In veterinary medicine, we use the term “Peek and Shriek” to refer to an exploratory abdominal surgery that reveals something beyond our clinical comfort level. You make an incision, take a peek, make a shriek, then close them up and immediately refer the client to a specialist. Those moments occur in behavior as well. We start with what seems to be a straightforward history, then encounter increasingly distressing behavior abnormalities or signs of significant medical involvement. In both venues, the client must be supported in the transition to their next source of care.

Clients without a primary veterinary care provider may not know where to start. The veterinary field has been under significant strain in recent years, with many companion animal clinics struggling to provide adequate care to established patients. Issues with productivity, staff turnover, and burnout are recognized at an industry level with no easy solutions available.¹ Maintaining a list of trusted medical referral partners, both veterinarians and veterinary behaviorists, allows you to set your clients up for success and strengthens professional partnerships. It also establishes you as a valuable resource.

Even if an individual has an established primary veterinary care provider, they may have a reason why they sought your help rather than that person’s. This presents an opportunity to assist them in recognizing the full extent of any abnormal behavior and adequately communicating their concerns in the clinic.

To facilitate that communication, consider writing a formal referral. Writing a formal document detailing your findings and the reasons for recommending additional care accomplishes several things. It provides the pet’s owner with a record to refer to, even if you are not comfortable rendering any services at that time. It supplies their next care provider with direct information about relevant concerns without relying on owner interpretation. Well-written referrals also demonstrate professionalism to service providers you may wish to connect with.

Professional boundaries are not meant to be impenetrable walls. Ideally, we partner with complementary service providers to facilitate comprehensive care that is mindful of individual qualifications and limitations. These connections can result in a mutually beneficial flow of referrals. Routine use of structured documents provides increased exposure to potential partners when you recommend that a client consult their primary provider rather than someone within your established network.

Directly forwarding a formal summary increases your chance of a positive first impression, circumventing a dangerous game of “telephone” where the client serves as the operator. Do not allow “I observed abnormal toileting behavior and recommend a veterinary visit” to transform into “My trainer told me he has a UTI and you have to give him antibiotics.” Demonstrating recognition of individual roles and professional boundaries helps to build trust. This document may also serve to outline what support options you do offer in the management of medical cases.

Patient outcomes can be significantly impacted by client adherence to medical recommendations, an unfortunately understudied area of medicine.² Available studies highlight client concerns regarding medication administration, including a reported lack of instruction and educational resources.^3,4 While prescribing is firmly in the hands of licensed medical professionals, mitigating stress during administration may be more easily accomplished through behavior consultation.

Fear Free, Low-Stress Handling, and Cooperative Care principles have more adherents than ever, and name recognition continues to grow.^5,6 The most common question that I am asked by veterinary colleagues who wish to implement those ideals is whether they are feasible in practice. Time constraints vary tremendously from one clinic to another. Factors include scheduled appointment time, paraprofessional ratios, default task delegation, medical record systems, individual efficiency, and expectations of clientele. Providers who are overwhelmed by existing offerings may be all the more hesitant to explore reduced-stress care despite an ideological interest. Outside services that reduce clinic burden, promote compliance, and improve outcomes are extremely valuable.

Trainers who offer medical support have a unique opportunity to establish long-term client-consultant relationships. Chronic conditions often require adjustments to treatment plans as underlying medical concerns progress or aging impacts coping ability. Behavioral health is a significant component of overall wellness, and even relatively basic interventions impact quality of life and client satisfaction. That can translate into return clients and word-of-mouth advertising, both of which reduce the cost of doing business.⁷

While a comprehensive review of ways in which behavior consultants can contribute to the management of medical cases is beyond the scope of this article, it is worth noting that services are not limited to preconceived notions of cooperative care. The idea of introducing consent procedures and the complex shaping of treatment behaviors may be intimidating to beginner consultants and clients alike. Behavioral support during times of illness may also include helping pet owners navigate medical restrictions, cope with abnormal eliminations, or adjust enrichment to suit special needs.

Extensive experience is not a prerequisite for brainstorming new litter-box locations or curating puzzle toy options to suit the cage-rested canine. There are tremendous opportunities to exercise creativity and learn on the fly as we adjust to accommodate the individual. Medical cases often require periodic reevaluation and challenge consultants to meet changing needs. When in doubt, check with their veterinarian to confirm that recommendations align with the overall care plan. As you gain confidence in this new area of practice, be sure to leverage those professional connections for promotion and development.

Providing behavior support for medical cases has a low bar for entry with varied options for further development. What starts as basic desensitization and counter-conditioning to handling can evolve into functional husbandry behaviors or active consent procedures. With time and the novel experiences provided by individual medical needs, skills naturally develop.

It is important to note that exposure to veterinary medicine is not a substitute for formal training and licensure. However, the educational benefit of collaborative partners is substantial. Veterinary contacts may be open to sharing journal articles, discussing research, and clarifying media coverage of medical news. Be mindful of the value of their time and any special interests they have shared when seeking educational resources or discussion.

Case success can be measured not only through personal and client observations, but health measures and outcomes. Work with your veterinary partners to determine which of your behavior interventions seem to have clinical effects. Consider offering a medication administration demo day for their chronic care clients. Identify their handling hurdles and incorporate desensitization to those holds or procedures into your kitty or puppy kindergarten classes. This communication allows you to further develop skills that demonstrate the value of your services to your referral network and measurably impact the quality of life of patients.

Consider the Five Freedoms and our ability to meaningfully influence each of them through behavior work.⁸ Compare them with the categories of the HHHHHMM Quality of Life Scale.⁹ This clinical tool not only quantifies a very nebulous area of veterinary practice but specifically guides families in making end-of-life decisions with their care provider.