Thursday, January 12, 2012

Gutter Language, or, The Art of Communication

So, I mentioned to Leo's Dad the other day that I had a professor in veterinary school who spent a decent chunk of lecture one day advising my class about the art of client communication, or, as he put it - the need for us to use "gutter language." Thinking back it still makes me laugh. At the time, I thought, what the hell? Why is he saying this? It's absurd. There are NOT going to be clients whose pets I am treating for kidney disease who do not know what "urine" is, or what it means to "urinate." I was going to be practicing in a reasonably well-off area with well-educated people living there, after all. And yet, I dutifully wrote down the list of alternatives he kindly provided: tinkle, pee, pee-pee, piss, go number one, pass water. I remember thinking how silly I would feel telling a client that their dog was having a problem with the part of his body that made the pee-pee, or that their cat's big problem was that his piss couldn't get out. And yet, as it happens, my esteemed professor was right. I do have clients who don't know what urine is. It's not common, but it's happened. It blows my mind.

It can be difficult to know where a client sits on the scale of understanding. I'll start sometimes by saying that I'd like to be stopped if I'm not being understood, but that doesn't always actually happen (after all - who likes telling The Doctor that they can't understand a word he's saying?) and I don't always realize a client isn't as up-to-speed as I think she is in time to catch myself (read: before I open my big mouth and start talking). Sometimes, I'll talk for five minutes about the pet's medical situation and it seems like the owner is with me but then it suddenly hits me that she's doing that "smile and nod" thing that I do when I take my car to the shop, and she actually has no clue. So, I'll stop, and ask my client if she understands what I've said so far. If she sheepishly admits to having no idea what I'm talking about, I'll smile and tell her that's ok. I'm not a monster, after all. I want my clients to understand. So then I'll take it down a level or five and eventually, hopefully, she will understand. If I have to say "pee-pee," I'll say pee-pee. I'll make sure to explain that pee-pee is usually called "urine" by veterinarians, in case she needs to speak with someone else about it, though. I've drawn pictures of the glomeruli and the beautiful convoluted tubules to make a point. Hearts and valvular disease are another thing often explained best by a drawing, even if my drawings are kind of lame. The important thing is to impart to the client the information he needs to know to provide the pet with the best possible care.

Sometimes, it's just really hard. I think back to that day in vet school when my professor was telling us about clients who didn't know what urine is, and how optimistically disbelieving I was at the time. Little did I know I would one day stand in a small room speaking to a man who had just gasped in utter shock "wait just a minute - do you mean to say that DOGS have LUNGS?"

I'll give you a moment.

Yes. My client truly did not realize that dogs have lungs, and he in fact had a follow up question after I replied to his first one, quoted above, by calmly saying "yes. That is what I mean to say. Dogs have lungs." His follow up question was "are you SURE?"


That's when I did a little demo. I panted, and then pointed to the dog, who was also panting. I breathed in deeply, to make the chest excursion obvious (shut up, Beavis), and showed him how his dog's chest did the same thing. I pulled out my anatomy book and a couple of chest radiographs and pointed out where the lungs were.** The guy remained sadly skeptical of the whole thing.

There are all kinds of people in this world. Teaching is not my favorite thing to do in life, but I'm happy enough doing it when my student (client) is interested and accepting. When my student either can not or will not understand me - that's when I throw up my hands in despair, and turn to the writing of snarky blog posts for release (snarky blog posts being the 2012 version of the snarky facebook post of 2010-11, the snarky web forum post of 2008-2010, the snarky email distribution list post of 2001-2006, the snarky inclusion in the note service handouts, or the snarky messages passed in class). Let's face it. It's really hard to explain recurrent aspiration pneumonia in a dog with laryngeal paralysis to a person who just can't quite wrap his head around the idea that DOGS have LUNGS. Yes, I can say "give him these pills, use these feeding methods, consider this surgery," or whatever other recommendations I may feel the need to make, and the dog may recover from the acute episode, and the client may even be just fine with how it all went down - but for me? That's not a satisfying interaction - especially since I know the client didn't understand why it's happening or what we can do to make it less likely to happen again.

But I do the best I can. I think we all do the best we can. And if for some reason I think my best isn't good enough, I bring in help. Sometimes, using the "phone a friend" lifeline is a great thing. We could all use a little help sometimes.

**Those anatomical drawings are copyright Hills Pet Nutrition. Obviously that makes me part of the Vast Veterinary Pet-Food-Pushing Conspiracy. Take no notice of the man behind the curtain, and all that. [insert eyeroll here].


  1. My first year out in practice, someone called the emergency line and said that their dog couldn't "make water." I thought that was awesome because dogs are not supposed to make water. Actually, it took me about 5 minutes to understand what the little old man was talking about. First, his accent was very thick...then the term he was using was nothing I had ever been exposed to.

    "Oh, you mean he can't PEE? Ok, that I understand."

  2. I have actually had clients argue with me about the fact that male dogs have nipples. They repeatedly report that male dogs wouldn't have nipples because they don't nurse puppies. I usually just mention MEN have nipples and then you actually see the light bulb turn on!

    One time, I was in appointment and the client mentioned her dog had flea beds. She keeps trying to clean them off her dog, but she can't get them to completely go away. Being a relatively new grad at the time, I was frantically searching for these so called flea beds. Thinking, "Crap! I don't remember learning about this in school!"

    Finally, I just asked her to point them out to me. Yep, you guessed it, the nipples. On her male dog. Yep, male dogs have nipples...and so it goes again.

  3. A complete lack of understanding of anatomy and physiology has its funny side.

    Lack of comprehension that an animal is in pain is another matter altogether ("he's been lying down for days, he can't walk, he won't eat, and he's very quiet, but I don't think he's in pain because he only cries when I try to move him"). To paraphrase Anna Sewell: this type of ignorance is wickedness.

    Yet another reason I'm glad I don't work in full-time practice anymore.

  4. What's shocking is the lack of knowledge some clients have regarding their own basic anatomy, let alone their dog/cat - I was there in 9th grade health class people, I know we covered this...
    One of my favorites was an elderly gentleman that called the ER one night wanting to discuss his dog that had "the sugar" and what could be done about those "cadillacs" in his eyes - ugh.
    I enjoy having dry erase boards installed in the exam rooms, it makes veterinary pictionary much more fun. :)

  5. Just to add to ccdvm, forget 9th grade; I have just checked and my 8 year old and 6 year old both know that dogs have lungs and what urine and urinate mean - Does that mean that they are smarter than some of your clients?

  6. I had a "professor" (really a coach with some sort of master's degree) that taught my first aid course in undergrad. When he talked about breathing, he told everyone that they used their "chest muscles." Seriously, in a college class. Not to mention that he regaled the class with stories of how, when he taught 4th grade guy, he told kids with asthma to "keep on running, just puff that inhaler over and over again." This guy was not only ignorant, he was dangerous.

    I have to admit, asking him what the diaphragm was for was funny.

  7. @Cav, I don't know about "smarter." I mean, smarter than some of my clients, yes. Better educated than some of my clients, yes. I do have some clients who seem to be of normal intelligence who are just unbelievably ignorant (I say that without value judgement. Were it not for the wonderful teachers in my life, I would be ignorant too), so, you know... Glad your kids are up to speed so far, though :)

  8. Startling how many people don't know what a fecal sample or spaying is.

  9. Just had an incident the other day in which we had to stoop to requesting that a client bring in a "crap sample" because they had no clue what "stool" or "feces" were. SMH. Also had a client come in once, furious with us and making a scene in our lobby because she had her dog groomed here and now he had ticks. All on his belly. Didn't we notice them? He MUST have gotten them here? Cue the discussion about male dogs having nipples, which included a doctor and another male dog brought out and HIS nipples shown to the owner. *Sigh.
    Then there was the lady who was absolutely SHOCKED to find out rabbits defecated. She wouldn't have gotten a rabbit if she had known they pooped.
    Or the lady who was convinced that the mammary tumors on her unspayed 8 year old dog were really pockets of worms. She also insisted on curing her by feeding her "green things" You can't make this stuff up folks.

    1. Apparently she never read that classic children's book, "Everybody poops"

  10. just to clarify, yes, the doctor did show HIS nipples to the the lobby.