Minimizing the patient's fear in the veterinary clinic
Adverse effects of a stress response
One study reported that 106 out of 135 canine patients (78.5%) were fearful on the examination table. 47 Eighteen of the dogs (13.3%) had to be either dragged or carried into the practice, and, <50% of the dogs entered the practice calmly. Dogs <2 yr, a patient population that is presented to veterinary hospitals relatively often, were more fearful than older dogs that see veterinarians less frequently, suggesting that recent exposure to the hospital environment on a repeated basis may increase fear. Hernander (2008) noted that dogs that had recently visited the veterinary hospital had higher stress levels than those that had not. 48 Dogs that had some control over their examination were less stressed, and dogs that had had only positive experiences were less fearful than others, suggesting that dogs learn from interacting with empathetic veterinary personnel. 47
Fear and stress also affect hospitalized patients. Postoperative patients that were not fearful and stressed had fewer physiological indicators of stress, experienced fewer nosocomial infections, had faster rates of recovery, and required fewer postoperative visits. 49Patients that underwent anesthesia were anecdotally often reported to later be more fearful or reactive, suggesting that postoperative distress behaviors may warrant medication and behavioral intervention to calm the patient. Those findings have profound implications for how hospitalized patients are cared for. Compliance and frequency of exams decline when clients believe that the inevitable result of a visit to the veterinarian is anxiety in their pets. 48,50
Manual restraint and forceful handling of animals in the veterinary hospital may interfere with successful case outcome. A heavy-handed approach can affect the ability to obtain accurate physical and laboratory data and may increase levels of physiological stress. Manual restraint also increases the likelihood of struggle and risk of injury to staff and patients. 16,51,52 The physiological after-effects of physical restraint can lessen the efficacy of subsequently administered sedatives or other forms of chemical restraint. This Task Force recommends that the least stressful, most humane methods of restraint be used first, an approach that allows the patient’s response to treatment and handling to determine the degree and duration of pharmacologic intervention. Examples of inappropriate physical restraint include nail trims that require several people to hold the animal; blood draws that require complete physical immobilization; ‘‘scruffing’’ cats that show no signs of arousal; ‘‘stretching’’ cats that may do better wrapped; and pinning dogs against walls or between gates, in runs, or fences for injections. All of those techniques make calm animals fearful and make fearful animals worse, less reliable in terms of safety, and less able to be calmly examined in the future. For humane, low-stress exams, less is truly more.