The Popularity Paradox

I wrote this in 2015 and had it published in the Canadian Veterinary Journal. It is available in full on their website here – The popularity paradox – PMC (nih.gov). Or you can read it below.

We are told that clients do not care how much we know, they want to know how much we care. In other words, being clinically competent and medically honest with our clients it far less important to them than us lavishing praise and affection and treats on their beloved pet. And this puts us all into a serious conflict of interest.

Private practice (even institutional practice) is a popularity contest. Pet owners have a lot of choices and are free to go where they please. If they find a visit to ABC Animal Hospital a cheery and happy experience, they come back. If they find the experience unpleasant in some way, they may just go somewhere else. So imagine this scenario:

Jane and John Doe have been married a year and have just purchased their very first pet, an 8 week old (let’s just pick one) English bulldog. They have had it for a week and are completely in love. They chose this breed because they saw pictures on the internet of some bully pups and videos of bulldogs riding skateboards and bouncing on trampolines. Now they are coming to you, bubbling with pride and enthusiasm, for post-purchase examination and vaccines. They chose your practice because your website features stock images including some of bulldogs, so obviously you love the breed too.

Now, you know that a bulldog is a money pit and will be prone to a host of physical and metabolic maladies, from brachycephalic upper air way issues, to horrible dental/oral anatomy/heath to orthopedic issues, skin-fold dermatitis and gale-force flatulence. Hot weather and exercise could be fatal. As the owner’s source of medical information, you have a moral and professional obligation to inform them of these issues so that they can be prepared to manage them, will know what to look for, will know what to avoid and so forth.

At ABC Animal Hospital, as soon as the Doe’s walk in with Princess Snuffles (PS), the staff start gushing about how adorable she is. During the examination, the DVM similarly expresses shared joy over the puppy and how much she is going to add to the Doe’s life together. Treats and cuddles are lavished on PS. The owners leave feeling thrilled that everyone at ABC also loves PS. But down the road as the problems start to express themselves and the visit become more frequent and expensive, the Doe’s question why you did not warn them of all these problems. Had they known, they would have returned the dog and selected a dog with a healthier build and constitution. Now it is way too late. They are deeply bonded to their fur-lemon.

In another scenario, the Doe’s go to XYZ Veterinary Clinic. After a reserved exchange of pleasantries and “Welcome to our practice” chat, the professional staff starts to evaluate PS. In so doing, they find a number of architectural concerns that are already evident and these are pointed out to the Doe’s. Then follows a list of anticipated problems, including reproductive concerns (did I mention that the Does plan on breeding PS because she is from such good lines and they are looking to make a few dollars besides?). Do you tell this naïve young couple that their precious prized (and expensive) new family member is seriously deformed in ways that are going to have a serious negative impact on its quality of life and longevity? If you spend their first visit going over all of the problems the dog has now, is going to have in the future and what they can expect this will all mean, they might leave your office feeling foolish for making this breed selection choice or angry with you for expressing your obvious disdain for their fur-child. The tone of the visit is negative and they leave feeling badly and thinking that they will not be back to see you because you obviously do not love Princess Snuffles the way they do.

Here is the conflict then. We have a moral and ethical obligation to provide our clients with accurate and valid clinical information and recommendations, including what problems to expect and how to avoid them (preventative medicine). But if we are truly honest about many of the deformed and unthrifty breeds that are so popular these days, we run the risk of alienating our clients and driving them away (to other clinics, Dr. Google or their breeder). So, we may be inclined to hold our tongues and sugar-coat our interactions with our clients.

And here is a link to a pdf version you may download – https://vetdentedu.ca/wp-content/uploads/2023/04/popularity_paradox.pdf