A (DACVB) is a veterinarian who has completed advanced specialist training:

Too many clinicians still ask: “Is it medical or behavioral?” The correct question is: “How much is medical and how much is behavioral?”

Historically, veterinary visits were traumatic for many animals. The smells, the sounds, and the physical restraint often triggered a "fight or flight" response. This didn't just harm the animal's mental state; it skewed medical results. Stress causes spikes in glucose, alters white blood cell counts, and raises heart rates, leading to false diagnoses.

Note that last point: Excessive grooming . A purely medical vet stops at the skin scrape. A vet trained in behavior knows that if the skin is clear, the issue may be a brain chemistry imbalance (feline hyperesthesia or OCD). Treating the skin with steroids will fail; treating the brain with fluoxetine might succeed.