What is a VCPR, and how can it benefit you, your veterinarian, and your horse?
Any relationship can be challenging at times. When a third party comes into the picture, however, the work gets even harder. Let’s say the relationship affects the health of one, the finances of another, the professional reputation of the other, and the general well-being of all three.
When it comes to the veterinarian-client-patient relationship (VCPR), that’s exactly what we’re looking at: three individuals coming together to form a mutually respectful (as much as the horse is capable, of course), long-term bond that focuses on the horse while safeguarding the veterinarian and the owner. It’s not an easy task! And it takes a lot of thought and consideration.
That’s why we’ve gone to the “relationship experts” of the equine veterinary world. To help you better understand the ideal VCPR—a relationship that carries a lot of weight in our horsey lives—we’ve sought out the signs of a healthy one. How does yours line up? And how can you better meet your relationship goals?
1. The horse is the focus.
The VCPR isn’t just a concept; it’s an American Veterinary Medical Association requirement for dispensing medications and a legal requirement for veterinary care in most states. And for good cause: If a VCPR is healthy, the horse is at the center—not owners’ competitive, breeding, or business goals; not their efforts to save time or money; and not veterinarians’ professional aims.
“If I could rewrite the VCPR acronym, I’d put the P for patient first, because the key to that VCPR is that the horse always comes first,” says Harry W. Werner, VMD, of Werner Equine LLC, in North Granby, Connecticut. “Certainly we the veterinarians are there for the needs and wants of the clients—but only as long as those needs and wants are legitimate and consistent with the health and welfare of the horse, who is priority.”
A good vet shows compassion—a trait that ranks as high as, if not higher than, knowledge and skills, says Werner. Good owners place the horse’s health and welfare above their own objectives or dreams, whether that means forgoing a competition, skipping a breeding season, or even choosing to humanely euthanize instead of prolonging suffering.
“My definition of a good client is one who wants you there for the horse,” he says.
2. Ethical practice is priority.
Ethical practice means not only doing what’s best for the horse but also maintaining a level playing field in equestrian sport. The humans in the VCPR equation must be prepared to uphold high ethics and support each other in doing so, regardless of the consequences, Werner says.
“There’s a lot of pressure on caregivers and stakeholders to do whatever possible to achieve the highest ranks in performance,” he says. “A good VCPR is an insurance policy against any medical, surgical, or pharmaceutical practices that are designed only to get the horse in the ring and get the ribbon. If owners and veterinarians make ethics the heart of their shared philosophy, this isn’t going to occur.”
Here the concept of “shared” is critical, says Sid Gustafson, DVM, whose equine practice is based in Bozeman, Montana. “The people in the VCPR have to match up in their beliefs and ideologies, without any coercion, pressure, or manipulation, if it’s going to be a successful relationship,” he says.
Veterinarians who refuse certain practices on ethical grounds might not get called back to certain farms or events, Werner says. And owners might have to “wrestle with accepting a lower return on investment.” But he says those potential consequences must pale in comparison to doing what’s right.
“When it comes to ethical veterinary practices, have your radar out, take the high road, and stay on it,” he says.
3. Communication and trust are key.
Owners and veterinarians need clear lines of communication that allow for and even promote fluid, open conversation about the horse, as well as confidence in each other, our sources say. This means listening well and communicating clearly and in a straightforward manner.
“Email and texting are great tools because they keep the dialogue going without having to be concerned about the other person’s availability,” says Susan Werner, business manager at Werner Equine and Harry’s wife. “They also give a good written record so everyone’s clear on what’s been said.”
Good communication also helps the people in the relationship understand when errors happen, says Gustafson. “Vets and clients alike are human and, therefore, imperfect,” he says. “Of course there will be mistakes sometimes (e.g., interpreting a test result incorrectly). But an open exchange helps reduce the risk of errors and also helps put them into perspective when they do occur.”
As such, strong communication is critical toward building mutual trust, our sources say. “People can really gain confidence just keeping the dialogue going,” Gustafson says.
When things go wrong, or when owners must face difficult decisions, communication and trust become even more essential and help pave the way for an optimum outcome, he adds.
4. The vet is involved in every decision, even at a distance.
Even when one party is absent, there still needs to be continuity of care within the established VCPR, our sources say.
A veterinarian that’s part of a productive VCPR knows a horse’s health history, training and management, nutritional background, and more. This helps build a strong, global picture that allows the veterinarian to give optimum individualized care, says Gustafson.
Unfortunately, we often overlook that when we’re at events. “Something that’s particularly disturbing in today’s equine competition world is the lack of legitimate VCPR in the upper levels,” Harry Werner says. “Certain (veterinary) outfits show up … with a tractor trailer pharmacy and pretend they’ve got VCPRs with the horses there, but they don’t.”
Gustafson agrees. “They know little or nothing about these horses, and it’s often the first time they’ve seen them, and there’s usually no physical exam or attempt to know the horse’s background so, in the end, the humans are failing the horse,” he says.
In a good VCPR owners and veterinarians collaborate to ensure good transfer of information even at events, Susan Werner says. That includes long-distance consulting, as well as accurate, thorough record-keeping.
“With modern technology, it’s easy to maintain good records and to share them,” she says. To be useful, records must be timely, comprehensive, and written in language other clinicians can easily understand.
5. All parties related to the horse are in the loop.
The VCPR should expand far beyond the three main parties, our sources say. It must acknowledge the roles of everyone involved in the horse’s veterinary care.
“In a good VCPR, the veterinarian has enfranchised the owner as part of the health care team, as well as the trainer, the farrier, and all other caregivers,” Harry Werner says. “The veterinarian will have identified all the people that affect the condition of the horse—in a positive or negative way—and include them into the team.”
In bad VCPRs the farrier or dental practitioner or stable manager, for example, might get overlooked. And, in some cases, even the veterinarian can be out of the loop. “If more veterinarians were involved in decision-making about conditioning practices, there might be fewer health issues related to training,” Gustafson says.
6. Internet use is responsible—and shared.
The internet empowers owners with access to unlimited equine health care information, says Harry Werner. That information—provided it comes from reputable sources—can be useful and even helpful in diagnosing and treating a case, but it can’t stand alone, he says. It can’t replace the near-decade of the veterinarian’s professional training and possibly far more years of experience, and it can’t replace the individualized attention that comes through a VCPR.
“I hear about Dr. Google all the time,” says Harry Werner. “It’s important to not dismiss what owners say they’ve read. I’d rather they share the link with me so we can discuss it together, because it’s possible it’s a product I haven’t heard of. This can build confidence and good communication, as well.”
Online veterinary evaluations, however, don’t fit into the VCPR—unless they’re follow-ups to an established relationship, says Gustafson. Telemedicine cannot yield good care for the horse if the veterinarian isn’t part of the VCPR. “So much comes from knowing how the horses live day to day in their home environment, and you just can’t get that information over a computer screen,” he says.
7. Boundaries and roles are respected.
Each member of the VCPR brings his or her own responsibilities and roles to the relationship. It’s up to the others to recognize and respect those, says Gustafson. “I don’t want a client calling me to tell me her horse needs an X ray or saying he wants his horse to take a certain medication because it worked well on his friend’s horse,” he says. “I’m not a pharmacy technician or a radiograph technician. This isn’t respecting my role as veterinarian. Rather, let me evaluate the horse and, when I’m there, ask if that medication or that X ray might be useful, and we can talk about it.”
Likewise, it’s important for veterinarians to respect their clients’ knowledge and capacities, he adds. “Nobody likes to be talked down to, and vets don’t get very far by being arrogant,” he says.
Owners also provide critical information through their observations that veterinarians need to recognize and appreciate, even if it’s just a gut feeling that something’s wrong, Susan Werner says.
On all sides of the relationship, our sources agree that boundaries are important. While it’s good to be friendly, the relationship should remain, above all, professional. “There needs to be some kind of space, so that decisions aren’t made based on how the other person is going to feel about you,” Gustafson says.
8. Parties are transparent about finances.
Money can destroy any relationship, including a VCPR. To have a healthy attitude toward money exchanges, it’s necessary to have full transparency with finances on both ends, says Susan Werner.
“Veterinarians need to be clear from the beginning about what the fees and payment terms are, to avoid unpleasant surprises,” she says.
Equine veterinary care can be costly, but it’s helpful for owners to understand the value they’re getting from advanced, albeit more expensive, technology, says Harry Werner. “If I communicate with owners about the multiple advantages of a technique before we perform it, and they appreciate that, we can avoid sticker shock when the bill comes,” he says.
And clients need to feel comfortable discussing finances openly with their veterinarians—including acknowledging that some options are out of their price range. “The goal is for owners to have timely information in a way that they can make informed choices,” Susan Werner says.
9. There’s chemistry.
Even when everyone does everything right, sometimes relationships fail simply because the chemistry isn’t there. And VCPRs are no exception.
“You need to match up with people you get along with,” Gustafson says. “That has nothing to do with medicine or knowledge. Maybe politics, maybe culture, maybe personality, who knows? But that match needs to be there.”
A good way to build that, or at least look for it, is in the physical exam, Harry Werner explains. Like with human patients, the physical exam is an opportunity to evaluate much more than the patient’s physical health. It’s when doctor and patient get to know each other.
“That’s the buying part, so to speak,” he says. “It’s often during that exam that you know if the connection is there or not.”
Sometimes the chemistry isn’t there with the horse, either. “You might have an owner with seven horses, and one of them just doesn’t seem to feel comfortable with the vet,” Gustafson says. “Who knows why? Maybe something in the horse’s past or something we can’t explain. But if that’s the case, the owner should consider a different veterinarian for that one horse—one he gets along better with.”
10. There’s tact, kindness, and respect when ending a relationship.
Not all relationships work out, for a variety of reasons—different ideologies, lack of confidence, poor chemistry, etc. When they don’t, they need to come to a close with tact, kindness, and respect, says Gustafson.
“Veterinarians and sometimes owners are professionals, but they’re also humans, and they have feelings,” he says. “It’s okay to end a relationship, but that needs to be handled appropriately. Sometimes a bad relationship with a client can really ruin a veterinarian’s day while he’s still needing to concentrate on the care of other patients. And that can be similar for owners.”
Whether it’s the veterinarian or the owner that makes the call, it’s important they inform the other party directly and with professionalism, through a tactful letter, email, or telephone call. No need to go into long details about why it’s ending or harp on old problems. No need for rudeness and certainly not for spreading negative information in social circles or on social media. (However, serious welfare concerns do warrant discreetly informing authorities or welfare organizations.)
Likewise, the party on the receiving end should accept the departure with tact and respect, our sources say.
A positive VCPR plays a vital role in upholding the health and welfare of the relationship’s primary focus: the horse. But it doesn’t happen on its own; it requires thought and effort on the part of all humans involved. Consider the relationship from each party’s point of view, and strive to build a healthy VCPR.