“The term spectrum of care is new, but the concept is not,” said Ryane Englar, DVM, DABVP (Canine and Feline Practice), associate professor of practice and executive director of clinical and professional skills at the University of Arizona College of Veterinary Medicine. “James Herriot [practiced] spectrum of care.”  

Englar guides her students to brainstorm what gets in the way of delivering individualized veterinary care and how to address a growing list of barriers. “What I get most excited about is encouraging students to think about more than cost,” she said. “Our professional skills curriculum, developed along with co-course director Teresa Graham Brett, prompts our students to think about what else [spectrum of care] encapsulates.”  

Spectrum of Care: More than cost 

Cost represents only a sliver of access-to-care issues. Even when clients do have the financial means to pursue advanced-level or traditional “gold standard” care for their pets, other barriers can arise, including access to specialists or specialty equipment, the client’s schedule, or the client’s physical ability to administer treatments.  

Englar shared that one of her elderly clients was faced with a difficult decision when her cat was diagnosed with diabetes and the client’s mobility constraints posed a challenge to administering insulin. With some creativity, they found a solution: The cat would eat on a table, where it would be easier for the client to administer the insulin. Both are doing well with the new arrangement.  

But what if someone hadn’t taken the time to discuss that barrier and find a solution? 

Cultural competency and spectrum of care 

Recent diversity, equity, inclusion (DEI) research has highlighted accessibility of care as its own unique barrier to veterinary care, including, but not limited to cultural and communication challenges, geographical limitations, and transportation concerns.  

Veterinary students at the University of Arizona are encouraged to consider how best to meet their clients where they are. “This requires investing in a partnership with clients to elicit their varied perspectives and to engage in shared decisionmaking,” said Englar.  

“Clients are experts in their own right when it comes to the care of their pets, and this means that veterinarians must partner with them to determine—as a team—which approach to healthcare delivery will be both effective and feasible.”  

To practice perspective-taking and seeking, a significant part of the professional skills curriculum that Englar and Brett developed concentrates on how students see themselves and others.  

Englar prefers to see barriers as opportunities for growth from which students and practitioners can learn. This requires veterinarians to tailor their care plans not only to the patient, but also to the client, and to consider how to navigate communication preferences, language barriers, and varied learning styles. Englar’s students discuss the significance of providing medical information in multiple formats, including not only verbal instructions, but also written discharge summaries, visual aids, and even video. 

“I think the students have been really surprised by how much we as individuals and as practitioners can flex,” said Englar. “Often all it takes is a moment to think outside the box and allow the client the opportunity to contribute to strategic planning. There’s so much we can learn from our clients by embracing relationship-centered care if we remember that we are a team and that there is no ‘one size fits all’ approach.” 

By introducing students to spectrum of care as early as their first semester of veterinary college and training them how to think critically about overcoming care-based challenges, Englar and Brett are preparing a new generation of veterinarians to have greater receptivity towards problem-solving with their clients. 

Broadening spectrum of care initiatives in education 

“Most schools introduce students to cost-based restrictions within healthcare through community practice rotations in low-income areas,” Englar said. “Cost is the easiest spectrum-of-care content area to address because it is something we are all, on some level, familiar with. However, we often make assumptions that cost of care is the only factor that determines patient care plans; and that is a mistake.”  

She emphasized the need for broader conversations, as well as the importance of withholding judgment.  

She herself was trained within a traditional program that felt “stuck in a mentality of ‘there’s only one right way’ . . . ‘If you’re not delivering the gold standard, then you’re automatically delivering something lesser,’” she said. 

“As a new grad, I often felt guilty about not practicing at the level that I was trained. However, as I’ve grown as a practitioner and educator, I now embrace the ability to flex between cases based upon a variety of patient- and client-specific factors—not just cost,” she said. 

“There is comfort in knowing that we can work with our clients rather than dictating care based upon individualized prioritization of needs, wants, and expectations. There is comfort in accepting that not every plan is ‘right’ for that patient or client, and that we need to approach each choice with openness and regard. Instead of thinking about all that we can’t do, let’s channel our energy into strategizing all that we can.” 

Further reading 

The American Association of Veterinary Medical Colleges Spectrum of Care Initiative  
https://www.aavmc.org/the-spectrum-of-care-initiative/ 

“The goal of the AAVMC’s spectrum of care initiative is to provide resources to colleges of veterinary medicine,” said Englar, who is an active member. The group is currently investigating how spectrum of care can become evenly more intimately incorporated into both preclinical and clinical curricula. 

Dr. Englar’s book: Low-Cost Veterinary Clinical Diagnostics 
https://www.wiley.com/en-us/Low+Cost+Veterinary+Clinical+Diagnostics-p-9781119714507  

Englar started this book as a clinical skills manual for students in the University of Arizona’s program, but it’s become much more. It’s “a resource for those who want to spruce-up and refresh their skills,” she said, including the entire clinical team, not just the veterinarians. Veterinary educators can also get an instructor guide through Wiley, the publisher.  

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. 

Photo credit: Jenpol © E+ via Getty Images Plus   

Disclaimer: The views expressed, and topics discussed, in any NEWStat column or article are intended to inform, educate, or entertain, and do not represent an official position by the American Animal Hospital Association (AAHA) or its Board of Directors.