Veterinary medical errors: Tell the truth, do it quickly

Everybody makes mistakes. As the saying goes, "to err is human." At some point, you and your team will make a medical error that may alter the outcome of a case or threaten a patient's life.

Do you remember discussing this topic in veterinary school or at national conferences? In my 40 years as a veterinarian, it's only in the past year that I've seen anything written about how to handle medical mistakes. This is because during our training (professional school, internship and residency) we're taught that we must be infallible—we can't make mistakes.

Our education drilled into us that with appropriate data—blood work, radiographs and biopsies—we can explain disease and figure odds with some measure of precision. Clients want a percentage for a successful outcome with any procedure.

But no matter how much comfort we as healthcare providers take in the scientific method, the truth remains that life is dynamic, unpredictable and non-linear. Medicine is not black and white—it's a lot of gray.

I've been a surgeon for more than 30 years, and pardon my modesty, I'm quite good at what I do. But I make mistakes every day. Ninety-nine percent of these errors don't affect the outcome of a case. The other 1 percent is what we need to discuss and help ourselves and our team members manage. I've trained veterinary students, interns and residents to critique each case and be honest about their mistakes. For every medical intervention there's an expected outcome. However, there's also the possibility of unintended consequences. Veterinarians should discuss with each client the potential complications of any procedure.

Apologize the right way

When I'm dealing with serious injury or a life-threatening disease, I spend time discussing with clients potential complications, after care and prognosis. They're willing to accept unwanted outcomes if you warn them ahead of time. When we make a medical mistake, we need to be truthful and communicate our regret to the client.

These are difficult conversations. Saying you're sorry opens you up to serious consequences. And saying, "I'm sorry," is hard because of what we're taught during our training. Apologizing does not come naturally to medical professionals.

Most lawyers and insurers will tell you to never admit that you made a mistake, although the AVMA-PLIT supports full disclosure with an appropriate apology. The group's stance is to tell the whole truth, and tell it quickly.

It's likely that the information will come out through other channels, and it's less harmful coming from the clinician. The data indicates that the likelihood of a lawsuit falls by 50 percent when healthcare professionals offer the client an apology and the details of a medical error immediately.

It's time to pull the covers back on medical mistakes and take a fresh look at an apology—why it's important, how to recognize when it's needed, and how to deliver it.

This must be an authentic apology, one that is heartfelt and offered because it's the right thing to do. The golden rule should always apply here: How would you want to be treated in the same situation?

Healthcare providers with the best communication skills are those least apt to be sued. Most problems in medicine that involve our clients result from poor communication. As we become busier and spend less time with our clients, the communication gap widens. As a veterinarian, you don't always have to be the communicator, but you must be sure that your entire team is delivering the same consistent message.

Clients trust you and your practice's team members

All of these things lay the groundwork for dealing with clients when a medical mistake has been made. Rule No. 1 is to deliver the complete truth in a timely fashion.

We all remember incidents in politics, sports and business where the cover-up of a transgression was much worse than the transgression itself. This is why it's important to train your team in how these matters should be handled.

I've seen medical mistakes permanently scar young veterinarians and technicians. As a practice owner, employer and mentor, the buck stops with you. Discuss these situations openly as a team and don't point fingers. Review all protocols to determine why the person made the mistake and how to prevent it from happening in the future.

Since veterinarians and technicians are trained to be infallible, when an error occurs, they often feel many emotions. These feelings include shame, anger, guilt, fear of criticism and vulnerability. These tough emotions may cause distress and a loss of self-confidence.

One of the biggest barriers to open disclosure is that most healthcare providers have no formal training in error discussion. The tendency is to cover these up or look the other way. Clients always want to know what caused a mistake to be made and that it won't happen to another animal.

I've fessed up

Sassy, a bouncy 6-year-old Boston Terrier, presented to me for excision of a large anal tumor. I discussed all of the potential complications of this type of surgery with the clients, and they wanted to proceed. Surgery was difficult due to the location of the tumor near the rectum and the pudendal vessels and nerves. There was considerable hemorrhage at the time of surgery and the mass was completely excised. Sassy recovered and was discharged to the client's care. At three days post-op, there was drainage from the incision and Sassy was febrile. I placed her on antibiotics, but the drainage persisted.

Six weeks post-op, a radiograph of the area showed what appeared to be a surgical sponge I left in the incision. My options were a) to cover up the mistake and make an excuse to retrieve the sponge knowing that Sassy would do well or b) to be honest with the owners and tell them how it happened, how I would fix the problem, and how I'd prevent it from happening in the future. I offered a heartfelt apology and disclosed all the information to the client. I corrected Sassy's problem by removing the sponge and she recovered. The clients were understanding, and I told them that we now count all surgical sponges so this problem cannot happen to another pet. The client incurred no additional charges. Clients will always be upset when a mistake occurs, but open, honest communication can save the veterinarian-client relationship.

The worst scenario is when a medical mistake results in the death of a patient. The same principles of open, truthful and timely communication apply just as they do in any other situation. Of course, the client may be more emotional and the staff members may be heartbroken. But you can't take the mistake back. All you can do is gather yourself and be honest.

Dr. Elkins practices at the VCA Veterinary Specialty Center in Indianapolis, Ind. He received his DVM from Auburn University in 1970 and completed a surgery residency and received a Master's Degree at Texas A&M University.