Veterinary-Client-Patient relationship

by Roberta Dwyer, DVM, MS, Dip. AC VPM
(Courtesy of the AAEP)

I am a conscientious, health-oriented horse owner who recently moved to another area. My 20-year-old retired mare is on one gram of Bute paste per day for arthritis. I recently contacted a recommended horse veterinarian for another box of Bute and was told that the veterinarian would have to make a farm call first. I do not want to pay the trip charge just to get the same medication my mare has been on for the past five years. Am I getting ripped off?

To illustrate my answer, let's first put the shoe on the other hoof. Since you are also new to the area, assume you have chronic arthritis which requires a prescription drug that you have been taking for the past year. You were under the care of a physician in Florida prior to your move. After getting a referral to a family practitioner in Ohio, you call and ask the physician to renew the prescription at the local pharmacy. What are the odds that it will be renewed without you being required to have an office call?

Or, you get a toothache, just like the occasional ones you got in Florida, for which the dentist prescribed a mild pain killer. Would any dentist prescribe a drug for a patient without seeing him first? Not likely.

All doctors, including veterinarians, who prescribe drugs must be familiar with their patient first. For veterinarians it is called establishing the veterinary-client-patient relationship (VCPR). There are three components to the VCPR:

  1. The veterinarian has assumed the responsibility for making medical judgments regarding the health of the animal(s) and the need for medical treatment, and the client (owner or caretaker) has agreed to follow the instructions of the veterinarian.
  2. There is sufficient knowledge of the animal(s) by the veterinarian to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s).
  3. The practicing veterinarian is readily available for follow-up in case of adverse reactions or failure of regimen of therapy.

In your case, a VCPR has not been established. A veterinarian must examine your horse prior to selling or prescribing medication. Even if a product or vaccine is available for over the counter sales at a local feed store, a veterinarian can not sell a prescription product without a VCPR. It is to your benefit-and your horse's benefit-to have the new veterinarian examine your horse to establish a working relationship. Then if an emergency arises, your veterinarian will be familiar with your horse and facilities.

The valid VCPR applies to all veterinarians and to all species of animals, not just horses. Many times veterinarians will not fill a prescription if the animal has not been seen for the past six months. Long-term use of any drug can have complications, such as liver or kidney disease. If a doctor refilled a prescription over and over again without seeing the animal, these complications could set in without the knowledge of the owner.

In order to make clients aware of the importance of a veterinarian examining an animal prior to dispensing medication, the American Veterinary Medical Association has made available wall hangings for veterinary offices.

So the answer to your question is no, you are not being taken advantage of by the veterinarian. Sure, you could probably obtain medication through a mail order catalog, but if an adverse reaction occurs, will you call the catalog company for help? No, you will call your veterinarian. By establishing a working relationship with a veterinarian, you are helping to insure the health and welfare of your horse.

Roberta Dwyer, DVM, MS, Dip. American College of Veterinary Preventive Medicine, is an assistant professor at the University of Kentucky's Gluck Equine Research Center in Lexington, Ky. She also is a member of the veterinary advisory board to The Horse.