Have you ever heard the term “gold standard” when referring to the veterinary care provided to your pet? It is a term that most of us vets are taught in vet school, and one which we are often told we should strive towards. But life isn’t that simple, and veterinary practice most certainly isn’t! A recent letter to the vet times from Veterinary Humanities UK brought this into focus a bit and has had people talking about how we should be communicating with owners when it comes to different options for care.
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What is “gold standard”?
Well, part of the problem is that this term means different things to different people! But in the context of the above letter, it tends to mean working up a case extensively until a definitive diagnosis is found, and then treating to the highest level available.
There has been huge advancement in veterinary treatment over the past 10-20 years. Some of the diagnostics and treatments that are available now would have been unimaginable in the past. For instance, MRI or CT scans, chemotherapy or laser surgery. This means that for some conditions where in the past we would have tried some treatment without necessarily knowing for sure what was going on – we can now usually find an answer! Which is great! Some conditions which would have been death sentences, are now treatable! That’s great! However – it’s not for everyone.
What is the problem?
The problem is that every case (that is every pet, every owner and every situation) is different, and they should be treated as such. Labeling one course of diagnostics and treatment as “gold standard” implies that all other options are substandard. This can lead to a lot of guilt for the owner and the vet. As well as communication difficulties between them. Vets who believe that they aren’t providing optimal care for their cases can become frustrated and dissatisfied with their job, and the owners can pick up on this. Equally owners who feel they aren’t providing what their pets need, or who feel they have been pressured into more intervention than they are comfortable with, can become resentful, and vet-client relationships can break down because of this.
High level diagnostics invariably come with a cost and can be beyond the reach of most normal budgets. Pet insurance has made these things an option for many more people than they would otherwise. But increasing amounts of claims on pet insurance is slowly making pet insurance more and more unaffordable too.
It is not all financial
There is also your pet’s temperament to consider. Being in hospital and procedures can be incredibly stressful for some pets. Some pets cope with everything well; others may be of a more nervous disposition and find the whole thing very traumatic. To give one example – radioactive iodine therapy is sometimes considered the “gold standard” treatment for hyperthyroidism in cats. Other treatments, such as surgery and daily medication are available.
Radioactive iodine therapy involves your cat staying in a specialist centre, in a kennel, for a prolonged period of time; sometimes up to 3 weeks. If you have an active outdoor cat who is used to having lots of freedom, hunting and not necessarily being handled by people very much, then this may not be the best option for him, as he will find the confinement very stressful. If you have a lazy, indoor lap cat who enjoys being around people and doesn’t do much exercise, then they may cope very well with it.
Equally, if your dog becomes a quivering bag of nerves every time they enter the vets’ surgery, then it may not be fair to put them on a course of chemotherapy which involves twice weekly visits for months on end. Equally, if you have a dog who loves seeing new people and doesn’t mind how many needles they stick in him as long as he gets lots of treats and cuddles, then it might be a great option for him!
There is also your capabilities to consider.
Your family and home situation will have a bearing on what level of care you can provide. For instance, if you have young children or if you are pregnant then having a dog on chemotherapy may be too risky for you. As dogs on chemo will excrete traces of chemotherapy drugs in their saliva, faeces and urine. This can be harmful to children and developing babies. If you work every day and need to send your dog to daycare, then a surgery with a prolonged recovery time and intense physio regime may not be for you. If you have physical limitations yourself, then you may not be able to give your dog daily injections; for instance if they were to become diabetic.
Our job as vets is to make your pet feel better when they are feeling poorly or in pain.
Our primary concern is their welfare. To improve their welfare, we don’t always need a definite diagnosis. We don’t always need an MRI scan, or to do a complicated surgery. Sure, it can be nice to do those things. And there are some cases where the outcome with advanced diagnostics and surgery will be much much better than without. But not everything is black and white and there are often no rights or wrongs – just whatever solution is right for you. If your dog is limping and we don’t know exactly why, yes we can do x-rays or CT scans to find out for sure. But if you can’t afford that, then it is also perfectly fine to put him on some pain relief without knowing. The pain relief will make him feel better, and that is the only thing that he really cares about.
It is also important to remember that euthanasia can be a perfectly valid option if your pet is suffering. Just because treatment options are available doesn’t mean that they are necessarily right for your pet. So you should never feel guilty about deciding to end your pet’s life because they are suffering.
We all need to consider the bigger picture.
Financial concerns, your individual pet’s temperament and resilience to veterinary treatment and your home situation, are all part of the picture to consider when making a treatment plan for your pet. In some cases, it is nice to have a definitive diagnosis so that we know exactly what we are treating. But it is not always necessary, because sometimes the treatment for several different conditions will be the same. In these cases it may be perfectly acceptable to skip some diagnostics and try some treatment. Not all conditions with a surgical solution necessarily need surgery, some will have a medical option as well.
It would probably be best if the veterinary profession ditched the term “gold standard” or at least redefined it. Gold standard isn’t one definite course of action. Gold standard is a vet and a client discussing all the options thoroughly, both being honest with each other, and coming up with a plan that suits them and puts the welfare of the pet first. Whatever that plan may be, it will be the best one for you and your pet, and so it will be your gold standard!
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