Natalie L. Marks
DVM, CVJ, CCFP, FFCP-Elite
Fearless columnist Dr. Natalie L. Marks is an educator, consultant and former Chicago practice owner. A leader within the Fear Free movement, she was a member of the original Fear Free advisory board and is Fear Free Certified Elite. She passionately believes that all veterinarians should be committed to the physical and emotional health of their patients.
Read Articles Written by Natalie L. Marks
It’s a new year and a new decade, which should give us even more incentive to strive for a better personal and professional life. As you check off another item on your list of resolutions, consider these seven ways to eliminate or reduce fear, anxiety and stress in your patients, clients and team members.
1. Don’t Hesitate to Sedate
Historically, the veterinary medicine industry has shown tremendous hesitation to sedate reactive or fractious patients and even acknowledge anxiety deserving of intervention. Many of us did not postpone an exam or procedure involving an anxious patient but instead pushed through a nail trim or called in team members for more physical restraint.
Many of us did not appropriately communicate to clients how they should transport their pet to the clinic, how certain sights, smells and sounds could trigger an anxious memory, or how such reactions could escalate with age. Many of us did not proactively send home pre-visit pharmaceuticals.
Vow that the new year will reveal a new you in practice. Don’t hesitate to recommend oral or injectable reversible sedatives for patients who show increasing levels of fear, anxiety and stress. Emphasize to clients that not only does such an approach allow for a more thorough exam and a calmer patient during diagnostic procedures, but it prevents another fearful memory. The patient is more relaxed, but so are the client and veterinary team.
Best medicine always generates best business. A sedated patient is more accepting of an oral exam, rectal palpation, radiography and the obtaining of samples for clinical pathology.
2. Teach the Language of Body Language
Learning any language can be challenging for an adult, but it’s even more of an uphill climb when we have to retrain a brain that memorized incorrect information. Take the time to teach clients what their dog or cat is telling you:
- Yawning is not just a sign of sleepiness.
- Panting doesn’t always indicate that a pet is out of shape after exercise.
- A crouched, frozen cat on the exam table is not just “being a good patient.”
The more pet owners understand these associations, the more we can help them incorporate strategies and trigger recognition at home, leading to a more peaceful coexistence and the prevention of escalating fear. The same holds true for team members. Interpreting body language leads to less restraint, helps us plan our exam and diagnostic strategy, and results in improved job satisfaction and better work culture. Make recognizing body language a priority with every team member and client.
3. Be Flexible During the Physical Exam
Veterinary students and young veterinarians tend to learn to do a physical exam in a consistent and non-wavering order so that it is thorough and detailed. In fact, the steps can become so habitual that we might forget where we left off when we stop or are questioned during the exam.
We need to change our mindset and sometimes allow the patient, their physical and emotional health, and their behavior to dictate the flow. If the patient presents with an ear infection and the ear is typically the first place you would examine, be flexible and look at the ear last. Pain is a trigger for fear and anxiety, and going right to the ear can cause the patient’s tolerance to deteriorate immediately and during later visits.
Stainless-steel tables are not a comfortable place for dogs and cats. Consider doing exams atop nonskid, warmed mats or towels. With larger dogs, a secured footing is often on the ground. Also, remember to take breaks and provide high-reward treats to patients during different palpations.
If a patient being examined demonstrates escalating fear and stress through its body language, use the episode as a teachable moment. Pause, regroup and plan another strategy that supports the patient’s emotional health and allow for the best medicine.
4. Towels Are a Veterinarian’s Best Friend
Towels should be an invaluable component of every exam room and treatment area. They are a wonderful reservoir for pheromone therapy when placed over a cat carrier and on the exam room table. They can be warmed for comfort and easily disinfected or replaced between patients. They are essential for the low-stress handling of cats because certain body parts can be gently contained for patient and staff safety. They are incredibly helpful when doing diagnostic tests because they allow for creative restraint. Finally, they are an economical addition to any practice. Start donation drives by asking clients to recycle their gently used towels.
5. Communicate the Importance of Physical and Emotional Health
For general practitioners, wellness exams and annual physicals are the foundation of our career. But many of us have fallen victim to a stigma: feelings of denial, embarrassment and even shame surrounding anxiety. We didn’t proactively discuss it with clients, and we didn’t acknowledge anxious behavior. We didn’t offer support and resources to clients that could lessen the stress in their dog or cat at the clinic and at home.
Now is the time to be open, transparent and empathetic to clients. Communicate to them how much our profession has learned about fearful and anxious behavior in pets and how our job is to advocate for the pet, protecting physical and emotional health. Explain to clients how fear triggers a lifetime imprint in the brain of dogs and cats and escalates with age and repetitive exposure.
Most importantly, be very clear to clients and your team about how emotional health care is just as important as physical health care.
6. Cats Are Not Small Dogs
Here’s something that should spill over into every aspect of your practice. Cats travel differently. Cats need a different section in the lobby. Cats have different body language and different responses to restraint. Cats react to stress much differently than dogs. Cats have different environmental needs, different ways of establishing territory and different nutritional requirements. They metabolize pharmaceuticals differently. They have different texture, noise and taste preferences. They have different dentition. Cats even have clavicles. The list goes on.
Communicating and accepting these differences will improve patient care and show your feline client base that the patient experience at your practice will be different and better.
7. Celebrate the Success
The successful removal of fear and anxiety in patients and clients generates momentum. Team members feel more motivated to see change and are more apt to acquire new habits. Showcase success stories and testimonials on your website and social media pages. Be proud of the implementation and let it generate referrals and public interest. Be proud of your team and let your clients know how many people are involved in preserving and protecting a patient’s emotional health.
While these are all general tenets, veterinary practices can take pieces of these strategies and make them their own. Change requires time, open minds and financial investment. But most importantly, it needs strong leaders who are passionate, clear in their mission, committed to the team and ready to leap forward. Change needs you.