Empathetic Patient Restraint

Every so often practitioners are asked to adhere to rules that can sometimes create more problems than they solve for busy clinicians. This usually occurs because those rules fail to take the relationship between the client, animal, and clinician into account. Consider the rule that owners should not hold their animals during veterinary examinations. Within a certain context this makes sense. Improperly restrained animals could harm owners who might then sue veterinarians. And, in fact, such situations have arisen. Therefore, the logic underlying this rule contends, to avoid law suits veterinarians should always have technicians hold animals throughout any veterinary procedure.

That appears relatively straight-forward until we take any effects that approach to restraint may have on the veterinarian’s relationship with the owner and the animal. As we are repeatedly reminded, the majority of companion animal owners view their pets as members of the family. Consequently, it seems reasonable to assume that at least some owners’ expectations regarding their role in the examination process will parallel that which they expect when their children require medical attention. In that realm, many parents expect to maintain in close physical contact with their offspring throughout the examination. Moreover, most pediatricians expect parents to do this and some even think unkind thoughts about those parents who won’t.

Granted a dog or cat might do a lot more damage with teeth and claws than the average young child with teeth and fists. But does this warrant a blanket approach that mandates restraint of all animals by others? Our answer to this question typically reflects our experience or fears. Those who have been threatened with a law suit, those actually sued by owners hurt by their own animals in the course of veterinary treatment, and those who can readily envision this happening naturally want to do everything to avoid such an experience. Having a technician rather than the owner handle the animal seems like the only sensible thing to do. Other practitioners who see primarily well-behaved pets belonging to responsible owners may take a more flexible approach. When the owner appears comfortable handling the animal and the animal appears comfortable being restrained by that person, they allow the owner to hold it. When the owner appears hesitant or unable to properly restrain the animal, they ask a technician to assume this responsibility for the client.

And how do owners view this situation? Not surprisingly, their views vary, too. Confident owners of stable animals have few problems with either holding their animals themselves or turning the job over to a qualified technician. However, for others the idea of someone else restraining their animals elicits a certain amount of resentment. They may believe that the veterinarian is expressing a lack of confidence in their ability to handle their own animal, which they may take quite personally no matter how true it may be. Others resent the veterinarian’s implication that their beloved animal, which they want and need to believe would never hurt anyone, could turn on them in an instant. Because of this and whether we opt to ask staff members to restrain all animals or just a select few, we need to pay attention to how we accomplish this task to avoid undermining the client-clinician and the clinician-patient relationship.

To understand how problems may arise, imagine Meg Jones getting upset when the technician holds Meg’s dog, Sammy, in what the owner considers a “death grip.” When Meg gets upset, Sammy automatically gets upset, too. He squirms and tries to get to her, both to receive comfort and give some to her. The more he struggles, the harder the technician holds him, and the more upset Meg and her dog become. When this downward human-animal spiral reaches a certain critical low point, the distraught dog may try to snap. When this happens, Meg probably wouldn’t agree with the veterinarian’s sentiments that, “Thank goodness my tech was holding Sammy. Otherwise he might have hurt you.” Instead, she will more likely believe that the veterinarian’s failure to allow her to hold her pet caused the problem.

Other times owners don’t object to another person restraining their pets as long as the veterinarian informs them that this will happen beforehand, and the handler accomplishes the task in an acceptable manner. Across the board, clients have little good to say about veterinarians who sweep into the examination room with a technician who grabs the animal and squishes it to the table. Whatever time it takes to both properly train and introduce the technician, inform clients of the impending process, and answer any questions regarding it is more than justified by the benefits doing so bestows on owner, animal, and the clinician-client relationship.

Because posters only work if clients read them, at most those describing any restraint process should supplement staff training and quality client communication. Lack of reading skills, forgotten glasses, and/or the distractions caused by the animal or others all may interfere with reading. Other times clients who do read any written material may take offense if they believe the wording reflects negatively on their animal’s behavior or on their own ability to control it. If so, this may undermine their relationship with the veterinarian: “You don’t trust me or my animal? Well, I don’t trust you either!”

Clients also rightfully expect any policy regarding their safety to be uniform. Crowded waiting rooms that increase stress can put clients and animals at risk as much as any examination room procedure. Minimizing waits, providing adequate space to permit easier client control of animals, and trained staff who can safely whisk problematic owner-animal combinations to more secure settings help ensure human and animal safety.

Ideal patient restraint consists of determining exactly the right amount of control exerted by exactly the right person at exactly the right time to ensure that the job gets down with the least amount of stress to and the maximum benefit for all involved. Once we learn to determine that, restraint meshes seamlessly into the treatment process.