PRACTICE MANAGEMENT
PRACTICE MANAGEMENT
Article reprinted with the permission of DMV360, August 2015, DMV360 is a copyrighted publication of Advanstar. Communications inc. All rights reserved.
5 Ways to Get Started with
1
Fear-Free Practice
Aug 01, 2015
By Jessica Vogelsang, DVM
DVM360 MAGAZINE
“Fear and anxiety are nosocomial infections, and
they are zoonotic. We created this problem. Patients
acquired it at our hospital and it was spread by other
pets and staff, then the owners catch it.” - Dr. Jonathan Bloom
This Toronto hospital has clients beating down the
doors requesting a lower-stress approach to veterinary care.
In an uncertain economic climate when veterinary
visits are on the decline, Willowdale Animal Hospital
in Toronto is enjoying unprecedented success. Clients
are raving, staff morale is the highest it’s ever been
and business is booming. Instead of cajoling and
pleading with clients to bring their pets through the
doors, Jonathan Bloom, DVM, has them lined up with
smiles on their faces.
Many practices with excellent staff and medicine are
struggling these days, but Bloom’s hospital has a secret ingredient: It has embraced the concept of FearFree practice, and as far as Bloom is concerned, you
should too.
“I started about seven or eight years ago,” says Bloom,
who will be speaking at CVC Kansas City Aug. 30. “It
started with x-rays. I looked at my staff and saw that
they’d have to take a whole bunch of views to get two
good images.”
Wondering how he could improve their efficiency, he
investigated. “I realised dogs and cats don’t like having
x-rays taken. There’s nothing natural about being in a
dark room, on a hard, cold table, having your limbs
held in four different directions with the viselike grip
of lead-lined gloves by people wearing aprons and
collars.” He decided to try a different approach.
Bloom implemented a policy that no pet would be
restrained for radiographs. “They’re either so sick they
don’t move, or they’re going to be sedated,” he says.
The results were immediate. “There were no retakes,
the pets weren’t stressed, and it was better for the
staff,” who reduced their radiation exposure while becoming more efficient.
Happy with the results and the owner responses,
Bloom made his next decree: “Don’t give owners an
update from the phones in the ICU. No one wants to
hear screaming cats.” About an hour later, Bloom says,
he reflected on what he had just said and realized that
was the wrong approach. “We shouldn’t be letting pets
get that upset in the first place,” he says.
Bloom started to ask himself and his team the following: If the pet could talk, what would he or she say?
It wasn’t that hard to figure out. “We create mental
health problems,” he says. “If you need two 150-pound
people to trim the nails on a 10-pound pet, that’s a
problem.” Bloom and his staff began experimenting
with various techniques to give pets a less stressful
experience, and they were buoyed by a receptive client response. “Pet owners may not be able to identify
dental disease or obesity, but they are experts at identifying fear and anxiety in their pets,” he says. “Owners
are on it. They are grateful for any effort made to help
their pets.”
He finds the veterinarians harder to convince than the
owners—at least at first. “Here’s the problem with training vets: They will spend a day learning the best insulin
for the two diabetic pets they see a year. But five of
the next 10 patients will be suffering fear and anxiety,”
he says.
2
Create a Fear-Free culture
In Bloom’s practice, everyone has a role to play in
creating the right environment for pets and owners,
and every employee is encouraged to give input on
how to minimise patient stress. No part of the patientclient experience is left unexamined, from the choice
of vaccines to the way appointments are structured.
Here’s what Willowdale has done to maximise calm
most successfully.
• Designate dog- and cat-only examination rooms.
Pets, especially cats, are often overstimulated
when visiting the veterinary hospital. Imagine
the experience of an indoor-only cat from the
car ride to the hospital—different lighting, different colors, different sounds and different smells.
Let’s at least try to keep cats in an as familiar environment as possible by providing cat-only rooms.
If you’re a small practice with limited number of
exam rooms, there’s an alternative, Bloom says:
cat-only appointment hours. “There’s no reason
a one-doctor practice can’t designate 2 to 4 p.m.
once a week as cat-only appointment hours,” he
says. Many cat owners will choose to come in at
other times, but those owners with highly fearful
cats will appreciate that option.
• Keep doctors on time. Veterinarians at Willowdale
make running on time a priority so as to reduce
clients’ and patients’ waiting time in the exam
rooms. But if a delay is unavoidable, a few minutes for pets and owners in the quiet environment
of an exam room is preferable to the waiting area.
During the last seven years, Bloom’s team has developed a multimodal approach to Fear-Free veterinary
practice. With nine other veterinarians on staff, finding common ground and common purpose was challenging at first. “Not everything works every time,” he
says. “If Plan A doesn’t work, it doesn’t mean there’s
no treatment; it just means we need a different approach.”
Figure 1: "Clipnosis": non-painful restraint using pegs.
Effective only in cats
Figure 2: Air muzzles are effective in cats and small brachycephalic dogs
3
Have the appointment begin at home
The front desk team at Willowdale sends out reminders a week in advance with a list of ways for clients
“to make their pet’s visit an enjoyable experience.”
Bloom has found that empowering clients to take action ahead of time creates a very effective partnership.
Owners are instructed to do the following:
•
•
It took some time, but the other veterinarians at Willowdale also came on board. When they did, Bloom
says, the wait was worth it. “It’s fun to watch them get
it,” he says. “They go from skeptical to ‘That was sort
of neat!’”
do but should—is to have clients bring all new patients into the clinic several days before the appointment to let them play