At the beginning of the year – (end of Jan still counts as beginning of the year, right?) we are often faced with a question like:

• What was your biggest takeaway or learning from the previous year?
• What did you learn in the previous year that you want to take with you to the new year?

I have seen questions like that coming up multiple times on my social media feeds as well as in the new planner-cum-journal I got for myself.  When it comes to my profession, I have a clear answer to that question:

Spectrum of Care and its application in veterinary medicine.

What is Spectrum of Care?

While reviewing the suggested reading list for my studies with MentorVet last June, I found a few American veterinary journals discussing the concept known as ‘Spectrum of Care.’ This fairly recent idea seeks to change the perception of what constitutes the ‘gold standard’ treatment in veterinary medicine and surgery.

The goal is to offer veterinarians a broader range of treatment choices for any particular condition, enabling them to deliver the best possible care for their patients while also taking into account the unique situations and constraints of the pet owners.

The primary objective is to ensure that pets remain in their caring homes and that pet owners are not judged as either good or bad based on their ability to afford the most costly, premium treatments. In simpler terms, we aim to stop pets from being abandoned on the streets or surrendered to shelters due to health problems that their owners cannot address due to factors like financial constraints or lack of transportation in accessing veterinary care.

The spectrum of care also promotes the importance of valuing veterinary professionals in primary care and general practice, who primarily engage with clients for whom specialist referrals may not be a viable choice.

Why do I love this concept so much?

Because it is something I have always – through my 20+ years as a vet, believed that exists but I just did not have a word for it.

I didn’t feel assured or capable of discussing it, possibly due to the fear of being judged as less skilled or less compassionate as a veterinarian. There wasn’t a precise term to address the reality that not every pet owner can pay for pyometra surgery at a specialized facility where blood gas analysis is conducted beforehand; not all veterinarians around the world have access to high-quality suture materials like PDS or pain relief options such as opioids. Even in cases where they do, many pet owners cannot afford the extra costs associated with those surgeries. Inhalant anesthesia isn’t universally available, nor are 24/7 emergency veterinary services accessible to all pet owners.

In the unfortunate event of a roaming dog meeting with a car accident that causes an open fracture, the dog may face two options: euthanasia or leg amputation when specialized orthopedic surgery and post-operative care are unavailable. Amputation emerges as a viable and compassionate solution in such circumstances. It requires just one anesthesia procedure, one course of antibiotics, and a well-thought-out pain management plan. Effective pain relief can include alpha-2 agonists, ketamine, and a constant rate infusion of lignocaine, potentially complemented by an epidural. A careful selection of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) can ensure the dog experiences minimal discomfort while receiving the care it desperately needs. Choosing amputation not only saves a life but also offers a pathway to recovery and a better quality of life for the injured animal.

In this situation, practicing SoC (spectrum of care) not only improves animal welfare by reducing the need for long confinement in an inpatient hospital, but it also ensures responsible use of antibiotics. This approach minimizes concerns about potential post-operative surgical site infections following orthopedic implants and procedures.

Reading more and more about Spectrum of Care has given me the correct terminology to discuss the matter and helped to connect with many like-minded vets. I have found my people!

Young vets in Europe/US are facing the risk of deskilling…

 In the US, scientific advancements, improved technology along with expansion of opportunities for veterinarians to get specialist qualifications have increased over the last couple of decades. This has led to the understanding of what is considered a gold standard treatment to be pushed further and further to the high end. To the other end of the spectrum. What this ultimately means is a higher cost of veterinary treatment but with the simultaneous increase in pet insurance schemes, the cost has still been doable to sufficiently many pet owners for this trend to continue.

But not to all.

The Access to Veterinary Care Coalition (2021) found in their study that 8 out of 10 pet owners in the US were not able to afford veterinary care. Even routine veterinary care has been found more expensive than expected by 59% of respondents in a study by the American Animal Hospital Association (2021). Besides this cost factor for an increasing number of pet owners, there is also another, serious side-effect threatening especially the younger generation of vets.

Young veterinarians working in general practices are facing the risk of deskilling.

When general practices are expected to refer to specialists, to ensure that the highest end gold standard treatment is offered to the clients, vets who work in general practice do not get to develop their skills much unless they go back to studies to become specialists themselves. With increasing opportunities within academia to get further qualifications, more and more young vets are choosing to do so. This leaves fewer vets available or interested in working in general practice. And it leads to more and more pet owners without access to affordable basic veterinary care.

…while vets in India still have great opportunities

The veterinary specialist qualification concept has not yet arrived to that extent in the veterinary sector in India. This of course directly means that some advanced treatments and procedures are only possible in very few private hospitals in the country and some people may see that reflecting negatively on the Indian veterinary sector.

However, what this indirectly means is that there is a huge untapped opportunity for many general practice vets to develop their skills and apply those skills to the patients they see. When there is not a referral specialist for every scenario, you have the opportunity to upskill yourself to provide the best possible care to your patients.  To practice Spectrum of Care. Not, “it has to be with all bells and whistles of the highest end gold standard, or nothing” – approach but something on the spectrum that is still evidence-based and good practice. A great example of this is the Indian Canine Epilepsy Project.

The Indian Canine Epilepsy Project by Dr Prathmesh Deshmukh from Acumedvets aiming for better care for idiopathic epilepsy

Dr Prathmesh, a veterinarian who has a neurology referral practice in Mumbai, is working with the North Carolina State University College of Veterinary Medicine, to develop better resources for primary care veterinary clinics and hospitals in India to handle idiopathic epilepsy cases. Referral neurologists are not available in most of the country and for most people advanced diagnostic imaging techniques are even rarer. To avoid pets getting abandoned because owners feel too overwhelmed by the seizures and the anxiety that dealing with a seizuring pet can cause for the family, primary care vets need to have confidence in dealing with epilepsy.

Dr Prathmesh and his collaborators have started this project by sending out a survey to primary care veterinarians, to gather information on their present practices in handling epilepsy cases. Further on, the vets participating in this initial survey, will be sent some simple guidelines on how to manage idiopathic epilepsy cases in a resource-limited situation and there will be a follow-up study on the feedback.

You can be part of this project by filling up the survey.  This will also give you an excellent opportunity to take your epilepsy management skills up a notch and to get a better understanding of the options that Spectrum of Care provides for idiopathic epilepsy care.