Professionalism does not just come with a veterinary piece of paper. It starts with a commitment to others, and dedicated self-sacrifice to be there when needed. It is more than a tie and clean shoes. It is a kind, caring, and information-sharing professional. It is not fancy toys (equipment) that no one knows how to use. It is the recurring continuing education, so the practice uses quality diagnostics. It is knowing when and how to use the tools and science available, when practicing the art of client-centered service and compassionate healthcare delivery.

Bio-ethics is not a fancy term for doing the right things right. It is sharing your perspective with members of your practice team, so there will be consistent standards of care. The leader's vision and core values must be clear and inviolate. If a staff member cannot embrace the vision and core values, that person should not be allowed to remain on the team. "De-hiring" is indicated per Building The Successful Veterinary Practice: Innovation & Creativity.

Continuity of care requires exceptional effort in medical record documentation, with no exceptions for owners or curmudgeons, who used to use those five-by-seven cards in the old days. Evaluative premises are separated from factual premises, and the why of the reasoning is discussed until the consensus and practice philosophy are compatible with the needs of the patient and the moral ethics of the attending providers.

Image speaks louder than words. As a leader, what you do speaks so loudly, no one can hear what you are saying. You must walk your talk, and set the example at all times, without exception, and hold yourself to a higher standard. It is reflected in body language and positive mental attitude, as well as how you treat others, even when you are tired. In a veterinary hospital it includes smells and sounds that the client can perceive. Perception is reality in the client's mind.

When you search for a new veterinarian or staff member that fits the practice, the major challenge facing the hospital owner today is that the practice doesn't know who it is. If you have not read Chapter 1, "The New American Veterinary Practice", Building The Successful Veterinary Practice: Programs & Procedures, I strongly urge you to read it and discuss it at a staff meeting in the near future!

Questions concerning where the practice fits in the healthcare community, outside threats and opportunities, interior strengths and weakness, or even the actual practice mission focus have generally never been assessed nor clarified in anyone's mind, including the ownership's. Even such basic operational things, such as the practice's core values or the long-term vision, have not been overtly addressed, as discussed in the first chapter of Building The Successful Veterinary Practice: Innovation & Creativity. As such, the practice does not clearly communicate the parameters discussed above to the potential associate or staff member. They don't know themselves. This is the role of leadership, not of management. There is a significant difference, as discussed in Building The Successful Veterinary Practice: Leadership Tools. In short, managers get work done through people, but leaders develop people through work. Which do you believe can build a better healthcare delivery team?

The strategic assessment process offers methods to identify the parameters discussed, but it does not cause the compromises required to add another veterinarian to a practice (see the VCI Signature Series Monograph, Strategic Response & Practice Positioning). Each person carries a set of values inside, values established through life experiences. These values are not negotiable and are the cornerstone of an effective professional match and practice harmony. When the values are matched, the attitude will be nurtured. When practice values and individual values do not, both lose. The violation of personal values is what causes veterinary medical professionals to leave a practice or even the profession.

Truth in hiring is the critical practice technique that needs to be present for an effective match. This includes being truthful with yourself, as well as with the candidate. Admit that practice weaknesses exist and clarify why. Define any outside influences that may affect the practice or candidate, as well as the community limitations. Share the information readily and present a balanced picture of the expectations and requirements. When truth in hiring has been implemented, there is a far better chance that values can be assessed in an open environment. And the never-ending story will continue, as long as the practice is growing. That is the price of prosperity.

Definition of Bio-ethics: applied ethics to real-life, day-to-day problems of ethical decision making in health care delivery.

In the past, veterinary ethics have been values we used to describe the profession, but bio-ethics are the values we use personally in practice. Sometimes the veterinarian is the person who makes the bio-ethical decision. But more often, the decision is laid at the feet of the medical lay people we come into contact with -- family, clients, public officials, judges, humane societies, and others. There is seldom any clear bio-ethical solution. Rather, there needs to be an awareness of its existence within the veterinary practice environment.

Choosing a Therapy When Doctors Disagree

This situation presents a wide array of ethical issues. Whether the client should be informed of the nature and prognosis of the illness is certainly pertinent, but it is hardly the most significant question in the bio-ethics at hand. Attention should be focused on a cluster of three basic ethical questions raised in this case:

 Who should make the ultimate decision, when choices between alternate modes of therapy must be made, is an obvious issue that must be faced in a multi-veterinarian practice.

 When we start to evaluate a patient, then continue to make the treatment decisions, often based on economics in lieu of best care, how should the client be involved in selecting the alternatives?

 The third, and perhaps the most fundamental issue, is who makes the decision when each of the alternatives, often conservative medicine versus exploratory surgery, is substantially correct?

The option to be chosen in each of the above three questions is not a medical decision based on scientific training, but rather, a professional value judgment.

Active Euthanasia

The American Medical Association states that active euthanasia is illegal, but they only deal with one species of animal. Exactly what are the fundamental measures of animal value and worth, which require the veterinary bio-ethics to be evaluated?

 A pedigree animal with a genetic defect, or maybe just not meeting the specifications of the American Kennel Club.

 Killing an animal because a family is relocating to a home that cannot allow animals, or maybe the travel requirements are too extensive to continue economic support of the family animal(s).

 The medical ethics of letting an animal die due to a disease syndrome versus accelerating the process and minimizing the family cost or anguish.

 A problematic issue in euthanasia is who should bring up the options first. Is it a client concern or a medical concern?

The alternatives in euthanasia are not based in veterinary science. They are based in personal value systems and practice philosophies.

Animal Abuse or Neglect

This issue is sad, but raises no difficult questions of principle at all. Presumably the family who supports the animal is deemed inappropriate to the animal's welfare. The original literature from Britain, presented at the Delta Society in the early 1990s, showed there was a ninety-five percent correlation between animal abuse and child abuse. The United Kingdom uses a common reporting office for both issues. Ten years later, research in the United States showed the same level of correlation. Armed with this current knowledge, now the veterinary practice, which must make the decision to elevate the issue to the appropriate community authorities, must face the bio-ethical issues of appropriate duty and responsibility to others.

 Was the neglect due to a lower than expected family knowledge of basic animal care husbandry, or is the situation caused by an overt disregard for the animal's welfare?

 Have you compared the animal's family care with Chapter 1, Sub-chapter A, Title 9, Code of Federal Regulations? Title 9, CFR, is the regulations derived from the USA Animal Welfare Act, and is updated annually.

 Does the practice have the right, or duty, to decide between referral to the social authorities versus in-house counseling on husbandry? If referring the case would cause a greater trauma to the family unit than individual counseling by the practice staff, is there a bio-ethical decision to be made?

 Will any form of counseling or referral, or lack of it, cause a significant loss in income or trust for the practice within the community?

 If the community laws or rules tend to promote certain action, or an uncertain or undesirable disciplinary behavior, should that affect the bio-ethical issues of this situation?

Needed Care

This issue is critical to get greater than seventy-five percent acceptance, using the word "need", versus the traditional "recommend", which results in less than fifty percent acceptance. The 2003 AAHA Compliance Study showed that most pet-owning clients are not compliant, because some veterinary practice never told them what was "needed". And if they were told, the narrative was so obtuse, the client did not understand the "need". For instance, in the 1980s, human healthcare discovered the word "benign" did not mediate the fear of death from cancer. About half the patients did not know the difference between benign and malignant, when discussing cancer. The physicians made all benign cancer become "lumps", and the issue was resolved, since only malignancies were called cancer after that point.

Needed care raises difficult questions of principle, when addressing a patient's needs with their human steward. Presumably the family who supports the animal is deemed appropriate to decide whether the animal can access the needed care, since an animal is property by law, not by heart. Yet concurrently, virtually any client, who is a non-veterinarian, cannot determine what is needed. That is the doctor's role and duty to explain. Therefore, words or phrases with unclear outcome expectations, such as "recommendation", "you should consider", or "when you think you are ready", are contraindicated for the animal's welfare and for appropriate bio-ethical behavior. The veterinary practice that makes the need statement clear, allows the decision to become time-related to access, rather than "levels of care." Bio-ethically, each animal should get similar diagnostics offered for similar syndromes, completely independent from pre-judgments about the client's ability to support the choice. Protocols become essential in larger practices. Staff need to elevate any variances to the leadership, so the doctors must face bio-ethical debates and decisions on what clients should hear as "needed care" in commonly recurring situations.

 Is the new generic medication being stocked just as efficacious as the brand name has been?

 Was the new medication decision purchased to improve the quality of patient care, reduce the cost to the client, or increase the net to the practice?

 When placebos or symptomatic care were used to placate clients, was the steward of that patient informed of the medical decisions and subsequent patient needs?

 Was the expected family knowledge of basic animal care increased or decreased by the healthcare episode?

 Was the causative situation for access caused by an overt disregard for the animal's welfare? Is there potential animal abuse? Since there is a ninety-five percent correlation between animal abuse and child abuse, is notification of the social authorities usually indicated?

 Was the client allowed to ask questions of a trained healthcare team member, who was well aware of the patient needs and services/products available, to allow an informed consent by the patient's steward?

 Do the providers refer cases in a timely manner, specifically those cases that are beyond their training or normal capabilities, or do they prolong the diagnostics and hope to siphon knowledge from the veterinary teaching hospital, or other phone sources, so they can use the case to become better?

 Have the providers shared the "why" of the protocols, as well as the process, and addressed the bio-ethical issues with the staff?

 Does the practice adjust policy or protocols concurrent with the veterinary professions' change in position or protocol? How does the practice's standards of care address the bio-ethical issues of these "traditional paradigm" healthcare situations?