Decision-Making in Veterinary Practice

Decision-Making in Veterinary Practice

The first-ever guide to rational decision-making in veterinary practice

The practice of veterinary medicine entails crucial decisions about patient care on a daily basis. Whether to admit patients displaying symptoms, whether to pursue diagnoses or prioritize therapeutic trials, whether to advise overnight stays after routine surgery, whether to refer patients; the answers to questions like these can significantly influence patient outcomes and standards of care. However, veterinary clinicians are seldom trained to analyze their patterns of decision-making, relying instead on the existing culture of a practice to dictate their behaviors. This can lead to irrational decisions, institutional inertia, reluctance to comply with evidence-based medicine, and failure to optimize patient outcomes.

Decision-Making in Veterinary Practice provides the first-ever dedicated guide to rational principles for decision-making in veterinary practice. Rooted in the study of normative ethics, it seeks to pose important questions and develop processes by which they can be answered. The book promises to transform the clinical performance of clinicians and practices that utilize it.

Decision-Making in Veterinary Practice readers will also find:

• Discussions of key issues based on extensive clinical experience and evidence
• Detailed discussion of important decision determinants like time of day, patient weight, criteria for stopping treatment, and more
• Essential insights on clinical decision-making and clinical reasoning

TABLE OF CONTENTS

Contributors xiii

Acknowledgments xv

Introduction: Why a Book on Decision-Making in Veterinary Practice? xvii

Section 1 Fundamental Concepts in Making Clinical Decisions 1

1 How to Define Your Success as a Clinician 3
Barry Kipperman

2 How to Obtain a Patient History 17
Barry Kipperman

3 Informed Consent 25
Barry Kipperman

4 Risks, Benefits, and Ageism 37
Barry Kipperman

5 Client Education Beyond Informed Consent: The Most Important Thing an Owner Needs to Know 47
Barry Kipperman

6 Euthanasia 53
Barry Kipperman and Kathleen Cooney

7 Referrals 67
Barry Kipperman

8 The Influence of Economics on Decision-Making 77
Barry Kipperman

9 How to Optimize Patient Outcomes 91
Barry Kipperman

10 Medical Errors 107
Barry Kipperman and Jim Clark

Section 2 Principles of Diagnosis 121

11 The Influence of Patient Weight on Decision-Making 123
Barry Kipperman

12 The Influence of Age and Aging on Decision-Making 129
Barry Kipperman

13 The Day of the Week Matters 135
Barry Kipperman

14 The Time of Day Matters 141
Barry Kipperman

15 Serial Monitoring of Laboratory Results 147
Barry Kipperman

16 Overdiagnosis and Useful Diagnosis 155
Barry Kipperman

17 The Minimum Database 167
Barry Kipperman

18 In What Order Should Tests Be Performed? 173
Barry Kipperman

19 Diagnostic Errors 179
Barry Kipperman

20 Providing a Prognosis 189
Barry Kipperman

Section 3 Principles of Treatment 199

21 Inpatient or Outpatient? 201
Barry Kipperman

22 The Therapeutic Trial 207
Barry Kipperman

23 Interpreting Therapeutic Outcomes 217
Barry Kipperman

24 Setting Goals and Therapeutic Endpoints 227
Barry Kipperman

25 Pain Management 235
Barry Kipperman

Index 245