Bigstock The thing about French bulldogs is they are not particularly healthy. Of course, veterinarians know how difficult Frenchies can be as patients, but it is not just because of their skin and ear issues, digestive problems, nonhealing corneal ulcers, untrustworthy intervertebral discs, proclivity to all sorts of neoplasms, and their lack of a functional respiratory system. Sometimes, it’s also their owners. Fundamentally, French bulldog owners (who more often think of themselves as “parents”) want the same things as any other veterinary client: excellent, affordable, and convenient medicine for their beloved animals. The difference, in my experience, is that those goals are wildly more unrealistic in brachycephalic creatures. For example, I was recently presented with a five-year-old, unspayed French bulldog during my shift at a local emergency room; I’ll call this critical patient Veronica. The dog was presented into the treatment area, clutched in the arms of a nervous receptionist, its gums cyanotic, and she was making that awful noise that’s halfway between gasping and snoring. My heart rate always goes up in these situations. When you’re presented with a French bulldog in the emergency room, things can go wrong quickly. Heck, being a French bulldog on a Tuesday can go wrong quickly! So, my adrenal glands were already squeezing when a technician read her core temperature at 105.3 F. Oh, great, I thought. Another disaster Frenchie I’m going to have to watch slip away. Secretly (and not so secretly), I, like many veterinarians, have been hoping this breed will become less popular. Sometimes it just feels impossible to manage them, and setting realistic expectations with their owners can be such an enormous challenge. Medically, however, it’s not that hard to know what to do in these situations: sedate, oxygenate, IV catheterize, and prepare to intubate. I have an excellent team of technicians who quickly put together emergency equipment and started the work on stabilizing Veronica … which left me rushing to the front area to speak with her owners. Collision course Although I would have loved to have started the client interaction with a lecture on the ethics of imposing brachycephalic airway syndrome on a companion animal, I instead conjured up some professionalism and introduced myself. Trying to suppress an appearance of being rushed (something that decreases trust in veterinarian-client interactions1) I explained the severity and timeliness of the situation. Veronica was incredibly unstable, and if we do not move quickly, she would run out of time. Her owners, a couple in their 20s, listened politely as a scary (but imaginary) clock ticked down loudly in my head. I wasn’t sure how much time the patient had, but opening with this simple, professional gesture shows respect and invites the type of collaboration that would give Veronica the best chance. Moving into “expert” mode due to the nature of the emergency, I started to lay out our mutual agenda. However, during my explanation of how the team was handling this critically unstable patient, I was shocked to hear the male partner shrug off Veronica’s severe dyspnea. He said, “Oh, she always does that in the car!” I was stunned. Here I was, in orifice-clenching dread of his pet’s imminent mortality, and he seemed to think car ride-induced cyanosis was a perfectly normal thing for a dog! Then his partner caught me with a presenting complaint right hook: Veronica had been limping for two weeks! At this point, I must have had a facial expression as if I had just been asked to perform a telemedicine fecal exam on a unicorn. I was quickly informed of consent for emergency stabilization, but it seemed our subconscious agendas were so different, we might as well have been in different universes. They are in a fantasy land where tissue oxygenation is optional; I am in a dystopian reality where my patients have the stability of a late-stage Jenga game. There’s no judgment here. I had nothing against these people. It’s not really their fault. Frenchies (and other breeds with a respiratory system barely compatible with life) are so easy to fall in love with. The truth is, most of their owners understand the breed, in general, has health problems, but also rate their own as healthier than most.2 Obviously, “most” dogs can’t be above average. As scientifically trained medical professionals, we understand this at a seventh-grade math level. However, just because numbers don’t have feelings does not mean that reality is easy for most people. Especially if you’ve shelled out five grand (or more) for a Frenchie puppy, it is hard to accept your investment might be fundamentally flawed. Next steps While still fathoming the gap in perception between myself and Veronica’s owners, a technician came into the room to let me know she was looking much better. Her gums had pinked up, and her temperature had come down a bit. She looked much more comfortable, and sure enough, she had a moderate grade lameness of her right forelimb. We now had some time to figure out a plan, so I tried to subconsciously recover my composure as I began taking a history. Even though I’m a clinical communication junkie and have a well-thumbed copy of Developing Communication Skills for Veterinary Practice on my bedside table, this interaction did not go swimmingly. The clients could not agree on how long the limp had been there or which leg was affected. They couldn’t agree on what Veronica’s appetite, energy, and attitude had been for the preceding days, weeks, months, and years of her life. One of them thought she wasn’t drinking water excessively, the other swore she would guzzle like an elephant at a watering hole. You know those error bars in scientific papers, that tell you how likely the truth is to fall between? Well, yeah, my conversation with these two lovely young people generated error bars wide enough to include all possible manifestations of the dang multiverse. This wasn’t unique to our situation. Having multiple owners involved in communication is a known challenge to veterinary clinical communication.3 I feel if you have practiced for more than a decade, you should get an honorary degree as a couples’ therapist. Also, this case wouldn’t have been a headache if it hadn’t also involved one of the other greatest problems in veterinarian-client interactions: money. Of which, they did not have enough for a “gold-standard” workup. If I’m completely neutral for a moment, I’d estimate the ideal emergency budget for a Frenchie in the low thousands. At least as much as you paid for the puppy, and probably doubled, and probably on an annual basis. If I’m being a slightly cynical punk, I can just report the reality, this almost never happens. Which is fine; one of my jobs as a clinician is to compassionately bridge the gap between expectations and reality. That’s why I’m such a fan of clinical communication. If you get good at this stuff, you can really bring people a long way out of their fantasyland without them hating you for it. If you think of the quality of the veterinarian-client-patient relationship as directly proportional to the quality of medical care you provide for animals, then dysfunctional communication becomes just as risky as a hypoplastic trachea in these situations. I’ve said it over and over until I’m as blue in the face as Veronica was that night: Nowadays, veterinary medicine is all about communication.4 Having a collaborative mentality with pet owners not only improves everyone’s experience, but it also improves the healthcare animals receive.1 To wrap up Veronica’s case: there was not enough money for imaging, or much else besides dispensing some multimodal analgesia. I sent the stable patient and the clients on their way. I could sense, or at least thought I did, they left trusting me and my clinic because we had stuck with them from start to finish, even though that was unexpected and challenging. GETTYIMAGES/SLAVICA Conclusion I’m sure we have all seen a CE lecture on a challenging brachycephalic case. It’s reassuring to watch it unfold at a calm pace, retrospectively clean, and expertly managed by a specialist who already knows the outcome. However, what’s often missing from those presentations is the messiest part of the case: the conversation. In real practice, the case does not end with a treatment plan. It ends with a client walking out the door feeling either confused, blamed, reassured, or respected. That emotional residue matters. Trust is not a soft outcome; it is a clinical one. It determines whether recommendations are followed, whether patients return, and whether care improves over time. Just as medical comorbidities complicate the biology we’re trying to manage, human thinking complicates the social systems wrapped around our patients. We can’t fix brachycephalic anatomy in the exam room, nor can we eliminate wishful thinking or financial constraints, but we can stay collaborative when things are unclear, imperfect, and frustrating. Veronica’s case wasn’t elegant. The conversation certainly wasn’t, but sticking with her owners—without judgment, without disengaging—gave that dog the best chance she was going to get. Messy communication isn’t a failure of care. Walking away from it is. Greg Bishop, DVM, is a small animal veterinarian and a part-time veterinary technology instructor in Portland, Ore. Dr. Bishop also creates the monthly cartoon series, “The Lighter Side.” The author’s opinions do not necessarily reflect those of Veterinary Practice News. References Kanji N, Coe JB, Adams CL, Shaw JR. Effect of veterinarian-client-patient interactions on client adherence to dentistry and surgery recommendations in companion-animal practice. Journal of the American Veterinary Medical Association. 2012 Feb 15;240(4):427-36. Proschowsky HF, Springer S, Lotze S, Rafn F, Sandahl Z, Bruun CS, et al. Perception of dog health and attitudes towards BOAS grading among Danish owners of French bulldog. Front Vet Sci. 2025;12:1605505. doi:10.3389/fvets.2025.1605505. Janke N, Coe JB, Bernardo TM, Dewey CE, Stone EA. Pet owners’ and veterinarians’ perceptions of information exchange and clinical decision-making in companion animal practice. PLoS One. 2021 Feb 1;16(2):e0245632. Groves CN, Coe JB, Sutherland KA, Bauman C, Grant LE. Clients prefer collaborative decision-making with veterinarians regardless of appointment type. Journal of the American Veterinary Medical Association. 2025 Jan 1;263(1):1-1. Geraz H, Pinello K, Mendonça D, Severo M, Niza-Ribeiro J. Investigating the life expectancy at birth of companion dogs in Portugal using official national registry data. Animals. 2024 Jul 23;14(15):2141.
