New Strategies for Improving Veterinary Visits
I have heard a lot of horror stories from both clients and other pet professionals about problems taking pets to the vet. The reactions range from pets shaking and struggling, to clawing and biting to the extent that they have to be harshly restrained or even sedated. Some pet and vet situations are outright hard to handle, and many are medically necessary but difficult procedures. More and more effort is being made now to help pets better handle those difficult situations.
What I think many people don’t realize is that restraint and sedation for treatment and examination can actually condition pets to have a negative response to a vet visit. An animal will become afraid when he recognizes that he is about to have a veterinary visit if he has had a prior bad experience. As trainers and pet care professionals we have an obligation to do our best to include better husbandry techniques and teach stress-free handling methods.
Could our efforts make it worse?
Classical conditioning is creating an emotional response on the part of the subject (the learner) to a stimulus. As professionals, we carefully use methods like pairing a procedure with food to improve a pet’s perception of a particular situation. In many cases we can have the vet, a tech, or even the owner pair the experience with a primary reinforcer, something that the dog perceives as pleasant. When the vet or tech shows up, have him give the dog a treat. However, I often hear from clients that the treatment staff is giving the patients food during treatments, but it doesn’t seem to be helping.
It seems simple, so what could go wrong? Actually the procedure I’ve described could work, or it could have an opposite result. If the learner already has a negative response to a stimulus due to past bad experiences, this strategy is counter-conditioning. In that situation, you could actually make the fear greater by enticing the animal outside of his comfort zone, setting him up to snatch the reinforcer and retreat. You can also inadvertently reinforce the wrong behavior, like a growl or hiss. If the learner already has a negative response to a stimulus due to past bad experiences, the best strategy is a well thought out plan of counter-conditioning.
With clients, I use a very simplified example of the ogre in the forest offering candy to a little girl: “Come here little girl, I won’t hurt you. Here is some candy.” Everyone knows that ogres are dangerous, that they offer candy to wayward girls just so they can snatch them and take them to their lair and eat them. But they are offering candy… So the learner (the little girl) becomes very conflicted. She wants candy, but she knows the ogre is trying to trick her.
Much the same can be said of trying to offer treats randomly during a nail trim or other medical procedure. If the treats aren’t pleasant enough to overcome the unpleasantness of the nail trim, or if the timing of the treats doesn’t pair the pleasant association of the food with the unpleasant experience of the nail trim, then the learner will not change his perception of the procedure for the better. This can actually cause the unfortunate result of associating food with the fear instead of reducing the fear as was intended.
Several strategies for improvement
It is not my intention to give a detailed training plan for these situations in this article. That has been done in depth by others, including “The Bucket Game” method by Chirag Patel and all of the stress-free handling work by the late Dr. Sophia Yin. My aim here is to get owners, trainers, and animal care professionals to reassess their approach for a better result.
The first strategy is to recognize that all training programs should include grooming, handling, and examination as an integral part of the curriculum. Many procedures are elective enough that we could train for them a bit in advance, so that the pet is actually familiar with the process before the medical need. Simple examples are teaching a pet to stand, to have his scruff lifted for a vaccination, or to have his mouth examined. And since non-elective medical situations arise when we don’t expect them, the more preparation the pet has beforehand, the easier those will be for them.
There are both operant and respondent conditioning techniques that we can teach clients, to help them better accustom their pets to husbandry. Examples of behaviors we can teach in training programs are: getting a pet to voluntarily enter his carrier; step on a scale, or present his paw for a nail trim. Probably all dogs should be taught to voluntarily put their noses into a muzzle before they need it. We can teach clients to give their pets a choice and present the option in very graduated increments, setting up the opportunity for the learner to offer the behavior. That would then make it clear to the teacher that the learner is ready for the next progression in the lesson.
There are a number of experiences that could be classically conditioned. Every time you present nail clippers, a collar, a muzzle or a brush, you could deliver a treat. We could give treats in the parking lot, at the reception counter and on the treatment table, all without ever doing any treatment. Almost all vets have treats on the counters, so go in, give your pet a treat and leave. Present disinfectant spray and deliver a primary reinforcer. If every time we presented an article of medical or grooming equipment, we paired it with an item that was valuable to that specific pet, we would change the whole outlook of the experience.
But it’s not really quite that simple
I talked a bit so far about the consequences, those things we do during or after the stressful situation to make the subject feel better. I mentioned an example earlier where the staff was using food to make a procedure more pleasant and didn’t feel it was working. This is often the case. Sometimes there are other factors, like things that happen before the treatment (antecedents) that also influence the results. Here’s another example of how the learner perceives the situation, or more notably how the teacher must better understand the learner.
In a simple iteration, I don’t like going to Grandma’s house, because she pinches my cheek and calls me cute. But she bakes the best cookies, and Mother says, “Don’t forget Grandma’s cookies!” So I should be perfectly happy to go. Right? Well, maybe not, especially if I really am tired of the “you’re cute” and cheek pinch moment. Plus, that might not be the only factor that influences my feelings about the visit to Grandma’s house.
It is important to examine even distant antecedents. At Grandma’s house there are a number of other stressors added to the fact that Grandma bakes cookies or gives me ice cream. If we want to lessen the unpleasant effects of the cheek pinch, we have to be aware of all of the events that affect the perception of the visit to Grandma’s house. Mother or Father might be stressed about the visit, getting everyone dressed and arriving on time. There might be other things I would rather be doing instead. I might not like the clothes I have to wear. Grandma may have even burned the cookies last time and they weren’t any good. Any of these things might be enough to make it that much harder to overcome the unpleasantness of the cheek event.
When we counter-condition to change behavior, measuring the results is important, because sometimes the improvement is slow or comes in small increments over a lot of repetitions. When a behavior is not improving, or is getting worse, what are the other factors in play? If the visit to the vet has been problematic because the animal isn’t used to going and we have had to chase him down, or it involves an unpleasant car ride and then an uncomfortable period in the waiting room, we don’t have a lot of flexibility to make the actual procedure pleasant. Distant antecedents make a difference in our ability to make improvement. These stacked stressors may have already shut down the animal to the point where learning or improvement can’t occur.
Owners, trainers, veterinarians, and staff can make a difference
It clearly takes some effort and adjustment on everyone’s part, but a gradual approach where we work to eliminate all of the unpleasant factors one at a time will help. We should communicate our desire to work with the veterinary community to make the whole examination and treatment process a coordinated effort between the pet, the owner and the staff. Next we should work to present the procedures to the pet in such a way that the pet learns he can handle them comfortably. We do this by not forcing an elective procedure while the pet still perceives it as unpleasant and always introducing the treatments in a way where the pet is participating and offering an indication he is willing to participate.
To be successful at improving our ability to create pleasant veterinary visits, we need to use a multifaceted approach. When we instruct and aid clients, we must remember to look at the whole picture, and to determine enough background information to understand all of the influences from the learner’s point of view. We strive to not only classically condition to create pleasant experiences with the procedures, but also make sure to eliminate all the distant antecedents that might be causing an unfavorable experience. This combined approach will necessitate a team effort that includes the vet, the trainer, the owner, and the dog.