Case-based clinical reasoning in feline medicine

Canfield, P. J.; Whitehead, Martin; Johnson, Robert; O’Brien, Carolyn; Malík, Richard

doi:10.1177/1098612x16631233

Cited by 8 publications

(6 citation statements)

References 22 publications

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“…Based on information received from the referring and tertiary care veterinarians there was a sense that the client was unable to pay for expensive treatments but there was also no indication that either had questioned the client in-depth about the bird’s diet or about how the multiple fractures had been incurred. Veterinary and medical care can often be influenced by tunnel vision or decision-making biases, in which the client and veterinarian focus on diagnosing and treating a specific injury and lose sight of the overall prognosis or presence of intercurrent disease [ 64 ]. Veterinarians rely heavily on the history provided by the client as well as on physical examination findings and these must always be placed in context with their knowledge of common conditions of any given species.…”

Section: Failure To Meet Animal Welfare Needsmentioning

confidence: 99%

“…Regardless of the bond or level of commitment that a veterinarian may feel that a given client has towards an animal, they should not assume that the client is aware of how best to meet an animal’s needs, even in the face of longstanding ownership. There is an increasing awareness of animal welfare issues associated with exotic companion animals, largely related to the client’s lack of knowledge about appropriate care, husbandry and needs of these animals [ 64 , 65 , 66 ]. From a virtue ethics framework ( Table 1 ), the referring veterinarian could have asked specific questions about the diet and husbandry of the bird and provided information about appropriate nutritional and husbandry needs, in addition to instituting appropriate treatment and follow-up for the fractures.…”

Section: Failure To Meet Animal Welfare Needsmentioning

confidence: 99%

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Speaking Up: Veterinary Ethical Responsibilities and Animal Welfare Issues in Everyday Practice

Trujillo

Fawcett

Brouwer

et al. 2018

Animals

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Simple SummaryVeterinarians have an ethical obligation to provide good care for the animals that they see in practice. However, at times, there may be conflicts between the interests of animal caregivers or owners, the interests of veterinarians and the interests of animals. We provide an overview of why and how veterinary ethics is taught to veterinary students, as well as providing a context for thinking about veterinary ethical challenges and animal welfare issues. We argue that veterinarians are ethically obliged to speak up and ask questions when problems arise or are seen and provide a series of clinical case examples in which there is scope for veterinarians to improve animal welfare by ‘speaking up’.AbstractAlthough expectations for appropriate animal care are present in most developed countries, significant animal welfare challenges continue to be seen on a regular basis in all areas of veterinary practice. Veterinary ethics is a relatively new area of educational focus but is thought to be critically important in helping veterinarians formulate their approach to clinical case management and in determining the overall acceptability of practices towards animals. An overview is provided of how veterinary ethics are taught and how common ethical frameworks and approaches are employed—along with legislation, guidelines and codes of professional conduct—to address animal welfare issues. Insufficiently mature ethical reasoning or a lack of veterinary ethical sensitivity can lead to an inability or difficulty in speaking up about concerns with clients and ultimately, failure in their duty of care to animals, leading to poor animal welfare outcomes. A number of examples are provided to illustrate this point. Ensuring that robust ethical frameworks are employed will ultimately help veterinarians to “speak up” to address animal welfare concerns and prevent future harms.

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Section: Failure To Meet Animal Welfare Needsmentioning

confidence: 99%

Section: Failure To Meet Animal Welfare Needsmentioning

confidence: 99%

Speaking Up: Veterinary Ethical Responsibilities and Animal Welfare Issues in Everyday Practice

Trujillo

Fawcett

Brouwer

et al. 2018

Animals

View full text Add to dashboard Cite

show abstract

“…System 1 requires less mental energy and operates fast but is more prone to mistakes owing to different cognitive biases, heuristics (‘rules of thumb’) and affective states. 31–35 System 2, however, is more analytical and problem-oriented, operating more slowly and deliberately, requiring more time and mental effort. 31–33 Different strategies have been recommended to minimize cognitive error that originates in cognitive biases afflicting the decision making process, particularly in system 1.…”

Section: Discussionmentioning

confidence: 99%

“…Metacognition, applications of checklists, diagnostic algorithms and slowing down while going through the diagnostic process are a few of the recommended strategies. 31,35,36 …”

Section: Discussionmentioning

confidence: 99%

Renal transitional cell carcinoma with bilateral ocular metastasis in a cat

Grader¹,

Southard²,

Neaderland

2016

Journal of Feline Medicine and Surgery Open Reports

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Case summary A 4-year-old, spayed female, domestic shorthair cat was presented for evaluation due to a 4 day history of inappetence and lethargy. Physical examination revealed mild dehydration and blindness of the left eye. Abnormal imaging findings included a well-margined soft tissue mass with irregular central cavity located in the dorsal aspect of the caudal lung lobe. Cytological examination of the mass revealed chronic inflammation with hemorrhage. Tests for parasitic and fungal diseases were negative. Ophthalmic examination 17 days after the cat was initially presented revealed severe diffuse pathology of both retinas. Left renomegaly was noted 22 days after the initial presentation, and cytological examination of samples obtained from the right vitreous, left kidney and the pulmonary mass yielded atypical epithelial cells exhibiting malignant changes. Post-mortem examination following euthanasia revealed renal transitional cell carcinoma with metastasis to both eyes, lungs and skeletal muscle. Immunohistochemical evaluation of the neoplastic cells in the eye revealed moderate cytoplasmic reactivity for CK7. CK20 immunohistochemistry was negative.Relevance and novel information To the best of our knowledge, this is the first report of renal transitional cell carcinoma with ocular metastasis in a cat. In addition, this report describes immunohistochemistry results of transitional cell carcinoma in a cat using CK7 and CK20.

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“…1,2 Cognitive failures are a significant contributor to these levels. 3,4 Current psychological theory, supported by neuroanatomical research, states that human reasoning is a continuous interaction between two processing systems; a fast, intuitive system (Type 1) and a slow, reflective system (Type 2). [5][6][7] In medical clinical reasoning, Type 1 processing has been referred to as 'patternrecognition'-a cognitive function which relies on mental networks known as "illness scripts" embedded in long term memory.…”

Section: Introductionmentioning

confidence: 99%

Use of Inductive, Problem-Based Clinical Reasoning Enhances Diagnostic Accuracy in Final-Year Veterinary Students

Neill¹,

Vinten

Maddison³

2020

Journal of Veterinary Medical Education

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Despite tremendous progression in the medical field, levels of diagnostic error remain unacceptably high. Cognitive failures in clinical reasoning are believed to be the major contributor to diagnostic error. There is evidence in the literature that teaching problem-based, inductive reasoning has the potential to improve clinical reasoning skills. In this study, 47 final-year veterinary medicine students at the Royal Veterinary College (RVC) were presented with a complex small animal medicine case. The participants were divided into two groups, one of which received a prioritized problem list in addition to the history, physical exam, and diagnostic test results provided to both groups. The students’ written approaches to the case were then analyzed and assigned a diagnostic accuracy score (DAS) and an inductive reasoning score (IRS). The IRS was based on a series of predetermined characteristics consistent with the inductive reasoning framework taught at the RVC. No significant difference was found between the DAS scores of each group, indicating that the provision of a prioritized problem list did not impact diagnostic accuracy. However, a significant positive correlation between the IRS and DAS was illustrated for both groups of students, suggesting increased use of inductive reasoning is associated with increased diagnostic accuracy. These results contribute to a body of research proposing that inductive, problem-based reasoning teaching delivered in an additive model, can enhance the clinical reasoning skills of students and reduce diagnostic error.

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Case-based clinical reasoning in feline medicine

Cited by 8 publications

References 22 publications

Speaking Up: Veterinary Ethical Responsibilities and Animal Welfare Issues in Everyday Practice

Speaking Up: Veterinary Ethical Responsibilities and Animal Welfare Issues in Everyday Practice

Renal transitional cell carcinoma with bilateral ocular metastasis in a cat

Use of Inductive, Problem-Based Clinical Reasoning Enhances Diagnostic Accuracy in Final-Year Veterinary Students

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