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
Decision-Making in Veterinary Practice is ideal for all veterinary practitioners, veterinary students, and clinical skills instructors.
“Decision Making in Veterinary Practice offers expert medical knowledge and an ethical sensibility to illuminate everyday veterinary issues like animal euthanasia, treatment of elderly patients, and moral stress. The result is an unparalleled practical road map to fulfilling the patient advocacy role of the veterinarian. I wish I had the benefit of Dr. Kipperman's wisdom when I was a young veterinarian. All veterinarians should read this terrific book—veterinary students, new graduates, and seasoned professionals.”
Simon Coghlan, PhD, BVSc
University of Melbourne
Victoria, Australia
“Decision Making in Veterinary Practice is a detailed and thoughtful discussion of many key aspects of veterinary clinical decision making. Drawing from decades of personal experience as an internal medicine specialist and practice owner, Dr. Kipperman provides numerous realistic case examples to illustrate both the challenges facing clinicians and many potentially helpful strategies for improving decision- making and optimizing patient outcomes.”
Brennen McKenzie, MA, MSc, VMD
Adobe Animal Hospital
Los Altos, CA
“Decision Making in Veterinary Practice is a helpful resource focused on how decisions are made, and how decision-making can be improved in the interests of veterinary patients. It contains many excellent case examples documenting positive and negative outcomes of decisions. A unique aspect of this book is its disclosures of Dr. Kipperman’s experiences as an internist – including humble accounts of lessons learned and insights into the moral distress experienced by veterinary specialists.”
Anne Quain, BVSc, MVetStud
Sydney School of Veterinary Science
Sydney, Australia
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
