Risk Assessment in Behavior Medicine
World Small Animal Veterinary Association World Congress Proceedings, 2005
Claude Beata, DVM, Behaviorist GNFVS, ECVBM-CA Charter Diplomate

Risk assessment is a major issue in behavior field. Some confusions are made between risk and danger. Risk assessment is a tool that helps the practitioner to make a decision in front of precise situations. Many factors can prevent us from giving a professional advice. Strong feelings such as fear, parental projection or protection principle can spoil our judgment.

Definitions

The word risk is very similar in French, Italian, Spanish and English. It is coming from Latin with different possible meanings. The first use was about insurance when traders began to observe that sometimes the goods they were buying overseas could be lost in a sinking.

In French, two synonyms of risk are "alea" (which remains in English as aleatory) and "hazard" (close to hazard). In Latin "alea" means dices as "al-zahr" in Arab. These definitions underlines the unpredictability of the outcome and this is a first important point. For us, risk is synonymous of danger when we have to consider that it is a larger concept.

Beside the hazard, we have to appreciate the individual characteristics such as vulnerability and we can reach to a first equation

Risk = Hazard x Vulnerability

Importance in practice

In general practice

Risk is a daily concern in general practice. Should I take this risk to have a surgery on this old dog? Is it clever to begin such expensive treatments when I don't know if the owner can stand by it? Every single day, we spend a lot of time to make decisions. We try to find a good balance between benefit and risk. So, risk does not always mean danger in our practice.

In behavior practice

With referrals, we see many dangerous dogs. It is obvious that, when aggressiveness is involved, vets are seeking specialized advices, and that is normal. As specialists, we can't only use precaution principle. That would mean to put to death 50 per cent of my caseload! So, we need to have a broader view and better tools to appreciate the risk and more to present it to the customer.

This brings us to split the risk in different levels.

Different levels of risk

Risk for the animal

We must not forget that we are vets and our first goal is to treat animals.

The main danger, many times, is for the pet exhibiting behavior disorders. Owners can ask for euthanasia or let the dog in a shelter. In France, behavior disorders are the first reason for putting to death or letting in shelters dogs under two years of age.

We must also keep in mind that dogs don't know what they risk; When a dog bites, he can't evaluate that maybe his owners are going to kill him for that.

Risk for the owner

First, physical risk can exist. Bites, scratches can hurt people and so many children suffer for years of physical--and psychological--wounds after an accident that we must not forget it.

Even when there is no physical injury, some people live in a daily fear and this is really a tremendous suffering.

When, finally, without help, without guidance, people decide to put the dog to death they have to live with strong guilt feelings.

Risk for the vet

Even if the physical risk, does exist, it is not the main one for us: we get used to dealing with it. There are more ethical, moral or legal risks.

It can be difficult to fulfill a professional sense of duty because the main question remains: to whom does the vet have the primary responsibility of care?

Risk for the group

When there is danger, there is a high risk for the harmony of the group, of the family. The vet may be confused by hidden loyalties or instrumentalization of the dog. Family therapy is not the goal of the vet, but he must keep in mind that sometimes data given by owners are truncated. Bias in communication are numerous and that can prevent the vet to establish a relevant diagnosis.

Risk for the society

Somewhere, as vets, we are soldiers of people safety. Because of our scientific knowledge, we must have a professional view of the problem and not be overwhelmed by the first common feelings.

Three main risks exist:

 To have too many dangerous dogs outside in the streets and inside the families. Regulations must exist to manage dangerous cases in a scientific way

 To increase the danger by inappropriate laws and rules

 To exclude animal from the city

Vets can and should help politicians to take the right decision to increase the safety and to respect any kind of life.

Risk gestion

Our goal is to give quite a way of dealing with risk in behavior cases but it could be seen in a wider use. After identifying the risky situation, we must define who we want to protect.

 First, protect yourself in a physical, ethical and legal way. If you want to keep on working, that's a must.

 Secondly, protect the animal. That is the first aim of your job.

 Third, protect the human beings mainly the weakest members of the family. But don't forget that we must not replace the parents. Our duty is to provide all the necessary information.

 Four, protect the group. Obvious and hidden loyalties are important to know to prevent unexplained failures of therapy.

 Five protect the society. For this, we can have different levels of intervention and vets must be a proposition force.

New APPROACH: cindynics

Cindynics or Riskology are new words for a scientific approach of risks. A same reasonable attitude can be set up for very different issues such as car accidents, terrorism, tsunamis and also dangerous dogs.

Cindynics are a wonderful tool box to build strategies in front of risks.

First point is to define a cindynic situation with the different actors and the conditions of place and time. After five parameters will be screened for each actor

 Facts

 Models

 Rules and laws

 Values

 Goals

Cindynics theory is based upon seven axioms: relativity, agreement, goal conflicts, ambiguity, experience feed-back, crisis and noxiousness.

Relativity

It is obvious that each actor of a situation can have many differences in these five axis.

The risk is not the same for each category of persons in front of the same kind of danger

Agreement

We gave as a first equation Risk = Hazard x Vulnerability. In cindynics theory, another equation is proposed

Risk = Probability * gravity (seriousness)

What is really interesting is that each part of this formula has to be agreed between the actors. Bites have not the same importance for all our clients.

Goal conflict

The goals of the actors are often different and they can be opposite. The vet may vent to treat the dog when people only want only to be sure that there is no more danger for the children. No valid solution can be found before having an agreement on the goal

Ambiguity

Ambiguity does exist even within a group of actors sharing the same project, even within one person. By nature, the perception on the five axis of the problem are ambiguous.

Experience feed-back

It is important to learn from our experience. Starting from hypothesis, you have to implement solutions. The perfect one does not exist. One must have processes to have a relevant feed-back and know what happened following the try. It is the only way to adapt models to facts and that's important to have efficient solutions.

Noxiousness

This is a very important and new point. Each action, each move that we can make to decrease danger will create another kind of danger. That does not mean that we must not act but we must not forget I and keep in mind the question: "What new danger am I creating?"

Synthesis

When you know all the actors, you can see very different points of view on values, rules, goals, facts and models. These differences are called dissonance and higher the dissonance, higher the risk. There are two ways for the dissonance to be refused:

 Firstly: the crisis and this is never the safest way.

 Secondly: a voluntary transformation and for that you need an operator. That can be a thrilling job for vets!

Conclusion

Risk is part of our life and part of our job. We must rely on science and theory to avoid subjective attitudes. We can have a positive and an efficient position to decrease main risks with dogs, using this new tool.

References

1.  Allard P (2000) Elements pour une problématique de l'histoire du risque. Du risque accepté au risque maitrisé. Représentaionet gestion du risque d'inondation en Camargue XVIII° et XIX° siècles Mémoire pour l'Habilitation à la Direction de Recherches, Université de la Méditerranée, Aix 1

2.  Asch M., Le Nineze A (2003) Le risque Editions EDP Sciences, Collection Mot à Mot

3.  Bernstein P (1998) Plus forts que les Dieux Editions Flammarion

4.  Fournier A., Guitton C, Kervern G.Y, Monroy M.. (1997) Le risque psychologique majeur Editions Eska

5.  Nicollet JL, Kervern GY.. (2001) Cindynique de l'interface homme-animal Atelier AMRAE

6.  Perretti-Wattel P. (2001) La Société du Risque Editions La découverte, Paris

7.  Steinlé-Feurbach M.F. (2001) Le risque dans sa génèse Journal des Accidents et des Catastrophes N°19

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)

Claude Beata, DVM, Behaviorist GNFVS, ECVBM-CA Charter Diplomate
France


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