The Art of Veterinary Practice (excerpt)

Chapter 1 – The Bond and Behavior: The Core of the Art of Veterinary Practice

Years ago, Dr. D. O. Jones opened a senior lecture in Preventive Medicine at the Ohio State University College of Veterinary Medicine by noting that every profession consists of two parts: a science and an art. “The trouble with medicine,” D. O. continued, “is that we’ve got too many scientists and not enough artists.” A few research-oriented individuals and those headed for careers in large animal medicine smiled indulgently while the rest nodded respectfully, more out of habit than anything else. Today, however, it no longer suffices to practice only the science of veterinary medicine or only its art regardless what professional course we pursue: More and more the public demands that we do both. Nonetheless, developing the art of practice appears so maddeningly nonspecific and even inconsequential when compared to the burgeoning sea of medical science and technology that threatens to drown us that it’s easy to ask, “Why bother?” Two reasons immediately come to mind. First, we need only read texts such as James Wilson’s Law and Ethics of the Veterinary Profession (1988) and the legal columns in various veterinary journals and animal-related publications to realize that miscommunication gets practitioners in far more trouble than medical incompetency: Bob Grant isn’t nearly so upset that his cow died as he is that Dr. Brown didn’t share her feelings about the severity of the problem and her doubts about the efficacy of the treatment from the beginning. Similarly, the equally troublesome problem of noncompliance frequently results from a breakdown in communication: By the time Dr. Brown realizes Mary McCormick’s relationship to her setter makes medicating and bathing the dog impossible, the once localized skin infection has spread over the animal’s entire body.

Why do we experience these communications problems? As we shall see in the chapters ahead, many times problems arise because we haven’t taken the time to work through our own beliefs and feelings about those more subjective aspects of practice that dwell within the province of its art. Lacking this awareness we may wind up projecting our own beliefs on the client: Ms. McCormick insists the setter growls and curls its lip ominously whenever she tries to do anything to it at home, but Dr. Brown loves all setters and dismisses Mary’s remark as overreaction. Other times, we may find ourselves grappling with our beliefs for the first time in the owner’s presence: The day the setter lunges and snaps at Dr. Brown, all of her thoughts focus on whether to freeze, fight, or run—reactions which contribute nothing to the diagnosis and treatment of the dog’s skin condition let alone its behavioral problem. Third and at the heart of the art of practice, many times we and our clients don’t speak the same language: The veterinary educational system demands we speak the language of science and technology even as the majority of our clients communicate in terms of behavior and the human-animal bond. Because a surprising number of veterinarians consider the latter strictly small animal concepts, and many small animal clinicians see these as specialties, we can see why we must broaden our awareness of the bond and behavior if we wish to relate to and communicate with our clients and patients successfully.

The Science of Behavior

Like veterinary medicine itself, animal behavior and the human-animal bond each possess science and art components, and we need to understand both to appreciate the whole picture. When most people think of the science of animal behavior, they think of Konrad Lorenz and his geese, Karl Von Frish’s dancing honeybees, and the primate worlds revealed by the work of Jane Goodall and Dian Fossey. In the past those studying animal behavior adhered to the rules of science laid down by those in physics, astronomy, and chemistry and these rules, in turn, relied on the supposition of objectivity—that is, on the assumption that the researcher could somehow separate him- or herself from the subject.

However, the very nature of animals and their relationship to humans made playing by these rules particularly difficult for those studying animal behavior, and gradually the science began to consider different standards. Perhaps no three books capture the essence of this evolution more than Edward O. Wilson’s The Diversity of Life (1992) and Donald R. Griffin’s Animal Thinking (1984) and Animal Minds (1992), which gained the attention of both the academic community and the general public. Wilson deliberately wrote his text in a lyric style to convey and blend the processes of scientific discovery and natural history, a blatant divergence from the scientific norm. Pioneer animal behaviorist Griffin continues his often highly controversial quest to convince his colleagues that animals must and do think in his presentation of numerous studies that offer compelling evidence for a less mechanistic view of animal behavior. Whether we agree with the approaches taken by these highly credentialed individuals or not, their work has found its way into the public conscience; and because the majority of our clients dwell in the public arena, it behooves us to recognize the reality of these orientations.

Within veterinary medicine, the science of animal behavior tends to view animals as displaying either normal or abnormal—that is, problem—behavior and an ever increasing number of texts describing both in large and small animals now exist (Beaver 1992; Campbell 1986 and 1992; Fraser and Broom 1990; B.Hart 1985b; Houpt and Wolski 1982; Price 1987). Although the veterinary profession as a whole still perceives behavioral problems as less important than medical ones, informal surveys of various segments of the public indicate that they do not share this view. Practically anyone intimately associated with an animal shelter will say that behavioral problems remain the number one killer of dogs and cats in this country. Nonetheless, practitioners who wouldn’t hesitate to do something to help a dog which vomited three times in forty-eight hours will allow their clients to endure shredded furnishings for years because “everyone knows black Labs like to chew.” However, this never-ending quality of behavioral problems—that they rarely either go away or kill the animal without treatment within a relatively short time like many diseases—causes them to loom in their owners’ minds far more clearly than that fractured femur or bout of colic. Ironically, the very fact that so many of these animals fit our deeply ingrained, albeit limited, definition of health as a strictly physiological phenomenon permits many practitioners to dismiss behavioral problems as inconsequential.

The Art of Behavior

As obvious as it seems that clinicians should pay attention to their patients’ behavior from a scientific perspective for practical as well as moral reasons, an awareness of the subjective aspects of animal behavior plays an equally critical role in client communication. Consider the following list:

• coughing
• diarrhea
• off-feed
• limping
• depressed

Every veterinarian immediately recognizes these as signs or symptoms that trigger an often precise sequence of diagnostic and treatment procedures. However, a day spent manning the phone in an average practice reveals that many clients don’t share this view. To them, the cough or diarrhea isn’t a sign of the problem: The abnormal behavior is the problem.

The failure to recognize the discrepancy between these two orientations leads to a common and very frustrating practice experience. The Smiths present their animal to Dr. McPherson because it’s coughing; they want the veterinarian to stop the cough. However Dr. McPherson perceives stopping the cough as the final step in a process that begins with the question, “What is causing the cough?” To that end, he hospitalizes the animal and begins an extensive work-up. When the Smiths call for a progress report hours later, he confidently reports the available results and promises more by noon the next day.

“Is Tuffy still coughing so bad?” ask the Smiths, thereby giving Dr. McPherson his first inkling that he and his clients may be experiencing a communication problem.

At this point explaining that no attempts have been made to treat the animal pending the completion of the tests strikes Dr. McPherson as only slightly less dreadful than telling the owners that the work-up—which he now realizes they might not see as related to their animal’s problem—is going to cost them several hundred dollars. Because the veterinarian didn’t recognize that he and his clients started from quite different points relative to the definition of the animal’s problem, he must now justify asking them to accept and pay for treating his version of the problem instead of theirs. A practitioner once described this challenge as akin to telling someone who thought he was in Philadelphia why you took him from your office in Denver to Los Angeles instead of to New York City which is where he really wanted to go: It can be done, but it’s not easy.

Theoretically one way to avoid this dilemma would be to educate clients to see these behaviors as signs the same way we do. However, this also can lead to miscommunication because each one of us assigns a wide range of meanings to these behaviors based on our education and experience, two data bases most of our clients do not share. Dr. McPherson examines a calf and diagnoses gastrointestinal parasitism based on the evaluation of numerous objective and subjective factors. However he only mentions the animal’s watery diarrhea and listlessness as he explains the condition to the owner. Several months later the farmer stops in for medication for another calf displaying “the same signs as the one that bounced right back after worming” and Dr. McPherson dispenses the same medication. When he sees the now severely ill animal a week later, there’s no doubt in his mind it suffers from coccidiosis.

In addition to lacking the time and wherewithal to teach clients to perceive their animals’ behaviors as symptoms of disease on the same level we do, we also run the risk of imbuing our clients with our own diagnostic prejudices when we expect them to speak our language. Perhaps the most glaring example in this category involves feline urinary problems. The client presents the cat with the complaint that it’s not using the litter box, and the examination and work-up confirms a diagnosis of urinary tract disease. If the veterinarian then says to the client, “Not using the litter box is a major sign of this problem,” the client links that behavior with that medical problem and we can wind up with a situation in which the client calls up and confidently announces “Socks has that urinary infection again,” and requests medication every time the cat doesn’t use the litter box. Because these problems do tend to recur in cats, few clinicians give dispensing medication without seeing the animal a second thought. However not using the litter box is also the number one behavioral problem of cats; but unless clinicians recognize the validity of the behavior in and of itself, they will continue to view it as strictly a sign of a medical problem. After treating Socks repeatedly and living with the cloud of impending urinary blockage hanging over herself and her cat for months, the owner reluctantly accepts Dr. McPherson’s suggestion that he perform a perineal urethrostomy to eliminate at least that troubling aspect of the problem.

“Darn,” says Socks’s owner as the veterinarian carries the cat off to surgery. “I wish I’d never gotten that other cat. Socks never had any problems until then.”

In this particular case the link between the behavioral and medical problems is so strong, it seems safest to assume the potential for both always exists. A “pure” case of in-house territorial marking in response to a new cat in the neighborhood becomes a cystitis and potential obstruction when the presence of the interloper sufficiently stresses Socks to the point that he no longer eats, drinks, or eliminates normally. His resistance goes down and he becomes a prime candidate for infection, at which time he begins leaving small puddles of urine in random locations throughout the house as well marking his usual spots. Conversely, Socks could begin urinating on the rug because of an infection but his territorial nature might compel him to continue doing so long after his medical problem is resolved. Treating only the behavioral or the medical component won’t cure the cat because each one represents only half the problem.

Although this example may appear dramatic, virtually every problem seen in practice possesses a behavioral component. Once we recognize this as well as that that behavior can serve as the greatest source of the owner’s concern, we can more readily communicate with clients and expand the scope of our treatment to include this parameter.

The Science of the Bond

Of all the discoveries that have affected the veterinary profession perhaps none has confused more than the studies of the human/animal bond. When we read Katcher’s and Beck’s New Perspectives On Our Lives With Companion Animals (1983) or scan the increasing number of studies citing the positive benefits of animal companionship for the physically, mentally, and emotionally impaired, these simply add scientific credibility to something most of us knew intuitively: Being around animals makes many people feel better. However, the scientific validation of the bond now hangs over our heads like the sword of Damocles. On the one hand, we use it to justify treatments that rival those for humans in terms of sophistication and expense. On the other hand, if we err in our judgment or if the treatment fails, we can no longer quite so confidently hide behind that once inviolate protective legal shield that defined animals as chattel.

Here again large animal practitioners who feel tempted to heave a huge sigh of relief and exclaim, “Thank God I don’t have to worry about that!” could find themselves in an increasingly vulnerable position in the years ahead. When we couple the positive answers to the scientific studies which currently seek to answer the question, “What can companion animals do to improve human physical, mental, and emotional well-being?” with the increased number of wildlife studies that take a less-than-chattel approach as indicated by Griffin’s work, we can see that food animals exist in an artificial void between these two populations. As studies expand to include the multifaceted human-equine bond and the relationships between children and their 4-H projects, and as wildlife biologists wax ecstatic about the highly complex relationships that exist among wild ungulates and ruminants, it will become increasingly difficult for large animal clinicians to hang on to any strictly chattel attitudes. Even if the veterinary profession would support such an orientation, it seems highly unlikely that the vast majority of the population who live off the farm will allow it. Like Dr. Brown confronting her belief that all setters are lovable when the dog lunges at her, it would seem wiser to work out our beliefs about the food animal bond ourselves rather than have beliefs regarding it forced on us by others.

One scientific finding relative to the human-animal bond possesses such profound implications for the practice of veterinary medicine, it’s difficult to believe that few even acknowledge its existence. The study, conducted in 1929 by W. Horsley Gantt, essentially reversed the roles of human-animal bond studies as we now know them. Gantt remotely monitored the heart rate of a dog at rest and then when an assistant entered the room and interacted with the animal. During this interval, the dog’s heart rate went from a resting 100 beats per minute to 150, then gradually dropped to 40 BPM as the assistant stroked it. When the petting ended, the animal’s heart rate returned to the resting level, all with no change in the animal’s outward appearance following the initial greeting display. (Lynch 1987, 16:16-21)

Or consider a study done at The Ohio State University College of Medicine by Frederick Cornhill, who fed rabbits a diet designed to create arterial plaque so he could test the efficacy of an anticholesterol drug. After a specific feeding period, Cornhill tested the animals’ blood cholesterol levels and couldn’t understand why some of the rabbits consistently exhibited 50 percent lower rates than the others. Eventually he discovered the culprit: The technician who cared for the animals liked these particular rabbits and spent time holding and stroking as well as feeding them each day (Padus 1992, 502).

So even as the scientific data convincingly argues that animals can make us feel better, other work offers compelling evidence that nothing more or less than our concerned presence and touch can make animals feel better, too. And because the goal of our profession is to use our knowledge and skills for the benefit of society as well as to relieve animal suffering, it seems only logical to incorporate this awareness of the bond into the practice of veterinary medicine.

Lewis Thomas, president emeritus of the Memorial Sloan-Kettering Cancer Center, noted that human medicine took a major step backward when the stethoscope replaced the physician pressing his ear against the patient’s chest, an expression of mutual trust that seems practically suicidal in these litigious days in which the specter of real or imagined political incorrectness and sexual harassment lurks everywhere (Thomas 1983b, 57-58). However, veterinarians and their staffs still can legitimately and effectively make use of the healing touch in practice. Unfortunately, busy practitioners often claim they have no time for such displays as they rush from examination room to surgery to farm calls, a grave error on several counts. First, owners perceive the veterinarian’s lack of intimate contact with the animal as not caring, an oversight far more unforgivable in their eyes than technical incompetency. Second, we deprive the animal of the benefits of that touch. And third, we deprive ourselves of the benefits that interaction with the animal confers upon us, too.

The Art of the Bond

To some extent the art of the bond, like the art of behavior, reflects our ability to go from the accurate answers of science relative to the general population to the precise ones that enable us to treat a specific animal owned by a particular person at a particular time in a particular place. The science of veterinary medicine teaches us the etiology, diagnosis, and treatment of the various autoimmune diseases, but the art of practice teaches us how to deal specifically with autoimmune problems in the Barnetts’ sheep or cat.

An awareness of the art of the bond leads us to ask questions such as:

• How strong is the relationship between this person and this animal?
• What form does that relationship take?
• What kind of treatment is acceptable to these owners?
• What kind of financial commitment do these owners want to make?
• What kind of time commitment do they want to make?

Although we will discuss each of these parameters in more detail throughout the book, at this point we should note that, unlike an evaluation conducted from a scientific point of view, the answers to these questions are most variable and relative—that is, no “right” answer exists save the one that holds true for that owner and that animal at that particular time. Moreover, and the far greater challenge, the owner’s “right” answer may not be the same as ours and we must find some way to make peace with that; otherwise we’ll spend a lot of time trying to change the owner instead of treating the animal.

For example, every practitioner sees patients which they consider to be in a deplorable state of neglect, either in terms of general husbandry or a particular problem. At such times, the urge to chastise the owner or herdsman looms as the most natural and caring response. However, the very fact that we stand in a stall or examination room with the owner tells us that this person does care in his or her own way—otherwise we wouldn’t be there. Although we may tell ourselves that pointing out the owners’ sins will insure they never make them again, in fact this usually alienates clients because we’ve taken what they viewed as a right and good response—getting professional help for the animal—and turned it into an attack on those very values. Consider the following clinician responses to the Smiths’ admission that their pet has been coughing for more than a month:

“How in the world could you let that poor animal suffer so long!”
“I’m glad you brought Tuffy in. Let’s see if we can help him get rid of that cough.”

Although the first response may make the veterinarian feel better, it effectively dooms any chance for open communication with the client. The Smiths thought they did the right thing when they brought the dog in when they did; when Dr. McPherson condemns them, they feel confused and disoriented and this makes them defensive which, in turn, irritates Dr. McPherson even more. Compare this to the second response in which Dr. McPherson commends the owners for bringing the animal in, then focuses all his energy on treating the animal with the owners’ full cooperation. An awareness of the bond also makes it very clear that to some extent all of our treatments function as placebos in that they won’t work if the owners don’t believe in their rightness for their animals and themselves at least enough to implement them as directed. Moreover, and one of those miracles of practice, if a solid bond exists between the owner and the animal and the practitioner and the owner and the animal, even the most rudimentary treatments can yield the most amazing results.

For example, surely every practice is blessed with at least one client like Bob Donahue and his family who adore their pet but can barely keep food on the table, let alone afford anything extra for an animal. What makes Bob stand out as the perfect client in many ways is his relationship with his dog, Lady, and his honesty. During his first meeting with the practitioner, he introduced himself as “Call me Bob,” and unashamedly admitted he was a little slow and would keep asking questions until he clearly understood exactly what the veterinarian wanted him to do. He also promised that he and his family would do anything they could for the dog in terms of home care, but he couldn’t afford to spend much and wouldn’t take charity.

When Bob brought Lady in with her hind leg smashed and solemnly announced a dollar limit that barely covered the cost of an examination and the most minimal medication, no acceptable course of action rushed to fill the void his words created in the veterinarian’s scientifically trained mind. Nonetheless, the way the dog and her owners felt about each other and the way the clinician felt about them all made anything seem worth a try.

To make a long story short, the dog fully recovered on a primitive regime based on strict confinement, good nutrition (which meant family members upgraded the dog’s diet with specific items from their own plates), meticulous care of the wounds and the dog’s environment, some questionable antibiotic back-up, and lots of support from the family and everyone who knew them and the dog. Throughout this process, the idea of formulating such an irresponsible regime in terms of her training never strayed far from the practitioner’s mind. And yet when Bob would call or stop in with his children, the awareness of both the reality and the power of the bond would erase those doubts—at least momentarily. Although the clinician most certainly would never include this case on her scientific résumé, that outrageous nontreatment brought several new clients to the practice because everyone liked Bob and Lady, and Bob delivered beer and soda to practically every general store in the county. He could never say enough good about the veterinarian even though she did next to nothing and some of that was questionable. But she can never say enough good about Bob, either, because he taught her about the power of the bond in a way no text could.

This in no way means that an awareness of the bond serves like St Jude, the patron saint of hopeless cases, to bail us out when clients won’t allow us to practice our medical magic. In fact, cases such as this demand we summon virtually every scrap of medical knowledge we possess as we take a meticulous history and conduct a scrupulous physical examination because there will be no blood tests, radiographs, or any other technological aids to fill in any details we might miss. Conversely, an awareness of the bond plays an equally crucial role when clients place no limits on our technology. Dr McPherson describes the work-up and treatment of a cow to Harry Simmons in terms of the animal’s market or breeding value and the owner says, “I don’t care what it costs. I want you to do everything you can to save her.” Or the practitioner negotiates that mostly uncharted minefield known as the human-equine bond and tells Chip O’Brien, the animal’s caretaker, that the ancient mare has multiple problems. “Frankly, I’d shoot her,” says Chip making no attempt to hide either his disgust for or dislike of the animal. “But my mother insists you do everything you can.”

In these two situations, the practitioner’s mind veers in three different directions simultaneously. One part immediately begins formulating a diagnostic protocol. Another (hopefully smaller) part notes that new tires for the truck just might be possible this month. A third part grapples with totally unscientific questions like “What’s the deal with old ‘Bottom-Line’ Simmons? How come this cow means so much to him?” or “Am I going to spend days working up this mare only to have that O’Brien clown louse up the treatment?”

Although some may prefer to ignore the latter considerations, every practitioner soon learns that solid owner commitment to the animal and the treatment process makes the high of a sky’s-the-limit case even higher. And few can deny the feeling of vulnerability that results from the awareness that the owner’s commitment to the animal and the treatment process goes no further than his or her checkbook.

Most of us learn to incorporate bond factors into our treatment regime, but unfortunately often as the result of what happened in the past when we failed to do so rather than as a matter of choice. Before Dr. McPherson lays a hand on her animal, Ms. Fellows defiantly announces there’s no way she’s going to fight with her dog three times a day to shove pills into it like he made poor Ms. Dickinson do, and Dr. McPherson suddenly sees liquid amoxicillin in a whole new light. Similarly, we learn to recognize those clients for whom environmental concerns take precedence over efficacy when we prescribe products for external parasite control: Even though their animals always sport a flea or two, the Carmichaels tell their friends about their great veterinarian who cares about the planet as well as the animals.

For those who never have considered the ramifications of the bond, all this subjectivity can prove most disconcerting. “Whatever happened to the good old days when you diagnosed a problem, prescribed the best treatment you knew, and the owner did whatever you said, no questions asked?” they ask wistfully.

Actually we can recreate such good old days with certain clients as we shall see in Chapter 9, but changes in human-animal relationships, owner life-style, the increasing cost and sophistication of medical technology, and the presence of alternatives make this only one of several approaches clinicians must use if they wish to meet the needs of their clients. Granted the idea of meeting the often highly subjective, sometimes bizarre needs of someone like Ms. Fellows who feeds her Pomeranian from a spoon strikes some as personally denigrating and a blatant attack on the values espoused by the profession. And most certainly practitioners who believe this should not subject themselves to the Ms. Fellowses of the world. However, unlike the good old days, fewer and fewer veterinarians practice in areas where they offer the only game in town and clients must play by the practitioner’s rules—or at least pretend to—if they want veterinary care for their animals. Not only is it increasingly likely that some veterinarian down the road would be more than happy to see Ms. Fellows simply to generate income, it’s also more likely that Ms. Fellows would go to someone in the next county if she believed that clinician more attuned to her relationship with her animal. Now the first practitioner could lose on two counts:

• He or she loses a client.
• Ms. Fellows could tell anyone who will listen that she quit going to the Valley Veterinary Hospital because “the doctor there doesn’t care.”

But what do you do if you find the relationship between the owner and the animal personally offensive for whatever reason? A quick rule of thumb reminds us that the only guaranteed change we can make is in ourselves; we might be able to change another, but it’s hard work with no guarantees. So you look at Ms. Fellows and her dog and ask yourself, “Can I change my beliefs to the point I can accept this woman and her dog as they exist right now?” If the answer is “No,” then do yourself and Ms. Fellows and her animal a favor and refer them to a colleague you believe would meet their needs better.

Although this seems like a no-win situation, in reality it can turn into a no-lose one. If Ms. Fellows does take your advice, she will view you as a caring person who put her and her animal’s needs first. Such people not uncommonly say to their friends, “Baby and I go to the Hillcrest Veterinary Clinic because her problems require special handling, but I bet you and your animals would be very happy with that nice doctor in the valley who’s much closer to you.” If Ms. Fellows says she doesn’t want to go anywhere else and asks why you don’t want to treat Baby, this gives you a legitimate opportunity to share your feelings about her relationship with the animal. Many times just expressing those concerns in a professional manner—that is, “Treating Baby like a person can lead to all kinds of medical and behavioral problems and that bothers me,” versus “You must be sick to feed that dog with a spoon”—enables these people to see their relationship in a whole new light.

Point of View

The key to effectively and efficiently integrating behavior and the bond into practice rests upon the practitioner’s ability to objectively evaluate these often highly subjective parameters as they affect the relationships between the owner and the animal, the owner and the practitioner, and the practitioner and the animal. Aside from noting that the idea of objectively evaluating subjective factors sounds like a New Age oxymoron, more than a few busy practitioners might also point out that there aren’t enough hours in the day as it is without taking on this additional burden. However, many times it’s our failure to summon the necessary objectivity that makes integrating these concepts time-consuming and emotionally draining.

For example, imagine Ms. Fellows revealing she spoon-feeds her dog. What kind of responses might this elicit?

• Ms. Fellows obviously lacks a few neurons.
• Ms. Fellows is definitely going to be a Problem Owner.
• People like Ms. Fellows shouldn’t be allowed to own animals.

Although all of these might sound legitimate, all spring from an emotional rather than an objective evaluation of the relationship between Ms. Fellows and her dog and offer no viable solutions. Having defined the relationship between owner and animal as aberrant, then what? What usually happens is that every time that client’s name shows up in the appointment book, the practitioner groans and prays he’ll be called out for a large animal emergency that day—provided it’s not to Farwell Farm because their herdsman is such a fussbudget about his Holsteins it can take all afternoon just to treat one case of mastitis there.

As we can see, such responses can generate a lot of negative emotion for the practitioner and take up a lot of time while doing nothing to resolve the problem. In fact, such evaluations only make the problem worse: Who wants to spend anything beyond the barest amount of time with people displaying the attributes ascribed to Ms. Fellows or the herdsman at Farwell Farm? It would seem we deserve a medal merely for tolerating them and not saying “I told you so” when their animals succumb to the negative effects of the relationship somewhere along the line. However if we remove our emotions from the process and look at the owner’s relationship with the animal as well as the resultant behavior objectively, this more likely will lead us to ask meaningful questions than pass judgment:

• Is this relationship acceptable to the owner?
• Is the relationship detrimental to the animal?
• How can I best maintain the animal’s physical and behavioral health within the context of the relationship?

By seeing the problem as it affects the owner, the animal, and the clinician, the veterinarian positions him- or herself as a viable source of information and assistance to the client rather than as a judge, and in doing so leaves the door open for a mutually rewarding relationship. As we shall see time and time again as we explore the many subjective factors that comprise the art of practice, this ability to view behavior and the human-animal bond objectively from the owner’s and animal’s as well as our own point of view can do much to untangle some of the most complex issues encountered in practice.

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