Finances often impact pet owners' decisions regarding their pets' health. Many veterinarians will present various diagnostic and treatment options to clients that represent different price points in an attempt to find some level of treatment for a pet. This is one component of practicing a spectrum of care.
The spectrum of care is “a continuum of acceptable care that considers available evidence-based medicine while remaining responsive to client expectations and financial limitations.”1 Providing clients with various options is not a new way to practice, but the term "spectrum of care" has risen in popularity in the past several years.
Having a defined term for this style of practice allows veterinarians and stakeholders to discuss the best ways to implement it, especially in the education of future veterinarians, who may have less exposure to this during their schooling.
While finances are the most common barrier to caring for pet owners, it is essential to remember that many other factors affect the decisions pet families make about their pet's care. Some of these include the pet's prognosis, ability to travel to appointments and administer at-home treatments, ability to travel to a specialist, and patient compliance with treatments.
Practicing a spectrum of care allows veterinarians to maximize patient outcomes and quality of life within their families' individual limitations while meeting the profession's moral, legal, and ethical obligations. Offering a range of options means clients can often receive some level of care for their pet, even if it is not considered the traditional gold standard.
For clients with limited finances, choosing which diagnostics and treatments to pursue is essential. Extensive information can be obtained from the signalment, a thorough history, and physical examination.
Consider three vomiting patients: a 10-week-old male Doberman puppy, a 2-year-old male neutered Labrador, and a 10-year-old female Pitbull. Your differential list for each patient was started based on signalment alone. History information — such as vaccine history, duration and frequency of vomiting, the likelihood of ingesting foreign objects, and timing of the last heat cycle — will narrow the differential list further and help prioritize diagnostic recommendations.
When choosing diagnostic tests, veterinarians should consider the following questions:
Answering these questions will help to develop recommendations to maximize diagnostic yield while preserving some client funds for treatment. Once a definitive diagnosis has been reached — or at least the differential diagnosis list narrowed down — a treatment plan can be discussed.
Communication is critical when practicing a spectrum of care. Veterinarians must know what limitations they need to navigate concerning patient care, and clients must understand the available options. Here are five tips to improve the success of spectrum of care communication.
Some clients are very open about their limitations, while others may be more reluctant to provide this information. Using open-ended questions can help to determine what barriers a client may be facing, which can help the veterinarian decide which options may be the best fit for an individual patient and family.
These questions might include:
Veterinarians should present options to clients that include traditional “gold standard” to more conservative options. While many veterinarians are taught to offer these options from the most extensive to the least extensive, clients often assume the first option presented is the best and may feel guilty if it is not feasible for them. Thus, veterinarians are encouraged to give options in an order that prioritizes the best fit for the client.
The ultimate decision lies with the client, with the guidance of the veterinary healthcare team, who are responsible for providing education about potential outcomes and next steps associated with each option presented.
Veterinary team members should share a spectrum of care mindset. They should be comfortable discussing options with clients and may include their own experiences or observations with different treatment options, which may help the client be more comfortable with their final decision. Team members are also excellent at eliciting information about client limitations when taking initial histories.
Some veterinarians fear they may open themselves to liability by providing options that differ from the traditional gold standard. Veterinarians can protect themselves by including the gold standard in the range of options discussed, thoroughly documenting all client communication, and establishing informed consent related to the option elected.
The diagnostic and therapeutic choices a client makes are affected by many factors. They do not reflect the strength of their bond with their pet. It is important to withhold judgment about a client's choices and ensure that team members do the same.
Practicing with a spectrum of care approach allows veterinarians and their teams to offer various options to clients that consider individual limitations–the most common of which is financial. Offering a range of options improves patient outcomes and allows veterinary teams to provide some care for more patients.
Clients are often more satisfied knowing they can do something for their pets, even if their resources are limited. Success when practicing a spectrum of care requires veterinary teams to focus on clear client communication, ultimately easing stress in cases limited by finances.
Pet insurance can be a powerful ally that helps support the spectrum of care philosophy. The essence of the spectrum of care lies in shared decision-making. Veterinarians and pet owners collaboratively explore treatment avenues and determine the most fitting course of action for the pet's health.
Pet insurance, as a participant in this dialogue, contributes by relieving the financial burden associated with certain unexpected procedures or treatments. This integration can help ensure that decisions are driven by medical considerations rather than financial constraints.
A Team Approach to Financial Conversations in Clinical Practice
Over the next several months, Dr. Boatright will explore ways to help reduce the stress of financial conversations and help to prepare pet owners for the costs of pet ownership — both expected and unexpected.
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Dr. Kate Boatright, VMD, works as a small animal general practitioner, freelance speaker, and author in western Pennsylvania. Since graduating from the University of Pennsylvania with her veterinary degree in 2013, she has worked throughout Pennsylvania as both a general practice and emergency veterinarian. Both in the clinic and outside of it, Dr. Boatright enjoys building relationships with her clients and educating pet owners on how they can keep their pets as healthy as possible. She loves being a veterinarian and educating students and colleagues on wellness, communication, and the unique challenges facing recent graduates. Outside of the clinic, she is active in many veterinary organizations, enjoys running, watching movies, and playing games with her husband, son, and cats.