Plan appointments to minimize wait and create a quiet, calm environment. Create a strategy to manage timid and fearful dogs to reduce the stress for the patient, the client, and the veterinary team.

Train the veterinary team in low-stress handling techniques. As appropriate, use positive reinforcement (e.g., treats or toys) and minimize distractions. Use quiet, calm body language and a calm voice.⁶ Pheromones may be helpful for their potential calming effect.^7,8 Providing sedation or antianxiety medication for the patient may be appropriate to reduce patient stress and fear, and to provide safety for the veterinary team.⁹ Consider sending the patient and client home if undue stress or fear results. Reschedule the exam for another time, and provide positive reinforcement techniques instead of the exam.

Use relationship-centered client communication to establish trust. Recognize that the client, as the caregiver and final decision maker, is the most important member of the healthcare team. Clients provide important information regarding the pet’s condition and frequently do the bulk of the work involved in performing prescribed care. Communication with empathy, reflective listening, and attention to body language improves the ability to gain relevant information, increases agreement to treatment plans, and improves outcomes in patient care, clinician effectiveness, and client satisfaction.^10,11

In addition to standard body systems review, a thorough history includes asking about the items listed in the Checklist for Each Life Stage (Table 2),  including the daily routine and using open-ended questioning techniques when appropriate. Inquire about behavioral, physical, or other changes since the last visit.

Include a veterinary exam and consultation at each of the routine puppy visits as well as prior to the spay/neuter surgery. Provide a wellness exam and consultation for adult dogs at least annually.¹² Consider semiannual wellness exams because a dog’s health status may change in a short period of time. Pets age faster than humans and many medical conditions are not associated with clinical signs; therefore, earlier detection of items such as body weight changes, dental disease, and other concerns allows for earlier intervention. In addition, semiannual exams may allow for more frequent communication with the owner regarding behavior and preventive healthcare. Consider more frequent examinations especially for mature, senior, and geriatric dogs.

Perform a thorough exam including the five vital signs (temperature, pulse, respiration, pain, and nutritional assessment) as well as the items listed in Table 2.¹³ When possible, use a defined scoring system (e.g., body condition score, muscle condition score).^13–18 The exam may also include the following: pain score; heart murmur grade; gait analysis; body mapping for skin masses and skin lesions; evaluation for breed-specific risks; and laboratory testing and/or imaging as appropriate for breed, age, and individual circumstances.^19,21,23