Spectrum of care is an increasingly important concept in veterinary medicine, particularly in emergency and critical care, where ideal treatment plans often intersect with real-world limitations. While “best practice” medicine remains the goal, it is not always attainable. Spectrum of care acknowledges high-quality veterinary medicine exists along a continuum and that ethical, compassionate care can still be delivered when ideal diagnostics or hospitalization are not possible.
This case from the emergency room illustrates why understanding and embracing spectrum of care is essential for improving patient outcomes while respecting client limitations.
What Is Spectrum of Care in Veterinary Medicine?
Spectrum of care refers to a range of medically appropriate diagnostic and treatment options, from best practice care to more limited or creative approaches. The defining principles include:
- Transparency and informed consent
- Respect for client financial, emotional, and logistical constraints
- Ethical decision-making centered on patient welfare
- Clear communication of risks, benefits, and limitations
Importantly, spectrum of care is not substandard care. It is intentional, thoughtful medicine delivered with honesty and professional judgment.
An Emergency Case That Required Spectrum of Care Thinking
Earlier today, I treated an eight-week-old intact male French Poodle mix in the emergency room. The puppy had recently been transported by car from Mexico to Omaha with his new family. During travel, he developed lethargy and inappetence.
He was initially presented to the emergency service the night before where hypoglycemia and hypothermia were documented. Some diarrhea was reported, and a parvovirus test was negative. He responded well to warming and intravenous dextrose supplementation, normalized his blood glucose, and began eating. Given his age and size, toy breed hypoglycemia was suspected, and he was discharged with recommendations for frequent feedings of puppy food and an deworming medication.
Later that same day, however, he deteriorated.
Severe Hypoglycemia and Limited Options
When the puppy was returned to the emergency room under my care, he was:
- Profoundly hypoglycemic (life-threateningly low blood glucose)
- Mildly hypothermic
- Dehydrated
- Lethargic
- Vomiting
- Early decompensatory shock
From a medical standpoint, the recommendation was clear: hospitalization with continuous glucose supplementation, antiemetic therapy, active warming, and diagnostic testing. I believed this was the best option for survival.
Unfortunately, hospitalization was not financially feasible for the family.
We also discussed euthanasia. Given the severity of his condition, it would have been a compassionate and ethically appropriate decision. However, before concluding that path, we explored whether any alternative options existed with full disclosure of meaningful risks and limitations.
Thinking Outside the Box: A Non-Traditional Approach
The puppy’s veins were extremely small and collapsed, making intravenous dextrose administration impractical. Because hospitalization was not an option, we had to think creatively.
I placed a nasogastric tube and administered a dextrose solution directly into his stomach. This eventually successfully normalized his blood glucose. However, unlike the previous evening, he remained nauseated, lethargic, and unwilling to eat voluntarily.
At this point, we faced another difficult decision.
Discharge Against Medical Advice…With Informed Consent
We do not typically discharge patients with nasogastric tubes in place. This approach carries risk and is outside routine practice. However, in this situation, the alternatives were limited:
- Discharge without nutritional support and likely continued deterioration
- Or attempt a carefully explained, non-traditional approach that might sustain him
After a thorough discussion, the owner elected to take the puppy home against medical advice but with full understanding of the risks. We administered an anti-vomiting medication. We trained them to provide nutritional support through the tube and reviewed warning signs and potential complications.
I was honest: I do not know if this will be successful. But when the alternative is near-certain decline and death, sometimes trying is justified.
Was This Ideal Veterinary Medicine?
No.
Was it best practice?
No.
Was it ethical, transparent, and centered on patient welfare while respecting client limitations?
Yes.
Only time will tell whether this approach saves his life. But this case highlights why spectrum of care is not a compromise. It is a framework for practicing medicine responsibly in the real world.
Why Spectrum of Care Matters for Veterinarians
Spectrum of care allows veterinarians to:
- Maintain ethical integrity when ideal care is unattainable
- Avoid false dichotomies of “gold standard or euthanasia”
- Empower clients through informed consent
- Improve access to veterinary care
- Focus on patient welfare rather than rigid protocols
We will not always get to practice best medicine.
But we always get to practice medicine.
And sometimes, practicing medicine well means listening carefully, thinking creatively, and meeting families where they are while never losing sight of the patient in front of us.
That is the true value of spectrum of care in veterinary medicine.
