Fear may not have to be the cost of getting the job done

Ask Marty Becker, DVM, when he first heard the idea of Fear Free practices and he'll take you back to veterinary school and his practices at Sandy, Utah, to Leo Bustad, DVM, PhD, in 1970 and R. K. Anderson, DVM, MPH, DACVB, DACVPM, in 1989. Then he'll tell you he didn't listen hard enough.

“R. K. Anderson was doing a clinic workshop for me and the staff right there in the trenches,” Becker recalls of the renowned behaviorist. “I remember him describing the typical vet who comes in, all happy, ready for the first visit; that puppy is so happy, that kitten is just forming and everything's fine until they get into the exam room. The pets get in there, they're elevated off their feet, there's something put inside them that they don't expect, they're manipulated in ways they've never been touched before and then something painful happens.”

Becker says he heard Anderson's message: Instead of the All Pets Complex, he was presiding over the All Pain Complex. That's where Becker's talk across the next 25 years about constant treats and convenient waiting rooms originated, in addition to other sources. But he didn't hear everything. “Here's what we didn't do,” Becker says. “We never stopped a procedure or modified a procedure based on the pet's anxiety. We didn't take any steps beyond just those treats to eliminate anxiety triggers or to reduce anxiety triggers. We just kept augering through the system as before.”

What he wasn't hearing

Now, Becker will tell you he's listening first to the sound of silence. He's listening to the cat or the dog that doesn't make a sound, the ones he used to love because he thought they were happy to be in the exam room and wouldn't make trouble. Today, he says, he hears terror in their silence. When he hears barks and screams, hisses and yowls, he hears pets whose brains are being rewired by fear. 

And the most important thing he hears, he says, is a voice saying it doesn't have to be like this; this fear is not just the cost of getting the job of animal health done. Augering through isn't, he says, good enough anymore. 

Dr. Marty Becker

Of course, since he is Marty Becker, he wants everyone else to hear what he hears. He heard Karen Overall, MA, VMD, PhD, DACVB, CAAB, speak at the CanWest Veterinary Conference five years ago about the evidence that fearful events alter the animal brain. He went out for a beer and decided this might be one of the most important things he'd ever heard about veterinary medicine. “When she said fear causes permanent damage to the brain, it all came together for me,” he recalls. “I thought, ‘Oh my God, urgent obligation.' Then I thought, ‘Unprecedented opportunity.'  

“I realized I always had the pet's physical well-being in mind, as almost all veterinarians do. The other thing I had in mind was customer service, attracting good employees, training and retention. It was better communication. It was leadership. It was marketing; it was management; it was motivation. It was taking care of the physical plant. It was looking at new uniforms and a new slogan and all that stuff I wrote about and talked about.

“And I realized the first tenet of bioethics is to do no harm. And we're causing harm. … From then on, for me, it became physical well-being and emotional well-being … I look back in hindsight-all the things I've lectured on over the years and I've been passionate about and written about, they were all incremental. This is transformative. This changes everything.”

This “aspirational” dream of Fear Free practices, he thought, could “transform” the profession. He hired a law firm to trademark the term Fear Free, and he formed a massive and diverse advisory board hoping to set in motion a for-profit educational movement that would lead to a new certification for veterinary hospitals and clinics: “I would hope in five years there would be 50 platinum certified Fear Free practices that would actually be certified through a site visit,” he says.

This month, Becker began marketing the concept. He sees educational modules and rigorous coursework at veterinary conferences and other venues because “this is so teachable,” and a movement he says will transform the atmosphere of a veterinary practice, improve the lives of companion animals and their owners, and-he argues-stem the tide of decreasing clinic visits and lost revenue.

Why create a for-profit rather than a nonprofit program? One reason, he says, is that many nonprofit movements he's been associated with have faltered because of funding issues. “To transform the profession, this needs to be economically sound, representing a broad swath of the profession and-from the start-filled with purpose, passion, and plan,” he says.

Technician Katie McMahon distracts a feline patient with food while veterinarian Laura Durant-Elliott conducts an examination at the Animal Wellness Center of Maple Grove owned by Dr. Carolyn Apker, a Fear Free advisory board member.

Fear is not the cost of treatment

Carolyn Apker, DVM, CVA, is one of 50 members of the Fear Free advisory board Becker has assembled. Becker asked her to join the board after a chance meeting in the Atlanta airport with one of her behaviorists who told him about her Maple Grove, Minn., practice. Apker graduated from veterinary school in 1982 and spent five years as an associate-five years that made her question the decision to become a veterinarian. “I was just heartsick about the way patients were handled, treated and spoken about,” she says. “I was thinking, ‘Could it be that all this time I was wrong?' I decided in 1987 to open a practice my way. If it didn't work, it didn't work.”

Twenty-seven years later, she says, she can “tell colleagues it worked … and it brought joy back into practice.”

Dr. Carolyn Apker

“Our clients don't want to see their family members go through all that distress,” she explains. “It discourages them from coming back. They find ways to justify their way out of coming back for annual or semiannual visits.”

Like Becker, she sees veterinarians focused on physical health but not mental health. “The emotional and psychological well-being of our patients has been underserved,” she contends. “We make sure they have the right diet, the nutrition they need, but the way we deliver care is at odds with our goal.

“You may have an animal in your hospital and his physical needs are being met and his pain control needs are being met but he's feeling lost, scared, manhandled. The old theory was that a kitty hissing and spitting in the back of the carrier was a bad cat. Now we know that's a normal cat who is frightened for its life. You have your way with him and get the job done. That doesn't happen at my practice.” 

She says she was inspired when she heard Overall describe a “revolution” in veterinary practice during a master class. And, after hearing Becker speak at a conference, she says she approached him to say she thought these ideas would create a “stampede” of veterinarians to Fear Free concepts. “I told him, ‘You can count me in on this revolution,'” she recalls.

One place she sees need for change is in the training of veterinary technicians. She's spoken on fear and pain at her local veterinary technical schools. “We need a whole group of techs who will not tolerate procedures that create fear for pets,” she says. “This is just as inappropriate as ignoring pain protocol.”

Changing how a practice treats animals is not expensive, she contends: “It doesn't take a $40,000 surgical laser.” It does take the ability to recognize fear as something dangerous to health. “This is far more important than most of the medical advancements we've seen,” she contends. “It's more important because it fundamentally changes how we interact with our patients.”

Oliver gets a peanut butter treat and calming caresses from technician Melissa Adelmann as fellow technician Catherin Linder completes a nail trim for the patient at the Animal Wellness Center of Maple Grove.

Tuning into fear follows tuning into pain

In a recent journal article, Bernard E. Rollin, PhD, philosophy professor at Colorado State University in Fort Collins, Colo., recalls a debate with a scientist in 1979 about the existence of animal pain. The scientist, he says, later called his dean to describe Rollin as “a viper in the bosom of biomedicine” who should not be allowed to teach. 

Feelings ran strong then about Rollin's efforts to suggest the ethical implications for animal research laboratories and veterinary practices of the denial of animal pain. Simply put, he made a lot of people uncomfortable. The first veterinary anesthesia textbooks, he points out, did not even mention felt pain. Bringing recognition of animal pain to veterinary medicine-in Apker's terms-fundamentally changed veterinary practice and procedure.

Dr. Robin Downing

Apker sees the Fear Free concept as a paradigm shift on the same order as the recognition of pain in animals. She remembers how the profession often thought about pain when she began practice. “We were told animals don't experience pain the way you and I do,” she says. “You don't give pain meds to animals because they'll injure themselves. Today, we've done a complete 180. We know how to recognize pain now.”

Becker agrees. “We were taught pets didn't feel pain like people did,” he says. “That was flat out wrong as they have the same neural pathways. Pets and people feel pain and need it prevented or controlled. We now assume a pet's emotional well-being either isn't fragile or can be ignored on the altar of their physical well-being. Well, guess what? Pets have emotions just like people and can feel anxiety, fear, or trust and love.”

Robin Downing, DVM, DAAPM, who has made pain management a focus of her career in Windsor, Colo., sees the way pain and fear combine in veterinary practice. “What must now be faced as we begin to understand and implement a Fear Free approach to practice,” she says, “is that many of the pets we see who are terrified are terrified because they suffer unnecessary pain and they know that when they are touched, by anyone-but particularly by a stranger-it will hurt them.” Downing uses harsh language to describe what happens to these animals who adopt a ‘bite first, ask questions later' defense. Labeled ‘bad actors,' she contends, they are “subsequently brutalized by their handling” in the veterinary clinic.

Becker remembers how, as a young veterinarian, he was taught how to do ear crops. He became, he says, good at ear crops. “And, today,” he says, “I regret every ear crop I have ever done.”

“It took the profession a decade to really understand and commit to pain management,” Becker says. “For the sake of pets, people, practices and the profession, I hope we can do this transformation-which is much larger than just pain was-in half the time. I fear veterinary practices that don't embrace Fear Free are doomed to second- or third-rate status; they will be looked down upon, and many will go out of business.”

For Apker, like Becker, it is a case of learning to hear. “Animals have been communicating,” she says, “but nobody has been listening. We need to tune into their communication.”

Want more? Find it all at dvm360.com/fearfree

>>>Video: Why go fear-free? Dr. Marty Becker explains it all. If patient fear and anxiety were a pandemic, what's the cure? Dr. Becker has more than a few ideas in mind.

>>>Facing fear head on: Tips for veterinarians to create a more behavior-centered practice. Dr. Karen Overall equips veterinary teams with the ability to assess and alleviate fear during veterinary visits to build a more positive patient experience and stronger pet-owner relationships.

>>>Posts and tweets about fear-free tactics. Share your fear-free techniques on social media to make clients less nervous to bring their pets into your practice.

>>>Is routine veterinary care contributing to lifelong patient anxiety? Explore the dramatic impact of a single visit on a pet's long-term behavioral well-being.

>>>Video: Comfy pets are happy pets. Dr. Andy Roark says to give your veterinary patients the royal treatment they deserve.

Ask Marty Becker, DVM, when he first heard the idea of Fear Free practices and he'll take you back to veterinary school and his practices at Sandy, Utah, to Leo Bustad, DVM, PhD, in 1970 and R. K. Anderson, DVM, MPH, DACVB, DACVPM, in 1989. Then he'll tell you he did not listen hard enough.

“R. K. Anderson was doing a clinic workshop for me and the staff right there in the trenches,” Becker recalls of the renowned behaviorist. “I remember him describing the typical vet who comes in, all happy, ready for the first visit; that puppy is so happy, that kitten is just forming and everything's fine until they get into the exam room. The pets get in there, they're elevated off their feet, there's something put inside them that they don't expect, they're manipulated in ways they've never been touched before and then something painful happens.”

Becker says he heard Anderson's message: Instead of the All Pets Complex, he was presiding over the All Pain Complex. That's where Becker's talk across the next 25 years about constant treats and convenient waiting rooms originated, in addition to other sources. But he didn't hear everything. “Here's what we didn't do,” Becker says. “We never stopped a procedure or modified a procedure based on the pet's anxiety. We didn't take any steps beyond just those treats to eliminate anxiety triggers or to reduce anxiety triggers. We just kept augering through the system as before.”

What he wasn't hearing

Now, Becker will tell you he's listening first to the sound of silence. He's listening to the cat or the dog that doesn't make a sound, the ones he used to love because he thought they were happy to be in the exam room and wouldn't make trouble. Today, he says, he hears terror in their silence. When he hears barks and screams, hisses and yowls, he hears pets whose brains are being rewired by fear. 

Dr. Marty Becker

And the most important thing he hears, he says, is a voice saying it doesn't have to be like this; this fear is not just the cost of getting the job of animal health done. Augering through isn't, he says, good enough anymore. 

Of course, since he is Marty Becker, he wants everyone else to hear what he hears. He heard Karen Overall, MA, VMD, PhD, DACVB, CAAB, speak at the CanWest Veterinary Conference five years ago about the evidence that fearful events alter the animal brain. He went out for a beer and decided this might be one of the most important things he'd ever heard about veterinary medicine. “When she said fear causes permanent damage to the brain, it all came together for me,” he recalls. “I thought, ‘Oh my God, urgent obligation.' Then I thought, ‘Unprecedented opportunity.'  

“I realized I always had the pet's physical well-being in mind, as almost all veterinarians do. The other thing I had in mind was customer service, attracting good employees, training and retention. It was better communication. It was leadership. It was marketing; it was management; it was motivation. It was taking care of the physical plant. It was looking at new uniforms and a new slogan and all that stuff I wrote about and talked about.

“And I realized the first tenet of bioethics is to do no harm. And we're causing harm. … From then on, for me, it became physical well-being and emotional well-being … I look back in hindsight-all the things I've lectured on over the years and I've been passionate about and written about, they were all incremental. This is transformative. This changes everything.”

This “aspirational” dream of Fear Free practices, he thought, could “transform” the profession. He hired a law firm to trademark the term Fear Free, and he formed a massive and diverse advisory board hoping to set in motion a for-profit educational movement that would lead to a new certification for veterinary hospitals and clinics: “I would hope in five years there would be 50 platinum certified Fear Free practices that would actually be certified through a site visit,” he says.

This month, Becker began marketing the concept. He sees educational modules and rigorous coursework at veterinary conferences and other venues because “this is so teachable,” and a movement he says will transform the atmosphere of a veterinary practice, improve the lives of companion animals and their owners, and-he argues-stem the tide of decreasing clinic visits and lost revenue.

Why create a for-profit rather than a nonprofit program? One reason, he says, is that many nonprofit movements he's been associated with have faltered because of funding issues. “To transform the profession, this needs to be economically sound, representing a broad swath of the profession and-from the start-filled with purpose, passion, and plan,” he says.

Technician Katie McMahon distracts a feline patient with food while veterinarian Laura Durant-Elliott conducts an examination at the Animal Wellness Center of Maple Grove owned by Dr. Carolyn Apker, a Fear Free advisory board member.

Fear is not the cost of treatment

Carolyn Apker, DVM, CVA, is one of 50 members of the Fear Free advisory board Becker has assembled. Becker asked her to join the board after a chance meeting in the Atlanta airport with one of her behaviorists who told him about her Maple Grove, Minn., practice. Apker graduated from veterinary school in 1982 and spent five years as an associate-five years that made her question the decision to become a veterinarian. “I was just heartsick about the way patients were handled, treated and spoken about,” she says. “I was thinking, ‘Could it be that all this time I was wrong?' I decided in 1987 to open a practice my way. If it didn't work, it didn't work.”

Dr. Carolyn Apker

Twenty-seven years later, she says, she can “tell colleagues it worked … and it brought joy back into practice.”

“Our clients don't want to see their family members go through all that distress,” she explains. “It discourages them from coming back. They find ways to justify their way out of coming back for annual or semiannual visits.”

Like Becker, she sees veterinarians focused on physical health but not mental health. “The emotional and psychological well-being of our patients has been underserved,” she contends. “We make sure they have the right diet, the nutrition they need, but the way we deliver care is at odds with our goal.

“You may have an animal in your hospital and his physical needs are being met and his pain control needs are being met but he's feeling lost, scared, manhandled. The old theory was that a kitty hissing and spitting in the back of the carrier was a bad cat. Now we know that's a normal cat who is frightened for its life. You have your way with him and get the job done. That doesn't happen at my practice.” 

She says she was inspired when she heard Overall describe a “revolution” in veterinary practice during a master class. And, after hearing Becker speak at a conference, she says she approached him to say she thought these ideas would create a “stampede” of veterinarians to Fear Free concepts. “I told him, ‘You can count me in on this revolution,'” she recalls.

One place she sees need for change is in the training of veterinary technicians. She's spoken on fear and pain at her local veterinary technical schools. “We need a whole group of techs who will not tolerate procedures that create fear for pets,” she says. “This is just as inappropriate as ignoring pain protocol.”

Changing how a practice treats animals is not expensive, she contends: “It doesn't take a $40,000 surgical laser.” It does take the ability to recognize fear as something dangerous to health. “This is far more important than most of the medical advancements we've seen,” she contends. “It's more important because it fundamentally changes how we interact with our patients.”

Oliver gets a peanut butter treat and calming caresses from technician Melissa Adelmann as fellow technician Catherin Linder completes a nail trim for the patient at the Animal Wellness Center of Maple Grove.

Tuning into fear follows tuning into pain

In a recent journal article, Bernard E. Rollin, PhD, philosophy professor at Colorado State University in Fort Collins, Colo., recalls a debate with a scientist in 1979 about the existence of animal pain. The scientist, he says, later called his dean to describe Rollin as “a viper in the bosom of biomedicine” who should not be allowed to teach. 

Dr. Robin Downing

Feelings ran strong then about Rollin's efforts to suggest the ethical implications for animal research laboratories and veterinary practices of the denial of animal pain. Simply put, he made a lot of people uncomfortable. The first veterinary anesthesia textbooks, he points out, did not even mention felt pain. Bringing recognition of animal pain to veterinary medicine-in Apker's terms-fundamentally changed veterinary practice and procedure.

Apker sees the Fear Free concept as a paradigm shift on the same order as the recognition of pain in animals. She remembers how the profession often thought about pain when she began practice. “We were told animals don't experience pain the way you and I do,” she says. “You don't give pain meds to animals because they'll injure themselves. Today, we've done a complete 180. We know how to recognize pain now.”

Becker agrees. “We were taught pets didn't feel pain like people did,” he says. “That was flat out wrong as they have the same neural pathways. Pets and people feel pain and need it prevented or controlled. We now assume a pet's emotional well-being either isn't fragile or can be ignored on the altar of their physical well-being. Well, guess what? Pets have emotions just like people and can feel anxiety, fear, or trust and love.”

Robin Downing, DVM, DAAPM, who has made pain management a focus of her career in Windsor, Colo., sees the way pain and fear combine in veterinary practice. “What must now be faced as we begin to understand and implement a Fear Free approach to practice,” she says, “is that many of the pets we see who are terrified are terrified because they suffer unnecessary pain and they know that when they are touched, by anyone-but particularly by a stranger-it will hurt them.” Downing uses harsh language to describe what happens to these animals who adopt a ‘bite first, ask questions later' defense. Labeled ‘bad actors,' she contends, they are “subsequently brutalized by their handling” in the veterinary clinic.

Becker remembers how, as a young veterinarian, he was taught how to do ear crops. He became, he says, good at ear crops. “And, today,” he says, “I regret every ear crop I have ever done.”

“It took the profession a decade to really understand and commit to pain management,” Becker says. “For the sake of pets, people, practices and the profession, I hope we can do this transformation-which is much larger than just pain was-in half the time. I fear veterinary practices that don't embrace Fear Free are doomed to second- or third-rate status; they will be looked down upon, and many will go out of business.”

For Apker, like Becker, it is a case of learning to hear. “Animals have been communicating,” she says, “but nobody has been listening. We need to tune into their communication.”

Want more? Find it all at dvm360.com/fearfree

>>>Video: Why go fear-free? Dr. Marty Becker explains it all. If patient fear and anxiety were a pandemic, what's the cure? Dr. Becker has more than a few ideas in mind.

>>>Facing fear head on: Tips for veterinarians to create a more behavior-centered practice. Dr. Karen Overall equips veterinary teams with the ability to assess and alleviate fear during veterinary visits to build a more positive patient experience and stronger pet-owner relationships.

>>>Posts and tweets about fear-free tactics. Share your fear-free techniques on social media to make clients less nervous to bring their pets into your practice.

>>>Is routine veterinary care contributing to lifelong patient anxiety? Explore the dramatic impact of a single visit on a pet's long-term behavioral well-being.

>>>Video: Comfy pets are happy pets. Dr. Andy Roark says to give your veterinary patients the royal treatment they deserve.