Some days in the clinic, I’m just tired. It’s usually on those days when I’ve had about a dozen nearly-identical conversations about the importance of clean teeth, heartworm prevention, or weight control. Sometimes it’s not though. Sometimes it’s just hard to get going and be enthusiastic after a vacation, or weekend, or lunch, or hearing my technicians make a truly awful pun while expressing anal glands.

Sometimes we just hit a point where we can’t get thrilled about marching into that next appointment, don’t we? The hard part of this scenario is that usually, no one cares how you feel about the next appointment, because it’s loaded up in an exam room and everyone is waiting for you to get in there.

At times like these, I can’t help but wonder, “What if I just took it easy in this appointment? Would anyone know or care if I phoned it in?” I mean, not the big stuff — just little things. What’s the harm in not telling one pet owner things she doesn’t want to hear anyway, like “your cat is overweight,” or “your dog needs a heartworm test,” or “we need to see your other pet for an exam before prescribing ear medicine for it.” It’s not like taking it easy this one time would make me a crappy vet.

The truth is: it could.

There’s a thought exercise I’ve recently become quite fond of called Sorites Paradox, or The Paradox of the Heap. In this exercise, we imagine a heap of rice on a table. I take one grain of rice and lay it by itself. Does that one grain of rice make a heap? I think we can agree it doesn’t. However, if I take additional grains of rice, one by one, and add them to this new pile, asking you each time, “Is this a heap of rice?”, at some point, I will add a single grain of rice and you will have to say, “Now it’s a heap.”

So one grain of rice does make a heap.

I’ve seen this paradox illustrated with money (“Can one penny make you rich?”) and exercise (“Can one workout make you fit?”). In all cases, the point is the same. Big things are made up of little things, and at some point the accumulation is undeniable. If I skip a conversation I don’t want to have with pet owners one time, could that possibly make me a crummy veterinarian or technician? Sorites paradox says yes.

A single grain of rice doesn’t make a pile, and a single penny doesn’t make us rich, and a single workout doesn’t make us fit, and a single half-hearted appointment doesn’t make us bad at our jobs… until it does.

The challenge is not to be AMAZING in the exam room whenever we are in just the right mood. Rather, the challenge is not to half-ass the appointments that happen when we are not in the perfect mood. It’s to have the conversation that needs to be had, to give people information they don’t necessarily want to hear, and to do and say what’s best for the pet every time.

Recently, when I’ve been standing outside that exam room and looking at a chart that says something like “Pet has fleas again. Owner says this time really will give medication,” I’ve been thinking about Sorites Paradox. I’m not a crappy vet, and those individual appointments are where I have to prove it. When it comes to bad appointments, I don’t want a heap, and neither do you.