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 stare accompanies a cacophony of explosive sounds from a 90-pound Rottweiler mix named Zeus.
His owner, Janice Jones, is at first apprehensive. Then incongruously she 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 her concern for her pet. Her misunderstanding of canine behavior overshadows any thought of danger to the veterinary staff. For Sarah, these types of exchanges were becoming much too common.
Just yesterday, Sarah had entered the room to find a beaming family with a happy and bouncy 80-pound yearling Golden Retriever. Coiled, sinewy, and flowing with hormones, "Casey" had flown into Sarah and almost knocked her down. Sarah reached to take the leash and gently encouraged Casey to follow to be weighed. Now Casey lunged at Sarah with teeth bared. "Mr. Hyde" the dog had suddenly shown up.
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 training in view of the owner.
D. Bring more people into the room.
I sent this scenario to Regis Philbin for inclusion in "Who Wants to be a Millionaire." He answered that this question is inadmissible since the answer was worth more than a million dollars. In economic terms for the profession, this is quite true.
Answer (b) is tempting.
Answer (C) is commonly employed by technicians with lots of experience working with dogs. This may seem like the most suitable thing to do, however, there will be very little understanding from the client perspective. Many clients will pay their bill and never return.
What about (d)? It does not take many years working in veterinary exam rooms to realize that this approach can backfire on you. When you call in for back-up it can be quite intimidating to dog and owner. Now you are losing ground.
The answer, of course, is (A). That seems to always be the answer doesn't it? The problem is that these clients seem to come in during times that are extremely busy. "Quality time" with the client and patient is 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 educating a client, some form of behavioral modification and training will be addressed. In many cases these patients should be referred to a qualified trainer or a board certified veterinary specialist.
Unfortunately, clients often misinterpret the bad behavior of a treasured pet as originating from the veterinary environment itself. Dog owners are quick to point out that their pets are perfect angels at home and only act out their aggressions when disturbed or "challenged" by veterinary staff.
Of course, being perfect angels at home is many times based on the fact that clients seldom ask their pet to do much else at home other than to be a dog. When a pet is suddenly put in a position of being leashed, restrained and otherwise denied full and continuous control of whatever pleases him or her, they react in a variety of ways-some of which can be very dangerous.
These clients can be unreasonably permissive and overprotective. To borrow from those professions who work with addition and related issues, these clients would be called "enablers".
Enablers allow their pets full control over their lives thinking that this is how they can best show their love and devotion (see sidebar). Behaviors that for a variety of reasons would be considered anti-social or unacceptable are allowed to continue for reasons that are quite complex and beyond the scope of this article. Nonetheless, veterinarians are put in a position of controlling the work environment for the safety of everyone. In the worst-case scenario, clients could bring suit over issues occurring in a veterinary hospital that neither the public nor the legal profession has even the slightest understanding.
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
It is easy for veterinarians and sometimes the attending staff member to lose their cool dealing with "enabler" clients. The stress of practice and the "heat of battle" seem to thin the white matter considerably on a busy day.
Loss of temper equates to loss of professional deportment. Job one is to remain calm. Indifference (low emotional output) to the animal's aggression can also be one of the most appropriate human responses to that aggression and can, in many cases, calm an aggressive pet. It is important to continue to talk to the people and the animal in a quiet voice in order to assure the 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 body are not directly over the pet. Some veterinarians may not feel comfortable doing this, but I have found this will remove the fear that some pets feel in the presence of a stranger in standing in a position of dominance over their head or shoulders. The owner usually responds favorably to this.
Lines of communication
An enabler client will give varied responses to excuse the threatening posture 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 such as men, uniforms, veterinary offices and certain sounds-as if this somehow is reasonable and expected of all pets. Often they will relate that the animal was beaten before they obtained the pet. (There is very seldom any evidence to support this contention. Although one can never justify the beating of any animal, the fact is that most alleged puppy beatings should be classified as "urban myths".)
Initially enablers are seldom swayed by facts. It is important to express your understandings of these issues as best you can and repeat your concerns on a subsequent veterinary visit.
Stuck in the present
The enabler mentality is stuck in the present-a very focused concern for their pet's comfort and happiness. Therefore enablers show little concern or reasoning for future events. The most common hurdle for the veterinarian to overcome is this: these owners do not recognize that the behavior of their pet is a problem issue that needs to be addressed both now and in the future.
Although I recognize that we have no formal training in this area, veterinarians must, at this point, take on the role of counselor.
Most clients should be kindly and professionally informed that these behaviors are unacceptable regardless of the owner's false reasoning and justifications. This should be done in a direct, but friendly manner. What happens at this point forward will make all the difference in the world for the pet, the family and the veterinary clinic.
It's very important to give your professional counsel concerning potential future issues with health and safety regarding family, friends and veterinary staff. You must directly show the owner that you are concerned and willing to help them if they will (above all else) recognize the issue as a real problem. This recognition may take time and the help from another family member.
Highest and best
Unless you are trained in this area, you should always recommend the highest and best level of behavioral counseling. Your first choice would be a referral to a board-certified veterinarian specializing in behavior. A second choice would be a trusted professional dog trainer who uses positive methods 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 client relations, it is helpful to face this issue directly. They need someone they can trust-you need someone who will trust your guidance.
You must get very personal and ask them simply to trust you. This makes them examine the issue head on. If they will not verbally agree to trust you 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 the home environment.
Here are some suggestions:
Owners who are unable to recognize the potential threat their pet poses to themselves and others should be separated from the pet for examination.
Young children and other family members, if present, should be asked to move to the other side of the room.
Trained staff should ask the client to leash the pet with a leash that is the property of the hospital. This is because leashes and collars that originate from these types of owners are often insufficient or too loose to control the animal. Staff then should take the hospital leash and the pet from the owner and lead the animal away from the owner. Leashing and walking an animal away from the owner is very often sufficient to remove the aggression from a fair number of aggressive dogs.
Experienced veterinarians will recognize that when some dogs are removed to another room by leash they will often become much more compliant.
Examination should proceed if possible in a caring and straightforward manner. If examination is impossible, further pressure on the pet will only make matters worse and safety is an overriding concern.
At this point, the pet should be led back to the owner and if the owner has agreed to trust you on matters concerning their pet, arrangements should be made to come back under sedation, with no extra family members at a less busy time for the hospital.
Make these pet owners better long-term clients.
Deep-down, enablers want to do the best thing for their pets. Persistence will eventually pay off when the other elements mentioned above start to fall into place. It is important that as a veterinarian you take the lead and train your staff accordingly.
In some cases, when a client refuses to allow you to work on behalf of everyone involved and the patient, you must ask him or her to find another veterinarian. 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 reputation will be enhanced. You will have taken a difficult situation and made it win-win. It will follow that clients like Janice Jones can become advocates for the hospital. It just takes communication, patience and a tincture of time.
Dr. Lane is a 1975 veterinary graduate of the University of Illinois. After graduation he practiced as an associate in California before moving to Carbondale, Illinois and establishing Lakeside Veterinary Hospital in 1978. Dr. Lane completed a master's degree in agricultural economics in 1996. He is the author of numerous practice management and economics articles.