Midterm ANSC 4410

VCPR

Veterinary Client Patient Relationship; a formal relationship between a veterinarian and a client that establishes the veterinarian's responsibility for the patient's care.

What does VCPR stand for

V: veterinary

C: client

P: patient

R: relationship

What are the 5 VCPR requirements (defined by AVMA)

1. vet has assumed responsibility for making clinical judgements regarding the health of the patient and client has agreed to follow the vet’s instructions

2. vet has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the medical condition of the patient. This means that the vet is personally acquainted w/ keeping and care of the patient by virtue of a timely examination of the patient by the vet or medically appropriate and timely visits by vet to the operation where the patient is managed

3. vet is readily available for follow up evaluation or has arranged for the following: veterinary emergency coverage, and continuing care and treatment

4. veterinarian proves oversight of treatment, compliance, and outcome

5. patient records are maintained

What should a client portfolio contain?

• Client name

• Address

• Phone number

• Email address

• Payment information

T/F: anyone can make medical decisions if they had some sort of relationship with the client

false

• only the client listed on the records or listed on the charts can make medical decisions

Patient chart should include what 6 things

1. patient name

2. breed

3. sex

4. color

5. age

6. weight

Why is the description of the patient important

the context matters towards the diagnosis

T/F: Rounds always start with signalment to start the information with the team

true

What might client communication tell us

• CC

  • ex: vomiting, vaccines, etc

• Appointment

• Estimate

• History

  • travel history, vaccination history, etc

• Vaccination status

  • which ones, doses, reactions, who administered

What does the client complaint (CC) tell us

tells us why they are here

T/F: Yes or no questions are sufficient to finding out more information

false

• opt for open ended questions to gather more info

What is the appropriate order of triage

1. emergencies

2. appointments

3. walk-ins

AVMA

American Veterinary Medical Association; the organization that defines the requirements for VCPR.

Signalment

A summary of key patient information including name, breed, sex, color, age, and weight.

Triage

assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties

Client Communication

The exchange of information between the veterinary staff and the client regarding the patient's health and care.

Why is the physical exam important

crucial for making medical decisions and evaluating

Documentation

The process of recording all aspects of patient care, which is crucial for legal and quality assurance purposes.

SOAP

An acronym for Subjective, Objective, Assessment, Plan; a method for organizing medical records and patient evaluations.

Differential Diagnosis (DDx)

A list of potential diagnoses that could explain the patient's clinical signs.

T/F: clients know everything you are saying in medical terms

false

• they have no to little medical education so you need to modify terms or explanations to match their needs

Estimates matter because

clients need to know if they can afford the services

• do not judge and give the same standard of care

• give them everything you deem necessary (itemized list) w/ explanation

  • this give them option to opt out of some services and write their reasonings/what was not given for your own records

T/F: you can do surgery without written consent if they verbally tell you

False

• ALWAYS requires written consent

• phone consent requires 2 people to hear and write down that they heard it

Client care includes

• communication

  • explain things in laymen’s terms

• education

• client handout

• questions

• payment for services rendered

T/F: Documentation is important and you should write everything down

true

Why is a medical record important

A medical record is a legal document

• failure to document often leads to internal control problems, liability/forensic concerns, embarrassment of the practice or client , or a reduced value per pet seen

• medical record keeping is everyone’s concern in the practice

• in quality vet healthcare delivery is there’s always time to document everything

• record everything that’s done, as it is done

• charge for everything that’s done

Client Education

The process of informing and teaching clients about their pet's health, treatment options, and care requirements.

What does SOAP stand for

S: subjective

O: objective

A: Assessment

P: Plan

Subjective (SOAP)

• Chief Complaint (CC): presenting problem

• History (Hx): owner’s story

• initial impression/observations

• Clinical signs (CS) noted

  • Vomiting/ Diarrhea (V/D)

  • Coughing/ Sneezing

  • Patient’s attitude

  • Appetite

• Past medical history

Objective (SOAP)

• vital signs

• findings of the physical exam

• lab data and results

• imaging (X-Ray) results

• recognition, review and recording of other doctors’ results

• any other diagnostic data

Assessment (SOAP)

• consolidation of Subjective and Objective data

• problems list

• differential diagnosis (DDx) list

• Diagnosis (Dx)

• Prognosis (Px)

Plan (SOAP)

• course of action RECOMMENDED to address the CC

• Diagnostics

• Treatments (Tx)

• Procedures- include risks

• advise

• instructions

• follow-up recommendations

Tips for Better Communication

1. Communicate Happiness

• happiness @ work is most accurate predictor of life expectancy

• take steps to make work more enjoyable

• happiness (and unhappiness) is obvious to clients

• smiling releases neurotransmitters that elevate mood

• make conscious effort to think and act in a positive manner

• if you show your clients that you enjoy your work, their pet, and them, they will reward you with affection and loyalty

Tips for Better Communication

2. Look and act professional

• professional dress and behavior demands respect

• dress and speak in an appropriate manner

• clients will judge you on your appearance

• your clients will only perceive your medicine as up-to-date if your dress, hairstyle, and hospital decor as well

  • impression are important

Tips for Better Communication

3. Listen to client, ask the right questions

• client concerns are always valid

• if they’re refusing care, ask them why

• it takes time, effort, training, and rehearsals to get your staff to be “patient advocates”

• questionnaires help streamline communication

  • helps determine what products and services that patient might need

• leading questions

  • prompt owner to mention things they may not think are significant

Tips for Better Communication

4. Be honest and don’t surprise them

• surveys show clients want to know the truth

  • less likely to sue if you tell the truth

• accurate prognosis

• accurate diagnosis

• all options for care are explained to client

• update clients when charges increase

  • as long as you acknowledge their comments or concerns, and even praise them for taking such good care of their pet, you’ll find that most of your clients keep coming back

Tips for Better Communication

5. Enthusiasm is contagious

• show them how interesting and exciting medicine and physiology can be, and your enthusiasm for latest and greatest treatments

• explain how complicated the body is and how sophisticated modern vet med can be

• make learning about their care fun

• give hospital tours

• explain services available

Tips for Better Communication

6. remember diff people learn best in diff ways

• be flexible in teaching habits

• use Laymen’s terms

• written material

• verbal comms

• models or diagrams

• read body language

  • if you don’t see the little light bulb going off over their head when you’re trying to explain something, try a diff approach

• ask them what they want your role to be

  • info presenter, advisor, decision maker

Tips for Better Communication

7. Repetition is key

• avg person needs to hear something at least 5x to remember it

• even motivated people remember less than 25% of what they hear

• written material is crucial

  • quality, professional, easy to read

• best clients are your most educated ones

• takes 5 reps to make a sale

Tips for Better Communication

8. treat clients as they are what they should be

• Don’t make pre-conceived judgements

• most people will rise to level of our expectations

• talk to them like intelligent adults who make intelligent decisions

• give your clients info to make good treatment decisions for their pets

• let them make a decision

• clear up any concerns or misinterpretations

• address $ concerns

• be clear, be concerned, and be persistent

Tips for Better Communication

9. Entire staff should be good communicators

• cannot handle all clients’ educational needs by yourself

• invest in training for entire staff

  • receptionists, technicians, and assistants

• income of practice is more dependent on skill lvl of staff than hours of operation

• clients should hear consistent recommendations from ALL employees

Tips for Better Communication

10. only way you can help your patients lead long and healthy lives is to educate their owners

• clients don’t have a degree in medicine or behavior

• take time and make effort to teach them what they need to know

• clients are decision makers

• vet staff are recommenders

• problems belong to client

• vet staff are problem solvers

Medical Record

A legal document that contains all relevant information about a patient's medical history and treatment.

Enthusiasm

A positive attitude that can influence client perceptions and engagement in their pet's care.

Repetition

A key strategy in communication, emphasizing that clients may need to hear information multiple times to retain it.

Professionalism

The conduct, aims, or qualities that characterize a profession, including appropriate dress and behavior in veterinary practice.

Client Portfolio

A collection of information about a client, including contact details and payment information, used for managing client relationships.

Client Handout

Written materials provided to clients to help them understand their pet's health and care instructions.

Veterinary Staff

The team of professionals, including veterinarians, technicians, and receptionists, who work together to provide care for patients.

Follow-up Recommendations

Suggestions made by the veterinarian for ongoing care and monitoring of the patient's health after the initial visit.

Body Language

Non-verbal cues that can indicate a client's understanding or confusion during communication.

Sus scrofa

genus and species of domestic swine

Pig (piglet)

young porcine

hog

older porcine

Gilt

female porcine before farrowing

sow

female porcine after farrowing

farrowing

giving birth

parity

each birthing event

boar

male porcine

barrow

male porcine that has been castrated

stag

male porcine castrated late in life, after developing secondary sex characteristics

shoat

domestic porcine of either sex, usually bt 60-160#

feeder pig

domestic pig, either sex; refers to end prod of farrow-to-feeder pig operation 30-100+#

roaster pig

domestic pig 100-190# sold for slaughter

• aka market pig

Characteristics of a pig

• gregarious

• strict social structure

• playful, curious, highly intelligent

• trained easily w/ positive reinforcement (i.e marshmallows)

• when frightened or confused: get excited, struggle and vocalize veraciously

• v similar anatomic/physiologic structures to humans

  • popular biomed science animal model

  • preferred animal for supplemental organs and tissues

Safety around pig

• sow w/ litter

  • strong maternal protective instinct

  • may attack- use caution when processing piglets

• boars

  • well developed canines/tusks

  • slashing motion when attacking (should be trimmed every 6M)

• knees

  • be aware of those running towards you

• hearing

  • high decibel screams

Identification of a pig (Ear Notches)

Pig ID through ear tags

Pig ID through temp ID

Handling/Restraint

• small pen

• hurdles/parturition

• let their natural curiosity take them

• never abuse/punish

Hand Restraint

Restraint Devices

Chemical Restraint

• Telazol

• Ketamine

• Anased

Risks of anesthesia (w/ Tx)

malignant hyperthermia

• uncontrolled pyrexia (condition where body temperature is higher than normal)

• muscle rigidity

• acid-base changes

---

Tx

• terminated ax administration

• IV procaine or dantrolene

• ccs

• hyperventilate

• sodium bicarb

• aggressive body cooling

IM injection sites

IV Injection sites

IV (<80#) injection sites

IV subcutaneous injection sites

Processing a pig

• ear notches

• tail docking

• clipping needle teeth

• injections

• castration

• vaccines

Tail docking prevents what

tail biting behaviors

Needle Teeth (Pros and Cons)

• Pros

  • helps prevent injury to sows udders

  • helps prevent face and body injury of other piglets that occur when piglets fight or attempt to establish a “peck” order

• Cons

  • clipping teeth too short and causing damage and/or infection to the gums

  • time and labor required to carry out procedure

Processing (injections)

Fe Dextran

• IM injections to prevent anemia from indoor raised piglets

Castration (processing)

1. hold piglet by both hind legs w/ its head down

2. using thumb, push up on both testicles

3. make an incision through skin of scrotum over each testicle in direction of tail

4. be sure incisions are made low on scrotal sac to allow for fluid drainage

5. doesn’t matter if you cut through white membrane on each testicle or not

6. pop testicles through each incision and pull on them slightly

7. pull each testicle out while pressing your thumb against piglet’s pelvis

8. thumb pressure on pelvis is important to ensure that testicular cords break off at point of your thumb rather than deep inside body, which may promote development of a hernia

9. if necessary, testicle may be cut free of cord using scraping motion

10. cut away any cord or connective tissue protruding from incision and spray wound w/ antiseptic

Vaccine protocol

• circovirus

  • diarrhea

• mycoplasma

  • joint infection

• rhinitis

  • atrophy of snout

• influenza

What info should the receptionist get from a new client

• name

• address

• phone number

• email address

• payment preference

Apppointment

• receptionist

• schedules either work-up or brief appointment

  • day

    • time

• doctor

• chief complaint: recent wt loss (for freddy)

• requests estimate prior to exam but willing to perform diagnostics

Signalment (for Freddy Flores)

• 8 yo

• male intact

• pitbull

• blue brindle

What was the chief complaint for Freddy Flores

recent wt loss

History of Freddy Flores

• taken by tech

• O owned p since a puppy

• no vaccine history

• never neutered (cost)

• not on F/T prevention but haven’t seen any ticks

• not on HW prevention

• eats Blue Diamond kibble and ppl food

• recently eating less

• no V/D, no coughing, no sneezing, no itching

• water intake/ urination wnl

Physical Exam (Freddy Flores)

• BAR

• T: 103

• P (pulse): 160

• R (respiration): pant

• haircoat: dull, lusterless

• BCS: 3/9

• Wt: 42.4# → 19kg

• Dry crustular nasum

• OU: sunken orbits, protruding third eyelids, injected sclera

• oral: missing few teeth, numerous worn teeth

• MM: pale, tacky

• LN (lymph nodes): NSF

• M/S: thin, no observable lameness, stiff on ambulation

• Neuro: CN wnl, proprioception wnl, withdrawals intact

• CV (cardiovascular): heart beats strong and regular, clear lung sounds in all fields

• Abd Palp: firm round soft tissue mass in the caudal ventral abdomen

• GI: NSF

• Repro/Renal: unilateral cryptorchid, R retained testicle

Rectal exam (Freddy Flores)

prostatic enlargement

Diagnostic plan for Freddy Flores

• CBC/CHEM/USUA

  • urine culture

• HWTAE

• Fecal floatation

• abdominal radiographs

• abdominal ultrasound

• CT scan

Estimate for Freddy Flores

• OV (40$): Vet exam

• CBC/CHEM/USUA (200$)

• U/S guided cystocentesis (25$)

• fecal floatation (25$)

• HWTAE (45$)

• abdominal radiographs (55$ initial; 50$ per rad)

• Ultrasound (120$ in house; 400$ referred)

• CT scan (800$ + anesthesia)

---

Owner declines

• add rads

• referred U/S

• CT scan

Sample collection

Venapuncture

• EDTA purple top

• Serum red top

---

Ultrasound Guided Cystocentesis

• white top

---

Fecal loop

• fecal float tube

ALB (CHEM panel)

albumin

• major protein found in body

• carries various substances through blood and important in maintain pressure within vessels

• high lvls = dehydration

• low lvls = chronic inflammation, liver disease, kidney disease, starvation and blood loss

ALP (CHEM panel)

• alkaline phosphatase

ALKP

• important in metabolism and found in liver cells

• high lvls = bile duct obstruction, cushing’s, liver disease, certain cancers and may be due to certain drugs such as steroids or phenobarbital

• low lvls = starvation/malnutrition or end stage liver disease

ALT (CHEM panel)

• alanine aminotransferase

• important in metabolism of nitrogen and most often assoc w/ liver

• high lvls = liver damage, toxin ingestion, Cushing’s disease, and various metabolic disorders

• low lvls = starvation/malnutrition or end stage liver disease

AMYL (CHEM panel)

Amylase

• secreted by pancreas

• important in normal digestion of starch

• high lvls = pancreatic inflammation or cancer, kidney disease, prostatic inflammation, diabetic, ketoacidosis, and liver cancer

• low lvls = malnutrition or starvation