Collaboration with specialists expands spectrum of options in general practice
Veterinary specialists are often sought out when a client wants to pursue the highest level of care, including advanced diagnostics or treatments that may not be available in a general practice setting. The vast knowledge that specialists have in their respective fields can bring great value to a case and improve patient outcomes.
But this positive impact is not isolated to cases where patients are physically seen by specialists. Opportunities for collaboration between specialists and generalists are growing in the virtual world where we now live.
Collaboration can expand the spectrum of care
Often when generalists are reaching out for virtual or phone consultations from specialists, it is because the owners can’t or don’t want to pursue referral. Barriers to referral are multifactorial and may include finances, availability of a specialist, and ability or willingness of the client to travel to a specialty hospital.
Kate Baker, DVM, MS, DACVP (Clinical Pathology), a clinical pathologist and founder of VetHive,(vethive.com) has spent the last several years exploring ways to collaborate with and educate general practice veterinarians about cytology. “While it would be wonderful to send all of your [cytology] to a pathologist, that's not reality,” she said.
As a specialist herself, Baker understands that specialists may have concerns about making recommendations outside of the traditional gold standard. “Sometimes you might ask yourself, am I doing [the general practitioner] a disservice by telling them to do something that’s not gold standard?” she stated, mentioning that some veterinarians may have concerns about their own liability.
“Sometimes, it's hard to take yourself out of your norm of what you're able to do and put yourself into another situation. I get it,” Baker said, “But I think we have to, as a profession, move past that.”
She encourages specialists to educate their colleagues on what the ideal is, but also share recommendations of: “Here's what I would do if I were in your position.” Baker noted that “there's nothing wrong with answering that question.”
In other cases, an owner may be willing to pursue advanced options but wants their primary veterinarian to perform a particular procedure or test. This could lead to a generalist questioning, “Is somebody going to criticize me for even trying this?” said Baker. “And that is where that support from colleagues, including specialists, is so important. Because GPs can do so much,” she continued. “We all have that ability to grow in our own knowledge and skills in any area we want. And that's such a unique, really cool thing about vet med.”
When generalists and specialists work together, new diagnostic and treatment options may become available for patients whose owners are unable to pursue referral.
Baker has loved teaching since her residency. While working at a diagnostic laboratory, she started an online forum through Facebook—the Veterinary Cytology Coffeehouse. As she explored ways to educate in a virtual environment, she felt called to create a community that would provide multi-specialty, practical resources for generalists.
“There needed to be something different,” she said. “There needed to be something where people really felt comfortable coming and saying, ‘I need help on this.’ And really establishing those relationships, not just these one-off consults.” This idea sparked the founding of VetHive, which launched early in 2023.
VetHive is a virtual community available through a website and app that offers continuing education and access to specialists in 17 disciplines. While most are specialists in small animal disciplines, there are avian, exotics, large animal, and equine specialists available.
The same specialists who respond to case questions on the message boards provide continuing education lectures and resources for users, allowing the opportunity for more interaction and relationship building.
The community is founded on four pillars that include creating a culture of support, rejecting the ivory tower mentality, being authentic selves, and viewing veterinary medicine as a team sport. Baker knows that these are strong statements, but she noted that “What we're trying to do is not say ‘just refer.’ That's just not helpful.”
Instead, specialists might say why a referral would be ideal but go beyond that sentiment and provide recommendations within the limitations of a given case. “All our specialists that are part of [VetHive] feel that way,” said Baker, “They will help as much as they can. Sometimes all of our hands are tied, but it's that feeling of ‘I want to help.’”
“When you create that safe space and people do feel comfortable [asking questions], then what happens is that everybody gets to benefit from learning from that case,” said Baker. “It is so powerful, the collective learning that happens when people are sharing cases. . . There's so much opportunity for knowledge sharing. Not just specialists and vets, but vets to specialists and vets to vets.”
Nonjudgmental collaboration is key
When general practitioners approach specialist colleagues with case questions, they may be concerned about the potential to receive judgment. “Brand new graduate to seasoned veterinarian to specialist, we all ask ourselves, ‘should I know this?’” said Baker. She stressed the importance of nonjudgmental, empathetic communication on the part of specialists who are advising generalists on a case, regardless of how the communication occurs.
Baker encourages specialists “to be mindful of your words and your tone.”
For example, instead of saying “Why didn’t you run that test before calling me?,” a specialist might say, “Did you get a chance to do this?” or “Would they allow this?” Or “Did you think about this?” suggested Baker. “There's a way to communicate those things without sounding [judgmental],” she said.
She encourages specialists to consider how a generalist might feel when asked a question about their case management and try to present things in a nonjudgmental way. Communicating in this way “takes more mental energy. But it's so important,” Baker said. “It creates safety in that conversation.”
Respectful communication must go both ways. This mutual safety and respect are essential to the VetHive community. Seeing the collaboration in real time through VetHive excites Baker.
“It makes me hopeful that we can have this better experience in our own professional lives,” she said, “that we can really feel comfortable doing our jobs and knowing that we're not alone in doing those jobs. And that goes for everybody. Not one particular subset of us.”
Photo credit: © Yurich84 E+ via Getty Images Plus
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.
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.