Contextual care seems to be the new buzzword (or two!) in veterinary medicine at the moment. One of the fun things about having students travelling around with me in my ambulatory ophthalmology service is finding out what they think about the current topics in veterinary medicine, be it contextual care or dangerous dogs or work–life balance.
I’ve been doing this job now for 36 years and all that time ago nobody mentioned contextual care. Having said that, it was obvious that a feral cat brought in with a broken leg would have a different level of care than one that came with owners who wanted everything possible done for their beloved (and insured) pet. I remember being told then that a cat’s bones heal well as long as they are in the same room! A bit of an over-exaggeration, I’ll grant you, but the take-home message was that a Robert Jones bandage around the leg and a cat cage in which to confine the animal for a few weeks should be quite enough, or so we were told 36 years ago.
But things have changed. In those days, as far as I remember, there was one book from BSAVA on feline medicine and surgery, with a short chapter on orthopaedics. There are now whole books on feline orthopaedics and experts waiting for cats with broken legs to undertake complex surgeries.
I’ve just found a research paper from 2022 on fracture repair in over a hundred cats and that was just for the humerus! Twenty-eight percent of those fractures were stabilised using a plate-rod construct, 54 percent using external skeletal fixation and 18 percent using bone plating and screws only. The take-home message from that paper was that external fixation didn’t seem to work as well as internal fixation; however, non-surgical options such as a splint were not discussed – the Robert Jones bandage didn’t get a look-in!
My overall worry, though, is that much of the literature about many different types of treatment emphasises gold-standard treatment (GST) options rather than… dealing with situations where expensive therapeutic options are not possible
A recent textbook from the States spent half a page at the end of each chapter on different fractures and discussed managing owner expectations and methods to treat fractures where surgical stabilisation was not an option. My overall worry, though, is that much of the literature about many different types of treatment emphasises gold-standard treatment (GST) options rather than, as that book did so well, dealing with situations where expensive therapeutic options are not possible.
At the vet school most of the cases have, of course, been referred for the best possible treatment options. Owners without sufficient funding just don’t make it over the threshold. In such cases, many are underwritten by the RSPCA through a separate clinic that brings these cases to the vet school. These animals get fantastic treatment too – of course they do, our clinicians are always aiming for the best possible outcome. Cats with fractures get surgical treatment, not Robert Jones bandages, as they certainly will do better that way.
Maybe it’s going to be during EMS that students get a real feel of how to cope with clients who just haven’t the funds to give gold standard treatment
The trouble is how do our students learn to cope when there isn’t an expert on hand? Maybe it’s going to be during EMS that students get a real feel of how to cope with clients who just haven’t the funds to give GST. And my worry there is that a fair number of corporate-owned practices also require their clinicians to offer the best and nothing less. Owners aren’t given the option to cut some corners in, say, opting out of pre-op bloods in a happy healthy young animal. And it’s tricky if you are an owner in that situation. Offered the tests as the “best option”, which client will argue against the vet’s opinion and say that they would prefer their pet not to get the best treatment?
Offered the tests as the ‘best option’, which client will argue against the vet’s opinion and say that they would prefer their pet not to get the best treatment?
Now, having said that, while the majority of pre-op bloods come back completely normal I did have one last week where the dog had a non-regenerative anaemia and high total protein – maybe a myeloma, and certainly one where I’m glad we didn’t go straight for surgery to remove a glaucomatous eye, but rather waited to assess further diagnostics. But, having said that, I can’t remember the last time that happened. How often do pre-op bloods change your treatment plan, I wonder? Now there’s an interesting student project for the future!
