"What if someone reads these records and judges me?": fear, legitimacy, and the hidden curriculum in veterinary clinical decision-making.

Abstract

Introduction: Spectrum of Care (SpOC) has been promoted as a means of improving access to veterinary care while supporting ethical and sustainable clinical decision-making. Yet many veterinarians who value contextualized, client-centered care continue to experience difficulty incorporating SpOC approaches into everyday practice. While these challenges are often framed as deficits in knowledge, resources, or training, less attention has been paid to the influence of professional culture.

Methods: This qualitative study drew on data collected as part of a mixed-methods evaluation of a SpOC workshop delivered to veterinarians in Ontario, Canada. Data sources included semi-structured interviews conducted 3 months following workshop participation (n = 17) and open-text questionnaire responses collected before, immediately after, and 3 months following the intervention. Data were analyzed using reflexive thematic analysis.

Results: Participants described numerous strategies that supported contextualized care, including collaborative communication, shared decision-making, supportive team cultures, knowledge of alternative care pathways, and a growth-oriented mindset. However, fear emerged as a pervasive influence on clinical decision-making. Veterinarians described concerns about peer judgment, client complaints, regulatory scrutiny, and the possibility that context-appropriate decisions would later be interpreted as substandard care. Importantly, these concerns often reflected anticipated rather than experienced criticism. Participants linked these fears to implicit professional norms learned through veterinary training and reinforced throughout practice, describing a hidden curriculum that privileges idealized or gold-standard approaches, narrows perceptions of acceptable care, and creates pressure to conform even when alternative approaches are clinically appropriate.

Discussion: These findings suggest that contextualized care may be constrained less by deficiencies in clinical knowledge than by professional and cultural forces that shape perceptions of legitimate care. Fear emerged as an immediate influence on decision-making, while the hidden curriculum functioned as a potential underlying mechanism, generating and sustaining that fear. These findings position SpOC not only as a clinical framework for improving access to care, but also as a lens through which broader questions of professional culture, legitimacy, and veterinary identity become visible. Until contextualized care is culturally legitimized alongside idealized models of care, fear and the hidden curriculum may continue to undermine efforts to improve access to care and support practitioner wellbeing.