A team approach to behavior medicine

Checking my schedule for the busy workday I see the usual suspects: standard wellness appointments, ear infections, a couple chronic weight loss cases. And then my stomach knots up. Today at 4:30 it's Boris.

This appointment is over eight hours away and already I'm fraught with anxiety.

What is it about Boris? He's a neutered male Rhodesian Ridgeback who shows severe aggression issues with strangers. And those issues are even worse with me, his veterinarian of many years.

I dread seeing Boris (or any one of my patients like him) on the schedule for multiple reasons. First is the wrench these appointments can throw into my day. Complicated behavior cases like this often require more than the allotted 30-minute appointment time and can put the rest of the day into a tailspin.

But more disappointingly, I feel like by prescribing one of the four go-to behavioral medications, crossing my fingers and hoping for the best, I am likely failing these patients and clients. But I've been unsure of how to improve this aspect of my general practice.

However, after listening to Fetch dvm360 conference speaker Lisa Radosta, DVM, DACVB, I realize how my staff and I could work together to be a better first line response to behavioral problems.

In order to see success (and, as a result, happy patients and clients), the approach needs not only consistency in application, but specific, realistic goals from the outset. For example, a client saying “I want a calm dog” is not enough. Instead, get specific: “Does not panic during fireworks” for a noise-phobic dog, or “Can be left alone” for a separation anxiety case. This level of detail changes the medical management and behavior modifications selected for the case.

One key to Dr. Radosta's approach is a sometimes overlooked aspect of efficient practice management: using you, the team, for everything you can do.

First: the front desk. She suggests the front desk team have clients fill out simple one-page screening forms (available on her website) regarding the pet's psychological health. The form also can be passed to clients scheduling wellness appointments that may mention behavioral issues and for patients over 10 years old where cognitive dysfunction is noted. This will save time and prevent the doctor from being blindsided by behavioral problems in the exam room.

Regarding treatment, here's where the rest of the team comes in. Dr. Radosta says that there are more layers to handling this type of patient than just prescribing trazodone, fluoxetine, clomipramine or alprazolam.

“Behavioral plans have three parts: management, medical treatment and behavioral treatment,” she says, “And veterinarians are often falling short on the behavioral component.”

Here's how Dr. Radosta says that last element can be tightened up: Following the exam and client consultation, the veterinarian should identify the behavior diagnosis and determine a plan. Then-another chance to utilize your in-house veterinary professionals-rely on technicians to institute that plan. Have a technician show clients how to implement the desired training/behavior modification techniques and carry out weekly follow-up sessions.

Having an educated, enthusiastic behavior-focused technician team is key to this approach.