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A recent article by Dr Jonathan Pycock entitled ‘The Pitfalls of Physiotherapy Referrals’ highlights the legal challenges that veterinarians face when signing referral letters from themselves to veterinary physiotherapists, at the request of the physiotherapist. The dilemma is especially acute when they know nothing about the practitioner they’re being requested to refer to.

Dr Pycock sets out various matters to consider when deciding whether or not to sign, highlighting the legal consequences of signing a form that one may not be 100% comfortable with.

He poses the question: ‘To sign, or not to sign?’ and then concedes that the question is not quite that simple. I would agree – the question is not that simple at all, and from my perspective, is not the question to ask. The more fundamental question, in my opinion, is:  ‘Will this patient benefit from physiotherapy, or not?’ And a vet cannot know the answer to this question unless she does the necessary investigation.

The MDT

The multi-disciplinary team is a concept with which most of us are familiar. Most vet physiotherapists and veterinary rehabilitation practitioners believe strongly that we are members of such a team, each contributing our unique insights and skill sets to the welfare of the animals we serve. As with all things legal, every country and province has slightly (or vastly) different rules, but when it comes to working together with referring veterinarians and other members of the healthcare team, vetrehabbers are of one accord – we need each other. If animal wellbeing is truly our priority, we must work together. We are not isolated practitioners, and our patients derive optimum benefit from the services of each of us when we work in unison with one another.

As a veterinarian, if you are confronted with a referral request because a client has opted to seek the services of a vetrehabber, and furthermore if that request elicits doubt in you, there are a few things you might do to solve the dilemma.

 1. Form a relationship with a veterinary rehab practice you trust
If your client is seeking the services of a veterinary physiotherapist or hydrotherapist, there is some indication that they want something in addition to what you have been able to offer. As a pet owner and not just a veterinarian, you are surely familiar with this situation. So, assuming you accept that the client wants something in addition to veterinary care, you might seek out and investigate the veterinary rehabilitation facilities in your area. Get to know one or two, so that you can refer your clients to them, instead of having your clients seek out vetrehabbers that you do not know.

 2. Partner with a physio

Partnering has many benefits for you, and can be as simple or as complex as your practice allows, or as you choose. For example, you can simply foster a referral relationship with a local vetrehab facility as mentioned above. Or you can have a veterinary rehabilitation practitioner take consultations in your practice at specific times, on specific days of the week, as well as consulting on post-operative cases. This would be beneficial for you, as you’d both generate an additional income stream and build a closer relationship with the vetrehabber and your clients.

You could even go all out and build a rehabilitation wing on to your practice, employing someone fulltime to perform physiotherapy and rehabilitation. This option will reap further benefits for your practice.

 3. Investigate the facility and their practitioners 

Seek knowledge about the facility and the rehabilitation practitioner who requests the referral letter. If your country has a registration or regulating body, you will easily find a list of registered practitioners on their website. For example, in South Africa the profession of veterinary physiotherapy is regulated by the South African Veterinary Council. If your country has not promulgated and regulated the profession, you may be surprised to find that the professionals choose to be regulated by a voluntary association such as NARCH in the UK for hydrotherapists. A quick search will let you know if there is a list of regulated professionals that you can refer to when you need additional information about someone.

 4. Reach out to the person requesting the referral

Building new professional relationships takes a bit of effort, but is so worth the trouble. Veterinary rehabilitation practitioners have knowledge and training which is different from vets, yet entirely complementary. Get to know them and what they do! It may surprise you to know that vetrehabbers are sometimes intimidated by vets, especially when they sense that vets are set against them.

Simply picking up the phone and getting to know the vetrehabber requesting a referral will go a long way. Feel free to ask them about their education, their experience and who they are registered with and regulated by. What facilities do they have – and, best question of all  – would they like to come and introduce themselves, and discuss the case in question, in person? This might kick off a productive working relationship, where each party provides a critical aspects of the animal’s long-term care.

The bottom line

At the end of the day, we are all working toward a common purpose – the best quality of life for our patients. And the best way to do this is together, as a team. Our patients can only benefit when we are openminded about the skills we do not have, and build relationships with those who have them. Moreover, a humble and open approach to veterinary rehabilitation as a field will yield benefits for a vet’s own practice. Working with, rather than in isolation from, veterinary rehabilitation practitioners will add a whole new dynamic to the services a vet can offer.

I am in no way suggesting that anyone sign a referral letter to someone they know nothing about. But nor can a vet, in good conscience, ignore that letter. It calls you to action. It calls you to expand your knowledge and your boundaries – and possibly to expand your practice.

No profession works in isolation, and veterinary rehabilitation practitioners have a great deal to offer. One question really guides all our work: ‘What can I do to give this animal the best quality of life for the longest amount of time?’

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