At NSVH we receive a large number of phone messages daily with questions, concerns and dilemmas. Our vets also initiate calls to follow up on sick patients, discuss referrals or report lab results. Much can be accomplished via the phone: discussing what breed of dog to adopt, assuring an owner that it can be normal for their new puppy to be lethargic after vaccinations, dispensing advice about how to feed a picky older kitty.
One request that we receive via phone isn’t quite as easily accomplished: prescribing medication for a pet we haven’t seen, for a pet we haven’t seen in over a year, or for a condition we haven’t officially diagnosed. In veterinary medicine, our code of practice requires that we have a valid VCPR (Veterinarian/Client/Patient Relationship) in order to diagnose and treat medical conditions. The American Veterinary Medical Association (AVMA), the nation’s largest professional veterinary association, defines the VCPR here. The standard, and the law in many states, is that the pet has to have been examined by a veterinarian within the past 12 months to maintain a valid VCPR.
So what does this mean in day-to-day practice? We cannot prescribe medication for an animal that has never been examined by one of our veterinarians. Often we receive phone calls with requests for heartworm medication for a newly rescued older dog, or to treat diarrhea in a new puppy. It is illegal for us to prescribe medication for an animal without a VCPR. A simple examination at our office establishes a VCPR, and then, with an appropriate diagnosis, appropriate therapies can be recommended or prescribed. Another common scenario: if Fluffy used to come to our practice, but hasn’t been examined since 2008, we do not have a valid VCPR and cannot prescribe her medication.
Finally, the VCPR also refers to appropriate diagnosis (by a veterinarian) of medical conditions before initiating treatment. For example, Fido suddenly starts urinating all over the house. Fido’s owners drop off a urine sample for analysis, assuming Fido has a urinary tract infection; they also request antibiotics. We look at the urine and determine that there is no evidence of infection, but that there is a large amount of glucose in the urine, suggesting diabetes. Upon conversation with the owner, it is revealed that FIdo has been drinking excessively for months, has a ravenous appetite and seems to have lost weight…hallmark symptoms of diabetes. Fido needs an examination, a weight check, and bloodwork to confirm the diagnosis. Making a diagnosis in “reverse order” like this does not benefit Fido, Fido’s owners or the VCPR. Diabetes is a complicated disease, and requires much education, as well as a hands-on demonstration for administration of insulin. This cannot be accomplished over the phone, or without a valid VCPR.
Human physicians adhere to the same standard, even more strictly so. I cannot call my son’s pediatrician and request antibiotics because I believe he has an ear infection, or Strep throat. Similarly, my internist would never prescribe medication for a urinary tract infection without an exam, urinalysis and urine culture.
Please call us anytime to discuss your canine concerns and feline frustrations. If you have a worry that Fluffy is sick, or Fido is ailing, we will recommend that you schedule an examination. A thorough history, examination, and sometimes diagnostic tests such as bloodwork or radiographs (x-rays) allow us to provide the best care for your furry friend! The VCPR is really about providing the best care, and the best medicine, for Fido, Fluffy and you, our clients.