Seven ways to make behavior referral easier

Written by Dr Dennis Wormald,
Last updated June 2022

Most GP vets feel like they don't understand veterinary behavior as well as they would like to. We don’t get taught much behavior at vet school, and once we graduate it’s often put into the too-hard basket. The good thing is that when a really tricky behavior case comes along, we know it needs referral to a behavior vet. However, herein lies the problem! I hear from a lot of vets that they recommend a client goes to see a behavior vet, but the clients often don’t follow through. This often doesn’t get noticed by you as the vet, because the client nods their head as you recommend they seek referral. You might assume your client has everything they need to know. You made your recommendation, the rest is on them, right? Sadly, we know that the animals that don’t get referral often have a much lower quality of life. Mental health conditions are very distressing to live with, for both humans and their pets!

I have worked as a GP vet for over 10 years while studying animal behavior, and have realized that my referral rate is much higher than a lot of my peers. People just seem to listen to me when I talk about referral, and actually follow through with an appointment. I have put together a list of 7 things that help clients follow through with your referral recommendations below:

1. Think of yourself as a salesperson
Before you cringe at the thought of this, let me explain. When recommending a client books in with a behavior vet, you are asking them to spend money. So whether you like it or not, you are selling them something. Pretending this isn’t the case will lose a lot of people. Although you don’t make money if the client books a referral appointment, your patient will get proper treatment and your client will appreciate it. These things are rewarding as a vet, and any improvements made at referral will be partly attributed to you for recommending it in the first place! The most difficult thing with taking on the role of the salesperson is that it’s hard to sell something if you aren’t sold on it yourself.

2. Think about sending your own pet to a behavior vet
As vets we often treat our own pets. We care the most about our personal pets, so will put in more time and care than other vets would. As a thought exercise, think about how your pets would need to behave for you to make an appointment with a behavior vet yourself. How bad would they need to be? Or would you try to just fix the problem yourself? What things would determine your decisions here? Would the cost put you off? If you can’t imagine yourself referring your own animal in most circumstances, then this is a problem. It is very hard to sell something if you wouldn’t buy it yourself. Many GP vets don’t truly value behavior referral, they just recommend it so they can say they tried. This happens when vets don’t understand the value that a behavior vet provides.

3. Understand the real reason for referral
Ultimately, there is one reason for referring behavior cases that is far more important than the others. Many vets and owners think this reason is to fix the problem that the owner brings up in the consultation. This isn’t always the case! By far, the most important reason is for the welfare of the animal. In the vast majority of cases, the problem behaviors that the owner is complaining about are tied to a poor mental welfare state. Negative emotions such as fear, anxiety and stress underpin so many of the behavior problems that animals have. When discussing whether a case needs referral with an owner, this is the most important point to get across. You need to mention that their animal is probably quite distressed, and that referral is important to help get them proper treatment so they can feel better. Just as owners will spend a lot of money to help their animal suffering from physical pain, they also see the benefit in treating mental pain too.

4. Know what actually goes on in a vet behavior consultation
You will need to give the client a short description about what a behavior consultation actually entails. To do this, you need to explain that normal GP vets aren’t taught much about behavior, but some vets have much more training in the area. You should mention that a behavior vet consultation will take at least 2 hours. It will involve a pre-consultation questionnaire, at least 30 minutes of history taking, discussion/education on the causes of the problems, a treatment plan and a discussion around medications if appropriate. The veterinary behavior consultation should also include guidance and follow-up for the patient as they start using the medications. This guidance will be invaluable for them, and greatly increase the compliance and efficacy of medications. Problems often crop up, from a medication not working, to managing side effects or doses. Having training and experience in this specialised area greatly improves the outcomes for patients that are referred to a behavior veterinarian.

5. Have a good hard think about the cost
Cost is often the reason that many GP vets say their clients aren’t interested in referral. It makes sense. If I tried to sell you something for hundreds of dollars that you didn’t understand or value, you probably wouldn’t buy it. This is especially true if it seemed really expensive. This is where vets simply don’t understand the finances of behavior referral. There is an underlying stigma in the profession that devalues treating mental pain when compared to physical pain. A dog can be perfectly happy living it’s life on 3 legs and yet most clients can come up with thousands of dollars for a cruciate surgery. Yet many dogs live their whole lives miserable, enduring untreated mental health conditions, when a referral appointment is under a thousand dollars. Even if you consider the amount of time spent with the patient by the behavior vet, it’s not overpriced. A consultation takes at least 2 hours of time, plus report writing and follow up. It ends up being 3-4 hours per patient on average. Have a look at how much you charge for 3-4 hours of surgery time or 3-4 hours worth of consultations. Do the calculations and you will see that the price is actually cheap. People don’t turn down referral because the dollar amount is too high, they turn it down because they don’t see the value.

6. Refine your spiel and use handouts
It’s a good idea to have a few key points that you aim to get across when mentioning referral. These can be based on the previous points in this talk article. A short summary might be:

  • Point out how their dog might be stressed or anxious
  • Empathise. Explain how it doesn’t feel nice to be worried or scared all the time
  • Describe what goes on in a referral behavior consultation
  • Mention the cost, and explain why it’s reasonable
And that’s it! If you like, you can put some of this into a handout to give the owner as well, sometimes they can’t remember everything you tell them and need to discuss it with their family.

7. Bonus point!
I know it can be hard work going through all these steps to get an owner to come around to the idea of referral. If you aren’t sure they need referral or they seem resistant, the best thing to do is send them an ABAdog behavior scan. This is a great first step for them, and it will reinforce your recommendations that they go on to seek referral. In the meantime, they will have some great advice to work on!