Drivers of decision making in pain diagnosis and treatment: Findings from an ethnographic study of veterinary practice.

Abstract

BACKGROUND: Poor pain management in horses is a welfare concern. The 'diagnosis' of pain cannot be separated from the broader set of interactions through which it emerges. The interactions that take place during veterinary consultations shape the ways in which, or whether, pain management is discussed. OBJECTIVES: To understand owners' and veterinarians' decision making in relation to chronic pain and its management. STUDY DESIGN: Qualitative ethnographic study. METHODS: Data were collected from four veterinary practices in Great Britain between May 2023 and April 2024. Around 200 h of ethnographic observation was undertaken, including the observation of 47 consultations. Additionally, semi-structured interviews with 18 veterinarians and 25 owners/carers were conducted. Principles of grounded theory were drawn upon throughout the collection and analysis of data. RESULTS: This study focusses on the veterinary consultation, discussing how the interplay of actors-both human and nonhuman-affected pain diagnosis and treatment decision making. There were four key processes that were common across the consultations observed: 'Establishing the presence of painful issues', 'Searching for the cause', 'The (de)escalation of issues of concern' and 'Targeting the source of pain'. In each consultation, dynamic multi-actor interactions coproduced matters of concern, and these were the 'things' to which peoples' perceptions of pain were related. Pain diagnosis was not a 'matter of fact', but emerged through relational practices. Consultations could move towards a focus on the horse's management, however, other matters of concern could obfuscate discussions about the subjective experience of the horse. MAIN LIMITATIONS: Focus on leisure horse population. CONCLUSIONS: Pain could become a matter of veterinary concern if it emerged through unique contexts and practices. The nature of presentation to the veterinarian as well as the (re)construction of issues affecting the horse through veterinary medical practices could create tensions for pain management. Opportunities to improve practice are highlighted.