The FAS Scale: Fear, Stress, and Anxiety

The Fear, Stress, and Anxiety Scale helps veterinarians understand when to stop an examination before it become dangerous. Laura Muller, LVT, nursing manager at Cherry Hill Animal Hospital in Cherry Hill, New Jersey, says implementing this scale in practice is extremely helpful.

Interview Transcript (slightly modified for readability)

“Something that’s really helpful in practice is actually implementing the FAS Scale. So, FAS stands for fear, anxiety, and stress, and this is something that clients necessarily aren’t good at recognizing, but us as professionals need to recognize these nonverbal—or sometimes verbal—cues. We tend to keep on going and going until it becomes a safety risk. That’s not the point that you stop. You stop when you notice that the patient is uncomfortable. Signs of that: discomfort, stress, these are all things that we know by lip licking, yawning, excessively panting (they’re not hot, it’s the middle of the winter), they’re getting worked up because they’re either experiencing fear or anticipating that fear. That anxiety, that excessive vocalizing, that pawing at the appointment door—that doesn’t look good and they’re really stressed out.

You can do a couple of things. You start with your treat ladder, you start with what I call buttering up. You talk about what the client should expect before the appointment—to bring in their toys and treats—but you want to stop before it gets to that point of escalating to where it becomes a safety concern. Not only is it better for client perception and staff safety, you want to make sure that pet isn’t leaving on that bad note. That the pet wasn’t held down for its vaccines. That the pet wasn’t screaming to where the client is so upset to the point they tell you to stop. You want to keep on making it a positive experience. And when the pet tells you its had enough, which is freezing, or instantly tensing up, obviously lip lifting, things like that. When you start to see the pearly whites, they’re not happy, and clients pick up on that too.

Things that you can do is just really communicate to the client just what your goals are. ‘Mrs. Smith, our goals are to make sure that Fluffy is happy when he’s here. I’m actually not getting a really good physical exam because he’s so worked up. Maybe what we can do is stop here for now and see if we can see Fluffy in 2 days. I’m going to send home some medications just in case of anxiety of the appointment, and I think you can see he’s a little more comfortable when he comes back.’ And clients like to see that. They like to see their pets relaxed. There are certain things they’re not going to pick up on, those low signs, but they see it when they flash their smile. We realize that it’s not safe to go forward. The dog pulls, the rabies bites—those are things of the past, they’re really archaic. They serve a purpose, but in general practice, they really don’t. There are so many more things we can do to keep our patients comfortable and safe.

In the Fear Free toolbox there is this really nice sheet that’s super easy to follow and we actually show this to clients. So, green means go; yellow, eh the patient is getting a little iffy, you might want to slow it down, we want them to be comfortable as we go forward; and red is stop. Stop is very obvious. These are the places where typically in veterinary medicine so far we have been like, ‘I don’t know how this is going, not really.’ But for the patient, they’ve already mentally gotten to that point where they’re not going to slow down, they’re not going to de-escalate, and we want to make sure we capture them while they’re still in a really, really good positive state of mind.

So, we want them to be relaxed, laying comfortable. Bella’s a really good example of that right now. Even though she’s had a really, really stimulating morning, she’s comfortable and relaxed, her back is actually facing me, she feels really comfortable, she’s laying down, she’s not really haunched and ready to pounce up, that’s when you start seeing that hissy tail going and when you start hearing them vocalize, showing their teeth, being disinterested and engaged can just be a cat being a cat, but with dogs, they’re a little bit more socially bonded to us. When they start backing away in the corner, when they start hiding underneath that giant chair, we want to try to bring them back to the positive side, right? We want to start offering them Easy Cheese. We want to take out the squeaky ball. We want them to kind of be distracted from what’s going on, but making a positive experience.

So, when a pet’s underneath the client chair and they’re just sitting there trembling, we’re not going to grab onto that leash and start reeling them in—that only makes it worse. So, think about with a pediatrician and you have a child at the doctor’s. You’re going to want to give them things to play with, you’re going to want to give them a lollipop. You’re not going to want to give them a lollipop when they’re screaming and so upset, it doesn’t help them then. You really want to make sure you’re minimizing that stress, and when you see those signs you kind of step back a little bit and re-evaluate and try to continue on a positive note.”