Re: Roles as a CCRP

[Guest guest]

Christi

 

I've been in the situation you describe.IMO, we are acting in the same arena as a referral surgeon, internist or dermatologist etc. Thereforre if I need images that are more diagnostic, I take them. I carefully explain to the owner that I need them. On the other hand, the other night I had a lab with bilateral stifle disease. The prev DVM wouldn't release the images without a 25 dollar fee. I told the owner that I don't need the images to make the dx, and at the time of surgery I would get my own images. If have knowledge of case management that needs certain meds, I prescribe them. If the client then wants to go back to their DVM for refills, that's their choice.

 

Richatrd Freedman VMD CCRT

 

Hello there.  I was wondering what everyone's thought is on prescribing meds, performing x-rays, etc. as a DVM, CCRP.  Isn't it our job (even as a referral) to control the pain of our patients?  And if we are working with the patient in our rehab facility, can't we address pain as part of our rehabilitation plan?  We had extensive lectures on pain in our certification program.  Is it not ok to dispense Tramadol or NSAIDs, etc. for pain and inflammation?  What about Adequan injections?  Do we have to send them back to the rDVM for everything even though we make the recommendations for pain/inflammation control?  What if we get a patient for kind of a second opinion and radiographs have been taken.  Sometimes, I want to take rads myself and get a better view, get a view that I can control the positioning and not rely on someone else doing it, feel for a drawer myself, etc.  What do you think?  Is that crossing the line?  Thanks for your input.

 

Christi , DVM, CCRP

-- Regards,

[Guest guest]

Hi Christi,

 

I work in a multi-specialty referral practice and this issue comes up a lot.  I can tell you that if you hope to grow your practice and continue receiving referrals from the veterinary community, it is wise to keep a good working relationship with the veterinarians who are referring cases to you.  I completely agree that is appropriate for us to prescribe medications related to the ailment that we are treating and performing diagnostic tests such as radiographs, or tick titers, or DM testing, etc., however, if it is a referral, I would have a conversation with the rDVM prior to running these tests.  More often than not, their response it to go ahead and do the tests here and I think they highly appreciate the fact that I am asking before I actually proceed.  I find that clients are quite understanding too if you explain that your goal is to improve the patients quality of life by working closely with their rDVM, which means they may need to go back to them from time-to-time.  Clients will appreciate you working with their rDVM closely rather than having an antagonistic relationship.

 

You will receive far more referrals from local veterinarians than you can receive from word of mouth or other direct client sources.  If you develop a good reputation with the rDVM community you will be busier than you ever imagined.

 

My 2 cents.

 

Best,

-- Leilani Alvarez, DVM, CVA, CCRT

 

 

Hello there.  I was wondering what everyone's thought is on prescribing meds, performing x-rays, etc. as a DVM, CCRP.  Isn't it our job (even as a referral) to control the pain of our patients?  And if we are working with the patient in our rehab facility, can't we address pain as part of our rehabilitation plan?  We had extensive lectures on pain in our certification program.  Is it not ok to dispense Tramadol or NSAIDs, etc. for pain and inflammation?  What about Adequan injections?  Do we have to send them back to the rDVM for everything even though we make the recommendations for pain/inflammation control?  What if we get a patient for kind of a second opinion and radiographs have been taken.  Sometimes, I want to take rads myself and get a better view, get a view that I can control the positioning and not rely on someone else doing it, feel for a drawer myself, etc.  What do you think?  Is that crossing the line?  Thanks for your input.

 

Christi , DVM, CCRP

[Guest guest]

I agree wholeheartedly! Call the rDVM and simply say "Based on what I'm seeing I think that this patient could benefit from a short course of pain medication. From my past experience I usually recommend Tramadol. Do you have that available to dispense or would you prefer for me to send it with them today?"

I am not yet certified, however our clinic does see many referred cases for reproductive work, orthopedic surgery, ultrasound and laparoscopy...so we do try to be respectful of any procedure that the rDVM can feasibly do on their own or did not specifically ask us to do.

a

Re: Roles as a CCRP

Hi Christi,

I work in a multi-specialty referral practice and this issue comes up a lot. I can tell you that if you hope to grow your practice and continue receiving referrals from the veterinary community, it is wise to keep a good working relationship with the veterinarians who are referring cases to you. I completely agree that is appropriate for us to prescribe medications related to the ailment that we are treating and performing diagnostic tests such as radiographs, or tick titers, or DM testing, etc., however, if it is a referral, I would have a conversation with the rDVM prior to running these tests. More often than not, their response it to go ahead and do the tests here and I think they highly appreciate the fact that I am asking before I actually proceed. I find that clients are quite understanding too if you explain that your goal is to improve the patients quality of life by working closely with their rDVM, which means they may need to go back to them from time-to-time. Clients will appreciate you working with their rDVM closely rather than having an antagonistic relationship.

You will receive far more referrals from local veterinarians than you can receive from word of mouth or other direct client sources. If you develop a good reputation with the rDVM community you will be busier than you ever imagined.

My 2 cents.

Best,

-- Leilani Alvarez, DVM, CVA, CCRT

Hello there. I was wondering what everyone's thought is on prescribing meds, performing x-rays, etc. as a DVM, CCRP. Isn't it our job (even as a referral) to control the pain of our patients? And if we are working with the patient in our rehab facility, can't we address pain as part of our rehabilitation plan? We had extensive lectures on pain in our certification program. Is it not ok to dispense Tramadol or NSAIDs, etc. for pain and inflammation? What about Adequan injections? Do we have to send them back to the rDVM for everything even though we make the recommendations for pain/inflammation control? What if we get a patient for kind of a second opinion and radiographs have been taken. Sometimes, I want to take rads myself and get a better view, get a view that I can control the positioning and not rely on someone else doing it, feel for a drawer myself, etc. What do you think? Is that crossing the line? Thanks for your input.

Christi , DVM, CCRP

[Guest guest]

 

I agree wholeheartedly!  Call the rDVM and simply say " Based on what I'm seeing I think that this patient could benefit from a short course of pain medication.  From my past experience I usually recommend Tramadol.  Do you have that available to dispense or would you prefer for me to send it with them today? "  

 

 

I like this approach.HOWEVER, I usually see patients after 6 pm, and I can't call the rDVM, they've gone home. So do I tell the client to wait until their next appointment (usually in a week) to get the pain meds from me after I have chatted with their vet, or make them drive back to their vet (90% of clients DON'T want to make another trip to their vet, people are busy and gas is expensive) or do I give it to them right away? What I'm often recommending these days is gabapentin, and we don't even carry big enough capsules for dogs over 20#, so I am sending them off with an Rx to a pharamacy.

 

We are very concerned about not antagonizing referring vets or be perceived to be stealing any business. But most of the time when I recommend someone go back to their vet for testing or meds, they just don't do it, so we don't get the testing or the meds (some do, but most don't). Also I find that about 75% of my clients are not being sent by their vet anyway, they are finding us on the web and coming on their own.

 

Pam Mueller PhD DVM CCRT pending

Animal Therapy Center Bethlehem

[Guest guest]

Pam,

Obvioulsy I have no idea of the personality of the veterinarians in your region, however if this happened to me repeatedly I would, outside of a regular appointment, call the rDVM and explain to them in advance how I like to handle these cases. Not as a question but more as a statement of fact...that often patients come in after thier office is closed and under those circumstances I would probably dispense medication to them to give them pain relief and that I would get started on any preliminary testing that we felt was needed.

As for those that find you online and come on your own...in that circumstance I would feel no obligation to the rDVM. I only feel obligated to nurture that relationship if the rDVM sends the case because it is their word of mouth that got the client there. In the case of a client that comes on their own...I would follow up with a call to the regular DVM and simply introduce yourself, update them on the findings and the recommendations, and let them know that you are sending them back for routine stuff. If they are pleased with the level of communication and the client percieves good service, they MAY start referring more cases.

I live in a very rural community and so I am struggling to even open up a dialogue on rehab for my patients. I am hopeful after the therapist module in December I will have more tools in my verbal arsenal to do just that.

a

Re: Roles as a CCRP

I agree wholeheartedly! Call the rDVM and simply say "Based on what I'm seeing I think that this patient could benefit from a short course of pain medication. From my past experience I usually recommend Tramadol. Do you have that available to dispense or would you prefer for me to send it with them today?"

I like this approach.HOWEVER, I usually see patients after 6 pm, and I can't call the rDVM, they've gone home. So do I tell the client to wait until their next appointment (usually in a week) to get the pain meds from me after I have chatted with their vet, or make them drive back to their vet (90% of clients DON'T want to make another trip to their vet, people are busy and gas is expensive) or do I give it to them right away? What I'm often recommending these days is gabapentin, and we don't even carry big enough capsules for dogs over 20#, so I am sending them off with an Rx to a pharamacy.

We are very concerned about not antagonizing referring vets or be perceived to be stealing any business. But most of the time when I recommend someone go back to their vet for testing or meds, they just don't do it, so we don't get the testing or the meds (some do, but most don't). Also I find that about 75% of my clients are not being sent by their vet anyway, they are finding us on the web and coming on their own.

Pam Mueller PhD DVM CCRT pending

Animal Therapy Center Bethlehem

[Guest guest]

Christi

I have a very strong opinion about this question and it comes from experience

from working in an emergency and referral background for many years as a tech

and then as a practice manager.

It is imperative that you do what is right for the patient. If the pet needs

pain medication now. Dispense it now! The amount you dispense is the key.

Dispense enough to get the pet through until the next recheck with you or their

RDVM. You may find that some DVMs don't carry what the pet needs as they are

not as advanced in pain management as you are or they have a limited pharmacy.

If they do carry it then they can dispense it if they want. They may not want to

carry it so then the client can purchase it from you.

The same goes for Adequan, or other joint supplements and food. Not every

clinic hosts the same product lines. You must be able to stand behind your

product choices and prescribe them. If there is suitable alternative that is

dispensed by the RDVM or one the client can purchase over the counter at a pet

specialty store you have to be able to say why your product is better or condone

an alternative selection.

Running diagnostic procedures... If it is the best for the pet and will allow

you to diagnose or treat the pet in a timely cost effective measure for the

patient and the client. Do It! You may have access to labs for sending specific

tests out, more skill in radiographic positioning for what you are looking for.

Communication is key to a successful practice. If rehabilitation is new to your

area or you are a newly certified CCRP, host an open house or a CE meeting at

your facility or meet with some of your potential referring DVMS. Keep your

referral letters timely and have an educational " ahh moment " in them, explain

your expectations of what you would like the RDVM to do with that patient and/or

what you would like to do with that patient. If appropriate pat them on the

back. If there a misdiagnosis call them and talk to them about it. Do not

scold them in writing. Remember professional courtesy. Give the RDVM the

option to handle what they can with follow up if they can

Meet with local dog clubs, shows, events or do CE at with the local TV or radio

channel. Remember with the advertising to keep it to the benefit of the

profession not just yourself but don't hesitate to say your name and toot your

credentials. Caution with free advice to clients.

In the exam room with the clients and their pets, remember you have only a few

seconds to make a profound first opinion. Don't blow it. Have confidence in

yourself and your skills. Compliment the pet and the client where appropriate.

If the client is investing in a referral, they care about their pet. Teach them

things they can do at home to benefit the pet's care. Tell them what you want

to do and why it is important. They will research you and your information on

the internet. Educate them on what sites to visit if they want to check things

out (always send them back to you or your website for more info or sites you

promote).

I like to believe that a referral practice is an extension of the community

practice that has referred to you. If you keep your boundaries clear about what

you can and will do and maintain that integrity you will build the trust of the

neighboring clinics. If you " pop " a Rabies vaccine because the client is at

your practice and they are due for it and you want to save them the drive or a

few dollars for an office call, you will blow the trust factor of that referring

DVM. It is better to put off that one client who maybe will come to you and pay

you $2000 over the year than alienate a RDVM who can refer up to $20 000 or more

in a year.

Veterinary medicine is based on trust and how you make people feel. In this

economy, people want value for service. Rehabilitation is new and people need

to know that there is value and need to feel good about you and what you offer.

I just stepped off of my soapbox as the choir sang their last note!

>

> Hello there.� I was wondering what everyone's thought is on prescribing

meds, performing x-rays, etc. as a DVM, CCRP.� Isn't it our job (even as a

referral) to control the pain of our patients?� And if we are working with the

patient in our rehab facility, can't we address pain as part of our

rehabilitation plan?� We had extensive lectures on pain in our certification

program.� Is it not ok to dispense Tramadol or NSAIDs, etc. for pain and

inflammation?� What about Adequan injections?� Do we have to send them back

to the rDVM for everything even though we make the recommendations for

pain/inflammation control?� What if we get a patient for kind of a second

opinion and radiographs have been taken.� Sometimes, I want to take rads

myself and get a better view, get a view that I can control the positioning and

not rely on someone else doing it, feel for a drawer myself, etc.� What do you

think?� Is that crossing the line?� Thanks for your input.

> �

> Christi , DVM, CCRP

>