BigStock "Ms. Frizzle” came in on a Wednesday afternoon. Not the character from the kids’ TV show, The Magic School Bus (something I’m sure many of my dorky veterinary colleagues grew up watching). This Ms. Frizzle was a feline patient of mine. She presented to the ER, where I work, for a urethral obstruction. We see a lot of blocked cats–sometimes three or four a day–so, when I got on the phone with the owner to review the plan, I knew how to set expectations appropriately. We’d sedate the cat and place a urethral catheter, relieving the obstruction and buying us time to determine the cause. I provided a cost estimate to the owner and discussed the case with her primary care veterinarian, who reassured me of the one glaringly unusual aspect of this case: Ms. Frizzle was female. It’s rare but not unheard of for female cats to block (according to one study, the actual ratio is somewhere about 25:1).1 Although I was sure I’d never had one before, and I’ve unblocked hundreds of cats. So, trust me, I made sure to confirm with the referring veterinarian Ms. Frizzle was, in fact, Ms. Frizzle, and she said that yes, weird as it was, the cat was a girl. She had a painful bladder but was otherwise stable when she arrived. A veterinary technician took Ms. Fizzle’s vitals, a receptionist attached her medical records to her chart, and we prepared to get her pee flowing again. I got on the phone with the owner to confirm the plan—a lovely client, worried about her pet, but also good-natured and somewhat amused by the unusual circumstances. The client has had Ms. Frizzle since kittenhood and wanted to do everything possible to get the cat well. If I do say so myself, my clinical communication skills in this case were top-notch. I set an agenda early and built trust throughout the conversation with partnership statements and minimal encouragers. I provided a clear summary of risks, benefits, reasonable alternatives, and estimated costs. It was beautifully done, consistent with the latest research on relationship-centered care, and an imaginary halo appeared above my head, signaling things were going smoothly. Everyone involved with this case, from the referring veterinarian to me, to the pet owner (clearly a fan of the scientific method herself), would be a rational, objective, and coldly clinical problem solver in this case. A small problem with the plan You know where this is going, right? None of the half dozen or so of us involved in the case had figured it out at this point, and it’s with extreme embarrassment and a genuine fear of professional repercussions that I admit it wasn’t until after Ms. Frizzle was under anesthesia that something seemed “off.” BigStock First of all, I admit I was fully prepared to unblock a female cat. I had spent 10-15 minutes looking up videos on the technique, and I just figured that, with such a long string of uninterrupted male cat urethral obstructions, I must have been due! Donning my sterile gloves, I lubed up a polypropylene catheter and went for it. It’s incredibly tempting to defend my next actions with a hyper-technical description of the uniquely similar anogenital distances of male and female cats, but that would be slipping into jargon, one of the mortal sins of effective communication. I guess it also would have been great if the little skeptical voice in my head had been a little bolder (for the sake of reference, imposter syndrome affects roughly half of all veterinarians).2 As it stood, the catheter wasn’t feeding. I will not say how long I kept trying, but eventually, my nearly 20 years of veterinary experience suggested a thought: What’s more likely, that this is truly a blocked female cat, or that I (guru of communication that I think myself to be) had been involved in a miscommunication? There were two reasonable options: a) seek help from a colleague, or b) reconsider the cat’s gender. In most cases of medical error, I would strongly encourage seeking help. Medical errors, including those rooted in miscommunication or incorrect assumptions, are common in clinical practice and can harm patients.3 Luckily for me, Option B could be tried in a few seconds before I would have to choke down on a humble pie and go with A. I reexamined the cat’s genitalia, and feeling like Sherlock Freaking Holmes, popped out … a surprise penis! Ms. Frizzle is not who she appeared to be! Once the mystery was solved, the catheter passed easily. The cat recovered uneventfully, and we were now back on track. Medically, at least. I did have that awkward conversation ahead: explaining to a trusting pet owner that we had just goofed big time. Obviously, “Ms.” Frizzle was now doing better, but he was also a completely different gender. How much faith would they have in me when I whiffed on something so obvious? A cold rush of negative thoughts hit me: A furious owner, verbal abuse, the clinic eating the cost of the procedure, an uncomfortable sit down with management, an online campaign against the “Misgendering Vet of Portland, Oregon,” and a placard with the words “He Miscommunicated” slung around my neck for the rest of my life. I decided to just get it over with. However, instead of blaming my imperfect communication skills, I decided to give them another chance. Just before calling the cat’s owner (you know, the one who had named him Ms. Frizzle), I took a deep breath and prepared my thoughts. Before I got her on the line, I had a plan in place: I would reassure her the pet was now in a much better medical condition and that something unexpected had happened. Step two is a signpost, a heads-up that the conversation is going to head in a potentially unexpected direction. With a whole lot of empathy for the potentially upsetting mistake, I delivered the news of Ms. Frizzle’s surprising genitalia. I added gobs and gobs of self-deprecating humor (my specialty and an underappreciated clinical communication tool),4 then paused to receive her response. She was surprised but never expressed any doubt in the rest of the veterinary team or me. Possibly, she was just a nice person. It’s easy to forget most of our clients are generally decent human beings. It could have been dumb luck (emphasis on the “dumb”), but it’s also possible the earlier investment in the relationship had paid off. She wasn’t upset. It really seemed as though all she cared about was whether Ms. Frizzle was okay. And he was. Trust is built before you need it There’s a phrase you sometimes hear in CE lectures about complex medical cases, and it is an unfortunate one: “Don’t trust the owners.” I understand the speakers are advocating a healthy sense of skepticism during history-taking, but I worry that as a profession, we’re over-indexed on solving puzzles at the expense of tending to relationships. You can trust owners; you have to. If you don’t, why would you expect them to trust you? Even when you know, in your science brain, that the owner is wrong, you still need to maintain mutual trust. That should never be interfered with (even if you know they’re wrong). Miscommunications are inevitable in clinical settings, but we, the veterinarians, are responsible for what happens next. Although most of us are constantly striving for excellence, there is a paradox about medical errors. It is not through punishing yourself or others that you gain more competence.5 Instead, welcome imperfection identification. In client relationships, trust and transparency always beat false confidence, at least in the long run. If you want honesty from your clients, you need to be honest with them. Back and forth, like playing frisbee with language,5 is the way to achieve the beautiful flow of collaboration. In a profession facing multiplying problems, including the erosion of trust in experts like us, we need to stop thinking like experts and start thinking like equal partners. This is the art of medicine. If we trust each other enough, solutions tend to appear—sometimes they even pop out. 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 Lekcharoensuk C, Osborne CA, Lulich JP. Epidemiologic study of risk factors for lower urinary tract diseases in cats. Journal of the American Veterinary Medical Association. 2001 May 1;218(9):1429-35. Appleby R, Evola M, Royal K. Impostor phenomenon in veterinary medicine. Education in the Health Professions. 2020 Sep 1;3(3):105-9. Wallis J, Fletcher D, Bentley A, Ludders J. Medical errors cause harm in veterinary hospitals. Frontiers in Veterinary Science. 2019 Feb 5;6:12. Bishop G. Can you make your clients laugh? Veterinary Practice News. 2025 Jun 25. Available from: https://www.veterinarypracticenews.com/can-you-make-your-clients-laugh/ Bontempo AC. Patient attitudes toward clinicians’ communication of diagnostic uncertainty and its impact on patient trust. SSM-Qualitative Research in Health. 2023 Jun 1;3:100214.
