Involvement in errors often results in serious health effects and emotional distress, as well as performance and work-related consequences in staff members. We’ve all been there: the sickening feeling in the pit of your stomach when you see that you have failed. The fear of the inability to now manage the case can prevent us from being able to help this patient at all. And the loneliness of knowing this is all your fault is very isolating. Sometimes, our distress prevents us from reaching out to the very people who are feeling similar emotions at that time: the owners.
Guilt
We know that vets feel guilty after making mistakes, and owners often have similar or even stronger feelings of guilt. Owners often berate themselves and feel guilty about not keeping close enough watch. “Maybe I shouldn’t have consented to surgery.” “My dog trusted me, and I let her down.”
Although full disclosure of errors is increasingly recognised as an ethical imperative, vets often shy away from taking personal responsibility for an error and believe they must “choose words carefully” or present a positive “spin”. Most practices won’t perform revision surgery free because it’s an “admission of guilt”. Maybe a healthier approach is to admit to the fault and still charge for the revision surgery. Otherwise, the result can be an impersonal demeanour that leads patients to view the practice as uncaring.
The last thing we need when feeling guilty is the added stress of hiding the guilt from the client. In the medical profession, approximately 30 US states have adopted “I’m sorry” laws, which, to varying degrees, render comments that doctors make to patients after an error inadmissible as evidence for proving liability. Until such statutes become universal, frightened clinicians are left to struggle with conflicting personal moral principles, professional ethics and institutional policies.
Fear
Owners often fear that if they question the expertise or skill of the vet, especially after an error, their pet may experience further harm or neglect. Fear of retribution or of future poor treatment because of asking questions about mistakes perceived must be unbearable for a pet owner at a time when they are at their most vulnerable. And yet we, consumed by our own guilt and fear, may be too self-obsessed to empathise with this client.
Vets who feel guilty after a medical error may have parallel feelings of fear – fear for their reputation, their job and their own future as well as that of their patient.
Isolation
Feelings of isolation can be harmful. Owners say that at times like this, they need someone involved in the case to reach out to them, no matter how painful. The vet at the same time is suffering alone, agonising over the harm they have caused, the loss of the pet owner’s trust, the loss of their colleagues’ respect, their diminished self-confidence and the potential effects of the error on their career.
When vets and nurses back away from patients and their owners, it may be because of their own feelings of guilt, fear and isolation, compounded by legal or institutional advice. Paralysed by shame or lacking their own under-standing of why the error occurred, vets may find a truthful conversation too awkward. They may also be unwilling or unable to talk to anyone about the event, inhibiting both their learning and the likelihood of achieving resolution. Many owners want more communication, not less; by put-ting our feelings aside for a moment, at least we can make them feel less alone in these feelings.
So how can we accept that complications can and do occur and remain professional, caring and mentally strong when it happens? Surely honest and direct communication is the most important antidote to guilt, fear and isolation. Owners want compassion; they want to understand their situation fully and to know what the event has taught the practice. They want as much communication as possible.
An organised structure restores communication and supports emotional needs. Such a structure could include:
- Morbidity and mortality rounds on a monthly basis to help to remove the stigma from making errors; these are paramount if we are to prevent further similar errors.
- Deploying “first responders” in a practice (usually staff members with a cursory training in mental health first aid) when an error occurs to guide the vets, nurses and pet owners through the plethora of ensuing emotions and keep communication open, honest and plentiful.
- Regular mental well-being seminars for the whole practice to help build emotional intelligence and resilience in a profession where to err is human.
- One-to-one counselling for individuals who are struggling to or even just “not thriving”.
