You may have heard the term ‘contextual care’ being used in discussions of veterinary medicine or even by a vet themselves. With the influx of media coverage, including television programmes, veterinary influencers and news reports, there is growing interest in the profession. Many people wonder how we make some of the decisions that we do. And why it may be that two patients with the same diagnoses receive completely different treatments. Unlike human medicine, where patients can follow specific instructions relating to their own care, and budget doesn’t come into the equation, there is a lot more to think about when it comes to making clinical decisions and providing care. 

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What is contextual care?

As vets, a huge part of our job involves communicating with owners and adapting treatment plans specifically to them and their pet. As you can imagine, every single animal is different, as is their owners circumstances; so our plan will be tailored specifically to them. This is called ‘contextualised care’. The aim of which is to provide the best possible outcome in the context of the individual patient, maximising their welfare. 

The truth is contextualised care has probably been taking place to some degree since veterinary medicine began

Before the development of modern medicine, practitioners had to work with what they had in order to keep animals fit and well. In the past, many conditions were treated symptomatically or without knowing the exact cause. Now we have a huge range of advanced diagnostic techniques available to help us find an answer as well as treat conditions that previously were untreatable. There is advanced imaging like CT and MRI as well as medical treatments such as radio and chemotherapies. This means we are able to ‘work up’ cases to a very high level. But this isn’t always necessarily the best option for that patient. 

For example, an elderly dog diagnosed with cancer is eligible for chemotherapy

The treatment protocol is expected to extend their life but involves weekly blood samples and chemotherapy at the vet clinic. The dog is anxious and becomes extremely stressed whenever they visit the vets, which makes their owner worried too. In this case, the ideal treatment may not actually be the best thing for that animal if it is going to cause them repeat episodes of stress. The option of palliative care might provide them with a better quality of life; where they may have a shorter survival period but are less stressed during that time. 

It can also be as simple as one treatment just being too expensive for an owner to afford. And that’s okay. Because we are giving the animal the best possible treatment from the funds we have available to work with. 

Of course, there is no right or wrong option in veterinary medicine. Vets are there to help owners make these decisions. Contextual care is about giving owners options and allowing them to make an informed decision based on what they believe will be best in their pets’ circumstances. 

Is contextual care the same as ‘gold standard’ care?

Another term you may have heard in veterinary medicine is ‘gold standard’. This often refers to providing the best or ‘perfect’ option. This might entail extensive testing and technically advanced treatments. Many people find the phrase ‘gold standard’ problematic as there is rarely a perfect option for a patient and it doesn’t take into account individual factors. 

However, it gets a little more complicated. ‘Gold standard’ can mean something different to different people. Often contextualised care is the true ‘gold standard’, as it is deemed the best thing for that individual patient at the time.

Why is contextual care important?

Contextual care is hugely important in veterinary medicine today as it allows owners to become involved in decision making; giving them the ability to voice any concerns they may have about treatment. An elderly owner may be unable to bring their pet to the vets three times a week for bandage changes. Or an anxious animal may not be a good candidate for a lengthy hospital stay; so alternative options can be explored. This allows us to maximise welfare for our patients based on their individual needs as well as provide peace of mind to their owners. 

Another critical aspect we have to think about is cost. It is no surprise to anyone that the cost of everything has been increasing in recent times and owners may not be able to afford every single treatment available. Providing realistic options and contextual care can alleviate a sense of guilt that some owners may feel for not being able to fund more expensive tests and treatments. 

Overall, contextual care can help us to provide a high standard of animal welfare as well as strengthen relationships with our clients and even their pets. It is a critical part of veterinary medicine and should be here to stay and evolve going forward.

Further reading