On Handling Outsized Risks From Bite-Sized Patients

How to Handle Outsized Risks from Bite-Sized Patients

Isabelle Francais

Recently two of my clients found themselves heading to their nearby urgent care facility after their own pets bit them. Both clients openly acknowledged they'd disregarded my counsel, happily paid their bills, and promptly sought medical attention.

At the risk of courting your derision along with your sympathy, I'll confess: Recently two of my clients found themselves heading to their nearby urgent care facility after their own pets bit them … in my exam room!

Bad, I know.

What's worse is that I was physically present to witness both events. Though I'd urged each of these clients to keep their hands well away from their anxious pets—in the second case, imploring a client not to attempt clipping her own terrified cat's claws—they'd apparently felt compelled to ignore their pets' warning signs (along with my advice).

The good news? Both clients openly acknowledged they'd disregarded my counsel, happily paid their bills, and promptly sought medical attention. I then made note of the events in their medical records, flagged the files for future reference ("Never allow this client to handle her own pets—no matter what she says!"), and called the following day to be sure both were recovering well. They were.

Whew!

It could have been worse. Someone could've been more seriously hurt than a few finger stitches' worth. It could've happened to one of my musician, athlete or surgeon clients. (Though I daresay they'd have been more cautious with their hands.)

Liability
But even after all that, my week wasn't over yet. I had yet to experience the dread that washed over me when I was told of our new volunteer's nose-to-nose kiss with an unmuzzled 150-pound Rottweiler. Who, by the way, his physician owner refuses to admit harbors extreme aggressive tendencies (despite my observations otherwise).

As you doubtless know, if it happens in the hospital … it's our responsibility. Never mind the mitigating circumstances of client cluelessness. Sure, we can take the thing to court but who wants to suffer that much?

Yes, it's one of the sad realities of modern small companion animal veterinary medicine, this exposure to the ravages of our patients' teeth, claws, beaks and heft. 

Luckily, it's been a pretty long time since my own semi-serious encounter with a tooth. (Three years?) And there's only been one measly ER-worthy bite wound among our personnel in about a year. In fact, things have been fairly boring in the injury department lately … save this last week's shenanigans and near-misses, of course.

Which got me to thinking…

In spite of our recent spate of luck (internally, anyhow), maybe we really do need some new policies. In fact, maybe the profession could stand to modernize a bit on that score.

After all, my own personal standards for pet injury-based risk can't be that much laxer than the average veterinarian's. Yet I'm sure the nice people at the Occupational Health and Safety Administration would have had a thing or two to say about how I handled myself during the week in question.

And I wouldn't blame them.

What About Me?
Why don't I demand that the scary Rottweiler arrive in a muzzle? (I have several patients whose records lay down the law on this point.)

Why don't I have a sign in every single room explaining why an owner cannot handle their pets (there's only a small one in the lobby)?

Why did I not scream bloody murder when the owner insisted on picking up her injured land shark of a Chihuahua? Or when the owner pulled her growling cat out of the carrier because "I know you want to sedate him but he bites me all the time anyway and I'm not going to let him boss us around."

After all, it's OSHA's job to ensure that work environments are as safe as possible for those who participate in daily tasks that inevitably involve some kind of risk or another. From its website:

"Every day in this country, more than 14 workers lose their lives in preventable workplace tragedies—close to 100 deaths every week."

An Ounce of Prevention
While I've never heard of a small animal veterinary hospital worker's death due to pet-on-person violence, I have no doubt it can happen (and has).

More often, we experience the loss of productivity that comes from a) sitting in the hospital with a Timentin drip for a couple of days, b) rescheduling surgeries until our hand fully recovers, and c) the inevitable psychological damage done when workplace injuries happen. And paying out increasingly astronomical sorker's comp premiums doesn't help much, either.

Which is why it often surprises me that OSHA doesn't get more involved in telling me how it is I've got to treat my patients. You'd think an organization that requires me to pick up pet blood spills with a special biohazard kit, label each and every single cleaning product with a color-coded sticker, and demands I wear closed-toed shoes at work would also require that we muzzle all of our dogs and sedate all of our cats.

But it doesn't.

And thank God for that. Because not every patient does well with a muzzle, of course. And how would I evaluate dentition (among other features) with a basket over her nose?

In fact, the only way to make our job "as safe as possible" might be to sedate each and every patient. And chemical restraint is by no means one-size-fits-all either, of course. So that's not happening.

Yeah, I'd hate for the regulatory powers-that-be to start telling me how I should manage my patients' behavioral peccadilloes. Luckily, it seems even OSHA appreciates that safety in veterinary settings is more about sound decision making than muzzling and sedating, and that the art of the judgment call will occasionally fall prey to a little bit of pet owner obstinacy.

Yet I can't help thinking that if we did have a little more regulatory muscle making demands on us when it comes to animal injuries that we might have a little more of a leg to stand on when clients see fit to ignore our policies and pleadings outright. 

Dr. Khuly is a small animal practitioner in Miami and a passionate blogger at drpattykhuly.com.

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