The strong bond between owners and their pets—often to the point that pets are considered members of the family—means that both veterinarians and physicians can support practices and activities that are healthy for animals and their owners. By encouraging dog walking, for example, veterinarians can help motivate owners to engage in physical activity,1 and by incorporating pet-related activities in education tools, physicians can improve patients' self-care.2 This connection argues for a one-health approach to health care, with veterinarians and physicians collaborating to improve the health of all species in the home.
Once they understand how asking about pets can enhance patient communication and care, family physicians see the value in collaborating with veterinarians.3 However, as is frequently the case with one-health initiatives, veterinarians will likely have to take the lead. Recent research into how physicians and other health-care professionals respond to veterinarian outreach provides clues to building interprofessional relationships and offers suggestions on ways veterinarians may be able to initiate the process.
Importantly, the human medical community's view of one health largely focuses on zoonotic diseases and global public health initiatives.4 Zoonotic diseases are indeed an important part of one health, and as with all infectious diseases, young, old, pregnant, immunocompromised,5 and mentally challenged6 individuals are at particular risk. But, other human health risks are also associated with animals, including injuries (eg, dog bites, trip and fall injuries, and horse kicks), environmental contamination (eg, allergens and Toxocara ova), and depletion of family resources (financial, emotional, and social).7
Of all health-care professionals, veterinarians are likely to have the greatest knowledge related to the prevention and management of zoonotic risks, particularly risks associated with infectious diseases and injuries. Physicians receive little training in zoonotic diseases and may, therefore, misunderstand zoonotic risks and their mitigation. For example, pediatricians may recommend removal of pets from the home to mitigate the risk of asthma, but such advice may be unfounded, especially given that exposure to pets in early life can significantly reduce the likelihood of children developing allergic disease.8,9 In fact, physicians often do not even know which of their patients' families include pets.2 On the other hand, physicians who are aware of the important role pets have in the family may be more likely to consider pet management options rather than pet removal to address health concerns.
Physicians may not be aware of the multiple health benefits of living with pets (collectively known as zooeyia).10 These physical manifestations of the human-animal bond can be categorized as follows7:
Pets can be sources of social capital and can have a ripple effect on social interactions. Their companionship reduces loneliness, and they facilitate social contact with others, encouraging the give-and-take among neighbors that builds community.
Pets can be motivators of healthy behavior. Dogs are more effective than human partners in encouraging physical activity, and children with dogs are more active than those without pets. Pets stimulate activities of daily living, such as eating, personal hygiene, moving about, and maintaining a safe environment, factors that are especially important for the elderly.11
Pets can be catalysts for harm reduction. Owners can be motivated to alter tobacco use to protect their pets from secondhand smoke. Homeless pet owners curb drug use or alter their drug choices so that they can take care of their animals and refrain from criminal activity to avoid incarceration.12
Pets can be therapeutic. Pets' impact on cardiovascular health is profound. Interactions with pets can stimulate the release of oxytocin, inducing a calming response. Pets are a major source of support for patients with long-term mental conditions.
Physicians' general interest in the field of one health can translate into action only when the clinical importance of a one-health approach becomes apparent.4 Two recent research projects with which we were involved explored ways to engage physicians in this type of one-health approach to the care of their patients. The first found that family physicians can be taught to ask their patients about pets in the family and showed that, when they do, patient care improves in clinically relevant ways.3 The second demonstrated that physicians can use pet-centric education tools to promote patient self-care by incorporating activities with pets.2
For the first project, working from the premise that physicians seldom explore areas when they lack the confidence needed to take appropriate actions, we investigated the impact of training family physicians and other health-care providers in zooeyia, the more common zoonoses affecting people, the benefits of interprofessional collaboration with veterinarians, and methods for asking patients about pets in the family.3 Training involved simple educational outreach, including a short (< 10-minute) discussion of a brochure that provided references from the medical literature. Before training, less than half of the participating physicians knew which of their patients lived with pets, and only 13% had asked. After training, participants indicated that they were committed to asking patients about pets in the family, when clinically appropriate, over the next 3 to 4 months, and follow-up surveys revealed that roughly a third of participants had incorporated asking about pets into their routine practice.
Our research3 has shown that, when talking about their animals, patients reveal clinically relevant information about social determinants of health (ie, the conditions in which they live, work, and age)13 that could have a profound effect on their health. We found that pet-centered discussions increased physician understanding of their patients' physical activity (83% of participants), family members and social capital (54%), and housing (54%). Once they knew about pets in the family, participating physicians found they could use that knowledge as a resource, and there were significant increases in patient-physician discussions around the positive effects of companionship and social interaction with the pet, the benefits of regular physical activity with the pet, the role of the pet as a motivator for controlling unhealthy behaviors, and the pets' therapeutic effects on anxiety and stress. Conversations about the risk of zoonotic disease and injury were also more common, and participating physicians indicated they were likely to collaborate with a veterinarian as appropriate to mitigate zoonotic risk. Of greatest clinical importance, conversations about patients' pets enabled physicians to establish patient-centered rapport and enhance their therapeutic alliance.3
For the second project, we developed a series of pet-centric education tools (Appendixa), with each tool involving activities related to a specific area of health care.2 Although validation of the tools' impact on patient engagement with their physicians and self-care is ongoing, results of an early pilot study2 were encouraging. Pet owners enjoyed the tools and shared them freely with family and friends. Healthcare professionals found that communication facilitated by these tools improved rapport and enhanced the therapeutic alliance with their patients.
Together, these projects have reinforced the idea that collaboration between veterinarians and physicians can improve the health of the entire family and that when veterinarians initiate an interprofessional approach, physicians will respond.2,3 Simply giving clients business cards to share with their physicians can open lines of communication,14 as can offering clients relevant pet-centric education tools to share with their health-care provider. For clients who have told their veterinarian about a health issue that could be affected by living with pets (eg, immunodeficiency), a letter inviting interprofessional engagement on the issue can be given to the client to share with their physician. Veterinarians can also provide evidence-based references that describe zooeyia and propose an interprofessional approach to mitigate zoonotic risk.7
At all times, veterinarians must respect their clients' confidentiality and must obtain and document permission before communicating with a client's physician. For veterinarians in the United States, this means that they must comply with the privacy rule of the US Department of Health and Human Services, which states that “[a]ll authorizations must be in plain language and contain specific information regarding the information to be disclosed or used, the person(s) disclosing and receiving the information, expiration, right to revoke in writing, and other data.”15
The authors did not receive any financial support in connection with the writing or publication of this article, and the authors declare that there were no conflicts of interest.
The views expressed in this article are those of the authors and do not represent an official position of their institutions.
The pet-centric education tools are available free of charge for interprofessional teams through the corresponding author.
2. Hodgson K, Darling M, Monavvari A, et al. Patient education tools: using pets to empower patients’ self-care—a pilot study. J Patient Exp 2018;1–5:10.1177/2374373518809008.
3. Hodgson K, Darling M, Freeman D, et al. Asking about pets enhances patient communication and care: a pilot study. Inquiry 2017;54:46958017734030.
6. De Hert M, Correll CU, Bobes J, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011;10:52–77.
7. Hodgson K, Barton L, Darling M, et al. Pets’ impact on your patients’ health: leveraging benefits and mitigating risk. J Am Board Fam Med 2015;28:526–534.
9. Stein MM, Hrusch CL, Gozdz J, et al. Innate immunity and asthma risk in Amish and Hutterite farm children. N Engl J Med 2016;375:411–421.
11. Heuberger R. Associations of pet ownership with older adults eating patterns and health. Curr Gerontol Geriatr Res 2017;2017:9417350.
12. Lem M, Coe JB, Haley DB, et al. Effects of companion animal ownership among Canadian street-involved youth: a qualitative analysis. J Sociol Soc Welf 2013;40:285–303.
13. World Health Organization. Social determinants of health. 2016. Available at: www.who.int/social_determinants/en/. Accessed Nov 3, 2018.
15. US Department of Health and Human Services. Summary of the HIPAA Privacy Rule. Available at: www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html. Accessed Nov 3, 2018.
16. Byers CG, Wilson CC, Stephens MB, et al. Owners and pets exercising together: canine response to veterinarian-prescribed physical activity. Anthrozoos 2014;27:325–333.
17. Westgarth C, Christley RM, Christian HE. How might we increase physical activity through dog walking? A comprehensive review of dog walking correlates. Int J Behav Nutr Phys Act 2014;11:83.
Pet-centric education tools designed to promote patient self-care by incorporating activities with pets.2
Family Mosaic With Pets: assists patients in creating a drawing or collage of their family, including pets, to encourage patients to advise their family physician about pets in the family and facilitate communication with their physician about important determinants of health.
Fun Activities With Pets: encourages patients to plan and schedule enjoyable activities (eg, walking their dog, riding their horse, training their bird, or playing with their cat) that benefit both patients and their pets and provides a proactive approach to prevent problems.
Calming Exercises With Pets: incorporates pet interactions in mindfulness training to relieve stress. Patients are encouraged to select and schedule a calming activity they can engage in with their pet (eg, cuddling with their cat, grooming their horse, or sunbathing with their lizard) and to identify a trait of their pet they can use to refocus when their mind wanders.
Healthy Habits With Pets: encourages patients to select and schedule regular physical activity with their pet and to track the intensity of and motivation for the activity and the effect of the activity on both the patient and pet. This tool is especially helpful for obese owners and owners of obese pets for whom an exercise program is indicated.
Celebrating Connections With Pets: encourages positive social interactions and strengthening social capital through engagement with pets. Pet owners develop activities that strengthen the bond with their pet and involve others in the owner's life (eg, taking their dog to the park, introducing their pet to friends, or enrolling in training classes for their pet).
Healthier and Safer With Pets: advocates interprofessional collaboration within the pet owner's circle of care, including veterinarians. Pet owners list topics of conversation for both their physicians and their veterinarians to enhance the benefits and manage the risks of living with pets.