Part one of this blog discussed the impacts that the COVID-19 precautions have on patient behaviour when visiting the veterinary setting. Part two will look at how veterinary professionals and clients can work together to improve the patients experience during their visit. This will help make the examination and treatment process more effective and potentially improve recovery rates.

How veterinary staff can help make visiting a more positive experience

The response of veterinary professionals to make patient visits a more positive experience can be undertaken with two separate approaches. The first approach looks at all of the implemented measures and how alterations can be made collectively to minimise their negative effects on the patients whilst keeping within the guidelines set out and without compromising the safety of staff and clients. The second approach looks at patients case by case, making it a more holistic approach.

Social distancing, PPE and the increased use of hand sanitisers and disinfectants are measures which cannot be altered due to health and safety implications. The use of practice cat carriers should also still be used for the same reason, they can however be set up and used in ways to improve the patient’s experience. The carriers should be sprayed with synthetic F3 pheromones (Feliway®), this should be done 15 minutes before use (Horwitz, 2018) to avoid aversive effects from the smell of the alcohol carrier evaporating (Rodan and Heath, 2015), transporting patients should be done in a calm, slow and smooth motion (Langley-Hobbs et al., 2014), carriers should be covered with a towel when being transported or when cats are not being handled (Rodan and Heath, 2015) and patients should still be examined in carriers where possible.

The way the veterinary environment is set up and the way in which veterinary professionals behave and interact with patients have a major impact on patient behaviour. By introducing as many of the examples set out in table one, patients should feel more comfortable during their visit.

Table 1: Human behaviour, patient interaction and environmental changes to help make visits to practice more positive.

Human behaviour and patient interaction changes

Environmental changes

● Eye contact should be avoided as it is threatening behaviour (Landsberg and Tynes, 2014) peripheral vision should be used instead (Dr Sophia Yin, 2017). ● Slow blinking at cats using peripheral vision is a friendly behaviour and builds trust (Langley-Hobbs et al., 2014). ● A gentle calm voice and use of reassuring words in a sighed breath have calmings effects on patients and staff (Langley-Hobbs et al., 2014). ● An upbeat tone can help motivate the patient to move (Landsberg et al., 2012) and maintains a hands off relaxed approach to handling. ● A calm demeanor is beneficial with slow and steady movements (Lawhead and Baker, 2017). ● Leaning over patients and reaching over their heads should be avoided as it can be threatening to them (Bassert and Thomas, 2014), instead approach from the side at their level (Hedges, 2014) whilst kneeling, squatting or sitting (Bassert and Thomas, 2014).Interacting with the patient during the examination helps patients feel more relaxed, cats can be stroked behind their ears (Langley-Hobbs et al., 2014) and dogs can be stroked on their chests.

● The use of DAP and Feliway diffusers can help keep patients calm (Prydie and Hewitt, 2015), these can be placed in consult rooms, wards and other areas of the practice. ● Playing classical music at low levels in all areas of the practice helps to relax patients and staff, and acts as noise cancellation to other background noises (Tilley and Smith, 2016). ● Use rooms that have windows that patients can look out of, patients are often calmer when distracted by the outside world (Overall, 2013). ● Dim lighting is helpful in consult rooms and wards as overly bright rooms can cause arousal (Overall, 2013). ● Reduce animal and human traffic around patient areas to help maintain a calm environment.Enrichment can be provided to hospitalised patients (when in wards), enrichment provides mental stimulation (Hosey et al., 2013) which in most cases reduces stress levels (Young, 2013) and promotes calmer behaviour.

The second case by case approach can be undertaken simply by asking clients questions tailored to the practice and to suit how the consultation will be conducted, the information can be gathered during the initial phone call if appropriate, as a courtesy call prior to the appointment, as an entry questionnaire or as an additional section on consent forms. Examples of questions include:

● Would they prefer to be seen by a male or a female veterinary surgeon?

● Is the pet comfortable with being handled/restrained for procedures?

● Is the pet comfortable with being picked up and placed on a table for examination?

● Is there anything in a general examination that they do not like (i.e. temperature being taken, paws being touched)?

● How are they socially around other cats, dogs and small animals?

The information gathered can then be used to tailor the consultation and their potential hospitalisation, to help the patient feel as comfortable as possible avoiding unnecessary situations that may normally be avoided with the client being present.

If veterinary practices undertake these approaches it will help to reduce the likeliness of patients displaying behaviours such as anxiety, stress, fear and nervousness, they are more likely to be in a calmer more relaxed state which will hopefully allow them to adjust to the new changes and cope with the situation.

How clients can help make visiting a more positive experience

Clients can help to make their patients visit to veterinary practice a more positive experience with help from their veterinary practice. Before visiting the veterinary setting clients should be reminded of the specific implemented changes that have been put in place at their practice, this should include what to do on arrival, how the consultation will be undertaken and how their animal will be taken from them if they have to be examined alone or if they have to be hospitalised. This information can be passed on to the client during their initial appointment booking if there is time and the situation allows or with a follow up courtesy call, general information regarding this should also be advertised on social media sites and emailed to clients as a preemptive measure too. Clients will feel more at ease armed with this knowledge as they will be prepared, rather than worrying and trying to anticipate the situation which in turn is likely to make them feel stressed or anxious with patients potentially mirroring these feelings. Other information that could also be passed on to clients to help the situation in general include the human behaviour alterations discussed in table one.

Clients could also undertake positive reinforcement training to help desensitise their pets to face masks prior to visiting the veterinary setting, this can be done in the home and when on walks.

By undertaking these steps clients can help veterinary professionals in providing improved conditions for patients to be examined in, which again reduces behaviours such as anxiety, stress, fear and nervousness.

Conclusion

There have been many changes that have been implemented since the COVID-19 pandemic which can affect how a patient behaves when visiting the veterinary setting, often causing them to be stressed, anxious or fearful. Alterations by veterinary practice and clients can be made together to make the patients visit a more positive one, in turn this can help them adapt to the way veterinary settings are now run making the examination, treatment and recovery process more effective.

Anthony Turner RVN, BSc (hons.) Applied Animal Behaviour and Training.

Anthony is a night RVN at Northwest Veterinary Specialists. He qualified in 2018 at an independent general practice where he had been working for four years. He also has a BSc (hons.) degree in applied animal behaviour and training which is a special interest of his. He has gained experience in this area from working at the RSPCA, running his own dog behaviour and training company and from his time in general practice where he also ran behaviour and training consults often taking on referrals from other local practices too.