The veterinary profession has always accepted that clients may try to blame them when diagnoses are elusive, treatments are unsuccessful or diseases are overwhelming. Throughout vet school, “being sued” remains the greatest concern for students (anecdotal but seemingly consistently reported!) and it takes a variable duration of qualification for the intensity of this apprehension to ebb.
In equine practice, pre-purchase examinations are a significant source of anxiety for many, whether this is the worry of failing to identify a clinically significant finding, potentially misinterpreting the significance of a finding or being accused of “passing” a “lame” horse. But there are other scapegoat predilection nightmares too – being held responsible for an “all risks of mortality” claim being denied by the insurance company, a horse’s vaccinations being non-compliant with competition rules or a horse failing to recover sufficiently despite costly treatments, for example.
The blurred line between what is the responsibility of the vet and what is the responsibility of the owner appears to be notably wide in equine practice. This is possibly as a result of the way client–vet relationships evolved back in the days of rural mixed practice – but perhaps it is more complex than that?
The blurred line between what is the responsibility of the vet and what is the responsibility of the owner appears to be notably wide in equine practice
While the majority of equine practices deal primarily with leisure horse owners, there is a considerable commercial presence among the industry’s clients, which perhaps dominates the behaviours and attitudes within it.
As the value of horses has increased, so too have the costs associated with keeping and competing with them. When a horse is unable to compete due to its vaccinations not meeting requirements, it is not uncommon for the owner, rider or trainer to hold the vet accountable despite the responsibility lying firmly with their (aforementioned) keeper.
Complaints often arise following in-depth or complicated investigations – frequently for lameness or poor performance – when the mounting costs are realised and the horse is only just starting its lengthy rest and rehabilitation period. It is understandable that the sum reached is inevitably more shocking on paper than it was during the piecemeal discussions held throughout the process.
The disquiet is likely exacerbated by the reality of loading up their still-lame horse to take it home when there is no guarantee of a successful recovery and every chance the patient may fatally self-harm while on paddock rest. And if it does survive the rehabilitation, they still face the journey of speculation about any future ridden and/or competition potential and whether selling is feasible or retirement or euthanasia is wiser. All while considering the search for an impossible replacement to invest all that time and money in all over again.
Vets are the mirrors and microscopes to the effects of other humans in a horse’s life
Horses are quite the recipe for owner disenchantment and veterinary disappointment. But if we assess the whole situation objectively, we often find that the start of the problem predates veterinary involvement, perhaps originating with the way the horse was bred, raised, trained, ridden and/or managed. Vets are the mirrors and microscopes to the effects of other humans in a horse’s life.
A common complaint that the British Equine Veterinary Association (BEVA) receives from horse owners relates to the rejected all risks of mortality insurance claims. Insurers’ claims consultants routinely use the fact that a claim doesn’t meet the BEVA euthanasia guidelines as their “get-out-of-jail-free” card, leaving the vet (and BEVA) to take the brunt of the criticism from the upset owner.
Rarely do the claims consultants acknowledge that the guidelines were put together to explain what all risks of mortality policies cover to vets rather than to determine the level of cover offered. Even less commonly do the disgruntled owners reflect that they are the ones responsible for reading the policy documents and complying with any conditions required to make a claim. There is an unwavering belief, for some, that the responsibility for a payout lies with the attending vet.
There is an unwavering belief, for some, that the responsibility for a payout lies with the attending vet
Tremendous effort goes into understanding equine insurance and competition requirements, and it takes considerable time for both BEVA and the individuals at the coalface to understand the nuances, keep abreast of changes and communicate the implications of these requirements to owners.
Some take the stance of burdening themselves with the responsibility and decision making in order to satisfy, placate or simply support their clients. Others feel it is not our job to play “nanny” and refuse to accept any such requests. However, there is probably some middle ground to be found that satisfies the role of the vet as a member of the horse’s “team” – rather than shouldering the entire responsibility, we can be educators, facilitators and providers of our veterinary services.
Instead of not confronting the accusations or apologising too readily when accused of failing to fulfil some perceived responsibility, perhaps we can take a step back to assess the situation more objectively. Did you ask the appropriate questions or prompt the necessary actions, such as asking whether the horse was insured before considering euthanasia or considering what disciplines it competes in? If not, it may be worth reviewing your knowledge and putting in place protocols and processes that facilitate this for you.
These protocols and processes will be particularly helpful in urgent or stressful situations and will no doubt aid new members of the team. They can be something as simple as a checklist and/or euthanasia consent form containing all the information to be discussed and recorded with the owner, or a crib sheet of vaccination requirements for the various competition regulatory bodies. Both of these, you’ll be glad to hear, will be available to BEVA members soon!
If we communicate our role and what we expect of our clients consistently and confidently, we could minimise the potential for unrealistic expectations and dissatisfaction among our clients
If you are sure you have satisfied your responsibilities and that the accusations posed are unfair, a complaint could be viewed as an opportunity to educate the client on where those responsibilities start and end for both parties. If delivered in a friendly and informative way, it could be an “awakening” for the client (and even you!) that vets are not responsible for everything, nor should they be blamed for everything that “goes wrong”.
Most vets are natural helpers, carers and “fixers” and are typically high-achievers and people-pleasers, even if these traits have become more covert from years of being in the game. It probably pays to remind ourselves, our younger colleagues and visiting students that we are required to be good at many things, both clinically and in how we interact with people. If we communicate our role and what we expect of our clients consistently and confidently, we could minimise the potential for unrealistic expectations and dissatisfaction among our clients.
