Quick tips for a better feline physical exam

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Performing physical exams is one of the most meaningful things veterinarians do. But cats don’t always make them easy, do they? The good news is there are ways to streamline your process so it’s faster, more efficient, and easier on your patients and staff. In a session at the Fetch dvm360® virtual conference this morning, Lauren Demos, BVMS, HonsBSc, DABVP (Feline), chief veterinary officer at Pettable, offered valuable tips for accomplishing these goals.

“The physical exam is a highly undervalued tool in today’s practice,” Demos said. Advantages include facilitating early diagnosis of medical conditions and providing peace of mind for pet owners. In human medicine, some disadvantages, such as the costs associated with doctor visits and diagnostic testing, and the potential for overdiagnosis or misdiagnosis, are receiving attention. However, veterinary patients can’t self-report symptoms, and they tend to hide their illnesses—even from observant pet owners. So, the physical exam remains an indispensable tool for veterinary clinicians. If your routine physical exam procedures aren’t working for you or your patients, it’s worth a little re-evaluation to modify them.

Understand and communicate the value of the exam

Helping pet owners appreciate the value of the physical exam may be the first hurdle in making exams more productive and less stressful. Demos said that pet owners’ experiences with their own health care providers may inform their perceptions about how veterinarians approach medical care, including why we perform physical exams.

Some owners expect a very limited physical, or no physical at all, when their pet comes to the office for vaccinations. These clients deserve to be educated about why exams are necessary for their pets’ health. Demos advised: “As veterinary health care providers, it’s important for us to communicate what we’re doing during the exam process, what we’re looking for, and what we’re finding while we’re finding it, so we can relay the importance of the physical exam component, which is the most important reason for wellness visits.”

Frequency of physical exams is another point that should be communicated to pet owners. It’s reasonable to recommend annual exams for adult cats, semi-annual exams for seniors, and more frequent visits for cats with chronic illnesses. Demos also noted that kittens between age 4 months and 1 year may benefit from an exam. “I generally like to have them back between 7 and 9 months of age,” she said. This visit is an opportunity for things like checking the teeth (for retained deciduous dentition or other anomalies), checking for a heart murmur that may not have been noted during the kitten vaccine visits, and educating the client about such topics at-home dental care and parasite prevention.

Create a positive environment for the patient

“For cats, the environment is critical. The less stimulation they have around them when I’m trying to do my exam, the better,” Demos said. Minimize or avoid loud noises, sudden or excessive movements, strong odors (eg, perfumes, scented candles), and other stimuli. Some cats respond well to synthetic feline pheromone sprays or diffusers, but others become agitated. So, use those products variably based on patient preference.

Touching the cat should also be a controlled process. Repeated trips in and out of the carrier and being handled by multiple people can create stress for some cats, making them more difficult to manage.

Assemble the necessary equipment

To improve efficiency and workflow, Demos suggested that all the equipment needed for exams should be in each exam room. Ensure that stethoscopes, thermometers, ophthalmoscopes, otoscopes, and other supplies are available and ready to use (ie, properly cleaned and charged).

To facilitate patient comfort and handling, make sure each exam room has a generous supply of towels. Keep other devices, such as gloves and cat muzzles, handy. And make chemical restraint available for patients that require it.

Standardize your exam procedure

Developing a methodical approach for each physical exam improves consistency and reduces the chances of overlooking a significant finding. “Clinicians miss more by not looking than by not knowing,” Demos said. Physical exams also become faster when veterinarians become accustomed to doing things in the same sequence each time. “This streamlines the amount of time you’re spending with the patient, and getting in and out of the room, to maximize the use of your time as a clinician,” she said.

Incorporate the essential exam components every time

The basic physical exam has 4 key components:

• History and signalment
• Visual assessment
• Vital signs (temperature, pulse, respiration)
• Hands-on physical exam

Demos begins her exams by reviewing the medical history before the patient enters the exam room, noting that this preparation helps improve efficiency. Once the client enters the room, details like feeding routines, urination and drinking, and presenting complaint can be clarified. This is also an ideal time to determine the client’s expectations for the visit and ask detailed questions that may not be evident from the initial history.

Once the cat is out of the carrier, visually assess things like mobility, body posture, mentation, behavior, body condition, coat condition, and how the cat interacts with its surroundings, as these details can provide valuable clues about the patient’s health. This is also an opportunity to determine whether the cat is relaxed, friendly, anxious, or aggressive before you actually handle the animal.

Depending on the practice, vital signs may be assessed by veterinary technicians or by the veterinarian. Demos considers body weight a meaningful part of this assessment. “It’s not just taking a single data point during a single office visit. The overall trend is important as well,” she said. Presenting a visual graph of the cat’s weight history can confirm weight changes that inform the need for diagnostic testing, diet counseling, or other intervention.

When handling the cat, use feline-friendly procedures to minimize patient stress. “Less is always more, single touches are better than multiple ones, and practice makes perfect,” Demos advised.

The hands-on physical exam should be a methodical assessment of the body’s major organ systems. This thorough, systematic evaluation can detect problems the owner was unaware of, enhance your patient care skills, and solidify the importance of the exam procedure with the pet owner. In addition to ausculting the heart and lungs; palpating the abdomen; checking the teeth, tongue, and gums for dental disease, masses, or lesions; and performing other basics, Demos cautioned attendees not to forget a few other key assessments, such as palpating the thyroid glands as well as the bladder and kidneys for signs of pain. Demos also reminded attendees to perform fundic exams, use an otoscope cone attachment to check the ear canals and tympanic membranes, and smell the ears for signs of infection. “Always look in every ear and every eye, in every patient you see, every time. That’s a good rule of thumb.” With consistency and practice, these assessments can become part of every routine exam.

Dr. Todd-Jenkins received her VMD degree from the University of Pennsylvania School of Veterinary Medicine. She is a medical writer and has remained in clinical practice for over 20 years. She is a member of the American Medical Writers Association and One Health Initiative.