Vet Spotlight: Dr. Capuzzi shares her tips on conducting virtual bedside manner

Meet Dr. Joan Capuzzi, who graduated from the University of Pennsylvania School of Veterinary Medicine, and has provided veterinary care for dogs and cats for over 25 years. She enjoys diagnostic challenges, brainstorming with clients about different options for addressing pets’ health issues, explaining the mechanisms behind animals’ health problems and providing second opinions. She also likes dispensing simple tips in the areas of pet nutrition, behavior and preventive health.

“The next part of the exam warrants owner participation. But care must be taken to ensure the owner is comfortable with this, and safe.”

I enlisted in virtual care as a way to earn supplemental income from the comfort of my home. I didn’t anticipate the gratification I have since reaped from providing care to animals that might not have gotten it in due time - or at all - because of long wait periods for in-person veterinary appointments, urgent evening and weekend needs that arise outside of normal office hours, geographic distance from care, and individual pet limitations (i.e., excessive stress with in-person vet appointments or car rides, cats refusing to get into carriers, etc).

I recommend asking lots of questions. My formula includes

• pet history questions - when/where acquired, diet, vaccine history, illness history throughout life, past and current medications, lifestyle, other pets in household
• description and history (chronicity, pattern, etc) of current health issue
• general health parameters - appetite, drinking/urination, energy level, presence of coughing/sneezing/vomiting/diarrhea.

If it isn’t obvious or the owner has not volunteered for it, I sometimes ask why they chose a virtual over in-person appointment. The answer to this often yields insight into the pet’s  physical/behavioral health status and/or owner husbandry/preferences/logistical issues.

Lastly, I always do a visual exam if the pet is available and amenable to it. This sometimes requires the owner to adjust camera/phone/laptop position and lighting. I note overall mentation, body condition score and ambulation, if possible. The next part of the exam warrants owner participation. But care must be taken to ensure the owner is comfortable with this, and safe. For dogs and cats that don't seem fractious, anxious, or extremely painful, I ask the owner to lift the upper lip so I can view the gingiva for perfusion and catch a glimpse of the teeth, and I ask them to lift the ears and direct the camera at the external ear canal openings. If there is a gastrointestinal issue or orthopedic pain, I might direct them to palpate the abdomen, the spine or other areas of suspected discomfort, to view the animal’s reactivity. And I have them focus the camera on specific problem areas, such as skin, nails or anal glands.

My other tips concern general conduct during the appointment, as well as afterwards:

Be on time. Have good lighting and a noise-free space in which to work. Maintain consistent eye contact with the pet owner. Ask pointed but open-ended questions.  Show empathy and patience. Follow your state’s VCPR rules on prescribing medications. When virtual prescribing is prohibited by state rules, consider OTC options to address the problem; many of these are available on the platform through Vetster’s partnership with PetMedsⓇ.

Also, ask the client what medications he or she has at home in the pet medicine box as they often have leftovers of exactly what they need; check that they are not expired. Advise the client that you are available by chat over the next few days for any followup questions. If indicated, check in with the client by chat the next day to see how the dog or cat is doing. Refer patient to their regular veterinarian for in-person appointment when indicated, and do not hesitate to direct them for immediate care at an emergency facility if needed.

Those that come to mind involved either urgent therapy that yielded immediate results, proper medication/treatment instruction or specialist referral.

For urgent care, I think of 6-year-old Belle, an Aussiedoodle that had consumed a grape within an hour of our appointment. I instructed the owner on dosing hydrogen peroxide, and ensured that the dog vomited adequately. The phone call was in the evening, when their regular vet was closed. I advised the owner, who was very relieved and grateful to not have to go to emergency at that late hour, to follow up with her regular vet the next day regarding checking renal values.

As far as treatment instruction goes, I deliver it regularly to one of the most common subsets of virtual vet appointments: ear infections. Many calls come in for agitated dogs who are scratching their ears and shaking their head uncontrollably. Most are recurrent ear infections, and these owners often have ear wash at home. When I ask how they are using the ear wash to clean the ears, the overwhelming majority respond as such, “I squirt a few drops into the ear each day, and it’s doing nothing.” Most were never properly shown how to clean the ears, but rather just sent home with a bottle. So, I position my virtual camera so the client can view proper technique as I clean the ears of one of my own dogs, using ear flush and gauze 4x4s. These clients are very grateful for this demo, as most tell me they were never instructed on how to do this.

I also find fulfillment from the appointments that warrant rapid remediation through either emergency or specialist care. By asking the right questions and doing visual exams, I have been able to determine that a male cat needed to be urgently unblocked and a dog with a bulgy eye was likely experiencing glaucoma, and appeared to have a lens luxation with possible cataracts, requiring prompt ophthalmologist attention.

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