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The case for pragmatism in equine practice

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What can help your approach

  • Insurance is no guarantee that an owner will want to go ahead with investigations or treatment. Their ethical standpoint, previous experiences and perception of the cost/benefit to the horse's quality of life may legitimately influence their decisions.

  • Some owners will want details of all treatment options and prognoses, while others will want to know 'what would you do if this was your horse?'. Explore with each owner how much information they want and what outcome(s) would be acceptable for them, then tailor your advice accordingly.

  • Pragmatism is a key element of good veterinary medicine. Tests are only worth doing if the results are likely to change what you’ll do with the horse in front of you. Consider each treatment option in the context of the short- and long-term welfare of the whole horse, not just its likely impact on the target body system(s).

I’ve had a number of horses and, consequently, a lot of vet bills. Some notable cases include the novice event horse who started chipping in at combinations and turned out to have grade 4 squamous and glandular ulcers that omeprazole didn’t fix. He needed antibiotics – most of which I ended up wearing. He was eventually retired due to coffin joint arthritis.

Then there was the lovely young horse who suddenly wouldn’t strike off correctly in left canter – she turned out to have kissing spines, which was successfully operated on, and she went on to win the BRC Eventers Challenge National Championships. Unfortunately, she was retired due to sclerosis of the left fore cannon bone less than a year later, and ended up being put to sleep when we couldn’t keep her sound.

Finally, there was the showjumper type who, out of the blue, refused to go at all. We never did get to the bottom of what was going on there, although her hind suspensories were operated on and we radiographed and bone scanned every inch of her.

The thing all these cases have in common is the varying pragmatism I’ve experienced from the vets involved. I keep my horses fully insured because I want to do right by them – if there’s an investigation or treatment that has a good success rate, then I want to be able to afford it. However, and here’s the rub, I don’t want to spend that money just because it’s not directly coming out of my pocket.

If doing a specific investigation will potentially alter the treatment plan then great, I’m all for it. But if the end result, in terms of management, is going to be the same, then let’s not put the horse through that process. Also, if there’s a conservative ‘watch and wait’ approach, I want to know about it. Don’t make me ask a litany of questions – provide the various options up front, and let me work through the pros and cons of them.

The horse was insured, so why wasn’t I just saying yes?

Some vets have been excellent at this, and, for my part, I’ve got better at asking the right questions and not making spur of the moment decisions. However, some vets have been so utterly committed to the ‘treat at all costs’ idea that we’ve parted company. Their view was that the horse was insured, so why wasn’t I just saying yes?

In one instance, I’d reached the point where I felt like we were treating the horse just so I could pursue my hobby, and this was ultimately detrimental to his welfare. It was an ethical line I didn’t want to cross. There was, and often is, a middle ground. In this case, it didn’t lead to a horse I could event, or even ride, but he had a nice field retirement for several years, and I was ok with that outcome.

So, vets, I know you’re the experts, and I really do want your opinion on the options available, but I also want the facts – what’s the prognosis, what’s the success rate, do you know what other factors influence outcomes, are there any other paths we could try? If you don’t know then that’s ok, sometimes I’ll take the gamble. However, sometimes I won’t, and it’s not always about money. Sometimes it’s about doing what I think the right thing is for that horse.

What I need from you is the time to talk through the options and come to the right conclusion for me and the horse in my care. I know that sometimes means I’m repeating myself or asking increasingly specific questions, but it’s important to me. Give me the space to figure out what works for me, and I’ll be an excellent repeat customer – my horses will make sure of that!

Do you want to get involved?

If you know a client who might be interested in writing for us, please contact us at vet.clientview{at}bmj.com. Any contributions will be assessed by the column’s veterinary coordinator, Zoe Belshaw.

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