Ethical dilemmas in equine practice

Is there clear guidance on whether to take referrals direct from a complementary therapist/ paraprofessional?

16 March 2018, at 11:01am

At the recent Society of Practising Veterinary Surgeons (SPVS) and Veterinary Management Group (VMG) joint annual congress held in January, I was fortunate to be on a panel considering ethical dilemmas in equine practice. The question “Should we accept referrals direct from a complementary therapist/paraprofessional?” was listed as a dilemma for the audience, but the healthy debate that followed previous questions meant we ran out of time. Hence, I thought it would be a good idea to raise it here and put forward my view.

Firstly, being a regulated profession we must follow the rules. Our regulatory body, the RCVS, is responsible for setting, upholding and advancing the educational, ethical and clinical standards of veterinary surgeons and veterinary nurses. Secondly, one has to do what “feels right” and act in the same way in which we would wish to be treated by fellow veterinary surgeons. Thirdly, animal welfare remains our first and foremost consideration.

The Code of Professional Conduct for Veterinary Surgeons is a well-written and accessible document. The Code makes it clear that veterinary surgeons have professional responsibilities in the following areas:

• Veterinary surgeons must make animal health and welfare their first consideration when attending to animals

• Veterinary surgeons must keep within their own area of competence and refer cases responsibly

• Veterinary surgeons must provide veterinary care that is appropriate and adequate

A whole section covers the “Supporting Guidance on Referral and Second Opinions”. This makes it clear that veterinary surgeons should facilitate a client’s request for a referral or second opinion. The guidance is crystal clear that the initial contact should be made by the referring veterinary surgeon and the client should be asked to arrange the appointment. The referring veterinary surgeon should provide the referral veterinary surgeon with the case history. Any further information that may be requested should be supplied promptly. The referral veterinary surgeon should discuss the case with the client, including the likely costs of the referral work, and report back on the case to the primary veterinary surgeon.

Another section in the Code is devoted to communication between professional colleagues, and is introduced with the wise words “Overtly poor relationships between veterinary surgeons and/or veterinary nurses undermine public confidence in the whole profession.” When taking over a colleague’s case, although both veterinary surgeon and client have freedom of choice, in the interest of the welfare of the animals involved, a veterinary surgeon should not knowingly take over a colleague’s case without informing the colleague in question and obtaining a clinical history.

The Code would seem eminently clear: a referral should not be made direct from a complementary therapist/para-professional. The referral veterinary surgeon should always make contact with the primary veterinary surgeon in order to obtain a full clinical history and, in turn, provide a full report of what has been done to the primary care veterinary surgeon. If the referral is taken on with no reference to the usual veterinary surgeon, one could also see problems if the horse develops an issue out of hours when the referral veterinary surgeon may not be available and certainly not available to provide appropriate veterinary care.

If the complementary therapist/paraprofessional feels that the horse needs specialist veterinary attention, they should communicate this to the owner who can, in turn, take the matter up with their usual veterinary surgeon. This would be the sensible and courteous approach.

I have recently had equine veterinary surgeons contact me to express disappointment that a veterinary colleague has attended a horse belonging to their client without consulting them, requesting the clinical history or providing information on what procedures they had performed. In these three cases, the situation involved a direct referral from an equine dental technician, but there are also reports of similar situations with direct referrals from a musculo-skeletal therapist.

As responsible veterinary surgeons, it would seem wise to follow the guidance on acting within your area of competence and refer cases where appropriate at an early stage. As referral/specialist veterinary surgeons, we should have a responsibility to follow the Code in the way in which referrals are accepted. That way everyone is a winner and most importantly, we are doing the best for the horse.


Jonathan Pycock is an equine claims consultant for the Veterinary Defence Society and an equine reproduction expert. He is a past president of the British Equine Veterinary Association.

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