On Getting Meds Without a Visit (or, What’s a VCPR and Why You Should Care)
Scenario A: Let’s say your cat gets an eye infection and you want to get her the same meds she was prescribed when she was last seen by her healthcare provider for the same thing. Problem is, your veterinarian says, "Sorry. Since we haven’t seen her in almost two years, we’re going to have to ask you to come in for a visit first."
Unfortunately, this makes you very angry. It’s just another way of getting to your wallet, you fume. I mean, it’s not as if you’re not there every three months with your other pets. How is it that you have to drag this one in for even the teensiest of problems when the treatment is so obvious? After all, you complain bitterly, it’s the pet who suffers!
Here’s another scenario:
Scenario B: You call your veterinarian and ask for the eye medication you get every year or so for your cat’s recurrent ocular condition. They hand it over. You medicate your cat for a few weeks and the eyes aren’t getting any better. In fact, they’re getting worse.
Turns out this is not your cat’s normal recurrent infection. Indeed, when you finally bring her in, she’s blind. She’s got chronic renal disease, i.e., kidney failure, and her rapidly progressing hypertension has led to irreversible changes that might have been mitigated had you brought her in for regular visits.
Or a variation on this theme:
Scenario C: Your cat doesn’t have kidney failure. She has corneal erosions caused by a chemical burn to her eyes. (Your shampoo technique? The fumigator?) And that medicine your veterinarian gave you? It makes them so much worse that now she actually risks losing her eyes.
You’re really angry now. How could your veterinarian give you a medication that is so dangerous?
Normally, this is a bit of a boring — albeit necessary — subject. Hence, why I’ve spiced it up with some entertaining anecdotes. While they raise plenty of issues, all of the above scenarios can be said to explain the need for one thing: A valid veterinarian-client-patient-relationship — aka the almighty "VCPR."
Cultivating a valid VCPR is the cornerstone of common clinical veterinary practice. It’s different from the standard human medical model but does approximate pediatrics’ approach, where it’s presupposed that a solid relationship between the parent(s) is required before the doctor can advocate best on the patient’s behalf.
As in the pediatrician’s scenario, veterinarians must have maintained a working relationship with the patient’s legal custodian. In our case, this relationship is one that’s somewhat murkily described as "valid."
In legal terms, it generally means clinicians have [at the very least] performed a physical examination on the patient within the past year. Though this is the typical interpretation of a "valid VCPR," some additional wiggle space (or less room to maneuver) might apply. This may be based on the intervals between communication and other variables, such as the state in which the patient/practitioner interface has occurred.
In any case, the issue tends to come down to this: I’m not very good at saying "no" when it comes to treating strays and other, “I can't bring him in but I NEED to treat him now, doc!” cases. Yet when I consider the above three scenarios, can you blame me for having to refuse 90 percent of these "must have meds!" requests?
Dr. Patty Khuly