By Sally J. Foote, DVM, LSHC-S
In most small animal practices, the intake is done by the technician. Weight check, temp, heart rate, and history are performed by the veterinary technician. With the advances of Low Stress Handling® skills, there may be some variation on how intensive the technician will be in gathering these vital signs prior to the veterinarian stepping into the room. There is acknowledgement of the stress level of the patient, so the technician may forego some of the intake exam to reduce stress and allow the veterinarian to triage care.
I always felt it was all fun and games until the doctor walks in, that is, until we were a total Low Stress Handling® culture. Yet, when I step in the room, the animals know now the real stuff starts. Therefore, it is so important for the DVM to reward the patients. Immediate recognition of the stress level must be communicated to create the handling plan and the order of the exam. The DVM must immediately triage the care for this patient upon greeting the animal and be fluid in adjusting the process as the examination goes on. All of this depends on good communication between the handler and the DVM.
Establishing this communication is essential to successful Low Stress Handling®. It starts with the DVM dropping their ego and being open to observation and teamwork. The reality is that the handler is the one who can feel and see the body language of the patient and therefore is the one who leads the information exchange to the DVM. Often the DVM is focused on looking at a lesion or feeling the joint as they focus in on feeling the range of motion. It takes time to learn to watch the patient’s response in these moments and assess the area one is palpating. Where the DVM is positioned may block the view of the head, tail, or ears so the body language could be missed. In short, DVMs must listen to the technician about any escalating anxiety or aggression.
A second point is the technician must speak up! Empowerment is not only about the technician being permitted to speak up but that the technician will. During the exam, it is difficult for the DVM to continually ask the tech how the stress level is. The doctor’s head is in assessing health which requires full attention so technicians must speak up, or, use a pre-planned nonverbal cue.
I think it helps to have staff sessions with mockup exams so you can practice this. It is a big step for some technicians to speak up because they may feel they are telling the doctor what to do. Yes, you are, and we need to hear you for this to be a low stress exam. Praise your staff when they interrupt you and ask you to wait until they have the animal ready for the exam. And techs, thank your DVM for listening to you. This will help you both develop essential two-way communication for improved low stress exams.
One place this two-way communication tends to fall apart is with a new DVM or technicians, or with relief veterinarians or technicians. To maintain the low stress care experience with temporary help, you must screen your professionals for Low Stress Handling® skills, and communication skills. I have sadly seen a new DVM hire in a bite risk situation because they failed to instruct the staff to indicate when the animal was ready, and at the same time, staff were inhibited in communicating clearly to the new DVM. In short, the old hierarchy was in place. Practice managers and owners: be sure to have an outline of how patients are handled and at least one scenario to screen how this temporary hire would triage care and communicate to the staff. Also, have your staff state how they would communicate to a temporary professional for patient handling and care. Without this step, you will have slip ups, staff injury, and frustration will abound. Set your practice up for success for your staff, the temps, and your patients.
Through-out my 30 years of practice ownership, I was always using methods to reduce patient stress. When I took a proactive approach to improve all of my staff’s skills, I realized that much of the creation of a less stressful exam was led by my technicians. At first, I had to coach them to speak up. I was the boss, the one with the high degree and the ultimate decision maker, so of course they would be inhibited in telling me what I needed to do. However, I clearly understood that they were the ones who spent more time with patients and could interpret the body language of the animal better than I often could during exams. I made a point to reinforce my support for them to lead handling. In your journey through Low Stress Handling® I hope you can see the value of creating an effective communication style with your technician. Interaction is between the handler, the DVM, the animal, and the client. An all-encompassing circle of care is created in the moment, with improvement of health and welfare as our primary concerns.