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Tuesday, July 16, 2019

Advancing the art of veterinary medicine through essential handling skills

 Essential handling skills advancing the art of medicine
lidocaine cream to lateral saphenous, for a less stressful blood draw
observe, respond, integrate 

Veterinary medical education has been focused on evidence based, medical science for the last thirty plus years.  The advancement of ultrasound, radiology, clinical pathology and pharmacology from the 1980’s to present has provided this evidence-based approach to medicine.  Client communication is one of the social sciences in our curriculum to aid in client communication.   We have phone apps to help us wade through the sea of medical knowledge to treat these conditions.  The hands-on application of our knowledge, also known as the art of medicine, is currently weak in our education.  

The art of medicine integrates the observation of the animal’s behavior, response to therapy, hands on care, and knowledge of the home environment.   Listening to the client’s ability and needs allows creation of the treatment plan for this animal.  In short, the doctor takes all the science and puts it into real life use for this patient and family.  To observe the way an animal stands, walks, responds to in the clinic and at home is the foundation of animal behavior knowledge in veterinary medicine.
hands on examination - a comfortable environment, rewarding for touch, observation of patient response 

In our age of science, the intuitive skills of observation have fallen away from our educational experience.  Many veterinary professionals gain these skills through experience. Unfortunately, the experience is derived from increasing patient anxiety during care.   For example, the diagnostic exam causes pain; pain triggers aggression; the animal bites and must be sedated.  The sedation allows the radiograph to be performed; the radiograph displays   the severe arthritis that caused the pain that triggered the bite.   Now the veterinary professional has learned – pain increases anxiety which leads to aggression.  In future exams, more time is spent watching the animal move, and interact in the exam room.  Consideration of anxiety and possible pain before initiating care or diagnostics is now standard.  The patient’s behavior is considered with response to therapy as an option for care if performing diagnostics on this day would harm welfare, and all of this is communicated to the client.   This is the integration of knowledge that creates the art of medicine.

It is essential for all veterinary professionals to have the ability to observe and interpret the behavior of any animal presented to them for care.  From this knowledge the appropriate techniques for approach, touch and triage for care can be applied.   The interaction with the animal is where the art of medicine lies.   The number of colleges offering education in the fundamentals of animal behavior is increasing, yet most of us need to gain education through conferences, webinars, articles and certification programs. 

Presently, there are three major veterinary animal behavior programs focused on improving the veterinary care experience.  Each of these programs contains fundamental animal behavior education.  The effect of environment, correct reading of body language of anxiety and aggression, methods of approach and touch to reduce fear and stress are addressed in each program.   Expertise in specific areas of veterinary care provide the focus of each program.  It can be overwhelming to complete each certifying program.  Integrating the parts of each program, choosing which program best fits with your practice perspective is often best.  Sharing collaboration and referral to other veterinary professionals certified in different programs is also a good way to enhance patient care.

  In my experience as a veterinarian, speaker and educator I find that learning the core fundamentals of multiple programs helps me create a well-rounded approach to care.  I can think more critically about a situation and apply this knowledge efficiently.  My presentations often blend the knowledge of the three behavior based veterinary care programs to encourage critical thinking.  I head Dr Sophia Yin’s Low Stress Handling® Certification program.  I was a contributing author to the first level of the Fear Free® certification program and support the Cat Friend Practice® program.  My strongest foundation of knowledge comes from the Low Stress Handling® certification program, yet I would be deficient in applying this knowledge without the benefit of education from Cat Friendly Practice® and Fear Free® Certification. 
wet lab presentation at Humane Alliance Asheville NC 

Each piece of our education is a tool in our tool belt.  The fundamental use of these educational tools may be similar, yet there are special features that make each unique.  Recognizing this uniqueness is most helpful when it is uses properly without judgement.   Please be kind with your colleagues.  No one is less than another as they are learning these less stressful care skills.  Start with the essential skills and encourage your co workers to learn and expand in the art of veterinary medicine. 

I am presenting the Essentials of Low Stress Handling at Anti Cruelty Society in Chicago Sunday Sept 15.  6 hours CE. Register here  I hope to see you there! 

Sally J Foote DVM, CABC-IAABC    July 2019