I remember the case like it happened yesterday, even though it’s been over 20 years. My last appointment at the end of a long Saturday involved a wellness exam and vaccines for a sweet 4-year-old Burmese cat belonging to an even sweeter elderly client. I still had a half-dozen callbacks and one discharge to do before I could catch a flight to surprise my dad for his birthday. And while I usually double-checked every injection before administering it, I didn’t do it during my last appointment. Not five minutes later, I panicked upon realizing I had given my feline patient a vaccine meant for the dog in an adjacent exam room.
My frightful experience might feel eerily familiar to you. Unfortunately, no matter how determined we are, how much we try to be perfect, or how many late nights we work or extra webinars we attend, we all make a medical error at some point. And while we hope mistakes rarely occur, a 2018 Veterinary Information Network survey showed that 74% of veterinarians were involved in a harmful medical error or close call in the previous year.
While I could rationalize that to err is human, I wasn’t prepared for the emotions that followed my vaccine blunder or how to process them. I felt shame, guilt, anger at myself and fear of what could happen to my patient, job, license and reputation. Those intrusive thoughts generated significant anxiety about my abilities and the possibility of more mistakes. I quickly learned that internalizing those feelings makes similar situations exponentially harder to overcome.
Here are three points to remember when a medical error happens.
The TEAM Approach
I had to make fast decisions on behalf of my patient. As a relatively new associate veterinarian, I was fortunate to have had a present and thoughtful mentor to guide me through a few strongly recommended next steps. After gathering my emotions for a few minutes, I took a few deep breaths and pulled a chair next to my client. I held her hand and calmly explained my error and what I would do (immediately call the vaccine company for guidance). I told her I wouldn’t leave her or her cat until I knew we were past any point of worry. Gratefully, my client listened, albeit with a look of semipanic, thanked me for my honesty and relayed that she knew I had their best interests at heart.
The steps I took were almost identical to the four pillars of the TEAM approach shared by Dr. Linda Fineman in American Veterinarian. Let’s look at how each applies to daily life in veterinary practice:
Truth: It’s difficult, but we must tell a client about a medical error and the pet’s condition. At the end, pause and ask for the client’s thoughts. Full disclosure is encouraged by the American Veterinary Medical Association Professional Liability Insurance Trust. If the client’s response is anger or threatened legal action, PLIT recommends speaking with a Trust veterinarian.
Empathy: While I don’t know of a more empathetic industry than veterinary medicine, we sometimes have difficulty communicating the emotion. Active and reflective listening helps rebuild trust with a client.
Apology: This piece of the TEAM approach is essential. We should deliver it with clarity, sincerity and compassion.
Managing: This is where we investigate, develop and communicate changes to help prevent an error from recurring. It’s also the time for empathetic discussions with the client to discuss other forms of support, such as financial compensation, transfer of the patient to another clinic or different agreed-upon resolutions. Such actions can restore the practitioner’s heart and professional spirit.
Moral Distress Is Real
Team members were around me that Saturday, yet I felt very alone. What I didn’t consider was that team members who observe a mistake can experience a similar flood of emotions. To take it further, think of someone who knows of potential harm and then learns that the client wasn’t told. How does that team member deal with the ethical dilemma?
In a profession suffering from compassion fatigue and burnout, we must strive to share resources and form support groups to help us and our colleagues process tragic events and the emotional aftermath.
The Trickle-Down Effect
Now that I’ve had decades to reflect on the vaccine mistake and other errors I’ve made, one underlying tenet connects them. We must show our clients and team members vulnerability, transparency and accountability. Equally important is to recognize that when we commit a serious medical blunder, our reaction almost always is a paralyzing fear of the unknown and what our client and team members will think.
These moments truly shape us. The emotional outcome is much better if we see the situation as an opportunity to grow and learn alongside our colleagues. The work culture improves when hospital leaders role-model behaviors, especially in challenging situations. Those leaders become more approachable, more human and more trusted.
I discharged my feline patient from the ER after several hours of monitoring. Then, for the first time in my career, I debriefed with my mentor and team to try to prevent repeating the vaccine error. We implemented new procedures and processes, including proactively preparing pet owners for the unexpected, even in mundane cases such as a vaccination. The more clients know of the risks, the easier they can process and accept an unwanted outcome. We also reinforced the practice’s internal open-door policy.
After a mistake, our innate protective response and stumbling block is fear. (I credit my life coach, Laura Neff, for that wisdom.) Supporting our colleagues with spoken validations, grace and actionable next steps helps remove loneliness, shame, guilt and disappointment. The response helps all of us become better clinicians and humans.