Tips for making veterinary visits less stressful for patients

alenka2194/stock.adobe.com

Veterinary visits are too often stressful and traumatizing for patients, making the experience a challenging one for the veterinary team, patients, and clients. So, what can veterinary professionals do to alleviate a patient’s stress and fear in the clinic, and what actions can be suggested to the pet owner to help reduce their pet’s anxiety before the visit?

This January, the 2025 Veterinary Meeting & Expo took place in Orlando, Florida, with almost 30,000 participants from 86 countries attending.¹ Among the educators lecturing to the multitude of attendees at VMX were Paul Bloom, DVM, DACVD, DABVP (Canine and Feline), Elite FFCP-III, adjunct faculty member at Michigan State University’s (MSU) Veterinary College; and Marty Becker, DVM, Elite FFCP-V, also known as “America’s Veterinarian,” founder of Fear Free, who presented the session Skin to Win: Making Derm Cases Less Stressful.

The lecture focused on how to minimize patients’ fear, anxiety, and stress (FAS) during dermatology appointments using a Fear Free approach. To gain insight into how this can be done, dvm360 reached out to Bloom and Becker to talk more about their session.

How does FAS affect patients and veterinarians’ ability to treat these patients?

Becker: Pets are like 1-year-old children. They are a) taken against their will for healthcare (some call it ‘hell-care’), b) have 0 idea how any procedure benefits them, c) can't anticipate the relief of [FAS]/pain even if it's moments away, and d) can't flee the threat.

The vast majority of pets that don't go to a practice where Fear Free principles/protocols are implemented feel like they're going to be harmed or killed; the pet's mom or dad feel like they're hurting their pet by trying to help them (by taking them to the veterinarian). The end result is that pets a) don't receive the necessary care, or b) receive care but suffer severe, permanent psychological damage and unnecessary pain.

Bloom: [FAS] makes it difficult to perform physical examinations on…pets. It also causes great distress when the owner sees their pet being fearful.

[If]…Fear Free techniques [are used], owners are more likely to bring their pets in for care. There was a study performed which found that 28% of cat owners and 22% of dog owners reported that they would bring their pets to the veterinarian more often if the visit was not associated with so much stress. So, it is great for the pets and great for the business.

It is a great practice-builder when owners go home and talk to their neighbors and tell them how happy their pet was to see the veterinarian. It’s better for the dogs to drag the owners into the clinics because [they will be rewarded] with food and praise than to have the owners have to drag them in.

Why are dermatology cases so stressful to patients?

Bloom: There are a number of reasons. One of the reasons is that the animals are very uncomfortable either with intense itching, or ear infections, or both. I think that their sleep patterns are disrupted because of these problems. This would make the animals less approachable, just like people who have their sleep disrupted. In addition, I believe many of these animals have pain associated with [their] skin disease, especially with ear problems. Anyone who [suffered] from [skin reactions] as a child probably still recalls the discomfort they had at that time. Anyone [who] does not believe [that] skin disease can cause pain has never had a severe sunburn.

Becker: Nerve-endings right on the surface of the skin [are] painful, infected areas [are] often very sensitive (face, feet, ears). Derm cases [are also] often chronic.

How are derm cases conventionally handled, and how should they be handled? What should be changed?

Bloom: I think that in the past when we had a dermatologic problem, we would go to the source…that was affected and examined [it], causing [the patient] to have discomfort, which then leads to escalation of [FAS]. A better way to approach it is to first befriend the animal, touching areas that cause pleasure. For example, scratching the chin or the cheek of the cat, or scratching the back of a dog.

Also, during this time, we should have high value treats being fed to the animal, such as cheese, peanut butter, hot dogs, catnip, [Greenies], Purée Temptations, Tiki Cat Vet Solutions Chicken in Creamy Gravy. Once we have established a pleasant contact, we then start to examine areas that are unaffected and then progress to the less affected areas and finally save the most affected areas for last. During this entire time, the owner should be [at] the head of the pet stroking them, talking to them, and feeding [them].

What are some other things veterinary practices can do to reduce FAS in patients?

Becker: The key is to keep [FAS] levels low, from the living room, to the exam room, to the treatment room, and back to the living room. A myriad of animal handling techniques, sedation protocols, design features, and husbandry techniques help accomplish this. Also, preventing and treating pain is a priority.

Bloom: It begins with a phone call where the [client service representatives] remind owners that if they have been prescribed pre-visit pharmaceuticals [PVPs], to be sure to give [them to] the pet prior to the visit. [Clients] are also told to bring their [pet’s] favorite toys, favorite food and if they have a favorite companion, to bring the companion with them. Lastly, we tell the owner…to make sure that the pets are not fed prior to the visit so they will be especially hungry, thereby more likely to eat and be appreciative of being fed.

When the owners arrive, rather than for the animal to come into the veterinary clinic immediately, it is best to leave the owner and the pet in the car until it is time to examine the pet. Interviews and history-taking can be taken over the phone.

I think it is very important not to separate the pets from the owners unless the owners request that because I think it increases the pet’s [FAS] and I think it also causes some anxiety and stress in the owners. Using [a] pheromone diffuser…in the exam room, along with playing classical music also will decrease [FAS]. Lastly, we try to have exam rooms for cats only so there is not smell of the dog in the room.

How should veterinarians handle cases in which the patient has an extreme level of FAS?

Becker: Stop! A) come back another day a different way (perhaps with [PVPs]), or b) go straight to sedation. I tell clients, "I'm not going to sacrifice your pet's long-term emotional wellbeing for the convenience of getting this done today.”

Bloom: Do not attempt to examine the animal because things are just going to escalate even more. They should either be sent home with some [PVPs] or given injectable sedation prior to the exam. Fighting the dog to do things will only worsen the FAS.

What are some things veterinary professionals can communicate to pet parents prior to their appointment to make the appointment smoother and less stressful for everyone involved?

Bloom: I think especially for cats, [clients] should leave their cat carriers out all the time and feed the cats in the cat carriers so that they [become] accustomed to the cat carrier. …Using pheromones in the car and in the carrier can improve the FAS. …Also, playing classical music on the radio can cause some relief. [Researchers] found that when classical music was played for…animals, they required 20% less propofol for tracheal intubation. They also found that [when playing] classical music, animals vocalized less often.

Becker: Get the carrier out a week before (not the night before or the morning of); start a magic carpet ride of pheromones from carrier, to car, to clinic; pre-heat or cool the vehicle, so go from 73 [degrees] in the house to 73 [degrees] in the vehicle to 73 [degrees] in the practice; don't baby-talk the pet on the ride; do play calming music; cover the carrier on 3 sides with a light sheet to reduce visual stimuli; only go into the practice when you can go right into an exam room; DON'T put the pet up on the exam room table unless absolutely needed (all animals’ #1 fear from birth is the fear of falling); use A LOT of PVPs; don't use harsh restraint (use considerate approach, touch gradient, gentle control).

Is there anything that we didn’t discuss that you would like to talk about or want the audience to know?

Bloom: I just want to stress that doing Fear Free techniques is a great practice-builder. Owners are impressed with the animals’ behavior in my clinic, [which] practices Fear Free techniques.

Becker, “America’s Veterinarian,” founder of Fear Free, has helped popularize the human-animal bond as well as the human-animal health connection. He has authored 23 books—several of which have been New York Times bestsellers. For decades, he was a veterinary correspondent for major media, including network television. Becker also wrote a nationally syndicated pet/veterinary column for more than 20 years and serves as chief veterinary correspondent for the American Human Society. In a correspondence with dvm360, Becker shared, “most don't know that I've owned multiple veterinary practices and still practice at age 70.”

Bloom, an Elite Fear Free Certified Professional with a Certified Cat-Friendly Veterinarian status, graduated from MSU in 1976 and became Michigan's first board-certified veterinary dermatologist in full-time private practice in 2001. He has received several honors, including the Distinguished Alumni Practitioner Award from MSU College of Veterinary Medicine in 2019 and the Philanthropist of the Year Award in 2020, the latter of whom he received alongside his wife. He is also a Fear Free Certified Professional and a Certified Cat-Friendly Veterinarian. In addition to his clinical work, he lectures internationally and has authored many book chapters. He also serves on the program committee for the American College of Veterinary Dermatology.

References

1. VMX 2025: A record-breaking celebration of innovation, education, and thought leadership in veterinary medicine. News release. North American Veterinary Community. January 30, 2025. Accessed February 4, 2025. https://prnmedia.prnewswire.com/news-releases/vmx-2025-a-record-breaking-celebration-of-innovation-education-and-thought-leadership-in-veterinary-medicine-302364497.html