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Horwitz, Debra, Ethical profit making - Making behavioural medicine part of daily practice.Proceedings of the AVA Annual Conference, Canberra 2012 Page B1.1.1

ETHICAL PROFIT MAKING-MAKING BEHAVIOURAL MEDICINE PART OF DAILYPRACTICE

Debra F. Horwitz DVM, DACVBVeterinary Behaviour Consultations

11469 Olive Blvd #254St. Louis, Missouri 63141 USA

IntroductionBehaviour problems in companion animals are a common owner complaint. Surveys ofpet owners reveal that more than 90 percent complain about their dogs behaviour. Often,these problems result in pet owners relinquishing their pets to animal shelters1. Furtherstudies have shown that dogs whose owners received behavioural advice from aveterinarian were at lower risk of being relinquished to a shelter.

In the same study however, only 25% of owners reported that their veterinarian routinelyoffered behavioural advice2. While the results were not as dramatic, the same factorswere important for relinquishment of cats to shelters3. This information underscores theneed for veterinary practices to incorporate behavioural medicine into routine office visits.

Behavioural intervention can include preventive counselling, early diagnosis of problems,normal behaviours that are problems for the owners, problems with established diagnosis,abnormal behaviours and advanced and challenging cases. While behaviouralconsultations may be beyond the scope of many veterinary practices, veterinary practicescan help pet owners assess the behavioural health of their pet.

You should evaluate your training to date, the resources you have (library, referral peoplenearby, continuing education in the past and planned in the future). Also consider theliability that some behavioural problems may pose. Aggression is a serious threat tohumans and possibly other pets and requires more time and expertise to treat. Decidewhat you are willing to handle, and how you will deal with cases you are not willing to treat.

Medicine should come firstAlways remember to do your medical due diligence with a good physical examination andany laboratory or imaging studies indicated. Keep in mind that if the behavioural change issudden, the first question should be why now? and often indicates the need to rule out allsorts of potential contributory medical issues. In older pets, a change in affect orbehaviour often is an early sign of pain, organ dysfunction, endocrine changes, Cognitive

changes or cancer.

Always rule out any contributing or concurrent medical problems that may be contributorybefore starting behavioural therapies. A good physical examination, mini neurologicalexamination and minimum database of laboratory work should be standard for behaviourcases. Always treat any concurrent problem and reassess the case in 7-10 days.Remember, once the medical problem is controlled or resolved, learning may contribute toongoing performance of the unwanted behaviour.


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Charging for your timeAlways schedule an appointment to deal with a behavioural issue even one casuallymentioned in a routine yearly examination. When an owner perceives that their pet has an

unwanted behaviour, this may affect all aspects of their interaction with that pet, includingproviding appropriate health care. Furthermore often pet owners are going to seek adviceand help elsewhere and willingly pay for that help. In some cases the help they seek maybe appropriate, but in many cases it is not.

Finally, other individuals charge a great deal of money for these services and in the USAoften a package of behavioural advice or training help may cost $300 to $1000 USD. Setaside time to educate yourself and/or your staff and then schedule and charge for thosevisits as you would any other veterinary service. Remember, helping keep a pet in theirhome could be just as life saving as any medical or surgical intervention.

Follow up

Whatever you decide to treat, also make a decision how follow-up will be obtained andprogress assessed. It will be difficult to judge the effectiveness of your behaviouralprogram without good follow-up. Follow up can be by phone and/or return visits. Makesure to allot time for these services in the daily or weekly schedule and also calculate acharge for them.

How to beginPreventive counsellingNew puppies and kittens are the lifeblood of practice and also provide opportunities forveterinarians to start pets and pet owners off to a satisfying lifelong relationship.Veterinarians and their staff can provide potential puppy and kitten owners with informationabout breed selection, health care needs, coat and feeding maintenance of potential pets.

Start by creating a library that has books on pet selection and become familiar withreputable sources of puppies and kittens in your area.

It may be beneficial to designate a staff member to become responsible for providingpotential pet owners with needed information. This person should be able to answerquestions about such topics as the ideal age to adopt puppies or kittens, what to do ifadopting an adult dog, what sex to obtain, as well as information about breed selection.

Once a client has obtained a new pet, and visits the practice, opportunities to providebehavioural services are numerous. Handouts can be created that deal with commonbehavioural topics for new puppies and kittens.

These include puppy and kitten proofing the home, confinement training (crates), house-training, chewing behaviours, destructive behaviours, socialization, play behaviours andmany more. Your clinic library can be stocked with books and videos that provide this typeof information.

Check lists can be made up that go in all puppy and kitten records to be sure that everypuppy owner gets the proper information on these topics as they visit for regular puppyand kitten examinations.


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Each puppy and kitten visit should include adequate time for the owner to ask questionsabout behaviour and to have the veterinarian ask questions about behaviour. These mightinclude queries on house-training; play biting, stealing, jumping and chewing behaviours.

Early diagnosis and interventionEven with a proper puppy and kitten program in place, there are adult animals in yourpractice that need behavioural information and advice. How best can these people beidentified? One of the most efficient ways is to provide each client with a behaviouralquestionnaire at routine health examinations.

The client could fill these out while waiting to see the veterinarian. Questionnaires couldbe general, or specific for each species. The use of a questionnaire will allow you or a staffmember to identify, triage and treat behavioural problems in your patients.

Canine questionnaire

Questions about the daily routine are informative. These include pet owner interaction,where the dog(s) sleeps, who feeds the animals, and how much time the pet spendsalone, amount of playtime and training time on a daily basis.

An aggression screening (whether the dog snarls, growls, snaps or bites) should ask aboutthe pets response to owner reprimands, owner handling such as wiping the feet orgrooming, taking objects from the dog, touching its food, moving the dog while it rests etc.and can yield very important information. Questions about unruly behaviour such asbarking, jumping and escape behaviours would help identify problem areas that needattention. Problems with house soiling or destruction should also be explored.

Feline questionnaire

Important areas to ask cat owners about include the litter usage, litter type, littermaintenance, food, daily routine and access to outdoors of the cat(s) in the home. Ownersshould be questioned about any aggression surrounding play, other animals, petting orfood.

Specific questions about problems with scratching behaviours, inappropriate chewing orelimination outside of the litter pan will target the most frequent cat owner complaints. Ifthe home has multiple cats, questions about placement of litter pans and food bowls mayhelp prevent later problems. Episodes of aggression between cats in multiple cat homesshould be explored.

Using the gathered information

Information gathered in this way can be used to determine if it is a problem that you oryour staff can deal with, a training issue, or a problem that should be referred to aveterinary or applied animal behaviourist.

The problems could be normal behaviours that are being expressed in a manner that isproblematic for the owner, a behaviour that is dangerous for family members, abnormalbehaviours or extremely challenging problems. If you discover areas of concern, then youmust decide how you might intervene. Intervention can take many forms. Interventionsinclude a one on one training situation, a headcollar or no pull harness, handouts; declawsurgeries, appropriate toys and training aids.


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Some normal behaviour that may be performed excessively in dogs includes barking,digging, or jumping. In cats it may be scratching, or problem play behaviours. Problems

with established diagnosis and treatments include house soiling in dogs and cats,separation anxiety and cognitive dysfunction in dogs.

Advanced and challenging behaviour casesThese cases include aggression cases in dogs and cats, compulsive disorders, advancedand serious fears and phobias, some separation anxiety cases and other behaviour casesthat are not responding to treatment. They present a challenge to all veterinarians. Theyneed to be worked up like any complicated case in veterinary medicine. Start with a goodhistory, physical examination and possibly laboratory testing.

Often medical problems and behavioural problems overlap, chronic conditions such asdermatological disorders, arthritis, and dental disease contribute to irritability and problem

behaviour. Addressing these issues may help diminish problem behaviour and even if thedecline is minimal, attending to animal health is important. Attempt to determine if theproblem is a normal but unwanted behaviour or an abnormal behaviour.

Next you should classify the behaviour problem and determine if you can help or need torefer the case. Treatment will usually include treating any medical problems, behaviourmodification, environmental manipulation and possible psychotropic medication. Youshould decide your ability to provide all of these.

A word about aggressionAggression cases, both in dogs and cats carry the risk of injury to humans and otheranimals and therefore have increased liability. A veterinarian must feel comfortable with

their level of expertise when dealing with aggressive animals. If unsure of how to proceed,safety precautions should be implemented and the case referred to a behaviour specialist.

Safety precautions: environmental constraints that prevent the dog from engaging inthe problem aggression. Gates, closed doors, crates, muzzles, head collars,separation from company or family members, leashes and supervision. Each time theanimal is allowed to engage in the aggressive response, not only is there a risk ofinjury, the pet perfects the behaviour.

Risk assessment: things to take into consideration include but are not limited to theseverity of the aggression to date, the victims, the predictability of the aggression, sizeof the animal, family composition, and ability of the owners to provide safety for

themselves and others, willingness of owner to accept responsibility for the problem5

.

Wherever you decide to intervene, behavioural history forms are helpful for diagnosis andtreatment and can be found in the books listed in the resource section below.

For difficult cases referral sources should be available. These might include the AustralianCollege of Behavioural medicine and the American College of Veterinary Behaviourist, or acertified applied animal behaviourist.


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Behaviour productsBehaviour products can be helpful to help pet owner manage and/or prevent minorproblem behaviours. These include head collars, toys, distraction devices and interactive

toys. Often owners are not providing good control or stimulation for their pets and theveterinary office can provide direction.

Head collars are helpful in many behaviour problems. Handouts can be especially usefuland many sources exist for obtaining handouts including the Lifelearn Handouts and manyof the books listed below include handouts on CD for printing and use within the practicesetting.


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Resources for veterinariansHorwitz DF, Mills D. (2009) BSAVA Manual of Canine and Feline Behavioural Medicinesecond edition. British Small Animal Veterinary Association, Gloucester, UK.

Horwitz DF, Neilson J, (2007) Blackwells 5 Minute Veterinary Consult Clinical Companion:Canine and Feline Behaviour, Blackwell Publishing, Ames IA

Houpt, K. (2004) Domestic Animal Behaviour for Veterinarians and Animal Scientists, 4thedition. Blackwell Publishing: Ames, IA.

Landsberg G, Hunthausen W, Ackerman L (2003). Handbook of Behaviour Problems ofthe Dog and Cat, 2nd edition, Saunders, Edinburgh, UK

Serpell, J; Barrett, P (Eds.) (1996) The Domestic Dog: Its Evolution, Behaviour andInteractions with People. Cambridge University Press, .

Turner DC, Bateson P (editors). (2000) The Domestic Cat, the biology of its behaviour, 2ndedition, Cambridge University Press, Cambridge,

Veterinary Information Network, a fee service for veterinarians with access to databasesof questions and answers provided by diplomates in various disciplines, a library, accessto journals and proceedings.

References1. Miller, DD, Staats, SR, Partlo, C., Rada, K. Factors associated with the decision to

surrender a pet to an animal shelter. JAVMA 1996; 209:4: 738-742.

3. Patronek, GJ, Glickman, LT, Beck, AM, et al. Risk factors for relinquishment ofdogs to an animal shelter. JAVMA 1996; 209:3:572-581.

4. Patronek, GJ, Glickman, LT, Beck AM, et al. Risk factors for relinquishment of catsto an animal shelter. JAVMA 1996; 209:3:582-588.

5. Horwitz D F, Assessing risk and prognosis in Aggressive dogs Clinicians Brief2006 4:9: 57-58.

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