Veterinary Minimalism

(originally published in Veterinary Forum: August, 2001)

In an art school comedy routine, an upscale interior designer gives his client the bad news: “I’m sorry, but you can’t afford to do minimalist.” The humor lies in the awareness that something reduced to its most basic components may possess more value than its fully embellished counterpart. This occurs because, even though the finished product may appear spare to the point of simplistic, it takes a great deal of knowledge and effort to reduce a complex concept to its most essential elements.

However because beauty lies in the eye of the beholder, not everyone takes the same view of minimalist art. Someone who appreciates all that goes into creating such a piece may exclaim, “Oh, how elegantly simple,” whereas those who believe that more equals better might grouse, “How boring!” or “What a waste of education!”

By contrast, in many ways veterinary education and research provides us with what amounts of an excellent example of (to coin a new word) maximalism, and specifically scientific and technological maximalism. Every year continuing education seminars and journal articles provide us with more and more knowledge about more and more diseases, diagnostic procedures, and treatments. However, within the confines of our practices we may find ourselves facing a sometimes dismaying reality: Many practices and those who work in and patronize them possess limits that may preclude the maximalist approach.

Faced with this reality, veterinarians typically take one of three approaches not unlike those taken by the attendees at the minimalist art show. Some eagerly embrace the challenge of reducing the latest information to those components that best compliment the needs and any limits of the practice, practitioners, clients, and patients. Dr. Green eagerly acknowledges the advantages of laser surgery for certain conditions, but also accepts that acquiring the equipment and proper training to use it exceeds the financial capacity of the practice at this time. Based on that awareness, she enjoys refining other skills that may offer her patients comparable benefits under similar circumstances, and compiling a list of those competent in the new technology to whom she can confidently refer her clients if her other options won’t best fill their needs.. Dr. Black finds the lack of state-of-the-art equipment in the practice where he works intolerably boring; within months, he quits and returns to academia to pursue an advanced degree. A third veterinarian, Dr. Brown, also chafes at the lack of facilities in her practice. However, unlike her colleagues, she neither sees this as a fascinating challenge nor a reason to leave; instead, she grumbles and complains about the deficits, making herself and everyone around her miserable.

In addition to each practice presenting us with the opportunity to develop or reject an appreciation of the value of minimalism, each client and patient encounter offers us a similar opportunity. Compare these two scenarios:

  1. Dr. Green performs a quick examination and gets only the most superficial history from the client, then focuses all of her attention on a flurry of intensive diagnostic and treatment procedures.
  2. Dr. Green spends a half hour getting a detailed history from the owner and conducting an in-depth physical examination. At the end of that time she orders a specific battery of tests to confirm what she suspects based on this information, and selects her treatment after further discussion with the owner.

In the first example, Dr Green devotes a minimum amount of time to the client and a maximum amount to conducting tests, analyzing their results, and treating her patient. In the second, she does exactly the opposite: she devotes most of her attention to the client, history, and physical examination, and minimal attention to any tests and their results. Which approach is right?

If you answered, “It depends on the situation,” you are correct. Although some veterinarians may feel more comfortable emphasizing particular aspects of the treatment process while de-emphasizing others to best meet their own needs, skilled practitioners view each case as a fresh canvas so to speak. If Dr Green works on the beloved cat of well-known clients which was found comatose in the yard by their 12-year-old latchkey daughter and the sobbing child ran a mile to clinic with the animal, Dr green’s first approach serves as a excellent example of veterinary client minimalism. She quickly grasps that the child can offer little in the way of a viable history and leaves her in the comforting hands of a staff member. She also immediately ascertains the cat’s dire condition from a physical examination limited to key areas that pose immediate, life-threatening problems to the animal. In this particular veterinary minimalist masterpiece, the client-clinician interaction becomes reduced to a mere shadow, while the diagnostic testing and treatment appear most boldly.

In the second case, Dr Green faces an edgy cat with intermittent diarrhea which has experienced numerous dietary changes and which goes to pieces when separated from his highly dependent owner who also falls apart when separated from her cat. This time the physical examination and history figure the most prominently in Dr. Green’s veterinary minimalist masterpiece, with any diagnostic tests and treatment providing a unifying background.

The practice of veterinary medicine does not, or should not, consist of subjecting an animal to everything time allows and the client’s wallet can afford. Nor should it involve doing the least we can get away with because we were on call last night. Quite the contrary, quality veterinary medicine should embody the skill necessary to quickly reduce each problem to its most fundamental components and then, after taking into account any practice, practitioner, client, or patient limits, focusing on those components that will achieve animal wellness in the most refined and graceful manner. Although an approach that reflects refinement and grace might seem alien to the practice of veterinary medicine, these adjectives also define elegance, a quality near and dear to the true scientist’s heart. For them and us, less doesn’t always have to mean less. Sometimes less means more.