When You Can’t Run Every Test: A Step-by-Step Approach to Diagnostics on a Budget

Incremental care isn’t cutting corners. It’s making each step count.

Picture this: a seven-year-old Maltese named Buddy comes in for hematuria, some accidents in the house, and maybe increased thirst. He’s been a healthy patient for years. Physical exam is unremarkable. Urinalysis shows dilute urine with red blood cells, white blood cells, and rods on sediment.

You’re confident there’s a UTI at minimum. But you’re also thinking about urinary calculi, bladder masses, kidney disease. Ideally you’d run blood work, radiographs, culture, and ultrasound right now.

The client says: “Can we keep this as tight as possible?”

This is where incremental care applies.

What Is Incremental Care?

The Access to Veterinary Care Coalition defines it as "patient-centered, evidence-based medicine in the context of limited resources."¹ In practice, it’s a stepwise approach: treat the most likely diagnosis, reassess, then run the next test if things aren’t improving.

It’s not about skipping steps. It’s about sequencing them based on clinical priority and what will actually change your plan right now.

Buddy’s Case, Step by Step

Visit 1: UTI is the most likely culprit in a previously healthy dog with this presentation. Treatment: empirical antibiotics. Cost to the client: an office visit and a course of antibiotics. You tell the owner: if this doesn’t resolve, our next step is a culture and imaging.

Visit 2 (two weeks later): Buddy’s better but not fully resolved. Blood in the snow this morning. You repeat the urinalysis, still seeing bacteria and now some crystals. You recommend a culture and radiographs. The client picks the culture first, since targeting the right antibiotic is the immediate priority. You note: if the culture comes back negative or symptoms persist, we need those images.

Visit 3 (three weeks later): Still hematuria. Now you run radiographs and find urinary calculi. You discuss options: dietary dissolution versus surgical removal. Given the cost of surgery, the client elects dietary dissolution. You counsel on the risk of obstruction in a male dog, set clear parameters for when to come back immediately, and start the urinary diet.

Outcome: Stones dissolved. Buddy’s been doing well on the diet since.

Why This Works

At visit one, you got a tremendous amount of clinical information before running a single diagnostic test. Signalment, history, physical exam, and urinalysis pointed you toward UTI as the most likely diagnosis.

Consider this: if three vomiting patients walked into your clinic right now (a 10-week-old Doberman puppy, a two-year-old Lab that ate a sock, and a 10-year-old intact female Pit Bull), you already have a differential list for each. All you had was the signalment.² The exam visit itself is the most cost-effective diagnostic you have.

The key question at each step: will this test change what I do right now? If blood work won’t alter your immediate treatment plan but radiographs will, run the radiographs. If empirical treatment for the most likely diagnosis is reasonable and the patient is stable, start there and reassess.

Choosing Tests That Change Your Plan

The textbook Low-Cost Veterinary Clinical Diagnostics highlights how much information we can extract from basic tests: PCV and total protein, blood smear, and urinalysis.³ These aren’t shortcuts. For the right patient, they’re the tests most likely to give you actionable information per dollar spent.

Think about it this way:

• Mini chemistry panel and electrolytes instead of a full panel when you’re focused on renal and electrolyte status
• PCV and blood smear instead of a full CBC when you need to know if a pet is anemic
• Urinalysis first for lower urinary signs, because it’s inexpensive and highly informative

You’re not running fewer tests for the sake of it. You’re running the tests most likely to change your next decision.

Communicating the Plan

Incremental care only works if the client understands the roadmap. At each visit, explain:

1. What you’re doing now and why it’s the right starting point
2. What you expect to happen if treatment is working
3. What the next step looks like if it’s not

This gives clients a clear picture without overwhelming them with every possible diagnostic and its price tag upfront. It also builds trust: you’re not withholding information, you’re presenting it in a sequence that respects their situation.

When Incremental Care Doesn’t Apply

Not every case allows a stepwise approach. A laterally recumbent cat with a urethral obstruction needs intervention now. A dog presenting with septic peritonitis needs surgical assessment today, not next week.

The question is always: is this patient stable enough for a stepwise approach? If yes, incremental care is a valid, evidence-based framework. If no, you need to have that harder conversation about what’s needed right now.

This post is based on a VetOnIt CE webinar by Dr. Kate Boatwright. Interested in building your clinical problem-solving skills? Check out our upcoming Internal Medicine CE on March 21 or explore the full On-Demand Library.

References

1. Access to Veterinary Care Coalition. Access to Veterinary Care: Barriers, Current Practices, and Public Policy. University of Tennessee, 2018.

2. Boatwright K. Improving Outcomes for Clients with Financial Limitations through a Spectrum of Care Approach. VetOnIt CE Webinar. 2023.

3. Dial SM, Elam RE. Low-Cost Veterinary Clinical Diagnostics. Wiley, 2023.