Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Calmer Pets, Safer Vets: The Power of Low-Stress Care
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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SPEAKER_03:Welcome to Veterinary Vertex, the AVMA Journal's podcast where we delve into behind-the-scenes look with manuscript authors. I'm editor-in-chief Lisa Fortier, joined by Associate Editor Sarah Wright. Today, we're discussing how a practice-wide certification in stress-reducing animal care lowers the rate of patient-induced injuries to veterinary staff in Small Animal General Practice with the co-authors Jean Pavlovsky and Ellen Everett. Jean and Ellen, thank you so much for taking time out of your super busy schedules to be with us here today.
SPEAKER_04:Thank you. Thanks for having us.
SPEAKER_01:Yeah, thank you so much for joining us, Jean and Ellen. As Lisa said, we're so excited to have you. And before we dive in, Ellen, could you share a little about your background and what brought you to investigating patient handling techniques and staff injury rates?
SPEAKER_04:I'd be happy to. So uh I am a small animal general practitioner. Um, and this paper was the result of um I joined the faculty at the University of Georgia um in community practice, so teaching primary care to that students. And a small portion of my job was scholarly activity, which I felt like a complete duck out of water, fish out of water. But um, I knew that I wanted to try to do research that had a really applicable, easy-to-approach impact on my general practice colleagues and on our patients. So that's kind of where my heart was when I tried to think up what to do. Um, and then I one day was, you know, checking email and uh a notification came out from the teaching hospital safety officer about everybody be careful. We've had a few more incidents of bites from our patients lately. Remember safety first. And I thought, huh, I there's a huge variation in how often I see veterinary staff getting bitten in the various practices I've worked in and, you know, visited over the years. I wonder what causes that. You know, it certainly ruins your day if you get bitten badly or scratched badly by a patient, but it can be even life-threatening or career-ending for those more serious injuries. So I started wondering about the variables, and then it dawned on me that some places I worked, a lot of the staff had training and either fear-free or low-staff handling. In some places I work, they had none. And we kind of resorted to a lot more of the traditional handling techniques. And I wondered if that was one of the variables that affected injury of the staff. So that's why we looked into it.
SPEAKER_03:Oh, that's fascinating. I'm an equine person, so I don't get bitten too much, but certainly a lot of strikes in the hind end coming at me.
SPEAKER_04:When you guys get hurt, you get hurt really bad sometimes.
SPEAKER_03:Knock wood. Uh, Gene, how did you and Ellen identify the specific stressors that most affect the patients in the veterinary clinical setting?
SPEAKER_02:Um, you know, uh, it's a really good question. We um used our own subjective experience on what the stressors might be. There's a lot of research out there on what the actual stressors within the hospitals might be that uh can result in various negative emotions and stress and fear and frustration and anxiety. And then we worked really hard on making a survey that would be easy for the participants to answer and provide that input on what those stressors were inside the hospitals. Uh, we identified uh the most common scenarios that uh led that we thought led to human injury. And then we focused our survey questions around those scenarios to try to identify uh where the injuries happen more frequently and how.
SPEAKER_03:And it's one thing to identify the where and the how. How did you actually measure that you improved incomes with this training? I meant outcome.
SPEAKER_02:Yeah, we uh our our I guess our survey uh went out to a variety of uh small animal practices. We tried to gauge the level of uh training and certification among those practices and determine whether or not the entire practice was um trained and certified. And that could have been all individual members of the practice achieving that certification or having the entire practice certified. And so then we compared the rates of injuries and the frequency at which people got injured among the groups of practices that we split up into those that got injured, uh recorded injuries more than once a month or less than once a month. And then we compared those two groups, which were nearly equal. And then that's where we saw the difference. Um the difference was basically in those practices that achieved 100% certification.
SPEAKER_03:Wow, that's pretty cool. What other surpr findings surprised you?
SPEAKER_04:One of the big ones that we were surprised about is that the practices, there was not a difference in injury rates among practices that used a lot of either pre-visit medication, so things like trazidone and gavapentin, or in clinic sedation. So maybe, you know, a pet is difficult to handle. You sedate them with some dexmed, etomidine, and buttorphenol or something like that to be able to draw their blood or trim their nails or whatever needs to be done. Um, and those using pre-visit meds and sedation are generally something that these low stress handling programs do advocate for. So we thought we would see more drugs being used in the practices that had more training and the practices, and we thought that that would also correlate with injuries, but it did not. So there was not a significant difference um between medication and sedation and injury rate. And we have a couple of theories about that. Um, one, maybe pets are getting really, really stressed in practices that don't have training in low stress handling. And then they end up needing to sedate more of their patients because that that animal has been escalated throughout the visit. Um that was that's kind of the theory that we came up with there. Uh, but there could be certainly more to look into with that in the future.
SPEAKER_03:I think too, again, speaking from the equine side, if you really heavily sedate a horse, you get a false sense of security. And maybe you don't move the same. I I don't know. Like I I it always makes me nervous when people are like, oh, he's sedated, it's fine. I'm like, uh-huh.
SPEAKER_04:That's a really good point.
SPEAKER_03:Gene, what future directions? I mean, you talked uh maybe part of it is the medication part, but what other unanswered questions has this line of research open for you guys?
SPEAKER_02:You know, uh there's so much research out there already on the benefits of reducing stress in the hospital for small animal patients. And there are hospitals that have successfully implemented those measures and maybe they've went out, gone out and achieved some form of certification and improved their culture within the hospital so that everyone is on board and everyone is participating in those measures. And there are hospitals that that either don't have an interest in that and don't see value in it or are struggling to implement those uh those uh measures. And so I think from the standpoint of um data and evidence, it would be um interesting to me to find out what it is that's made those hospitals successful that have been able to implement the culture shift, which is I think is the most difficult and achieved um lower rates of injuries and and maybe even better um income, as you had said before, because more happy clients, more happy patients uh come in more frequently. And so I would be interested to see what it is that's made those hospitals successful.
SPEAKER_01:Yeah, my cat's hospital, they're all fear-free certified, they have like a little sticker on the door. I will say anecdotally, from like a client perspective, it is really nice, like seeing your pet just be a bit calmer and you can definitely see the change. I might just be also just more hyper aware of it from coming from a clinical practice setting like myself, but it's it is really nice from a client perspective as well.
SPEAKER_02:For sure. For sure.
SPEAKER_01:So, what are some of the key take-home messages that you hope veterinarians will remember from this work?
SPEAKER_04:I think the big thing to send home is that we didn't see a statistical difference in injury rates unless every individual in the practice. So that goes from, you know, the people working at the front desk all the way back um had training. And we had a couple different reasons that we thought that might be the case. You know, as Jean mentioned, the cultural shift. So people are sort of gonna, there's gonna be a little peer pressure to follow your training if everybody's been through the same training, or you see your colleague struggling with a patient, maybe getting a little frustrated or the patient's looking a little stressed or starting to show some signs of aggression. And maybe you step in and say, Hey, I got an idea. Let's try doing something different so that we can still accomplish what we need to with that animal without escalating their aggressive behavior. Um so maybe it's a culture shift thing. The other component that we theorized is that, you know, if the whole team isn't on the same page with reducing stress in our patients, maybe the veterinarian has done fear-free or low stress or cat-friendly training, and maybe some of the more experienced technicians have too. But if your new higher vet assistant who doesn't have a lot of training on reading body language and is maybe a little nervous, is the first person to go get that pet out of their carrier. Maybe they're a little nervous and they don't know what to do, so they pick the cat up by the scruff. That patient already has escalated before it even meets the more experienced members of the team. And so the early experience that that animal has, you even when their owner gets them in the car to come to the vet, maybe they need some pre-visit meds, or maybe they need a different type of carrier, or maybe they need nausea meds for the car ride, and all of that goes into reducing stress in the patient so that hopefully they're less likely to injure somebody and have a bad experience themselves throughout their vet visit.
SPEAKER_03:Well, maybe if this is available in the 90s, I might have gone into small animal because say this before that I would go in with a nasty bull or a stallion or mean chestnut mare any day, but a mean cat in the cage, no way. No way was anyone near that cat.
SPEAKER_04:That's a huge part of it. I remember being really scared early in my career, and I worked in a place where there were a lot of young vet assistants who had minimal training. So I knew like if anybody is getting the rabies shot on this cat today, it's gonna, it's up to me. I gotta, you know, I gotta bit put my big girl pants on and go get this hissing, spitting cat out of the carrier and deal with it. And that was really scary. And I can see why people, you know, I think some of the old handling techniques that many of us were taught just a few years ago, they come from a place of fear and misunderstanding. And so um, I think that we all need we'll all evolve how we practice medicine. And that includes how we handle our patients. 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're ready. Because I think it's it's a new um, it's gonna save us getting hurt and our patients having bad experiences.
SPEAKER_03:Yes. Ellen, was there was that hissing, spitting rabies cat or cat getting rabies vaccine, the sentinel case, or was there another case that made you realize the importance of handling techniques?
SPEAKER_04:You know, at that point in time, I did not have much exposure to some of the training 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 colleagues say things like, oh, fear-free training is just feeding peanut butter and not putting a muzzle on, and you're more likely to get hurt if you're in a practice that's into fear-free. And that individual who said that obviously hadn't seen the content of these training programs, or they wouldn't have been saying that because it's not true. Um, but I think there's just a lot of misconceptions and um maybe some stubbornness, maybe some shame. So hopefully we can all keep an open mind. And now there's, as we've alluded to, kind of a monetary incentive for practices to get their staff this training. If you have not as many people getting hurt, missing work, driving up your workers' comp insurance rates, that's a positive for everybody.
SPEAKER_01:So, Jean, looking ahead, what are the next steps to research in this area?
SPEAKER_02:Well, it you know, I I think it's it's it's interesting that that question came up because even since our paper, there have been papers published on similar topics um in what I thought was a good direction. Other people have picked up. For example, there's been uh two papers already evaluating the patient handling methods and their impact on physiological and behavioral measures. So, how does the way we handle patients change their physiological parameters and their stress scores? That that's already been looked at. There's been a paper that uh looked at uh the cost comparison between um sort of early and late sedation. You know, how how does this uh impact the cost of care? Um, so I I think for me, as I um sort of alluded to in a previous question, I I think for me I would really be interested in knowing uh the specific factors that go into successful implementation of these programs. You know, the programs are out there for veterin teams to uh participate in and and engage in, but how does that actually happen? And what is it that makes them successful? So somehow I I I I I think in order for this to become a more wide widespread, acceptable way of doing things, we need to know what it is that's made others successful so far.
SPEAKER_01: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 of your program for handling birds too. So yeah, definitely very interesting. And Jean, kind of going long, though, I just asked, but are there any other specific areas that you think are most in need of deeper investigation or refinement?
SPEAKER_02:I I think it's um I mean I think it sort of goes along with the with the initial question on how to change the culture. I think it it would be this this may be a little digging, digging a little too deep into the psychology of being a veterinarian and veterinary professional. But um I I think that in in a lot of cases, we become somewhat immune to our patients' emotional stress. Um, and it has been actually shown that um human medical practitioners and providers do become somewhat immune to um, especially children's uh emotions when they're undergoing medical procedures. And it sort of becomes uh this is the way we do things. And in order for us to be able to get this done, uh, we need to be able to restrain this child or something like that. So I think that's trying to figure out why it is that we become immune to these types of things and and maybe finding ways to bring back um the reason why we're actually in this professional, as I think Ellen alluded to this. And if I may just add to what Ellen had said, uh had said, I think that for me this type of a topic became important for a couple of reasons. One is having children myself made me uh made me think about how they uh how scared they may be going to a medical professional. I have one one kid that has, you know, a fairly immense fear of medical procedures. And then having my own animals that become scared, I think it just kind of triggers a little bit of compassion and tries, it kind of makes you think differently about what we do. So I think kind of digging into this sort of underlying reasons for why we sometimes don't think of our patients as being scared and instead think of them as being mean, um, that changes your perception and the way you approach them, I think. And if you think of them being scared or stressed versus just, you know, homicidal and trying to murder you, I think that that probably changes the way you handle them as well.
SPEAKER_03:Yeah, I think that's a really good point. I even see it at the barn that I ride at. If a horse is like jigging around and you know, they're about to change a bandage or something, and uh, you know, I've seen people get upset with a horse. I'm like, calm down, they're just afraid. They're just afraid that that might hurt.
SPEAKER_02:Right. Yeah. I mean, the fear of pain is fear of pain is real.
SPEAKER_03:Yeah, yeah. And like you said, it's a culture shift. Gene, were there particular experiences in your education or early career that shaped your approach to this topic?
SPEAKER_02:Yeah, you know, I mean, uh, for the first few years of my life, uh, or my my life, my career, uh, I did the same things that everyone else did and implemented the same handling measures. And I've seen um uh I mean, honestly, unnecessary suffering, even physically. I mean, the use of local anesthetics for the sake of time, you know, hand, you know, handling patients in such a way that just made them more scared. And, you know, when I compare my early career to my later part, I got hurt more doing the things that I was taught to do then. You know, the scruffing of the cats and holding animals down until, you know, until you got things done made people get hurt more. And so then when we were in the initial parts of this study, uh it seemed obvious to us, at least subjectively, that the way we handled patients impacted how much we got hurt. And so there were probably dozens upon dozens of specific examples which made this easier to launch, you know, in terms of the study. But it all really surrounds the same thing, you know.
SPEAKER_03:How about on the people side, Ellen? Were there any mentors or colleagues that played a pivotal role in guiding your thinking on this topic or in research methods in general?
SPEAKER_04: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 an interest in it, not enough to become a behaviorist myself, but I've always, you know, sort of kept an ear perked whenever uh interesting behavior topics were being talked about at continuing education conferences and things like that. Um I'm not afraid to tackle your, you know, basic general practice level behavior problem, whereas I feel that a lot of that's our sort of feeling out of their l element with that sort of thing. Um, so she helped us with I reached out to her um because I said, I've never published a paper before. I don't I need help. I don't even know where to write how to write one. And she Kind of was our uh our coach on this paper as well as um the wonderful statistician at UT who uh got all the numbers sorted out properly for us and made sure that our survey questions were um unbiased and we're not going to lead our respondents to answering a certain way. So that was really important to us. And we're grateful for their guidance.
SPEAKER_01:Yeah, it's important to have a good team.
SPEAKER_04:A good foundation really helps you along the way when it comes to And everyone on the team was very patient because I had very little time between teaching and seeing patients to work on this. And it was the project was also interrupted by two maternity leaves. Uh so we it's spread out over a couple of years, but we got it done. And definitely Gene was uh very instrumental toward the end in getting us across the finish line.
SPEAKER_01:Awesome. That's great to hear. And Jean, looking back, is there any aspect of your training that you now see differently because of this project?
SPEAKER_02:Um there wasn't a whole lot of behavior training in in vet school at all. I I remember I remember graduating and just the most basic of things, I thought back and and remembered that no one taught me how to potty train a puppy. You're just supposed to figure, figure this out on your own, you know? So there wasn't much in my uh in my vet school career. And um the advice that I got from people that mentored me uh is is no longer considered to be the standard advice for managing behavior. A lot of it was based on outdated theories like dominance theory and, you know, and things like that. And so in in retrospect, I would have probably been happier and avoided injuries more if I had, you know, if the behavior science was where it is now and if we were taught differently, I think um, you know, I think we all probably would have benefited from from that.
SPEAKER_04:And that's one of the beauties that I loved during my time teaching, and I think you probably feel the same way, Gene, is that we can have this opportunity to give some of this information to vet students now and make this a little bit more mainstream.
SPEAKER_02:For sure.
SPEAKER_03:Fantastic. Uh, Alan, what is one tool or technique that you use every day in this aspect that you can't imagine practicing today without the game?
SPEAKER_04:You know what? Every time that I open a packet of churu for a cat patient, if anyone doesn't know what churroo is, it's this um very yummy, very aromatic uh treat that comes in like a little tube and they lick it uh right out of the package while you um examine them or draw their blood or whatever it is you need to do. And it is like very addictive for cats. Even the most scared kitties will get a little whiff and then come and say, Yes, I need to lick that. And a lot of them just that is the restraint, letting them lick the churu. They're so into it that they don'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 before churu? Uh, it's amazing. It's amazing stuff.
SPEAKER_03:That's amazing. Gene, how about you? What's your tool that you can't imagine practicing without?
SPEAKER_02:Uh mine's more of a technique. You know, there are dogs uh that are super stressed and scared, and you can't even touch them. Like you you want to sedate them, but in order to be able to sedate them, you have to approach them, you have to handle them, you have to poke them with the needle. And so for me, uh the drive-by sedation technique has been sort of revolutionary. You know, it's a it's a sort of a hands-off way to sedate a dog without having to restrain them at all, um, which makes a huge difference. So that's been that's been a game changer for me.
SPEAKER_03:Very cool. And Jean, what what's a common misconception about low stress handling that you really enjoy clearing up with people?
SPEAKER_02:Yeah, and then I I think Ellen sort of referenced this a little bit, but the common misconception is that minimal handling actually increases injuries. You know, I've had people say to me in response to a statement such as, well, you know, we don't recommend scruffing cats. The response at times has been, well, do you want me to get hurt more? Do you want me to get bit? You know? So like there is a misconception out there that handling them less will result in more injuries. And the corollary to that is that the more you hold them, the more you restrain them, the less likely you're gonna get injured, which is actually the opposite of what we found in our study. And it makes sense because most animals do feel threatened when they're restrained more. And the more threatened they feel, the more protective they're gonna be, and the more aggressive they might become. And so the more you hold them, the more uncomfortable they become, the more scared they are, and the more aggressive they are. And so it's a it's it's it's not an easy conversation with uh people who are really set in their ways and and are averse to learning a new technique or changing things they do. But it is something that I like to talk about because I think it's important to clear up those misconceptions.
SPEAKER_01:Yeah, this is another good Mythsbuster episode. It's also so hard to like retrain your brain about something. I feel like it's like a knee-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:Or the big um hugging a dog against your chest for restraint. Um, it's just what we were all taught, even you know, like five, 10 years ago. Standard um and still is being taught uh by some individuals and some institutions. So uh it'll it'll come with time, I think. But the more we can open people's eyes and help them realize that there's a lot of good reasons to embrace this, I think it'll be mainstream someday soon, I hope.
SPEAKER_01:Well, baby steps, we're getting there. And Gene and Ellen, thank you so much for joining us. Really appreciate you being here today.
SPEAKER_02:Thank you for having us. Thanks very much.
SPEAKER_01:And for our listeners and viewers, you can read Gene and Ellen's article in JAFMA. I'm Sarah Wright here at Lisa Fortier. Be sure to tune in next week for another episode of Veterinary Vertex. And don't forget to leave us a rating and review on EPA Podcasts or wherever you listen.
