Reinforcing an expectation of fear
As veterinarians, we often expect our patients to be afraid of us and to threaten us—many practices have muzzles in each exam
room but not treats. We seem to forget that fear and threats may be related and that we can greatly influence fear. But just
how much do we actually contribute to fear in our patients?
A study examining the behavior of dogs at veterinary hospitals found that 106 out of 135 (78.5 percent) of the dogs studied
were fearful on the examination table.3 Eighteen (13.3 percent) of the dogs had to be dragged or carried into the practice; fewer than half of the dogs entered the
Another study that focused on the role of waiting rooms in creating patient stress reported the following:4
> Dogs that had recently been to the clinic had higher stress values than those that had not visited recently. This finding
has profound implications for the invasive nature of some of the care provided by veterinary staff as perceived by the dogs.
> Dogs that stayed in waiting rooms that were not chaotic and had sufficient time to calm down were less stressed than those
that were moved quickly.
> Weighing dogs on the scale is much more stressful than sitting in the waiting room. This finding supports the idea that we
should teach dogs how to be weighed, as well as design and place scales so the dogs have some control over their participation
in the process.
The time has come to question the extent to which these distressed behaviors interfere with our ability to assess patients
and provide the state-of-the-art care they deserve. We also must determine to what extent we cause or contribute to these
dogs' and cats' concerns. Quite simply, visits to veterinary practices can be scary for our patients: the floor is slick,
there are strange sounds and smells, there's not enough interpersonal approach space, the table is cold and provides poor
footing—even their people are tense.
Any dog or cat that is not physically ill should be able to happily walk in the door of a veterinary hospital. If the patient
is shaking, trembling, drooling, hiding, lying flat on the floor, scanning the environment, urinating, defecting, vomiting
or trying to leave, it goes without saying that it is not enjoying the experience. So we need to change our behavior to change
this response for three important reasons:
1. We need to distinguish between patients whose early fear is a truly pathological diagnosis and those that are just afraid
of what we're doing to them and where we're doing it. If most of our patients are afraid, we can't adequately evaluate their
2. While we can manhandle puppies and kittens and often falsely dismiss fear as "normal," to do so sends the wrong message to
the patient and the client. We shouldn't manhandle any pet, nor will we be able to manhandle many of these patients as they age and grow
without the increased costs incurred by additional staff time, the effects of stress, and job-related injuries. Modern zoos
have abandoned forceful handling. Children's hospitals are now open, engaging places where kids participate in the delivery
of their care. So why are we still struggling with our veterinary patients?
3. The delivery of veterinary care may teach cats and dogs that humans can be threatening. This realization will contribute
to the development or worsening of any behavioral problem.
These three factors suggest that—unwittingly and without malicious intent—our delivery of veterinary care can be a causal
factor in worsening patient behavior.