Monday, July 6, 2015

Dr Marty Becker on Fear Free Vet Visits

Dr Marty Becker
Dr Marty Becker spoke to the Australian Veterinary Association Practice Management conference.
Do you dread taking your companion to the veterinarian? Does your companion animal dread the vet visit the way some kids freak out about a doctor or dentist visit? As a vet, do you dread seeing stressed out, frightened patients?

As a kid I tried to evade our dentist’s inspection by applying a Bandaid to my mouth. It gave her a laugh but didn’t stop her! At least it was a fairly unambiguous sign that I was terrified. We’re not always good at picking up those signs in animals.

This week I had the opportunity to see US veterinarian Dr Marty Becker deliver presentations on “fear free” vet visits to the AustralianVeterinary Association Practice Management conference.

It was a really honest series of lectures from a very engaging speaker. Six years ago he went to a veterinary meeting in British Columbia and saw veterinary behaviourist Karen Overall give a presentation on fear in veterinary clinics.

“I looked back at all these pets over the years that I knew I had a hand in traumatising,” he said. “I went from retiring to refiring – I thought what an impressive opportunity if we change it”.

“It” being the level of anxiety and fear that animals experience in a veterinary context.

To contextualise, this is coming from a veterinarian who trained over 30 years ago – when vets were taught, in universities, that animals did not feel pain – and if they did it was probably good because it would keep them from moving. The great thing is that Dr Becker – and the profession – have moved on. We now recognise pain in animals and take steps to address it. It’s time to proactively tackle fear.

Dr Becker said that frightened animals in vet hospitals either freeze, fight or (try to) take flight. The animals who opt for the latter two end up being “man-handled, manipulated, threatened and abused” just so we can perform an exam and diagnostics. So is there an alternative?

Some of the resources Dr Becker uses in his fear free practice.
According to Dr Becker, absolutely, but all members of the team have to accept that fear free visits require acceptance that we need to care for an animal’s emotional wellbeing as much as its physical wellbeing. He believes just like the advent of feline medicine, dental radiography and multi-modal pain management, fear-free visits are the next revolution in veterinary practice.

Dr Becker learned that “Fear is the worst thing a social species can experience and it causes permanent damage to the brain” and “fear in response to something painful or disturbing can condition the pet to experience more fear in response to those circumstances”.

Hence the importance, as Hippocrates said, of us remembering to: Cure sometimes, treat often, comfort always.

Fear free practice
More items that aid in fear free practice - including treats and Kong fillers, "Scents of Security" bear and "Through a dog's ears" and "Through a cat's ears" music.
Fortunately there are now excellent resources available online for veterinarians who want to work to make all their vet visits “fear-free”. You can check some of these out here

A couple of key pointers I picked up are:
  1. Work with the owner to ensure that the patient is in a relatively calm state when they arrive at the practice. Use of pheromone spray in the carrier, fasting the animal for a few hours prior to the visit. If an animal has a preference for rewards (e.g. a ball instead of food treats), get the owners to bring these. For certain very anxious animals that he has examined, Dr Becker dispenses trazadone for the owners to administer 30-60 minutes prior to the visit.
  2. Don’t be shy about giving treats (especially in an animal that has been fasted!) In one fear-free practice the average number of treats delivered in a 15 minute wellness exam was 60. Obviously these are very small treats. Dr Becker favours turkey, chicken, and “Easy Cheese” spray cheese (cheese and bacon flavour). Bear in mind that intermittent reinforcement is more effective than rewarding every single time. Limiting food before the appointment enhances the appeal (and efficacy) of treats.
  3. Identify and address anxiety triggers in your practice. They might be key spots dogs pee on outside, to certain noises to use of the same room for potentially stressful procedures, for example anal gland expression and nail clips. Dr Becker sometimes does nail clips on a bench outside. Doing online training like can provide alternative strategies for animal handling.
  4. There can be a tendency to comfort animals more in front of the owner. It is important that whether the owner is there or not, everyone handles a pet as if the owner is there looking over their shoulder.
  5. We need to focus more on smell. Veterinary treatment can strip the familiar scent from animals and replace it with the foreign scent of a clinic. Use of pheromones and allowing animals to have something familiar smelling with them can reduce anxiety and make reintroductions into the household smoother.
  6. We need to be careful not to put animals off balance in the way we handle them for examination.
  7. As veterinarians we should be including information on each patient’s anxiety triggers, behaviour, exam room preference and reward preference where possible.

Vetfolio in conjunction with the American Animal HospitalAssociation will be offering online accreditation in “fear free” practice for veterinarians. There will be six examinable modules available from January.

For more information on Dr Marty Becker check out hiswebsite or follow him on Facebook.