Six Veterinary Habits to Break Now, From Antibiotics to Ownership

By Elena Vasquez

Doxycycline for nearly every kennel-cough patient, metronidazole for uncomplicated acute diarrhea in dogs, cefovecin or amoxicillin-clavulanate for a dysuric cat: these prescriptions happen every day, despite guidelines that, in the words of Miami practitioner and columnist Patty Khuly, VMD, MBA, "aren't especially ambiguous anymore."

Her argument, published in Veterinary Practice News, is blunt. The profession is skilled at stating its values — evidence-based medicine, One Health, antimicrobial stewardship, spectrum of care — and less accomplished at acting on them. Her list of six failures is not a catalog of sins, she writes, but a set of things practitioners "already know how to do" and could start doing tomorrow.

Where does antibiotic prescribing go wrong?

Khuly names companion-animal antimicrobial habits directly. She questions reflexive doxycycline for kennel cough, reflexive metronidazole for uncomplicated acute diarrhea, and empirical treatment of feline dysuria.

Stewardship, she writes, sometimes means "culture when convenient, prescribe when not." Her checklist of habitual behaviors to unlearn:

• Perioperative antibiotics given reflexively for clean surgeries
• Subclinical bacteriuria treated simply because an analyzer flagged it
• Empirical antibiotics substituted for cytology and culture in recurrent or deep infections
• A laboratory number treated instead of the patient

Veterinary education emphasizes acquiring knowledge, she notes, but practice demands something harder: periodically questioning what we have done for decades and asking whether the evidence has moved on.

Diagnostics get the same scrutiny. Practices keep ordering standard panels even when the results would not change the plan, she writes, while skipping one or two cheap tests whose findings could change the approach entirely — usually because the client's diagnostic budget went to the pricier cookie-cutter panel the practice prefers.

The takeaway: unlearning habitual prescriptions and panels is the fastest available improvement at the exam table.

Is spectrum of care still just a conference phrase?

The profession increasingly accepts that more than one medically acceptable treatment plan exists, Khuly writes, but hospital procedures have not caught up. The pattern she describes: the veterinarian invests physical, intellectual and emotional capital in the exam room, then sends a technician to "go over the estimate." When the client declines half of it or leaves, someone at the front desk hands her an AMA form.

"What exactly happened to the veterinarian during the most consequential part of the medical decision?" Khuly asks. Veterinarians should explain estimates when the estimates require medical prioritization, she argues. Deciding what to remove from Plan A to create a medically defensible Plan B or C is practicing medicine — a signature on an AMA form is not.

Her inventory of policies that interfere with humanity:

• Mandatory deposits delivered as ultimatums rather than folded into a medical conversation
• Refusal of outpatient management when a reasonable outpatient Plan B exists
• Treating "declined" as the end of a conversation instead of asking why
• Requiring irreversible decisions before clients have had five minutes to absorb catastrophic news
• Refusing reasonable exceptions because "that's hospital policy"
• Allowing production targets, appointment times or corporate workflows to cap how long a veterinarian spends on the conversation that matters

Protocols should make good medicine easier, she concludes. When they prevent practitioners from behaving like human beings, they deserve interrogation.

Who is deciding the profession's future?

Most veterinarians do not belong to their local or state VMA, Khuly writes, and fewer still attend meetings, sit on committees, testify on legislation, communicate with regulators or run for leadership. The result: veterinary policy that does not reflect what practicing veterinarians want.

Someone will define the VCPR, she writes. Someone will write the rules on telemedicine, technician scope of practice, prescribing, controlled substances, animal welfare and corporate ownership. "If we're not in those rooms, other people will be" — increasingly, people whose interests overlap with the profession's only when doing so is profitable.

Khuly also flags conflicts of interest: many veterinarians serving at the highest levels of professional organizations also work for corporate interests and may not always disclose those conflicts.

Does seniority equal expertise?

The profession runs on hierarchy, she writes: young veterinarians defer to older ones, associates to owners and medical directors, interns to residents, residents to specialists. General practitioners defer to specialists — sometimes even when they know a patient they have managed for 12 years is not being managed well under specialty care.

"Expertise matters enormously, but seniority is not expertise," Khuly writes. Neither is practice management nor ownership. Young veterinarians should be taught not merely how to accept mentorship but how to disagree professionally — with a medical director, a specialist, a corporate protocol or a published recommendation. A related VPNPlus+ column by NAVTA president Jennifer Serling offers practical tips on navigating the tech-vet hierarchy without burning bridges.

Junior veterinarians have the same right to sit on a committee, write a letter to the editor of JAVMA, or seek AVMA office as anyone else, she argues, and the profession needs age diversity to stay representative and democratic.

Why should more veterinarians own something?

The profession has convinced itself it is brilliant enough to understand acid-base physiology, anesthetize a 16-year-old Chihuahua with cardiac disease and remove an intestinal foreign body at 2 a.m., yet insufficiently "business-minded" to read a P&L statement, Khuly writes. Business is a learnable skill, not an inherited trait.

Ownership need not mean building an eight-doctor hospital from scratch. It can mean buying the tired one-doctor practice nobody else wants, starting a mobile service, creating a niche cat or goat practice, partnering with three colleagues, or buying into the hospital where you already work.

The stakes go beyond personal wealth. The fewer veterinarians who own veterinary businesses, the fewer veterinarians decide what veterinary medicine becomes.

What ties all six together?

Agency, Khuly writes. Prescribing metronidazole out of habit surrenders agency to habit. Handing an owner an AMA form because procedure dictates it surrenders agency to policy. Skipping the VMA meeting surrenders agency to whoever shows up. Assuming you are too junior to speak surrenders agency to hierarchy. Declining ownership because you are "not a businessperson" surrenders agency before you have even tried.

The profession has spent considerable time discussing the forces acting on it — consolidation, inflation, student debt, workforce shortages, angry clients, burnout, online pharmacies, private equity and the rising cost of care. All real, Khuly concedes, but she closes with a challenge that practitioners can act on at the next appointment: spend a little more time on what remains stubbornly within our control.