Teamwork makes the dream work - Veterinary Practice
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InFocus

Teamwork makes the dream work

“If we start seeing our diagnoses not just as veterinary problems with veterinary solutions, but as team problems with team solutions, we might see outcomes improved across the board”

Everyone knows that working as a team can improve patient outcomes, but how can we maximise this effect in ambulatory equine practice? It is fairly obvious in the hospital setting that vets, nurses and support staff need to work in a seamless synchronised fashion. However, on the road where ambulatory equine vets are often working alone or with remote support staff (whether it’s first opinion work or following up referral cases), how can we maximise this effect?

Those working in equine practice will recognise that the average UK horse is surrounded by a fair few people – owners, riders, trainers, grooms, farriers, physiotherapists, chiropractors, osteopaths, equine dental technicians, saddlers, nutritionists… and that’s just naming a few. So, where do all these people fit in when it comes to identifying and solving health-, riding-, performance- and, ultimately, welfare-related problems? The answer is “everywhere” – to varying degrees, of course, but they are all inextricably linked, and as vets, we need to work with them all to achieve the best possible outcome for our patients.

Besides ourselves, owners and riders usually have the greatest impact on how successfully we help our patients as they are normally the ones who contact us and participate throughout diagnosis, treatment and rehabilitation. But when it comes to identifying issues and reaching a diagnosis, it never ceases to amaze me how often the rest of the horse’s “team” can provide vital information which may otherwise have been missed. During my working day, I sometimes feel like a police detective acquiring information from numerous “witnesses” when it comes to complex medical or poor-performance cases. Frequently, key information is uncovered when digging into the patient’s history and finding out what has been picked up on and discussed previously with these other allied professionals.

It never ceases to amaze me how often the rest of the horse’s “team” can provide vital information which may otherwise have been missed

Farriers can provide a wealth of information when it comes to lameness and endocrinopathic laminitis. They spot subtle alterations in shoe wear or changes in hoof shape caused by abnormal growth and loading forces. Then after diagnosis they can be all that lies between success and failure, irrespective of any veterinary intervention. The importance of good farriery can be easily overlooked, but in practice it is frequently evident when inappropriate farriery has caused problems or prevented a successful outcome, and this is not always the fault of the farrier. Sometimes it is through the owner’s failure to book farrier visits frequently enough, as many horses need shoeing cycles of five to seven weeks (or even less in some cases), but owners can try to stretch the interval out of ignorance or in an attempt to save money. Other times inappropriate farriery is carried out due to a failure in communication between vet and farrier. I rarely leave it to the owner to pass on my comments or beliefs regarding changes to trimming and shoeing, preferring instead (with permission) to liaise directly with the farrier, but keeping the owner “in the loop”. This commonly takes the form of a WhatsApp group, where X-rays, photos, videos and voice notes can be shared.

Musculoskeletal therapists also provide a wealth of information and skills which would be foolish to ignore. Some of the best physiotherapists I have known can accurately locate the source of pain and provide invaluable adjunctive therapy to my largely medicinal offerings, which can be the difference between transient and sustained success. Where attention and importance are awarded to the value of physiotherapy in a horse’s maintenance and recovery from injury, you see a clear uplift in the horse’s prognosis, which is impossible to deny.

Where attention and importance are awarded to the value of physiotherapy in a horse’s maintenance and recovery from injury, you see a clear uplift in the horse’s prognosis

I am lucky at my practice in the fact that we have a tremendously talented and skilled array of allied professionals in our surrounding area, all of which are working harmoniously with owners, vets and between themselves to create the best possible conditions for the horses they work on. I dread to think what it must be like without these kinds of individuals, and I hope most equine vets can boast the same of their relationships with allied professionals in their areas. However, possibly the most influential factor on injury rates and prognosis for recovery, which varies more widely than anything else and affects all vets and allied professionals, is the actions of owners and riders. I’m not talking about leisure versus professional or between disciplines as those factors are obvious. What is much more subtle but equally as apparent when you stop and think about it is owners’ attitudes towards cause and effect and the ability to recognise their own impact on the horse’s health.

Possibly the most influential factor on injury rates and prognosis for recovery […] is the actions of owners and riders

I am particularly overwhelmed by two types of owners in my work as a first opinion vet. The first is the experienced horse owner or professional who accepts no responsibility for why their horse may have acquired a health issue or injury and merely sees the incident as “bad luck” or, sadly and more commonly, a failure on the horse’s part. Largely these individuals succumb to the same problems time after time. Barring accidents and genuine episodes of bad luck, there can sometimes be causes to identify and address if we are willing to look for them. Typical examples are the dressage horses that never hack or cross-train and then suffer the consequences of repetitive injury from sustained training in arenas. Or yards where poor-quality deep surfaces have caused suspensory injuries to multiple horses, but the pattern has yet to be queried. Some horses have been ignorantly allowed to become overweight or intentionally kept obese to satisfy onlookers in show rings, yet the incidence of laminitis and orthopaedic disease is ignored. Another commonly witnessed situation is where the horse is treated like a classic car: ridden infrequently or not trained sufficiently to sustain the level the rider wishes to work at. These horses are being kept in a state of vulnerability to injury which many owners and riders are not aware of. It takes training and fitness to carry out much of the work we ask our horses to do, even just low-level dressage schooling, never mind competitive dressage and any amount of jumping. So, without the necessary conditioning work, they are pretty much guaranteed to sustain injuries which could have potentially been avoided.

Then on the other hand, there are the owners and riders who are meticulous in trying to work out why something has happened. They have a burning desire to improve their methods in order to avoid their horses experiencing preventable problems. These people may be successful professionals or inexperienced happy hackers, but their willingness and determination to learn for the sake of their horses is admirable. From owners who experience their first laminitic episode and then rethink and literally rebuild their horses’ lives and environments to safeguard for the future, to riders who humbly realised their horses’ injuries were indicative of a failure in training and their way of riding. Where open-mindedness exists it is amazing what can be achieved. I have seen horses written off due to orthopaedic injury be successfully rehabilitated by a complete overhaul in how they were kept and ridden. These owners and riders are often innately driven to assess and improve the ways they do things.

As vets and allied professionals, we are in a unique situation where we can forge a framework to guide and support owners in taking a more holistic approach to their horses’ health

What is more of a challenge, but perhaps more the responsibility of vets and allied professionals, is trying to help those who may not be able to spot where improvements can be made, to see them and make a change. The realisation I have had in my time as an ambulatory vet is that owners can often single-handedly turn the tide on their horses’ risk of being ill or injured. Some will do this without our intervention; however, most will want guidance and some will not know what it is they need.

As vets and allied professionals, we are in a unique situation where we can forge a framework to guide and support owners in taking a more holistic approach to their horses’ health. The more closely we work as a team, the better the chance of the horse experiencing a successful outcome, and we may even avoid issues before they happen. For instance, my persistent mantra in dealing with most sports injuries in horses is that any veterinary treatment I can administer is best viewed as a window of opportunity within which we can address all the other causes. Failure of treatment can absolutely be disease progression (among other things like incorrect diagnosis, of course!), but I wonder how much of the time we are failing to recognise the bigger picture and, to paraphrase Henry Ford, “leaving owners to always do what they’ve done and always get what they’ve got”. If we start seeing our diagnoses not just as veterinary problems with veterinary solutions, but as team problems with team solutions, we might see outcomes improved across the board.

If we start seeing our diagnoses not just as veterinary problems with veterinary solutions, but as team problems with team solutions, we might see outcomes improved across the board

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