Maureen E. Sutter, DVM*
Bucyrus, KS
*Corresponding author: Dr. Sutter (msutterdvm@gmail.com)
©The author

In the dynamic world of equine veterinary medicine, where every horse is unique and every owner’s circumstances differ, how do we ensure optimal care for every horse? Providing spectrum of care (SOC) in equine ambulatory practice offers a range of diagnostic and treatment options, from basic to advanced, to find a solution while providing veterinary care to horses in a field situation. While the term spectrum of care is fairly recent, the concept has been practiced for years in veterinary medicine. It acknowledges that there are many ways to treat most cases and where the veterinarian is able to work with the client to find an appropriate solution to fit their individual needs and circumstances. There is no “one-size-fits-all” solution in most cases.

A common veterinary practice philosophy focuses on client- and patient-centered care. Equine practitioners want to offer a wide range of treatment options, regardless of the client’s available budget. This includes presenting all appropriate options, from conservative management to advanced diagnostics, including referral, if warranted. This allows the client to make an informed decision regarding their goals, finances, and horse’s needs. It is important to provide clear communication to ensure the client understands the available options, keeping in mind it’s not just about finances, it’s about ethical practice, client satisfaction, patient well-being in difficult situations, and preventing abandonment of care due to perceived high costs.

Examples related to SOC are seen daily in equine ambulatory practice. When a horse presents for colic, treatment options can be presented during the physical examination and initial assessment. Treatment may start with conservative medical management by utilizing sedatives, NSAIDs, and fluids via nasogastric tubing. Depending on the initial findings, additional diagnostics like blood work, abdominocentesis, or an abdominal ultrasound may be warranted. The practitioner might also suggest hospitalization for IV fluids or discuss referral for possible surgical intervention. The horse’s age, temperament, and overall health status may influence treatment decisions.

Working up an equine lameness can also showcase options to utilize SOC. Practitioners may start with a conservative management approach by using stall rest and pain medications, or they may perform a thorough lameness evaluation with diagnostic nerve blocks. They may utilize diagnostic equipment (radiographs or ultrasound) or discuss referral for more advanced diagnostics. The purpose of the horse (retired pasture horse vs high-level athlete) may impact the desired outcome and thus SOC.

New veterinary graduates can embrace the SOC by developing their style of communication and enhancing their clinical skills.2 It is important to be transparent about costs with the client and to not judge them for financial limitations. This involves clearly presenting tiered estimates and discussing all options up front. Remember, good medicine is not always the most expensive option; rather, it’s about providing the most appropriate care that leverages a variety of resources to achieve the best possible outcome for each patient.1 Working with diverse clientele can be challenging, and having good communication skills can be very helpful when talking about SOC options. Mentorship is important for new graduates, and a good mentor can help with communication skills around SOC.

Utilization of SOC in equine ambulatory practice is not a novel concept but an approach to the flexible, patient- and client-centered care that veterinarians have long provided. By understanding that one size does not fit all, practitioners can effectively present a range of evidence-based diagnostic and treatment options. This enables clients, regardless of their socioeconomic circumstances, to make informed decisions that align with their goals and resources, ensuring that horses receive the best possible care. Embracing and articulating SOC strengthens the veterinarian-client-patient relationship, fosters animal well-being, and empowers new graduates to confidently navigate the complexities of real-world veterinary medicine.

References

1.Fingland RB, Stone LR, Read EK, Moore RM. Preparing veterinary students for excellence in general practice: building confidence and competence by focusing on spectrum of care. J Am Vet Med Assoc. 2021;259(5):463–470. doi:10.2460/javma.259.5.463
2.Brown CR, Garrett LD, Gilles WK, et al. Spectrum of care: more than treatment options. J Am Vet Med Assoc. 2021;259(7):712–717. doi:10.2460/javma.259.7.712