and most treatable higher with a higher point score. So, if the disease we are screening for is uncommon, we would give the test for that disease one point. If it is a common disease, we would give three points. So, for each of these three categories, award one, two, or three points.
More common
More important
More cost‐effective
Let's look at the following possible tests: complete blood count (CBC), chemistry panel, thyroid profile, urinalysis, urine protein:creatinine (UPC) level.
If we are recommending laboratory testing for a senior pet and the client is willing to spend a certain amount of money, we might choose a chemistry panel, CBC, and thyroxine (T4) for an overweight Labrador retriever. The T4 would get a score of 3 for each of the three categories.
For a normal‐weight soft‐coated wheaten terrier, the calculation is different. We would recommend the chemistry panel and CBC but instead of the T4 we might choose the UPC ratio. In the retriever, hypothyroidism is more common and for the wheaten, glomerulonephropathy (GN) is a big concern. Here is a link to a client education video on GN in soft‐coated wheaten terriers: www.youtube.com/watch?v=eTwyUbiFPbU.
If the Labrador is young, however, the T4 becomes less important – it is neither as important nor as cost‐effective if there are unlikely to be clinical signs of hypothyroidism. If it's an older Scottish terrier we are seeing instead of a wheaten, our top concern might be transitional cell carcinoma, so the urinalysis is more important than the UPC.
Whether to offer clients standardized wellness care plans that are the same for everyone, or individual, customized ones is a philosophical decision that every practice must make (see 10.17 Payment and Wellness Plans). Both for wellness packages and diagnostic protocols for disease states, it is a choice whether to individualize or generalize.
Individual plans take more time and effort, but are less likely to include unnecessary tests.
Generalized plans are less expensive to administer and help to prevent missed diagnoses because of underestimated risk. It may make more sense to generalize in a large corporate practice with many recent graduate veterinarians, or in an emergency case where you do not have time to waste waiting for one test result before deciding on the next. A boutique practice in a high‐end market with an experienced team may be more likely to customize.
A health risk assessment form (see 1.2 Providing a Lifetime of Care) can assist the veterinary healthcare team in using client‐provided information to guide recommendations. The comments and recommendations need to be tailored to an appropriate locale and demographic. For example, a schnauzer and a Doberman pinscher both have risk for heart disease but not the same kinds. For the schnauzer, auscultation is warranted to listen for a mitral valve murmur and perform an ECG to look for atrioventricular (AV) block. In the Doberman, the focus is on looking for ventricular premature contractions (VPCs) caused by cardiomyopathy.
In a digital report card sort of format, it is easier to choose and print those risks that applied, and the client would not see those recommendations that weren't applicable to them.
Some diseases are high risk for a great many dogs and cats. We should ensure that every client is aware of these common risks and has the opportunity to prevent or screen for these diseases when possible.
The second way to prioritize risk is by seriousness of problem – a higher risk for death, pain or illness. We should ensure that every client is aware of these less common but serious risks and has the opportunity to prevent or screen for these diseases when possible.
A point scoring system may be useful for recommending wellness screening laboratory testing.
Wellness plans can be designed to be the same for every patient or individualized for each patient.
In ill patients, our risk analysis helps to guide us toward the most likely diagnoses so that we can diagnose and treat the pet appropriately.
Abbreviation
ECGElectrocardiogram
Recommended Reading
1 Fleming, J.M., Creevy, K.E., and Promislow, D.E.L. (2011). Mortality in north American dogs from 1984 to 2004: an investigation into age‐, size and breed‐related causes of death. J. Vet. Intern. Med. 25: 187–198.
2 Gough, A. (2018). Breed Predispositions to Disease in Dogs and Cats, 3e. Ames, IA: Wiley Blackwell.
2.8 Risk Management
Tara Harmon, APR
The Cincinnati Insurance Companies, Fairfield, OH, USA
2.8.1 Summary
With pet ownership comes risk that the pet may require substantial healthcare services and at considerable expense. Each pet owner manages this risk differently. Pet health insurance is one of the most common ways in which pet owners mitigate pet health risk.
2.8.2 Terms Defined
Deductible: The amount of financial loss an individual agrees to pay before insurance coverage applies.
Fixed Cost: A consistent and predetermined cost.
Insurance Policy: A legal contract between an individual and an insurance company. The insurance company agrees to pay for claims in exchange for payment of premium.
Premium: Amount paid to an insurance company in exchange for insurance coverage.
Risk‐Averse: Less likely to take risks.
Variable Cost: A fluctuating cost.
2.8.3 How Risk Management is Defined
Risk is the possibility of
