By Dr Dave Nicol

The test result comes back normal when you were expecting clarity. What do you do when you don’t quite know what to do? This may sound like a rhetorical question, but it’s one we all must confront eventually. After building a rapport with your client and fostering a relationship of mutual trust, what happens when your patient — their beloved pet — presents with a problem you are struggling to diagnose despite doing some diagnostics.

For many, poor communication combined with an inappropriate sense of guilt (at spending a client’s hard-earned cash) cause problems that can lead to damaging client conflict and stress. But this is largely avoidable with better communication skills. Read on the learn more.

Money Ill Spent?

You’ll probably be familiar with this situation. You’ve been presented with a problem, formulated your plan and ordered at some diagnostic tests, and this will have cost the client money. The problem is that you think you have nothing to show for it because all the results have come back normal. To the client, this can seem like wasted time and money. But keep in mind that a negative result is far from nothing. It helps you move closer to a differential diagnosis, by ruling out a large number of possible explanations for your patient’s condition.

It also signals you that you are dealing with something a bit trickier than the usual run-of-the-mill case. For example, a dog comes in with chronic vomiting. You do some bloodwork on it. Maybe you do a stomach biopsy under anaesthetic. But the blood test return with normal findings and the biopsy reports “nonspecific inflammatory changes” (don’t they just always seem to come back as this!).

The bill for this procedure is relatively high and the pet has undergone an anaesthetic with the attendant risk thrown into the bargain. Now you feel a little bad because you spent the cash, placed the animal at risk and you still don’t have a definitive answer for the client or a satisfying solution for your patient’s problem.

Negative Can Be Positive – Let’s Celebrate Normal!

But that’s okay because you’ve ruled out some potentially serious explanations, including liver disease, pancreatitis, and kidney disease. You’ve also ruled out a stomach or peptic ulcer and certain kinds of focal neoplastic processes. What’s left, though not 100% certain, is much more likely to be a form of inflammatory bowel disease. Far from feeling guilty about a normal test result, you should be relieved!

So you’ve got a presumptive diagnosis. Congratulations! Now, you can focus on treatment with far greater confidence that you will a) do no harm and b) make a positive difference to the disease process and health status of the pet concerned. Of course, there’s no certainty it will work, but at least you will have done a thorough job at gotten to a point of treatment. That’s a perfectly satisfactory outcome and you now have time to spare until you review the results of your treatment plan. So, you should never feel bad about those normal findings. Celebrate them.

Managing Client Expectations

The key to avoiding having an upset client on your hands in this scenario is to manage expectations from the start. Let them know that these cases can be tricky; that answers are not always as easy to come by as we might wish. Make sure they understand from that first consultation onward that you can probably identify some treatment that’s will manage the patient’s symptoms, but that it’s important to do some initial testing to rule out other, more serious potential problems.

Be very clear that you hope to get a result but that sometimes you will have tests return normal results and frame this as a positive as it helps you rule things out and get closer to the answer or at the least, a plan.

Oh, and always state the anticipated costs of these investigations, so the client won’t be blindsided when the bill comes. In this way, you will have managed the client’s expectations from the start of the process, and gotten them on board with your actions – even if you don’t hit the nail on the head.

The trick with almost all communications is to think about what you want the end to look like ahead of time and frame how it is likely to play out so your client feels informed and doesn’t get nasty shocks which they are free to interpret through their own frame of reference. And, once you have done this, you should never feel guilty about a normal test result.

If you learnt something from this article, or are inspired to transform your own feelings of guilt experienced as a veterinarian, you will definitely benefit from checking out the VetX webinar: 4 Steps to a Happy and Successful Career as a veterinarian.