I recently read an article written by the American Animal Hospital Association (AAHA) the other day that listed their guidelines for veterinarians to use for pets that are having general anesthesia and surgery. I found it a bit amusing and here is why.
AAHA has been around for many years. It was formed in order to insure a higher standard of care by member hospitals, which created a sense of security for pet caretakers. Years ago it was very popular and many hospitals were members. Member hospitals proudly displayed the AAHA certified sticker on their entrance door and also in the yellow page ads at the time when it was the gold standard for advertising. People looking for a vet clinic might choose an AAHA certified hospital over one that was not.
AAHA created a list of standard guidelines that were required in order for hospitals to become members. The hospital would be inspected by an AAHA representative to make sure that they had the required equipment, etc. and if approved, the hospital was invited to join. Once a year, AAHA would send out a representative to re-inspect the hospital to make sure that they were maintaining the guidelines. Unfortunately, it wasn’t uncommon that vets would find ways to get around the guidelines.
An example would be that AAHA required that all syringes that were used on animals be new and not re-sterilized syringes. This would increase the overhead of the vet clinic as it was common practice to re-use syringes after sterilizing them. So, when the AAHA inspector would come, they would conveniently hide all the used syringes. This is just one way that some would skirt around guidelines.
The recent guidelines posted by AAHA for general anesthesia and surgery is nothing new. These guidelines are being followed already by any veterinarian worth their salt. There would not be a reason for a vet to avoid these practical guidelines as they were taught these in school, used these during their surgery rounds in vet school and adapted them into their standards of practice in the private hospitals. The only motivation for AAHA to do this is to show the public that their member hospitals do follow standard protocols.
What is the difference between guidelines, recommendations and requirements in veterinary practice? It is good to know as it will definitely affect your pet.
Veterinary recommendations are typically done by the individual veterinarian when it comes to your pet’s health situation. These recommendations are usually standards of practice as defined by the state board of veterinary medicine by each state. An example might be giving IV fluids to a pet during anesthesia. This is considered a standard of practice (usual protocol followed by vets) and backs up the vet’s recommendation. Taking X-rays for a dog that is limping is a recommendation by the vet that follows the standard of practice. Giving drugs that are not approved by the FDA might be considered a standard of practice and therefore recommended by the vet. Giving Gabapentin to a dog or cat is an example. The drug has never been approved by the FDA for dogs and cats but many vets have used it over the years and it is now accepted as a standard of practice and vets routinely recommend its use.
Guidelines are usually created by organizations like AAHA or the AVMA (American Veterinary Medical Association) which is our national organization. Most vets are members of the AVMA. It is common for the AVMA to establish guidelines for vets to follow. It is one of their functions and most vets do follow these guidelines. However, guidelines do have their limitations.
The AVMA has no authority or enforcement when it comes to their guidelines, so it is solely up to the individual vet to accept the guidelines or not. The AVMA cannot punish a vet for not following their guidelines. They are only a suggestion, based on scientific evidence and research.
A good example for AVMA guidelines is the vaccination guidelines. The AVMA guidelines state that no pet should be given core vaccinations (DHPP, FVRCP) more frequently than once every three years. Research tells us that about 40% of veterinarians still recommend giving core vaccines once a year to their clients. They have opted not to follow recommended guidelines and the AVMA cannot do anything about it. I won’t go into why these vets choose to ignore these guidelines, but I think you can figure it out.
Veterinary requirements are established by the State Board of Veterinary Medicine for each state. They are laws and they can be enforced by either fines or license suspension. Veterinary requirements as defined by the standard practice laws for each state are established by veterinarians and put into law by the state legislature.
An example might be the use of veterinary technicians. Each state defines what veterinary technicians can and cannot do. One state, like Washington state, requires all veterinary technicians to go to school and be certified. This is not required in Idaho, where they believe that the best way is to train the technician in the hospital. Most states require that a licensed vet tech must be handling the anesthetic maintenance and recording all vitals during surgery. Other states do not. Again, each standards of practice is different is each state.
If a vet clinic does not follow these standards they usually get reported by a client or disgruntled employee and the state board will thoroughly investigate the complaint and hand out punishment to the vet or clinic owner. Malpractice by vets is defined by not following the guidelines of standard of practice by the state. Not something vets like to go through.
I hope this helps you understand a bit more about these differences and how they work. The more we know, the more we empower ourselves to be our pets ambassador for their health and well being.