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| TOP TEN cal health assessment is not to "rule out" disease or a primary behavior problem, but rather to determine how one might influence the other. For example, recent-onset biting might be due to osteoarthritic pain, but not all dogs respond to pain by biting. Once the pain has been managed, the biting behavior may con- tinue because, in the dog's mind, it stopped unwanted encounters. A holistic approach to veterinary behavioral medicine is to consider the interconnection between physical and behavioral signs. For more information on performing an orthopedic assessment, read Ten Ways to Improve Your Orthopedic Examination in our September/October 2011 issue, available at todaysveterinarypractice.com. 3 ATTEND TO DETAILS IN THE BEHAVIORAL HISTORY Attention to details and tailoring treatment sug- gestions to the individual patient are what distinguish the veterinary clinician's behavioral assessment from the bottomless advice pit of the Internet, other pop- ular media, or even from behavior-related scientific articles. Making a home visit or requesting photographs or videos of the home environment, for example, can help when you are making recommendations for a safe haven from thunderstorms or adding additional litter LoÝiÃÊ>n`Êvoo`ÉÜ>ÌiÀÊÃoÕÀViÃÊÌoÊ«ÀiÛinÌÊÃoVi>lÊÌinÃionÊ among household cats. Details about both physical and social environments can point to solutions specific to the individual patient. Turn to page 34 to view the client handout How to Improve Your Pet's Environment, which is also available at todaysveterinary practice.com under Resources. 4 82 CHARGE FOR YOUR TIME Incorporating behavioral medicine into an appointment can take more time than a normal wellness visit allows. How can time be used most efficiently while providing this much-needed clinical service? A double-time doctor appointment should be sufficient for review of a behavior history completed in advance by the owner, physical examination and diagnostic workup, recommendations for safety and, if indicated, medication. Further management, such as recommendations and `imonÃÌÀ>ÌionÊovÊÌÀ>inin}Ê>n`ÊiµÕi«minÌÉÌoolÃ]ÊV>nÊ be scheduled with a technician and invoiced accord- ingly, with a recheck appointment with the veterinarian Today's Veterinary Practice July/August 2012 arranged for several weeks later. A behavior appoint- ment can be efficient and still very helpful to the client when team member time is delegated appropriately. Veterinary technicians interested in furthering their knowledge and becoming credentialed in behavior can do so through the Academy of Veterinary Behavior Technicians. Further information can be found at avbt.net. 5 USE ONLY FORCE-FREE, HUMANE BEHAVIOR MODIFICATION METHODS There is no required certification for nonveter- inary dog and cat behavior modification. Anyone can h>n}Ê>ÊÃhin}liÊ>n`ÊVl>imÊÌoÊLiÊ>ʺLih>ÛioÀiÃÌ»ÊÌh>ÌÊ is, ironically, unless he or she is a veterinarian). As a result, competence, education and, most important, ethical practices vary wildly. To complicate things further, even certification does not guarantee that humane-only techniques are used. In veterinary practice we are obliged to "do no harm" and should recognize that aversive techniques, such as "alpha rolling" dogs onto their backs, use of shock collars, and other harsh treatments, are popu- larly promoted but harmful to the patients we are sworn to protect and help. In behavioral medicine, we have the opportunity to educate clients about humane care as well as the science of learning. Positive reinforcement can shape behavior without putting the client in danger from a pet adversely responding to a behavior modification technique. 6 COLLABORATE WITH LOCAL TRAINERS Taking the time to meet with local dog train- ers and observing one of their group classes can lead to a mutually productive relationship. Most dog owners benefit from working with a competent trainer, which provides the opportunity to influence their choices. In addition, some dog professionals offer behav- ior consultations and basic social skills training. In turn, trainers are often enthusiastic to have a working relationship with a veterinary practice that they can refer dogs with physical or behavioral problems to for examination, workup and, if you determine there is a need, medi- cation. It is important, however, to "vet" the trainer