Mind Over Miller: To confess mistakes or not, that is the question

I was a practicing veterinarian for 32 years. In all that time, I was never sued for malpractice. Did I ever make a mistake? Of course. You can't treat thousands of patients without occasionally making a mistake. Were my clients aware of my mistakes? Yes, usually. Sometimes it was because the error was obvious, but more often it was because I told them. If I confessed a mistake, I did it remorsefully, which brings me to the purpose of this column.

Dr. Robert M. Miller

I just finished reading Blink: The Power of Thinking Without Thinking by Malcolm Gladwell. It's about the decisions we make and the actions we take automatically or with little thought. Early in the book, Gladwell discusses medical malpractice:

Believe it or not, the risk of being sued for malpractice has very little to do with how many mistakes a doctor makes...patients don't file lawsuits because they've been harmed by shoddy medical care. Patients file lawsuits because they've been harmed by shoddy medical care and something else happens to them.

What is that something else? It's how they were treated, on a personal level, by their doctor. What comes up again and again in malpractice cases is that patients say they were rushed or ignored or treated poorly.

Many articles in the veterinary press, usually written by attorneys, advise veterinarians to never admit fault. I disagree. Clients often regard such an attitude as arrogant, and it antagonizes them. I think clients want to know that you're truly sorry.

The first year I practiced in California I worked for the late Dr. Ralph Reese, a popular mixed-animal practitioner. The first time Dr. Reese used tube gauze--it was a new product--he placed it on a boxer's limb too tight, and as a result, circulation was compromised, gangrene developed, and the dog's limb had to be amputated. Dr. Reese confessed his mistake to the owners. He was so contrite and obviously remorseful that the dog's owners comforted him. They not only paid for the amputation, they insisted that Dr. Reese continue to see their dog because, in their words, "He's so caring."

In last fall's newsletter from the California Veterinary Medical Board, News and Views, Dr. Richard Spickard said in an article titled "Is It Always Someone's Fault?":

Many of the complaints received by the Veterinary Medical Board have very little to do with the actual care the patient received. Some can be relegated to communication challenges. Some are due to the difficulty explaining complex medical concepts in accurate lay terminology.

Most of the complaints, however, have some component of BLAME. What an emotionally loaded word! Consumer complaints are all about the emotional response of the complainant. Blame is about establishing guilt and assigning punishment. We are definitely a blame-based culture.

Granted, we are a less forgiving, more litigious, and more materialistic society than we were half a century ago. However, human emotions don't change. If we deny obvious guilt, make feeble and transparent excuses, or arrogantly deny fault, it understandably arouses client resentment. What recourse does a client have to rectify the situation other than launching a lawsuit? On the other hand, if we are genuinely sorry and are obviously suffering from the fact that we have inadvertently done harm, the client is much more likely to respond with compassion.

During my first 20 years of practice, I immobilized more than 2,500 horses with succinylcholine. In all that time, I lost only a single horse. The horse belonged to my children's 16-year-old babysitter. The horse just, inexplicably, went down and died, and all of my efforts at resuscitation were futile. I finally gave up and sat down on the bumper of my vehicle, completely crushed, dejected, and near tears.

The young owner, who had watched the entire sad scene, came over and put her arm around my shoulders and said, "It's not your fault, Dr. Miller. These things just happen. I know you did things right."

Had I been devious and made excuses would she have reacted with sympathy? Would you?

Robert M. Miller, DVM, is an author and a cartoonist, speaker, and Veterinary Medicine Practitioner Advisory Board member from Thousand Oaks, Calif. His thoughts in "Mind Over Miller" are drawn from 32 years as a mixed-animal practitioner. Visit his Web site atwww.robertmmiller.com.