Veterinarian-Client-Patient Relationship Overview
By Nancy S. Loving, DVM • Jan 20, 2013 • Article #31234
Make an annual wellness exam the number one item on your horse-health to-do list, recommends Tanner. The exam will include evaluating your horse’s heart, lungs, gastrointestinal system, soundness, and dental health. This is also a great time for you and your vet to plan a deworming strategy for the year.
Photo: Anne M. Eberhardt/The Horse
Establishing and maintaining an active, functional veterinarian-client-patient relationship (VCPR) is the cornerstone to providing the best care for horses, said Richard Lesser, DVM, of Equine Clinic at OakenCroft, in Ravena, N.Y., during a recent veterinarian discussion on ethics. This VCPR is a legal "contract" between the veterinarian and the horse owner and/or trainer (client), and it implies that they will consult each other about the health of the horse (patient) following an examination.
Several veterinarians described the VCPR from a sport-specific practice point of view during the 2012 American Association of Equine Practitioners' (AAEP) convention, held Dec. 1-5 in Anaheim, Calif.
Harry Werner, VMD, of Werner Equine, in North Granby, Conn., explained that the VCPR implies that the veterinarian has assumed responsibility for making clinical judgments, that the owner has consented, and that the veterinarian has sufficient information about the horse to make appropriate clinical decisions.
Each segment of equine practice can present different VCPR challenges. Lesser reported the many challenges broodmare practice can introduce. These horse owners are generally off-site, which can complicate veterinarian-owner communication. Lesser remarked, "It helps to have a discussion with owners as to their exact expectations, while at the same time providing them with information as to what the veterinarian can deliver."
Lesser also treats pleasure and show horses, noting that in his experience these animals' owners frequently communicate with their veterinarians and therefore pose fewer problems in the VCPR realm.
It's not just a matter of owner and veterinarian conversing, however. "The letter and spirit of the law should be followed, as for example when it comes to prescribing medication," Lesser added. "Just because a veterinarian may have briefly seen the horse or trainer doesn't mean there is an active, valid, and licit relationship."
He emphasizes that a valid interaction means the veterinarian has seen the horse within the past year and dispensed medication after examining the horse for a specific problem.
Sport Horse and Ambulatory Practice
Karen Nyrop, DVM, of Calgary, Canada, weighed in on VCPRs in sport horse and ambulatory practice. "A VCPR is established when the person calls and asks for services," she explained. "Usually this entails face-to-face communications and exam of the horse."
However, she added, "There are situations when the trainer and/or owner are not present, and other challenges present when the horse has been seen by multiple other veterinarians with no accompanying medical records or documentation."
If veterinarians conduct long-distance prepurchase exams it further stretches the need for optimal VCPR: Practitioners must communicate clearly what veterinary services they offer, along with determining the buyers' expectations.
"Emergencies may or may not be restricted to previously established relationships," she said. "This can be difficult in an emotionally charged case."
Another challenging situation arises at sales and sport horse auctions, Nyrop explained: "There can be conflicts of interest at these venues when the seller's vet takes the required radiographs and reads the films for the sale, or the sales vet works for the sales company rather than for the buyer."
She stresses that veterinarian-to-veterinarian communication must be improved, coupled with respect and prompt responses between vets.
Racetrack practitioner Jeff Blea, DVM, of Von Bluecher, Blea, Hunkin Inc., in Sierra Madre, Calif., described VCPRs in the Thoroughbred industry, underscoring the necessity of a complete communications triad between owner, trainer, and veterinarian.
"The vet is responsible to both the trainer and the owner, and the owner should have access to all information," he said. "The trainer may tell the owner everything but may not always explain it well. Therefore, at times it may be best to have the vet directly explain information to the owner."
Misunderstandings can and will arise, for example, if an owner gets a bill for procedures he or she wasn't expecting, he noted.
To sum up the essence of a proper VCPR, Werner quoted Abraham Verghese, MD, a Stanford University physician and author: "A proper examination earns the patient's trust ... and serves as a ritual that transitions two strangers into a doctor and patient."
In closing, Werner recommended that veterinarians "listen well, speak well, empathize, maintain clinical skills, record findings, respond, and follow through."