Biting the Hand that Heals You: Encounters with Problematic Patients in a General Veterinary Practice

Clinton R. Sanders 1
University of Connecticut

This discussion focuses on veterinary practice as a form of service delivery. Based on data collected during a year of participant observation in a major veterinary hospital in the northeast, the paper examines the criteria veterinarians routinely used to define nonhuman patients as problematic and the means they employed to deal with troublesome animals. The conclusion frames veterinarians' tactics for evaluating and controlling patients within the larger context of how rule-breakers are identified in everyday interactional settings and the routine approaches used in the exercise of social control.

Veterinarians, like other service deliverers (eg., Cassel, 1991; Davis, 1959; Lang, 1981; Paules, 1991), routinely categorize those with/for/upon whom they work in order to anticipate potential problems and devise effective control tactics. Occupational typologies constructed by service workers differentiate between "good" and "bad" clients. Problematic recipients of service impede the conventional flow of the commercial encounter, limit the service deliverer's financial or sociopsychological rewards, and/or display some character flaw or moral inadequacy (Mennerick, 1974).

Like those who deliver human medical services (Lorber, 1981) and other service workers, veterinarians engage in this form of typologizing. However, special features of the veterinary profession create distinctive problems and require unique responses by the veterinarian. 2 While all medical encounters are negotiated exchanges balanced between cooperation and conflict (Lazare, et al., 1987), the triangular nature of the veterinarian's interactions with both a human client and an animal patient make for especially challenging encounters. 3 Within the triangular exchange among the doctor, client, and animal, the client and veterinarian cooperate to cast the animal in the role of the "virtual patient" (Gregory and Keto, 1991). Because the patient is a non-verbal and relatively powerless actor in the situation, the client and doctor exchange information and observations to determine the problem experienced by the animal and to devise the appropriate treatment. In this exchange the client calls upon his or her everyday, intimate experience of the companion animal while the veterinarian primarily employs technical expertise. Ideally, the sharing of these different types of information leads to a cooperative interaction and mutually satisfactory clinical outcome. However, when lay and professional, everyday and technical, evaluations and concerns do not coincide, significant conflict may result. 4

Further, the companion animal is typically deemed to be the less responsible member of the patient/client dyad (cf., Sanders, 1990). When the patient disrupts routine interactions in the veterinary encounter, one explanation is that the animal's misbehavior is the responsibility of the owner who is ignorant, overly permissive, or otherwise derelict in exercising control over the patient. While this definition of client responsibility and related absolution of the animal are not the focus of this discussion (see Sanders, forthcoming), this interpretation is integral to the patient-client-veterinarian triad, routinely available to veterinarians, and one way in which patient rule-breaking may be understood.

While interactions with clients are of key importance in understanding routine veterinary exchanges, this analysis focuses on veterinarians' definitions of and interactions with problematic patients. Following a brief description of how the data were collected, I present the major criteria used by veterinarians to categorize problematic patients including controllability and aggressiveness of the animal, hygienic features of his or her physical condition, and evaluations of the patient's medical situation (especially, whether or not the illness can be effectively diagnosed and treated). The paper concludes with general observations about rule-breaking and social control leading to a discussion of animal rule-breaking in veterinary settings and the social control tactics used to deal with patients violating occupationally situated expectations.

The Research

Discussion is based on data collected during a year of ethnographic research at a major veterinary hospital in New England. Nine veterinarians, together with some two dozen veterinary technicians and administrative personnel, worked in the setting. Entry to the clinic was achieved through the sponsorship of one of the five partners in the hospital corporation ­ a veterinarian with whom I had become friendly during fifteen years of professional association.

I visited the clinic an average of three times a week, typically spending between two and five hours each visit observing, interacting, reading available journals, and ­ eventually ­ assisting with the routine business of the clinic. In my role as participant, I helped restrain animals during exams, "held veins" in animals' forelegs while blood was drawn, fetched equipment and supplies, carried and positioned anesthetized patients in surgery, comforted frightened and injured animals, assisted in limited ways during surgeries and necropsies, and accompanied veterinarians on "farm calls" as they attended to dairy herds.

In addition to the observations and field interview data collected during my stay in the clinic, I also conducted lengthy, semi-structured interviews with the 9 veterinarians (6 men and 3 women) working in the hospital at the time the research was concluding. As is conventional, these interviews were used to refine and expand analytic "hunches" generated in the course of the fieldwork. Excerpts from both these interviews and my fieldnotes are used extensively to illustrate major points made in the following discussion.

Further assistance was provided by 3 of the doctors who agreed to read early drafts of this and other papers drawn from the research. The cautions, expansions, and gentle criticisms these "key informants" provided were invaluable in the construction of this discussion. Their general agreement as to the credibility of the descriptions and analyses I constructed is a forceful indication of the internal validity of the data upon which this discussion is founded (Hammersley, 1990; Lincoln and Guba, 1985, pp. 289-331).

Problematic Animal Patients

The way veterinarians defined and interacted with their animal patients largely depended upon the length of the relationship with the patient, the symptoms the animal presented or the reason he or she had been brought to the clinic, the species of the patient, and the behavior of the animal in the clinical exchange. Veterinarians defined some animals merely as interesting or routine cases or conditions (Herzog, et al., 1989) as do physicians in their encounters with human patients (Becker, et al., 1961, pp. 329-330; Dingwall and Murray, 1983). On the other hand, patients with whom the veterinarians and their staff were most familiar typically were regarded as distinct individuals. These animal/individuals were often central to continuing stories that comprised the local lore of the hospital. Staff conversations frequently revolved around regular patients' exploits, physical problems, personality characteristics, and interactions with their owners and clinic personnel. Responding to key episodes in these ongoing stories, staff rejoiced when a regular patient recovered, expressed concern when the animal's physical condition deteriorated, and mourned when he or she died. In contrast to these positively regarded individual patients, other animals were notorious because of the problems they routinely presented while interacting with doctors and support staff.

Uncontrolled Patients

In human medicine the patient's failure to comply with instructions is typically seen negatively as a rejection of the physician's authority and is often viewed as a key factor should the patient fail to respond to treatment (see Danziger, 1981; Friedson, 1987). For the veterinarian, however, whether or not the patient was cooperative typically had more immediate interactional consequences. Veterinary patients who were difficult to control required the veterinarian to expend more time and energy than were normally justified. In addition the uncontrollability of the "hyper" patient made it more likely that the animal would be hurt during diagnosis or treatment. Here is a description of a typical encounter with an uncontrolled patient. Notice that the owner does not provide assistance ­ a significant failure in the eyes of the veterinarian and one of the marks of a "bad" client:

The case involves a young man who has brought in a year old male chocolate Lab ("Bear") for shots. Bear is reasonably well behaved while receiving the inoculation. Then the owner asks Nancy (vet) to trim his nails. A major battle ensues. After some jockeying for position Nancy finally gets a major choke hold on the dog's neck (Bear appears to be tiring) and wrestles him over into the corner. All this time Nancy is shouting, "Be Good! Hold still!" in a deep command voice. After finally subduing the dog and trimming his nails we leave the exam room together. She is panting after it is over and makes a small joke to kind of defuse the situation. "Who needs aerobics when you have dogs like this." During the battle the owner was not much help and was totally unapologetic when it was over. His only overt acknowledgement of the trouble Bear caused was to direct a light "You've been a bad dog" to the animal as they were leaving. As we stand at the pharmacy counter I comment to Nancy that this encounter seemed to be quite a trial. "Would you call Bear a 'bad patient'?" "Well," she replies, "I would say he was difficult ."

A particularly interesting feature of this incident is the even-tempered manner in which the veterinarian interprets and handles the problem. She defines the dog's behavior as due to fear rather than maliciousness. This tendency not to blame the patient for his or her misbehavior, to see it as a consequence of the stressful situation, physical discomfort, inadequate training by the owner or other factors outside the animal's voluntary control, was typical of the interpretative framework veterinarians used to define intractable patients.

Understandably, veterinarians did not always interpret the patient's behavior so charitably and respond with such patience. Here is another episode in which an intractable dog prompts the doctor to lose his temper:

I go into the exam room with Don and see "Amber" ­ a female golden brought in by an older working-class couple. Amber has some skin problems on the back hip and at base of her tail. It is the result of a standard flea allergy and the area has to be shaved. I help hold the dog and hand Don gauze squares soaked with saline solution.... The procedure obviously hurts, but the dog still wags her tail submissively as Don shaves and cleans the sore area. After this is over the dog runs frantically around exam room rubbing the itchy spot on the walls leaving large splotches of blood.... The owner asks about "one of those things you put around their neck" and says he wants one put on so the dog will not worry at the spot. Don goes out and gets a white plastic Elizabethan collar out of a cabinet, assembles it with some difficulty, and takes it into the exam room. The dog does not want it around her head and begins to struggle wildly. Don eventually does get collar on but, in the course of the renewed struggle, it comes off again. He grabs the animal by the scruff of the neck, lifting her forefeet off the ground and shaking her vigorously. He screams, "Bad dog! Hold it now! Be good!" He then takes the collar and storms out of the exam room with me following closely behind. In the pharmacy area he tries to put the collar back together and calm down. "I'm losing it," he says. "I'm usually better than this in these situations."

While patients who were, as one doctor put it, "so hyper that they won't relax enough for you to even examine them" often tried the veterinarians' patience, they were regarded with far less distaste than were "fractious" animals. Aggressive patients threatened more than the doctor's ability to effectively exercise control, complete an examination, and devise an appropriate treatment. They physically threatened the practitioner.

Dangerous Patients

By far the most important characteristic of an animal that defined it as a "bad patient" was if he or she acted threateningly or aggressively when examined or treated. Although all of the doctors maintained that they rarely were bitten by dogs or otherwise injured by patients, I frequently observed them being snapped at, nipped, scratched, or pecked by animals. One vet accounts for the difference between what I had observed and what I had been told (see Becker and Geer, 1957):

(After seeing his encounter with an aggressive dalmatian) I ask Dick how often he has been bitten and he says that it has happened only once in his 17 year career.

Sanders: This is really interesting to me. You all say you rarely get bitten and yet I have been here only a few weeks and I've seen half a dozen incidents of biting.

Dick: Oh, you get nipped fairly often. Getting bitten is when you look down and the fat is hanging out of the holes in your arm and you have to be taken to the emergency room. You soon learn that cat scratches are the worst and they happen all the time. I always get them on my palm. They are always worse the next day. We have a hard time getting emergency room people to give us antibiotics, but we insist since [cat scratches] always get infected. 5

When encountering an unfamiliar patient, veterinarians were generally watchful for signs of aggression. Certain canine breeds were not considered to be typically dangerous ­ golden retrievers, Labradors, Newfoundlands, for example ­ while others (eg., chows, dobermans, German shepherds, malamutes) were more commonly menacing, particularly in the stressful situation of the veterinary clinic (see Hart, et al., 1983; Houpt, 1983; Landsberg, 1991). Familiar dogs who were aggressive had this noted in their records and a red tag was placed on the cage door of dogs admitted to the hospital in order to warn veterinarians and technicians that the animal was potentially dangerous.

Since regular patients' exploits were central to clinic lore, narratives often revolved around their aggressiveness. Doctors and technicians typically took such a reputation into account when interacting with the animal. Here is an incident in which a technician suffers the consequences for her initial failure to recognize a reputedly dangerous cat. Notice the "excusing tactic" (Sanders, 1990) employed by the attending veterinarian:

Back in the surgical prep area Laura, Mary Sue (techs) and Don (vet) are gathered around a table with a large black Persian cat. An IV fluid bag is hanging up next to the table and Don is trying to insert a catheter into the cat's leg. The cat lets out a low sharp growl and lunges at Mary Sue. She pulls back her hand and yells with pain ­ "He got me! He got me good! Hey! This is 'Midnight,' 'Midnight Monroe' (patients are routinely referred to by their "call" names combined with the last name of their owners). This is an evil cat! We never come near this cat unless it is anesthetized. And here I have been waving my hand in front of its face. This is the cat from hell!"

Don: Well, he's not feeling very well right now.

MS: Yeah, that's why I still have a hand. You can't even walk by this cat's cage without him trying to get you. You open up the door and it lunges at you (places hand so it covers her face as a demonstration). He's like that creature in "Alien." We never handle this cat without anesthesia. I thought it looked like Midnight Monroe, but I assumed that if it was it would be muzzled and in a bag. This cat would just as soon rip your face off as look at you.

A regular patient's reputation for potential danger often was condensed into cautionary phrases (eg., "look out!," "bites," "Q.O.F." [quick of fang]) and entered on the cover page of the animal's case record. Warnings offered by owners provided another basis for caution. "Good" clients were defined as those who warned the veterinarian about their animals' potential dangerousness and/or effectively assisted in controlling fractious patients. 6

Whatever the source of information, if a doctor suspected that a patient presented a danger, routine mechanical solutions were employed. Dangerous dogs were muzzled and "prickly" cats were put in a special sack or wrapped in an towel. A more extreme approach was to tranquilize them, although this was not preferred since the tranquilizer's effects could make some diagnoses more difficult and sedated animals commonly had to be admitted to and remain in the hospital until the medication wore off. 7

Dirty Patients

In their comparison of large animal and small animal veterinarians, Bryant and Snizek (1976) observe that one reason why veterinarians prefer to work with companion animals is that such office-based practice is less physically defiling than work with farm animals. While this may be the case, 8 the doctors I observed were routinely involved in "dirty work." Hughes (1971, pp. 343-345) states that those in prestigious positions commonly delegate dirty work to lower status personnel. Although veterinary technicians largely were responsible for the sometimes unsavory tasks of cleaning and deodorizing examination rooms and cages, 9 the veterinarians routinely were exposed to defiling substances and strikingly unappealing sights and odors. For example, the doctors frequently expressed the pungent secretions which built up in a dog's anal glands. Impacted anal sacs ­ a common problem with the smaller breeds ­ cause the animal some discomfort and often must be lanced and drained. Even when a dog's anal glands are working properly, they can be an unsavory experience for veterinarians. When frightened or upset ­ emotions which are common for canine veterinary patients ­ dogs' anal sphincters may contract causing secretions to be expelled, sometimes rather dramatically. Dogs who "blow their anals" were viewed with understandable distaste:

Don tells a defilement story. "You weren't here Saturday were you? You should have been. The grossest thing that has ever happened to me in my vet career happened. This client brought in an old English sheepdog. He was real nervous. I had the owner pick up the front of the dog (to put him on the examination table) and I picked up the rear. HE BLEW HIS ANALS ALL OVER ME! (It went) all down my pants leg, up my shirt, over my arm. His anals must have been the size of an egg. I almost puked. I just said, "I'll be back" and I went in the back and stripped off all my clothes and took a shower and eventually came back in [surgical] scrubs."

Odoriferous contamination with patients' body fluids and the unpleasant sights and smells related to maggot infestations of open wounds were considered by the veterinarians as the most unsavory aspects of their jobs. Different animals have differing secretions and smells and the rising popularity of pot-belly pigs as companion animals and the continuing moderate favor enjoyed by ferrets (a rather musky member of the weasel family) presented veterinarians with a rising number of problematically dirty patients.

Defiling bodily excretions are also potentially dangerous to the veterinarians and technicians. A few of the parasites and diseases which afflict companion animals are communicable to humans. On one occasion I noticed a doctor giving medication to a cat caged in the isolation area. When I asked what was going on, he replied:

"[The cat] was in the other day to be spayed and she blew diarrhea all over everything while she was being prepped. We checked it out and she has _____ (he names some serious sounding disease). It's caused by a zoonotic organism, so Cassie (a tech) and I are both exposed. I didn't want anyone else exposed to it. I was trying to remember what I did afterwards. I think I ate two cookies without washing my hands. This is a parasite where you're supposed to wash your hands and scrub carefully under your nails and everything ... but it is all coming out OK so far."

Medically and Emotionally Problematic Patients

When asked what she saw as a "problematic patient," one veterinarian succinctly replied, "One that is going to die." Animals who arrive at the hospital so ill or damaged that they can not be saved and those whose physical problems resist diagnosis were defined as especially troublesome because they made the veterinarians feel powerless.

Similar feelings of powerlessness arose when patients were ill or injured and cared for competently but failed to respond appropriately to treatment. The veterinarians regarded these animals with a mixture of puzzlement and disappointment. One doctor described this type of client during an interview.

There are some breeds and some individual animals ­ this is a funny thing ­ that just won't fight. It's like they just give up. It doesn't matter what you do for them, they just don't get better ­ like Afghans and greyhounds. I don't know if it is a spiritual problem or if some animals just can't handle being sick. I had almost rather like to see them spit and fight a little bit ­ they are at least fighting. But the animals that just lay there ... they might just have a broken leg but they are never going to get up and walk. This doesn't happen very often, most animals will fight injury.

The veterinarians defined as problematic all patients who failed to respond to treatment or were so sick or injured that they could not be treated effectively. However, while some such cases were merely frustrating, the doctors experienced others as exacting a considerable emotional toll. Animals who had been treated regularly throughout their lives and were seen as likeable and cooperative commonly were regarded and related to as unique individuals rather than mere cases (see Sanders, 1993; Shapiro, 1990). When these familiar patients were sick or injured and failed to respond to treatment, declined, and died, their terminal progression created significant sorrow for the doctors and clinic staff. 10

One of the cases I encountered during my fieldwork poignantly brought home for me the intense disappointment generated when highly regarded patients fail to respond to treatment. A large, gentle collie became the focus of special concern and attention in the hospital after his emergency admission for serious injuries from being hit by a truck. For weeks we all followed "Muddy's" condition, rejoicing when his temperature declined and when he ate and worrying when he appeared listless or in pain. Rather than confine him in one of the crates reserved for severely injured animals and surgical cases, the doctor handling Muddy's case set up bedding near a wall in the surgical preparation area where he could be exposed to daily clinic activity and be more carefully watched by doting doctors, technicians, and researchers. After surviving two operations on his badly damaged rear leg, Muddy appeared to rally. Then a few nights later he attempted to stand and redamaged his leg beyond repair. Muddy's stricken owners chose to have him euthanized. For days after this unfortunate and unexpected passing the atmosphere of the hospital was uncharacteristically restrained. The veterinarian responsible for Muddy's case was noticeably distressed by her experience with this problematic patient. I quote from fieldnotes:

I am getting ready to leave for the day and notice Nancy. Knowing that she had been in charge of Muddy and had put him down on Thursday night, I express my condolences. "I was very sorry to hear about Muddy. I was here for the puppy class on Thursday night and Katy (a tech) told me what had happened. I went back and said goodbye to him. I was kind of shaken. I'm sure you were too." "Yes," she replies, "we're all pretty depressed about it. You try to keep yourself distanced from it, but Muddy was different. He had been here for so long and people were so good taking care of him." I observe that I had gotten used to him lying on his blanket in the surgical area. "It's not going to be the same without him there." After explaining that she had decided not to isolate Muddy in a cage because she thought the stimulation would be beneficial, Nancy says that the owners were so upset that they didn't come in to witness the euthanasia for fear that their distress would make things harder for the dog. "I guess the end of his life wasn't that bad," I comment. "He had a lot of people caring for him and didn't really seem to be in that much pain. He actually seemed pretty happy at times. It's a terribly sad thing." Nancy is visibly saddened by the whole situation. As we talk she stares down at the floor and chokes back tears.

Probematic Interactions and Social Control Tactics

Controlling social actors to keep their behavior within specified rules is a matter of central concern in all settings. As part of this process of social control labels are applied to those who are identified ­ rightly or wrongly ­ as rule-breakers. In turn, various negative social responses are directed at them ­ for example shaming, exclusion, or physical coercion ­ with the intent of making the violators see their errors and return to the straight-and-narrow of conventional behavior. 11

The complex process of defining and responding to rule violations proceeds on many levels, from official agencies of control (e.g., courts) to the intrasubjective realm where social actors' evaluate their own rule-breaking and incorporate these evaluations into their self conceptions. Of central importance is the manner in which behavioral expectations and their violations shape everyday, face-to-face social exchanges. At this level, deviance ­ its definition and control ­ is routinely problematic. Rule-breaking injects stress and unpredictability into interactions. Identified rule-breakers are the focus of control maneuvers because they are seen as annoying, dangerous, dirty, immoral, or otherwise troublesome.

In places where humans routinely encounter animals, as in the veterinary clinic discussed above, people typically assign social designations and shape their interactions with animals in line with these designations (see Arluke, 1988; Phillips, 1993; Wieder, 1980). In veterinary settings patients are most commonly regarded by doctors and staff as either routinely unproblematic or as troublesome. As we have seen, this latter category may involve behavioral, physical, or medical typifications. Some patients are defined as medically problematic because their illness is difficult or impossible to diagnose, they are unresponsive to seemingly appropriate treatment, or they are so ill or injured that effective medical intervention is futile. These patients strain the practitioner's expertise.

Other animals are designated as troublesome because they are difficult to control, dangerous, or defiling. Dealing with these patients requires the veterinarian to invest more than ordinary amounts of time and energy while potentially threatening his or her well-being. Some of these animals are absolved of responsibility because, given the situation or features of their relationship with their owners, they are not seen as capable of exercising what Goffman (1971, p. 121) refers to as "intelligent self-control." Less frequently, other unruly patients are relegated to a kind of moral category in that their troublesome behavior is seen by veterinarians as the result of individual choice or character flaws (recall the case of "Midnight Monroe" presented above).

To a considerable degree then, whether the animal-other is defined as an object or as a sentient subject/being (Arluke, 1990; Tuan, 1984) is the major factor determining how the veterinarian deals with a problematic patient. As an object the patient is absolved of responsibility for "its" misbehaviors or violations of expectations and propriety. Presumably impelled by constraining natural forces beyond "its" control, the animal is crudely (or practically) subjected to mechanical or chemical restraints designed to insure that "it" will conform to basic expectations and not make trouble for those working on it or for the organization in which they are situated. 12 Further, as the less responsible member of the animal-owner unit, veterinarians and staff often define the patient's misbehavior as a result of the permissiveness or ignorance of the client. Consequently, the animal is absolved of moral responsibility for its violation of propriety.

In a sense, then, this orientation couches the animal in the role of quasi-child. As in situations where children misbehave when accompanied by their parents (see Cahill, 1987), the owner is held responsible for the animal's violations and is expected to take steps to control further rule-breaking. When the responsible human partner/client engages in what are regarded as appropriate remedial actions (Goffman, 1971, pp. 95-187) ­ for example, he or she acknowledges the violation and offers reasonable explanations or physically intervenes ­ the flow of the social exchange which has been disrupted by the animal's infraction is re-established (see Stokes and Hewitt, 1976). In these situations the veterinarian typically regards the contrite or actively intervening owner as a "good" client.

On the other hand, when the owner appears to be ignorant or incapable of exercising appropriate control, the doctor often will intervene as the dominant control agent. In some cases the veterinarian's intervention takes the form of instructing the client about the management activities expected vis-a-vis his or her pet. A more extreme approach ­ used when the animal-human dyad seriously violate norms of propriety ­ involves the veterinarian taking steps to overtly highlight the violation and, in turn, degrade the client's status in the encounter. 13

As practical actors in an occupational setting, veterinarians are interested in efficiently identifying patients with whom they can expect to encounter problems. The doctors use various resources to accomplish this labelling process. Official records ­ for example, notations on case folders ­ indicate potentially problematic patients. Prior personal experience ­ with the species, breed, or individual patient ­ also is used to anticipate potential trouble. Even when veterinarians do not have personal experience with a particular patient or client, stories about troublesome individuals are part of the narrative lore of the clinic, and veterinarians use these reputational labels to anticipate and avoid problems.

In the absence of prior documentary, experiential, or narrative warning about the potential for patient rule-breaking, veterinarians tend to be watchful and cautious. Clients who provide assistance by defining their animals' subjective state or behavioral inclinations are much appreciated as appropriately cooperative partners in the typologizing endeavor. Veterinarians use this information to shape their interactions with potentially troublesome patients.

In light of the descriptions presented in this discussion, veterinary practice is an activity of considerable interest to social scientists concerned with medical service interactions, deviance and social control, animal-human relationships, and a variety of other substantive issues. From the practical perspective of veterinarians, however, the understandings and tactics presented here have routine and immediate utility. Anticipating, evaluating, and effectively handling problems with both human clients and animal patients go well beyond the technical skills the practitioner acquires in the course of veterinary training. The social management skills examined in this article are integral to what interviewees routinely referred to as "the art of veterinary practice." As such, these abilities are dependent on insights gained through experience as well as the personal sensitivities the veterinarian brings to his or her day-to-day round of occupational interactions.

Notes

1. Correspondence should be sent to Clinton R. Sanders, Department of Sociology, University of Connecticut, Greater Hartford Campus, 85 Lawler Road, West Hartford, CT 06117. An earlier version of this material was presented at the Qualitative Analysis Conference, Carleton University, Ottawa, Canada, May 1992. I appreciate the comments offered by Arnold Arluke, Eleanor Lyon, Ken Shapiro, and two anonymous reviewers.

2. Approximately 38 percent (34.7 million) of American households include an average of 1.5 dogs, 31 percent (27.7 million) include an average of 2 cats, and 6 percent (5.2 million) include an average of 2.5 birds. Seventy-eight percent of dog owners, 60 percent of cat owners, and 8 percent of bird owners used the services of a veterinarian during 1987 (American Veterinary Medical Association, 1988). By the end of the 1980s, veterinarians worked approximately 53 hours per week on the average and earned an average of $51,745 per year ( Journal of the American Veterinary Medical Association , 198 , 8 [April, 15, 1991], p. 1432).

3. It is instructive to compare the triadic exchanges which take place in veterinary settings with somewhat similar interactions encountered in pediatric medicine (see, for example, Tannen and Wallat, 1983) and geriatric practice (see Coe and Prendergast, 1985).

4. Gregory and Keto (1991) discuss the various differences between interactions in human medical settings and those which take place in veterinary settings. In brief, they emphasize the lack of ritual and mystery, open emotionality, use of "plain language," overt discussion of death, and the negotiability of diagnosis and treatment which differentiate veterinary exchanges from those between a physician and human patient.

5. Most of the veterinarians mentioned cat scratches as a common occupational hazard. Large animal practices, especially equine specialties, were generally regarded as the most dangerous:

Yeah, equine practice can be dangerous. One time I was in a stall helping with breeding and the horse started rearing up and there just wasn't any place I could go. I really got scared. There's this fairly young guy, Dr. B_____, out in S____ who has an equine practice. His wife would help out sometimes. One time she got kicked in the head and eventually died. It does happen. When you look at the obits in the journals and you see notices on fairly young people, you will see that they usually did equine work.

6. For a detailed discussion of how veterinarians categorize and interact with clients see Sanders, forthcoming. In general, veterinarians negatively defined clients who were ignorant, inattentive, demanding, apparently neglectful of their pets' health and welfare, overly concerned with cost of veterinary services, and/or emotionally over-involved with their animals.

7. Sometimes the tranquilizers routinely used to control aggression in patients could have unexpected consequences, as in the following (rather extreme) account:

I used to use Promazine but sometimes it has just the opposite effect on these (pit bulls). I actually had one get aggressive on me so I switched to Innovar. I shot one up and he jumped off the table and went for me. He came at me and I kicked him so that he hit the wall over there under the fire extinguisher. He just jumped up and came at me again and I kicked him again. The third time he arched up and hit the wall and then ran into Xray. I got him with a capture loop. By that time my adrenaline was so up that I just went BAM! onto the table. Later we took him back to the client and I said, "You better watch this dog. He's getting kind of aggressive." It was her son's dog and she was scared shitless of him.

8. As members of a general practice, the veterinarians in the clinic I studied engaged in work with both "small" (companion) animals and "large" animals (principally cows and horses). When I told them about Bryant and Snizek's explanation for vets' presumed preference for office work as opposed to farm work, they tended to respond with some amusement. While agreeing that clients in the clinic tended to treat them with somewhat more respect than did dairy farmers or "horse people" encountered on the farms, they were quick to point out the routine dirty work involved in dealing with companion animals. For the most part, they tended to describe their large animal work with considerable pleasure since they enjoyed interactions with the dairy farmers ("horse people" were not so highly regarded) and "being on farm" freed them from the physical confines and routines of the clinic.

9. The veterinary technicians who were given the most unsavory of the routine janitorial tasks in the clinic and were responsible for the macabre job of filling and emptying the cremation furnace also found the dirty work features of their job to be trying. I quote from field notes:

As I come in the back door through the garage, I am greeted by Bonnie who is in the room with the freezer along with Jennie. They are taking what remains in the crematorium, processing it in the blender and putting the resulting powder into the blue cardboard boxes in which they give the ashes to the owners. For the first time I see the end product of cremation ­ actually sizeable chunks of bone from 4 inches long to powder. Initially the leavings are put into a plastic trash can and pounded with a length of 2x4 to break up the largest chunks. The techs are careful to make sure that the name of the owner is always attached to the ashes ­ they know where the body was because they have labeled the various trays that go into the furnace. All in all it is a pretty grizzly business. I mention this to Bonnie who says, "When I first got here 20 years ago I lost 9 pounds in a couple of weeks. My husband told me not to come back here anymore but I told him I would get used to it. (Me ­ What was it that affected you like that?) It was mostly the smell ­ the medicinal smell. The only thing that really gets to me now is when I come in in the morning and reach into a cat cage and stick my hand into warm cat poop. That makes me gag. It is kind of disgusting here [in the cremation area] when the animal doesn't burn all the way and you have to deal with partially burned entrails."

Because they were primarily responsible for routine microscopic analyses of stool samples brought in by clients the techs also jokingly commented on the pungent aspects of this task.

10. Arluke (1990) makes a similar point in his discussion of the distinctions technicians make among the laboratory animals in their care and the "uneasiness" they experience when certain animals with whom the technicians have developed relationships are experimentally "tortured" or eventually euthanized.

11. Given space limitations, this discussion of the complex process of social control is massively simplified. Those interested in considerably more detail should see Becker, 1963; Lemert, 1972; Collins, 1975, pp. 364-393; Rubington and Weinberg, 1978; Pfuhl, 1986.

12. In their study of hospital emergency rooms, Dingwall and Murray (1983) observe that physicians typically define children as "naive" ("pre-theoretic") and, as is often the case when vets account for the uncooperative actions of animal patients, thereby exclude them from the "bad" patient category (an evaluation of moral worth) because they are not seen as able to make choices.

13. Here is such an incident from my fieldnotes in which an aggressive dog's behavior prompts the veterinarian to recount a story in which he employed this sort of status degrading tactic:

(The battle with the muzzled bull terrier) leads Martin to tell a story about a previous encounter with this animal and his owner. "This dog is a lot better than he used to be. When this dog was a puppy his owner's husband was still alive. He was this real big guy ­ died a few years ago from a heart attack. He brings the dog in and we go and try to put him on the table and the dog tries to take my face off. The guy is standing back there with this big shit-eating smile on his face. He thought it was funny. So I said, 'Mr. Randal, why don't you come over here and hold him so he doesn't bite.' That wiped the smile off his face real fast. No way. He was more afraid of the dog than I was.

References

American Veterinary Medical Association (1988), The Veterinary Services Market for Companion Animals , prepared by Charles, Charles Research Group, Overland Park, Kansas.

Arluke, A. (1988). "Sacrificial symbolism in animal experimentation: Object or pet?" Anthrozoos 2 , 2, 98-117.

Arluke, A. (1990). Uneasiness among laboratory technicians," Lab Animal , 19 , 4, 20-39.

Becker, H. (1963). Outsiders: Studies in the sociology of deviance. New York: Free Press.

Becker, H. and Geer, B. (1957). Participant Observation and Interviewing: A Comparison. Human Organization , 16 , 3, 28-32.

Becker, H., Geer, B., Hughes, E., and Strauss, A. (1961). Boys in white: Student culture in medical school. Chicago: University of Chicago Press.

Bryant, C. and Snizek, W. (1976). Practice modes and professional role playing among large and small animal veterinarians. Rural Sociology , 41 , 2, 179-193.

Cahill, S. (1987). Children and civility: Ceremonial deviance and the acquisition of ritual competence. Social Psychology Quarterly 50 , 4, 312-321.

Cassell, J. (1991). Expected miracles: Surgeons at work , Philadelphia: Temple University Press.

Coe, R.M. and Prendergast, C. (1985). The formation of coalitions: Interactive strategies in triads. Sociology of Health and Illness , 7 , 236-247.

Collins, R. (1975). Conflict sociology . New York: Academic Press.

Danziger, S.K. (1981). The uses of expertise in doctor-patient encounters during pregnancy. In Conrad P. and Kern, R. (Eds.), The sociology of health and illness: Critical perspectives. (pp. 359-376). New York: St. Martins.

Davis, F. (1959). The cabdriver and his fare: Facets of a fleeting relationship. American Journal of Sociology 65 , 158-165.

Dingwall, R. and T. Murray (1983). Categorization in accident departments. Social Health and Illness, 5 , 121-148.

Friedson, E. (1987). Client control and medical practice. In Stoeckle, J. (Ed.), Encounters between patients and doctors (pp. 179-191). Cambridge, MA: MIT Press.

Goffman, E. (1971). Relations in public , New York: Basic Books.

Gregory, S. and Keto, S. (1991). Creation of the 'virtual patient' in medical interaction: A comparison of doctor/patient and veterinarian/client relationships . Paper presented at the meetings of the American Sociological Association, Cincinnati.

Hammersley, M. (1990). Reading ethnographic research . London: Longman.

Hart, B., Murray, S., Hahs, M., Cruz B., and Miller, M. (1983). Breed-specific behavior profiles of dogs: Model for a quantitative analysis," in Aaron Katcher and Alan Beck (Eds.), New perspectives on our lives with companion animals (pp. 47-56). Philadelphia: University of Pennsylvania Press.

Herzog, H., Vore, T., and New, Jr., J. (1989). Conversations with Veterinary Students. Anthrozoos 2 , 3, 181-188.

Houpt, Katherine (1983). Disruption of the human-companion: Aggressive behavior in dogs. In Katcher, A. and Beck, A. (Eds.), New perspectives on our lives with companion animals (pp. 197-204). Philadelphia: University of Pennsylvania Press.

Hughes, E. (1971). The sociological eye. Chicago: Aldine.

Landsberg, G. (1991). The distribution of canine behavior cases in three behavior referral practices. Veterinary Medicine , October, pp. 1011-1018.

Lang, C.L. (1981). Good cases ­ bad cases: Client selection and professional prerogative in a community mental health center. Urban Life , 10 , 3, 289-310.

Lazare, A., Eisenthal, S., Frank, A. and Stoeckle, J. (1987). Studies in a negotiated approach to patienthood. In Stoeckle, J. (Ed.), Encounters Between Patients and Doctors, pp. 413-432. Cambridge, MA: MIT Press.

Lemert, E. (1972). Human deviance, social problems, and social control (2nd edition). Englewood Cliffs, NJ: Prentice-Hall.

Lincoln, Y. and Guba, E. (1985). Naturalistic inquiry , Beverly Hills: Sage.

Lorber, Judith (1981). Good patients and problem patients: Conformity and deviance in a general hospital. In Conrad, P. and Kern, R. (Eds.), The sociology of health and illness: Critical perspectives , (pp. 395-404). New York: St. Martins.

Mennerick, L. (1974). Client typologies: A method for coping with conflict in the service worker-client relationship. Sociology of Work and Occupations, 1, 396-418.

Paules, G. F. (1991). Dishing it out: Power and resistance among waitresses in a New Jersey restaurant . Philadelphia: Temple.

Pfuhl, E. (1986). The deviance process (2nd edition). Belmont, CA: Wadsworth.

Phillips, M. (1993). Savages, drunks, and lab animals: The researcher's perception of pain. Society and Animals 1 , 1, 61-82.

Rubington, E. and Weinberg, M. (Eds.) (1978). Deviance: An interactionist perspective (3rd edition), New York: Macmillan.

Sanders, C. (1990). Excusing tactics: Social responses to the public misbehavior of companion animals. Anthrozoos , 4 , 2, 82-90.

Sanders, C. (1993). Understanding dogs: Caretakers' attributions of mindedness in canine-human relationships. Journal of Contemporary Ethnography , 22 , 2, 205-226.

Sanders, C. (forthcoming). Annoying owners: Routine interactions with problematic clients in a general veterinary practice. Qualitative Sociology.

Shapiro, K. (1990). Understanding dogs through kinesthetic empathy, social construction, and history. Anthrozoos , 3 , 184-195.

Stokes, R. and Hewitt, J. (1976). Aligning Actions. American Sociological Review , 41 , 838-349.

Tannen, D. and Wallat, C. (1983). Doctor/mother/child communication: Linguistic analysis of a pediatric interaction. In Fisher, S. and Todd, A.D. (Eds.), The social organization of doctor-patient communication , (p. 203-219). Washington: Center for Applied Liguistics.

Tuan, Y. (1984). Dominance and affection . New Haven: Yale University Press.

Wieder, D. L. (1980). Behavioristic operationalism and the life-world: Chimpanzees and Chimpanzee researchers in face-to-face interaction. Sociological Inquiry, 50, 75-103.

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