College Connection | Winter 2025
Tips for conversations about physical examinations
College Connection | Winter 2025
PRACTICE ADVISORY SERVICE
Tips for conversations about physical examinations
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A good place to start is with the veterinarian-client-patient relationship( VCPR) since one needs to be established before providing veterinary services. A VCPR is established through a conversation and represents an agreement between the client and the veterinarian on the scope of services to be provided and the duration of those services. Maintaining the VCPR is not dependent on the timing of physical examinations.
There is no requirement for an annual physical examination of a patient to maintain the VCPR in Regulation 1093 or College policy. It is not the“ law”.
A VCPR ends when the agreed upon scope of services are completed; ownership of the patient has changed; upon the death of the patient; or through the process of discontinuation, when the veterinarian and / or client determine they no longer wish to maintain the VCPR.
When does a physical examination need to be done? The clinical decision to perform a physical examination is made by the veterinarian and is based on determining the patient’ s current condition.
When determining the appropriate interval between examinations, this considers what services have been agreed to within the VCPR and the individual needs and circumstances of the patient. Regulation 1093 and College policy state a veterinarian is to maintain recent and sufficient knowledge of a patient to administer, prescribe, or dispense a drug.
So, what constitutes recent and sufficient knowledge of a patient? That is the professional judgment of the veterinarian based on what is happening for the patient at a specific time. What information is needed and how often it is gathered will vary depending on several factors including, for example, the condition that is being treated and when the last physical examination and / or diagnostic tests occurred.
Questions from veterinary teams and clients regarding the requirement for a physical examination before prescribing or refilling a drug often come up. To prescribe a drug, a veterinarian must:
• have an established VCPR;
• have recent and sufficient knowledge of the patient by virtue of a history and either in-person physical examination or in-person visits to the premises where the patient is kept to reach a general or preliminary diagnosis;
• believe the drug is prophylactically or therapeutically indicated for the patient; and
• be readily available in-person for adverse reactions to the drug or failure of the therapy regimen.
Once a veterinarian has performed an in-person physical examination, they can decide when another examination is required to continue to prescribe for a patient. When refilling a drug for a known condition, a veterinarian gathers information from the client to consider whether the drug is still appropriate, and whether the patient’ s condition is stable enough to warrant the prescription refill without further examination. When determining the required assessment, spectrum of care should be considered to provide options for clients to access care and to ensure the animal’ s welfare.
When prescribing for a patient with a chronic medical condition, clients may request ongoing refills of drugs but decline recommended follow-up assessments, such as a physical examination and / or diagnostic tests. While the patient needs the drug, if the veterinarian has not assessed the patient recently, ongoing refills of drugs could be a risk. And professional obligations will not have been met. Client education is key to ensuring the veterinarian can confidently proceed with refilling the drug.
The physical examination is an important tool for gathering information to make diagnoses, determine treatment plans and optimize continued care delivery. Stay tuned for our next article with tips to support conversations with clients about requirements for a physical examination of their animal.
cvo. org / vcpr
Public confidence in veterinary regulation cvo. org 4