How emotional care can improve emergency outcomes in patients

Although emergency veterinary practices may succeed in triaging and assessing patients’ airway, breathing, and circulation (ABC), there is sometimes a lack of consideration for the emotional wellbeing of those patients. In an interview with dvm360 on her Fetch Kansas City conference lecture, Natalie Marks, DVM, CVJ, CCFP, Elite FFCP-V, spoke about the intersection of a patient’s emotional health during an emergency visit and a veterinarian’s ability to get a diagnosis for that patient. She also explained that a painful and fearful emergency room experience for a patient can lead to a more extreme response the next time that patient goes to a hospital.

Below is a partial transcript:

Natalie Marks, DVM, CVJ, CCFP, Elite FFCP-V: …often, when a patient is brought into an emergency setting and immediately brought into I'm just going to call ‘the back’—into the treatment area—, there are certain situations and sometimes certain practices where there is not a lot of consideration about the emotional health in that moment as well, meaning that we're doing a great job of triaging, temperature, pulse respiration, pulse [oximeter], ability to walk, just assessing ABC—you know, all of the emergency strategies for physical health and triage—but often, if we just took a step back just for a few seconds and thought about some of the other factors that play a role, like pain and fear and anxiety, not only can we help that patient often feel better, because we know pain (which is often a big component of many of our patients in the emergency room and emergency situations) will often create fear, anxiety, and stress; but we also know that [in] anxious patients and fearful patients 2 things happen:

1. It's very difficult to do a physical exam accurately on a patient who's highly anxious because often (if we'd miss the signs they're showing us, which often in an emergency setting, we're not really thinking about that)…they will get to a point where they become reactive, which means it's very difficult, of course, to get an accurate heart rate or to work in their mouth, or to do some of the different procedural imaging that we need to do. So it delays our ability to get a diagnosis.
2. the other thing it does is it basically imprints on that patient that that experience, for lack of a better term, sucked, and they're going to remember that permanently in their amygdala as a very fearful experience for them and for the pet parent, and so the next time that patient goes to a veterinary hospital, it's going to be even worse for that team, the next team to work with that patient, because it's going to not only trigger that fearful memory, but we know very clearly that any time that fearful memory is triggered, we actually will see a longer intensity and duration of response.