January 05, 2015

(Dan) Hey folks, welcome to Doc Talk. I’m glad that you joined us today, it’s gonna be a great show. Dr. Brian Lubbers from the Veterinary Diagnostic Lab at Kansas State University is going to join us today. We’re gonna talk about what a valid veterinary/client/patient relationship is and how you can utilize your veterinarian. Thanks for joining the show. Hope you enjoy it. Stay tuned. Closed Captioning brought to you by AgriLabs, the Perfect Pairing of Performance and Value. (Dan) Hey folk,s welcome to the show. Brian, welcome to the show. (Brian) Thanks. (Dan) It’s a pleasure to have you all here. This is Dr. Brian Lubbers and Brian is Director of Microbiology at the Kansas State Veterinary Diagnostic Laboratory here in the College of Veterinary Medicine at Kansas State University. And Brian, we get to talking about some of these things. And you’re boarded in pharmacology. (Brian) Hm uh. (Dan) And we start about the things coming down the road as far as antibiotics, drugs, usage, on farm recommendations. People really need to be working with their veterinarian and getting their veterinarian on the farm. And that starts by having a valid veterinary/client/patient relationship. (Brian) Yep, that’s right. And I think it’s important to remember too, that this is actually in the federal regulations. This is not something that just the veterinary profession decided we needed to do, this is an important part of antibiotic use and prescribing from the federal side too. (Dan) You bet. And you know it’s… we’ve gotten a little bit of a different situation with the rural practitioner and being spread out but really when it comes down to judicious antibiotic usage there’s no difference between the pediatrician and the child prescribing and the veterinarian prescribing for cattle. (Brian) Absolutely not. In both of those instances we’re relying on a trained professional with scientific knowledge to really make appropriate medical recommendations, very similar. (Dan) Yea. And it’s a huge responsibility for the veterinary professional. (Brian) It is. It is. Yep. (Dan) When you start to think about antibiotic resistance and the things that we’re talking about, that’s being laid at the feet now and the responsibility and the accountability to that practicing veterinarian. (Brian) Yep. Absolutely. (Dan) So, let’s get down to, what is a veterinary/client/patient relationship? (Brian) A veterinary/client/patient relationship, and that’s the spirit of it, right? It’s a relationship between those three parties, the veterinarian, the client, the livestock producer and then the client’s animals which is the veterinarian’s patient. And so when we look at veterinary/client/patient relationships and the regulations there are four conditions that they’ve laid out to have a valid veterinary/client/patient relationship. The first is that the veterinarian has assumed making all the medical decisions for that producer and those patients. The second is that the client has agreed to follow those instructions. So, whatever the veterinarian recommends the client has to follow that. The veterinarian has to have enough knowledge of those animals and that operation to make appropriate medical decisions. And so, the guidelines don’t specify a number of visits or time frame, but they do say, that the veterinarian has to have a physical presence on that farm. And then the last one is that the veterinarian is readily available for follow up in case of bad drug reactions or things aren’t working as they expected to. (Dan) So really it’s…the veterinarian’s got to be able to be on the farm, has to have working knowledge of the herd and you get back to the place where the producer is agreeing…that relationship isn’t one sided. (Brian) Right. Oh, absolutely not, no. It is a veterinary/client/patient relationship. So, everybody is involved with that. (Dan) Cool. Well, let’s take a break. When we come back, let’s start to tease down through these four conditions and we can start to discuss a little bit about how we build that relationship. (Brian) Sure. (Dan) Thanks. Thanks for watching Doc Talk. More with Dr. Brian Lubbers from the Veterinary Diagnostic Lab at Kansas State University after these messages. (Dan) Hey folks, welcome back to Doc Talk. Dr. Dan Thomson here with Dr. Brian Lubbers where he is the Director of Microbiology at the Veterinary Diagnostic Laboratory here in the College of Veterinary Medicine at Kansas State University. And we’re talking about something that is really important for producers and veterinarians to understand and to adhere to and that’s a veterinary/client/patient relationship. And as we discussed during the break Brian, there are verbal and written VCPRs. (Brian) Right. And I think, you know, it’s really up to the veterinarian and the client what they’re comfortable with to decide is a verbal agreement enough, or do we want something in writing. It’s not specified, it’s not required to have either or form. But it’s important that both parties agree, this is the way we want to proceed. (Dan) And as we’re moving forward in some of these farm assessments like beef quality assurance assessments and the farm assessment for dairy and PQA Plus for swine. We’re in those programs, they actually require a signed veterinary/client/patient relationship. You know, the veterinarian has said I’m on the farm. We have a relationship. And the producer is saying I am going to adhere to the protocols of Dr. XYZ. And so it is becoming a lot more formal. But…so talk to me a little bit about the difference in farm size and you know, how that plays into like a written versus a verbal… (Brian) Sure. And I think probably the underlying point is that these are federal regulations, but they were built with enough flexibility to try to tailor to every situation out there. So, you have a small cow/calf operation that doesn’t have a lot of change in the operation; they’re pretty consistent. They’re not bringing in new animals, their veterinarian… they have one veterinarian that they work with. That veterinarian prescribes all their drugs, that veterinarian writes their treatment protocols, maybe designs their vaccination protocols, all of that you know, that’s a pretty intimate relationship and everybody probably understands that. I’m your veterinarian and you’re my client and we are in a VCPR. And maybe one or two visits a year is enough, for me to come out and really feel like I know your operation and what’s going on with those animals. You know, on the flip side we have a very large dairy or stocker operation or feedyard with new animals coming in a lot. The situation for that particular operation is changing pretty frequently, maybe there are multiple veterinarians involved. So, there might be a primary veterinarians involved and then maybe a consultant on top of that. It’s probably more important in that situation to have a more formal agreement in place to really define who’s role is what. (Dan) And it keeps everybody on the same page. (Brian) Absolutely. Keeps everybody on the same page. (Dan) One of the things when we were going down through there was time frame does not specify as far as number of visits, you know, and you say that that could be dependent on the type of operation as well. (Brian) Yea. And again, it’s all about flexibility to tailor to every operation out there. But at the end of the day really, it’s what is that veterinarian and what is that client comfortable with? The veterinarian has to feel like he has enough knowledge of the situation at any given time. And the client really it benefits the client too if the veterinarian knows what’s going on on their farm. (Dan) Yep. Well, we’re gonna take a break folks. This is Dr. Brian Lubbers. He is the Director of Microbiology at the Veterinary Diagnostic Lab at Kansas State University. When we come back, we’re gonna talk a little bit more about drug use, veterinary/client/patient relationship and following some of the rules and guidelines. Thanks for watching Doc Talk and we’ll be back right after these messages. (Dan) Hey folks, welcome back to Doc Talk. Dr. Dan Thomson here with my friend and colleague Dr. Brian Lubbers. He is from the Veterinary Diagnostic Lab here at the College of Veterinary Medicine at Kansas State University where he serves as the Director of Microbiology and he is a boarded pharmacologist, which means that he is a veterinarian that deals a lot with bugs and drugs. (Brian) Yep. That’s what I do. (Dan) And so, we’ve been talking about the veterinary/client/patient relationship. And so, why do we need to have the veterinary/client/patient relationship? I hear producers say, I don’t need a vet our at my place. Or I hear you know, the… some people have a very good relationship with their veterinarian and some people say, I don’t need one. And so why do we have to have this veterinary/client/patient relationship? (Brian) Sure. So, the veterinarian client/patient relationship was originally defined for a couple of specific reasons. and the first one was prescribing drugs. So, any prescription drug, you have to be in that relationship. Very similar to your example earlier about the pediatrician. You know it’s very similar. Any time an antibiotic is used extra labeling, so that means anything that’s not on… so if it’s used for a different animal species, a different disease, a different dose, any of those things, there has to be a veterinarian involved with a valid veterinary/client/patient relationship. So, that was kind of the original reason for having the VCPR. (Dan) OK. And there are some drugs that are over the counter and things to that nature. But even some of that is changing as far as in the feed and things as we’re moving forward. And so, that VCPR is going to be important even for some of the things that used to be non… (Brian) Yeah, absolutely and that’s why… we’re seeing a refocus back on the valid… the definition of valid veterinary/client/patient relationship. Because there are new regulations that are currently going into place by December of 2016. Those will be finalized and will be in effect and a lot of those regulations… the keystone of that is veterinary oversight. And really that’s just another way of saying- having a valid veterinary/client/patient relationship. (Dan) So talk to me a little bit about.. because I think that it… I think that the producer, it has taken a drift to not understanding that the veterinarian and having that veterinarian on the farm, whether it’s for a herd health check, or to establish that VCPR, to establish your treatment protocols it really protects the producer. (Brian) Absolutely. I know from when I was in practice. And certainly there’s all kinds across the spectrum, but I think if you’re in a situation where you view the veterinarian as another expense line in the farm budget, I think when a valid veterinary/client/ patient relationship is done correctly, there should be mutual benefit across the board. And it starts with animal health and welfare. But generally those things spill over into productivity. And veterinarians are trained to do all of those things, right? We’re trained to correct animal health issues, but we’re also trained to maximize productivity and so I think having that relationship should be beneficial to everybody involved. (Dan) Absolutely. I don’t know how many hours we spend either giving or taking continuing education credits, but our job is to also kind of serve as that sounding board of bringing the new technology, the new production practices, to the farm. And so work with your local veterinarian, get ’em out to the farm, and utilize that veterinary/client/patient relationship because your livelihood and your farm’s livelihood depends upon it. We’re gonna take a break. When we come back more with Dr. Brian Lubbers talking about the valid veterinary/client/patient relationship. (Dan) Hey folks, welcome back to Doc Talk. This is our final segment with Dr. Brian Lubbers about veterinary/client/patient relationships, but really what we’re talking about when we moved into this veterinary/client/patient relationship is we’re talking about stewardship of antibiotics. And what I mean by that is we need to really be stewards of these technologies so we can have them be effective. I heard down there at the CDC where you and I were on a program and they said that we’re entering a time where because of resistance to antibiotics in humans that we could be going back to a time where people are dying from the simple infections that they had before we had antibiotics. (Brian) We talk about the post antibiotic era. And another thing too that I don’t think probably gets enough attention, is we have problems with antibiotic resistance in veterinary medicine too. (Dan) Big time. (Brian) I know from our lab we track those things and we are seeing some increases in antibiotic resistance, so the antibiotics don’t work to some bacteria that are pretty important in veterinary medicine too. (Dan) Yea. So talk to me then about why… I mean we’ve established this veterinary/client/patient relationship. But really the veterinarian and the producer have a responsibility to society and a responsibility to the animals of getting this right. (Brian) Right. And that’s what, you know the deeper that VCPR relationship goes, the more you get into those kinds of things. And so I think that’s why we can never emphasize too much having that relationship. But you know the short version of that answer Dan is if we’re trying to maximize the efficacy, the ability of our antibiotics to work, and minimize the development of resistance really we’ve got three things we need to do. (Dan) OK. (Brian) We look for alternatives to antibiotics whenever they’re effective, so not using them is always a good first step. When we need to use antibiotics, we use them at the right dose or at the right time to maximize the efficacy and minimize the resistance there. And then the last piece of that is to evaluate to make sure those antibiotics are working like we think they were. And then that really is a cycle, it’s not a one, two, three. We should always go back to- can we find alternatives to using antibiotics? (Dan) It’s a continuous improvement. (Brian) Yep. Absolutely. (Dan) And it’s a cycle you’re making adjustments in your management- shelter, nutrition, preventative medicine, vaccines, all those things- working through a total herd program with the veterinarian which then comes back to decreased antibiotics usage. (Brian) Yep. And you mentioned earlier about bringing new technologies. You know that is the veterinarian’s job, or one of his roles in the VCPR – to bring in new technologies. And these things change all the time. And so non antibiotic alternatives are kind of an area of research that’s pretty hot right now. So if that’s one of our goals is to minimize use of antibiotics, that’s a very strong role for the veterinarian. (Dan) Cool. Well thanks for being on the show today. Thank you for watching Doc Talk. And remember when you’re talking antibiotics, you can’t manage with the bottle. There’s no silver bullet. It’s up to you and animal husbandry. Remember, always work with your local veterinarian. And if you want to know more about what Dr. Lubbers and I do here at the vet school, you can find us on the web at www.vet.ksu.edu. I’m Dr. Dan Thomson, you’ve been watching Doc Talk today. Thanks for joining us and I’ll see you down the road. Closed Captioning brought to you by AgriLabs, the Perfect Pairing of Performance and Value.

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