Is the “Gold standard” still gold standard?

Gold-standard care is defined as a treatment or procedure widely deemed to be the best available.

After graduating from veterinary school a couple of eons ago I started my first job with the intention to provide every patient I saw with gold-standard care.

In reality, on finishing my first year, I could say that I aimed high but often found myself striking out when it came to selling that gold standard to my clients.

o ver the last few months, I have heard growing unease with that term “gold standard”. Leaders and influencers in our profession have expressed a concern that the aim to shoot high, to always be reaching for that kind of platinum care, may actually be putting our clients under unrealistic pressure. It may not always be the right thing for our patient. And maybe, the constant striving for that level of care is also putting unnecessary pressure on ourselves and our teams.

I first heard Jody Lulich refer to this concept many years ago in a presentation on lower urinary tract disease, an area where he is quite the guru. He had a lot of pearls that day, but the pearl I remember the best, was a discussion about using the “small rocks” first. Do the easy and economical things that make good medical sense first so there is room in the virtual “jar” (an analogy for our clients’ financial reserves), when you need to utilise those “big rocks”, i.e., perform the more expensive tests and treatment options.

Don’t get me wrong – I am a firm believer that we need to practice great medicine. I am not suggesting that it’s ok to take a short cut. We still need to provide a good level of care for our patients. We need to work to try to determine the underlying cause for our patient’s presenting symptoms and treat that cause with effective and safe medications or surgical procedures. t here is no doubt that most of the time we will need reliable diagnostics to help us with reaching a diagnosis. But we should also appreciate that the physical examination and a thorough history are as valuable a diagnostic tool, as many of the other tools we have at our fingertips, and they are an integral part of the “art” of being a great GP veterinarian. I have heard it discussed among feline practitioners that goldstandard care may be at odds with feline-friendly practice. How can we provide feline-friendly care, to those little animals who so dearly love to be in control, if every cat we see receives a gamut of procedures every time they come into the clinic? t he challenge of treating cats is in minimising the impact of their experience in the consultation room. If that goes poorly, we risk the cat’s caregiver not wanting to bring the cat back. So, can we think about what procedures are necessary for that cat on that day, and maybe defer some in order to minimise impact? t his may well mean that we end up with a cat that is more comfortable about coming into the clinic, allowing us to ultimately provide better holistic care for that animal.

Finally, how does the concept of gold-standard care make us feel about ourselves? How do we feel when, like my experience as a new graduate, we don’t manage to convince people to accept our gold-standard treatment suggestions? Do we feel like we should have communicated our plan in a more concise way? or perhaps we could have delivered the information in a better manner? Should we have pushed a little harder? Could we have used different words? Do we beat ourselves up with the thought that our colleague could have done better than we did in that moment, for that patient?

If we can perhaps spend some time on our history and physical examination, being careful and gentle with our patients so their experience is not a negative one. If we can be responsible with the finances of our clients, understanding the power of the human-animal bond, often meaning people will do anything for their pet, sometimes beyond their own means. And if we can ultimately be a little gentler on ourselves, understanding that the gold standard may sometimes be an unrealistic and unachievable goal, then I believe that we will have patients and customers that are more likely to return regularly.

t his allows us the opportunity to provide better care over the life of that pet, strengthens our bonds with our clients, and helps us to dial back that constant pressure we put ourselves under, just a touch.

to read more on this topic, please see:

Skipper A, Gray C, Serlin R, O'Neill D, Elwood C, Davidson J. 'Gold standard care' is an unhelpful term. Veterinary Record 189, 331, 2021, https://doi.org/10.1002/vetr.1113

Natalie Lloyd, CAV President