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As veterinarians, we support not only our patients but also the millions of humans who share their lives with animals. Veterinarians and their colleagues are accustomed to being reminded that the veterinary profession is built on human connections with animals, and we recognize that the human-animal bond is important in all settings. In terms of academic theory and practical application, however, the human-animal bond approach is most advanced in the area of companion animals. The benefits of promoting the human-animal bond in companion animal practice are, by now, quite clear. It has, for example, been shown that the bond between owners and their pets has an important influence on the care those pets receive, that owners who have the strongest bonds with their pets are more likely to accept health-care recommendations from their veterinarian, and that highly bonded owners visit their veterinarian more often and are more likely to seek preventive care. For veterinarians in companion animal practice, however, it can sometimes be unclear how the human-animal bond can be incorporated into everyday practice activities. For those veterinarians, focusing on client communication and animal handling provides practical methods for emphasizing the human-animal bond.
42 JAVMA • Vol 249 • No. 1 • July 1, 2016
As veterinarians, we support not only our
patients but also the millions of humans who
share their lives with animals. Veterinarians and
their colleagues are accustomed to being reminded
that the veterinary profession is built on human
connections with animals, and we recognize that the
human-animal bond is important in all settings.1,2 In
terms of academic theory and practical application,
however, the human-animal bond approach is most
advanced in the area of companion animals.
The benefits of promoting the human-animal
bond in companion animal practice are, by now,
quite clear.3 It has, for example, been shown that the
bond between owners and their pets has an impor-
tant influence on the care those pets receive, that
owners who have the strongest bonds with their
pets are more likely to accept health-care recom-
mendations from their veterinarian, and that highly
bonded owners visit their veterinarian more often
and are more likely to seek preventive care.4
For veterinarians in companion animal prac-
tice, however, it can sometimes be unclear how
the human-animal bond can be incorporated into
everyday practice activities. For those veterinarians,
focusing on client communication and animal han-
dling provides practical methods for emphasizing
the human-animal bond.
Client Communication
Empathic client communication is essential to
supporting and advancing the human-animal bond
in companion animal practice. Empathic communi-
cation emphasizes the ability to listen for underly-
ing messages and implies, in essence, that the vet-
erinarian attempts to understand the prevailing
problem from the client’s perspective. Empathic
communication allows the veterinarian to effective-
ly propose solutions while also gaining the support
Opportunities for incorporating the human-animal
bond in companion animal practice
and commitment of the client, resulting in a higher
likelihood of adherence to the treatment protocol.
Two other vital aspects of effective client com-
munication are engagement and education.5,6 En-
gagement involves listening to the client’s concerns
and is reinforced through the use of reflective lis-
tening, whereby the veterinarian summarizes the
conversation, allowing the client to correct miscon-
ceptions. Education is vital in achieving good treat-
ment outcomes, as it not only allows clients to un-
derstand what is going on with their pets but also
enables clients to make sensible adjustments in the
treatment plan while still ensuring an overall good
These three aspects of communication—empa-
thy, engagement, and education—are vital to good
client communication at any time, but particularly
when dealing with owners of elderly pets and pets
with terminal conditions. In general, it is advisable
to avoid asking clients to make important decisions
when they are under emotional stress or during a
crisis. When possible, therefore, veterinarians should
have discussions about emergency treatment, end-
of-life care, and invasive or expensive procedures
with clients before a critical situation develops and
should record the clients’ wishes in the medical re-
cords. These so-called advance directives will keep
hospital staff informed as to the wishes of the cli-
ent when impending events threaten the life of a
An important consideration regarding client
communication is apparent gender-based differenc-
es in veterinarian-client interactions.7 Women veter-
inarians are reportedly more relationship-centered
during appointments, seem to have more rapport-
building perspective with clients, talk to pets more,
and are seen by clients to be less hurried. These
communication styles may encourage clients to
provide lifestyle and social information that could
From Zoetis Inc, 100 Campus Dr, PO Box 651, Florham Park, NJ 07869 (Knesl); the Department of
Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis,
Davis, CA 95616 (Hart); the College of Education and Integrative Studies, California State Polytechnic
University, Pomona, CA 91768 (Fine); and 1304 Pacific Dr, Davis, CA 95616 (Cooper).
Address correspondence to Dr. Knesl (
Oliver Knesl bvsc, msc
Benjamin L. Hart dvm, phd
Aubrey H. Fine edd
Leslie Cooper dvm
JAVMA • Vol 249 • No. 1 • July 1, 2016 43
be relevant to their pets. There is reason to believe
that when men engage in the same relationship-
centered communication, freely talk to the pet, do
not act hurried, and focus on rapport building, they
are as effective as women in engendering client sat-
isfaction and the best clinical outcomes for patients.
Traditionally, client communication involved the
veterinarian making recommendations that the cli-
ent was obliged to follow. One major disadvantage
of this traditional approach is that decision-making
is not shared and responsibility for treatment out-
comes is similarly not shared. If the outcome of treat-
ment is unsatisfactory, the veterinarian will most
likely be held accountable, regardless of whether the
treatment was the best available option. Conversely,
if the veterinarian takes on the role of a teacher, re-
porting diagnostic outcomes and listing treatment
options but leaving the decision-making entirely to
the client, the client may become confused and the
outcome may be less than optimal.
By taking on the role of a collaborator, the
veterinarian not only provides information about
diagnostic outcomes and treatment options but
also seeks information about the client’s desires
and concerns, including concerns about costs. The
veterinarian and client can then discuss the pros
and cons of the various approaches and arrive at
a more-or-less joint decision. This collaborative ap-
proach generally results in higher rates of client
compliance with proposed treatment plans and the
highest levels of client satisfaction.
Animal Handling
Physical handling and restraint are necessary to
perform examinations and obtain diagnostic samples,
but the handling and restraint methods that are used
can have far-reaching effects. Veterinarians and their
staff may lose credibility if they do not compassion-
ately handle active, fractious, fearful, and distressed
animals. Clients may be disinclined to return if their
pet was fearful, if their pet threatened or injured staff,
or if the veterinarian was angry or uncomfortable.8
For these reasons, attention has recently turned
toward reducing stress and anxiety in animal pa-
tients during hospital visits. Establishment of safe
movement routes for reactive individuals, designa-
tion of quiet areas for clients to visit with hospital-
ized pets, and development of separate waiting and
examination areas for individual species are some
potential methods for reducing animal stress and
anxiety.9 In addition, all staff members, but especial-
ly animal caretakers, should be trained in identify-
ing behavioral signs of stress, anxiety, fear, and pain
in the animals with which they work. Because signs
in many species can be subtle, simply assuming that
stress, anxiety, fear, and pain don’t exist because
overt signs are not seen can be misleading.9–12
Veterinarians and staff should strive to con-
tinually learn new restraint and handling tech-
niques that reduce fear and agitation. Any situation
or handling that results in increased emotional
arousal, agitation, or fear can waste time and lead
to distress and injury for animals and handlers.
Many low-stress techniques take advantage of nat-
ural calming signals (eg, dark and quiet environ-
ments),9,13 and information on low-stress handling
techniques for companion animals in a clinic set-
ting is widely available.9 More recently, the Fear
Free Initiative14 brings together resources related
to low-stress handling, behavior, clinic design, and
protocols, with the goal of making clinic visits as
stress free as possible for veterinarians, staff, own-
ers, and animals.
Clients can be encouraged to desensitize their
pets to handling and procedures that are likely to
occur during a veterinary examination and to ac-
climate their pets to methods of transport early in
life. Dogs with a history of fear-related aggression at
the clinic can be conditioned to comfortably wear a
basket muzzle during visits, saving time and reduc-
ing danger to caregivers and veterinary staff. Clients
can also be advised on the use of products that may
help reduce stress in diverse situations, such as spe-
cialized clothinga and head halters.b
The development of faster-acting antianxiety
medications and safer sedatives has made chemical
restraint a reasonable alternative when other stress-
reduction techniques are not effective or practical.
If possible, the decision to use chemical restraint
should be made before the animal becomes emo-
tionally aroused, as waiting can decrease the effec-
tiveness of the drug and allow fear of the situation
to be reinforced.13
The strengthening of the bond between humans
and their pets has changed the landscape for veteri-
nary medicine, with highly bonded owners showing
an increasing willingness to do whatever it takes to
maintain the health of their animals. Understanding
how to incorporate the human-animal bond in com-
panion animal practice by enhancing client commu-
nication and improving animal handling techniques
will allow veterinarians to improve the care that they
provide not just to the animals they see but also to
their owners. As stated by Dr. Rick Timmins in a recent
interview, “only when I began to understand [the pet
was meaningful to the human in some specific and
important fashion] could I be effective in my work.15
Dr. Hart’s contribution was partially funded by the Center for
Companion Health, School of Veterinary Medicine, University of
California, Davis (2009-54-F/M).
This manuscript represents work the authors completed in
their role as members of the AVMA Steering Committee on Human-
Animal Interactions (SCHAI).
The authors thank Drs. Lynette Hart and Emily Patterson-Kane
for assistance in drafting and reviewing the manuscript.
44 JAVMA • Vol 249 • No. 1 • July 1, 2016
a. Thundershirt, ThunderWorks, Durham, NC.
b. Gentle Leader, PetSafe, Knoxville, Tenn.
1. Levinson B. Pets and human development. Springfield, Ill:
Charles C. Thomas Publisher LLC, 1972.
2. Schwabe C. Veterinary medicine and human health. 3rd ed.
Baltimore: The Williams & Wilkins Co, 1984.
3. Catanzaro TE. Promoting the human-animal bond in veteri-
nary practice. Ames, Iowa: Iowa State University Press, 2001.
4. Lue TW, Pantenburg DP, Crawford PM. Impact of the owner-
pet and client-veterinarian bond on the care that pets receive.
J Am Vet Med Assoc 2008;232:531–540.
5. Cornell KK, Kopcha M. Client-veterinarian communication:
skills for client centered dialogue and shared decision-making.
Vet Clin North Am Small Anim Pract 2007;37:37–47.
6. Hook ML. Partnering with patients—a concept ready for ac-
tion. J Adv Nurs 2006;56:133–143.
7. Shaw JR, Bonnett BN, Roter DL, et al. Gender differences in
veterinarian-client-patient communication in companion ani-
mal practice. J Am Vet Med Assoc 2012;241:81–88.
8. Hammerle M, Horst C, Levine E, et al. AAHA canine and feline behavior
management guidelines. J Am Anim Hosp Assoc 2015;51:205–221.
9. Yin S. Low stress handling, restraint and behavior modifi-
cation of dogs and cats: techniques for developing patients
who love their visits. Davis, Calif: Cattle Dog Publishing, 2009.
10. Epstein M, Rodan I, Griffenhagen G, et al. 2015 AAHA/AAFP
pain management guidelines for dogs and cats. J Am Anim
Hosp Assoc 2015;51:67–84.
11. Underwood WJ. Pain and distress in agricultural animals. J Am
Vet Med Assoc 2002;221:208–211.
12. Grandin T, Deesing MJ. Genetics and behavior during handling,
restraint, and herding. In: Grandin T, Deesing MJ, eds. Genetics
and the behavior of domestic animals. 2nd ed. London: Aca-
demic Press, 2014;115–158.
13. Herron ME, Shreyer T. The pet-friendly veterinary practice: a
guide for practitioners. Vet Clin North Am Small Anim Pract
14. Fear free veterinary visits. Available at:
fear-free-veterinary-visits. Accessed Aug 3, 2015.
15. Fine AH. Our faithful companions; exploring the essence of our
kinship with animals. Crawford, Colo: Alpine Publications, 2014.
For all commentaries, views expressed are those of the authors
and do not necessarily reflect the official policy of the AVMA.
... The financial benefits of investing in and implementing behavioural services should be considered (Figure 1). Lowstress handling (Yin, 2009) and behaviour-centred patient handling have been associated with positive client perception of the veterinary team (Sherman and Serpell, 2008;Döring et al, 2009;Yin, 2009;Feilberg et al, 2021), as well as increased client compliance and client retention (Sherman and Serpell, 2008;Yin, 2009;Knesl et al, 2016;Calder et al, 2017). Owners may refuse veterinary treatment or may not return to the practice if they perceive that their dog had a negative experience (Döring et al, 2009;Knesl et al, 2016;Calder et al, 2017). ...
... Lowstress handling (Yin, 2009) and behaviour-centred patient handling have been associated with positive client perception of the veterinary team (Sherman and Serpell, 2008;Döring et al, 2009;Yin, 2009;Feilberg et al, 2021), as well as increased client compliance and client retention (Sherman and Serpell, 2008;Yin, 2009;Knesl et al, 2016;Calder et al, 2017). Owners may refuse veterinary treatment or may not return to the practice if they perceive that their dog had a negative experience (Döring et al, 2009;Knesl et al, 2016;Calder et al, 2017). Loftus' (2014) discussion of behavioural considerations for the veterinary practice implies that behaviour-friendly practices reap financial gain through increased owner compliance, repeat visits and word-of-mouth advertising. ...
Despite the advancements in the field of veterinary behaviour medicine, problem behaviours remain a leading cause for canine relinquishment and euthanasia in the UK and so should be of concern to veterinary professionals. This review aimed to critically evaluate the literature on the perceptions of the veterinary care team, including the veterinary practitioner and the veterinary nurse, of their roles in canine behaviour medicine. Additionally, the review discussed barriers to the delivery of behavioural medicine in practice and subsequently examined the benefits of applying a behaviour-centered approach to care. Despite revisions to the Royal College of Veterinary Surgeons curricula, inadequate behavioural training during undergraduate studies was identified as a primary barrier to the provision of behaviour support in practice by veterinarians and veterinary nurses. Furthermore, veterinary professionals frequently identified a lack of time to discuss, educate and diagnose behavioural problems. However, should the barriers to the provision of behavioural medicine be addressed, current literature suggests that the benefits of applying behaviour medicine to practice may include financial growth for the practice, workplace safety, improved perception from clients and ultimately improved animal welfare.
... As explored in Chapter One, the veterinary surgeon's role has been primarily shaped by the social norms of the time, including which animals 'deserved' care and how this was provided. The work of the modern-day veterinary surgeon, particularly those working in companion animal medicine, has continued to be shaped by modern-day perceptions of animals, particularly pets and the humananimal bond (Hines, 2003;Knesl et al., 2016). This is likely to influence not only the practices of the veterinary profession but also the expectations of the pet owners, which have been noted as often being a source of difficulty for veterinary professionals (Anon, 2014;Deacon & Brough, 2019;Irwin et al., 2021;Platt, Hawton, Simkin, Dean, et al., 2012;Polachek & Wallace, 2018;Richards et al., 2020;Waters et al., 2019). ...
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Background Veterinary surgeons have been identified as being at increased risk of suicide and psychological distress. Research has identified factors that may be associated with this; there is nevertheless a lack of literature providing an in-depth account of the veterinary surgeon profession, which may shed further light on this concerning statistic. Methodology This research used a psychosocial approach. Narrative interviews were completed with eight veterinary surgeons who had previously experienced psychological distress. The data were analysed using Interpretative Phenomenological Analysis. Results Four themes were identified. The first was related to how participants perceived their profession, which appeared to be a vocation connected to their care for animals and often became a dominant aspect of their identities. Participants reported that the reality of veterinary medicine differed from the idealised portrayals in the media and their training courses. The second theme related to how participants made sense of their experiences of psychological distress. The third theme reflected the specific challenges participants identified within their occupation; their relationships with colleagues, their exposure to pet owners, and their experiences of traumatic clinical work. The final theme connected to participants’ exposure to death, primarily via euthanasia. Death appeared to be conceptualised as a ‘gift’ by some participants, whilst others shared how this frequent exposure to death impacted them emotionally. These four themes were then integrated into a hypothesis relating to possible social defences in the veterinary surgeon profession. Conclusion Veterinary surgery is a multi-faceted role and is often highly distressing. As a result of this inherent distress, professionals are suggested to engage in a range of social defences that inevitably become integrated into the practices and policies within veterinary medicine. It is hypothesised that this may contribute to the observed increased risk of suicidality and distress in the veterinary workforce.
... As companion animals were increasingly considered family members [4], companion animal practice borrowed methods and values from human medicine. According to Knesl and colleagues, "the strengthening of the bond between humans and their pets has changed the landscape for veterinary medicine, with highly bonded owners showing an increasing willingness to do whatever it takes to maintain the health of their animals" [5]. To this end, it could be said that companion animal practice has co-evolved with the human-companion animal bond. ...
Full-text available
Advanced veterinary care (AVC) of companion animals may yield improved clinical outcomes, improved animal welfare, improved satisfaction of veterinary clients, improved satisfaction of veterinary team members, and increased practice profitability. However, it also raises ethical challenges. Yet, what counts as AVC is difficult to pinpoint due to continuing advancements. We discuss some of the challenges in defining advanced veterinary care (AVC), particularly in relation to a standard of care (SOC). We then review key ethical challenges associated with AVC that have been identified in the veterinary ethics literature, including poor quality of life, dysthanasia and caregiver burden, financial cost and accessibility of veterinary care, conflicts of interest, and the absence of ethical review for some patients undergoing AVC. We suggest some strategies to address these concerns, including prospective ethical review utilising ethical frameworks and decision-making tools, the setting of humane end points, the role of regulatory bodies in limiting acceptable procedures, and the normalisation of quality-of-life scoring. We also suggest a role for retrospective ethical review in the form of ethics rounds and clinical auditing. Our discussion reenforces the need for a spectrum of veterinary care for companion animals.
... Zeker klanten met een hechte band met hun dier kunnen voor een buitenstaander irrationele reacties vertonen. De band tussen mens en gezelschapsdier ("human -animal bond") wordt door de American Veterinary Medical Association gedefinieerd als "de relatie tussen mens en dier die voordelig en heilzaam is voor de gezondheid en het welzijn van zowel mens als dier" (Knesl et al., 2016). Deze band bestaat uit emotionele, psychologische en fysieke interacties tussen dier en mens. ...
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Slecht nieuws kan gedefinieerd worden als elke boodschap met een nadelige invloed op het toekomstbeeld van de klant. Slechtnieuwsgesprekken komen frequent voor in de diergeneeskunde en de dierenarts-klantrelatie wordt in belangrijke mate bepaald door de manier waarop het slechte nieuws gecommuniceerd wordt. In de humane geneeskunde en meer recent ook in de diergeneeskunde bestaan verschillende richtlijnen om een slechtnieuwsgesprek uit te voeren met minder stress en meer voldoening bij zowel dierenarts als klant. In de uiteenlopende modellen kunnen vijf essentiële elementen gevonden worden. Als eerste is er de voorbereiding van het gesprek, met het creëren van een juiste setting. Vervolgens wordt het perspectief van de klant bevraagd, gevolgd door het kort en direct meedelen van het slechte nieuws zelf en het empathisch reageren op eventuele emoties. Verdere informatie en een planning volgen in kleine hoeveelheden op het moment dat de klant hier terug voor open staat.
... When compared to clients who did not receive the HRQOL survey, clients who completed the survey were more likely to report a better overall service, demonstrated by veterinary teams addressing their questions related to preventive and other services and care, as well as consideration of the QOL of their pet. This interaction could therefore be interpreted to be less transactional and more cooperative, and it has been suggested that a collaborative approach results in higher rates of client compliance with treatment plans and the highest levels of client satisfaction (16). ...
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This paper describes dog owner and veterinarian perceptions around the use of a validated canine quality of life (QOL) survey to facilitate wellness conversations in two clinical settings: a veterinary teaching hospital (pilot, Phase 1) and five corporate general practice hospitals (Phase 2). Phase 1 results showed that dog owners felt the survey was valuable for understanding their dog's QOL, with 81% of owners expressing interest in learning more about canine QOL. Phase 2 reinforced owner perceptions about the survey conveyed during the pilot phase, and veterinarians reported that the survey facilitated client communication related to preventive care without increasing consultation time. These results demonstrate that beyond using QOL assessments to track patient health, the use of a QOL survey during veterinary visits could improve owner-veterinarian discussions around QOL, wellness, services and preventive care. To fully realize these benefits in clinical settings, veterinary staff preparation may be needed to communicate the purpose of QOL assessments to clients and thus facilitate deeper conversations about client needs and concerns. Key tools for achieving these could therefore include (1) sufficient veterinary team training to understand the QOL assessment and its purpose (2) training in how to communicate QOL to clients, and (3) reflexive use of QOL assessment results to engage clients in preventive care discussions. The veterinarian and client can then discuss the pros and cons of the various aspects of QOL and preventive care to arrive at a cooperative decision.
Routine high‐quality dental care is necessary to provide optimum health and quality of life (QOL) for our patients. Due to their severity, frequency, and chronicity, dental disorders have been found to have the most significant impact on overall health‐related welfare, compared with other common disorders. The Five Freedoms are one option for guiding practicing veterinarians in conversations regarding animal welfare needs assessment for un‐ or undertreated dental disease. These include: freedom from hunger, thirst, and malnutrition, freedom from pain and injury, freedom from infection and disease, freedom from fear and distress, and freedom to express natural behaviors. Behavioral scores for the evaluation of pain exist for a variety of systems and species. Dental assessment and treatment should be conducted by properly trained veterinary professionals. Performing dental procedures without anesthesia ‐ commonly known as anesthesia‐free dentistry or non‐anesthetic dentistry ‐ holds no medical benefit for the animal.
Evidence‐based veterinary medicine (EBVM) is a set of tools for generating reliable research evidence, disseminating it to clinicians, and using it to support clinical decision making. EBVM provides a system for ensuring that the information clinicians need is not only accurate and relevant but available and easy to use. In the research environment, EBVM guides the design and conduct of scientific studies to minimize bias and ensure the data generated are reliable. EBVM includes techniques and training for clinicians to help identify their information needs and then find relevant and useful evidence. EBVM is useful in meeting our ethical obligations to pet owners. Pet owners have an ethical and often a legal right to be informed about the possible risks and benefits of medical interventions. EBVM methods should be a core part of veterinary medical training. EBVM helps veterinarians provide better care and client communication with greater confidence and less time and effort. Veterinary medicine has made incredible strides regarding the sophistication of care that can be provided by veterinarians in practice. In practice, incremental care has been a part of veterinary medicine since its founding. The veterinary healthcare team are informed service providers. There are both ground‐up and top‐down approaches to implementing incremental care practices in the profession. Organized veterinary medicine also has a role to play. Incremental care is a philosophy that holds that there are medical options falling along the entire cost spectrum for most health conditions and that all the available options should be discussed with pet owners. This is in contrast to “gold standard care,” in which only the most effective and most expensive treatment options are, at least initially, presented. Licensing boards and legislatures are inconsistent in their approach to standards of care in veterinary medicine. Prevalence and incidence are both terms used to describe the occurrence of a disease over a period of time. Epidemiology focuses on factors of disease, such as cause, risk factors, frequency, and distribution/pattern. Prevalence and incidence are terms commonly used when describing the study of epidemiology. Prevalence can be expressed over a period of time, referred to as period prevalence, and can also be expressed at a specific point in time, known as point prevalence. There are two ways in which incidence can be expressed: incidence risk and incidence rate. Prevalence is commonly utilized in veterinary medicine as it does not require defining the population that is at risk of developing that disease. Hemangiosarcoma is an aggressive form of cancer that is most commonly encountered in German shepherd dogs, Labrador retrievers, and golden retrievers. The incidence rate is the number of new cases per year divided by the at‐risk population per unit time. Veterinary medical checklists are an effective strategy to reduce avoidable errors. Failures occur in every industry, including veterinary medicine. Comparisons are more difficult to make between veterinary medicine and the aviation industry due to the paucity of studies in the veterinary literature. There is one tool in particular that the aviation industry has relied upon that has gradually trickled into various facets of human healthcare: the checklist. In aviation, checklists may be used for ordinary procedures, such as take‐offs and landings, as well as for malfunctions and emergencies. Checklists in veterinary surgery are an appropriate tool to address surgical instrument retention, among other surgical errors. In addition to surgical errors, medical errors may occur in veterinary practice. Checklists are also important aspects of convergence schedules, to ensure that client communication is managed appropriately. Human‐based errors in medicine and surgery can and will happen to some degree to every veterinary practice and every healthcare provider. Today's consumers want their healthcare on their own schedules, and at their own convenience. Veterinarians providing telehealth must comply with all laws and regulations associated with their license to practice veterinary medicine. Telehealth has the potential to enhance animal care and the delivery of veterinary services, and regulations are evolving accordingly. Veterinarians with a valid Veterinarian‐Client‐Patient Relationship (VCPR) have professional discretion to confer with specialists and consultants, but they remain the physicians of record and do not transfer that VCPR to the specialist or consultant. Veterinarians providing telehealth must be legally authorized to practice veterinary medicine. Technology is available that allows remote monitoring of pets, and this can be an important resource when considering virtual care. Remote monitoring can play a key role in wellness care. Veterinarians may initially have some worries that offering telehealth services will cannibalize their office visits, but such fears are generally unfounded. Pet‐specific care is a concept that can revolutionize our approach to providing veterinary healthcare. When marketing veterinary services, it is important to know the client signalment as well as the patient signalment. The most effective way to market veterinary services is to customize the marketing strategy to target client demographics. Baby Boomers grew up during the American‐dream, white picket‐fence era post World War II. Steve Jobs and Bill Gates are both members of the Baby Boomer generation. Generation X is often referred to as the bridge between Millennials and Baby Boomers. Generation X also has strong brand loyalty, particularly to those brands who give back. Millennials began entering the workforce as the economy crashed, and as a result are the largest generation of entrepreneurs. The youngest generation that is beginning to develop its buying power is Generation Z, the iGeneration, or Gen Z. Assessing risk accurately and using that assessment to inform medical care for patients is a skill that can be developed and improved. Wellness care is all about reducing risk. Some health risks are nearly universal, such as exposure to contagious diseases and parasites. In ill patients, risk analysis helps to guide us toward the most likely diagnoses so that we can diagnose and treat the pet appropriately. Risk assessment also guides our client education efforts. Some diseases are high risk for a great many dogs and cats. We should ensure that every client is aware of these common risks and has the opportunity to prevent or screen for these diseases when possible. The second way to prioritize risk is by seriousness of problem. A point scoring system may be useful for recommending wellness screening laboratory testing. Wellness plans can be designed to be the same for every patient or individualized for each patient. With pet ownership comes risk that the pet may require substantial healthcare services and at considerable expense. Pet health insurance is one of the most common ways in which pet owners mitigate pet health risk. The ways in which individuals manage risk typically fall into one of four categories: avoidance, mitigation, transfer, and acceptance. Risk avoidance is the elimination of an exposure that has the potential to result in a negative outcome. Risk mitigation is an activity that may lessen the chance of a negative outcome associated with a particular risk. Most pet owners do not understand or plan for the true financial risk that comes along with being a pet owner. The best way to be fully prepared for the true financial risk of pet ownership is to transfer the risk to an insurance company by purchasing pet health insurance. Most people transfer risk through purchase of an insurance policy. Owning a pet and providing appropriate veterinary care for that pet's lifetime costs more than most pet owners realize, and veterinarians need to be prepared to discuss costs at the time they make their recommendations. Transparent and upfront cost discussions with clients based on appropriate healthcare recommendations will lead to improved relationships, happier and more trusting clients, happier team members, and better outcomes for pets. Providing appropriate preventive and end‐of‐life care for a pet is only the tip of the iceberg when it comes to the total cost of pet ownership. If cost of care is a barrier, a veterinarian should offer payment assistance options rather than modifying the recommendations. As more and more people embrace the perception of pets as family members, the veterinary profession has worked hard to meet the needs of a more demanding audience of veterinary caregivers. The escalating discrepancy between emotionally invested owners and the higher cost of advanced veterinary medicine has been widely characterized by industry analysts as an affordability crisis. The primary concern is that as the gap between veterinary cost and ability to pay widens, a lower percentage of pets will receive the treatments the industry has prepared for them. This chapter presents the primary affordability factors affecting the demand for veterinary services. It also presents supply‐side considerations factoring into the affordability of veterinary care. Pet owners are finding it difficult to pay for the more expensive veterinary services offered by an increasingly sophisticated veterinary profession, leading to what industry analysts have described as an affordability crisis. Professional service providers have been particularly vexed after the provision of their service with both billing and collecting from their clients. There are whole consulting industries whose sole purpose is to provide professional service providers with the skills and support to actually charge a “full” price without providing discounts, and buoy the self‐worth of the provider. The goal of a sound patient payment discount program should be to: reward for expected good behavior on the part of compliance, reward the client for achieving strategic financial benchmarks, and reward intended patient intangibles such as marketing the practice to other potential clients. Some pet owners may prey on the humanistic trait of most veterinary hospitals to emphasize patient care over finances. Blockchain may be a foreign concept to many, but it is an important topic because it is demonstrating real benefits in many aspects of human healthcare and is bound to gain more prominence in veterinary medicine as well. It could be particularly useful in pet‐specific care in which various stakeholders could have secure privileges to various aspects of the medical record. In a blockchain, individual records are bundled together into blocks, and then linked sequentially within the chain. The three parts of the process are thus: the record, the block, and the chain. To make sure only authorized users have access to the information, blockchain systems use cryptography‐based digital signatures to verify identities. Blockchain is more difficult to hack, and tends to be more secure than traditional systems. The concept of placebo is well known in human medicine. In fact, the caregiver placebo effect may be evident around 30–40% of the time regarding subjective evaluations, such as for lameness in dogs and cats. Another manifestation of caregiver placebo effect can be seen as a feature of being enrolled in a study, or receiving an intervention perceived as new and potentially exciting – known as the Hawthorne effect. One very interesting aspect of placebo studies is that sometimes they can still provide benefits even if the patient/client knows they are administering placebos. This is known as the honest placebo effect. The nocebo effect is an interesting phenomenon in which people have negative expectations about something and that alone is enough to make them perceive an ill effect. The human–animal bond (HAB) is the glue that keeps companion animals in families. Veterinary clinics and the wider community benefit from strong HABs. The HAB may affect owner decisions as to the choice of pet and where it is acquired, how the pet lives with them and owner lifestyle such as where they live, work, and take holidays. When veterinary clinic staff are aware of the HAB in general and, more specifically, the nature of their personal bond with their pets, it can help them support owners and accept different approaches to pet care. Compassion fatigue can occur when staff are interacting with clients whose attachment levels are very different from their own beliefs and attitudes about the HAB. Education of staff about the HAB and how it varies with different people can help staff accept owner decisions and minimize staff stress. Veterinary professionals should play an active role in promoting the human–animal bond among their clients. Education should be taken beyond the typical exam room discussions to include alternative methods that are easily absorbed by pet owners. The human–animal bond is a mutually beneficial relationship between people and animals. In addition to traditional exam room conversations, some opportunities are considered to educate veterinarians' clients. These include: enhanced exam room communication, custom literature, practice blog and social media, educational open house, and community event. The entire veterinary healthcare team should contribute to educating clients on important topics that impact the human–animal bond. To promote the human–animal bond, veterinary professionals should educate clients on the importance of preventive care, fear, and stress in animals, positive reinforcement training, enrichment, exercise and nutrition, pain in pets, and pet health insurance. The very good news is that pain management is now a central, and increasingly sophisticated, feature of small animal medicine and surgery, with an increasingly wide array of tools at the disposal of all members of the veterinary team. Underrecognized and undermanaged pain inflicts very real physiological and medical consequences, resulting in significant patient morbidity and in the extreme can contribute to mortality. Evidence‐based industry guidelines and consensus statements are available to direct veterinary clinicians to the highest, wisest, safest multimodal strategies for acute and chronic pain. Several clinical metrology instruments are validated for both dogs and cats to assign scores for acute postsurgical pain. Disasters, man‐made or natural, can be devastating. Lives can be disrupted or lost, property damaged or destroyed. It is vitally important that veterinary practices have a written disaster plan to cover emergency relocation of animals, back‐up of medical records, continuity of operations, security, fire prevention, and insurance and legal issues. For practices affected by a disaster, first and foremost there needs to be an evacuation plan for people and animals. Veterinarians should be included in the larger local or state government's disaster planning, and veterinarian should have a role in the incident command system. Disaster planning needs to include preparation for continuity of operations. Sometimes clients will have to go to an emergency shelter that also allows pets. Having medical records, medications, food, and water ready to go will make the evacuation less stressful. Sterilization surgery is considered the norm in North American dogs and cats, and is increasingly performed at young ages to prevent breeding of adopted dogs, and potentially reduce behaviors that may lead to relinquishment. The primary purpose of gonadectomy is to manage canine and feline populations. The majority of American veterinarians advocate for elective sterilization surgery. Most American dogs and cats undergo elective ovariohysterectomy (OVH) or castration within their first year of life. Neutering curbs unfavorable behaviors: castrated male dogs roam, mount, and urine‐mark less frequently, and male cats are less likely to spray. OVH is the standard sterilization surgery for bitches and queens in the US. Ovariectomy (OVE) may be performed as a minimally invasive technique using laparoscopy. The desire for less invasive procedures has led to the successful adoption of OVE in other countries. Pet overpopulation is a global, multifaceted, animal welfare issue. The veterinary healthcare team (VHT) is on the front line of the intersection of animals and the people in their lives, and the One Health concept recognizes the interconnection between people, animals, and the environment they share. The VHT should be knowledgeable about how their actions fit into the larger picture of the human/animal environment. Zoonotic diseases are those that can pass between people and animals. Connection between human and animal health is the use and misuse of antibiotics. Antibiotic use should be restricted for appropriate bacterial diseases and education by the VHT will help clients understand this use. A distrust of commercial pet foods has led some clients to make their own pet food or sometimes veterinarians recommend homemade diets for pets with specific medical conditions. Clients with a love for exotic pets pose a unique challenge for VHTs. Wildlife poses a unique threat to pets and people. Cancer is a disease of dysregulated genes. Personalized cancer medicine (Pmed) is a therapeutic approach to pet‐specific care that most often analyzes the molecular features of a patient's cancer, and uses this information to design treatment plans that target critical genetic alterations in that patient's tumor. Pmed can also be used to form the scientific rationale for new drug development that starts with the cancer patient rather than cancer cells in tissue culture. It is clear that cancer is a disease of dysregulated genomics. New genomic characterizations of cancer has fueled the field of precision medicine as a therapeutic approach, delivered recent drug approvals in human oncology, and is increasingly available to all species of cancer patients. Precision cancer medicine can be utilized to improve the understanding of a patient's cancer.
When considering the unique aspects of health‐related welfare of small breed dogs, dental disease prevention and treatment is key to ensuring wellness. By ensuring our clients understand what it means to provide a healthy environment, appropriate behavioral expression opportunities, optimal nutrition, excellent health, and positive mental experiences, we can positively guide the way our clients care for their animals, and potentially choose breeding stock free from heritable dental conditions. Animal welfare, in comparison, chooses to focus on the subjective needs and experience of the animal itself, i.e. what impacts on that patient's daily quality of life is the severe periodontal disease having, and what can be done to alleviate them. When assessing patients with dental disease using the FAWN system, the majority of focus is placed on the need to be protected from pain, suffering, injury, and disease, as well as the need to be able to exhibit normal behavior patterns.
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Dental, oral, and maxillofacial diseases are some of the most common problems in small animal veterinary practice. These conditions create significant pain as well as localized and potentially systemic infection. As such, the World Small Animal Veterinary Association (WSAVA) believes that un‐ and under treated oral and dental diseases pose a significant animal welfare concern. Dentistry is an area of veterinary medicine which is still widely ignored and is subject to many myths and misconceptions. Effective teaching of veterinary dentistry in the veterinary school is the key to progression in this field of veterinary medicine, and to the improvement of welfare for all our patients globally. These guidelines were developed to provide veterinarians with the information required to understand best practices for dental therapy and create realistic minimum standards of care. Using the three‐tiered continuing education system of WSAVA, the guidelines make global equipment and therapeutic recommendations and highlight the anaesthetic and welfare requirements for small animal patients. This document contains information on common oral and dental pathologies, diagnostic procedures (an easily implementable and repeatable scoring system for dental health, dental radiography and radiology) and treatments (periodontal therapy, extractions). Further, there are sections on anaesthesia and pain management for dental procedures, home dental care, nutritional information, and recommendations on the role of the universities in improving veterinary dentistry. A discussion of the deleterious effects of anaesthesia free dentistry (AFD) is included, as this procedure is ineffective at best and damaging at worst. Throughout the document the negative effects of undiagnosed and/or treated dental disease on the health and well‐being of our patients, and how this equates to an animal welfare issue, is discussed.
Objective: To survey first-year veterinary students' knowledge of companion animal (dog, cat, and horse) behavior and popular-culture (ie, pop-culture) behavior myths related to animal body language, motivations, and learning prior to participation in an introductory animal behavior course; evaluate potential associations between sources of prior behavior knowledge and knowledge on the preclass survey; and determine whether postclass scores on the same survey were predictive of final examination score for the behavior class. Sample: 156 first-year veterinary students. Procedures: Students were invited to participate in an anonymous electronic survey before and after a semester-long, 2-credit introductory animal behavior course. Demographic features, self-assessed animal behavior knowledge, and sources of prior behavior knowledge were evaluated as predictors of preclass survey knowledge scores. Postclass survey knowledge scores were evaluated for association with final examination scores as a measure of validity. Results: Preclass knowledge scores were low (mean ± SD, 49 ± 12.7%; n = 152). Reporting peer-reviewed journal articles as a source of incoming knowledge predicted 9% higher scores, whereas reporting magazines or online pop-culture articles as a source of incoming knowledge predicted 7.6% lower scores for preclass behavior knowledge, compared with scores for students not citing those respective sources. Companion animal ownership was not associated with preclass survey knowledge scores. Postclass knowledge scores were substantially improved (mean ± SD, 84.3 ± 8%) and predictive of final examination scores. Conclusions and clinical relevance: Results indicated a profound deficit of behavior knowledge among veterinary students at the start of their curriculum. Students graduating from veterinary institutions without a comprehensive behavior course may be at a disadvantage for day 1 competency in addressing animal behavior problems.
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The 2015 AAHA Canine and Feline Behavior Management Guidelines were developed to provide practitioners and staff with concise, evidence-based information to ensure that the basic behavioral needs of feline and canine patients are understood and met in every practice. Some facility in veterinary behavioral and veterinary behavioral medicine is essential in modern veterinary practice. More cats and dogs are affected by behavioral problems than any other condition. Behavioral problems result in patient suffering and relinquishment and adversely affect staff morale. These guidelines use a fully inclusive team approach to integrate basic behavioral management into everyday patient care using standardized behavioral assessments; create a low-fear and low-stress environment for patients, staff and owners; and create a cooperative relationship with owners and patients so that the best care can be delivered. The guidelines' practical, systematic approach allows veterinary staff to understand normal behavior and recognize and intervene in common behavioral problems early in development. The guidelines emphasize that behavioral management is a core competency of any modern practice.
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The robust advances in pain management for companion animals underlie the decision of the American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines. The 2015 Guidelines summarize and offer a discriminating review of much of this new knowledge. Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian-client-patient relationship. These Guidelines support veterinarians in incorporating pain management into practice, improving patient care. The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual patient basis. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention and treatment of pain in animals. The Guidelines include both pharmacologic and non-pharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. Post-surgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Chronic pain is dominated by degenerative joint disease (DJD), which is one of the most significant and under-diagnosed diseases of cats and dogs. DJD is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats. © ISFM and AAFP 2015.
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To describe the relationship between veterinarian and client genders and veterinarian-client-patient communication. Cross-sectional descriptive study. Random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets. For each practitioner, 6 clinical appointments were videotaped, and the resulting 300 videotapes were analyzed with the Roter interaction analysis system (RIAS). Linear regression was conducted to study the relationship between demographic factors, measures of veterinarian-client-patient communication, and gender of the veterinarian and client. Female veterinarians conducted more relationship-centered appointments, provided more positive and rapport-building statements, talked more to the patient, and were perceived as less hurried or rushed, compared with male veterinarians. Clients were more likely to provide lifestyle-social information to female veterinarians. Same-gender veterinarian-client interactions were relationship centered and included client provision of more lifestyle-social information. Gender influenced veterinarian-client-patient communication, and previously described physician gender differences in medical communication were largely replicated in the veterinary context.
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This paper is a report of a concept analysis of partnership within the context of a professional-patient relationship. The concept of partnership has been previously characterized as immature, with a need for further consensus and consistency. Critical attributes previously reported include relationship, power sharing and negotiation, with empowerment as the primary consequence. Rodgers' evolutionary method of analysis for concept development was used to re-examine the concept of partnership. Historical documents and previously published conceptual papers were reviewed for context. A search of multidisciplinary literature published between 2000 and 2004 was undertaken using the keywords of 'partnership' and 'partnering', combined with nurse/professional/physician-client relationship. Attributes, uses, antecedents and consequences were inductively derived from the citations analysed (n = 62). Previous authors affirmed that partnership involves a process and a consistent set of eight attributes. Relationship, shared power, shared decision-making and patient autonomy are attributes that distinguish partnership from other related concepts. Most of the literature, however, consisted of expert opinion or descriptive research. Little progress has been made in applying theory, developing tools to test the process, identifying when partnerships are needed and what specific outcomes occur when they are present. Partnerships between healthcare providers and patients develop over time. They are created to support patients in having a greater voice in their care and to empower them in self-management. A descriptive model of partnership is proposed to support researchers in generating or applying existing theory to the development of research designs and tools that could test how this process actually works.
The distinction between norms and facts is long-standing in providing a challenge for psychology. Norms exist as directives, commands, rules, customs and ideals, playing a constitutive role in human action and thought. Norms lay down ‘what has to be’ (the necessary, possible or impossible) and ‘what has to be done’ (the obligatory, the permitted or the forbidden) and so go beyond the ‘is’ of causality. During two millennia, norms made an essential contribution to accounts of the mind, yet the twentieth century witnessed an abrupt change in the science of psychology where norms were typically either excluded altogether or reduced to causes. The central argument in this book is twofold. Firstly, the approach in twentieth-century psychology is flawed. Secondly, norms operating interdependently with causes can be investigated empirically and theoretically in cognition, culture and morality. Human development is a norm-laden process. © Cambridge University Press 2006 and Cambridge University Press, 2009.
Low-stress handling is important for the safety of the veterinary staff and for the welfare of the patient. The commitment to ensuring the emotional well-being of the patient should be equal to that shown toward the physical well-being of the animals under a veterinarian's care. Before handling animals it is essential to assess the environment and the patient's response to it. Taking the time to create a behavior handling plan makes future visits easier and bonds clients to the practice. Understanding how and when to use handling tools is key to making patient visits safer, more humane, and more efficient.
Different tests have been developed for evaluating the temperament of cattle, pigs, and sheep and some studies appear to have conflicting results. This may be due to confusion between the basic emotional systems of fear and separation distress (panic). Methods used for temperament tests can alter results such as how tightly an animal is restrained in a squeeze chute during temperament evaluation. Animals with a more reactive (fearful) temperament will exhibit greater agitated behavioral reactions when suddenly confronted with novel objects. Animals can be habituated to new things but learning is very specific. Habituation to one type of strange object may not transfer to other types of objects. Animals with smaller-diameter leg bones and slender bodies may be more reactive (fearful). Facial hair whorl position is related to a vigilant temperament and it may be more evident in populations with more diverse genetic backgrounds.