Make the Most of Your Lane: Why to Stay Involved in Medical Cases

Written by Dr. Denise Johnson, DVM, CCBC

Peer reviewed

Summary: When veterinarians and behavior professionals work together, everyone can benefit. Clients and their animals can develop deeper relationships through continuity of support, behavior professionals get the chance to network and expand their business, and veterinary professionals can expand their knowledge of behavior as well as their list of trusted referrals. This article discusses best practices for behavior professionals working more closely with veterinarians on medical cases. 


We talk extensively about what not to do as behavior professionals: Don’t work outside your level of expertise, don’t promote anecdotes over scientific evidence, and please don’t violate local laws governing the practice of veterinary medicine! Between those directives and the important but sometimes exclusionary recommendation to refer cases to a veterinarian or veterinary behaviorist, it can feel as though cases are divided into behavioral versus medical, with most behavior professionals excluded from the latter. Behavioral support is no substitute for veterinary care but can augment it beautifully. Here we explore the reasons to stay engaged even when cases are found to have a major medical component.

Continuity of Client Support

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.

Networking and demonstration of value

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.

Service expansion and business-building

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.

Expand experience and knowledge base

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.

Improve quality of life for pets

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.

Five Freedoms of Animal Welfare The HHHHHMM Quality of Life Scale
Freedom from hunger and thirst Hurt
Hunger
Freedom from discomfort Hydration
Freedom from pain, injury, or disease Hygiene
Freedom to express normal behavior Happiness
Mobility
Freedom from fear and distress More good days than bad days

This translates to an opportunity to not only improve welfare in the home but to actually help clients have more and better time with their companion animals. Having a measurable impact does not require a veterinary license. In fact, behavior consultants may be uniquely positioned to spend more time actively advocating for individual needs.

As mentioned, the length of scheduled appointments is one of many factors that influences a veterinarian’s time management. I have personally worked in clinics with time allocated to an individual sick patient visit ranging from 15 minutes to an entire hour. That time splinters into history taking, examination, review of diagnostic options, diagnostic performance with or without concurrent interpretation, and initial recommendations. Financial discussions may further consume already limited time.

Calls, emails, and recheck visits extend support opportunities, but the focus may rest on medical management of priority conditions rather than comprehensive behavioral health. Many fantastic providers do it all themselves or utilize their referral partners and resources to do so. Without remaining involved in the case, we cannot determine whether that has occurred or whether the client could have been better served through our collaboration.

In conclusion

When a client approaches you for behavioral support for an issue that is secondary to a medical problem, do not assume that the solution is purely medical. By remaining involved and engaged when your case is referred to a veterinary care provider, you form a care team that supports both the physical and mental health of the patient. The network that you nurture becomes a source of business as well as an opportunity for professional development in a tremendously rewarding segment of behavior work.

References

  1. American Veterinary Medical Association (2021). Are we in a veterinary workforce crisis? Last accessed 10/6/2022
  2. Wareham K.J,Brennan M.L, Dean R.S. (2019) Systematic review of the factors affecting cat and dog owner compliance with pharmaceutical treatment recommendations. Veterinary Record, 184:5, 154. 
  3. Chapman E. (2018) The importance of client compliance and the influences upon client compliance when orally medicating cats, Veterinary Nursing Journal 33:5, 127-130.
  4. Taylor S, Caney S, Bessant C, Gunn-Moore D. (2022) Online survey of owners’ experiences of medicating their cats at home. Journal of Feline Medicine and Surgery.
  5. (2022) More Than 100,000 Professionals Have Pledged to Prioritize Pet Emotional Wellness With Fear Free Certification. Benzinga. Last accessed 10/6/2022.
  6. CattleDog Publishing (2020). CattleDog Publishing Joins the VIN Family. Last accessed 10/6/2022.
  7. Beylo B., (2020) Lifetime Value & Customer Acquisition Cost: A Framework For Investing. Macro Ops: Unparalleled Investing Research. Last accessed 10/6/2022.
  8. Association of Shelter Veterinarians. The Five Freedoms, Farm Animal Welfare Council 2009. Last accessed 10/6/2022.
  9. Villalobos A, Kaplan L., (2007)“Palliative Care: End of Life ‘Pawspice’ ” In: Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond. 1st ed. Ames: Blackwell Publishing Professional, 303-308.

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