Calmer Pets, Safer Vets: The Power of Low-Stress Care

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A calmer patient isn’t just a kinder visit—it’s a safer workplace. We sit down with researchers Drs. Gene Pavlovsky and Ellen Everett to unpack new data showing that veterinary teams see decreases in bites and scratches when every staff member completes low-stress handling certification. Partial participation helped culture in pockets, but it didn’t move the needle on injuries. The lesson is clear: safety is a system, not a solo skill.

We trace where stress truly starts, from the parking lot to the waiting room, and why early moments—carrier handling, first touch, body language checks—set the tone for the entire appointment. Gene and Ellen explain how teams identified high-risk scenarios and compare practices that rely on pre-visit medications or sedation to those built on consistent, low-stress workflows. The surprise? More drugs alone did not equal fewer injuries. Instead, shared training and peer accountability turned the tide: a receptionist who redirects a nervous dog to a quiet space, a certified veterinary technician who swaps scruffing for treats and positioning, and a veterinarian who uses “drive-by” sedation for severely fearful patients.

Along the way, we challenge a stubborn myth that heavier restraint makes staff safer. Data and lived experience point the other way—restraint escalates fear, and fear drives defensive aggression. We talk practical tools like Churu for cats, environmental tweaks, and stepwise protocols that protect staff while preserving patient welfare. We also cover the business case: fewer missed days, lower workers’ comp exposure, smoother procedures, and clients who notice the difference and come back.

If you lead a small animal practice, teach vet students, or simply want better outcomes without bruises or burned-out teams, this conversation maps a path from intention to implementation. Subscribe, share with your team, and leave a rating and review—then tell us what’s helped your hospital make low-stress care the norm.

JAVMA article: https://doi.org/10.2460/javma.25.05.0325

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Episode Transcript

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SPEAKER_03 (00:35):
Welcome to Veterinary Vertex, the AVMA
Journal's podcast where we delveinto behind-the-scenes look with
manuscript authors.
I'm editor-in-chief LisaFortier, joined by Associate
Editor Sarah Wright.
Today, we're discussing how apractice-wide certification in
stress-reducing animal carelowers the rate of
patient-induced injuries toveterinary staff in Small Animal

(00:56):
General Practice with theco-authors Jean Pavlovsky and
Ellen Everett.
Jean and Ellen, thank you somuch for taking time out of your
super busy schedules to be withus here today.

SPEAKER_04 (01:08):
Thank you.
Thanks for having us.

SPEAKER_01 (01:10):
Yeah, thank you so much for joining us, Jean and
Ellen.
As Lisa said, we're so excitedto have you.
And before we dive in, Ellen,could you share a little about
your background and what broughtyou to investigating patient
handling techniques and staffinjury rates?

SPEAKER_04 (01:22):
I'd be happy to.
So uh I am a small animalgeneral practitioner.
Um, and this paper was theresult of um I joined the
faculty at the University ofGeorgia um in community
practice, so teaching primarycare to that students.
And a small portion of my jobwas scholarly activity, which I

(01:43):
felt like a complete duck out ofwater, fish out of water.
But um, I knew that I wanted totry to do research that had a
really applicable,easy-to-approach impact on my
general practice colleagues andon our patients.
So that's kind of where my heartwas when I tried to think up

(02:05):
what to do.
Um, and then I one day was, youknow, checking email and uh a
notification came out from theteaching hospital safety officer
about everybody be careful.
We've had a few more incidentsof bites from our patients
lately.
Remember safety first.
And I thought, huh, I there's ahuge variation in how often I

(02:28):
see veterinary staff gettingbitten in the various practices
I've worked in and, you know,visited over the years.
I wonder what causes that.
You know, it certainly ruinsyour day if you get bitten badly
or scratched badly by a patient,but it can be even
life-threatening orcareer-ending for those more

(02:50):
serious injuries.
So I started wondering about thevariables, and then it dawned on
me that some places I worked, alot of the staff had training
and either fear-free orlow-staff handling.
In some places I work, they hadnone.
And we kind of resorted to a lotmore of the traditional handling
techniques.

(03:10):
And I wondered if that was oneof the variables that affected
injury of the staff.
So that's why we looked into it.

SPEAKER_03 (03:18):
Oh, that's fascinating.
I'm an equine person, so I don'tget bitten too much, but
certainly a lot of strikes inthe hind end coming at me.

SPEAKER_04 (03:26):
When you guys get hurt, you get hurt really bad
sometimes.

SPEAKER_03 (03:29):
Knock wood.
Uh, Gene, how did you and Ellenidentify the specific stressors
that most affect the patients inthe veterinary clinical setting?

SPEAKER_02 (03:39):
Um, you know, uh, it's a really good question.
We um used our own subjectiveexperience on what the stressors
might be.
There's a lot of research outthere on what the actual
stressors within the hospitalsmight be that uh can result in
various negative emotions andstress and fear and frustration
and anxiety.
And then we worked really hardon making a survey that would be

(04:00):
easy for the participants toanswer and provide that input on
what those stressors were insidethe hospitals.
Uh, we identified uh the mostcommon scenarios that uh led
that we thought led to humaninjury.
And then we focused our surveyquestions around those scenarios
to try to identify uh where theinjuries happen more frequently

(04:22):
and how.

SPEAKER_03 (04:23):
And it's one thing to identify the where and the
how.
How did you actually measurethat you improved incomes with
this training?
I meant outcome.

SPEAKER_02 (04:32):
Yeah, we uh our our I guess our survey uh went out
to a variety of uh small animalpractices.
We tried to gauge the level ofuh training and certification
among those practices anddetermine whether or not the
entire practice was um trainedand certified.

(04:52):
And that could have been allindividual members of the
practice achieving thatcertification or having the
entire practice certified.
And so then we compared therates of injuries and the
frequency at which people gotinjured among the groups of
practices that we split up intothose that got injured, uh
recorded injuries more than oncea month or less than once a

(05:14):
month.
And then we compared those twogroups, which were nearly equal.
And then that's where we saw thedifference.
Um the difference was basicallyin those practices that achieved
100% certification.

SPEAKER_03 (05:25):
Wow, that's pretty cool.
What other surpr findingssurprised you?

SPEAKER_04 (05:30):
One of the big ones that we were surprised about is
that the practices, there wasnot a difference in injury rates
among practices that used a lotof either pre-visit medication,
so things like trazidone andgavapentin, or in clinic
sedation.
So maybe, you know, a pet isdifficult to handle.

(05:51):
You sedate them with somedexmed, etomidine, and
buttorphenol or something likethat to be able to draw their
blood or trim their nails orwhatever needs to be done.
Um, and those using pre-visitmeds and sedation are generally
something that these low stresshandling programs do advocate

(06:12):
for.
So we thought we would see moredrugs being used in the
practices that had more trainingand the practices, and we
thought that that would alsocorrelate with injuries, but it
did not.
So there was not a significantdifference um between medication
and sedation and injury rate.

(06:33):
And we have a couple of theoriesabout that.
Um, one, maybe pets are gettingreally, really stressed in
practices that don't havetraining in low stress handling.
And then they end up needing tosedate more of their patients
because that that animal hasbeen escalated throughout the
visit.

(06:53):
Um that was that's kind of thetheory that we came up with
there.
Uh, but there could be certainlymore to look into with that in
the future.

SPEAKER_03 (07:03):
I think too, again, speaking from the equine side,
if you really heavily sedate ahorse, you get a false sense of
security.
And maybe you don't move thesame.
I I don't know.
Like I I it always makes menervous when people are like,
oh, he's sedated, it's fine.
I'm like, uh-huh.

SPEAKER_04 (07:19):
That's a really good point.

SPEAKER_03 (07:21):
Gene, what future directions?
I mean, you talked uh maybe partof it is the medication part,
but what other unansweredquestions has this line of
research open for you guys?

SPEAKER_02 (07:32):
You know, uh there's so much research out there
already on the benefits ofreducing stress in the hospital
for small animal patients.
And there are hospitals thathave successfully implemented
those measures and maybe they'vewent out, gone out and achieved
some form of certification andimproved their culture within

(07:53):
the hospital so that everyone ison board and everyone is
participating in those measures.
And there are hospitals thatthat either don't have an
interest in that and don't seevalue in it or are struggling to
implement those uh those uhmeasures.
And so I think from thestandpoint of um data and
evidence, it would be uminteresting to me to find out

(08:14):
what it is that's made thosehospitals successful that have
been able to implement theculture shift, which is I think
is the most difficult andachieved um lower rates of
injuries and and maybe evenbetter um income, as you had
said before, because more happyclients, more happy patients uh

(08:35):
come in more frequently.
And so I would be interested tosee what it is that's made those
hospitals successful.

SPEAKER_01 (08:40):
Yeah, my cat's hospital, they're all fear-free
certified, they have like alittle sticker on the door.
I will say anecdotally, fromlike a client perspective, it is
really nice, like seeing yourpet just be a bit calmer and you
can definitely see the change.
I might just be also just morehyper aware of it from coming
from a clinical practice settinglike myself, but it's it is
really nice from a clientperspective as well.

SPEAKER_02 (09:00):
For sure.
For sure.

SPEAKER_01 (09:02):
So, what are some of the key take-home messages that
you hope veterinarians willremember from this work?

SPEAKER_04 (09:07):
I think the big thing to send home is that we
didn't see a statisticaldifference in injury rates
unless every individual in thepractice.
So that goes from, you know, thepeople working at the front desk
all the way back um hadtraining.
And we had a couple differentreasons that we thought that

(09:29):
might be the case.
You know, as Jean mentioned, thecultural shift.
So people are sort of gonna,there's gonna be a little peer
pressure to follow your trainingif everybody's been through the
same training, or you see yourcolleague struggling with a
patient, maybe getting a littlefrustrated or the patient's
looking a little stressed orstarting to show some signs of
aggression.
And maybe you step in and say,Hey, I got an idea.

(09:49):
Let's try doing somethingdifferent so that we can still
accomplish what we need to withthat animal without escalating
their aggressive behavior.
Um so maybe it's a culture shiftthing.
The other component that wetheorized is that, you know, if
the whole team isn't on the samepage with reducing stress in our

(10:12):
patients, maybe the veterinarianhas done fear-free or low stress
or cat-friendly training, andmaybe some of the more
experienced technicians havetoo.
But if your new higher vetassistant who doesn't have a lot
of training on reading bodylanguage and is maybe a little
nervous, is the first person togo get that pet out of their

(10:33):
carrier.
Maybe they're a little nervousand they don't know what to do,
so they pick the cat up by thescruff.
That patient already hasescalated before it even meets
the more experienced members ofthe team.
And so the early experience thatthat animal has, you even when
their owner gets them in the carto come to the vet, maybe they

(10:53):
need some pre-visit meds, ormaybe they need a different type
of carrier, or maybe they neednausea meds for the car ride,
and all of that goes intoreducing stress in the patient
so that hopefully they're lesslikely to injure somebody and
have a bad experience themselvesthroughout their vet visit.

SPEAKER_03 (11:11):
Well, maybe if this is available in the 90s, I might
have gone into small animalbecause say this before that I
would go in with a nasty bull ora stallion or mean chestnut mare
any day, but a mean cat in thecage, no way.
No way was anyone near that cat.

SPEAKER_04 (11:26):
That's a huge part of it.
I remember being really scaredearly in my career, and I worked
in a place where there were alot of young vet assistants who
had minimal training.
So I knew like if anybody isgetting the rabies shot on this
cat today, it's gonna, it's upto me.
I gotta, you know, I gotta bitput my big girl pants on and go
get this hissing, spitting catout of the carrier and deal with

(11:47):
it.
And that was really scary.
And I can see why people, youknow, I think some of the old
handling techniques that many ofus were taught just a few years
ago, they come from a place offear and misunderstanding.
And so um, I think that we allneed we'll all evolve how we
practice medicine.
And that includes how we handleour patients.

(12:08):
There's no shame, there's no,you know, oh, you're old school
and you're doing it wrong.
It's just this is a new way.
Let's all embrace it when we'reready.
Because I think it's it's a newum, it's gonna save us getting
hurt and our patients having badexperiences.

SPEAKER_03 (12:25):
Yes.
Ellen, was there was thathissing, spitting rabies cat or
cat getting rabies vaccine, thesentinel case, or was there
another case that made yourealize the importance of
handling techniques?

SPEAKER_04 (12:37):
You know, at that point in time, I did not have
much exposure to some of thetraining protocols that are out
there now.
And I was just doing my best.
And I certainly also, you know,scruffed many a cat and um
didn't know any better.
And so and I heard colleaguessay things like, oh, fear-free
training is just feeding peanutbutter and not putting a muzzle

(12:59):
on, and you're more likely toget hurt if you're in a practice
that's into fear-free.
And that individual who saidthat obviously hadn't seen the
content of these trainingprograms, or they wouldn't have
been saying that because it'snot true.
Um, but I think there's just alot of misconceptions and um
maybe some stubbornness, maybesome shame.
So hopefully we can all keep anopen mind.

(13:21):
And now there's, as we'vealluded to, kind of a monetary
incentive for practices to gettheir staff this training.
If you have not as many peoplegetting hurt, missing work,
driving up your workers' compinsurance rates, that's a
positive for everybody.

SPEAKER_01 (13:40):
So, Jean, looking ahead, what are the next steps
to research in this area?

SPEAKER_02 (13:44):
Well, it you know, I I think it's it's it's
interesting that that questioncame up because even since our
paper, there have been paperspublished on similar topics um
in what I thought was a gooddirection.
Other people have picked up.
For example, there's been uh twopapers already evaluating the
patient handling methods andtheir impact on physiological
and behavioral measures.

(14:05):
So, how does the way we handlepatients change their
physiological parameters andtheir stress scores?
That that's already been lookedat.
There's been a paper that uhlooked at uh the cost comparison
between um sort of early andlate sedation.
You know, how how does this uhimpact the cost of care?

(14:27):
Um, so I I think for me, as I umsort of alluded to in a previous
question, I I think for me Iwould really be interested in
knowing uh the specific factorsthat go into successful
implementation of theseprograms.
You know, the programs are outthere for veterin teams to uh
participate in and and engagein, but how does that actually

(14:48):
happen?
And what is it that makes themsuccessful?
So somehow I I I I I think inorder for this to become a more
wide widespread, acceptable wayof doing things, we need to know
what it is that's made otherssuccessful so far.

SPEAKER_01 (15:03):
Yeah, I think that'd be a great question too to look
at in avian species as well.
I think there is like a fear ofyour program for handling birds
too.
So yeah, definitely veryinteresting.
And Jean, kind of going long,though, I just asked, but are
there any other specific areasthat you think are most in need
of deeper investigation orrefinement?

SPEAKER_02 (15:22):
I I think it's um I mean I think it sort of goes
along with the with the initialquestion on how to change the
culture.
I think it it would be this thismay be a little digging, digging
a little too deep into thepsychology of being a
veterinarian and veterinaryprofessional.
But um I I think that in in alot of cases, we become somewhat

(15:44):
immune to our patients'emotional stress.
Um, and it has been actuallyshown that um human medical
practitioners and providers dobecome somewhat immune to um,
especially children's uhemotions when they're undergoing
medical procedures.
And it sort of becomes uh thisis the way we do things.

(16:06):
And in order for us to be ableto get this done, uh, we need to
be able to restrain this childor something like that.
So I think that's trying tofigure out why it is that we
become immune to these types ofthings and and maybe finding
ways to bring back um the reasonwhy we're actually in this
professional, as I think Ellenalluded to this.

(16:28):
And if I may just add to whatEllen had said, uh had said, I
think that for me this type of atopic became important for a
couple of reasons.
One is having children myselfmade me uh made me think about
how they uh how scared they maybe going to a medical
professional.
I have one one kid that has, youknow, a fairly immense fear of

(16:52):
medical procedures.
And then having my own animalsthat become scared, I think it
just kind of triggers a littlebit of compassion and tries, it
kind of makes you thinkdifferently about what we do.
So I think kind of digging intothis sort of underlying reasons
for why we sometimes don't thinkof our patients as being scared
and instead think of them asbeing mean, um, that changes

(17:13):
your perception and the way youapproach them, I think.
And if you think of them beingscared or stressed versus just,
you know, homicidal and tryingto murder you, I think that that
probably changes the way youhandle them as well.

SPEAKER_03 (17:26):
Yeah, I think that's a really good point.
I even see it at the barn that Iride at.
If a horse is like jiggingaround and you know, they're
about to change a bandage orsomething, and uh, you know,
I've seen people get upset witha horse.
I'm like, calm down, they'rejust afraid.
They're just afraid that thatmight hurt.

SPEAKER_02 (17:42):
Right.
Yeah.
I mean, the fear of pain is fearof pain is real.

SPEAKER_03 (17:46):
Yeah, yeah.
And like you said, it's aculture shift.
Gene, were there particularexperiences in your education or
early career that shaped yourapproach to this topic?

SPEAKER_02 (17:56):
Yeah, you know, I mean, uh, for the first few
years of my life, uh, or my mylife, my career, uh, I did the
same things that everyone elsedid and implemented the same
handling measures.
And I've seen um uh I mean,honestly, unnecessary suffering,
even physically.
I mean, the use of localanesthetics for the sake of
time, you know, hand, you know,handling patients in such a way

(18:19):
that just made them more scared.
And, you know, when I compare myearly career to my later part, I
got hurt more doing the thingsthat I was taught to do then.
You know, the scruffing of thecats and holding animals down
until, you know, until you gotthings done made people get hurt
more.
And so then when we were in theinitial parts of this study, uh

(18:40):
it seemed obvious to us, atleast subjectively, that the way
we handled patients impacted howmuch we got hurt.
And so there were probablydozens upon dozens of specific
examples which made this easierto launch, you know, in terms of
the study.
But it all really surrounds thesame thing, you know.

SPEAKER_03 (19:03):
How about on the people side, Ellen?
Were there any mentors orcolleagues that played a pivotal
role in guiding your thinking onthis topic or in research
methods in general?

SPEAKER_04 (19:12):
Well, we have to definitely give a shout-out to
Dr.
Julie Albright.
She's uh board of behaviorist,and she was my behavior
professor in vet school.
Um, and uh I sort of took aninterest in it, not enough to
become a behaviorist myself, butI've always, you know, sort of
kept an ear perked whenever uhinteresting behavior topics were

(19:32):
being talked about at continuingeducation conferences and things
like that.
Um I'm not afraid to tackleyour, you know, basic general
practice level behavior problem,whereas I feel that a lot of
that's our sort of feeling outof their l element with that
sort of thing.
Um, so she helped us with Ireached out to her um because I

(19:53):
said, I've never published apaper before.
I don't I need help.
I don't even know where to writehow to write one.
And she Kind of was our uh ourcoach on this paper as well as
um the wonderful statistician atUT who uh got all the numbers
sorted out properly for us andmade sure that our survey
questions were um unbiased andwe're not going to lead our

(20:17):
respondents to answering acertain way.
So that was really important tous.
And we're grateful for theirguidance.

SPEAKER_01 (20:25):
Yeah, it's important to have a good team.

SPEAKER_04 (20:27):
A good foundation really helps you along the way
when it comes to And everyone onthe team was very patient
because I had very little timebetween teaching and seeing
patients to work on this.
And it was the project was alsointerrupted by two maternity
leaves.
Uh so we it's spread out over acouple of years, but we got it
done.
And definitely Gene was uh veryinstrumental toward the end in
getting us across the finishline.

SPEAKER_01 (20:50):
Awesome.
That's great to hear.
And Jean, looking back, is thereany aspect of your training that
you now see differently becauseof this project?

SPEAKER_02 (20:58):
Um there wasn't a whole lot of behavior training
in in vet school at all.
I I remember I remembergraduating and just the most
basic of things, I thought backand and remembered that no one
taught me how to potty train apuppy.
You're just supposed to figure,figure this out on your own, you
know?
So there wasn't much in my uh inmy vet school career.
And um the advice that I gotfrom people that mentored me uh

(21:22):
is is no longer considered to bethe standard advice for managing
behavior.
A lot of it was based onoutdated theories like dominance
theory and, you know, and thingslike that.
And so in in retrospect, I wouldhave probably been happier and
avoided injuries more if I had,you know, if the behavior

(21:45):
science was where it is now andif we were taught differently, I
think um, you know, I think weall probably would have
benefited from from that.

SPEAKER_04 (21:56):
And that's one of the beauties that I loved during
my time teaching, and I thinkyou probably feel the same way,
Gene, is that we can have thisopportunity to give some of this
information to vet students nowand make this a little bit more
mainstream.

SPEAKER_02 (22:12):
For sure.

SPEAKER_03 (22:13):
Fantastic.
Uh, Alan, what is one tool ortechnique that you use every day
in this aspect that you can'timagine practicing today without
the game?

SPEAKER_04 (22:21):
You know what?
Every time that I open a packetof churu for a cat patient, if
anyone doesn't know what churroois, it's this um very yummy,
very aromatic uh treat thatcomes in like a little tube and
they lick it uh right out of thepackage while you um examine
them or draw their blood orwhatever it is you need to do.
And it is like very addictivefor cats.

(22:44):
Even the most scared kittieswill get a little whiff and then
come and say, Yes, I need tolick that.
And a lot of them just that isthe restraint, letting them lick
the churu.
They're so into it that theydon't care what you're doing.
And every time I open a reach,reach over and grab a pack of
churu and open it for a kitty,I'm like, how did we ever even
do anything with cats beforechuru?
Uh, it's amazing.

(23:05):
It's amazing stuff.

SPEAKER_03 (23:07):
That's amazing.
Gene, how about you?
What's your tool that you can'timagine practicing without?

SPEAKER_02 (23:12):
Uh mine's more of a technique.
You know, there are dogs uh thatare super stressed and scared,
and you can't even touch them.
Like you you want to sedatethem, but in order to be able to
sedate them, you have toapproach them, you have to
handle them, you have to pokethem with the needle.
And so for me, uh the drive-bysedation technique has been sort
of revolutionary.
You know, it's a it's a sort ofa hands-off way to sedate a dog

(23:34):
without having to restrain themat all, um, which makes a huge
difference.
So that's been that's been agame changer for me.

SPEAKER_03 (23:42):
Very cool.
And Jean, what what's a commonmisconception about low stress
handling that you really enjoyclearing up with people?

SPEAKER_02 (23:51):
Yeah, and then I I think Ellen sort of referenced
this a little bit, but thecommon misconception is that
minimal handling actuallyincreases injuries.
You know, I've had people say tome in response to a statement
such as, well, you know, wedon't recommend scruffing cats.
The response at times has been,well, do you want me to get hurt

(24:13):
more?
Do you want me to get bit?
You know?
So like there is a misconceptionout there that handling them
less will result in moreinjuries.
And the corollary to that isthat the more you hold them, the
more you restrain them, the lesslikely you're gonna get injured,
which is actually the oppositeof what we found in our study.
And it makes sense because mostanimals do feel threatened when
they're restrained more.

(24:33):
And the more threatened theyfeel, the more protective
they're gonna be, and the moreaggressive they might become.
And so the more you hold them,the more uncomfortable they
become, the more scared theyare, and the more aggressive
they are.
And so it's a it's it's it's notan easy conversation with uh
people who are really set intheir ways and and are averse to
learning a new technique orchanging things they do.

(24:55):
But it is something that I liketo talk about because I think
it's important to clear up thosemisconceptions.

SPEAKER_01 (25:02):
Yeah, this is another good Mythsbuster
episode.
It's also so hard to likeretrain your brain about
something.
I feel like it's like aknee-jerk to scruff the cat,
right?
And you have to remember, oh no,like we can't there's different
ways we can do things.
Yeah.
Right.

SPEAKER_04 (25:12):
Or the big um hugging a dog against your chest
for restraint.
Um, it's just what we were alltaught, even you know, like
five, 10 years ago.
Standard um and still is beingtaught uh by some individuals
and some institutions.
So uh it'll it'll come withtime, I think.
But the more we can openpeople's eyes and help them

(25:34):
realize that there's a lot ofgood reasons to embrace this, I
think it'll be mainstreamsomeday soon, I hope.

SPEAKER_01 (25:45):
Well, baby steps, we're getting there.
And Gene and Ellen, thank you somuch for joining us.
Really appreciate you being heretoday.

SPEAKER_02 (25:52):
Thank you for having us.
Thanks very much.

SPEAKER_01 (25:55):
And for our listeners and viewers, you can
read Gene and Ellen's article inJAFMA.
I'm Sarah Wright here at LisaFortier.
Be sure to tune in next week foranother episode of Veterinary
Vertex.
And don't forget to leave us arating and review on EPA
Podcasts or wherever you listen.