Wednesday, November 4, 2015

Stress reduction in the vet clinic: interview with Dr Zenithson Ng

Ideally, our patients should be relaxed enough to explore the room. This kitten was bold enough to take on the exam table.

When I went through uni, one of our lecturers shared this: people become vets because they love animals, only to realise that they are the thing that animals fear most. Certainly I don't think this is the case for all animals, but it is devastating to see a patient hide under a chair when you walk into the waiting room. Now I know how my dentist feels!

Dr Zenithson Ng is a veterinarian who has developed a professional interest in fear and stress reduction in veterinary settings. He is a clinical assistant professor in small animal clinical sciences at the University of Tennessee, and took the time out to explain the rationale behind proactive stress reduction.

What is your current position? 

Clinical assistant professor of Community Practice (primary care medicine and surgery for dogs and cats)

Why did you become interested in animal welfare and stress reduction in veterinary settings?

Animal welfare has always been a passion of mine since I became heavily involved in shelter medicine as a veterinary student.  I recognized the stress and anxiety dogs and cats suffered from in shelters and had veterinary and behaviourist mentors who taught me so much about recognizing and managing these signals.  After understanding stress and the impact it has on animal health and wellbeing, I began to implement stress reduction techniques in veterinary practice.  I saw immediate positive differences in the way animals responded to low-stress handling which have become a part of my practice since it is best for my patients, clients, and me. 

Were there any particular experiences which made you realise this was important?

Hindsight is always 20/20, and knowing what we now know about low-stress handling, I remember countless times in practice where we manhandled dogs and cats, wrangling them to the point of exhaustion, pinning them between doors, using rabies poles, and creating a terrible negative experience.  We always thought we were smarter and stronger than these animals and they had to give in.  I think back to these moments, and my heart breaks for these animals that are only acting in this way because they are scared and stressed, and all we did was exacerbate and worsen their experiences.  I regret all the times I have witnessed these events and wish we could have done differently by them. 

How does stress impact on an animal’s wellbeing at the vet?

Stress is a natural phenomenon for all living beings which should be recognized and embraced to alleviate their exaggerated responses.  When animals are stressed at the veterinary office and we do nothing to help them, we cannot provide them with the quality care they deserve.  Our physical examinations are limited, procedures such as blood draws are time consuming and difficult, and diagnostics such as blood pressure and bloodwork parameters may be inaccurate to assess.  When clients see that their animals are stressed, they can be reluctant to bring them back to the veterinarian for essential preventive care or end up waiting on medical problems rather than coming in early. 

What can owners do to reduce stress associated with veterinary visits?

There are numerous things owners can do to reduce stress, but the three most important things that can be done are:
  1. Don’t feed the pet the morning of the appointment so they will be hungry for positive reinforcement in the form of tasty treats.  Bring the animal’s favourite treats and toys to have during the appointment.   
  2. Bring the pet in for routine, preventive health wellness appointments so the animal can have a positive experience and not see the vet’s office only as a place where they are restrained and poked and prodded with needles. 
  3. Remain calm, cool, and collected.  I believe strongly that animals are sentient beings that can be empathic to human’s emotions, especially owners.  Often times, pet stress and anxiety parallels the stress and anxiety of their owners at the veterinary clinic.  The best thing to do when an owner is nervous with the pet is to remain calm and breathe deeply to remain strong for his or her loved one.

What are three things veterinarians and nurses can do to reduce stress in patients?
  1. Use lots of positive reinforcement throughout the entire appointment. 
  2. Patience makes perfect.  Go slowly and methodically when approaching and handling animals that are stressed. 
  3. Recognize the pet that is beyond behavioural modification and low-stress handling techniques.  This animal would likely benefit from chemical restraint early in the appointment if it is safe to do so.  Often times, the staff continues the same or alternate handling techniques with different staff members over and over again, which causes the patient’s anxiety to escalate exponentially.  If the animal had been sedated earlier, it would have been a much smoother and faster process.

How would you like to see veterinary practice change in the future?

Fortunately, I have already seen great changes in veterinary practice regarding animal stress and welfare in the past decade.  We have come a long way in the “fear-free” movement by educating and implementing low-stress handling techniques in practice.  I would love to see the profession recognize Low-stress handling certification ( and Cat-Friendly Practice certification ( as standards of care in all hospitals.  In addition, I would like to see more research on the outcomes of such certifications and practices.  Currently, we are researching the effect of the approach of 4th year veterinary students to clients and patients on stress behaviours in dogs.  Hopefully, the knowledge we gain from such studies can provide evidence for the changes that need to occur in practice.   

Any advice you’d like to share with veterinarians and future veterinarians?

Understand that animals are empathic living beings that react to their environments.  Animals are not intentionally malicious and should never be punished for perceiving a situation as stressful.  Use these observations of stress and fear behaviours as opportunities to educate the owner in recognizing and managing stress.  With this knowledge, we can transform potentially negative experiences into positive ones that keep client and patient coming back again and again.  

Thank you, Dr Ng. If you want to learn more about the UT College of Vet Medicine, click here.