Assessing and changing our behavior
We must change the way that we behave during consultations to help our fearful patients. We can do this by:
> Not interrupting clients. Clients cannot evaluate our medical skills, but they can evaluate our ability to convey information, to understand their
concerns and to show empathy. And our value is assessed by how well we listen. Yet the median and mean lengths of time clients
talk before being interrupted by the veterinarian are 11 and 15.3 seconds, respectively.9 The main reason clients provide incomplete information to closed-ended questions is that we are interrupting them. As a
result, the primary concern or key piece of information is often delivered at the end of the appointment when it's least likely
to be competently addressed.
The Manual of Clinical Behavioral Medicine for Dogs and Cats contains a one-page questionnaire that can be completed by all clients at all appointments and can help owners provide behavioral
information in objective terms while also helping veterinarians accurately assess and treat complaints in a data-driven manner.
> Not scaring our patients. We must cease to be part of the problem. In the studies discussed above,3,10 dogs that had had only positive experiences were less fearful than others. And dogs less than 2 years of age that saw veterinarians
frequently were often more fearful than older dogs that saw veterinarians infrequently, suggesting that repeated exposure
may enhance fear to a certain age. Another study noted that muzzles interfere with our behavioral and physical assessments.11 All early fear must become a treatment priority.1,2
> Teaching patients to participate. Discuss with owners the importance of encouraging and practicing compliance at home, so at exam time the pet is comfortable
with a tip-to-tail examination. And we need to include in every patient record the objective assessment of patient behaviors,
as outlined above. We cannot fix what we cannot see, understand or quantify.
> Calling on our understanding of neuroscience. We must incorporate what we know about the neurochemistry and molecular genetics that affect fear, arousal, learning and
development into any neuroscience taught in the veterinary curriculum, and here's why:
- Learning of adaptive fear at the neurochemical level in the amygdala and the hippocampus is modulated by cortisol concentrations.
- As cortisol concentrations increase, brain-derived neurotrophic factor (BDNF) increases, which allows molecular memory to
be made through the creation of new proteins.
- Fear can be almost instantly encoded because the amygdala is "preadapted" to respond to perceived threats. However, behaviors
associated with learning to cope with arousal cannot be encoded at the molecular level if the cortisol concentration is too
- An optimal range of cortisol produces an optimal range of BDNF and cytosolic response element binding (CREB) protein.
- Only when CREB and BDNF are within this range is true complex, associative and adaptive learning occurring at the molecular
We now know that neurodevelopmental periods interact with absent or excessive stimuli to alter brain function and development.
What we do not know is why this area of neuroscience is essentially missing from veterinary education and veterinary medicine
when the stakes are so clear and so high. It is incumbent on us to address the single most important aspect of our patients'
well-being—their behavioral and mental health needs—using the same rigor and scientific approach that we use to vaccinate
patients or treat them for diabetes. It's time to fight fear.
Dr. Karen L. Overall is a researcher, the editor of The Journal of Veterinary Behavior: Clinical Applications and Research, and the author of more than 100 publications, dozens of chapters and a new book, The Manual of Clinical Behavior Medicine for Dogs and Cats.