Attending to In-Clinic Patient Behavior: Where, When, How
Patient behavior during clinic visits can dramatically affect efficiency, client perception of our value, staff satisfaction, client and staff safety, and income. Following are some strategies that the authors have found successful in detecting and addressing such behaviors.
Use initial phone calls to schedule appointments.
Has your pet visited a veterinarian in the past?
How did your pet respond to the visit? What was his/her behavior like?
Did your pet show any signs of fear at any time in the veterinarian's office?
Did your pet growl or nip, hiss, or scratch?
How can we help you and your pet have a good experience?"
Improve the outside environment, if needed.
Provide a grassy area or other substrate for elimination.
Decrease noise in the environment (eg, trees, acoustic tiles, carpeting on floors or walls).
Consider having at least 1 waiting area outside in a comfortable area out of traffic that provides seating.
Address the reception area and procedures.
Book appointments based on the pet's behavioral needs (eg, fearful animals are the first appointments of the day so there is no waiting).
Have separate areas for dogs and cats.
Install no-slip flooring or have tiles or mats available for use when needed.
Provide client information, resources, and materials.
Provide food treats in each exam room, in the waiting room, and to all staff.
Train receptionists in basic behavior so that they can help triage patients and meet special needs.
Enhance the exam room.
Install no-slip floors or provide mats.
Use soft, no-slip, washable surfaces on exam tables (bath mats if you use an exam table).
If possible, allow pets off-lead and let them explore the exam room. Knock and announce yourself before entry to ensure that the pet is restrained, if needed.
Provide food treats. Give them before and throughout the exam-not just at the end.
Provide water for patients and clients.
Use another exam room if one has housed a pet in distress (potential role of phero-mones).
Use behavioral medications to decrease anxiety during appointments, if necessary.
Try enhanced methods of examination.
Observe, assess, and acknowledge the patient's level of comfort and ease.
Recognize and redress physical limitations.
Use a questionnaire to screen for behavior issues.
Refer or consult with a specialist if necessary, and possible.1,2,3
Be aware of your own and your staff's body language, gestures, and tone of voice.
Be nonthreatening; be calm.
Develop a nonjudgmental rapport with both the client and patient.
Learn and use distraction techniques to help distressed pets.
Order the procedures starting with the less-invasive ones. Build trust first, and have clients work at home to desensitize pets to distressing manipulations.
Always end on a happy note for both the pet and the client!
Hospitals, treatment areas, and kennels can be managed to help.
Separate cats and dogs.
Create visual and scent barriers (particularly in recovery areas-separate if possible).
Decrease light and noise by using rheostats, acoustic tiles, or white noise machines. Use music.
Control pain before, during, and after surgery or treatment.
Use soft bedding like synthetic sheepskin and add comfort toys, including those that smell like "home."
Provide and supervise exercise and social interactions, if appropriate, with compatible animals.
Provide environmental enrichment (e.g., food toys, interactive toys, puzzles, other compatible pets, birds, caged pocket pets, fish).
Provide cats with hiding boxes/perches.
Train staff in behavior,1 especially appropriate handling and animal contact.
Discharges are key events for improvement.
Be aware of reception/discharge area traffic/timing.
Ensure safe transfer by using leashes, crates, or carriers, or back doors, and staggered entries/exits.
You can try spraying Feliway (Veterinary Product Laboratories-Phoenix, AZ), a feline facial pheromone, in a fearful cat's carrier.
Recognize that the experience of the patient may affect his or her interactions with other pets in the household (alterations in smell, appearance, physical abilities, effects of sedation, discomfort). Discuss this, and appropriate management, with clients.
Ensure that pain is managed at home, too.
Follow up by phone for all routine appointments.
End on a happy note. Use praise for both the clients and pets!
This article is a consensus work produced by the course members and leaders of the North American Veterinary Conference Postgraduate Institute 2004 Advanced Behavior program.
Course members were: Stephen Brammeier, DVM; Jan Brennan, DVM; Sondra Brown, DVM; Deb Bryant, DVM; Debbie Calnon, BVSc (Australia); Tamera Cole Stenson, DVM; Gary Colwin (Australia); Steve Dale; Cristina Dominguez, DVM (Spain); Dennis Dougherty, DVM; Eva Dudzic, DVM (Canada); Kathy Gaughan, DVM; Ute Jung, DVM; Kim Kendall, BVSc (Australia); Michelle Lem, DVM (Canada); Gaea Mitchel, DVM; Randi Olson, DVM; Beth Procassini, VMD; Peggy Rucker, DVM; Debra Shirley, DVM; Susan Simmons, DVM; Gail Stevenson, DVM; Steven Stratemeyer, DVM; Kim Taylor, DVM; Sally-Ann Williams, BVSc (Australia).
Course leaders were Karen L. Overall, MA, VMD, PhD, Diplomate ACVB, ABS Certified Applied Animal Behaviorist, and Kersti Sekse**l**, BVSc, MRCVS MA (Hons), FACVSc (Animal Behaviour), Diplomate ACVB