The scope of medical problems encountered by the equine ambulatory practitioner is immense; there is a wealth of information available to ambulatory practitioners pertaining to specific medical topics. It is certainly possible to practice high-quality equine medicine in a field setting. However, hospital referral should be offered to clients for conditions not conducive to successful treatment in the field. Prompt referral of difficult cases is a sign that the practitioner wants the best treatment for the patient and is often gladly accepted by the client. When surgical or hospital referral is not an option, it is imperative that the ambulatory practitioner not only offer humane alternatives but also inform and educate horse owners on equine suffering and welfare issues so that clients do not have unreasonable expectations of a positive outcome.