∗Association for Veterinary Family Practice
†California State Polytechnic University
‡University of Missouri
24.1 The origin of veterinary family practice
The evolution of the relationship between humans and companion animals has had a marked effect on the practice of veterinary medicine during the past few decades. A prime indicator of the changing role of pets in human society is the extent to which humans have welcomed companion animals into their homes. In a survey of Canadian pet owners conducted in 2001, 83% of the respondents indicated that their pets were part of the family—including 26% of respondents who described the pet as the baby in the family (IPSOS-REID, 2001). In a more recent survey of US pet owners, 86% of participants declared that their pets were part of the family, with 50% claiming that the pet is just as much a part of the family as any other person in the household (GfK Roper Public Affairs and Media, 2009).
Historically, the legal status of animals reflected society’s perception of animals as chattel, considered only in terms of their economic value. That perception is changing. Some communities seek to alter that status through statutes—for example, replacing the term “pet owner” with the word “guardian,” or outlawing certain procedures perceived to be inhumane (Fiala, 2005; Sapperfield, 2002). Although courts have occasionally confirmed the non-economic value of animals by issuing awards to pet owners for suffering and loss of companionship (Fiala, 2004; Lofflin, 2004), cases seeking emotional damages are being denied (Whitcomb, 2009). Bills have been introduced in a number of state legislatures in 2009 (Hawaii, Massachusetts, Mississippi, New Jersey, New York, Oregon, Rhode Island, and Washington, DC) which change laws to award non-economic damages in cases where a pet is wrongfully injured or killed (Whitcomb, 2009). The legal status of companion animals continues to be a hotly contested issue.
With the strengthening of the bond between humans and their pets, veterinary clients demand technologically advanced health care for their pets, and they show an increasing willingness to spend more money to maintain the health of their animal companions (Grieve et al., 2003). The veterinary profession has responded with a revolution in medical and surgical technology and knowledge. In urban and suburban America, the number and type of veterinary specialty services offered have grown dramatically in the past few decades. Enhanced technology and scientific knowledge, however, will not meet all of the needs generated by the evolution of the human/animal bond. Over 30 years ago, psychologist Boris Levinson (1987) predicted that the “…veterinarian will become involved in the emotional life of the family whose pet he treats. He will become aware of the meaning of the pet to its owner.” There are additional sets of skills and knowledge required to advocate for the well-being of animals in the context of their roles in the human family (see Table 24.1) and to interface with the emotional bond between human and pet. Enhanced interpersonal skills are essential, including client communication, emotional intelligence, leadership, teamwork, conflict management, human psychology and media interaction. The discipline of veterinary family practice (www.avfp.org) seeks to define and teach the skills and knowledge necessary to meet the objectives of veterinary family practice, as described in Table 24.2.
It has been well established that companion animals in a home exert a positive influence on the health and well-being of the human family members. Coronary patients who are pet owners have a greater survival rate than non-pet owning coronary patients (Friedmann et al., 1980). Pets decrease loneliness and depression in people with inadequate social support, including elderly, single women, and people with disabilities or chronic diseases (Garrity et al., 1989; Siegel et al., 1999; Zasloff and Kidd, 1994). Pets can lower their human companions’ blood pressure (Friedmann and Thomas, 1995). Mayo Clinic oncologist Edward Creagan stated: “I prescribe pets to a third of my cancer patients to help them cope with the rigors of their terrible disease. I consider getting a pet to be one of the easiest and most rewarding ways of living a longer, healthier life” (Creagan, 2002).
Schwabe (1984) reflected on how the impact of pets on human well-being presented a challenge to the veterinary profession: “There has been great reluctance… to suggest that veterinarians may have, in fact, even more significant and perhaps unique social roles to play vis à vis the emotional and even the closely related physical well-being of animals’ owners than of the animals themselves.” Schwabe’s insight has given birth to the concept of One Medicine, espoused by the American Veterinary Medical Association. This concept acknowledges and embraces the overlap of veterinary, human and environmental health. It is now quite obvious that a veterinary practice is far more than a repair shop for dogs and cats. The fact that approximately 75% of human diseases emerging in the last three decades have been zoonotic places veterinarians in the front lines in their detection and prevention (Taylor, 2001). Signs of animal abuse suggest a potential for violence towards humans, imbuing a greater responsibility for the veterinarian to be alert for and to respond to any such indication (Flynn, 2000). It is not unlikely that the veterinarian will be the first to witness evidence of spousal, child or elderly abuse and, in many states, they are mandatory reporters of any suspicions of abuse. Because of the trust that develops in a veterinary family practice, the practitioner may become aware of specific needs of elderly or disabled clients and have the opportunity to direct them to appropriate social services or other resources. Ormerod (2008) proposed the formation of a multidisciplinary professional network (MPDN), consisting of veterinarians, police, child protection officers, medical practitioners, community mental health workers, teachers, social workers and humane society officers. This network could be an excellent resource for the veterinarian encountering zoonotic, novel or emerging diseases, suspected animal or human abuse, or clients in need of social services.
An area that is very ripe for collaboration with mental health providers relates to pet loss. The intense bond between owner and pet increases the grief at the loss of the shorter-lived species, and requires the veterinary practice team to skillfully counsel clients about end-of-life issues. Unfortunately, the loss of a pet has not been given significant attention by most mental health professionals in the past. This is now changing because most realize the importance of animals in the lives of their patients. The loss of an animal can be hard for most people, both young and old. Research has found that the grieving process is exceptionally more difficult for people who live alone or those who have a more limited social support and spend a great deal of time with their pets (Planchon and Templer, 1996). Furthermore, for families who have to decide if they need to euthanize their pet, the grieving process can be arduous. Sharkin and Knox (2003) point out such decisions may be very difficult to grapple with, especially when evaluating the quality of life for the animal or a person’s desire to have more time with his /her beloved pet. Feelings of guilt may also arise in people who feel they need to euthanize the animal because of the financial burdens of keeping the animal alive. It is within these types of scenarios, as well as others, that a closer relationship with veterinary family practitioners and health providers needs to exist. A viable relationship between mental health practitioners and practicing veterinarians can be very beneficial in this time of need. Providing supports such as grief and loss support groups would be a positive collaborative option. Veterinarians could develop community referrals to send some of their clients that seem to be struggling significantly with the loss. The concept of One Medicine seems to be a logical fit within this area. And the role of the veterinarian is truly vital.
24.2 The role of veterinary family practitioners in AAT/AAA
Animal-assisted interventions provide an opportunity for the veterinary family practitioner (VFP) to work closely with owners of animals with specific functions outside the family. This interface provides an excellent model for an MPDN. Often, the most important role identified for veterinarians in AAT/AAA programs is “…the need for careful behavioral and medical (zoonotic) screening of animals…” (Johnson and Meadows, 2000). The American Veterinary Medical Association expands this role in the Wellness Guidelines for Animals Used in Animal-assisted Activity, Animal-assisted Therapy, and Resident Animal Programs (American Veterinary Medical Association, 2001). These guidelines recommend that the veterinarian should work closely with the individual with primary responsibility for the animal, the therapist and a qualified behaviorist to develop a wellness plan that will enhance the health and welfare of the animal. The Guidelines also state that “Total wellness encompasses the physical and behavioral attributes of the animal, as well as the characteristics of interaction between people and animals participating in the program.” This is in accordance with the concept of veterinary family practice, in which the veterinarian is an active member of a team that includes the hospital staff, the pet owner and area specialists, all of whom are focused on the well-being of the pet. A major aspect of well-being is enabling the pet to perform a particular function effectively without stress or discomfort. When the function is participation in an animal-assisted therapy or animal-assisted activity program, the VFP can be a valuable partner with the therapist and the individual responsible for the care of the animal. The following discussion will assume that the therapist is the individual responsible.
24.2.1 Animal selection
The first opportunity for the VFP to facilitate the work of the therapist is to counsel the therapist on the species or breed of animal appropriate for the therapeutic objectives. It is important that the therapist be specific about the work expected of the animal during therapy. A discussion of these expectations will lead to identifying the characteristics which are essential to therapeutic success. A list of possible expectations can be found in Table 24.3.
Mental, social or physical qualities of the patient or client may determine the appropriateness of a given species or breed. Is the patient immunocompromised? Does the patient have allergies or phobias? Are there aspects of the patient’s history that suggest a positive or negative value of a particular choice of species or breed? Are there limitations due to a physical disability or the patient’s age?
If the therapist is seeking a relaxing environment, fresh or salt-water aquariums have been shown to have calming and other beneficial effects on humans (Katcher et al., 1984). Although there are now veterinarians specializing in aquaculture, it is likely that a VFP will refer the therapist to a local store specializing in fresh water or tropical fish for supplies and information. Although reptiles may be interesting to certain patients, in general they are non-interactive, are the object of some phobias, and may carry a high risk of zoonotic disease (see below). Reptiles are usually not recommended as therapeutic animals (Hess et al., 2005). However, should a therapist determine that a reptile could contribute to a superior therapeutic outcome, precautions need to be put into place. Fine (2005) notes that antiseptic hand wash needs to be available, at all times, especially after the client handles the animal. There are several gentle species of reptiles which may be appropriate to incorporate. Bearded dragons tend to be gentle animals and are very comfortable in being handled. Therapists who consider utilizing reptiles need to be in contact with a specialist who can explain the physical needs of the animal.
It is becoming more common for birds of various species to be used as therapeutic assistants. With the exception of cockatiels, love birds and budgerigars, most of the parrot species should be considered wild animals in the process of becoming domesticated. Certain individual birds of other species may be appropriate for patients who benefit from interaction and visual stimuli. But it is important that these birds be carefully evaluated to ensure that they are tame, easily handled by a variety of people and are predictable. Risks to the patient include unintentional scratches or intentional bites associated with inexperience in handling pet birds. In spite of the increasing popularity of birds as pets and the rapidly growing veterinary specialty of avian medicine and surgery, our knowledge about the behavior and the emotional and physical well-being of these creatures is still limited. Many of the species of birds chosen to be pets (Amazons, African grays, cockatoos) are very social and highly intelligent. They are curious, but easily startled and instinctually seek to escape a situation perceived as threatening. Conditions of domestication are at odds with the instinctual behavior of these birds. Confinement in cages and deprivation of interaction with conspecifics leads to considerable frustration and stress. Therapists considering using birds need to be aware of the special behavioral challenges that could arise as a consequence of the therapeutic interaction. Fine (2003) noted the strong commitment therapists must consider when they utilize larger birds. Clinicians need to be aware of the lifespan of these animals as well as their needs for special care. Unfortunately, many people do not realize that the attention that one gives a bird early in its life is the same amount required when it ages. Therefore, careful planning needs to be instituted, so one will be able to live harmoniously with a bird over time. It is highly recommended that, if birds are to be considered, appropriate and thorough training of both human and avian partners be implemented.
Rabbits and “pocket pets” such as small mammals like guinea pigs, hamsters, mice and rats, offer a visual and tactile experience that may have therapeutic benefit. But they also have an element of unpredictability and are somewhat fragile because of their size.
Cats are a popular therapeutic animal because their soft fur and audible purr in response to petting can have a very positive effect on patients. Care must be taken, however, to choose animals with a docile disposition and their claws must be managed in order to prevent accidental or intentional scratches. The claws can be clipped short on a regular basis or protected with a covering such as Soft Paws® (Soft Paws Inc., Lafayette, LA).
Dogs are certainly the most common therapeutic animals and the subject of the majority of research on the subject. This is undoubtedly a result of their trainability, sociability and predictability. The latter is a result of years of breeding for specific traits, which allows the VFP to make recommendations depending on which personality characteristics will help achieve therapeutic objectives.
It is important to remember that selection of a particular species is just the first step. If a dog, cat or even a guinea pig or rabbit is chosen, an appropriate breed should be identified. Years of selective breeding offer some consistency in physical characteristics, personality and behavioral tendencies within breeds. This does not, however, guarantee identical performance by individual members of a given breed. Mixed breed dogs (and cats) may also be considered. In this case, determining the breed influence and applying a temperament test might help suggest whether an individual animal might have the desired traits. For dogs, some well-established screening tests exist, such as the PALS Behavior Evaluation Form for Dogs (Bustad, 1980) and the AKC Canine Good Citizen® Program (www.akc.org/events/cgc/). These instruments can be of value if used in a consistent and thorough method.