OPINION: To judge or not to judge?

I can always recall that both in retail and veterinary clinics we used to be advised “not to x-ray the clients pocket”.

This means that we should not judge what we think a client has to spend on their pet. When the cost of a case and the client’s wishes were brought up in ward rounds or team meetings, the response of x-raying pockets was often brought up to rebut any changes to patient care.

The concept of “judging” our clients is a harsh one. And the rebuttal against clients and sometimes teams ability to care for a patient was used to halt conversations on alternative care options. Which was at once both infuriating and unreasonable.

Context not judgement

With ongoing conversations about contextualised care (CC) still happening and bringing clarity to shared decision-making, is this now the time to retire the phrase and the concept that changes to a care plan because of clients’ needs are implemented with a judgemental approach.

Asking about how tablets are given or toileting routines happen aren’t to judge, they are to find out realistically how some care options will be successful.

We can’t ever fully know how care is provided in a pet’s home. There may be multiple carers, physical or mental barriers and of course the hot topic of fees. The presences of any of these contexts in themselves stop care, and  they alter how it is delivered.

Changing a care plan to take this into account is surely sensible for the appropriate outcome. I personally hope that using terminology associated with context brings in my previous thoughts on “social ward rounds”.

Trust and risk

Finally, it is worth reflecting on the veterinary relationship with clients and patients. In human care the concept of a role of trust or risk. The risk approach of human medical care is part of being a government-funded health scheme.

The risk approach places the responsibility of health care more with the health care organisation, that is, the NHS. In a direct opposite to this veterinary care is a trust-based system. The responsibility for seeking and implementing care is with the animal owner/guardian.

To be providing a trust based medical model is a privilege. Trust is hard to earn and easy to lose. Let’s stay with that and use CC as the language to raise the context of us all involved in patient care.