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 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.4
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.
Client Communication
Empathic client communication is essential to supporting and advancing the human-animal bond in companion animal practice. Empathic communication emphasizes the ability to listen for underlying messages and implies, in essence, that the veterinarian attempts to understand the prevailing problem from the client's perspective. Empathic communication allows the veterinarian to effectively propose solutions while also gaining the support and commitment of the client, resulting in a higher likelihood of adherence to the treatment protocol.
Two other vital aspects of effective client communication are engagement and education.5,6 Engagement involves listening to the client's concerns and is reinforced through the use of reflective listening, whereby the veterinarian summarizes the conversation, allowing the client to correct misconceptions. Education is vital in achieving good treatment outcomes, as it not only allows clients to understand 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 outcome.
These three aspects of communication—empathy, 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 records. These so-called advance directives will keep hospital staff informed as to the wishes of the client when impending events threaten the life of a patient.
An important consideration regarding client communication is apparent gender-based differences in veterinarian-client interactions.7 Women veterinarians 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 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 satisfaction and the best clinical outcomes for patients.
Traditionally, client communication involved the veterinarian making recommendations that the client was obliged to follow. One major disadvantage of this traditional approach is that decision-making is not shared and responsibility for treatment outcomes is similarly not shared. If the outcome of treatment 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, reporting 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 approach 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 compassionately 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 patients during hospital visits. Establishment of safe movement routes for reactive individuals, designation of quiet areas for clients to visit with hospitalized 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 especially animal caretakers, should be trained in identifying 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 continually learn new restraint and handling techniques 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 natural calming signals (eg, dark and quiet environments),9,13 and information on low-stress handling techniques for companion animals in a clinic setting 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, owners, 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 acclimate 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 reducing 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 specialized 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 emotionally aroused, as waiting can decrease the effectiveness of the drug and allow fear of the situation to be reinforced.13
Conclusions
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. Understanding how to incorporate the human-animal bond in companion animal practice by enhancing client communication 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
Acknowledgments
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.
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