Does your dog know when you are approaching the veterinary clinic? Sadly, many dogs are nervous, anxious, or just uncomfortable at the vet’s office.
Thankfully there is a movement of veterinary professionals who are working hard to create positive, low-stress experiences for dogs entering veterinary hospitals, reducing stress for dogs (and owners!). And the organization that is providing formal training to veterinarians and their staff members also teaches dog owners how to help their dogs feel more comfortable at the vet.
Visionary Veterinary Visits
Fear Free is the brainchild of Marty Becker, DVM, whose veterinary practice is the North Idaho Animal Hospital in Sandpoint, Idaho. Dr. Becker is better known for his weekly nationally syndicated newspaper feature “Pet Connection” and his 17-year stint as the resident veterinary contributor on “Good Morning America.” He is also the author of some 25 books on pets and pet health.
“The idea for Fear Free and the slogan ‘Taking the pet out of petrified,’ came out of a lecture by a boarded veterinary behaviorist, Dr. Karen Overall,” says Dr. Becker. “Previously, I, like the vast majority of my colleagues, thought of pet’s distress at the veterinary office as unavoidable collateral damage. Through her lecture, I knew that we – all of us who deal with animals including veterinarians, veterinary nurses, trainers, groomers, boarding personnel – were causing repeat, severe, irreversible psychological damage to the animals we care for. Nobody gets into a career of working with animals to make life worse for them.”
Dr. Becker began envisioning an organization that could educate pet professionals of all kinds about how to recognize the signs of fear, anxiety, and stress, and how to handle pets in ways that at least reduce, and at best, eliminate these emotions and the negative behavioral fallout that often results from handling that does not consider or prioritize the animal’s experience.
“Once we realized the damage we were doing to pets, and the potential physical and emotional benefit we left unrealized, hundreds of top veterinary professionals and others involved in animal care committed to bringing a science-based, compassionate approach to pet care,” Dr. Becker says. He collaborated with veterinarians, veterinary behaviorists, and force-free trainers to create a curriculum, and offered the first Fear Free certification course in 2016.
Today, Fear Free provides education and certification to veterinary professionals in methodologies developed by board-certified veterinary behaviorists, anesthesiologists, pain experts, and more. According to the organization, more than 48,000 veterinary and pet professionals (including groomers, trainers, and more) have been certified in Fear Free dog-handling techniques.
Ultimately, the Fear Free approach to handling dogs in any situation is beneficial to the dog population as a whole, but its most potent gifts may lie in improving our pets’ veterinary visit experience.
“Fear Free veterinary visits make taking the dog to the hospital fun for the dog and fun for the dog’s guardian, for the veterinarian and for veterinary personnel, too,” says Kenneth Martin, DVM, DACVB, a co-owner of Veterinary Behavior Consultations, in Austin, Texas.
Dr. Martin explains that the Fear Free practices “take the fear, anxiety, and/or stress out of waiting to be seen by the veterinarian. Dogs are provided with non-slip surfaces, calming pheromones, aromatherapy, and soothing music. Greetings include a considerate approach to interactions with the dog, who is touched and handled in ways that reduce stress. Treats, toys, and various distraction techniques are used to keep the dog comfortable and make the visit enjoyable.”
This is not business as usual in a vet clinic! Every interaction between the dog, owner, and clinic staff is intentional, and “the dog’s emotional response to the veterinary visit is noted to make each and every veterinary visit a more enjoyable experience, from the trip to the hospital until arriving back home,” Dr. Martin says.
Fear Free Certification
Fear Free offers courses for veterinary professionals and staff on how to improve animal hospital encounters for their patients. Fear Free has considered every aspect of the patients’ veterinary hospital experience and has suggestions for changes that result in a drastic drop in the patients’ stress and discomfort.
Veterinary staff members who take the courses learn how to recognize the signs of stress and fear in their patients, understand how a patient’s perception affects its behavior in the veterinary hospital setting, assess their own hospitals for stress-provoking infrastructure and practices, and employ dozens of new tactics to improve the vet-hospital experience for their clients’ pets. There are currently eight modules in the course, with an examination at the end of each module. A veterinary provider must pass each exam with a score of 80% or more in order to continue. Upon successful completion of all the modules, a Fear Free certificate is awarded. The certification is valid for one year; continuing education units and examinations must be completed annually for the practitioner’s certification to remain current.
A veterinarian working in a group practice can become certified individually, but if there are other staff members with an interest in Fear Free precepts, they might want to pursue a Fear Free practice certification, described on FearFreePets.com:
“Practice Certification takes Fear Free implementation to the next level – from an individual to a joint effort that requires the entire practice team to work together to safeguard the emotional wellbeing of their patients, clients, and team members.”
In order for a practice to become certified, more than 25% of the staff must be Fear Free Certified with active memberships; this must include 100% of the practice’s leadership and/or management team and 50% + 1 of the practice’s full-time veterinarians.
Once a practice has achieved this and completed an online self-assessment of the standards, Fear Free will send a Fear Free Practice Certification Veterinarian to conduct an on-site visit and evaluation of the practice. The results will be submitted to Fear Free for review and final determination of pass or fail.
The basic Fear Free certification course costs $279 for an individual; the price per person for the certification decreases when the number of people working in the same veterinary practice who also seek certification increases.
Maintaining an active membership requires an annual fee of $99 per person and completion of four continuing education units each year from Fear Free’s large library of educational offerings. All of this adds up to a significant investment of money, time, and interest in providing a stress- and fear-free veterinary experience to the practice’s patients.
Fear Free Veterinary Visits Are Different
In many ways a Fear Free approach to veterinary care is about prioritizing the needs of your dog above all else and ensuring that he is comfortable in any veterinary setting. “We have made huge advancements that have allowed us to help dogs live longer and healthier lives by looking after their physical well-being,” says Jonathan Bloom, DVM, a Fear Free certified practitioner at the Willowdale Animal Hospital in Toronto, Ontario. “Now it’s time for us to help dogs live happier lives, by looking after their emotional well-being.”
Things You Can Do to Reduce Your Dog’s AnxietyIf your dog is anywhere from mildly anxious to downright terrified of going to the veterinarian, we’d strongly suggest looking for a Fear Free certified veterinarian or, better yet, a Fear Free certified veterinary practice. You can search for these at fearfreepets.com. But there are many more ways you can incorporate stress-reduction techniques into your dog’s veterinary visits or trips to the groomer, even if there are no Fear Free certified practitioners nearby. “Simple things, like teaching a dog to allow someone to touch and massage her all over helps her accept and enjoy being touched,”says Ken Ramirez, executive vice president and chief training officer of the Karen Pryor Academy for Animal Training & Behavior, based in Waltham, Massachusetts. “It is also helpful to teach your dog to enjoy wearing a muzzle and going into a kennel; make it fun!” Ramirez suggests. (See “Nuzzle Up to Muzzles,” WDJ February 2019.) “A positive reinforcement training program is the best place to start,” Ramirez says. “When animals enjoy playing and interacting with their owners, there is a foundation for building trust and teaching fun games that can be transferred to a visit to the veterinarian.” The Karn Pryor Academy developed its own course, “Better Veterinary Visits,” a $139 online course for teaching vets and veterinary technicians to implement low-stress, cooperative care with all their patients, and to teach the principles to their clients. Currently, the course has expanded to embrace dog trainers and pet owners; anyone with an interest in low-stress animal handling can take the course and benefit from the material. “The course focuses on methods of management and techniques for training animals to prepare them for a veterinary visit as well as deal with behavior while in the veterinary office. We focus on the foundation behaviors needed for better veterinary care and teach students techniques for changing an animal’s emotional responses when visiting a veterinarian.” You can learn more about the class and how to register online at karenpryoracademy.com/courses/better-vet/. Today, most zoo animal trainers and handlers use positive-reinforcement-based methodologies to teach their exotic-animal wards to willingly participate in exams, instead of using physical force or manipulation to control the animals. Happily, there are a number of other places where a motivated dog owner can learn the same techniques. I attended one such course on force-free husbandry training at Karen Pryor’s Clicker Expo.
Changing AssociationsWe know that veterinarians are there to help our dogs, but our dogs don’t always understand that! To help them, we should prioritize improving our dogs’ associations with vet clinics and procedures. Heather B. Loenser, DVM, the Veterinary Advisor for Professional and Public Affairs for the American Animal Hospital Association, offers advice that can help your dog feel more comfortable about going to a veterinary clinics:
- If a dog has neutral or positive feelings about the vet, support those positive associations by stopping by the hospital just to get weighed or to get treats from the team at the front desk.
- Always bring lots of treats and deliver them generously to your dog when you are waiting, and when allowed to do so, during the exam.
- Be calm yourself.
Advocate and Protect!If, in the middle of a veterinary appointment, things start getting too tense for your dog (or you!), don’t be afraid to advocate for your dog (or yourself!) and insist on a time out. Depending on your dog’s medical needs that day, you might cut the visit short and make arrangements to come back another day; your dog’s emotional health is worth the cost of another visit! If the care needed is urgent, at a minimum, ask your veterinarian about administering an anxiety-relieving medication to your dog. As Dr. Martin says, “Fear Free Certified veterinarians know when to stop! This may mean needing to reschedule a veterinary visit or take other steps in order to set the dog up for success.” It’s all about meeting your dog’s physical needs – but not at the expense of emotional needs.
“If pets don’t like being up on exam room tables, we examine them on the floor. If they don’t like liver treats, then we offer them chicken treats. If they feel more secure being near their owners, then we do their entire exam, vaccine, blood sample collection, etc., beside their owners,” he says.
Fear Free practitioners generally book longer appointments times and require their technicians to use Fear Free restraint and handling methods so their patients are not rushed or intimidated into compliance during examination procedures. Because more time is taken with the animals, the practitioner may charge more for visits than vets who spend just a few minutes with the patient, leaving the collection of vital signs and biological samples (blood, urine, feces) to the technicians.
When an entire practice is Fear Free-certified, the client should notice even more departures from conventional veterinary clinics. Waiting rooms are arranged in a manner that gives dog and cat clients plenty of room so they feel safe and not overstimulated, and provisions are on hand to make any wait comfortable for the patients, with soft beds or mats and non-slip paths that facilitate a smooth flow of patient traffic. Species-specific appeasing pheromone diffusers and/or aromatherapeutic diffusers will likely be in use in waiting and exam rooms.
When the visit is complete, a technician may invite you and your dog to relax and enjoy some treats in the exam room while your bill is being prepared; you can make a payment, receive medications and instructions, and make a follow up appointment (if needed) in the same room, so when all of this business is complete, you and your dog can make a smooth exit to your car, instead of having to stand in line back in the waiting room to do these things.
Even the disinfectants in a Fear Free certified practice are likely to be different from those used in veterinary hospitals that don’t adhere to Fear Free protocols.
“When you embrace Fear Free certification, you begin to realize that our patients can suffer sensory overload during their veterinary visit. Overwhelming sights, sounds, and smells need to be eliminated when you make a commitment to Fear Free,” says Julie Reck, DVM, owner of the Veterinary Medical Center of Fort Mill (South Carolina).
Dr. Reck switched all the cleaning products in her hospital to an accelerated hydrogen peroxide-based disinfectant that kills pathogens but does not leave a lingering chemical smell, and pheromone diffusers are used throughout the facility. The disinfectant is not only less overwhelming for the patients, she says, it’s safer for the clients and staff.
Dr. Reck is also a huge proponent of Fear Free practice certification; not only is her practice Fear Free certified, she joined the Fear Free Executive Council and is on the organization’s speaker’s bureau.
Emotional Health Complements Physical Health
It’s scary to think about how one negative experience at a vet clinic, or even just a couple uncomfortable ones, can adversely affect how your dog regards vet visits for the rest of his life. I witnessed this with my youngest dog, who needed major surgery before her second birthday. She went from a puppy who loved going to the vet to a dog who became wary of vet visits after several stressful and painful diagnostic visits and consultations before bilateral TPLO surgery.
Dr. Martin says that this type of negative experience isn’t necessary. “In the past, the veterinarian and dog owner alike have justified the stress of the veterinary visit and/or procedure as being in the best interest of the dog – but the dog doesn’t know that!” says Dr. Martin. In contrast, he describes the Fear Free protocols for a vet visit as “a feel-good sensory experience, incorporating pleasant sights, sounds, smells, taste, and touch.”
But Fear Free veterinary visits aren’t just about making dog feel better emotionally; they also can have measurable impacts on your dog’s physiological health – and your veterinarian’s ability to accurately diagnose or monitor your dog’s health.
“Stress negatively influences physical parameters such as heart rate, respiratory rate, and temperature,” says Dr. Martin. “In the stressed individual, these parameters, routinely checked with most veterinary visits, are not an accurate representation of the dog’s overall health. And stress suppresses the immune response.”
Thanks for a very informative article. I’m hoping you can help me to somehow understand the use of the standard ‘cone of shame’. I’ve yet to find a vet clinic that doe not employ the use of the cone as their standard protocol following most surgical procedures. Even very well known hospitals with vets trained in the latest methods and technologies in their specific fields, send the dog home wearing the cone.
I’m just a dog trainer trying to make life better for dogs and their owners. My ten y.o. Weimi, Chip, had TPLO surgery 2 months ago by a board certified orthopedic surgeon. He did a great job of explaining the procedure in terms I could understand and I felt comfortable having him do the surgery. Chip doesn’t love going to the vet, but he can tolerate it. The surgery went well and I went to pick up Chip. The vet tech(hats off to all of you)brings Chip into the waiting room wearing a cone, trying to keep him from banging the walls with the cone. I could see immediately that Chip was stressed out but instead of fighting the cone, he was despondent and reminded me of a dog who had given up hope. I was prepared and brought two inflatable collars which I put on as soon as we got in the car.
The equation here seems to be 1 + 1 = 3. And seems to illustrate your point about the physical needs of the dog vs the emotional ones. Any surgery has some element of stress. Post surgery when dog wakes up in a strange place with strange people with a body that has undergone something that he can’t quite figure out just compounds the stress. And then a cone is put around his head. He now cannot see to either side and if he moves his head the cone bangs the side of the crate. Then the vet says he has to wear the cone for at least 10 days. And most dog owners will do just that..
Why is the standard cone the only option offered at vet clinics? I think we would all agree that we should try to provide a stress free environment for our dogs in all situations. Having my dog wear a cone only adds stress and does nothing to create a positive association with going to the vet.
Why do clinics continue to use something that makes the negatively affects the emotional condition of most dogs. It seems that we as dog owners just accept it as something that can’t be helped. Why aren’t dog owners given different options or at least educated about other collars that will make the dogs recovery much more humane? There has to be a better way!!
Scratching my head,
There are other options like the inflatable collars that still prevent the dog from getting at his sutures but is far less bulky. The dog is still able to maneuver and manage stairs without getting it caught and he is able to see peripherally. I have a large dog that is still very hesitant to use our staircase and when he was dealing with a nasty ear infection last year, I used a bath towel instead of the huge cone. I folded the towel in half lengthwise, then folded again. I then wrapped it around his neck and secured it with 2 large safety pins on top where he couldn’t scratch them loose with his hind feet. He was still able to move around normally without bumping into anything. He also has a ThunderShirt which works very well to keep him calm during vet visits and when we need him calm to prevent injury, like post medical treatment.
Yes ,i agree with you.
My other problem when i
take my DOG to the VET,
IS the waiting X.I have an
APPT X,yet when I get there
sometimes we have to wait
A 1/2 a hour or longer to see the VET.THIS adds to the DOG’S anxiety and stress.
I kept wanting to read the title of this article as be wary of free vet care! Need a hypen:
Fear-Free Veterinary Care
Thank you. Made me cringe when I read it in the email message. I thought they were talking about being wary of the free care now being offered by some county shelters.
LOL…I was just about to comment on the same issue when I read yours.
It’s like the old English joke, “Let’s eat Grandma!” vs “Let’s eat, Grandma!” Commas save lives.
I had the same experience as Elizabeth W. I clicked on the article to see what was going on with “free vet care.” Definitely needs a hyphen: Fear-free veterinary care.
I do not know if there are any certified “Fear Free” veterinarians in southwestern Ontario, but when we go to the vet I tell my dog(s) cheerfully (and truthfully) that we’re going in the car-car (yeah!) to see “Dr. Vet.” They know the clinic, and my older dog Katie esp. hides under a chair, suspicious of all medical intervention, but they also quickly learned that Dr. Vet dispenses wonderful treats from a drawer in her exam table, and that helps make it a positive experience. Sadly, Katie died of cancer six weeks ago, but I still have a nine-year-old boy for whom I try to make visits to Dr. Vet as pleasurable as possible, w lots of treats.
Elizabeth, I read it the same way and was pleasantly surprise when I realized the true topic of the article. This has been a long time coming and is waaaaaaaay overdue. I have large dogs who are terrified of smooth surface floors and it is quite a struggle to get them into the vet’s office door. Textured, non-slip floors would be so much better. Loved this article and sincerely hope this is the direction vet care is going. Thanks, WDJ!!!!!!
There ought to be a hyphen between “fear” and “free” in the title. I thought the article was about how we should be afraid of free veterinary care.
Does Fear Free training and certification include a requirement that the practice demand that all clients keep their pets under control in the waiting area and respect other pets’ need for space? Anyone with a dog who is fearful of or reactive to other dogs knows that a vet waiting room is a potential hazard to behavioral modification just due to the presence of other dogs. Yet time and again, other owners with their pets on Flexi leashes (usually older women with miniature or toy breeds) have allowed their little darlings free rein on their Flexis to approach my dog, despite all my body language indicating I do not want this interaction. I can have my back to them with my body as a barrier and obviously be trying to distract my dog with treats and quiet talk and their dogs are still allowed to creep around to the side to try to reach my dog. Once time when this happened, my dog was two weeks out from major surgery and had come in to have her stitches removed. Her shaved area with the incision was easily visible. I had her in a corner as far from the check in desk as possible. As the other dog approached, my dog became restless despite my work to calm her, and I started audibly saying, “It’s ok, Leah, you’re all right”, etc. Then the other owner asked from across the room with her dog still too close, “What’s going on with her?” At that point I snapped, “She had major surgery on her spine two weeks ago!” Then one of the techs at the desk realized there was an issue and got us into an exam room. I put this whole incident on the practice. I am not going to beg other dog owners to respect my dog’s space, or take responsibility that belongs to someone else, to get ignorant dog owners to behave when they can’t grasp the fact that this is a hospital and all dogs should be assumed to have health issues that should automatically prohibit any interaction. Part of Fear Free certification should be a notice to clients that in a health care setting, their dogs are not welcome to interact with anyone other than the staff.
Just curious, but have you ever just – politely – told other people that your dog doesn’t like other dogs?? I agree people can be clueless and I always ask if it’s ok for my dog to “say hi” to a new dog regardless of where we are. My boy has a chronic health condition and there are times when I know he isn’t going to want interaction, so I – again, politely, rather than “snapping” – will simply tell people that he isn’t feeling well that day. It definitely seems to work well for us. Perhaps you should try being nice instead of irritable.
I am perfectly polite in any situation where, as you said you do yourself, someone asks if it is ok if their dog interacts with mine. I can then gently tell them, after looking at their dog’s body language and behavior for signs that the dog is overexcited, or going to be pushy rather than submissive, that my dog does not do well with meet and greets. But that is not in a vet’s office. My point is that in the hospital environment, cluelessness can’t be excused and compliance gently requested in a situation where an owner is giving their dog the opportunity to actually cause harm because they are in a place where they are likely to encounter other pets who are not well. That is a zero tolerance point for me, and I believe it’s the practice’s responsibility to educate, not mine, unless they would like to pay me or give my pet free health care in exchange for doing their job for them. The vet’s office is not a place for social meet and greets, unless both parties want to go outside and do it out of the waiting room context, and front desk staff should be trained to tell people that. Could social meet greets be great for dogs who might otherwise be nervous at the vet’s office? Absolutely, but again, not in the waiting room, as it sets an example that is not generalizable to everyone. Perhaps another aspect of Fear Free certification should be that the practice has to provide educational material to their clients on how to train their dogs to focus on them and be calmer in distracting situations. I’ve spent years and hundreds on training classes to do just that. I bring a mat to the office for my dog to sit on, and distract her with treats while we wait. Sometimes another client who obviously wants to learn will ask how I get her to stay calm and in one place. Then we can have a great conversation.
I agree that more restraint should be used in a vet clinic waiting room. It is stressful enough to just be there with a nervous pet without the added tension of someone else letting their dog roam around the room at the the full length of their retractable leash, bothering other animals. Pet owners that use that style of leash are usually, from my own observance to be less likely to train their dogs to behave better in public settings. Only when things get out of hand to they reel them in like a fishing line and give me a dirty look because my dog is barking and getting upset. Drives me nuts!
Our chihuahua is not dog-friendly and is fearful of many things. Our vet clinic agreed that when we come for an appointment we can all stay in the car until it is time to bring him in. They either phone our cell or go to the door to wave us in. Then we go to an exam room immediately. This is much appreciated.
Also our little guy is terrified of needles, and trying to get blood from him in the past has resulted in hysterical and nearly uncontrollable behavior (even though he has had his daily Zoloft). The techs decided to wrap him in a towel, lay him on his side (like a cat, they said), and, most importantly, cover his eyes. What an amazing improvement! We do stay in the room with him for these procedures and that probably helps, too.
Our Vet is a mobile vet hospital and she comes right to our house. If you cannot make it outside to the hospital on wheels then she comes in and takes care of the pet right in your house. We just love this since we have a rescue who is afraid of everything and everyone.
Regarding cone collars –
I recently used my travel inflatable neck pillow with a snap on my 70 lb. part lab.? rescue dog after he had a melanoma removed from his lip. It worked great, prevented him from scratching or rubbing lis lip, did not interfere with his line of vision, and looked pretty comfortable when he rested his head on it. This could work with dogs his size depending on the purpose for the collar.
Thank you for covering the Fear Free movement and concepts in such detail. I would like to add, however, that it is not only veterinarians that can embrace Fear Free. I’m a Fear Free certified canine rehabilitation and massage therapist based in Christchurch, New Zealand and I specialise in in-home care in a mobile practice. I became Fear Free certified last year – the first such therapist in NZ to do so. I’ve always had a proportion of dogs in my practice who suffer from some type of anxiety or stress. Being unwell, recovering from a surgery or an accident, also adds stress. Dogs cannot ‘opt in’ to hands-on techniques like rehab and massage the way a human can. Trigger points can be painful to release. Fear Free allows me to interact with clients in a way that helps them recover and feel better – rather than adding to their stress. I was horrified to learn from a client that some other practitioners are using muzzles on dogs who are in pain to force stretching and manipulation of limbs. If you would like to cover Fear Free rehab in dogs, I would be happy to contribute to your publication.
How do I find a fear free vet?
I agree with all the others who commented that you need to hyphenate fear-free so we don’t think you’re talking about needing to fear some free vet care (not that I’ve ever encountered a vet who doesn’t charge anything).
I’m sad that there was no mention of Dr. Sophia Yin DMV, a pioneer in this field.
I’m sad that there was no mention of Dr. Sophia Yin DVM, a pioneer in this field.
These changes are great…doing things for the patient/customer rather than the vet/clinic. My two goldens are both extremely anxious and will never take treats at the vets. My male is not friendly towards other dogs so we always leave him in the car while we check in and make sure we can bring him directly to an exam room. And instead of using the cone, I slept on the floor with one of them after a procedure. (We tried an inflatable but he could still reach. I like the towel idea and will try that if it is needed in the future.)
I thought that it made sense when you said that finding a good veterinarian hospital is important since one or two uncomfortable visits to the vet can cause adverse effects for your pet in not wanting to return. I have been thinking about getting a dog but I have been worried about their disdain from going to the vet. I would be sure to find a reputable veterinarian so that my dog wouldn’t be worried about visiting the hospital.
I really like the idea that keeping pets emotionally healthy at the vet can help their physical health as well. Going to a vet can be a terrifying experience for some pets, especially if they need to have a procedure done. Taking steps to help them feel at ease sounds like a great way to make the experience less traumatizing for their health.