A FEW WORDS..... Difficult client conversations and new things on pyometras from Ep 12

Blog post for Ep 12: Two Week Takedown: Difficult Clients, Aggressive Patients, and Pyometra Debates

Welcome back to another Two Week Takedown - where we take a step back from the consult room chaos and talk about what’s actually happening in UK general practice right now.

This episode was a proper mix. The kind of conversations that don’t sit neatly in textbooks but come up every single day:

• Clients who don’t want your plan

• Patients you physically can’t treat easily

• The uncomfortable reality of money

• And those clinical grey zones… like antibiotics in pyometra

Let’s get into it.

The Reality: Not Every Client Is “On Board”

We’ve had loads of messages recently asking:

> “How do you deal with clients who just won’t listen?”

And honestly — this is one of the hardest parts of the job.

Not the medicine.

The people.

A big turning point is this:

👉 Stop trying to win the argument

👉 Start trying to lower resistance

A couple of simple phrases that genuinely change the tone of a consult:

“That’s absolutely fine - we can do that… but can I just show you another option?”

“I’m not saying what’s been done before is wrong… just that we might be able to approach it differently.”

It’s subtle, but it works.

You’re not confronting them.

You’re inviting them.

Chronic Cases: Why “Planting the Seed” Matters

We’ve all seen them:

• The spaniel with recurrent ears

• The chronic diarrhoea dog

• The “just give me the same meds again” consult

The trap is going straight in with: 👉 “This isn’t working”

Instead, try: 👉 “There’s probably an underlying reason this keeps coming back”

Even if they don’t change today - you’ve planted the seed.

And next time?

They’re far more likely to come back ready to listen.

One Underrated Skill: Knowing the History

This is a big one.

When you say:

> “I can see you’ve tried these three different treatments over the last few years…”

You instantly gain trust.

Because now you’re not: ❌ “just another vet saying the same thing”

You’re: ✅ someone who actually understands the case

Even a quick skim of notes can completely change how your advice lands.

The Older Cat Consult: A Different Mindset Entirely

Older cat owners are… different.

Not difficult. Just wired differently.

Their priorities are usually:

• “Don’t stress them”

• “Don’t overdo it”

• “Is it really worth it?”

So the approach changes.

Instead of: ❌ “We need to investigate this fully”

Try:

👉 “There are one or two simple things we can check that are actually very treatable”

👉 Have conversations about the client's worries and address their fears.

👉 Find the solutions that best suit the client, their timeframe, their worries and their budget.

That shift - from “full work-up” → “targeted, low-stress care” - makes a huge difference.

Let’s Talk About Money (Because We Have To)

This is the bit nobody enjoys.

But it’s unavoidable.

And actually - how you handle it matters more than what you recommend.

The key principle: remove the shame

Say it out loud:

> “Yeah… it is expensive. I completely get that.”

You can almost see people relax when you do this.

Because suddenly:

• They don’t feel judged

• They don’t feel “less than”

• They feel like you’re on their side

Practical Tip: Always Give Options

Even when options aren’t ideal - give them.

Examples:

• IV fluids → SQ fluids as a compromise

• Gold standard → “stepwise” approach

• Referral → in-house stabilisation

  
  

Not perfect. But realistic.

And sometimes that’s what matters most.

The Hardest Conversations: When There Isn’t a Good Option

Blocked cats.

GDVs.

C-sections.

These are the consults that stay with you.

Because sometimes the reality is:

👉 The best treatment exists

👉 But it’s not financially possible

And that leaves you with:

Compromise care

Or euthanasia

Charlotte came up with this phrase that changes everything

> “This isn’t the wrong decision. It’s just not the ideal one.”

I say something like "it's not an ideal world, we don't all have thousands of pounds to do everything, so we have to make practical decisions to get through this the best way we can... "

And you’ll often see it physically in client's body language:

• shoulders drop

• tension goes

• breathe more easily

Over the years, it's amazing how you can learn to notice breath, eyes, stress signals such as touching the back of their head or stroking the top of their head.

Aggressive Patients: When Medicine Meets Reality

We discussed a really tough case — a large aggressive young dog diagnosed with diabetes.

And this is where textbook medicine falls apart.

Because yes: 👉 insulin is the correct treatment

But if:

• the dog is dangerous

• the owner is nervous

• there’s a baby on the way

  
  

Then the real question becomes:

👉 Is this actually manageable?

The uncomfortable truth

Sometimes the limiting factor isn’t the disease.

It’s:

• safety

• compliance

• real-life practicality

  
  

And acknowledging that early is critical.

Clinical Debate: Antibiotics in Pyometra

This sparked a lot of discussion — and probably will again.

The “ideal” (based on guidelines):

• Peri-operative antibiotics

• No routine post-op antibiotics

The reality in GP:

Many of us still send them home with antibiotics

Why?

Because:

• It feels safer

• There’s still infected material present

• Nobody wants the complication case

Where this probably lands

We’re in that classic transition phase:

• Evidence says one thing

• Practice hasn’t fully caught up yet

And like a lot of things in vet med…

👉 We tend to change when we see others doing it safely

Bigger Picture: Contextualised Care

If there’s one theme from this episode, it’s this:

👉 There is no “perfect” treatment plan

👉 There is only the right plan for that situation

And that includes:

• the patient

• the owner (their fears, history with other pets..)

• their finances and perceptions

• the temperament

• the reality of home life (they met be caring for their partner with dementia)

Final Thoughts

General practice isn’t about textbook medicine.

It’s about:

• communication

• judgement

• flexibility

• and sometimes making the least worst decision

And if you’ve ever walked out of a consult thinking:

> “That wasn’t ideal… but it was the best we could do”

You’re doing it right.

Over to You

We’d genuinely love your thoughts on this one:

Are you still using antibiotics post-pyo?

How do you handle cost conversations?

Where do you draw the line with difficult or aggressive patients?

Drop us a message, comment, or share your experience - it’s these discussions that make us all better.

Enjoyed this post?

Share it with a colleague - it really helps us keep these conversations going.

And we’ll see you in the next episode 👋