How mastering veterinary fundamentals enables truly personalised, compassionate care

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“Learn the rules like a pro, so you can break them like an artist.”

This quote from Pablo Picasso perfectly captures something I’ve grappled with throughout my veterinary career—and it’s a tension every veterinarian faces when they leave university and enter the real world of practice.

At university, we’re taught to work up cases to the highest level. We learn to obtain comprehensive databases on every patient, generate extensive lists of differential diagnoses, and pursue cutting-edge diagnostics and treatments. The “gold standard” is drilled into us—and for good reason. Understanding the ideal approach to every condition is essential.

But then we graduate, walk into our first job, and quickly discover that the real world doesn’t always align with the textbook. Clients have financial constraints. Pets have anxiety that makes certain procedures traumatic. Some families simply can’t provide the level of post-treatment care that certain interventions require. And suddenly, we’re faced with a choice: do we rigidly adhere to what we were taught, or do we adapt?

I started practicing in a low socioeconomic area at a high-volume, busy hospital, where I learned hard and fast from day one that I could not practice what I was taught at university for every case. I didn’t have a choice but to quickly learn and adapt—to bend gold standard to apply to these cases, with the main barrier being finances.

Those first few years of practice shaped my clinical skills and diagnostic approach in ways I didn’t fully appreciate at the time. When discussing cases with colleagues out of interest, seeking their input and opinions, wanting to collaborate, I was often hit with: “Well, obviously you must do X, Y, and Z diagnostics.”

They didn’t have direction, advice, or an opinion on situations where diagnostics of X, Y, and Z were not financially possible. I was often left feeling like I hadn’t advocated hard enough, hadn’t recommended strongly enough, hadn’t pushed hard enough for those diagnostics. I felt like I hadn’t done a good enough job, that I wasn’t a good enough veterinarian, and that I was failing myself, the profession, and the pet—even though I was doing the best that I could within the restraints and within the scope of diagnostics and treatment that I was given by the clients.

But recently, I discovered that this style or approach to veterinary medicine was not just my personal adaptation to, one, provide treatment for animals, and two, to simply survive in the veterinary profession. This style actually has a name. It’s actually recognised.

And that gave me the validation I really needed—validation that this style was not wrong, not incorrect, but legitimate. I’d spent years perfecting a skill I didn’t even know existed.

What Is Spectrum of Care?

Spectrum of care (also called contextualised care) refers to the range of diagnostic and therapeutic options veterinarians can provide when tailored to each patient and client’s unique situation. It’s not about lowering standards or providing “second-rate” care. It’s about recognising that excellent veterinary medicine has always required adaptation to individual circumstances.

As Dr Sarah Babcock, a veterinarian and lawyer, puts it: “Sometimes the gold standard gleaned from textbooks has limited practical application to patients, clients, and the care provided. For me, the gold standard is meeting a client where they are and providing adequate patient care.”¹

This perspective was incredibly validating for me. It wasn’t that I was practising inadequate medicine—I was practising the art of veterinary medicine.

The Foundation: History and Physical Examination

One of the most important principles I’ve learned is this: the first diagnostic tool is the patient history, and the second is the physical examination.

Before I even consider advanced diagnostics, I ask myself: If all I had was the history and physical examination, what would my working diagnosis be, and why?

This approach requires:

• Reviewing your pet’s medical history and current symptoms before the consultation
• Asking targeted questions based on my top differential diagnoses
• Conducting a thorough, focused physical examination
• Forming a working diagnosis before recommending any tests

This isn’t about avoiding diagnostics—it’s about using them strategically and judiciously. When I do recommend testing, it’s because I genuinely believe it will provide critical information that will change how we manage your pet’s condition.

The Real Cost of Diagnostics

Let’s talk honestly about money, because it’s the elephant in the room at every veterinary consultation.

In Australia, we don’t have Medicare for pets. You bear the full cost of veterinary care, and diagnostics are expensive:

• Complete blood screening: $300+
• Urine analysis with culture: $300+
• Radiographs (three views, including sedation and hospitalisation): $800+
• Abdominal ultrasound (including sedation and hospitalisation): $800+
• Advanced imaging (CT/MRI): $4,000-$5,000+

A complete diagnostic workup can easily cost $2,000-$3,000 before we’ve even started treatment. For many families, this is simply not feasible—and that doesn’t make you a bad pet owner. It makes you human.

Whilst third-party payment options like VetPay and Afterpay can help spread costs, they’re not a solution for everyone. They cost more in the long run due to interest and fees, and if you genuinely can’t afford the repayments, they’re not a viable option.

This is where the art of veterinary medicine becomes essential.

A Case Example: Diabetic Ketoacidosis

Let me share an example that illustrates how spectrum of care works in practice.

A 12-year-old diabetic cat developed diabetic ketoacidosis (DKA)—a life-threatening complication where the body can’t use glucose for energy and starts breaking down fat instead, producing toxic ketones. The cat was lethargic, vomiting, dehydrated, and in pain.²

The textbook “gold standard” approach includes:

• Comprehensive diagnostic workup including urine culture and abdominal ultrasound to identify underlying triggers
• Placement of a specialised intravenous catheter or continuous glucose monitor
• Regular insulin administered via continuous infusion using a syringe pump
• 24-hour intensive monitoring in a critical care facility
• Aggressive fluid therapy with careful electrolyte supplementation

Cost estimate: $3,000-$5,000+ for the first 48 hours.

But what if the owner can’t afford this?

This is where clinical expertise and honest communication become critical. Modifications might include:

• Intramuscular insulin injections instead of continuous infusion (both are evidence-based approaches)
• In-house bacterial culture rather than external laboratory testing
• Hospitalisation during business hours with the pet going home overnight for owner monitoring
• Focused diagnostics on the most critical parameters

These modifications require sound clinical judgment, clear communication about risks, and thorough documentation—but they can make the difference between treatment and euthanasia for a pet whose condition is manageable with modified care.

The key is being direct and honest. If there’s absolutely no way to provide adequate care without certain diagnostics or treatments, I’ll tell you that plainly. Animal welfare is always my top priority. But in many cases, there are options—and it’s my job to present them without judgment.

The Mobile Veterinary Advantage

When I transitioned from clinic practice to mobile veterinary work, I unexpectedly discovered that practising in your home further enhances the amount of clinical information I can gather—without invasive or expensive tests.

In your pet’s home environment, I can assess:

• Housing conditions: Is the environment suitable for home treatment? Are there temperature extremes, cleanliness issues, or hazards?
• Lifestyle factors: Activity level, access to outdoor spaces, potential exposure to toxins or foreign material
• Multi-pet dynamics: How do your pets interact? Could stress from other animals be contributing to clinical signs?
• Your realistic capabilities: Can you administer medications? Provide post-operative care? Recognise warning signs?
• Environmental stressors: What might be triggering anxiety, behavioural changes, or stress-related illness?

For anxious pets, the home examination is transformative:

In a clinic, an anxious dog might have a heart rate of 180-200 beats per minute, making it nearly impossible to hear a heart murmur. Their abdominal muscles might be so tense from fear that I can’t properly palpate for pain or masses.

At home, that same dog is relaxed. Their heart rate drops to 100-120 bpm. Their muscles relax. Suddenly, I can hear that subtle murmur or feel that abdominal abnormality that was completely masked by fear in the clinic.

I can observe things impossible to see in a clinic:

• How does your pet navigate stairs?
• Are they limping when they think no one’s watching?
• How do they interact with family members?
• What’s their actual appetite and eating behaviour at home?
• Do they show signs of pain during normal activities?

These observations provide diagnostic information that cannot be obtained through any laboratory test or imaging study. It’s intelligence gathering of the highest order—and it costs nothing beyond the consultation fee.

This was a pleasant surprise when I started Personalised Mobile Vet. I knew home visits would reduce anxiety, but I didn’t fully appreciate how much richer the clinical picture would become.

My Approach: Empathy Without Judgment

One of PMV’s core values is that we don’t judge.

Dr Philip Richmond, a veterinarian and mental health specialist, emphasises the importance of “making the charitable assumption” about client decisions: “There is more to every situation than what we see and hear in the examination room.”¹

I take this to heart in every consultation. You may decline diagnostics or treatment for reasons I don’t fully understand—and that’s okay. My job isn’t to judge your decisions.

Particularly as a new graduate, and even now, the recommendations I make are often ones I couldn’t afford myself for my own pets. It’s easier than you think to be empathetic and not judge financial situations when you have financial restraints as well. I understand what it’s like to weigh the cost of diagnostics against other family priorities. I understand the guilt, the worry, the difficult decisions.

My job is to:

1. Provide you with information: What are the possible diagnoses? What are the risks of each option? What are the potential outcomes?
2. Present all available options: From the comprehensive approach to modified alternatives, including doing nothing
3. Explain the trade-offs: What do we gain or lose with each choice?
4. Support your decision: Whatever you choose, I’m here to help you implement it as safely and effectively as possible

I’m a coach, not a dictator.

I don’t tell you what to do. I give you the information you need to make an informed decision that’s right for your family and your pet. This is a team effort—we’re in this together.

When Diagnostics Are Necessary

I want to be clear: spectrum of care is not about avoiding diagnostics or providing substandard care. Animal welfare is always my top priority.

There are times when specific diagnostics or interventions are absolutely necessary, and attempting to manage a condition without them would compromise your pet’s welfare. In those situations, I’m direct, honest, and matter-of-fact—as I always am.

I’ll strongly advocate for diagnostics or treatment when:

• The condition is life-threatening and time-sensitive
• We cannot adequately assess pain or suffering without testing
• The risk of complications without diagnostics is unacceptably high
• Home management would be unsafe for the pet or family

I’ll recommend referral to specialist or emergency care when:

• The condition is beyond my scope of expertise
• Equipment or facilities I don’t have access to are essential
• 24-hour monitoring is required
• Surgical intervention is needed

I’ll recommend euthanasia when:

• Quality of life cannot be maintained
• Pain or suffering cannot be adequately managed
• The condition is terminal and comfort care is no longer effective

These are difficult conversations, but they’re part of responsible veterinary practice. Spectrum of care doesn’t mean “anything goes”—it means thoughtful, individualised care within the bounds of professional ethics and animal welfare.

The Art of Veterinary Medicine

Dr Amara Estrada, a veterinary cardiologist, reflects on the artistic nature of veterinary practice: “As an undergraduate art history major, I remember studying the work of abstract artists like Picasso and being astonished at the incredibly realistic drawings they did before they developed the iconic styles that made them famous. It is common practice for artists to learn to work in classical styles before they branch into more abstract work—and we can draw parallels between this training and what we do as veterinary professionals.”¹

This metaphor resonates deeply with me. Mastering the fundamentals—understanding disease processes, diagnostic techniques, treatment protocols—enables creative, contextualised application.

After 12 years of clinical experience, I’m still honing these skills. Every case teaches me something new. Every client interaction refines my communication. Every challenging situation strengthens my clinical judgment.

“One of the most vital and often difficult parts of developing as a veterinary professional is learning what can be left out, modified, or put off until later whilst also preventing suffering and offering bodies a chance to heal,” writes Dr Richmond. “This is the true art of veterinary medicine.”¹

This lifelong work—mastering the art of knowing when and how to adapt—is what makes veterinary medicine both challenging and deeply rewarding.

Legal and Ethical Considerations

Practising spectrum of care doesn’t mean abandoning professional standards. Every modification to standard protocols must be:

• Based on sound clinical reasoning: Not arbitrary or convenience-based
• Clearly communicated to clients: You must understand the risks and limitations
• Thoroughly documented: All discussions and decisions are recorded in medical records
• Within professional ethics: Maintaining animal welfare as the top priority

I take these responsibilities seriously. My genuine care and compassion for animals, combined with my commitment to their welfare, guides every decision I make. Spectrum of care is not about lowering standards—it’s about questioning whether “gold standard” procedures add significant value in each unique situation.

Sometimes they do. Sometimes they don’t. Clinical expertise is knowing the difference.

Conclusion

Discovering the concept of spectrum of care was transformative for me. It validated an approach I’d been developing through years of practice—an approach that felt right but often left me questioning whether I was doing enough.

The answer, I’ve learned, is that “enough” isn’t a fixed standard. It’s contextual. It’s individual. It’s the result of combining clinical expertise with empathy, honest communication, and respect for the unique circumstances of each pet and family.

At Personalised Mobile Vet, this philosophy is embedded in everything we do. By bringing veterinary care into your home, we can gather richer clinical information, reduce your pet’s anxiety, and have unhurried conversations about what’s truly best for your situation.

We’ve learned the rules like pros. Now we’re breaking them like artists—not recklessly, but thoughtfully, skilfully, and always with your pet’s welfare as our guiding principle.

That’s the PMV way.

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References

1. Berlin K, ed. Spectrum of Care & The Art of Veterinary Medicine. Clinician’s Brief. 2024;22(Special Edition):1-33.
2. Benaryeh B, Statz G. The case: unwell diabetic cat after boarding. In: Berlin K, ed. Spectrum of Care & The Art of Veterinary Medicine. Clinician’s Brief. 2024;22(Special Edition):28-31.