Emily M. Tincher
Dr. Emily M. Tincher is senior director of veterinary relations at Nationwide. The second-generation veterinarian is a member of the AVMA Early Career Development Committee and president of the Veterinary Leadership Institute board of directors. She has experience in education, partnerships and emergency medicine.Read Articles Written by Emily M. Tincher
As veterinary health care professionals, many of us were taught to preferentially recommend the gold standard of care so much that the terms “gold standard” and “standard of care” are often confused with each other and inaccurately used interchangeably. It’s easy to think we’re only succeeding if we persuade clients to accept the highest technical level of care possible. But the danger in doing so is that we alienate whole populations of pet owners who might not be able to afford such care or might prefer a different treatment plan.
It is well-documented that the number of pets visiting veterinary clinics for routine care is down, while the number visiting only sporadically (often for urgent care) is up. Additionally, an estimated 50% of U.S.-owned cats and dogs do not visit a veterinarian annually. So how do you practice good medicine, meet families where they are and provide more care for more pets? By embracing a spectrum of care approach.
As defined in the Journal of the American Veterinary Medical Association, a spectrum of care approach “aims to [provide] a continuum of acceptable care … while remaining responsive to client expectations and financial limitations.” It combines evidence-based medicine with a pet family’s emotional, physical and financial resources, then communicates a range of options to them without judgment.
How can we maintain an appropriate standard of care and our legal and ethical obligations, and how do we know what meets a pet’s basic needs? Ideally, we rely on evidence-based medicine, backed by research studies or peer-reviewed publications that allow us to say, “We know that this particular condition has this particular outcome with this particular treatment in some cohort of pets.” Knowing we don’t have as much outcomes-based research as we might like — especially for more basic or intermediate approaches to care — practicality, extrapolation and clinical experience also play key roles.
Consider this example: When a puppy presents with parvo, we have an advanced-level protocol involving hospitalization and aggressive treatment, which published research has shown typically has about a 90% success rate. However, we also have an intermediate option, the Colorado State protocol for outpatient management, which has about an 80% success rate. And we have a basic one-time outpatient treatment option, with an unknown success rate. We know that 8 in 10 dogs will recover with the Colorado State outpatient option, versus 9 in 10 with hospitalization. And the difference in cost is drastic, often three to four times higher.
As applied scientists, we feel confident recommending options when we have evidence backing us. Obviously, options are case-dependent, as when considering surgical versus splinting options for a broken leg. Remembering that a range of options can lead to a similar recovery for the pet (though perhaps with tradeoffs in risk factors, expense or time commitment for the family) led our Nationwide team to adopt the mantra “Basic doesn’t mean bad.”
Considering Client Resources
The medical component is just one element of a spectrum of care approach. In order to provide effective care and to build trust with pet families, we need to understand each pet owner’s resources, needs and goals. (Hint: This extends beyond their financial budgets.)
Nationwide partnered with Mind Genomics Advisors to identify the subconscious drivers of how pet owners approach veterinary care. We found that across demographics, such as age, education, race and ethnicity, and household income, they fall nearly equally into three groups, each with their own primary motivating factor:
- Convenience: This group prefers the easiest option, perhaps opting for a single treatment over repeated visits to avoid stressing their anxious pet or juggling a busy family life, even if it is more expensive.
- Optionality: This group wants to hear all the available options, and they don’t want the most expensive listed first. (In fact, none of the groups do.) Interestingly, these pet owners often choose advanced or intermediate levels of care and lean heavily on evidence-based medicine for their decision, but they need to trust that you’ve given them a full range of choices.
- Cost: Financial constraints are most pressing for this group. They often select more basic or intermediate levels of care, and they are the most concerned about being judged by the veterinary health care team, valuing employment of the skill of clinical empathy.
It’s essential to remember that, regardless of group, pet families uniformly believe their pets’ health is important. That’s why they’ve come to you, after all. They just have different preferences and needs when it comes to their pet’s care, and none of them want to feel judged for their choices. Having an awareness of and showing empathy for them is important to maintaining trust. Which leads us to communication.
Of course, you can’t know what group each pet owner falls into just by looking at the client. Our research reinforced that. That’s why training the entire veterinary health care team, from CSRs to CVTs to DVMs, to communicate in a way that is purposefully devoid of judgment, using open-ended questions and active listening, is a huge step toward successfully practicing a spectrum of care approach. It’s also important to note that ensuring the risks and tradeoffs are communicated to the pet family, then documenting the conversation in the medical record, allows the pet family to be a central decision-maker and ensures the standard of care is upheld.
The cognitive bias associated with the first choice presented in a list of options means that we have a responsibility to carefully consider how we convey care plans to pet families. The long-term win, after all, is for the pet to receive some care over none, and to return for more care over its lifetime. Some families will choose different options than we might as veterinary professionals, and that’s OK. Nationwide is working on communications programs — available to veterinary health care teams later this year — centered on the spectrum of care and the skill of clinical empathy.
Veterinary health care teams want to serve the diverse population of pet families and the pets they love. To do so, we must meet them where they are, understanding their goals, needs and preferences.
In other words, the real skill in practicing across a spectrum of care comes from combining medical knowledge with clinical empathy and creative thinking: “What other cards do we have to play here to get the best outcome possible in this case?”
A spectrum of care approach can help your team deliver the best outcome for each family. One that not only helps their pet, but also meets their needs, fits their budget and leaves them feeling good about their relationship with you, their pet’s trusted caregiver.
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To learn more about the Nationwide spectrum of care programs, visit spectrum-of-care.com.