Following our first installment on the vitally important topic of client communication (Watch Your Mouth, Part 1), here are some more thoughts about things to say and things to ban. Never say, “Don’t worry” to a nervous client. Murphy’s Law says that if you ever use those fateful words with a veterinary client who is fearful of anesthesia, anxious because her pet is being hospitalized all day, or worried that her pet will be fasted all morning, something bad will happen. It never fails. A colleague who worked at an MRI facility was always peeved when her radiologist called a disc hernia “moderate.” To her, moderate is a tricky word. Think about it: In politics, a moderate is kind of stuck in the middle. So our colleague’s concern is that neither the referring vet nor the client might be encouraged to act on a moderate disc hernia or a spinal cord that is moderately compressed. She prefers the word “significant.” So she believes a disc hernia should be described as mild, significant or severe. “Moderate doesn’t lead to action. Significant usually does.” Thanks to this wise colleague, now I actually describe disc hernias, degenerative joint disease and other lesions with one of these three words: mild, significant or severe. Classic misuse of words if you ask me: Please don’t tell clients that male perineal urethrostomy cats are turned into females! Please don’t tell clients that we “break the bone” when we do a TPLO or a corrective osteotomy. At best, this scares people. At worst, that may lead them to decline surgery. Yet surgeons are much gentler than that. We respectfully cut bones with a saw. Heard about a paralyzed dog with no deep pain: “Your dog does not feel obnoxious stimuli.” Huh? Heard about a critical patient in ICU: “Your cat still has an obtunded mentation.” What? Although I don’t give vaccines (besides to my own pets), I believe we have shot ourselves in the foot (sorry, no pun intended) by asking (and training) clients to bring in their pets for “yearly shots.” Sure, vaccines are a wonderful thing, but at least as important is the yearly, comprehensive, tip-of-the-nose-to-tip-of-the-tail physical exam (PE). Wanna know a little secret? One of my totally subjective criteria to know if a referring vet is good or great, is how often they pick up something important on PE during a yearly visit. The great ones palpate splenic masses, intestinal masses and anal sac tumors (you do stick a finger up there as part of every PE, don’t you?). Great referring vets diagnose chronic otitis worthy of a total ear canal ablation. They notice a redundant vulvar fold in need of an episioplasty. What a client neglected as yet another fatty tumor suddenly turns out to be a mast cell tumor. On the medical side, they diagnose renal insufficiency, liver disease and KCS. Surely this is at least as important as “yearly shots” given after a cursory exam—or none as is often the case at vaccination clinics. Correcting this may take a while, but it should be possible to “retrain” clients within your own clientele. Recommend (bi)yearly health check-ups, perform thorough PEs and I’ll bet you’ll be impressed by your own findings. Dr. Phil Zeltzman is a mobile, board-certified surgeon in Allentown, PA. His website is www.DrPhilZeltzman.com. He is the co-author of “Walk a Hound, Lose a Pound: How You and Your Dog Can Lose Weight, Stay Fit, and Have Fun Together.”
