What is the Fear Free concept in Veterinary Medicine?

Jessica Hamilton Seid, DVM
MSPCA-Angell West, Waltham

Fear Free is the concept of practicing veterinary medicine that involves the reduction of feelings of stress in our patients which in return will result in a better experience for all involved — including pets, owners, and the veterinary team. Fear Free was created by “America’s Veterinarian” Dr. Marty Becker who has devoted his life to the health of pets and those who love them. He has written numerous books, serves on advisory boards for humane organizations and is an adjunct professor at multiple veterinary colleges. The Fear Free concept is based on recognizing and taking steps to reduce fear, anxiety, and stress (from now on referred to as FAS in this article) associated with visits to the veterinary hospital and requires good communication between the owner and veterinary team.

In order to reduce FAS, we first must understand how our canine and feline patients communicate signs of FAS to us. Common signs of FAS in a dog are: a tense face, lips drawn back, tail down, body lowered, dilated pupils, snarling or growling. Common signs of FAS in a cat are tucked tail, crouched posture, hissing, pupils dilated, and ears pinned down to the side. The first step in addressing FAS is a discussion with the owner regarding any concerns they have about coming into the veterinary hospital or known stressors for the pet. A stressor can be any experience, environment, an inanimate or living object that disrupts the body’s normal state of functioning. Examples of stressors to pets include noise, odor, pain, disease processes, and unfamiliar people. Our goal is to reduce stress as it has negative effects on pets, owners, and the veterinary team and ultimately can result in decreased veterinary wellness visits, a decreased ability to appropriately examine and treat the pet, and slower recovery from disease or injury.

The first point where we can reduce FAS is getting the pet to the veterinary hospital. Long before being transported to the veterinarian, cats (and small to medium dogs) should be acclimated to their carriers being safe havens at home.  The carrier should be left out in an area of the home where the pet likes to be, with soft, comfortable bedding or a non-slip mat for dogs and with a top-off option to make it more accessible. The bedding can be sprayed with appeasing cat or dog pheromones and toys can also be added for extra incentive. If transporting a medium to large dog an approved restraint device should be used. Pheromone sprayed bandanas can be used in medium to large dogs. As with carriers, medium to large dogs should be acclimated to wearing their restraint device at home. The carrier or pet should be secured in the back seat. The drive should be low stress, avoiding hard stops or starts and with calm music or silence.

Once you have arrived at the veterinary hospital, to reduce stress in the waiting area, cats and dogs should be kept in separate areas as much as possible and cat carriers should be kept elevated off of the floor on a sturdy table or chair. Dogs should be leashed and kept close to the owner to minimize stress and interaction with other waiting pets. If a pet is experiencing FAS in the waiting room then going into an exam room to wait for a veterinary team member may be advised by the client service coordinator.

To encourage a positive experience and decreased FAS at the veterinary hospital, rewards such as treats, toys, or petting/brushing can be used during an exam or when obtaining diagnostics as long as it is not contraindicated based on why the pet is at the hospital. It is also important for both the owner and veterinary team to be calm, speak in quiet voices and for the veterinary team to approach the pet in a slow manner as dogs and cats are sensitive to loud noises and quick movements. If additional restraint is needed for a procedure such as obtaining a blood sample or performing radiographs (x-rays), veterinary team members may use things like a towel wrap, muzzle, or Elizabethan collar to ensure the patient is adequately restrained and comfortable during the process. If restraint is causing significant FAS, then giving a mild sedative may be recommended by the veterinarian to make sure that the necessary diagnostics can be obtained in the least stressful way for the pet.  Overall the goal is to make the veterinary experience the least stressful as possible for the pet, which will, in turn, make it less stressful for all involved. In some instances, it can also be beneficial for the veterinarian to provide a mild sedative for the owner to give to the pet at home prior to coming into the veterinary hospital in a known pet that has significant anxiety or stress associated when coming in for veterinary visits. If you feel that your pet may benefit from taking a medication prior a veterinary visit to reduce stress, then have a discussion with your veterinarian, as ultimately communication is key in these situations. There are many different options for pre-visit medications based on the health status of the pet. The strategies that best work for each individual pet are recorded in the medical record for future reference and updated as needed.

If it is medically necessary for your pet to stay overnight in a veterinary hospital, the veterinary team at a Fear-Free hospital has guidelines in place to minimize FAS as much as possible during their stay because increased stress in a patient can delay healing and recovery, or can even potentially result in development of additional medical problems. Angell works to minimize loud noises in the hospital, such as beeps, talking, barking or loud animals, as well as minimize smells, since dogs and cats have a keen sense of smell, by cleaning surfaces and equipment between patients, changing scrubs if needed, not wearing perfume, and placing calming pheromone diffusers around the hospital. You may also hear or see music or white noise machines as they provide interference with any noise that must occur. Lights are kept low, and pets are given soft bedding and places to hide or a privacy curtain, if appropriate, to make them more comfortable. When moving a pet around in the hospital, whether it be for a walk outside, physical exam, or medical procedure, it is done slowly and calmly, minimizing any interaction with other patients, providing open doorways and non-slick mats if needed. At times, mild sedatives or anti-anxiety medications can be used in the hospital to reduce FAS in a stressed patient if needed and if not contraindicated based on the medical needs. The Fear Free concept doesn’t stop at the lobby or exam room: it extends throughout the entire hospital and is as much a priority of the veterinary team as the medical care for your pet.

Fear Free is a new concept in veterinary medicine which aims to recognize and reduce fear, anxiety, and stress associated with visits to the veterinary hospital. Achieving this takes effort and requires active communication between the owner and the veterinary team, but the reward is a better experience and less stress for all involved — the pet, owner, and veterinary team.

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