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On Dishing Out the F-word and Dropping the O-bomb

By Patty Khuly, VMD, MBA

Posted: Dec. 20, 2012, 5:30 p.m. EST

Scanning my journals and trade magazines in search of news and notable literature, I came across a veterinarian-authored how-to piece explaining how we should approach the fraught topic of weight loss in pets.

Go easy, the author urged, as pet owners are easily put off by language they may perceive as accusatory or judgmental. A veterinarian who charges into this subject without gentle preamble risks not only his client’s badly needed buy-in, he risks losing his client altogether.

I might have read past this well-stated bit of advice except that it coincided with an email delivered by an indignant Miami Herald reader (I write a weekly pet advice column) who seemed to echo her sentiments:

My veterinarian and I are on the outs. She’s been insisting for years that my cat is overweight and has now started using words like ‘fat’ and ‘obese’ to describe him. I’ve never denied that [my cat] can stand to lose a few pounds, but I think using that kind of language is just plain rude. Is this the kind of bedside manner being taught in vet school these days?

Ouch, that stings!

Yet we have heard this argument before. Plenty of physicians have lately been advocating a more gentle, “judgment-free” exam room climate in which motivations are addressed and the underlying issues more obliquely discussed.

You can’t beat patients over the head and expect to get good results, they say. It’s only by carefully guiding patients toward greater awareness that we can truly secure a patient’s compliance.

Which makes a good deal of sense. After all, a defensive client like the one above is not a good partner. The attitude oozing thickly from between the lines implies that she’s planning her defection after years of loyal patronage—an outcome that might have been prevented had client communication been handled more adeptly.

It’s a solid argument for the softer touch. Rough talk can lead to client loss.

Nonetheless, I couldn’t settle my hackles for hours after reading this missive. To my read, it smacked of more than a hint of unreasonableness and injustice. Hence, why I spent the balance of one Sunday afternoon plotting a defense of her veterinarian. Here’s an excerpt:

Your question begs another … By your admission, [your cat] has been overweight for years and, as your veterinarian’s increasingly strong words intimate, you’ve done nothing about it. What would you suggest she say?

Given your sensitivity to your vet’s brand of tough talk, here’s what I might offer you instead:

Excess weight in cats is a cruel killer. Type II diabetes, debilitating liver disease and crippling arthritis are only a trio of the possible options you’re predisposing [your cat] to. So by feeding your cat more calories than he needs, you’re effectively causing him needless pain and putting him at high risk of potentially life-ending disease.

Does that work any better?

Now hang on, I know what you’re thinking: How does this kind of passive-aggressive riposte do anything but fan this client’s flames?

Fat and obese pets
Do you use the words "fat" or "obese" when speaking to clients about their overweight pets?

Here’s where I’ll confess: I’m seldom shy about employing some pretty harsh language to press my point, though typically only on this, among a smattering of other subjects for which animal welfare becomes an overriding concern (cosmetic surgery, hoarding and neglect, among others).

Though it may seem self-righteous and unnecessarily contentious to do so, it’s my deeply held belief that many cases do require that we arrive at a moral judgment and that we state our case firmly, convincingly and unambiguously—at odds with profitability though it may be.

Indeed, to fail to state our hard-won professional opinion, or to varnish it for client consumption or retention, as the case may be, is neither helpful nor ethical—not when our patients’ welfare is at stake.

In any case, expressing ourselves effectively, even if critical and disapproving, is only normal and, moreover, often professionally appropriate. I mean, anyone who believes client communication can ever be truly non-judgmental probably believes in the fiction of squeakily objective journalism, too. We are human, after all.

Yet every practitioner draws the line differently. Which begs the question: At what point do you dispense with the polite trappings of by-the-book client interactions and speak freely as any concerned human would? When the dog who dines daily on chicken breasts alone dies because of his diet? When the hoarder can’t afford her own dental care because she’s paying for her cats’?

But I digress. Back to the inciting issue.

Personally, I’ve found that using the “F-word” and dropping the “O-bomb” can be an extremely effective technique for getting my clients’ attention, securing their compliance and ultimately helping them achieve weight loss (or whatever else is at stake) on behalf of their pets.

Though I completely understand that we should always do our best to earn our clients’ trust carefully and deliberately through measured interactions—and in so doing try to recruit our clients’ cooperation through the use of non-threatening, emotionally neutral and highly supportive language—at some point we should be forgiven for feeling morally compelled to speak out more forcefully.

So when all else fails, can you blame me if I trot out words that can rub my clients the wrong way?

I shouldn’t think so. Not when so many of us have learned that sometimes there’s no substitute for frank talk and tough love—not only when it comes to client compliance, but for the sake of our professional integrity, too.  

Dr. Khuly is a small animal practitioner in Miami and a passionate blogger at drpattykhuly.com.

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Reader Comments
There is a point where you do have to get firm with your clients because your being too nice about "FooFoo's" morbid obesity is clearly not getting your point across. I always start out in a humorous manner & comment on the fact that "FooFoo" seems to be eating really well & see if the clients jump in with a comment of, "yes, she's probably eating too well," or something similar. I have a pre-printed diet plan that addresses all the objections-- I can't feed her separately, or it's too hard to keep track, etc, etc. I utilize Purina's 1-9 BCS score chart every single time & ask the client to assess their pet's appearance based on the chart. I give them a copy of it to "post on their fridge" to remind them of their goal. And all throughout I stress that it's almost always a very simple problem to work on to start with--ie, portion control-- & provide them with a measuring cup & request that they pop in monthly to reweigh their pet so we can keep track of their progress. In a humorous manner, I ask "Do you want a diabetic dog?" And smiling the whole time, I agree with them as they're shaking their head "no." I rarely have people getting angry with me & most seem to realize & admit their pets are overweight once they see the BCS chart.
Christine, Chandler, AZ
Posted: 1/24/2013 8:17:28 PM
I completely agree with Dr. Khuly. I am personally amazed at the number of times I have told a pet owner presenting to my ER that their pet (BCS of 7 or 8/9)is too heavy, fat, or morbidly obese ("morbidly" gets their attention) and am told in reply "My vet has never said anything about his/her weight." Maybe they did, but the language wasn't adequate to convey the seriousness of the issue?

Don't get me wrong - I think the "fluffy" comedians are hilarious. But if being seriously overweight is the new norm for people and pets, it is incumbent on care providers to educate their patients/owners, and sometimes you've got to get their attention before they can learn anything. You may need to use the F-word and drop a few O bombs (I find the MO bombs give me a good opening to explain the disease issues).
Mike, Dallas, TX
Posted: 1/24/2013 7:51:37 PM
I really like Dr. Khuly's column. I wrestle with this myself. I have had any number of indignant clients react negatively to the F and O words. Something I have been trying is this: Now (long pause and sad knowing look) about your cat's "waistline"....You realize she is a little plump, no? Well if we don't do something right now, she is in danger of becoming obese, with all the nasty and expensive health and life threatening problems that can accompany obesity, liver disease, DM, etc. Tongue in cheek as the cat is already obese. I almost hate myself over this subterfuge, but sometimes it works wonders!
Jane, san diego, CA
Posted: 1/24/2013 6:31:47 PM
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