Periodically a change in scientific or public opinion arises that requires seemingly Olympian communication skills to incorporate successfully into private practice. What makes these situations so challenging is that they can present multiple philosophical or emotional obstacles, or both, that can appear overwhelming at first. However, by approaching these situations methodically even the most complex among them can become manageable. The process begins with the practice owners, who must analyze their own and their clients’ historic orientations as these relate to any proposed new ones. If changes are necessary, determining which ones to make and how to make them is step 2. Those who accomplish this must then muster their group communication skills to achieve a consensus within their practices, and once that is achieved, all within the practice must successfully communicate that view to members of the public and other professions.
Some companion animal practitioners will soon get a crash course in how this works as the once almost sacred procedures of pre-adult spay and neuter promoted by many veterinary practices, shelters, and breeders are increasingly being questioned. What is the relevant history of companion animal gonadectomy in North America? For over 50 years spay and neuter has functioned as a keystone in many companion animal practices in the United States, and for better or worse, what happens in the US sometimes has a way of creeping across the border into Canada. Aside from the reliable income the surgical procedures generated, they also carried considerable positive emotional charges for some individuals and organizations. Clients who spayed or neutered their cats and dogs when told to do so by their veterinarians were often viewed as more responsible than those who did not. Not only were these people congratulated for not contributing to the unwanted pet population, they also may have been told that the surgery would protect their animals from various medical or behavioral problems that have long been associated with intact reproductive organs.
In such a way, promoting spay and neuter became synonymous with knowledge and caring. Additionally, many practitioners discovered that their desire to spay and neuter as many animals as possible also served as an excellent source of positive public relations. Nowhere was the concept of mass spay and neuter — and the sooner the better — embraced more enthusiastically than by the shelter community. Throughout this period, if anyone questioned the soundness of this approach as it affected an individual animal, breed, or species, it was mentioned only to a few trusted friends, and then only in private. Questioning it publicly meant risking the wrath of so many that it could threaten the practitioner’s livelihood. Scientific articles that considered the possible consequences of the surgeries were, for the most part, published in journals only a few in the animal-care community, let alone the general public, would read. The few articles published in veterinary journals usually described small studies, the results of which could easily be dismissed by those who chose to do so. In short, spay and neuter became an expression of personal philosophy that extended far beyond the animal on which it was done.
Over time, increased knowledge of the nonreproductive effects of sex hormones has caused more veterinary practitioners, as well as others, to question whether surgical sterilization is the benign procedure once believed. This has led to more studies, some of them quite large, which indicate that it is not. This, in turn, puts all practitioners in a very difficult position.
Consider the communications challenges faced by practice owner, Dr. DiSilva, when he learns of a large study that demonstrates a relationship between pre-adult castration and ovariohysterectomy (OHE) and certain knee and hip problems. Dr. DiSilva gives thanks that he did not argue years previously when some of his clients who were heavily involved in canine sports said they wanted to delay surgery at least until their animals were fully mature. He also gives thanks that they shared an early study regarding the relationship between the surgery and anterior cruciate ligament injuries, which he never would have seen otherwise.
“At the time, though, I wasn’t sure I agreed with their decision,” he admits. “But they were all conscientious clients and they did have that study. Now I’m glad I trusted them because if I’d pressured them and one of their animals had developed problems, I would have lost them as clients for sure.”
At that time, Dr. DiSilva treated this as an isolated incident and, although he had mixed feelings about doing it, he chose not to share the study’s results with his other clients. However, knowing that the Internet with its numerous pet-related lists makes it increasingly easy for all of his clients to learn about such research and share that information with others makes him view the appearance of the latest findings differently. As he sees it, he has 4 choices as a practice owner: 1) he can continue recommending pre-maturity spay and neuter to his clients, as in the past, including references to how this will enhance the animal’s health; 2) he can continue recommending pre-maturity spay and neuter, but drop any references to health benefits; 3) he can continue recommending pre-maturity spay and neuter, but inform his clients that this may be a factor in certain health problems; and 4) he can provide his clients with information regarding the full range of the surgery’s potential for beneficial and negative effects and let them make up their own minds.
As an established practice owner, Dr. DiSilva has client relationships that span close to 30 years and he treasures every one of them. Consequently, when evaluating possible changes to his practice protocol, he considers how these could affect his long-term relationship with the owners as well as any impact they could have on a particular animal now and in the future. He is also well aware that the practice’s income is directly related to how any changes in protocol may affect his clients’ relationship with him.
So even though Dr. DiSilva does find the idea that his clients would never hear of those newer studies and question his current protocol momentarily appealing, he knows that the first two options would cost him far more in the long run than he would ever gain. Any doubts he harbors vanish when he recalls what happened when some of his colleagues took that approach when the question of over-vaccination was raised. Even though they may not have suffered any financial losses from ignoring the issue, postings on a wide variety of Internet lists for pet-owners plus conversations with his clients and companion animal-owning friends made it clear that those practitioners who did not openly and honestly discuss these concerns with their clients lost credibility compared with those who did. Worse, even those practitioners who had sound medical reasons for maintaining their individual protocols were viewed as greedy and uncaring simply because they did not take the time to communicate their reasoning to their clients. In both cases, the lack of communication cost the practitioners their clients’ trust, which Dr. DiSilva considered a far more serious loss than any loss of income.
A second piece of practice history further convinces Dr. DiSilva that full disclosure and client choice is the best approach to take for his practice. Concurrent with the trend toward spaying or neutering all companion animals as a means of population control was a trend toward clients forming more intimate, symbolic relationships with those animals. Often these relationships were lumped together under the heading of “treating pets as family members,” an anthropomorphic analogy that was, and is, extensively promoted and used in the marketing and sales of companion animal-related products and services. When viewed in this light, what veterinarians may see as simple surgical procedures to control the canine and feline populations, individual owners may view as major operations to which they submit a loved one. Having directly or indirectly supported such a human-animal relationship, practitioners who then ask clients to dismiss as insignificant any possible harm that the elective procedures might cause those fur-covered family members relative to any greater population good might not find a very receptive audience. Those people could rightfully question the validity of equating the pre-adult surgical sterilization of their animals — which they would never permit out of their control long enough to reproduce under any circumstances — with the solution to someone else’s irresponsible behavior.
For all of these reasons, Dr. DiSilva acknowledges that the best response for him personally and for the practice economically and ethically is to present the information to his clients, discuss their options, including the pros and cons of each, and let them make up their own minds. True, he may need to learn more about all of the studies, and perhaps even put together a client handout on the subject, but in his mind, it will be worth it.
Having overcome this hurdle, in the next column Dr. Silva faces another one: ensuring a unified response from his associates and the rest of his staff.