Client Communication Rule - Frequently Asked Questions
The Client Communication Rule, WAC 246-933-345 was created in response to concerns raised by the public on the importance of veterinarian communication with the client so that the client can provide informed consent for veterinary care of their animal(s).
The rule formalizes and clarifies existing standards that veterinarians should already be following for communication with clients and related record-keeping.
- Should the veterinarian review every possible diagnostic measure, medication, or treatment they might administer to a patient?
No. The spirit of the rule is to set appropriate expectations with clients so they are informed of what the treatments and diagnostic testing will be. Veterinarians need not review “every possible” diagnostic measure, medication or treatment; however they should review likely and foreseeable care they may administer based on the specific situation.
Veterinarians are held to a professional standard of care, which a competent veterinarian would reasonably do under the same or similar situation. Veterinarians must inform owners, in an easy-to-understand manner, of the likely risks and benefits of a particular diagnostic measure, medication, or treatment, so that the owner can make informed decisions about care.
- Should veterinarians contact the client each time there is a change to patient orders for treatment and care? Should they discuss all details of effects the change might have? Similarly, does every medication used during anesthesia require discussion with the client?
A veterinarian should inform a client in advance about the components of a procedure, medications used and why, risks, benefits, alternative measures, and likely outcomes of a procedure. A general plan and likely and foreseeable adjustments to that plan should be developed and discussed with the client prior to hospitalization so the client can give informed consent. The intent is that clients understand the approach being taken.
In emergency situations or when the client cannot be contacted in a timely manner, it may not be reasonable for the veterinarian to seek consent.
- How detailed should documentation be? Is there general verbiage that can be used that would adequately cover everything conveyed to owners or should specifics be written down for each case, listing all differential and definitive diagnoses, proposed treatments, side effects, etc.?
The rule requires a practitioner to document the following topics that were discussed:
- Proposed diagnostic tests;
- Differential diagnoses;
- Definitive diagnoses;
- Proposed treatments;
- Common side effects or adverse outcomes from proposed diagnostic testing or treatment;
- Most likely side effects or adverse outcomes from proposed diagnostic testing or treatment based on patient signalment and disease status. Patient signalment may include, but is not limited to, species, breed, age, and sex;
- Estimated cost;
- Prognosis; and
- Alternate diagnostic and treatment options for the patient.
The rule is intended to clarify the existing standard of care. While the exact amount of detail is best left to the practitioner's discretion, a third party reviewer should be able to discern the information that was provided and the client's consent to care. The rule's intent is not to create additional requirements for documentation. It outlines the standard that the board uses when reviewing disciplinary cases. This should have minimal or no impact for veterinarians following general standards for documentation.
- Must veterinarians discuss with the client every possible side-effect, such as bruising with a blood draw with each owner?
Veterinarians must inform a client of outcomes that are reasonably foreseeable. For example, if venipuncture is being performed in a patient with ecchymosis of unknown etiology, the potential for bruising and bleeding should be discussed with the client. The client should be given sufficient information so that they can provide informed consent.
- Some clients may not understand all the details of what veterinarians try to communicate with them. Can we still treat the patient?
The veterinarian must provide enough information in a manner the client can understand so that the client can provide informed consent. If that is not possible in a non-emergency situation, the veterinarian should not provide care. In an emergency, if a client is unable or unwilling to provide informed consent, the veterinarian should provide sufficient care to deal with the emergency.
- If a client doesn't want to discuss the information can we still treat the patient?
The veterinarian must provide enough information so that the client can provide informed consent. If a client is unable or unwilling to provide informed consent, in a non-emergency situation, the veterinarian should not provide care. In an emergency, if a client is unable or unwilling to provide informed consent, the veterinarian should provide sufficient care to deal with the emergency.
- Are there any resources available to help us communicate and provide information to clients?
Yes. Many resources exist. Client information sheets are available for many drugs through the FDA and many professional organizations offer handouts for clients on a variety of topics such as diseases, treatments, procedures, diagnostics, behavior, etc. Some organizations and clinics have also made resources available to the general public on their websites or other online platforms. The board is working on creating a list of links to available resources. This webpage will be updated when those resources are ready.
As a reminder, the new rule is meant to clarify the board's expectations for client communication, based current standards of care and will not significantly change how the board handles disciplinary cases.