College Connection | Fall 2023
Contextualized Veterinary Care : It ’ s not black or white and certainly not gold
College Connection | Fall 2023
Contextualized Veterinary Care : It ’ s not black or white and certainly not gold
The following article is reprinted with permission of the Alberta Veterinary Medical Association and the author , Connie Varnhagen . The College appreciates the opportunity to share this topical and informative article .
By : Connie Varnhagen , PhD , RVT , Alberta Helping Animals Society
Noah Johns has a small hobby farm . This year , both of his calves are scouring . The gold standard treatment for calf scours is hospitalization , IV fluids and tube feeding . Noah ’ s finances are severely limited , and he has declined hospitalization for the calves .
Deb Finkelstein ’ s cat , Bucko , has moderately elevated blood glucose . The gold standard treatment for diabetes mellitus is insulin injection , blood glucose monitoring and prescription food . Suffering with rheumatoid arthritis , Deb lives alone and is quite mistrustful of other people . She will have a difficult time administering insulin , even with an insulin pen .
The inability to follow the “ gold standard ” in diagnosis and treatment causes frustration and angst across the profession . The fault is not in the owner or the animal but rather in attempting to meet a non-existent standard of perfection .
“ Gold standard ” derives from 18th century economics , whereby trade was valued in relationship to gold . 1 The gold standard has become ubiquitous in veterinary medicine as the most advanced level of care possible . 2
In practicality , the gold standard also does not exist – in economics or in veterinary medicine . Noah ’ s financial situation does not allow for gold standard scours treatment in hospital . Deb ’ s physical limitations do not allow for gold standard diabetes treatment . Carla ’ s family situation does not allow for gold standard surgery and rehabilitation .
Across the profession , veterinarians consider context in presenting and discussing diagnostic and treatment options with their clients . Pulling together all the situations that influence ethical veterinary care , we simultaneously consider the patient , the owner , the human-animal bond and the socio-cultural and professional environment in which we practice . This approach is summarized in the contextualized veterinary care model shown in the figure pictured below .
The veterinary team is accustomed to considering the patient :
• How might signalment affect treatment outcomes ?
• How might concomitant disease or injury states affect treatment outcomes ?
• Will the patient ’ s behaviour affect ability to diagnose and provide care ?
The team must also consider owner characteristics :
• Does the owner understand the veterinary needs of the patient ?
• Are there emotional or relational states to consider in offering diagnostic and treatment choices ? How well can the owner participate in providing needed treatment ?
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Carla Petrie reports that her husband , Don , doesn ’ t accept the veterinary surgeon ’ s recommendation for gold standard surgery for Stretch , the family dachshund with intervertebral disc disease , and wants to euthanize the young dog . |
Patient
signalment state behaviour
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Human Animal Bond
commitment
preservation
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Owner
understanding state ability
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Environment :
• practice resources
• cost
• legislation
• VCPR
• living conditions
• socio-economic status
• culture and belief systems
• racialization
• societal norms
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Public confidence in veterinary regulation cvo . org 3