Behavioral history taking (Proceedings)
There is no way around it: collecting a behavioral history is time-consuming. But never boring. Given a chance, pet owners will share every detail of every episode that they can recall. Most people are also eager to offer their theories regarding the development of the problem. A systematic means of politely limiting the information flow can be developed with experience.
One way to shorten the length of the visit is to ask clients to complete and return a history form prior to the actual consultation. Points for discussion and elaboration can be highlighted.Standardized forms, available in many veterinary behavior textbooks, facilitate systematic and thorough collection of baseline husbandry information. Owners can record the diet as well as the feeding and exercise routine. Household people and pets can be listed. These facts may appear unrelated to the primary behavioral concern. Yet information that might initially seem irrelevant, or that clients did not consider important enough to mention, can sometimes offer the key to the diagnosis.
You did what?!
Clients usually feel responsible for their pet's behavioral disorders. It is important to formulate questions so that they do not suggest blame. Defensive clients withhold valuable information lest they or their pet be unfavorably judged.
How much is too much?
Part of the art of history-taking is learning which information is likely to be relevant to the situation at hand. It can be helpful to begin by asking for a brief description of the behavioral concern, to be followed by a more detailed description of the first and last episode. Then, ask the client to share details regarding 3 additional episodes of their choice.
This information should provide an understanding about the progression of the behavior. The age of the pet at the time of onset will be a consideration in forming a list of differentials.
The rate of progress is also significant, particularly when diagnosing behaviors that owners describe as sudden in onset. If there were no changes in the household routine or environment when the problem behavior surfaced, then an underlying medical condition may be present.
Of course, it is necessary to listen to the client's perception of the main behavioral complaint. At the same time, discourage clients from interpreting the information—just ask for the facts. Analysis is the job of the clinician.
Try to listen to the descriptions as though you were watching a videorecording of the behavior.
Better than creating mental images is obtaining real photos or videos. Encourage owners to share pictures of the environment and of all household members, people and pets, that could not attend the consultation. Videorecordings of pets and people interacting, or when safe, pets engaging in the problem behavior, are invaluable. Specify emphatically that no person or pet, including the patient, should be placed in harm's way for the purpose of a creating a recording.
Before concluding the history taking session, it will be important to ask about any other behavioral concerns the owner has experienced with the pet. When writing the treatment plan, it may be necessary to prioritize, initially focusing on the problem that is considered most serious or most dangerous. Some behavioral conditions will need to be addressed simultaneously for a successful outcome.
Similarly, learn the details of all prior interventions. This includes any environmental or behavior modification steps. Learn the dosage and duration of therapy for all psychoactive medications.
In many cases, the pieces of the puzzle fit together and the diagnosis is neatly formed. Sometimes, something is missing. There may still be one more question left to ask. Offer the client some safe interventions to get them started, and schedule a recheck visit in the next day or two. Take the paperwork home, sleep on it; reread, research and if necessary, refer.