Can Non-Veterinary Practitioners “Diagnose” and “Treat”?

The Elephant in the Room

We all constantly make judgments about what we observe. It looks like it will rain today, so I will take my umbrella with me to help from getting wet. The stoplight is red, so I will stop to prevent getting into an accident. These are all forms of making a diagnosis or assessment of a situation and taking action to resolve the issue or prevent something from happening.

When dealing with horses, everyone is searching for clues as to what might be the cause or source of a sudden behavioral change, training difficulty, poor performance, or lameness.

Why then does the veterinary profession claim exclusive rights to providing a diagnosis, while all other members of the horse’s healthcare team are warned that they cannot diagnose?

The answer lies in how different healthcare providers define what clinical signs they are looking for, how they describe what they perceive as the inciting cause, and what they may have to offer to help resolve the issue.

Let’s begin by defining the term “diagnosis”.

Elephant in the Room art by Leah Saulnier at www.paintingmaniac
Elephant in the Room – art by Leah Saulnier at paintingmaniac.com

A veterinary diagnosis refers to the process of identifying and determining the cause of a medical condition or disease in animals. It is a crucial aspect of veterinary medicine and involves detailed review of the owner’s complaints and the systematic evaluation of a horse’s medical history, a physical examination, and diagnostic tests to arrive at an assessment of the underlying cause of disease or injury.

Veterinarians use their knowledge, expertise, and medical tools to perform diagnostic procedures, which may include lameness examinations, blood work, or diagnostic imaging techniques like X-rays or ultrasound. The goal of providing a diagnosis is to accurately identify the underlying health problem and develop the appropriate treatment plan with the goal of improving the horse’s overall well-being.

A veterinary diagnosis is typically based on a pathoanatomic diagnosis. That means that the specific pathology (gastric ulcer, infection, broken bone) can be identified, and a specific treatment can be provided to hopefully resolve the issue.

The anatomic component means that the owner’s complaint or observed clinical sign can be localized to a specific anatomic structure, such as a flexor tendon, fetlock joint, or tooth.

Identification and treatment of most of these issues requires extensive education and training that can only be provided by a veterinarian. Pathologic disorders can be severe and can be life-threatening, which require an immediate, accurate diagnosis and individually tailored treatment. This forms the basis of state practice acts and national regulations covering the practice of veterinary medicine.

The other type of diagnosis, used extensively by many different healthcare practitioners, is considered a functional diagnosis. A few examples:

  • Physical therapists identify muscle weakness and recommend strengthening exercises.
  • Chiropractors palpate joint stiffness and provide local high-velocity, low amplitude thrusts.
  • Acupuncturists localize pain and insert needles to help improve movement.
  • Bodyworkers and massage therapists detect pain and restriction and use various techniques
    to release tension and improve posture and range of motion.

Weakness, stiffness, pain, and restrictions are all functional deficits associated with poor
performance, which can be caused by a wide range of disorders, some of which cannot be readily associated with a pathoanatomic disease process. Many chronic musculoskeletal disorders (osteoarthritis) are structural disorders that are mostly associated with functional disabilities (pain, stiffness, weakness). Once osteoarthritis develops, it cannot be reversed. The only method of treatment is to address the functional aspects of the disease.

Non-veterinary paraprofessionals often conduct assessments of their patients to determine the specific needs and areas of concern. If these practitioners are taking an appropriate medical or performance history, conducting a comprehensive evaluation based on their training and expertise, and formulating an assessment that guides their recommendations or treatment, then it sure seems like they are providing a “diagnosis” and proposing a “treatment”.

However, it’s essential to clarify that these assessments are not equivalent to medical
diagnoses provided by a licensed veterinarian, as one may focus more on a pathoanatomic diagnosis and the other on functional deficits.

Treatment can take on many forms depending on who is providing the therapy.

  • Physical therapists may prescribe therapeutic exercises.
  • Chiropractors may use high-velocity, low amplitude forces.
  • Saddle fitters may recommend changing saddle pads.
  • Farriers may apply corrective shoes.
  • A veterinary surgeon may select one of several available surgical techniques.
  • Antibiotics are prescribed by veterinarians for most bacterial infections.

All members of the healthcare team can provide safe and effective treatment when based on the perceived needs of the individual horse and the practitioner’s level of education or training, equestrian skills, and scope of practice.

The challenge is, when owners or trainers reach out for help from various sources, they may get several different and sometimes conflicting answers. This often leaves them with an uneasy feeling and confusion as to who to believe or trust. It can also cause conflict between members of the horse’s healthcare team. This is why a team approach is needed to address all of the structural and functional components of the horse’s well-being or underlying health issues.

As a non-veterinary equine practitioner, what has been your experience regarding the use of the words “diagnosis” and “treatment”? Do you find yourself tippy-toeing around these words even though you always strive, within your scope of practice, to determine a primary cause and develop an appropriate treatment plan, in collaboration with the horse’s veterinarian and involved team members?

Save the date! Dr. Haussler’s next public Zoom event is scheduled for September 27th. Come share your experiences!

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Resources

Want to learn more?

Browse our RACE-approved catalog of online learning modules.