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?"

*sigh*

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].