NEW Client Notes Fall 2022


Client policy during Covid-19 “social distancing” requirements (Fall 2022 update):

The situation regarding business openings and safe exposure continues to be fluid and recommendations changing often as new infection surges come and go with humans infected and spreading virus without showing clinical signs and new, concerning emergent variants of remarkably increasingly contagious nature (latest is Omicron). At this time, we simply still do not feel we can safely use our “pre-pandemic” practice model of meeting in person with pet owners and pet(s) for extended appointments (unlike general medicine appointments of only 5-15 minutes actually with the doctor, our specialist doctor is in same room as the public pet owners for ¾-4 hours at a time) in the same small exam room breathing the same unfiltered air. For now, we will be still only meeting new cases briefly “in person” in the open-air cul de sac or driveway in front of the doctor’s home office in Carmel Valley (just east of Del Mar) ideally driving down immediately after the rest of the appointment is first done via telemedicine. Legally, all licensed veterinary doctors (including specialists like Dr. Melese) must establish a Veterinarian/Client/Patient (VCPR) legal relationship during an “examination” of the patient (“in person”) and actually meeting the pet owner & pet in order to provide any veterinary services including establishing a diagnosis, treatment plan, prescribing medications, etc. Due to ongoing exposure concerns, we will establish this VCPR by “seeing” the patient/pet parents in person outside with a “curbside meeting” in Carmel Valley using appropriate “social distancing.” Before this very brief (usually less than 10 minutes) “in person” part of the visit occurs, we will convene at the initial appointment time using “video chat” Zoom (Zoom is free to use and ideal since audio & visual telemedicine) with pet parent safely at their home with the pet and at their computer (or tablet or cell phone if they prefer) using telemedicine/video chat with the specialist doctor who is still working remotely from his home office but can hear & see what is going on at your home, which we were not able to with our prior office appointment practice model. Although we could also theoretically do the “curbside exam” first then followed by the video-chat, it is usually better to plan for doing the “curbside exam” after the telemedicine consultation so that the doctor knows a lot about your case before meeting your pet and, potentially, training aids and/or medications, etc. may be able to be dispensed by the doctor at that time. FOR CLIENTS COMING FROM SOME DISTANCE, WE HIGHLY RECOMMEND AN AFTERNOON NEW PATIENT APPOINTMENT since the “team” will have more “breathing room” for the pet parent to drive down to Carmel Valley home office immediately following the Zoom appointment compared to trying to “squeeze” this in between end of new AM telemedicine consultation and the doctor starting with the afternoon appointments! Some new clients coming from a long distance have driven down early and done their Zoom appointment from a local park/family or friend’s home, etc. so that, once that Zoom portion is over, they can quickly swing by the doctor’s home office for the brief “curbside exam” then head home. We are sorry for the challenging nature of meeting the legal needs of establishing the legal VCPR after the initial appointment via telemedicine for both clients and our doctor, but this is the present reality (hard to have predicted this 12-24 months ago☹) and we would not offer this arrangement if we had not found that we can still provide very effective help using telemedicine followed by handouts sent later via e-mail. Follow-up/recheck appointments can all be simply via phone or videochat for up to 12 months after we have actually seen the pet “in person.” For those that must come a great distance for this brief “check in,” we apologize for the necessary challenge and will work with you as best we can to accommodate your travel/timing needs but cannot legally (state law) provide any treatment or diagnosis until we get to meet the client & pet “in person.” We have now done hundreds of new cases using this Covid 19 model since March 2020 and the progress and the positive results so far are comparable to when we were able to see each new patient “in person” at a clinic exam room or by housecall during the entire appointment. We also have an online pharmacy partner integrated into our practice so can provide any needed refill medications or other veterinary products that will be shipped to you as needed using that resource “contact free.”

Please check our website for future updates or inquire with our office (e-mail best since little time to “chat” on phone these days but leaving voicemail can work as long as you leave your e-mail address) if you have remaining questions about your upcoming appointment not found on FAQs on website or in e-mails we have sent you. As with all Telemedicine appointments, payment will be due and taken at the end of the appointment (see P.S. below).

We are sorry for any disruption in our “normal” specialty practice services and our clients’ schedule with these steps but they are for all of our health and it is vital for us all to work together to make it through this difficult time so that we all “get ahead” of these dangerous variants by vaccination, public health measures and acquired immunity from infections (hopefully without severe disease 😉).

We hope you and yours stay safe during this time 😊

Patrick Melese DVM, MA, DACVB and staff
Board Certified Veterinary Behaviorist