Patients may be fractious as a result of an underlying behavior problem and/or situational fear, anxiety, and stress (FAS). These patients may be instinctively attempting to defend themselves or escape from a perceived threat, resulting in a stress response that can negatively impact health (eg, tachycardia, hypertension, cortisol release, increased oxygen consumption) and potentially exacerbate adverse effects of comorbidities.1 Patient and team member safety should be considered when managing fractious patients with comorbid disease.
Fear, Anxiety, & Stress
FAS can be prevented or diffused in some patients with gentle handling (eg, conducting examinations in a quiet area of the clinic) and environmental modifications (eg, using atomized calming pheromones).2,3 Gentle handling should be a component of every examination.
Use of an FAS scale can help determine whether an examination or procedure involving a fractious patient should proceed.4 If the situation cannot be diffused, the appointment should be rescheduled, anxiolytics prescribed for the next visit, and a behavioral consultation recommended. If immediate diagnostic testing and/or treatment are needed, sedation should be given, as forceful restraint can escalate negative patient behavior and possibly result in injury to the patient and/or team member.
Sedative doses required to reduce a patient’s excitement level are often higher than sedative doses in a calm patient5; however, higher doses may increase risk for physiologic adverse effects, which is especially concerning in patients with comorbidities.5 In addition, if a full diagnostic assessment is not possible, the extent of a comorbidity’s impact may not be known; therefore, the safest, most effective, and most humane solution is often referral to a veterinary behaviorist to investigate the underlying cause of fractious behavior prior to admission to a veterinary hospital (if possible).6,7