When we’re working with an owner to decide on a treatment plan for a patient, do you ever find that you just have too many options? When there is only one course of action, then owners may not like the answer that we give them, but it does simplify the decision-making process. In my experience things get difficult when there is more than one option.
How do you work out if one choice is better for an animal than others? Do you go with the financial perspective – an owner who can only afford the cheaper option, or do you believe that more expensive is obviously better? That approach might help an owner to reach a decision, but it doesn’t necessarily mean that this is the right decision for the vet, owner or pet.
I was reading an article from Annie Duke, on decision making, and she suggested that we should look for options which create more opportunities. Making a decision which only results in one outcome puts more pressure on that decision making process. If you get it wrong, then you (the vet or the owner) have to live with it. Choosing an option that creates more opportunities, relieves the pressure of making a decision.
Think about your career. If you have a general degree in English or History, then it might open lots of doors into business, politics, journalism, media or teaching. If you have a veterinary or a medical degree does that restrict you to being a vet or a doctor? Maybe not later in life (there are lots of transferrable skills in medicine and veterinary medicine after all), but in the first year after graduation, it could narrow down choices (and I know there is someone disagreeing with this comment!).
So, in veterinary medicine, where could we create treatment options that result in more opportunities for a successful outcome for our patient?
Orthopaedics is the first one that comes to mind. If a cat or dog presents with a badly fractured leg, in years gone by, we might have amputated a limb at the start of the process. But now, with new techniques and highly skilled surgeons, it might be possible to repair the fracture. There is always the possibility that it might not work, but in that case then we still have the option of amputation. So now we have two options instead of one – there is an option to go for surgery which could be a success and save the leg, but we still have a back-up solution if the surgery doesn’t work.
But treatment comes at a cost for both the owner and the animal. A decision to put an animal through surgery means that we are making a decision on behalf of another animal to put them through one or more procedures. This could mean a long stay in hospital away from family; it could mean a degree of discomfort and/or pain (albeit minimised through multi-modal analgesia approaches) for the animal; it could mean emotional upset for the owner; and it could all come at a financial cost. And all of these factors need to be discussed, and emotional aspects considered to reach a consensus.
Juggling all of these different factors is not easy and every vet and owner will have a different opinion. Personally, this is why I dislike the algorithm, NICE guideline approach of the NHS. A framework is fine as a starting point for a conversation, but it’s not a map that should be followed unquestioningly.
Oncology is another specialty that creates more options for patients and owners. Utilising different treatment options using chemotherapy, radiation, surgery, immunotherapy or hormonal therapy gives people options.
But does creating more opportunities mean that you’re just creating more options, and then all that happens is decision paralysis? I would argue that is not the case. An opportunity means that there is still a door that can be opened with a chance of success. An option is just that – it could be good or bad; right or wrong. Thinking about opportunities requires us to run scenarios through in our head. What if A happens and the owner is upset? What if B happens and it all goes wrong? But what if C happens and everyone is happy? But scenario planning is a topic for another day.......
The next time you’re faced with a case, and you don’t know where to start, perhaps thinking about a decision that could create more opportunities might be the way to approach it. Greater opportunities for success mean a more positive owner experience, and ultimately, improved animal welfare.
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