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Reward the patient - reward your self

This is the first of a 3 part series of articles to address the benefits of rewarding during the exam to achieve co operative pet behavior, recording those rewards with a scoring system in the medical record, and the financial and staff morale benefits from this.

A healthy pet wellness exam should not be upsetting, but how many of your patients are anxious, timid or downright aggressive when they are at your clinic?   Some procedures such as vaccination or heartworm testing are  slightly painful.  Often the  veterinary staff will see animals react with fear at some point during the examination.  Some pets may just cower a little or shake while others may go into full blown aggression.   Some dogs come in happy go lucky ready to greet and accept a treat from everyone.  Although there is not much pain occurring during wellness  exams, there are additional factors that are causing the anxiety in many pets coming to a veterinary clinic.

The majority of traditional restraint methods focus on holding the animal, keeping teeth, claws or hooves away from the veterinarian while not increasing physical pain. The trouble is that these methods often increase anxiety or stress on the animal.  Handlers may quickly position animals for treatments, startling the animal or forcing the body of the animal into position.   Has it ever happened to you that a cat exam went from one to three techs holding the cat down to receive vaccinations?   This cat is not schizophrenic.   The cat is clearly telling you it does not like to be held down.  Most staff would agree that the animal is telling us that it does not like the restraint, but many staff would argue that hard holding is the only way to get the job done.    It is possible to motivate, or get the animal to do what we need without so much force.  This forceful way of handling incites the anxiety and fear.  Rewards during the veterinary exam are one way to motivate animals to behave better. It is possible to “teach” a dog to lie on its side to have the abdomen examined or nails trimmed without struggle.  Yes even cats will co operate with blood draws when they are not restrained so tightly.
Animals tell what they are thinking primarily by their body language.   Veterinarians and techs have not been educated in normal, fearful and aggressive body language, especially how it presents in the veterinary clinic. So we miss the cues that tell us that the pet is stressed.   We continue in our traditional methods of restraint only to cause more fear and problems.  Animals are always telling us what they are thinking.  Every response has some preceding action that causes it.  Understanding what that pet needs to feel less upset is the first step to providing a better response.  In other words, give a pet a reward for the right behavior, and they will likely repeat it.

Rewards are a very powerful motivator for pets and people.   First of all, these animals are working to be good when they come to the clinic. Rewarding a pet for coming into a veterinary waiting room, standing for examination on a table or receiving a vaccination is not spoiling them.  They have to ignore smells, sounds, and the hands of humans they do not know well.  The dog or cat has learned that there is something painful or uncomfortable about getting on that exam table or when the person in a white coat enters the room.  Rewarding this animal for not struggling and for just being there is the paycheck they deserve.    So the reward helps to insure good behavior because it is paired with the behavior we want – no struggling or attempting to bite.  Another powerful benefit of rewards is how they help to change the attitude (feelings if you will) of the pet.  Because dogs like chewie treats, and they feel good when they get them, seeing the chewie treat helps them become “happier”.  Now when you pair that chewie treat with seeing the exam table the dog will associate the good feelings that the treat gives.   This is not spoiling – this is learning!   Think of it this way.  Imagine you are nervous about getting your mammogram.  Just seeing the mammography department makes you break out in a sweat.  You go from mildly sweating to heart pounding and headache as you proceed through the exam.  Last year, it was uncomfortable and they had you wait an extra 30 minutes as they took additional views.  Although everything was ok, you were sore, scared and emotional.  Now imagine a different scenario.  Imagine as you walk into that mammography department the receptionist gives you $10 for showing up.  When you come into the room in your little cape, the tech gives you $10 again and through the exam upping it to a $20 bill during the big squeeze.  As more views are taken you continue to get more money.  Now, would this experience make you feel any better about getting your mammogram?  Would you feel a little less tense each time they gave you money through the exam?  I imagine you would, since money makes many people feel good.  I would also argue that you worked for that money reward.  You were not being spoiled by getting money, it was a way to help you associate something good with the mammogram, and help make the next year’s exam be less upsetting to you.

Timing the rewards is important so that we are reinforcing or rewarding the right behavior. Typically the reward needs to be given within a second of the right behavior (1). Cut the treats up, about the size of half of a cheerio.  One treat is cut up or broken into many small pieces so the amount of food eaten is not much.  When the animals reacts with growling or struggling, stop the rewards then resume as the animal relaxes or decreases struggling.  This way they are pairing the rewards with less struggling.

Rewards can be food, petting, verbal praise or even changing the place of exam (2).   Food motivates many pets, especially dogs.  It helps a lot of the animal is hungry when they come in for their exams.  Not all clients will comply with fasting their animal, but many will cut feeding in half before exam time which does help.  When you do use treats, have a choice and make the pieces about the size of a half a cheerio.  That way the reward can be consumed quickly, there will not be many additional calories, and the treats go a lot farther.   For cats, rubbing the head between the ears, not using much physical restraint, and the security of the carrier are rewards - they help the cat feel "happier".  Yes, cats can be happy to come to the veterinarian.  Other tools that positively reinforce the dog or cat for exams are Feliway or DAP and towels to wrap the head and body.

It is also important to learn the early signs of fear in dogs and cats.  The signs are different so know the species you are working with.  Observe what the pet is doing.   For dogs, freezing, tail low, head held low, and cowering are signs of fear.  As the dog becomes more fearful then they will become aggressive. Cats will crouch down, ears back, tail flicking, and freeze(3).  References  are "Low Stress Handling ,Restraint, and behavior modification of dogs and Cats" by Dr. Sophia Yin.  The Bella Behavior Label System (pat pend) kit by Dr. Sally J Foote,  has feline and canine body language in the clinic chapters to educate your staff.   Other resources available through www.avsabonline.org.  Use these  references to help you  understand what you see.

As you use rewards, less stressful handling, or tools to help the animal become less stressed record this in the medical record.  Make a place or use a system that makes it easy for all the staff to see what motivates this pet to be the most relaxed and co operative for exams.  Consistent handling will speed up the process of this pet learning how to co operate with you.  Each pet may be different so it is important to know what works for this pet for exams.  By having the record and scoring the impact of the reward, now you can really improve your positive handling skills and ability to observe behavior.  As you and your staff increase in confidence, you may also build your credibility in behavior consultations and therapy.  There will be fewer staff injuries and you  will likely enjoy your work more because the wrestling matches will be a thing of the past.  What a reward for you - a day without bites, scratches and all sorts of messes in the clinic.

If you would like to learn more about positive reinforcement during exams for co operative pet behavior visit my site www.drsallyjfoote.com.  Join my email list, read my behavior blog, download articles and forms and view videos. 
Next month - how recording and scoring rewards  during the exam builds teamwork, improves client compliance and reduces staff stress. 

references:
1. How to behave so your dog behaves  S. Yin  2004
2. Handbook of Behavior Problems of the Dog and Cat  Landsberg,Hunthausen,Ackerman  2nd ed 2003 pg 56
3. Clinical Behavioral Medicine for Small Animals  K Overall DVM ACVB 1997  pg 23-39; 58-68

Sally J Foote, DVM  CFBC-IAABC
Okaw Veterinary Clinic Tuscola IL
drsally@drsallyjfoote.com

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