Animals, veterinarians and the sociology of diagnosis

Stalling or oiling the engines of diagnosis? Shifting perspectives on the DSM and categorical diagnosis in psychiatry

Diagnosis in psychiatry and its precursors has long attracted debate and dissent. Attempts to discipline professional praxis are associated especially with the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). In this article, I explore how social actors with the institutional power to contribute in important ways to shaping psychiatric contexts construct the problems with and purposes of the DSM and of diagnosis in psychiatry. I suggest that despite common assumptions that influential psychiatrists and related stakeholders uncritically adopt the DSM and other tools of categorical diagnosis, their relationship with these is rather more nuanced, ambivalent, and even fraught. However, I will also show that critiques can themselves be folded into particular styles of psychiatric thought in ways that do little to impact wider concerns about biomedicalisation and pharmaceuticalisation-and might even further accelerate these processes. Moreover, since professional critiques of the DSM often underscore its ubiquity and entrenchment, when positioned against implicit or explicit justifications of the ongoing use of this text they might inadvertently contribute to a 'discourse of inevitability'-acting to 'oil' rather than 'stall' what Annemarie Jutel terms the 'engines of diagnosis'.

Perceived role of the veterinarian in promoting dairy cattle welfare

Improving the lives of animals in agricultural systems has primarily focused on minimizing negative experiences. Research is needed on the promotion of positive experiences (pleasure, enjoyment, play, choice, happiness) for animals and the role of veterinarians in their promotion. Our aims were to describe how Canadian bovine veterinarians and veterinary students perceive the role of a veterinarian in positive vs. negative experiences for dairy cows and to analyze the rationale provided to explain their answers. Canadian veterinary practitioners (n = 78) and veterinary students (n = 148) responded to an online cross-sectional survey and were asked, on a 7-point scale, how important the role of a veterinarian is to promote practices that influence the experience of dairy cows. We used qualitative description to analyse participants' open-ended text responses. Practices to minimize negative experiences were most important (mean ± SE; 6.8 ± 0.03), a balance of positive and negative experiences was less important (6.4 ± 0.05), and encouragement of positive experiences scored lowest (6.0 ± 0.06), although all scored highly. Four themes were identified to explain participants' reasoning regarding their perceived role of a veterinarian in the promotion of dairy cattle welfare, centered on: the animal, the producer, the veterinarian, and society. Participants indicated that promoting positive experiences was less important than decreasing negative experiences (5.9 ± 0.09). There were four themes identified to explain participants' reasoning regarding the relative importance of promotion of positive experiences versus decreasing negative experiences which centered on: frameworks to compare positive and negative experiences, impacts on the animal, the participant's view of their role, and the practicality of implementation. These results indicate modest differences in valuing avoidance of negative vs. promotion of positive welfare. There were no differences in the quantitative analyses between veterinarians and veterinary students. We conclude that veterinarians are favorably disposed to positive aspects of welfare for dairy cows but may be more focussed on avoidance of negative aspects of welfare.

Past, present and imaginary: Pathography in all its forms

Diagnosis is a profoundly social phenomenon which, while putatively identifying disease entities, also provides insights into how societies understand and explain health, illness and deviance. In this paper, we explore how diagnosis becomes part of popular culture through its use in many non-clinical settings. From historical diagnosis of long-deceased public personalities to media diagnoses of prominent politicians and even diagnostic analysis of fictitious characters, the diagnosis does meaningful social work, explaining diversity and legitimising deviance in the popular imagination. We discuss a range of diagnostic approaches from paleopathography to fictopathography, which all take place outside of the clinic. Through pathography, diagnosis creeps into widespread and everyday domains it has not occupied previously, performing medicalisation through popularisation. We describe how these pathographies capture, not the disorders of historical or fictitious figures, rather, the anxieties of a contemporary society, eager to explain deviance in ways that helps to make sense of the world, past, present and imaginary.

Justifying Euthanasia: A Qualitative Study of Veterinarians' Ethical Boundary Work of "Good" Killing

(1) Veterinarians are regularly required to euthanize their "objects of care" as part of their work, which distinguishes them from other healthcare professionals. This paper examines how veterinarians navigate the ethical tensions inherent in euthanasia, particularly the collision between the routine practice of killing animals within their profession and the broader social and moral implications. (2) Using the sociological concept of ethical boundary work as a theoretical framework, this research observes how veterinarians draw boundaries by positioning their euthanasia practices on the ethical "good" spectrum. A grounded theory study of 17 qualitative interviews with veterinarians was conducted. (3) The findings highlight differences in ethical boundary work within veterinary medicine, particularly in the distinction between farm animals and companion animals. Economic and emotional reasoning play differing roles in explanation and justification. Ethical boundary work is a tool for distinguishing normative frameworks in different areas of veterinary medicine. (4) In conclusion, veterinarians grapple with the realities of an imperfect world and often rely on boundary work to assert diverse interests and navigate multiple contexts. By exploring the complexities of ethical boundary work, this study contributes to a more comprehensive understanding of the moral landscape within veterinary practice.

"What If It Was Your Dog?" Resource Shortages and Decision-Making in Veterinary Medicine-A Vignette Study with German Veterinary Students

The here presented vignette study was part of a survey on ethical judgement skills among advanced veterinary students at the University of Veterinary Medicine Hannover, Foundation. The vignette describes a fictitious dilemma in veterinary practice due to medication supply shortages. First, the students should make an ethically justified decision: who of the two patients in the waiting room gets the last dosage of a medication. Important factors were the animal patients' characteristics (age, state of health, life expectancy), the patient owners' wellbeing, and context-related criteria. Second, the students were asked for decisional changes if one of the patients was their own dog. They reacted in four different ways: (1) for a professional, this should not make a difference; (2) most likely being "egoistic" and preferring their own dog; (3) giving the medication to the other dog; and (4) avoiding a decision. Finally, the students judged a list of possible solutions to the dilemma on a 9-point scale. They preferred patient-related criteria to patient-owner-related criteria in this task. In the overall results, it became obvious that no "gold standard" or guidelines for situations of medication shortages exist, yet, which presents an important subject for future research and veterinary ethics teaching.

Life, Death, and Humanity in Veterinary Medicine: Is it Time to Embrace the Humanities in Veterinary Education?

Medical humanities is a multidisciplinary, interdisciplinary field of study that has experienced explosive growth in the United States since the 1960s. Two key components of medical humanities include first, the use of literature, poetry, and visual arts in the education of medical students, and second, the representation or examination of medical culture by scholars in the humanities, arts, and social sciences such as literary and film creators, sociologists, and anthropologists. The American Association of Medical Colleges recently reported that as of 2018, approximately 94% of medical schools had core or elective humanities offerings in their curricula. The examination of the medical milieu by scholars across the humanities has resulted in the emergence of important specialty fields such as end-of-life care, disability studies, and health disparities research. Veterinary medicine has been slow to embrace the humanities as relevant to our profession and to the education of our students. Only sporadic, isolated attempts to document the value of the arts and humanities can be found in the veterinary literature, and valuable observations on our profession made by scholars in diverse disciplines of the humanities are largely buried in publications not often accessed by veterinarians. Here a case is made that the time is right for the emergence of a more cohesive field of veterinary humanities. Embracing the observations of humanities scholars who engage with our profession, and appreciating the ways in which the humanities themselves are effective tools in the education of veterinary professionals, will bring many benefits to our evolving profession.

Vets and Vaccines: A Discursive Analysis of Pet Vaccine Critique

Critique of vaccination policy and practice has a long history, and social scientists and others have devoted significant efforts to understanding this phenomenon. This attention has only increased in light of the coronavirus pandemic, with public health concerns expressed about opposition to vaccination strategies. However, much less attention has thus far been devoted to understanding veterinary vaccine critique. This is problematic, given the central role of animals in the production and consumption of vaccines, and the existence of veterinary professional anxiety and international media coverage. The lack of existing literature may reflect a wider paucity of research on the veterinary profession; a paucity actively being challenged by new fields of veterinary anthropology and sociology. This short report is based on a discourse analysis of a UK campaign group, which questions aspects of companion animal vaccine policy. Findings suggest that the kinds of discourses used are similar to those made in the human vaccine domain: questions of risk, trust in expertise and imaginaries of science are thus not unique to human medicine. However, the article argues that some of the discourses identified are actually in line with wider social and cultural developments in healthcare. This argument has potential implications for veterinary professionals, as well as scholars interested in animal or human medicine. The article concludes by identifying future research trajectories, focused on further analysis of discursive practice, or the use of ethnographic observation to more fully understand the relationship between humans and non-humans, including animals and vaccine technologies.

Accessing veterinary healthcare during the COVID-19 pandemic: A mixed-methods analysis of UK and Republic of Ireland dog owners' concerns and experiences

Background

This study explored dog owners’ concerns and experiences related to accessing veterinary healthcare during the COVID‐19 pandemic.

Methods

Data were obtained through two cross‐sectional owner‐completed surveys conducted in May (first nationwide lockdown) and October 2020 and owner‐completed diaries (April‐November 2020). Diaries and relevant open‐ended survey questions were analysed qualitatively to identify themes. Survey responses concerning veterinary healthcare access were summarised and compared using chi‐square tests.

Results

During the initial months of the pandemic, veterinary healthcare availability worried 32.4% (n = 1431/4922) of respondents. However, between 23 March and 4 November 2020, 99.5% (n = 1794/1843) of those needing to contact a veterinarian managed to do so. Delays/cancellations of procedures affected 28.0% (n = 82/293) of dogs that owners planned to neuter and 34.2% (n = 460/1346) of dogs that owners intended to vaccinate. Qualitative themes included COVID‐19 safety precautions, availability of veterinary healthcare and the veterinarian‐client relationship.

Conclusion

Veterinary healthcare availability concerned many owners during the COVID‐19 pandemic. Access to veterinary healthcare for emergencies remained largely available, but prophylactic treatments were delayed for some dogs.

Coalitions of touch: Balancing restraint and haptic soothing in the veterinary clinic

This article responds to recent calls to further incorporate the study of animal health care into the sociology of health and illness. It focuses on a theme with a long tradition in medical sociology, namely clinical communication, but explores matters distinctive to veterinary practice. Drawing on video recordings of 60 consultations across three small animal veterinary clinics in the United Kingdom, we explore how clients and veterinarians (or "vets") fashion fleeting "coalitions of touch," that aptly position the animal to enable the performance of medical work, often in the face of physical resistance. Building on recent developments in the study of haptic sociality, we analyse how care and emotional concern for animal patients is communicated through various forms of embodied action; thus, how the problematics of forced care and restraint are mitigated through distinctive ways of touching and holding animal patients. Moreover, while prior studies of small animal veterinary work have highlighted the significance of talk within the clinician-animal-client triad, we reveal the fundamentally embodied and collaborative work of managing and controlling patients during sometimes intense and fast-moving episodes of veterinary care.

One Health Animal Disaster Management: An Ethics of Care Approach

In this article, we consider the One Health framework for orienting guidance for animal disaster management through an ethics of care approach. While One Health was created at the beginning of the 21st century in response to the persistence of emerging infectious diseases and the view that the health of humans and other animals are contiguous, it can be a useful tool for promoting animal welfare and considering animals' experiences during a disaster. However, implementing One Health strategies into animal disaster management is not without its challenges, since ethical judgments are implicit in all decisions and recommendations made about how to conceptualize a "disaster" and their impact on animals and their welfare. Our discussion is divided into three sections. First, we consider the significance of a One Health framework for animal disaster management. Here, we highlight how One Health strategies can be employed in disaster health and natural disaster. Next, we use an ethics of care approach to lay the contours for an interspecies account of relational solidarity, thus offering a vision for how One Health strategies can reimagine the ethical dilemmas involving human-animal conflicts during a disaster. Lastly, we consider the textured nature of our relationship with animals, the moral weight of common vulnerability and interdependency and illuminating insights from animal welfare science.

"Refugees from practice"? Exploring why some vets move from the clinic to the laboratory

BACKGROUND

Named veterinary surgeons (NVSs) are a mandated presence in licensed animal research establishments in the UK. Some NVSs come into their laboratory roles having left general veterinary practice, which is currently facing significant recruitment and retention challenges. Understanding the factors that motivate veterinary professionals to move from practice to laboratory roles provides insight into the issues underlying recruitment and retention challenges in veterinary practice.

METHODS

Qualitative semi-structured interviews with 33 NVSs were conducted in-person or over the telephone. The interviews were transcribed, anonymised and analysed using an inductive approach.

RESULTS

Participants' accounts of their career trajectories generally emphasised push factors motivating them to leave practice, rather than pull factors to move into a laboratory role: Indeed, many participants recalled originally having little knowledge of the NVS role upon discovering it. The push factors recounted by interviewees strongly reflect the factors identified in recent research into recruitment and retention in the veterinary profession, such as business concerns and poor work-life balance.

CONCLUSION

This study shows that laboratory animal work is often considered by NVSs as more manageable or fulfilling than practice work. To improve retention, the push factors identified by NVSs should be addressed in practice management and veterinary pedagogy.

Telling their own stories: Encouraging veterinary students to ethically reflect

BACKGROUND

Veterinary practice raises complex and unique professional ethical dilemmas. There is increasing discussion of how best to deliver ethics education to veterinary students, so that they are fully prepared to address ethical conflicts in professional practice. This paper proposes the use of innovative methods to allow students to share and reflect on their own experiences of ethical dilemmas.

METHODS

Two innovations are described. The first is formal and compulsory, and involves a small-group facilitated session for final year students, wholly designed around student dilemmas. The second is informal and voluntary, and constitutes a short-story writing competition.

RESULTS

The methods described are conducive to student engagement in ethics and ethical reflection.

CONCLUSION

Veterinary schools should consider adopting student-led techniques, deliberately designed to allow students to tell their own stories. Similar methods could also be adapted for use in clinical practice, thereby creating opportunities for professional dialogue on ethical dilemmas.

Antimicrobial use and practices by animal health professionals in 20 sub-Saharan African countries

The use of antimicrobial (AM) in animal production is an important contributor to antimicrobial resistance (AMR) worldwide. Animal health professionals should play a key role in ensuring judicious use of AM. However, they are subjected to influence from clinical and non-clinical factors. The present study evaluates the perceptions and concerns of animal health practitioners regarding antimicrobial use (AMU) and prescription practices. A cross-sectional online questionnaire survey was conducted among animal health practitioners, predominantly veterinary doctors (88 %) in 20 African countries. Results showed that the most prescribed and administered AM were tetracycline (66 %) followed by β-lactams (32 %) and macrolides (25 %). Most respondents were very confident in deciding on the right dose of AM (77 %) and treatment plans (76 %) as compared to choosing the correct AM (52 %) and making an accurate diagnosis (46 %). Self-reported confidence in the implementation of antimicrobial stewardship was significantly influenced by the respondents' work environment, gender and access to information on AM. Lack of diagnostic facilities and susceptibility tests were major hindrances to adequate prescriptions and use of AM. Perceived drivers of AMR identified were excessive prescription by animal health professionals and the use of AM without proper diagnosis. Almost two thirds (62 %) of the respondents had sufficient information on AM when needed while the main source of information was professional training and drug labels. Thus, reinforcement of regional and country-level guidelines and tailored continuing education programs for veterinarians as well as the development of field-friendly disease diagnosis and management tools are essential to considerably improve AMU.

Veterinary Diagnostic Practice and the Use of Rapid Tests in Antimicrobial Stewardship on UK Livestock Farms

In this paper we consider the shifting role, practice and context of veterinary diagnosis in addressing concerns over what is, in the context of the growing threat of antimicrobial resistance, considered unnecessary or excessive antimicrobial medicine use in UK livestock farms. With increasing policy and regulatory interest in diagnostic practices and technologies, coupled with an expanding focus on the development and deployment of new rapid and point-of-care on-farm diagnostic testing, this paper investigates current diagnostic practices amongst veterinarians working on dairy, pig and poultry farms in Great Britain (England, Wales, and Scotland) and, more specifically, veterinarians' use and perceptions of new and emerging rapid and point-of-care diagnostic tests. Drawing on a series of 30 semi-structured interviews with farm animal veterinary professionals across the three sectors, this paper examines the manner in which such tests are both used and anticipated in clinical farm animal veterinary practice and the possible impact rapid test technologies might have on broader farm animal health management and disease control. Analysis of the transcribed interviews reveals a number of complexities around the use of rapid and point-of-care diagnostic tests. The relative rapidity and simplification of such tests, facilitating immediate treatment responses, is held in balance against both the accuracy and the more detailed and documented procedures of established laboratory testing routes. In situations of multifaceted on-farm etiologies, respondents maintained that rapid tests may offer restricted diagnostic capabilities, though in other situations they were found to offer ready confirmation of disease presence. A third complexity arising from the growth of rapid and point-of-care testing and revealed in this study relates to the shifting distribution of responsibilities in animal health care within contemporary food chains. The growing availability of rapid and point-of-care tests effectively diversifies the range of diagnostic actors with consequences for the flow of diagnostic and disease information. The veterinarians in this study identified areas where new rapid and point-of-care tests would be of particular value to them in their clinical practice particularly in addressing concerns over inappropriate antimicrobial use in animal treatment. However, despite the considerable policy advocacy on rapid and point-of-care tests as key tools in shifting diagnostic practice and reducing unnecessary antimicrobial use, veterinarians in this study, while recognizing the potential future role of such tools and technologies, nonetheless viewed diagnostic practice as a far more complex process for which rapid tests might constitute only a part.