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.
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 (firstname.lastname@example.org).
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.
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.
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For all commentaries, views expressed are those of the authors
and do not necessarily reﬂect the ofﬁcial policy of the AVMA.