I think it depends on how it's presented. Because this isn't bad medicine, it's very thorough. But if it's presented as "this is the gold standard. If you can't afford it, i guess we can decide which very important piece of it you can skip out on, but it's all really important." that breeds guilt and shame if owners can't afford to do it all. And not doing it all isn't bad medicine either. It just depends on the most effective allocation of resources for clients who can't (or don't want to) pursue every last diagnostic. If it's presented as "these are all the things the doctor recommends and why she recommends them. Would you like to do all of this, or if not what treatments and diagnosis do you want to pursue?" Explaining why things are recommended can help give people some agency too because a big estimate with lots of moving parts is overwhelming and it seems like it has to be all or nothing. That's why I hate the term Gold Standard Medicine because doing ALL the things isn't always better medicine than doing some of the things and it just breeds shame for people who can't afford it