IN-DEPTH: PRE-PURCHASE EXAM FOR SPORT AND PLEASURE HORSES
Radiographs hold a very important role in the decision process of purchasing a horse. Since the imaging part of the PPE will be covered separately, a few comments are added here. The so-called “standard” set of radiographs varies enormously. The requested number of radiographs in the United States varies between 24 and 64. In Europe, the requested standard views vary as well. The stan- dard is 18 views in Germany as of 2018, while pre- viously it has been 12.4,5 In the Netherlands, typically 18 radiographs are obtained;6 in Belgium, 22; France has no common “standard”; Sweden, 12; Italy, 23 or 32; United Kingdom, 28; and so on. In most countries these recommended standards are not based on scientific evidence but on experience and judgment of opinion leaders in equine medicine in the particular countries. A first step toward de- veloping a more standardized PPE could be a con- sensus on which views are most important, resulting in a standard number of radiographs. Regarding the review of radiographs, a trend toward evaluation of the images by board-certified radiologists is nota- ble. It is important to have specialists to consult to seek their advice; however, the final evaluation and judgment of potential clinical relevance of radiolog- ical abnormalities should be performed by the prac- titioner or clinician responsible for the PPE. If radiographs are being sent around the world, estab- lishing who is liable for their interpretation should be discussed with the client. It cannot be empha- sized enough that it is important to read the horse, not just the radiographs. Too many sales are being “killed” by accurate radiograph interpretation de- scriptions without clinical background information. Ultrasonographic examinations are increasingly requested during PPEs in most places. It is impor- tant to remember that ultrasonography is a dynamic examination and the evaluation of images without short video clips may be very misleading. Even short video clips may not give the most accurate information. A written report on the ultrasound findings is favorable. Additional examinations such as MRI or scintig-
raphy are not routinely performed, although may be advised in cases of unclear clinical or radiographic findings. Blood samples are always drawn for examination
on substances (doping). The client has the choice between immediate examination or storage of the sample for a defined amount of time in the clinic. Complete blood cell count and biochemistry analyses are performed routinely.
4. Documentation
As in all aspects of veterinary medicine, documen- tation is the key to success if it comes to litigation. Documentation should include all telephone calls, discussions, and explanations besides the examina- tions and imaging. The witnesses should also be documented: all people present during the commu-
nication and examination, including interns and ex- terns, technicians, and anybody else in attendance.
5. Report
The report should contain a summary of the exam- ination, and not simply a copy of notes taken during the examination. In some countries recommenda- tions and even templates are provided by veterinary associations.6–8 Radiographs sent across the globe should always include an opinion and written report of the veterinarian who produced the radiographs. The decision to purchase or not purchase a horse is solely the buyer’s decision, not the veterinarian’s. Not even the recommendation is the veterinarian’s job! The report should list the findings of the ex- amination, followed by the prognosis of those find- ings. An opinion that “nothing speaks against the use in sports of this horse, based on today’s medical examination”, may be stated, but it is unwise for a veterinarian to tell the buyer to proceed with the purchase or not, and absolutely impossible to predict the sports career of the four legged companion. It is beyond discussion that the choice of words in
the report is key to the satisfaction of the clients, both buyer and seller, and for the veterinarian’s own protection. How can one differentiate between a slight asymmetry and a lameness? Is it possible to state a horse as “slightly off,” but fit to do his job? Does one mention very slight stiffness in the back or a marginal exostosis in the tibia plateau of a stifle? Of course the risk for possible litigation is re- duced by having the majority of horses fail the PPE. However, over time it will hurt one’s reputation when too many of these “failed” horses perform very well. Experience is the key to successful judgment. One also has to keep in mind that a horse chang-
ing stables or even continents will have to deal with different food, different equipment (saddle and other tack), new training techniques, riding style, show schedules, different footing, farrier, etc., so there is an associated risk that the horse will not function the same way as it did under its former circum- stances. These changes have to not only be dis- cussed with the buyer, but also advice has to be given to prevent future problems related to possible management changes.
6. Conclusion
The amount of legal cases involving veterinarians1 as well as the controversy regarding many aspects of the PPE show that increased mutual understanding needs to be sought regarding this essential and im- portant part of the job. Communication, discus- sion, and an open mind will be necessary to start down a road toward more uniformity in the per- formance of PPEs. Young and unexperienced vet- erinarians should seek advice from experienced col- leagues. However, even for experienced clinicians a second opinion should be consulted as often as possible. However, different experiences with cer- tain changes, as well as different opinions, will al-
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