Insight2 November 2026

Contextualised care: words matter!

Ruth Serlin

Vet, applied linguist and ADHD coach Ruth Serlin discusses the importance of language when carrying out contextualised care.

Contextualised careCommunication and teamwork

Toby is a six-year-old crossbreed dog with lymphadenopathy and polydipsia. I suspect lymphoma. Chemotherapy may offer longer survival, but Toby finds hospital visits distressing. His owner is caring for a parent with substantial needs and has limited financial and emotional capacity. My last two lymphoma cases had different outcomes: one received chemotherapy but relapsed quickly and was euthanised after five months; the other received no further intervention and euthanised three months later. 

As Toby’s vet, I  carefully consider clinical options for Toby, keeping his welfare central and drawing on evidence. I also need to understand the circumstances in which this care will take place. What might treatment involve? What matters most to Toby and to his owner? What can realistically be sustained? Significantly, does the way I think and talk about the possibilities shape the care Toby receives, how the client feels about our shared decision, and how I understand my own professional identity? 

There are various words we can use; is referral for chemotherapy the gold standard? Is a less intensive approach pragmatic? Might we choose a point on the Spectrum of Care? Or are we exploring what is appropriate for this animal and owner and the wider situation, and contextualising our approach? 

As an applied linguist, I am interested in the relationship between language and the worlds we create together. Words convey ideas but they also create our understanding of the world and its possibilities. 

Gold standard is an understandable term to aspire to, but we have begun to wonder about its wider associations. Gold suggests value and excellence. But if one approach is the gold standard, how might we understand the alternatives? Bronze? Substandard? What might that convey to an owner who cannot provide that care and to a practitioner who can’t provide it? 

We may not intend to suggest that other approaches are inferior, but the possibility is there. A vet may feel they have let an animal down by not pursuing every investigation. An owner may feel guilty about being unable to undertake treatment. When we cannot provide what we understand to be the gold standard, we may experience stress, disappointment or even shame. We may question our competence. Are we doing enough? Have we let the animal down? Will colleagues judge us? (Ritzie et al. 2026).  

Pragmatic decision-making described in the BSAVA Shelter Medicine Manual offers a thoughtful approach to applying clinical reasoning in context, keeping animal welfare central (Everitt et al., 2018). Pragmatism has subsequently become associated with charity work, experience, common sense, and potentially ‘doing less’. These associations risk obscuring the original emphasis: not cutting corners or providing a lower standard of care, but translating theory into thoughtful, context-sensitive practice. 

Pragmatic is often defined to me as ‘sensible’, ‘practical’ or ‘realistic’. My question is: sensible according to whom, and in what circumstances is this judgement applied to colleagues?  

This is why, for me, contextualised care feels the most appropriate term. I see it as a way of conceptualising what we do when we care for animals. It includes clinical considerations alongside the contextual factors that influence how care can be delivered in the real world. ‘We cannot separate clinical decisions from their social contexts’  (Skipper et al. 2024)   

When contextualising care, we consider the patient, carer, clinical team, practice or organisation, available resources, professional responsibilities, relationships and wider social and environmental circumstances. These factors interact, and their significance varies from one situation to another. We also consider the clinical options available. 

Clinical judgement remains essential. Contextualised care does not mean that all clinical options are equally good, or that context excuses poor reasoning. Evidence, professional judgement, ethics and animal welfare remain central. Rather, it gives us space to understand how these things come together in a particular case. This stepping away from judgement of people’s lives and circumstances can help us communicate and empathise with clients and make the conversations less weighted and stressful.  

In the USA, Spectrum of Care emerged partly in response to the rising costs of veterinary care (Stull et al., 2018). Like contextualised care, it recognises that there may be several appropriate, evidence-informed and welfare-based ways forward, rather than assuming that the most expensive or technologically advanced option is always the only one worth considering. 

However, I am interested in how we visualise and talk about the spectrum. It is often represented as a line or dial, with gold standard at one end and pragmatic care at the other. We talk about working along or across the spectrum. It is this conceptualisation that makes me pause. Do we inadvertently reinforce the idea that one end represents better care and the other a compromise? 

I find it helpful to think of spectrum of care as a way of considering clinical options, while contextualised care offers a broader understanding of the circumstances in which those options are considered and decisions made. 

Returning to Toby, I need to discuss the evidence, possible treatments, likely outcomes and burdens of care. I also need to understand his welfare needs, his owner’s circumstances, my own clinical perspective, the business context and wider professional and societal expectations. And I need to create an interaction where these things can be discussed where we accept we need to make clinical judgments but not judgements of contexts and people.  

The way we frame that conversation affects how the client feels about the decision, whether that is no further intervention, steroids or chemotherapy. It also affects how I feel about the care I have provided, and how I support colleagues as we navigate a complex situation together. 

I am not suggesting that changing our language will resolve every difficult decision. But I believe it is worth being curious about the words and metaphors we use. What do they help us notice? What assumptions do they carry? How might they influence how we understand and judge ourselves, our colleagues and our clients? What worlds do we want to create?  

Maybe in five or ten years, we will have another term for this way of thinking about veterinary care. What matters is that we continue having these conversations.  Words matter, and we should be intentional about the words we choose, seeking to do the least harm and to create a world in which possibilities can be explored openly, without judgement, with evidence and welfare at the core. 

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