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The Veterinarian-Client-Patient Relationship (VCPR)

THE VETERINARIAN-CLIENT-PATIENT-RELATIONSHIP
In order to legally and ethically provide prescription medications or perform medical, surgical and dental procedures we must have a valid veterinarian - client - patient relationship (vcpr). The current consensus among veterinarians is that the most essential component of the vcpr, and the bare minimum needed to establish and maintain it for any patient, is an examination within the prior year. 
But the qualifying characteristics of this relationship vary from patient to patient and, for a particular patient, may also vary from situation to situation. Examples: 1) a patient has had an exam within the preceding year but has a chronic health problem that can change its health status significantly in less than a year's time; 2) a patient has had an exam within the preceding year but has suddenly developed a significant new problem.

The subject of the vcpr comes up most often when we are presented with a request to refill a  prescription medication. At a minimum we must have examined the patient within the previous year, but we also consider other factors. For some problems and some patients the previous exam will have been within a year of the requested refill, but a more recent exam will be necessary. 

THE FEDERAL GOVERNMENT PROVIDES A DEFINITION:

Code of Federal Regulations TITLE 21--FOOD AND DRUGS
CHAPTER I--FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN
SERVICES (CONTINUED)
PART 530_EXTRALABEL DRUG USE IN ANIMALS--Table of Contents


(i) A valid veterinarian-client-patient relationship is one in
which:
(1) A veterinarian has assumed the responsibility for making medical
judgments regarding the health of (an) animal(s) and the need for
medical treatment, and the client (the owner of the animal or animals or
other 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); and
(3) The practicing veterinarian is readily available for followup in
case of adverse reactions or failure of the regimen of therapy. Such a
relationship can exist only when the veterinarian has recently seen and
is personally acquainted with the keeping and care of the animal(s) by
virtue of examination of the animal(s), and/or by medically appropriate
and timely visits to the premises where the animal(s) are kept.

THE AMERICAN VETERINARY MEDICAL ASSOCIATION ALSO DEFINES THE VCPR:

The American Veterinary Medical Association (AVMA) has a helpful set of guidelines and answers to various related questions (reprinted here in the original form; you can access these and a lot of other useful veterinary and pet care information pieces at avma.org).

III.    THE VETERINARIAN-CLIENT-PATIENT RELATIONSHIP
A.    The veterinarian-client-patient relationship (VCPR) is the basis for interaction among veterinarians, their clients, and their patients.  A VCPR exists when all of the following conditions have been met:
1.    The veterinarian has assumed responsibility for making clinical judgments regarding the health of the animal(s) and the need for medical treatment, and the client has agreed to follow the veterinarians' instructions. 

2.    The veterinarian has sufficient knowledge of the animal(s) to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s).  This means that the veterinarian has recently seen and is personally acquainted with the keeping and care of  the animal(s) by virtue of an examination of the animal(s), or by medically appropriate and timely visits to the premises where the animal(s) are kept. 

3.    The veterinarian is readily available, or has arranged for emergency coverage, for follow-up evaluation in the event of adverse reactions or the failure of the treatment regimen.

B.    When a VCPR exists, veterinarians must maintain medical records (See section VIII).

C.    Dispensing or prescribing a prescription product requires a VCPR
1.    Veterinarians should honor a clients request for a prescription in lieu of dispensing. 

2.    Without a VCPR, veterinarians merchandising or use of veterinary prescription drugs or their extra-label use of any pharmaceutical is unethical and is illegal under federal law.

D.    Veterinarians may terminate a VCPR under certain conditions, and they have an ethical obligation to use courtesy and tact in doing so. 
1.    If there is no ongoing medical condition, veterinarians may terminate a VCPR by notifying the client that they no longer wish to serve that patient and client.

2.    If there is an ongoing medical or surgical condition, the patient should be referred to another veterinarian for diagnosis, care, and treatment.  The former attending veterinarian should continue to provide care, as needed, during the transition.

E.    Clients may terminate the VCPR at any time. 

AND THE AVMA ANSWERS COMMON QUESTIONS ABOUT THE VCPR

Veterinarian-Client-Patient Relationship: VCPR (FAQ)

The following FAQs provide simplified explanations and answers about the VCPR. For a complete definition of the VCPR, read the VCPR section of the Principles of Veterinary Medical Ethics.

Q: What is a Veterinarian-Client-Patient Relationship (VCPR)?

A: A Veterinarian-Client-Patient Relationship, or VCPR for short, exists when your veterinarian knows your pet well enough to be able to diagnose and treat any medical conditions your animal develops. Your part of the VCPR is allowing your veterinarian to take responsibility for making clinical judgments about your pet's health, asking questions to make sure you understand, and following your veterinarian's instructions. Your veterinarian's part of the VCPR involves making those judgments, accepting the responsibility for providing your pet with medical care, advising you about the benefits and risks of different treatment options, keeping a written record of your pet's medical care, and helping you know how to get emergency care for your pet if the need should arise.

Q: How is a VCPR established and maintained?

A: A VCPR is established only when your veterinarian examines your animal in person, and is maintained by regular veterinary visits as needed to monitor your animal's health. If a VCPR is established but your veterinarian does not regularly see your pet afterward, the VCPR is no longer valid and it would be illegal and unethical for your veterinarian to dispense or prescribe medications or recommend treatment without recently examining your pet.
A valid VCPR cannot be established online, via email, or over the phone.

Q: Why is a VCPR so important?

A: For one, it's required by law in many states – in order for a veterinarian to diagnose or treat your animal, or prescribe or dispense medications, a VCPR must be in effect according to the state's Veterinary Practice Act (if you have questions about your state's Practice Act, contact your state veterinary medical board). Two, it's the best thing for your animal's health. Your veterinarian should be familiar with your animal's medical history and keep a written record of your animal's health so they can provide your animal with the best possible care. The AVMA's Principles of Veterinary Medical Ethics also requires a VCPR for a veterinarian to prescribe medication or otherwise treat an animal.

Q: How can a VCPR be ended?

A: You, as the client, can terminate a VCPR at any time by notifying the veterinarian. If your veterinarian chooses to end the VCPR, they should notify you and, if your animal has an ongoing illness, provide medical care until you have transitioned to another veterinarian.

Q: What does my veterinarian offer that an online source can't match?

A: Your veterinarian knows you and knows your animal(s), and this is critical to keeping your animal(s) healthy. For example, your veterinarian can customize a vaccination program to give your animal the best protection from disease and make sure that it isn't getting a vaccine it doesn't need. Vaccine and drug reactions, although uncommon, can occur, and your veterinarian is trained to recognize and treat them to minimize the chance that the reaction will become severe or even life-threatening – you can't get that from a website!

Figuring out what's wrong with an animal is like solving a very complex puzzle – your veterinarian has to figure out how to fit all of the clues (pieces of the puzzle) together to solve it. Veterinarians have, on average, 8 or more years of college and in-depth veterinary school training to prepare them for this task. Their training makes it possible for them to thoroughly evaluate, diagnose and treat your animal's problem. Doing these things effectively involves thorough knowledge of your animal's body systems and how they function, as well as a familiarity with how medications and other treatments work and if any treatments interfere with others. Hands-on physical examination is incredibly valuable to your pet and can't be replaced by a phone conversation, web-based conversation, or email description.

This information has been prepared as a service by the American Veterinary Medical Association. Redistribution is acceptable, but the document's original content and format must be maintained, and its source must be prominently identified. Please contact Dr. Kimberly May(800.248.2862, ext 6667) with questions or comments.

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