Refusing outpatient management simply because hospitalization is preferred when a reasonable outpatient Plan B exists. Treating “declined” as the end of a conversation rather than asking why. Requiring clients to make irreversible decisions before they’ve had five minutes to absorb catastrophic news. Refusing reasonable exceptions because “that’s hospital policy.” Allowing production targets, appointment times, or corporate workflows to determine how long a veterinarian can spend on the conversation that actually matters. Protocols should make good medicine easier. When they prevent us from behaving like human beings, they deserve to be interrogated. 3) Stop outsourcing the future of our profession Most veterinarians don’t belong to their local or state VMA. Fewer still attend meetings, sit on committees, testify on legislation, communicate with regulators, or run for leadership positions. Then we’re surprised when veterinary policy doesn’t reflect what practicing veterinarians actually want. Someone will decide what constitutes a VCPR. Someone is going to write rules governing telemedicine, technician scope of practice, prescribing, controlled substances, animal welfare, corporate ownership, and dozens of other issues that determine how we practice. If we’re not in those rooms, other people will be. Increasingly, some of those people work for organizations with interests that overlap with ours only when it’s profitable for them to do so. In fact, many veterinarians serving at the highest levels of our professional organizations also work for corporate interests and may not always disclose their conflicts of interest. We can’t complain corporations are gaining too much influence over veterinary medicine while simultaneously outsourcing professional leadership to whoever has the time, money, and organizational machinery to show up. Don’t you deserve their seat instead? 4) Stop waiting until you’re ‘senior enough’ to have an opinion Veterinary medicine has an annoyingly persistent hierarchy: Young veterinarians defer to older veterinarians. Associates defer to owners and medical directors. Interns defer to residents and residents to specialists. General practitioners also defer to specialists, sometimes even when they know the patient they’ve been managing for 12 years isn’t necessarily being managed well under specialty care. Expertise matters enormously, but seniority is not expertise. Neither is practice management nor ownership. We need not defer to hierarchies merely because they exist. They all deserve to be questioned. To that end, one of the things we should teach young veterinarians is not merely how to accept mentorship, but how to disagree professionally—with a medical director, specialist, corporate protocol, or published recommendation. Tips to effectively talk to docs without burning bridges This VPNPlus+ exclusive by NAVTA president Jennifer Serling gives practical tips for those intimidated by the tech/vet hierarchy that can also work for other relationships. Not a member? Sign up today for this Tech Talk column, and much more at www.veterinarypracticenews.com/vpnplus/. Just because you’re not senior doesn’t mean you’re inferior. You have just as much right to sit on a committee, write a letter to the editor of JAVMA, or seek office at the top of the AVMA’s hierarchy as anyone else in our profession. We need age diversity as much as anything else if we’re to make our profession as representative and democratic as it should be. 5) Own something Maybe not everyone should own a practice, but far more veterinarians should seriously consider it. We’ve somehow convinced ourselves we’re brilliant enough to understand acid-base physiology, anesthetize a 16-year-old Chihuahua with cardiac disease, and remove an intestinal foreign body at 2 a.m. — but insufficiently “business-minded” to understand a P&L statement. Business isn’t an inherited personality trait. It’s a learnable skill. Practice ownership isn’t limited to building a gleaming eight-doctor hospital from scratch. It can mean buying the tired one-doctor practice nobody else wants, starting a mobile service, creating a niche cat or goat practice, partnering with three colleagues, or buying into the hospital where you already work. This matters beyond personal wealth. Ownership confers agency and power in our profession. The fewer veterinarians who own veterinary businesses, the fewer veterinarians decide what veterinary medicine becomes. 6) The common denominator: reclaim some agency Maybe that’s what all these things have in common. Prescribing metronidazole because that’s what we’ve always prescribed is surrendering agency to habit. Handing an upset owner an AMA because that’s the hospital procedure is surrendering agency to policy. Letting someone else attend the VMA meeting is surrendering agency to whoever shows up. Assuming you’re too junior to speak is surrendering agency to hierarchy. Finally, deciding you could never own a practice because you’re “not a businessperson” is surrendering agency before you’ve even tried. Veterinary medicine has spent a lot of time lately discussing the forces acting upon us: consolidation, inflation, student debt, workforce shortages, angry clients, burnout, online pharmacies, private equity, and the ever-rising cost of providing care. All true … but maybe we should spend a little more time thinking about the things that remain stubbornly within our control. Patty Khuly, VMD, MBA, runs a small animal practice in Miami, Fla., and is available at drpattykhuly.com. Columnist's opinions do not necessarily reflect those of Veterinary Practice News.
