Most equine veterinarians do not have specialty degrees, but they have had many clinical experiences after years in practice. After four years in veterinary school and in many cases an internship, practitioners have a strong basis of knowledge. After a few years in practice with mentorship and continuing education opportunities, they have a toolbox of techniques and treatment plans that usually bring successful resolution of patients’ medical problems.
For those practitioners, it can sometimes be hard to decide when to refer patients (and clients) to those with specialty degrees and board certifications when cases are not resolving as expected.
The trusting relationship that veterinarians have with their clients can cut both ways. Clients want the familiar communication and comfort of their primary doctors, yet also want the best outcome for their horses. Practitioners might fret about losing control of a case and having decisions made at a referral center that they might not agree with.
Clients expect a horse’s primary doctor to be well-informed about what is occurring at the referral institution, yet that veterinarian might be having trouble receiving timely updates. It is common for clients to call the primary to ask how the horse is doing first thing in the morning, and it can be unsettling not to know.
If a serious decision needs to be made for surgery or euthanasia, often the client reaches out to the primary to help with the decision, yet the primary veterinarian might not have the information needed in order to help.
The years of trust and relationship between the horse owner and that horse’s veterinarian provide a great deal of comfort and confidence that can be missing at the referral level due to the newness of the experience.
Simultaneously, the primary veterinarian wants to have the very best outcome for the client that trusts them implicitly, and for the patient that they perhaps have cared for over many years. If they lack the necessary diagnostic tools, treatment modalities, specialized knowledge, or hospital facilities to provide the needed care, a recommendation for referral should generally follow. Offering referral to a specialist when the chosen treatment is not resolving the issue satisfactorily is wise from a liability standpoint as well as from a professional perspective. While clients may choose not to pursue that option, discussing it early in the course of a potentially serious or life-threatening condition is good practice.
When having such a discussion, referral to a specialist can be offered along with other treatment options. For instance, in the case of a severe impaction colic, one can cite statistics about outcomes and give estimates of costs for treatment at home versus at a referral hospital, as well as lay out expectations for each type of care.
It is wise to include decision points where a referral might be more strongly recommended, such as, “If Blaze hasn’t passed any manure by tomorrow, or the impaction is larger on a rectal exam, I think you should consider taking him to the referral center.” If the client declines referral and the outcome of the case is negative, the doctor can at least feel that he or she offered an alternative and were given the directive to simply do the best they could in the farm setting.
Offering the possibility of referral to a specialist early in the course of a potentially serious condition allows the client to begin considering what the decision would be if the initial treatment is unsuccessful. Some clients will choose to engage a specialist early, and others will choose not to use the services of one at all.
What is important is that referral is a choice that the client understands and has time to consider with the help of his or her trusted veterinarian.
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