Drivers of decision making in pain diagnosis and treatment: Findings from an ethnographic study of veterinary practice.
Authors: Smith Rebecca, Perkins Elizabeth, Pinchbeck Gina, Ireland Joanne
Journal: Equine veterinary journal
Summary
# Editorial Summary: Pain Diagnosis and Management in Equine Veterinary Practice Understanding how pain diagnosis emerges during veterinary consultations requires examining the complex interactions between vets, owners, horses and the broader context of practice—this is the premise of Smith and colleagues' ethnographic study conducted across four UK veterinary practices between May 2023 and April 2024. Through approximately 200 hours of observation of 47 consultations supplemented by semi-structured interviews with 18 veterinarians and 25 owners/carers, the researchers identified four recurring processes that shape pain management decision-making: establishing whether painful issues exist, searching for underlying causes, escalating or de-escalating concern, and targeting the pain source. Critically, pain diagnosis emerged not as an objective finding but through relational practices and dynamic multi-actor interactions—meaning that what becomes a veterinary concern depends heavily on how the problem is presented, how it's discussed, and what other competing issues dominate consultation time. The study revealed that discussions about the horse's subjective experience of pain could be overshadowed by management concerns or other matters of concern, and that tensions arising from how issues are reconstructed through veterinary practice can undermine effective pain management. For equine professionals, these findings suggest that improving chronic pain recognition and treatment requires deliberate attention to consultation dynamics: creating space for the horse's pain experience to remain central, actively managing competing narratives about what 'matters' in each case, and recognising that pain diagnosis is collaborative sense-making rather than a straightforward clinical finding.
Read the full abstract on PubMed
Practical Takeaways
- •Be aware that how you present your horse's symptoms to the vet and how the vet frames the problem significantly influence whether pain management becomes a focus of the consultation
- •Advocate clearly for discussion of your horse's pain experience itself, as veterinary consultations may prioritize other clinical findings over addressing the horse's subjective pain
- •Understand that pain diagnosis is shaped by the interaction between you, the veterinarian, and the horse's presentation—collaborative communication about pain perception is essential
Key Findings
- •Pain diagnosis emerges through relational practices and multi-actor interactions rather than being a straightforward matter of fact
- •Four key processes structure veterinary consultations: establishing presence of painful issues, searching for cause, (de)escalation of concerns, and targeting pain source
- •Other matters of concern during consultations can obfuscate discussions about the horse's subjective experience of pain
- •The way issues are presented to and reconstructed by veterinarians through medical practices creates tensions for effective pain management