Problematic nonverbal veterinary practice communication

An informal survey of people involved in the veterinary process revealed that the phrase “problematic nonverbal veterinary communication” often elicited specific behaviors they considered “no-nos.” These included eye rolls, yawns, foot-tapping, or sighs during interactions with clients and heavy-handedness when interacting with animals. However, a more common form of problematic nonverbal client and animal communication often is overlooked. Consider Dr. Carradine who retreats to the treatment room and lets out a stream of muted curses after bidding her clients, Mr. and Ms. Rohr, and their dog a cheerful farewell.

“I don’t get it,” the practitioner fumes. “The Rohrs adore that dog and he gets tons of love and treats. But he’s still such a jerk, I can’t even do a decent physical on him. Plus, he’s getting worse as he gets older!”

For many practitioners involved in such interactions, quality client communication in these situations means doing what Dr. Carradine did. They flee before their anger and frustration with the client and the animal cause them to say or do something that they later would regret. Then they vent afterward. However, they may neglect to address the cause of this breakdown in nonverbal communication. When Mr. and Ms. Rohr bring their dog in for his annual examination and any needed vaccinations or routine veterinary care, they do not want Dr. Carradine merely to talk to them about their animal. They expect her to give the dog a comprehensive physical examination.

All practitioners know the diagnostic value of palpation. Fewer may recognize that the longest, sustained palpation of any unanesthetized animal may occur during the physical examination. However, they may not recognize what pressure to certain parts of the animal’s body during palpation may communicate to the animal and, by extension, to the client. Instead, clinicians may focus strictly on the animal’s body as a physiological machine and any signs of physical anomalies or discomfort this process reveals. Some may become so focused on the medical implications of this interaction with the animal that they ignore any behavioral and bond significance pressure on certain areas of the body may have for a specific animal.

Consider this telling anecdote that occurred decades ago when heartworm disease first appeared in the New England area of the United States. The only available preventative at the time was a large, unpalatable tablet that had to be given once daily from June to December to all dogs and puppies 8 weeks of age or older. If clients wanted to protect their dogs from heart-worm disease, they needed to insert the tablet into the puppy’s mouth and ensure the animal swallowed it. Soon an array of owner-friendly hands-off medications made this daily human-canine ritual obsolete. However, veterinary staff members with an interest in behavior noticed something unusual about those first puppies whose owners daily medicated them: none of those animals developed aggression as they got older.

What could explain this? Although practitioners seldom may think about it, the simple act of opening an animal’s mouth to insert a pill and ensure the animal swallows it communicates a strong behavioral and bond message. And the same may hold true for veterinarians attempting to do a physical examination today. Applying pressure on a dog’s muzzle to open the mouth to examine the animal’s teeth, gums, or pharynx may signal dominance to some animals. Dogs like the Rohrs’ that have not learned to accept such behaviorally significant handling from certain people may resist and even attempt to bite. Similarly, pressure on the top of the head during an ear examination may cause some animals behavioral pain in addition to any pain associated with an ear infection. Then there are all those edgy dogs whose owners bring them in for nail trims. Just holding the paws of some dogs may generate behavioral pain that far exceeds any physical discomfort caused by the nail trimming itself. In these situations, what seems like a neutral mechanical act to the veterinarian may communicate a much stronger — and negative — behavioral message to the animal.

There also may be bond effects that contribute to the breakdown in communication when these situations arise. The Rhors know that their dog does not like to be restrained. No matter how many delectable treats they try to feed him before, during, and after a visit to the veterinary clinic, he has no interest in food when he is in a self- and owner-protective mode. The clients also know from their experience withholding food in hopes that the dog will accept treats during the examination only causes their now hungry and edgier dog to ignore the treats and resist restraint even more.

Further complicating matters, the Rohrs also sense that their dog’s resistance upsets Dr. Carradine even though she hides it well. When clients blame themselves for their animal’s behavior, they may become more anxious about veterinary visits themselves. Because anxious dogs may detect owner anxiety, client anxiety may cause their dogs to progress from relatively passive to more active resistance to handling over time. In the Rhors’ case, this practitioner-client-animal interaction inadvertently has been repeated and reinforced by the veterinarian and the clients for almost 2 years.

Compare Dr. Carradine’s approach to Dr. Wasiak’s. When the latter sees young animals for the first time, she takes time to explain the physical examination process to the clients step-by-step. Then she asks them to repeat the basics at home daily: applying pressure to the animal’s head and muzzle, looking into and smelling their new animal’s ears, opening the animal’s mouth and checking the teeth and color of the gums, holding the feet, massaging the animal’s body, palpating the abdomen. There are 2 goals to this process. One is to accustom the animal to being handled by the owners and others in the household. The other is to build trust between the owner and animal, instead of treat-dependent obedience that may vanish in more stressful veterinary situations. Both changes will make it easier for the animal to accept this handling from others.

Furthermore, we live in an age in which companion animals especially may pick up vials that carry potentially deadly human medications or other harmful objects, many of which also carry their owners’ animal-comforting scents. When this occurs, owners unwilling to open their animals’ mouths may waste valuable time trying to locate what they consider a more enticing treat to encourage the animal to drop the stolen object. When that fails, they may scramble to collect the necessary information regarding the stolen object and its contents and then seek veterinary assistance. During the time it takes owners to do that, what could have been a frightening, but manageable event may become something far more serious. All because these people were afraid to handle their own animals in a behaviorally and bond significant manner, even to save the animals’ lives.

In addition to improving their handling skills and the confidence in themselves and their animals that go with that, routine sham physical examinations at home also teach clients what is normal for their animals. This also is a boon to those animals and their veterinarians. Once owners know what their animals normally look, feel, and act like, they will be able to detect changes sooner than those who lack this knowledge and these skills. The sooner owners detect something different, the sooner they will seek veterinary care, and the better the chance of treating and resolving the problem.

Obviously, if an animal’s behavior poses a legitimate threat to the practitioner or staff members, then some form of chemical or other enhanced restraint would be warranted to enable them to do their work. However, this approach does have the potential to backfire. When Dr. Carradine prescribes pre-visit medication for the Rohr’s dog, Ms. Rohr feels more inadequate than ever because she feels entirely responsible for everything the dog does, regardless of the circumstances. Meanwhile her husband believes the dog’s unruly behavior results from the veterinarian’s inexperience and lack of handling skills. These conflicting practitioner and client beliefs and any negative emotions and behaviors related to them may destabilize the dog and his behavior even more. In a worst-case scenario, the Rohrs may delay seeking veterinary care from Dr. Carradine as long as possible or even seek it elsewhere.

Although skilled practitioners and veterinary staff members take care to recognize the signs of physical pain in the animals in their care, they may not recognize the potent nonverbal messages they may communicate to physically healthy animals during routine veterinary procedures. Nor may they realize that some of the messages communicated by them, their staffs, and clients can cause certain animals’ behavior- and bond-related pain. Recognizing, understanding, and educating clients about the potential bond and behavioral messages implicit in the nonverbal communication that can and will occur during a veterinary procedure as basic as a physical examination may result in an enhanced veterinary experience for practitioners, clients, and animals alike.