Clinical Suite: Cat-Friendly Practices

Overview

Margie Scherk, DVM, DABVP, catsINK, Vancouver, Canada

There's A Problem

The number of companion cats continues to rise, and money spent on food and toys is increasing, but the number of feline veterinary visits is decreasing.

Six years ago, the AVMA identified that there were 13% more pet cats than dogs, yet cats fail to receive the same degree of veterinary attention.¹ Worse, in 2011 feline visits decreased 4.4% from 2006,² and the 2013 Bayer Veterinary Care Usage Study suggests that fewer than half of the estimated 74 million pet cats in the United States may not receive regular veterinary care.³ Team training techniques vary, and as many as 31% of practices do not offer training in cat-friendly methods.³ Why? What can we do?

Five Problems We Can Address

• The myth of self-sufficiency and low maintenance⁴: This falsehood leads to a mistaken belief that cats do not require preventive care the way dogs do. In fact, clients may even own additional cats they don’t tell us about because they don’t realize they need regular care.

• Cats, evolved to not need a social support network, are adept at hiding signs: This often means by the time a problem is evident to their caregiver, the problem has been present for longer than the owner realizes.

• In general, owners do not enjoy taking cats to the practice: Cats may show signs of stress/distress, vocalize, urinate, defecate, vomit, or salivate, and it can be a challenge to get them into their carrier. Cats may sometimes scratch or bite owners, who also become distressed and may feel guilty (toward the cat) or resentful (toward the practice) for needing to bring them in.

• Compliance suffers when clients do not understand the implications of examination or treatment: When clients neither understand what has been done (and why) nor feel confident in their ability to perform treatments, compliance (and healthcare) deteriorates. Having to pay for care that they don’t understand doesn’t help.

• Team members have an aversion to feline visits: Many find cats more difficult, unpredictable, and time consuming to work with, and feline problems harder to diagnose. So, the team may be less inclined to recommend or provide necessary follow-up. When cats object to handling or examination, teams sometimes use techniques that, although efficient and “effective,” are not conducive to reducing fear.

The Client's Perspective

Many clients feel guilty seeing their precious friend distressed at home before travel, and on the way to and in the practice, as well as when they return home. Additionally, they have to finance the experience and pay for their guilt! Try to think from their perspective: Why would they want to bring their cat in unless he or she is obviously sick?

Primer

Margie Scherk, DVM, DABVP, catsINK, Vancouver, Canada

What can we do to increase feline veterinary visits and improve the overall experience for cats?

TAILOR THE EXPERIENCE

Every contact with a client is an opportunity to teach him or her about preventive-care protocols tailored to the needs of their special companion. If the patient has a preexisting illness, working compassionately with the client helps ensure that appropriate and empathic follow-up is provided to optimize quality of life.

ASK!

Take a client cat inventory: Does the client have any other pets at home?

EDUCATE

Use every medium you can to educate your client base (eg, email, newsletters, social media), but don’t underestimate the power of someone hearing his or her own name and the care expressed in your voice (over the phone or in person). All team members should teach clients about the subtle signs of sickness.

A SMOOTH RIDE

Provide tips on how to make the trip to the practice more pleasant. Every phone call to book an appointment is an opportunity; ask clients whether they feel anxious about bringing their cat in and be empathetic. Find out if they have a carrier and whether the cat likes it, and teach them how to make it a safe, secure, and comfortable part of their cat’s life. Carriers should be carried horizontally (not hung from the shoulder or hand) and secured in the car using a seatbelt, the same as a child car seat. Brief car rides associated with rewards rather than fear can also help change attitudes. The client and the cat will learn to not dread the event.

PHASE OUT FEAR

Fear and pain are the main reasons cats “act out.” Cats are small predators but they are also prey animals; they rely on distance to remain safe, so it is not surprising they freeze or fight when they feel threatened and cannot flee. Although we may be frightened of those that become more defensive and show fear or aggression, showing compassion for the defensive patient, moving slowly, and recognizing perceived threats goes a long way to reduce fear.

FIND THE THREATS

To identify what may frighten cats, imagine being a cat and evaluate the practice and the way the team interacts with cats. Perform a practice audit; think about what sounds, smells, sights, textures, and tastes might be scary. Consider the cat’s point of view (eg, superior sense of smell, poor close-up visual acuity, superb hearing). In what ways is the practice showing predatory threats toward cats?

READ THE SIGNS 

Preventing fear is the goal, and reading cats’ body language and the many signals they convey allows us to change their experience so they do not have to become defensive or aggressive.

CHECK YOUR (C)ATTITUDE 

A respectful attitude toward cats (ie, your team’s [c]attitude) can result in a more pleasant experience for feline patients, their owners, and the veterinary team.

Communication

Jessica Goodman Lee, CVPM, Brakke Consulting, Dallas, Texas

HOT-BUTTON ISSUE

“Frisky seems fine. I don’t understand why I need to bring him in every year if he doesn’t need vaccines.”

It is common for clients who own cats to think this way, but it is the duty of the entire veterinary team to reeducate them! Ideally, the education process starts with the cat’s first visit. If this is not possible, do it the next time—it is never too late to set expectations for regular preventive care.

The key is not to focus on vaccinations; explain that these will be given as needed but they are not the purpose of regular examinations. Focus instead on the value of the annual comprehensive physical examination and consultation.  

Help owners understand that cats are very different from dogs. Cats are masters at hiding illness, making regular (at least annual) examinations and assessment by a veterinarian that much more important. Explain that regular examinations can mean the difference between a disease that has progressed from one caught early enough to be cured or medically managed.

Spend time speaking with clients about their cat’s diet, weight management, dentistry, and behavior at every visit, and it will not take long for them to stop focusing on vaccines and start realizing the importance of investing in their cat’s healthcare.

Take a minute to compare the number of cat photos versus dog photos on your website and social media pages. Are they equal? How many of your social media fans are cat owners?

WHAT CAT OWNERS ARE SAYING

US Pet Ownership & Demographics Sourcebook²

In 2011, 45% of cat-owning households never visited a veterinarian—an increase of 10% in 10 years.

Bayer Veterinary Care Usage Study III: Feline Findings³

Approximately 58% of cat owners said their cat “hates” going to the veterinarian (presenting the biggest barrier to preventive care). In addition, 44% said that when they do bring their cat in, their veterinarian does not recommend regular examinations. Other feedback includes:

• Comfort of waiting room for cat

  • 57% less than satisfied

• Comfort of waiting room for cat owner

  • 56% less than satisfied

• Perception of value for money spent

  • 59% less than satisfied

Banfield Pet Hospital State of Pet Health 2012 Report⁵

The number of overweight cats has increased 90% in the past 5 years, yet 69% of owners think their cat is just the right weight. Furthermore, over the past 5 years, the following feline diagnoses have increased significantly:

• Arthritis 67%

• Diabetes Mellitus 16%

• Flea Infestations 12%  

• Hyperthyroidism 13% 

• Kidney Disease 15% 

• Otitis Externa 34% 

• Roundworm Infections 12.4%

Kidney disease is 7 times more common in cats than in dogs—one in every 12 geriatric cats is diagnosed.⁵ Cats diagnosed in the early stages of the disease live an average of 2-3 years, whereas cats diagnosed in the later stages live fewer than 6 months on average. Additionally, 29% of cats with kidney disease have periodontal disease, a possible contributing factor to the condition.

Workflow

Jessica Goodman Lee, CVPM, Brakke Consulting, Dallas, Texas

Who does which task and when? The outlined process below offers a team workflow solution to ensure each team member is effective and comfortable with feline patients from the first interaction with the client to scheduling follow-up and encouraging compliance with the treatment plan.

Technician / Assistant

• Escort client & patient to examination room promptly

• Take a full history

• Ask client about any abnormalities or changes in behavior

• Offer toys for client-patient interaction (and relaxation) while waiting for veterinarian

• Document conversations in medical record

• Communicate history to veterinarian

• Confirm all client questions are answered

• Show client how to administer treatment, and have client practice treatment

• Ensure client feels comfortable with treatment

• Schedule recheck (or escort to front and verbally communicate need for recheck to receptionist)

• Ensure all necessary reminders are set up in medical record

Roles

Jessica Goodman Lee, CVPM, Brakke Consulting, Dallas, Texas

Every team member assumes an important role in improving feline veterinary experiences. Following are roles and responsibilities of each practice team member to make visits less stressful for the patient and the client.

Receptionist

ROLE: Initial client point of contact

RESPONSIBILITIES:

• Ask clients if they have a carrier when making an appointment for a cat; offer one they can borrow if not

• Ask if clients would like mailed/emailed recommendations for making travel more comfortable; even better, offer an instructional video on your website about reducing the stress (both theirs and their cat’s!)

• Know the client and patient’s names as they enter the practice; even if the cat cannot be seen, it can mean a great deal to the owner when the receptionist can say, “Hi, Ms. Thompson! How’s Precious today?”

Technician / Assistant

ROLE: Client education & medical assistance

RESPONSIBILITIES:

• Receive extensive training on proper restraint and handling (it’s not acceptable to have only a few team members who are “good with cats”)

• Complete a thorough check-in by reviewing the owner-completed feline lifestyle questionnaire;  use this to prepare the veterinarian before he or she  enters examination room

Veterinarian

ROLE: Medical expert & client educator

RESPONSIBILITIES:

• Be comfortable handling cats and conducting  thorough physical assessments in a cat-friendly examination room using the touch-and-talk method; this adds tremendous value and can help build trust and loyalty with owners

• Agree to hospital’s standards of care and recommended protocols for feline patients (start with AAFP/AAHA Feline Life Stage Guidelines); put them in writing

• Decide which handouts and educational material should be given to client

• Attend more feline-specific CE

Practice Manager

ROLE: Supervisor of practice protocols & team/client education

RESPONSIBILITIES:

• Organize educational meetings and oversee protocol recommended by the cat-friendly task force (see Training the Team)

• Oversee creation of a Catering to Cats training manual with:

  • Cat appointment protocols

  • Scripts and talking points on common diseases and conditions

  • Medical record templates

  • Cat owner preexamination questionnaires

  • Protocols for cat handling

  • Skills for speaking with cat owners on the phone

  • Begin a feline-specific marketing program; start with current clients and send newsletters and incentives that are feline-specific and geared to compliant or noncompliant owners

Training

Jessica Goodman Lee, CVPM, Brakke Consulting, Dallas, Texas

Plan a series of team meetings that focus on improving your practice’s feline experience. Even better, create a task force with a member from each department to head the initiative and train others. Although inundating a client with data may not be the best way to communicate, supplying this data to your team (see What Cat Owners Are Saying) helps them understand the extent of the problem and encourages implementing changes.

POSITIVE CHANGES

Begin the brainstorm and improve the feline experience at your practice:

• Prioritize having a room available when a cat arrives. The waiting room can be an area of great stress for both clients and cats. It takes about 15 minutes for cats to acclimate to surroundings, so the sooner they get into the room, the sooner they will feel more at ease.

• Make sure any designated cat waiting areas are far away from the main reception area.

• Reserve an examination room(s) solely for cats. Keep a feline pheromone diffuser (feliway.com) plugged in and pheromone facial spray available. Technicians and veterinarians should also spray themselves before entering the room (after allowing the alcohol from the spray to evaporate).

• Consider having a cat concierge, or someone designated to help clients with the carrier, and escort the cat and client into the examination room. This person would follow up to ensure there is minimal wait time and later take payment and schedule rechecks in the examination room before escorting the client back to the car.

• Display cat-specific reading material and artwork and play soft music or nature sounds.

• Consider letting cats out of their carrier once in the examination room so they can roam (but ensure there are no small spaces where they can crawl and make it difficult to reach them); consider removing the carrier from the room until it is time to leave.

• Ask clients to complete a feline lifestyle questionnaire to emphasize preventive medicine and behavior changes they may not have thought were relevant. This may also spark conversations on heartworm, litter box management, nutrition, obesity, flea and tick prevention, and zoonotic disease.

Download the Feline Lifestyle Questionnaire

COMMITMENT LIST

Ensure the team commits to:

• A renewed understanding and respect for cats and clients

• Improving the veterinary experience for cats and clients

• Reaching out to and educating more cat owners on the importance of feline preventive medicine

• Celebrating the unique nature of cats through your marketing, website, and social media.

Tips

• Consider achieving the Cat Friendly Practice designation awarded by the AAFP.

• Achieving a reputation as a practice with a strong affinity for cats takes time and effort, but doing so offers significant rewards both for practices and feline patients.

Handout

Margie Scherk, DVM, DABVP, catsINK, Vancouver, Canada

What Your Cat Isn’t Telling You: Top 10 Signs of Sickness

If you see any of these signs in your pet, it’s time to call the veterinarian.⁶ Even subtle changes can be really important.

Problem 1: That’s not where he should be “going”!

When cats avoid the litter box, they are trying to tell you something. The message may be one of physical discomfort or psychological distress.

Problem 2: He’s not acting like himself.

Changes in a cat’s interactions with people, other animals, or the environment may indicate pain or distress.

Problem 3: Is he just getting older?

A decrease in energy may be abrupt or gradual. If your pet is healthy, he or she shouldn’t be “just getting older.” Activity changes could be a result of dehydration, pain, or some other underlying illness. Acting young for his age may also be a sign of a problem, such as hyperthyroidism.

Problem 4: What’s up with his sleeping?

Has the pattern (times of day and night), places, or posture of sleeping changed?Is your pet yowling at night? This can be caused by a decline in vision or hearing, high blood pressure, hyperthyroidism, pain, or dementia.

Problem 5: He’s not eating or drinking the way he used to.

This refers to quantity and changes in behaviors associated with eating and drinking (eg, where, how often, amount at each instance, enthusiasm, body posture).

Problem 6: His weight seems to be changing for no reason.

Even when on a diet, weight loss is normally very gradual. Things that could cause rapid weight loss include dental or oral disease. Weight gain, meanwhile, often results from eating too many calories, but it could also be caused by fluid accumulating in the chest or abdomen.

Problem 7: He won’t stop grooming! And is that a hairball?

Nonstop grooming is a sign of skin irritation (eg, itching, dryness, pain) or distress. However, a decrease in grooming is also often associated with mouth, joint, or back pain. If you are finding hairballs, these may be a sign of skin or intestinal problems, psychological distress, or pain.

Problem 8: Is he stressed?

In addition to inappropriate elimination and overgrooming, signs of distress include hiding, chewing on nonfood items, tail flicking, and holding ears farther back than normal.

Problem 9: His vocalization is changing.

Changes in vocalization (eg, tone, pitch, urgency, frequency) should be evaluated by your veterinarian.

Problem 10: He has bad breath.

Many conditions in the mouth cause bad breath. Periodontal disease is very common in cats, but bad odors can also come from infected ulcers, tumors, abscesses, and from grooming anal sacs or an infected body region.

Taking Me on Trips

The Perfect Carrier

Despite previous unpleasant experiences, a cat can be taught that a carrier and travel don’t have to be stressful. A carrier is important for everyone’s safety and should be a cozy, secure place. The right carrier should be sturdy and open quietly from both the top and the side. The top should come off quickly and easily to allow you to access your kitty without pulling or tipping him out.

A Happy Place

Make the carrier a place that your cat likes to be in at home. Put it somewhere convenient for both you and your cat, such as near his favorite resting place. The location should be out of the way and safe from intrusion. If this spot is off the ground, it should be secure and big enough that the carrier won’t fall. Keep the door open at all times for easy access and put a soft towel or fleece inside. It may also help to keep the carrier top off for some time to encourage climbing into the new nest. You can use dangly toys (eg, wands) to encourage your cat to climb into and out of the carrier. Feeding your kitty inside the open carrier helps change associations in a good way.

Practice Makes Perfect

When your cat climbs into the carrier, immediately praise him and give him a reward (eg, treat, catnip, cat grass). Over a few days or weeks, once your cat associates the carrier with rewards, close the door to the carrier before you praise and reward. Open the door again so he can come out at will.

Facial pheromones (feliway.com) can be sprayed in or wiped inside the carrier to increase the sense of security. Try to apply it 15-30 minutes before your cat gets into the carrier so the alcohol in the spray evaporates.

Ready for Lift-Off

When (re)training your cat or kitten to be a fear-free traveler, it is important to break the trip down into the following little steps, providing rewards at each step to be sure that your cat is comfortable with each one before moving on to the next step on the next day. Wean him or her into the new, stress-free experience, one new step at a time:

• Cover the carrier with a towel or blanket

• Hold the carrier steady with a hand on either side, or stabilize it with one hand under it and the other on the handle

• Place the carrier into the back seat of the car (ie, away from potential airbag harm) and secure it with a seatbelt

• Close the door, get into the front seat and close your door, and start the engine

• Drive to the end of the driveway and back.

Begin with short trips around the block, then increase to slightly longer drives, working up to a drive to the practice (without the cat being examined or handled) to complete the process.