Contextualized Care in Vet Med: Consideration or excuse? An opinion piece. (#360)

In veterinary medicine, contextualized care refers to adapting clinical recommendations to the specific circumstances of each patient, client, and environment.

Contextualized care is what almost all vets do every day.

So, why has it become a topic of discussion?

• Patient factors: species, breed, age, comorbidities, temperament, and quality of life considerations.

• Client factors: financial constraints, cultural beliefs about animals, ability to administer medications or follow complex regimens, and emotional readiness for treatment decisions.

• Environmental factors: rural versus urban practice limitations, availability of referral services, diagnostic equipment, or advanced therapeutics.

Why is Contextualization Important?

• Ethical relevance: It prioritizes what is practical and beneficial for each patient within the client's realities, rather than pursuing textbook-perfect care unattainable in each setting.

• Client adherence: Tailored recommendations increase client compliance, strengthening the veterinarian-client-patient relationship.

• Resource allocation: Especially in rural or under-resourced regions, it ensures optimal use of limited veterinary infrastructure.

Contextualized Care and the Rising Cost of Veterinary Medicine

Some argue that contextualized care has gained popularity precisely because of the escalating costs of veterinary care in recent decades.

As gold-standard diagnostics, specialty referrals, and advanced therapeutics become prohibitively expensive for many clients, the profession has adapted by:

• Framing lower-cost or incremental care as a thoughtful choice, rather than merely a financial necessity.

• Emphasizing shared decision-making and tiered care options to maintain access to veterinary services for a broader client base.

• Avoiding ethical discomfort when clients cannot afford advanced care, by rebranding limited care as contextualized rather than second-best.

This shift reflects both practical realities and a rebranding of care tiers to preserve client trust.

However, it also raises concerns that:

• Cost constraints may be driving care decisions more than medical best practice or patient welfare.

• Veterinarians may become complacent with minimal care as the norm, rather than advocating for broader systemic solutions to affordability issues.

Contextualized Care versus the Ivory Tower

Proponents of contextualized care often contrast it with the so-called ivory tower of academic veterinary medicine, where:

• Referral hospitals and universities operate with access to advanced diagnostics, specialist teams, and seemingly limitless resources.

• Recommendations are made based on ideal scenarios, often ignoring real-world limitations faced by primary care veterinarians and their clients.

While this critique has merit, it also risks dismissing the vital role of academic centers in pushing the boundaries of veterinary knowledge, developing new treatments, and setting standards of care.

Without these centers of excellence, the profession risks stagnation.

"Gold Standard is Nonsense"

Some practitioners go further, declaring that the concept of a gold standard is nonsense. 

Their reasoning includes:

• A belief that gold standards are unrealistic and fail to consider the financial, cultural, or logistical constraints of real-world practice.

• Frustration with recommendations that feel elitist or judgmental, rooted in academic ideals rather than everyday realities.

• The sense that medicine is inherently uncertain and variable, making rigid standards impractical.

However, dismissing gold standards entirely risks abandoning professional aspiration and reducing care to what is merely possible today, rather than striving for what should be possible tomorrow.

• Without gold standards as reference points, veterinary medicine becomes entirely relativistic, with no benchmarks to guide quality, ethics, or progress.

• Gold standards are not meant to be imposed blindly, but to inform and guide clinical judgment and contextualization.

Who Drives the Profession Forward?

If everyone were to settle for contextualized care, always adapting to current limitations rather than striving for improved standards, who drives the profession forward?

• Do we risk veterinary medicine remaining where it is now, never advancing diagnostics, treatments, welfare standards, or scientific understanding?

• Innovation arises precisely from pursuing what is currently impractical, unaffordable, or unavailable in general practice settings.

• Contextualization must not replace aspiration. The profession needs both realistic adaptation and visionary progress to evolve.

Is Contextualized Care an Excuse for Ignorance?

This criticism arises when:

• Contextualization is used to justify not knowing gold-standard care, rather than consciously choosing an alternative.

• Veterinarians fail to inform clients of available options, assuming refusal or unaffordability.

• It becomes an entrenched habit that limits professional growth or disincentivizes updating knowledge.

For example, if a clinician has never learned about advanced seizure management options or novel cancer therapeutics, they may default to contextualized care to mask their knowledge gaps.

In these cases, it becomes a shield for ignorance rather than an informed adaptation.

Best Practice: Contextualize Knowledge, not Knowledge Itself

The distinction lies in knowing the ideal recommendation first, then contextualizing it.

True contextualized care involves:

• Knowing current best practices and standards of care.

• Communicating them transparently to the client.

• Modifying recommendations realistically based on client/patient circumstances, with informed consent.

Conclusion

Contextualized care, when grounded in sound knowledge and ethical communication, is a hallmark of compassionate and realistic veterinary practice.

However, when it replaces the pursuit of knowledge, dismisses gold standards as irrelevant, or becomes merely a response to unaffordable care, it risks:

• Undermining professional integrity and patient welfare.

• Limiting innovation, aspiration, and progress within the profession itself.

Ultimately, contextualization must be balanced with knowledge and aspiration.

Gold standards are not nonsense - they are the compass that guides veterinary medicine towards better care, scientific advancement, and improved welfare for animals and the people who care for them.

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