Clinical reasoning - a guide to improving the quality of your practice

It is an unfortunate fact that time is money! The more cases a practicing vet can see the more money he / she will earn. There is significant pressure to shorten and minimise clinical investigations. Additionally, we are all trying to reduce costs to the clients to make equine consultation and treatment more feasible economically for them. We are also under pressure from vets who will undercut strongly to gain clients. It’s not about clinical acumen, caring and communication ability, it’s about who is cheapest! No-one can work for nothing – we all must make a living and that should reflect the quality of the work we do. The pressure towards poor quality practice is very high. Modern practice has gained a reputation amongst horse owners that vets are “always in a hurry and even more of a hurry to get the money”. 

How many of us carry out a proper clinical assessment and how many of take a proper clinical history when we are called to see a horse? Of course, common sense should prevail and there is a very different approach to the clinical examination of a serious colic case, a horse with a fever and a nasal discharge and a horse with a chronic lameness or a chronic skin problem.

The only way to maintain a strong and loyal client base is to maintain the quality of the professional service that is provided. We continue, regrettably, to hide behind the “cost of drugs”, preferring to charge a huge mark up on drugs rather than charging for a proper professional clinical service. Of course, to some extent that is justified because of the poor quality veterinary service; in truth much of this is probably not worth much! We can either chose to “make a living on selling drugs and visits” or we can make a living on providing our professional services just as lawyers, accountants, dentists and doctors do! The public perception of the veterinary profession has fallen to a new low as “money” becomes the drive for practice survival. However, high costs with high quality professional work are much better tolerated than low quality casual or disinterested work. The good clinician will always survive whilst the poor one has to become increasingly desperate. The quality veterinarian may lose a few (usually bad paying) clients but they soon come back when they realise that they are dealing with a proper profession and not just a drug pushing hopeless and inadequate vet! An inadequate article will remain inadequate and it will cost more in the end Most general practice professionals are committed to providing a high-quality service to their patients. Yet quality improvement is not routinely embedded in general practice, and various barriers need to be overcome to create a culture in which quality improvement is recognised as central to the provision of good general practice services. The quality of equine practice therefore depends on the efficiency of the veterinarian. So how can an efficient and effective clinical approach be developed so that the quality of the medicine can be improved. We need to reach the point where the veterinarian has clients clamouring for his / her consultation.

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