Veterinary conundrum #14,123: The enabler

Sarah, a certified veterinary technician, enters the room to a hackled and uninterrupted display of aggression.

The room is thick with coiled energy. A penetrating and icy defiant stareaccompanies a cacophony of explosive sounds from a 90-pound Rottweiler mixnamed Zeus.

His owner, Janice Jones, is at first apprehensive. Then incongruouslyshe states to Sarah, "Your records and papers are upsetting him."(This is a true story word-for-word.)

Sarah tries to act calm and aloof so as not to alarm Zeus any further.Mrs. Jones interprets this as a sign of indifference to her pet's "distress."

Mrs. Jones now has moved past a point of understanding anything but herconcern for her pet. Her misunderstanding of canine behavior overshadowsany thought of danger to the veterinary staff. For Sarah, these types ofexchanges were becoming much too common.

Just yesterday, Sarah had entered the room to find a beaming family witha happy and bouncy 80-pound yearling Golden Retriever. Coiled, sinewy, andflowing with hormones, "Casey" had flown into Sarah and almostknocked her down. Sarah reached to take the leash and gently encouragedCasey to follow to be weighed. Now Casey lunged at Sarah with teeth bared."Mr. Hyde" the dog had suddenly shown up.

Golden answer

How should these cases be handled?

A: Educate the client

B: Carry a gun for protection

C. Lead the pet to the back and begin dominance trainingin view of the owner.

D. Bring more people into the room.

I sent this scenario to Regis Philbin for inclusion in "Who Wantsto be a Millionaire." He answered that this question is inadmissiblesince the answer was worth more than a million dollars. In economic termsfor the profession, this is quite true.

Answer (b) is tempting.

Answer (C) is commonly employed by technicians with lots of experienceworking with dogs. This may seem like the most suitable thing to do, however,there will be very little understanding from the client perspective. Manyclients will pay their bill and never return.

What about (d)? It does not take many years working in veterinary examrooms to realize that this approach can backfire on you. When you call infor back-up it can be quite intimidating to dog and owner. Now you are losingground.

The answer, of course, is (A). That seems to always be the answer doesn'tit? The problem is that these clients seem to come in during times thatare extremely busy. "Quality time" with the client and patientis always sorely lacking.

Let me say up front that this is not an article about canine behavior.It is an article about human behavior. Naturally, in the course of educatinga client, some form of behavioral modification and training will be addressed.In many cases these patients should be referred to a qualified trainer ora board certified veterinary specialist.

Skewed perception

Unfortunately, clients often misinterpret the bad behavior of a treasuredpet as originating from the veterinary environment itself. Dog owners arequick to point out that their pets are perfect angels at home and only actout their aggressions when disturbed or "challenged" by veterinarystaff.

Of course, being perfect angels at home is many times based on the factthat clients seldom ask their pet to do much else at home other than tobe a dog. When a pet is suddenly put in a position of being leashed, restrainedand otherwise denied full and continuous control of whatever pleases himor her, they react in a variety of ways-some of which can be very dangerous.

These clients can be unreasonably permissive and overprotective. To borrowfrom those professions who work with addition and related issues, theseclients would be called "enablers".

Enablers allow their pets full control over their lives thinking thatthis is how they can best show their love and devotion (see sidebar). Behaviorsthat for a variety of reasons would be considered anti-social or unacceptableare allowed to continue for reasons that are quite complex and beyond thescope of this article. Nonetheless, veterinarians are put in a positionof controlling the work environment for the safety of everyone. In the worst-casescenario, clients could bring suit over issues occurring in a veterinaryhospital that neither the public nor the legal profession has even the slightestunderstanding.

Your goals are:

· Cool off

· Keep the lines of communication open

· Ensure a safe working and home environment for everyone involved.

· Make these pet owners better long term clients

Cool off

It is easy for veterinarians and sometimes the attending staff memberto lose their cool dealing with "enabler" clients. The stressof practice and the "heat of battle" seem to thin the white matterconsiderably on a busy day.

Loss of temper equates to loss of professional deportment. Job one isto remain calm. Indifference (low emotional output) to the animal's aggressioncan also be one of the most appropriate human responses to that aggressionand can, in many cases, calm an aggressive pet. It is important to continueto talk to the people and the animal in a quiet voice in order to assurethe pet and the owner that you are proceeding, albeit with measured caution.I will often sit on the floor in order to make sure that my head and bodyare not directly over the pet. Some veterinarians may not feel comfortabledoing this, but I have found this will remove the fear that some pets feelin the presence of a stranger in standing in a position of dominance overtheir head or shoulders. The owner usually responds favorably to this.

Lines of communication

An enabler client will give varied responses to excuse the threateningposture of a pet. Some state that their animal has never "really"bitten anyone. Owners will mistake the fear a pet exhibits as a dislike.They may state that the pet does not "like" certain things suchas men, uniforms, veterinary offices and certain sounds-as if this somehowis reasonable and expected of all pets. Often they will relate that theanimal was beaten before they obtained the pet. (There is very seldom anyevidence to support this contention. Although one can never justify thebeating of any animal, the fact is that most alleged puppy beatings shouldbe classified as "urban myths".)

Initially enablers are seldom swayed by facts. It is important to expressyour understandings of these issues as best you can and repeat your concernson a subsequent veterinary visit.

Stuck in the present

The enabler mentality is stuck in the present-a very focused concernfor their pet's comfort and happiness. Therefore enablers show little concernor reasoning for future events. The most common hurdle for the veterinarianto overcome is this: these owners do not recognize that the behavior oftheir pet is a problem issue that needs to be addressed both now and inthe future.

Although I recognize that we have no formal training in this area, veterinariansmust, at this point, take on the role of counselor.

Most clients should be kindly and professionally informed that thesebehaviors are unacceptable regardless of the owner's false reasoning andjustifications. This should be done in a direct, but friendly manner. Whathappens at this point forward will make all the difference in the worldfor the pet, the family and the veterinary clinic.

It's very important to give your professional counsel concerning potentialfuture issues with health and safety regarding family, friends and veterinarystaff. You must directly show the owner that you are concerned and willingto help them if they will (above all else) recognize the issue as a realproblem. This recognition may take time and the help from another familymember.

Highest and best

Unless you are trained in this area, you should always recommend thehighest and best level of behavioral counseling. Your first choice wouldbe a referral to a board-certified veterinarian specializing in behavior.A second choice would be a trusted professional dog trainer who uses positivemethods of behavioral modification.

You must ask the owner to trust you and try hard to accept your guidance.It may seem silly to ask a client to trust you but in this area of clientrelations, it is helpful to face this issue directly. They need someonethey can trust-you need someone who will trust your guidance.

You must get very personal and ask them simply to trust you. This makesthem examine the issue head on. If they will not verbally agree to trustyou with regard to guidance in this issue, then immediate referral is preferred.

Ensure a safe working and home environment

It is up to the veterinary clinic to tend to these issues:

* Clinic safety of the owner's family and pet.

* Safety of staff

* Safety of other clients and their pets

* Safety of the pet, other pets and the family in thehome environment.

Here are some suggestions:

Owners who are unable to recognize the potential threat their pet posesto themselves and others should be separated from the pet for examination.

Young children and other family members, if present, should be askedto move to the other side of the room.

Trained staff should ask the client to leash the pet with a leash thatis the property of the hospital. This is because leashes and collars thatoriginate from these types of owners are often insufficient or too looseto control the animal. Staff then should take the hospital leash and thepet from the owner and lead the animal away from the owner. Leashing andwalking an animal away from the owner is very often sufficient to removethe aggression from a fair number of aggressive dogs.

Experienced veterinarians will recognize that when some dogs are removedto another room by leash they will often become much more compliant.

Examination should proceed if possible in a caring and straightforwardmanner. If examination is impossible, further pressure on the pet will onlymake matters worse and safety is an overriding concern.

At this point, the pet should be led back to the owner and if the ownerhas agreed to trust you on matters concerning their pet, arrangements shouldbe made to come back under sedation, with no extra family members at a lessbusy time for the hospital.

Make these pet owners better long-term clients.

Deep-down, enablers want to do the best thing for their pets. Persistencewill eventually pay off when the other elements mentioned above start tofall into place. It is important that as a veterinarian you take the leadand train your staff accordingly.

In some cases, when a client refuses to allow you to work on behalf ofeveryone involved and the patient, you must ask him or her to find anotherveterinarian. This is a reality. The number of these clients, nevertheless,will be very small in comparison to the number that you can help.

For the enabler clients and their pets that you can help, your reputationwill be enhanced. You will have taken a difficult situation and made itwin-win. It will follow that clients like Janice Jones can become advocatesfor the hospital. It just takes communication, patience and a tincture oftime.

Dr. Lane is a 1975 veterinary graduate of the University of Illinois.After graduation he practiced as an associate in California before movingto Carbondale, Illinois and establishing Lakeside Veterinary Hospital in1978. Dr. Lane completed a master's degree in agricultural economics in1996. He is the author of numerous practice management and economics articles.