Why do we need to talk about spectrum of care?
Editor’s note: This is a recurring column on the role of the spectrum of care in improving outcomes in clinical practice. Catch up on Kate’s first column, “What is the spectrum of care?”.
When I speak on the concept of spectrum of care, I often get the question, “Why do we need to talk about this? What you’re describing is how we already practice medicine!" If that's true, then that’s great! Unfortunately, it’s not how most vet students are taught, which is one major reason we need to talk about it—so that future veterinarians continue to practice this way, allowing the profession to serve as many clients and patients as possible, despite individual limitations.
To have these important conversations, we need a common language to talk about this "art" of practicing veterinary medicine.
The practical knowledge gap of the early-career veterinarian
Scientific advances in the knowledge and technology available to veterinary patients has led to great changes in the medical options available. There is more to learn than ever before, but vet school is still only four years long. Much of the coursework and clinical rotations focus on gold-standard care, and learning in a tertiary care facility—or “ivory tower” as it is often known—limits the exposure of students to cases where alternative treatment plans are pursued or even discussed.
This creates a practical knowledge gap for young veterinarians, who have an extensive amount of knowledge but don’t always know the best way to apply it or how to approach the most common presentations, especially in general practice.
Many young veterinarians are most comfortable with gold-standard options and may feel uncomfortable straying from this standard, which can create ethical dilemmas that add a layer of stress to the already difficult period of career transition.
Even if students are exposed to thinking about a range of options during school, communication training is often limited. This creates another barrier to effectively offering a range of diagnostic and treatment options to clients. Clear communication is critical to effectively working within the spectrum of care and protecting oneself from liability by establishing informed consent.
The consequences of ethical dilemmas
Numerous studies have documented that early-career veterinarians are among the highest risk groups for psychological distress and burnout. Ethical dilemmas and moral distress are some of many documented contributing factors.
“Moral distress” is defined as knowing the right thing to do but being unable to do it. For instance, if a client presents with a blocked cat, the ideal treatment would be to relieve the obstruction and hospitalize for diuresis with an indwelling urinary catheter, but if the client is unable to afford hospitalization, what is a veterinarian to do?
Some veterinarians may feel they are compromising patient care if they pursue outpatient therapy in these cases. But when the alternative is euthanasia, outpatient therapy is often a reasonable option, provided the patient is relatively stable and the client has been fully educated.
By improving the exposure of early-career veterinarians to the spectrum-of-care approach—especially the thought processes behind it and how to communicate the variety of options to clients—we can minimize situations of moral distress for our young colleagues and improve mental health.
Teaching spectrum of care
Thankfully, as conversations are growing in the United States about access to care, some schools, such as The Ohio State University, are adjusting veterinary training programs to increase exposure to concepts like spectrum of care. Communication has also been recognized as a core competency and is increasingly included in the curriculum.
Implementing change in the veterinary education system will take time. In the meantime, those who are serving as mentors to veterinary students and early-career veterinarians do a service for the student or new vet as well as their future patients and clients when they approach cases with a spectrum-of-care mindset, including the thought processes behind which options we offer to clients, and the communication skills we need to have these important conversations.
Kate Boatright, VMD, is a small animal veterinarian, speaker, and author in western Pennsylvania. She graduated from the University of Pennsylvania in 2013 and has worked in rural small animal general practice and emergency clinics ever since. She is passionate about inciting positive change in the profession through mentorship and servant leadership in organized veterinary medicine. She writes a monthly column for NEWStat on the role of the spectrum of care in improving outcomes in clinical practice.
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