The Fear Free Initiative: Happy Pets Are Just Good Business

A hissing, spitting cat hiding in its carrier can strike fear in the heart of even the most seasoned veterinarian, while the silent puppy averting its eyes brings a sigh of relief for an easy exam. both animals are exhibiting signs of fear and should be cause for concern.

It is not surprising that animals in the clinic exhibit higher respiration, temperature, heart rate, and blood pressure, as well as different behaviors, than at home,^1,2 since they are in unfamiliar surroundings with strange people and other animals. The floors can be slippery. There are strange sounds and smells, and even a well-meaning pat can be potentially unwanted attention.

A study, by Bayer Healthcare, found that patient visits have been substantially declining despite increases in pet ownership, which may be a result of the 38% of dog owners and 58% of cat owners who report that their pets hate going to the veterinarian.³ However, it doesn’t have to be this way.

A paradigm shift is happening in veterinary medicine. Although the physical aspects of care will always be at the forefront, the emotional well-being of animals is now recognized as an important contributor to good health. Reducing pet stress, anxiety, and fear associated with visits to the veterinary clinic has spurred the embrace of the Fear Free^SM Initiative. At the center of the initiative is the realization that fear leads to permanent changes in the brain, specifically the region of the amygdala. This means that a puppy or kitten’s first experiences with a veterinarian stays with it for life. Therefore, while examinations require contact that may not be entirely pleasant, there is much that can be done to reduce the risk of a fear response. By employing techniques that reduce stress, the cortex can override the amygdala, which can lead even older animals that are fearful from previous experiences, to learn that the veterinary clinic is a good place.

The principles of the Fear Free^SM Initiative may be different than what you are currently doing in your practice to reduce stress. Adopting them needs to be pervasive, but not necessarily difficult or expensive to implement. However, committing to establishing a Fear Free^SM clinic must be a conscious effort that is embraced by everyone in your practice. Below are some of the approaches to creating more relaxed visits for your patients.

MODIFY THE ENVIRONMENT

• Play low-volume, mellow music, and eliminate extraneous noise
• Eliminate bright overhead lights; use targeted lighting instead
• Paint the office in muted tones
• Avoid using disinfectants with strong odors
• Spray species-specific pheromones and have catnip or treats readily available
• Place nonslip bath or yoga mats on exam tables

CONDUCT MORE THOUGHTFUL EXAMINATIONS

• Speak softly and start by talking to the client first, to allow the pet to acclimate to the room
• For larger animals, conduct the exam on the floor
• Go slowly, proceed with the exam as the animal presents different body parts, and provide frequent treats; a dog trained to give his paw offers you the opportunity to exam it
• Allow the animal to remain on the client’s lap for noninvasive procedures, such as temperature-taking

TRAIN ALL STAFF TO RECOGNIZE AND ADDRESS FEAR

• Ask the client about their pet’s level of stress; they are the experts in identifying fear in their own animal
• Allow the animal to approach the staff, and avoid direct eye contact
• Offer treats almost continuously, especially to distressed animals
• Do not be afraid to suggest rescheduling the appointment if the animal is overly stressed

MANAGE THE RECEPTION AREA

• Create dog- and cat-only zones
• Minimize wait times
• Place scales away from other waiting patients

ADMINISTER ANTI-ANXIETY AND PAIN MEDICATIONS

• Sedate the animal instead of using forceful restraint
• Use topical lidocaine for blood draws and other semi-invasive procedures

EDUCATE CLIENTS ON HOW TO PREPARE THEIR PET FOR THE VISIT

• Request that clients bring pets when they’re hungry so they’re more receptive to treats
• For cats and small dogs, instruct clients on the appropriate carrier for their pet, and provide instructions on training their pet to tolerate the carrier
• For larger dogs, suggest the client bring their pet to the clinic, outside of appointment times, to help the pet get familiar with the unique environment

Implementing some of these strategies may not only reduce the patient’s stress—a noble pursuit in its own right— but will demonstrate to the client that you sympathize with their pet’s feelings. Subsequently, you will gain a more loyal client who is less hesitant to bring in their pet for a visit.

Dr. Jonathan Bloom, DVM, medical director of the Willowdale Animal Hospital in Toronto, Canada, has found that since adopting Fear Free^SM methodology, his practice has gained clients and he has even seen an increase in visits, while other veterinary practices have not. He believes that by creating a Fear Free^SM environment, you eliminate one of the greatest barriers clients face when deciding whether or not to bring their pet into the clinic, an animal that does not want to go. Furthermore, becoming Fear Free may help with employee retention. As Deborah Breitstein, DVM, who has employed Fear Free^SM practices since opening Animal Health Care of Marlboro, in Englishtown, New Jersey, in 1992, stated, “If the animals are not stressed, then the clients are not stressed, and the employees are not stressed.” Dr. Bloom adds that “staff morale has never been higher, staff has never been happier and never more engaged,” since embracing the Fear Free^SM Initiative.

If you are interested in joining the Fear Free^SM Initiative, the American Animal Hospital Association, in conjunction with the North American Veterinary Community (NAVC), has been offering Fear Free^SM Certification since April 2016. Applicants will need to complete an 8-module online course through the VetFolio platform (www.vetfolio.com) and take an exam after each module. A veterinarian will be able to call their practice Fear Free^SM Certified when a minimum of two staff members have successfully completed the program. The certification will last for a period of 3 years. If you would like to learn more, an introductory course on Fear Free^SM veterinary visits, by Dr. Marty Becker, is currently available on VetFolio for 1 Continuing Education credit.

Meredith Rogers has a bachelor of science degree in animal health from the University of Connecticut and a master of science degree in microbiology and molecular genetics from Rutgers University/UMDNJ. She received certification as a Medical Publication Professional from the International Society for Medical Publication Professionals in 2013 and has more than 19 of years experience creating medical, veterinary, and scientific content for a variety of healthcare audiences, including doctors, nurses, pharmacists, veterinarians, and patients. She lives in Kingston, New Jersey and shares her life with a horse, a dog, and a cat, so animal health is always a top priority and a passion for her.

REFERENCES

• Quimby JM, Smith ML, Lunn KF. Evaluation of the effects of hospital visit stress on physiologic parameters in the cat. J Feline Med Surg. 2011; 13(10):733-7. doi: 10.1016/j.jfms. 2011.07.003.
• Bragg RF, Bennett JS, Cummings A, Quimby JM. Evaluation of the effects of hospital visit stress on physiologic parameters in dogs. J Am Vet Med Assoc. 2015;246(2):212-5. doi: 10.2460/ javma.246.2.212.
• Spinks I. Bayer veterinary care usage study III: feline findings 2011. Bayer DVM website. www.bayerdvm.com/Admin/f i l e . a s p x / downloadfile/54001665. Accessed January 29, 2016.