6 ways to save time with Fear Free

Many veterinary professionals agree that Fear Free is a great concept, but some argue that the protocols takes too long to be practical. I admit, I had my reservations when I became Fear Free–certified several years back, mainly because I was already comfortable identifying fear in dogs and cats. But it wasn’t until I became certified that I realized I had to rethink everything I knew about being a veterinarian, from exams to surgery to client education.

The more I incorporated Fear Free principles into my daily routine, the more instinctual the process became. Cats that were untouchable without injectable sedation could now be examined with feline-friendly handling and anxiolytics. Dogs that once thrashed during restraint were peacefully being vaccinated while licking a smear of squeeze cheese on the wall.

Fear Free emphasizes that a patient’s emotional health is just as important as their physical health. Whether you’re considering individual certification or seeking ways to save time, the following Fear Free techniques are a great place to start.

1. Be prepared

Have you ever started an exam on a patient only to find that the otoscope is across the room? Or maybe you forgot to pull up the vaccines. Not only does this waste time, but taking your hands off and putting them back on a patient can trigger a startle response. Save time and reduce stress by collecting samples in the exam room rather than bringing a patient to the treatment area. That way, they won’t be forced to adjust to new, high-traffic surroundings while waiting to be seen by a technician. Most exam rooms have a drawer that’s not being used, so fill them with syringes, needles, butterfly catheters, and sample tubes.

2. Stock up on treats

Who doesn’t love giving patients treats? Getting a fearful patient to take a treat from you during an exam can transform their emotional state. The more relaxed they are, the smoother the visit. If you’re seeing a patient for an annual exam or a concern that’s not gastrointestinal, try serving them pea-sized, tasty treats during the exam. If you need your hands to be free during vaccinations or when handling sensitive areas, spread squeeze cheese or squeezable treats on a surface at the level of the patient’s face to encourage positive reinforcement.

3. Anticipate and treat for pain

Fear and pain are often intertwined. For example, if you try to take x-rays of a limping patient without analgesics or sedation, you risk increasing their fear level and needing 3 team members to assist with restraining them. I never used to use pain medication for severe otitis, but then it dawned on me that there was a reason dogs with a history of recurring ear infections were head shy or tried to bite during routine otoscopy. They were afraid of the pain.

Even rethinking your approach to needle pokes can reduce fear among patients and promote efficiency in the clinic. How many times have you had to administer several vaccines to a patient only to find that by the second vaccine, it’s agitated and needs more restraint? Have you ever been unable to draw blood from a patient because they jerked every time you got the needle into the vein? Rethinking your needle size (my default is now 25 gauge for vaccines) and pretreating the area with an inexpensive lidocaine cream such as SuperNumb are both Fear Free approaches that can save time and reduce the patient’s stress levels.

4. Provide stability

The fear of falling is common among patients, yet we routinely put them on slippery scales or exam tables or grab them by their hocks and swing them through the air into dorsal recumbency for a cystoscopy. Instead, take 5 extra seconds to place a towel or a nonslip mat on the scale or exam table. Use the inclined plane approach for dorsal recumbency by angling the pet’s back against your kneeling body and let them slide down your chest and thighs into the trough. The more stable your patient feels, the easier they will be to handle.

5. Consider wants versus needs

When a technician comes in with a patient history on a clipboard with a page with multiple paragraphs on it, you know you'll be tackling several health concerns. If you try to work up every problem, you’ll get behind, and the result is an overwhelmed pet. Fear Free asks you to consider a patient’s wants versus its needs. Ask yourself these 2 questions first: (1) What is medically essential for that patient to have done during their visit? (2) What can wait until a recheck 2 weeks later with anxiolytics on board? Prioritizing what’s most important will help you stay on time for your appointments while minimizing fear, anxiety, and stress.

6. Use anxiolytics routinely

The COVID-19 pandemic has brought extensive changes to the veterinary profession, including an unprecedented number of owners who now are receptive to previsit anxiolytics for their pets. Remember, don’t wait until a patient shows signs of aggression to have that conversation. Just because the patient didn’t try to bite or scratch this time doesn’t mean they won’t during their next visit (especially if we continue to ignore the signals they’re sending). If you advocate for a patient when they’re showing mild to moderate signs of stress, you’re creating an insurance policy to help future veterinary visits go much more smoothly.

Julie Liu, DVM, is a Fear Free relief veterinarian in Austin, Texas. She’s also a freelancer and a mentor.