As a general rule, I'm very honest with my clients and tell them what I'm thinking. Veterinarians, (unlike human doctors, I believe) hash things out with their clients; let them in on the decision-making process and go over everything so that everyone understands the disease process and what the course of diagnosis/treatment may turn out to be. People, I've found, do not like surprises, and hardly anyone gives you carte blanche in pursuing a case, so this approach generally works out pretty well.
I was having one of these discussions recently. I was doing my best at explaining the pathophysiology of recurrent ear infections in dogs to an older woman who seemed pretty with-it. I could tell that we were on the same wavelength and I was excited that I was making things clear, until...I began suffering from The Two Conversations Syndrome.
The Two Conversations Syndrome is one I believe affects anyone, in any field. But for me, oftentimes it manifests itself as the "conversation I wish I was having with the client" versus "the one I actually am." Allow me to use the ear infection lady as an example:
Dr. T: "So, in the case of an ear infection in a dog, what we have is an overgrowth of the normal yeast and bacteria in the ear along with a change in the normal cleansing mechanism of the ear itself."
Client: "Well, I have been cleaning Rusty's ears. I've been using peroxide and then bathing the ear with warm water and sometimes I'll use one of those face-cleansing pads. Then, I read on the internet that I should put a few drops of mineral oil in there after I'm done cleaning, but I didn't have any of that so I used olive oil. This has been going on for a few weeks and the olive oil didn't seem to be working, so recently, I've been using some medicine I bought at Wal-mart. I can't remember the name of it."
Dr. T's conversation she wishes she was having with the client: "What the HECK?!?! Why, WHY did you think that was a good idea?! No wonder he has a freaking ear infection. Your poor dog probably hates you right now."
Dr. T (actual conversation): "Well, those cleaning methods are probably not such a good idea. We have specially formulated ear cleaners for dogs that are very gentle on the skin of the ear itself, while breaking down the waxy debris in it. I'd also stay away from putting anything other than prescribed medications in the ear. Olive oil is something I probably wouldn't use. Actually, anytime you read something in the internet and are considering using as a treatment, just give us a call and we'll be happy to discuss it with you."
Client: "Oh, ok. Well, I've also been cleaning the ear three times a day. Is that too much?"
Dr. T's conversation she wishes she was having with the client: "For real? THREE times a day?? I can hardly get people to medicate their dogs three times a day when they actually NEED it, much less when they don't."
Dr. T (actual conversation): Yes ma'am. Definitely too much. What we want to do with ear cleaners is remove the debris without stripping the ear of its natural wax and destroying too much of it's normal flora. I'd definitely recommend cleaning much less often than that.
Client: "OH I see! It's just like with women!"
Dr. T's conversation she wishes she was having with the client: "Um, what? Do I want to even ask what you mean by that? Ohhhh, Lordy..."
Dr. T (actual conversation): "Hmm, I'm not sure I see what you mean."
Client: You know, we have a normal flora too. My gynecologist was telling me all about it because I was having so many problems - you know, down there- he said I was douching too much. See, I was having this odor-"
Dr. T's conversation she wishes she was having with the client: "NO! NO! NO! Please. Stop. Ears. Burning. Nausea...Ohhhhhh...."
Dr. T (actual conversation): "OH! I see! Yes, it's just like that! OKAY, well I'm going to take a look at Rusty's ears now, alright? HEYYY there Rusty! Good boy! Let's take a look..."
See what I mean? You can't make this stuff up, folks.