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Our Dirty Laundry On Lack Of Definitive Care Standards

Uniformity and holding to standards can be lost in the pace of a veterinary practice.

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I like to sift through my stack of journals and industry periodicals and collect animal books and consume online pet press with equal vigor. I consider all of it work-related, and not just so I can deduct the sizable expense from my taxes at year’s end.

I like to think the literary mix lends me some big-picture perspective on where the profession is headed, as on the recent exposure of this critical issue: the complex administration of professional standards in veterinary medicine.

Readers React

After the July 1 Journal of the American Veterinary Medical Assn. published a paper by the Association of Shelter Veterinarians on guidelines for spays and neuters in low-cost settings, I reviewed its implications on my personal website.

I argued in favor of more stringent standards on spays and neuters in all settings. I asserted that the public needs to be better informed about what it’s paying for when its pets are sterilized, in part so it will pony up to fair prices beyond the discounted comparison shopper’s rates we too often settle for in private practice.

Within days I had more than a hundred fiery comments and e-mails, largely aimed at the profession for its abuse of public trust when animals are sterilized.

“How do we know when a veterinarian is using a gown, a fresh pack of sterilized instruments, an IV catheter and a pulse oximeter? I can’t believe we need to ask for these as extras! Why do not all veterinarians consider them basics? If veterinarians are going to ‘cut corners,’ they need to tell us they intend to do so… so we know what we’re paying for.”

Preaching to the converted, I retorted.

As much as I attempted to explain that standards are not so set in stone in veterinary medicine, that it varies by locale and by provider (hence how many of us welcome the guidelines carefully penned by the Association of Shelter Veterinarians), I couldn’t help feeling I let the cat out of the bag—more like having unearthed a hamper full of unmentionable dirty underwear for all the non-veterinary world to see.

Demanding Uniformity

So much for my big-picture perspective on what drives veterinary medicine. I clearly had not anticipated the fury of a pet-driven populace on the issue of standards.

Clients care not only about how high our standards are when they pay for them; they also demand some uniformity. If not for their own pets, then on behalf of pets whose owners may not understand the implications of an abdominal procedure sans pain control.

Why else if not to provide minimum standards for the most easily abused animals, they intoned, would guidelines be needed in low-cost settings?

Then how can it be OK to spay a dog in private practice without at least one analgesic on board? To neuter a dog on the same pack you spayed your last cat with?

If the client doesn’t know it happens, nor understand the calumny of these practices, does that make it doable? Moral? Ethical? Legal?

If at least a couple of other vets in your locale perform services at this low level on their client-owned patients, thus meeting the legal definition for “minimum standard of care,” does this make it OK?

“Good” Medicine

In the same edition of the JAVMA, Dr. Franklin McMillan, an internist, spoke to the practice of “good” medicine in an interesting essay titled, “Is good medicine defined by profit structure?”

In his commentary, Dr. McMillan also struggles with the notion of standards in veterinary medicine. But his take is different and speaks to the mutability of the concept of “good” medicine as it runs afoul of those who would monetize it: Is best medicine always the most profitable? What standards do we apply to doing right by our patients—by our paying clients whose resources are surely not unlimited?

It’s clear that both ends of the economic spectrum suffer from the dearth of clear guidelines for how veterinary medicine should be practiced. On one end, we risk losing sight of humane considerations in our earnest efforts to profit; on the other, we chance self-congratulatory excursions in luxury vehicles while our patients endure an excess of intensive care units (for example).

Standards are critical in any field, and veterinary medicine is surely not immune. Why, then, do we allow our colleagues so wide a berth when it comes to complying with the minimum? And on the high-side, why—where low-income considerations are more easily discounted—do we automatically assume that more is better?

If we are to be defined by our lowest common denominator, be it minimum standards or the need to define “good” medicine with money, our profession stands on the brink of a cultural precipice with respect to how companion animal medical care is managed.

On July 13, The New York Times Magazine and The Boston Globe ran stories I considered critical, if grudgingly conciliatory, of veterinary medicine’s power to advance companion animal well-being. The former piece, “Pet Pharm,” came down on the psychoactive pharmaceutical trend in veterinary medicine, while the latter, “How Far Should We Go to Save Our Pets?” though far more positive, questioned our insatiable drive to irradiate pet goose limbs in our quest for a cure—or worse.

It’s clear: The waters are less warm to our advances. If my read of the big picture is on target this time, given the increased scrutiny afforded our profession, how we manage profession-wide considerations when it comes to standards will doubtless prove crucial in the colder climes to come. 

Dr. Khuly blogs regularly at www.dolittler.com.

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