Covid Update 10/8/2020 : Currently to protect staff from transmission of Covid, it is necessary to separate dogs from their pet parents for some care until this epidemic is over. Many veterinary clinics have come up with great ways to reduce stress during this time including having the pet parent on the other side of a window during weighing, doing some procedures outside with social distancing, and allowing the pet parent to be “present” virtually using live video platforms. I hope this epidemic will soon be over so that pet parents can return to being present during routine procedures.
Some changes clinic implemented would be great to continue using in the future including :
- Utilizing the parking lot for patients and their pet parents waiting for appointment times.
- Alternatives to making payments at the front desk.
- Doing some basic care like vaccinations in the parking lot.
- Use of video to allow clients to see how their pets did when separation is necessary and to start the conversation about ways the pet parent can help their pets cope better in the future.
Original Article
Pet parents are what psychologists and animal behaviorists call a stable attachment base for their pets. Our presence reassures our animals and helps them handle scary situations with less stress and fewer negative psychological outcomes [1,2,3].
When I adopted Astrid after a 10 year break from dogs, I was surprised by a veterinary practice trend that I hadn’t encountered before. The technician wanted to take Astrid to the back for her blood draw and vaccinations. With my previous pets I had always been present for these routine procedures. Since then I have found “taking animals to the back” for routine procedures to be standard practice at 3 out of 4 clinics I have visited. This may seem like an insignificant change to make the technicians job easier but it can actually have far reaching consequences.
The “stability effect” has been studied in children and in dogs. Studies have shown that dogs are anticipating negative experiences in veterinary clinics and are coming in stressed, leading to increased heart rate, breathing, cortisol levels, hiding of pain, and increased risk of the dog being less cooperative and more likely to bite [3,4, 5].
Unfortunately, one of the reasons clinics take dogs to the back is that some dogs seem to behave “better” when away from their owners. But in many cases, this “good behavior” is because the dog does not feel secure enough to express fear and anxiety when away from their owner and shuts down.
Why do I care so much about being with my pet for these procedures?
- I want the least stressful and most positive visit for my pet as possible. Being present and supportive is part of how I can achieve this.
- I want to know how well my dog is cooperating with veterinary staff and what specific components are stressing her out. I can use training to improve any sticking points, which will make the veterinary staff’s job easier. I find when veterinary staff take dogs to the back they feel compelled to comfort the owner by saying “She did great” instead of giving me an accurate assessment.
- My dog is dog reactive and the fewer chances for her to cross paths with other dogs in the clinic the lower her stress level will be. Many veterinary staff members may not have the skills to manage her in the clinic without a reactive episode, which would set back our training.
- Veterinary staff often feel compelled to “Get the job done” because some pet parents may expect that. However, if my dog is giving veterinary staff trouble and is so stressed that she needs more than moderate restraint, I want to be present to offer to bring her back another day. Bringing her back after some training and perhaps with drugs on board could make the veterinary staff’s job easier.
- I know my dog’s history and some of her triggers and I am trying to make the veterinary staff’s job with my pet as easy and safe as possible. I even proactively muzzle her for some procedures even though she has never bitten anyone, just to help everyone feel more relaxed.
- My previous human reactive dogs would have bitten a technician if staff tried to remove a dog from me in the manner they have removed Astrid from me. Until these dogs were further along in their training, they were very dependent on the secure attachment base to me when with strangers.
Reasons veterinary staff give for taking dogs to the back and things I would like them to consider.
- “Pet parents may be upset by the restraint needed with some pets.”
If a dog needs more than gentle restraint for routine blood draws and vaccinations, the dog is stressed and intervention alternatives should be chosen as the standard of care. Each time a dog is restrained for something the dog views as scary is done, it only scares the dog more and will escalate the level of restraint needed for this dog over its lifetime.
The “get it done” attitude is useful for emergencies but is harmful for routine procedures. Please look into the Fear Free or Low Stress Handling programs for more information on how to successfully use gentle restraint and involve pet parents in a safe manner.
- “The dog will look stressed and cause the pet parent worry.”
If the dog is stressed, this is a teachable moment, an opportunity to discuss with the pet parent what they can do to reduce the dog’s stress in the future and make life easier. Have a pamphlet ready that teaches the owner how to Desensitize and Counter Condition. Many pet parents do not recognize basic stress signs in dogs and this leads to dog bites, especially to children, and they end up asking veterinary staff to euthanize their pets. These routine veterinary procedures give staff an opportunity to show the pet parent subtle stress signs and what they mean, potentially saving the dogs life.
Find a force free/ positive reinforcement trainer in your local area that would be willing to work with your clients to improve their dog’s comfort and cooperation with veterinary procedures. This can result in happier clients, fewer injuries to your staff, and pet parents who are more willing to bring their dog to the vet at the first signs of problems because they no longer feel guilty for stressing out their dog.
- “The pet parent doesn’t know how to restrain the dog properly and will put veterinary staff and themselves at risk.”
Pet parents can be present without restraining their own dog. If you aren’t comfortable with the pet parent restraining their pet, then have the staff do the restraining. In some cases, it may be helpful to have the pet parent restrain their own dog but this should be a case-by-case decision after a relationship of trust is built up one visit at a time with the pet parent and dog. You can have the pet parent sit in a chair out of the way, or better yet ask the dog to do specific behaviors at your request to aid your work, feeding the dog treats and help to distract the dog. Make the experience more positive so the dog will become more cooperative over time. Give the pet parent clear instructions on what you want them to do. If they can’t follow simple instructions, then it would be appropriate to either communicate things differently or take their dog to the back.
- “The dog might bite someone and then the pet parent might sue or insurance will ask why they were present.”
Learn to read stress signs in dogs to reduce the risk of dogs biting. Use basket muzzles on any questionable cases or when dogs are in pain. Use anti anxiolytics and sedatives on dogs that have a history of being highly stressed at the vet’s office. Consider how your handling and restraint techniques and pet parent communication might be improved. Talk to livestock and horse vets on how they handle the added risk of having the owner present as they rarely separate the owner from the animals and often have the owner helping with restraint!
- “The pet parent will be anxious and make the dog behave worse.”
For owners that are visibly anxious give them the option of not being present and network with some pediatricians to learn how they calm down anxious parents.
Please know that sometimes dogs are better in the back, not because they were feeding off owner anxiety, but because they are actually more stressed and have shut down which can look very similar to a calm dog. These dogs do not feel confident enough to express their fear and anxiety without their pet parent there to back them up. They may eventually reach the point where they can’t contain their fear anymore and suddenly lash out and bite one of your staff while in the back.
- “The pet parent and dog are untrained and we only have so much time to get the job done.”
Preemptively set aside time with new client appointments to help train the pet parent and suggest ongoing training for their dog. Recommend a positive reinforcement trainer or better yet collaborate with a positive reinforcement trainer to have canine cooperation classes at your clinic. Provide clients a discount on services for a period of time or other incentive to participate.
To me, veterinary clinics that taking dogs to the back without their pet parents for routine blood draws and vaccinations is a sign that we need to make improvements in the veterinary clinic and in the education of dog parents. We need more collaboration between veterinary staff, force free trainers and owners.
It is my responsibility as a dog parent to be my dog’s advocate, to support and comfort her, to help her learn how to cooperate effectively with veterinary staff. When veterinary staff separate a dog from their pet parent for these routine procedures, our power to do these things is stripped away. Often, there is a communication breakdown as clinic staff feel obligated to reassure owners that their dog “Did just fine” or “Did great” when separated, even if their dog was freaking out and making the clinic staff’s job difficult.
References
- Horn L, Huber L, Range F. The Importance of the Secure Base Effect for Domestic Dogs – Evidence from a Manipulative Problem-Solving Task. Dornhaus A, ed. PLoS ONE. 2013;8(5):e65296. doi:10.1371/journal.pone.0065296.
- Gácsi M, Maros K, Sernkvist S, Faragó T, Miklósi Á. Human Analogue Safe Haven Effect of the Owner: Behavioural and Heart Rate Response to Stressful Social Stimuli in Dogs. Kalueff AV, ed. PLoS ONE. 2013;8(3):e58475. doi:10.1371/journal.pone.0058475.
- Erika Csoltova, Michaël Martineau, Alain Boissy, Caroline Gilbert, Behavioral and physiological reactions in dogs to a veterinary examination: Owner-dog interactions improve canine well-being. Physiology & Behavior, Volume 177,2017, Pages 270-281, ISSN 0031-9384, https://doi.org/10.1016/j.physbeh.2017.05.013.
- Bragg RF, Bennett JS, Cummings A, Quimby JM. Evaluation of the effects of hospital visit stress on physiologic variables in dogs. J Am Vet Med Assoc. 2015;246:212–215. doi: 10.2460/javma.246.2.212.
- Dorothea Döring, Anita Roscher, Fabian Scheipl, Helmut Küchenhoff, Michael H. Erhard. Fear-related behaviour of dogs in veterinary practice. The Veterinary Journal, Volume 182, Issue 1, 2009, Pages 38-43, ISSN 1090-0233, https://doi.org/10.1016/j.tvjl.2008.05.006.
Where dogs and science meet 
I thoroughly enjoyed your article. I hope it helps to educate both pet parents and some Vets practices on a different point of view.
If my guys are resisting going to the back; my Vet takes me too.
I do understand the logic behind the practice, but Kevin has been our family Vet for over 30 years, so there are zero trust issues.
If i had to have a different Vet see my “kiddos”, i would insist on being present.
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Thank you for your article. It’s so lovely to see someone so dedicated to the happiness of their dog- which is absolutely as it should be. I worked as a vet for nearly 10 years and in my experience a lot of people have huge anxiety themselves when going to the vet and their dogs pick up on it in particular when there is a procedure going on. Some dogs really do relax more without their owners. I think sedation is often a great idea for anxiety but most people would don’t want to go down that path because it adds to the cost of the procedure. I think that if dog owners want to reduce anxiety the best approach is to create a positive attachment to their local clinic when they are young and healthy. For example you could just sit in the waiting room and reward them when they are calm and happy. You can also get the staff and to give them a pat and then go home. If they need a blood test it’s usually something that would be good to know asap so waiting for another time is not always the best clinical decision. There is also the issue that the vet may in fact be anxious. Having to draw blood for some new vets can be very nerve racking, especially with the owner peering over their shoulder. Just my two bobs worth
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If vet staff are nervous being watched, this is something to be practiced with others until they become confident, not a good excuse for taking dogs away from owners. I used to get nervous being watched by strangers during these procedures, but through practice I learned how to get the job done calmly infront of strangers.
I am fine with vet clinics taking dogs to the back on a case by case bases with owner permission, but I find it unacceptable for clinics to have taking dogs away from owners for these routine procedures as standard procedures.
As noted in the article this article focused on routine procedures, not for emergency situations that need immediate treatment, thus the blood draws like CBC, chem panel and other routine blood draws can wait for another day when needed if the dog is not currently showing clinical signs.
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You are an educated, compassionate and obviously extremely capable vet tech. Thank you for your not only professional but common sense response. The vet clinic that employs you is extremely lucky. You should say the clinic’s name, city/state and your name so folks living there can come to it, request you as their tech at least initially and be able to tell the vet you’re the reason why that clinic was chosen. Kudos!
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If a vet is nervous with pet parent present they need to choose another profession. Most blood draws are done by vet techs. Even a newly minted doctor out of vet school should be capable and comfortable of a simple blood draw in front of pet parent. Zero excuse acceptable. If you experience something like this RUN don’t walk your pet’s life & health are too important to risk to a doctor that incapable & unsure of him/herself. Get vet referrals not just from friends but rescue groups in your area as they’ve dealt with numerous veterinary clinics and can help steer you to reputable, responsible and caring ones. I carry vets’ cards in my wallet and have multiple vets recorded on my phone to refer people to when asked and I know who does what at about what cost. Not everyone can afford the best, most comprehensive clinic so I have vets for basics, in-depth (i.e. not all clinics are equipped to do something as basic as an eye pressure test which really IS basic but requires a certain small handheld piece of equipment) and others who may be specialists in varying modalities (Chinese medicine & accupuncture both with needles & laser, neurology, rehab, cancer, ACL repair, cardiologist, eyes, allergies, etc.) You research your own doctors don’t you? Your pets deserve no less.
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We do have to remember that many people go into the veterinary field as introverts, I compassionately understand their nervousness dealing with clients as an introvert myself. But because they choose a field that deals with emotional people and animals it is imperative that those nervous doing tasks in front of pet parents learn coping skills and the people skills necessary to do their job to the best of their ability. I have seen many responses on Facebook from people in the veterinary field in other countries that are shocked that separating pet parents from their pets for routine procedures ever became a standard practice at some clinics in the United States.
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Taking dogs to the back is pure bullshit. I will NOT go to a clinic that practices such. Only time a dog ANY dog because I rescue & foster hence had had hundredd of dogs and vet visits “goes to the back” is if I’m at a trusted vet and clinic had an emergency hence is so far behind that waiting for a room to be available would take hours or a severe emergency (unconcious from disease like Addison’s complicated by recurring ehrlichia) accident needing triage) PERIOD. Anyone whose vet practices “back room” should find a reputable vet because THAT vet clinic is questionable in its professionalism and capabilities. Xrays needed? Sure then too but ONLY AFTER examining dog in room with me present. Those are the ONLY instances that practice is allowable. My one long term foster’s cardiologist INSISTS on pet parents being present at animal’s side when undergoing exam so he can explain as process is ongoing and BECAUSE it lessens pet’s anxiety. Any vet or vet tech who says otherwise is a CLEAR INDICATION TO NOT USE THAT CLINIC PERIOD.
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Owner compliance is nil. No one wants to train their dog, so your statement that people want to see whats wrong with their dog so they can train I don’t believe, I can’t even get people to get their dogs to lose weight let alone training to not be afraid of the vet, it’s easier said in words then done. I am always honest with people if their dog tried to bite me I tell them, I don’t tell everyone that they were “good”. We usually do things in the room, but blood does come back so we can get it done quicker and with someone I trust to hold. If a dog is really bad we give them drugs to go home with and try again another day, we really don’t push it and we give up if the dog is stressing out and flailing or being really aggressive.
I’m all for popping back for quick procedures as long as people are honest with how the dog reacted in the back to owners.
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I agree that there are plenty of owners who do not train their pets, but there are also many of us who are invested in training our animals just like some of your clients probably do have their pets lose weight or prevent their pets from becoming overweight in the first place. Training for husbandry tasks has been on the rise among dog owners and should be encouraged by veterinary clinics. I am glad you are being honest with your clients about how their dogs do. I personally rarely restrain my own animal, I let the techs restrain her if needed while I am at her head distracting her with food and I think this is the best task for most pet owners.
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And also – what if we stopped all procedures on children because they were “scared or nervous”. Vets take a lot of precautions that help make things easier and less stressful – but removing that completely is impossible. Children cry after getting shots or even their ears looked at. Dogs will protest too. I’ve found many dogs do do better away from their owners and some do better with them. Sometimes the owners anxiety makes the dog anxious and everything is worse. It really depends on the situation.
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Couple things to emphasize based on the facebook comments. This article was purposefully geared toward routine procedures, not emergency visits because ER care can not be put off, the staff often have never seen a particular client before to know how they will handle things, and emotions run higher in the ER setting.
On restraint, my very first two sentence on the subject stand to be repeated “Pet parents can be present without restraining their own dog. If you aren’t comfortable with the pet parent restraining their pet, then have the staff do the restraining. “. I personally choose not to restrain my own animal unless directed to by the veterinary staff, I would rather be able to focus on watching my dog and providing treat distraction!
I also stated in the article that taking dogs to the back is the right thing to do under specific circumstances “Give the pet parent clear instructions on what you want them to do. If they can’t follow simple instructions, then it would be appropriate to either communicate things differently or take their dog to the back.” “For owners that are visibly anxious give them the option of not being present”.
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I brought my dog to the vet to get my dog’s sutures removed. The technician came to bring my dog, Tavi, the back. Tavi sat on my feet, and the technician didn’t come any closer. He asked me if I wanted to stay with Tavi. I hesitated. I wasn’t sure if being there would really help, or if I would get squeamish or anxious and make it worse, so I handed over the leash, telling the technician that he was fine last time he had to go out back.
After reading this, I see I made the wrong choice. I should’ve gone with him.
I also have more appreciation for the staff at my vet because they saw he was nervous and gave me the option to stay.
Thanks for this article. 🙂
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If you get squeamish or anxious around needles, you can look around the room and find something to focus on during those procedures (I wouldn’t participate in retraining my own animal if using this technique). I do blood draws and injections on animals but I can’t watch it done to me so I regularly use this trick when I need a blood draw. I like examining a poster or something that has lots to look at.
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Reblogged this on Phoenix Working Dogs and commented:
Excellent thoughts here. I am one handler who prefers to be present, and hold my own dog, for routine procedures. If you feel you need to take my dog “into the back” without me, then I have to wonder just WHAT you are planning to do with her!!
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I once snuck out in the back corridor behind the vet clinic’s consultation room, & peaked in through the window to the treatment room, after the vet & nurse had taken my dog out there for a blood draw, as was their policy for routine procedures. I was not supposed to be there, but I’d waited for a long time and was alone in the consultation room, and nervous about how my dog was taking it since she’s suspicious of strangers and hates restraints, so I just wanted to see what took so long.
What I saw was the vet & nurse basically fighting to restrain my panicked & muzzled dog on the surgery table, trying to get the needle in her while she was jumping around like a rodeo horse. Dangerous situation for everybody, and not one I’d have put my dog in if I’d known.
I quietly snuck back to the consultation room & continued waiting, feeling terrible. Finally they came back with her. They had not managed to get the blood draw, and the vet said that “for the safety of his staff” they were not able to do it, so I’m guessing she may eventually have growled or snapped at them (something she’s never done with me present).
I never revealed that I had seen their handling of my dog, I just changed vet, and have never since allowed my dog to be taken “out back” for routine procedures. If a vet clinic’s policy is to take pets out the back for standard procedures , then my policy is to find another vet, whose handling is of a quality that’s OK for the owners to see
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If you have a “pet parent” restrain their pet and they get bitten – be prepared to pay out! It’s high on the list of why people sue – for loss of use of their hand (or whatever), pain and suffering, etc. If they are in a profession where they have to use their hands, then you may be required to pay out for their lifetime salary of what they would have made. The malpractice companies won’t even try to win these cases because a vet won’t win. Would you risk this if you were a vet?
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This concern was covered in the blog. The pet parent does not have be the person restraining the dog even when they are in the room. I am not the person who restrains Astrid unless the veterinary staff ask me to. I would far rather focus on observing my dogs body language and be at her head to cue her cooperative care behaviors and counter condition her to the procedures.
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My Cocker is extremely fearful. I give her calming medicine before bringing her to the vet. Even so, she resists to the point of the vet not being able to complete a procedure such as a blood drawer while in the back. I have asked to be present and either help restrain her or keep a hand on her and she has no problem at all.
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You should all be aware of VEG: Veterinary Emergency Group which is a new company that’s popping up all over the country. They only do emergency and they do not separate people from their pets ever. Not even for emergency surgery. Their website is VEG.VET
There’s a link to the video with the founder explaining it all near the bottom.
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I work as an ER vet where pet parents get to be with their fur kids 99.9% of the time (the 0.1% is when we are taking xrays and we legally can’t let them – but they can watch through a window). The pet and the parents are much calmer and happier seeing what we are doing and even helping with keeping the pet calm. I have never had an issue. Quite the opposite, I have only had a positive response to this. I absolutely love having the clients at all times and I think it’s the future of veterinary medicine. I couldn’t imagine it the old fashion way “taking the pet to the back”.
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What about situations when a dog needs an x-ray and the machine isn’t mobile?
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This blog was about routine procedures dogs go through every year like vaccinations, blood draws, nail trims, and exams. X-rays and other procedures that generally require sedation are not what this blog was addressing as they have always been procedures that need to be done without pet parents present due to safety concerns.
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At VEG, people can stay with their pets through everything including surgery. For x-rays, we have the pet parents right outside the x-ray suite just like our staff.
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