Letters to the Editor Thoughts on “humancentered veterinary medicine”
The recent commentary “Human-centered veterinary medicine”1 raises several questions that I hope the authors can address. First, after pointing out that the veterinary profession is “a predominantly White profession with a growing gender imbalance,” the authors go on to state, “Unless a transformation occurs, veterinary medicine will soon lose its ability to serve our increasingly diverse society.” What is not explained, however, is why we should assume that veterinarians of a certain race (White) or gender (female) would be incapable of serving a diverse society. For decades, the veterinary profession worked to increase the number of women veterinarians. Now that there is a growing gender imbalance, how is the fact that women outnumber men problematic? Second, in discussing how a human-centered approach could be incorporated in practice, the authors suggest “displaying a sign to indicate alliance with the LGBT community (eg, a rainbow symbol).” However, it is not clear how associating one’s practice with one community or another enhances our role in society, nor is it explained how a practice owner would express support with, for example, the African-American, Hispanic, or Christian communities. Could indicating alliances in this way lead the public to assume that a practice is not friendly toward a particular community simply because it does not indicate such support with a visible symbol? Providing multilingual information sheets is a reasonable suggestion in areas where language barriers might hinder communication between veterinarians and clients. As well, in areas where language might be a barrier to patient care, it seems wise for veterinarians serving those areas to learn at least a few key words or phrases. JAVMA, Vol 245, No. 8, October 15, 2014
These are good suggestions by the authors, inasmuch as they directly address communication issues. Third, the authors state that “the use of human-centered approaches would help reduce stress” in an academic or practice environment. However, it is not clear how this would be accomplished, and I would contend that there are many other more substantial sources of stress in day-to-day practice operations. Finally, the authors define human-centered systems as “humanistic, values-driven systems that enhance performance by mediating how people interact in the workplace and society,” but I find this definition to be vague. In the case of a private practice, what are the values that drive such systems and who determines those values? How is performance defined in this context? What constitutes “mediation” and under whose authority is mediation accomplished? After reading this commentary, I remain unconvinced of the need for complex human-centered systems. To my mind, there is a much more simple, universal guideline by which to operate. It is called the golden rule. John S. Parker, DVM Briarpointe Veterinary Clinic Novi, Mich 1.
San Miguel SF, Reed WM, Davis KC, et al. Human-centered veterinary medicine. J Am Vet Med Assoc 2014;245:374– 375.
The authors respond: We thank Dr. Parker for his letter. The goal of any commentary is to stimulate thought about ideas or perspectives. In our commentary,1 we suggested taking a human-centered approach to promote inclusiveness in the veterinary profession. Other health-care professions have recognized the need for inclusiveness to maintain and optimize service and relevance to society, yet progress toward inclusiveness in the veterinary profession has been slow. Navigating inclusion in veterinary medicine is complex. Therefore, we offer further illustrations of the concept of human-centered veterinary medicine and additional resources for information regarding inclusion in our profession in response to Dr. Parker’s letter. Dr. Parker asked, “why we should assume that veterinarians of a certain race (White) or gender (female) would be incapable of serving a diverse society.” When people hear about inclusion strategies, they can sometimes feel threatened or interpret these strategies as challenging their own abilities. As authors of the commentary, we never assumed that individual veterinarians, as well-educated professionals, would not be capable of serving a broad-based clientele. However, we contend that, as individuals and as a profession, we can take actions that can increase opportunities to expand the profession’s societal impact.
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For example, if a veterinary practice is not wheelchair accessible, it will likely have a decreased opportunity to serve pet-owning persons who use wheelchairs. If the practice decides to make changes so that it is wheelchair accessible, many clients will not even notice because the changes do not have a personal impact. Other clients might be appreciative that the practice was thoughtful enough to make the facility more accessible. It is unlikely, we contend, that clients will decide that because the practice installed a wheelchair ramp, the practice only wants people who use wheelchairs to bring their pets there. The American Association of Feline Practitioners Cat Friendly Practice initiative offers another example. The Cat Friendly Practice program gives veterinarians tools to provide a practice environment that is more welcoming for feline patients and their owners.2 The intent is that such environments will reduce the stress on feline patients, thereby attracting more cat-owning clients and, ultimately, increasing the number of cats receiving health care. This will likely have little
Views: Letter to the Editor
impact on clients who only own dogs. In fact, dog-owning clients who also have cats might consider bringing their cats in for wellness examinations once they see the changes. However, we think it is unlikely that dog-owning clients will stop going to cat-friendly practices. Although we cannot take credit for the definition of human-centered systems as cited in our commentary, we hope these examples further illustrate how the concept of human-centered veterinary medicine offers a strategy to increase inclusiveness and thus expand veterinary services to underserved populations. There are many strategies for developing a more inclusive veterinary profession that is wellpositioned to serve societal needs. We recommend the certificate programs in diversity and inclusion in veterinary medicine3 offered by Purdue University through the Center of Excellence for Diversity and Inclusion in Veterinary Medicine and the book Navigating Diversity and Inclusion in Veterinary Medicine4 for those wanting to further explore this concept.
Sandra F. San Miguel, DVM, PhD Willie M. Reed, DVM, PhD Kauline Cipriani Davis, PhD Adrianne Fisch College of Veterinary Medicine Purdue University West Lafayette, Ind Lisa M. Greenhill, MPA, EdD Association of American Veterinary Medical Colleges Washington, DC Elizabeth A. Sabin, DVM, PhD American Veterinary Medical Association Schaumburg, Ill 1. 2.
San Miguel SF, Reed WM, Davis KC, et al. Human-centered veterinary medicine. J Am Vet Med Assoc 2014;245:374–375. American Association of Feline Practitioners. CFP veterinary information. Available at: www.catvets.com/cfp/veterinaryprofessionals. Accessed Aug 27, 2014. Center of Excellence for Diversity and Inclusion in Veterinary Medicine. Advancing inclusion through human-centered veterinary medicine. Available at: humancenteredvetmed.org. Accessed Aug 27, 2014. Greenhill LM, Cipriani Davis K, Lowrie PM, et al, eds. Navigating diversity and inclusion in veterinary medicine. West Lafayette, Ind: Purdue Press, 2013.
JAVMA, Vol 245, No. 8, October 15, 2014