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Are we all guilty of sugaring the pill?

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01 July 2017, at 1:00am

Dr DAVID WILLIAMS uncovers a long-lost guide to effective scientific communication and wonders whether vets are doing their best in this regard

I MUST ADMIT I’M NOT THE MOST ORGANISED person in the world. My office might be described as organised chaos, which would not really be particularly accurate as there is little order in there at all! This does mean that having a tidy-up can be really interesting. The memo that had to be acted upon five years ago eventually surfaces. And what do you know – even though I had not “actioned it” (if I can use such a horrendous phrase), the world did not stop turning and civilisation did not grind to a halt! Having said that, I’m writing this five days before the election and just after Trump has taken America out of the Paris climate agreement, so by the time you read this civilisation as we know it may well have imploded, but I can hardly blame my unactioned memo for those catastrophes, can I? Just under the memo on the pile of paper in the corner of the office, I came across an excellent little guide to “Effective Scientific Communication”. I’m not quite sure where it came from all those years ago, but you might find it entertaining. “It has long been known” is the first phrase, translated as “I haven’t bothered to look up the reference.” “It is believed” really equates to “I think” while “It is generally believed” means “A couple of guys I work with think so too”! “Typical results are shown” turns into “The best results are shown” and “Three samples were chosen for further study” really means “The others didn’t make sense, so we ignored them.” It gets better – or maybe worse! “The four-hour sample was not studied” equates to “I dropped it on the floor” while “The four-hour result may not be significant” is code for “I dropped it on the floor but managed to scoop up most of it.” “It has not been possible to provide definitive answers” should be read as “The experiment was negative but look – I’ve been able to publish it somewhere at least!” “These investigations proved highly rewarding” means “My grant is going to be renewed!” while finally “Correct within an order of magnitude” is apparently the scientific way of saying “Wrong”! But as we laugh at those caricatures of science writing, are we all guilty of sugaring the pill in what we say when talking to owners? Two days ago, I operated to remove a corneal sequestrum in a Persian cat. Talking to the student who was scrubbed in operating with me, I explained how we could remove the necrotic tissue, leaving sufficient cornea underneath as a support for the sliding graft we were going to create from neighbouring tissue. It was at that point that it became obvious that the cornea left was actually paper-thin and starting to ooze aqueous humour. The key thing about being a reasonable surgeon is always to have a plan B. So I fashioned a graft from the third eyelid to fill the gap. All well and good. The cat awoke apparently comfortable and I rang the owner to explain that the surgery had been “somewhat more complicated than we had anticipated”, but that we expected a successful outcome. Not exactly the whole truth and nothing but the truth! By the next morning the eye looked to be producing more tears than one would expect from an eye that was still wide open and without any discomfort that would elicit excess lacrimation. The intraocular pressure, measured with my Tonovet tonometer (so gentle it can be used even in damaged corneas), was far lower than one would expect. The graft must be leaking. I rang the owner again and explained exactly what I thought was happening. No point in beating around the bush. We needed to go in again even though there wasn’t a slot in theatre until the end of the day. This is just the sort of thing that happens at 5pm on a Friday, isn’t it? In fact what seemed to have happened was that haemorrhage and a fibrin clot was adhering the graft to the third eyelid and separating it from the delicate surrounding cornea. Some judicious manipulation and further suturing solved the problem. Maybe I had left slightly too big a gap between two sutures far ventrally and that was where the problem lay. So the final question was whether, when I discharged the cat this afternoon, I should tell the owner the full story.

Truth or lies?

I’ve got the repeat of the election debate earlier in the week on in the background as I write this. The one thing that comes across is that, for the vast majority of the politicians, one can never be sure whether what they are saying is really what they think, or they are just telling us what they think we want them to say. Maybe Caroline Lucas is a bit different, possibly even Tim Farron. But what I want to be sure of is that when I talk to an owner I’m giving
them the truth. That is especially the case when something has not gone as we had hoped… But there I go trying to sugar the pill. Let me rephrase that – when something has gone wrong! Or when we are having that end-oflife conversation about a pet with the
owner. Truth be told, it is much easier as an experienced vet working in a specialist clinic to explain that there has been a problem than for a new graduate. But how are students to learn how to conduct themselves in such situations? All too often I think we might ask a student doing EMS with us to leave the room if we are dealing with a problem case or performing a euthanasia, but those are just the times when students need to see how we deal with the situation. So maybe the take-home message is that the next time that conversation needs to happen and there is a student
or a new graduate who can be with you, use that as a teaching opportunity. And don’t use jargon that needs a translation guide to make what we are saying crystal-clear!