The truth is: medical errors happen.
I was inspired to write an article on medical mistakes after listening to lectures by Dr. Marie Holowaychuk at the 2024 AVMA Veterinary Leadership Conference that discussed Imposter Syndrome and Perfectionism. Dr. Holowaychuk said no one readily discussed medical mistakes until her residency year, which surprised her. This got me to reflect on my own mistakes and how I have been addressing them, because the mindset of “just don’t make one” is unrealistic.
The thing about mistakes is: We all make them.
- We are human.
- We learn as we go.
- Self-compassion is necessary to survival.
It’s important to have professional liability insurance (ex. AVMA PLIT, Safehold) and license defense coverage. This is the same as the need to have car insurance.
There are plenty of articles that discuss medical mistakes in human and in veterinary medicine. For example, in the July 2023 JAVMA, an article on medical errors mentioned six response steps (article below). The third step is supporting the health care workers involved because they too suffer from the mistake. After a mistake occurs, we should focus on risk reduction through system improvement so there is less reliance on an individual remembering a procedure. Tasks should also be designed so that they have built in redundancies to make it hard to err in the first place.
One former veterinary specialty hospital administrator I spoke with shared how their hospital established a team from different departments and staff positions to review mistakes and staff concerns. They met monthly to discuss reported errors/concerns that were submitted through a google form. This was not anonymous, so follow-up could occur. The medical director would reach out to the client to review the situation. This communication also helped the pet parent feel that corrective action was happening while the error was being investigated. Then the team would come up with a plan to correct the issue. This would then be shared with the training team.
There are many CE training opportunities to improve our medical skills. But we should also learn how to deal with anger, guilt, inadequacy, depression, and suicidal ideation. This can be aided with therapy, including talking to a veterinary social worker. (More information will be available in a different article.)
I also highly recommend the book Burnout by Emily Nagoski which addresses the stress-response cycle. We experience stress daily and minimizing the chronic and detrimental effects helps us improve our quality of life.
Board complaint 101
While most medical errors do not go beyond the hospital walls, sometimes board complaints happen. Here is a summary of what this entails.
- DON’T PANIC. Work with the Veterinary Board of Governors investigation. Very few complaints go all the way to a hearing. The goal is to protect the public, not to take someone’s livelihood.
- A complaint is assessed and is either closed or investigated. The veterinarian will be requested to give an account of their side of the story as well as submit medical records. The basic review period for an investigation is 17 days.
- An investigated case will either result in closing a case or legal action or adjudication. To pursue discipline, the evidence must be clear and convincing and may result in formal disciplinary charges, informal decision, or consultation with an expert. The basic review period for a case disposition is 140 days.
The Washington State Department of Health website has a specific section for veterinarians and clients. There is a section on client communication and a section where clients can file complaints.
My mistakes
Just for transparency, here are three stories that show how I grew as a veterinary professional.
- A story about ignorance. When I was a veterinary assistant before vet school, a young adult canine went into respiratory/cardiac arrest at the beginning of a dental procedure. CPR was initiated, and I started breathing for the animal with the anesthesia bag. The pet wasn’t resuscitated, and the family was informed of the tragedy by the attending veterinarian. I was never formally trained in CPR, though I had been part of the team that did what we could to help revive the pet. However, five years later while in vet school, I learned the proper way to “breathe” for an anesthetized patient and realized that I could have made the difference for the dog if I had known to open and close the pop-off valve. It was five years too late for that pet, but I won’t make that mistake again.
- I made a missed diagnosis due to busyness and fatigue. During my second year at a full-time emergency practice, an adult Great Dane was brought in for acute vomiting. At the time, the hospital location was a two-hour drive away from specialty hospitals, and the owner did not want to make the long drive for further diagnostic testing. So, a barium study was offered on a 130-pound dog. I was roped into helping take abdominal x-rays on a large, non-compliant patient because another team member had health restrictions. Two people, including myself, had to lift a very heavy dog multiple times in six hours. It was a very busy day at the hospital, and one of the two-hour intervals became a three-hour interval for the x-rays. At the time, I was trying to work on confidence, so I told the owner that the barium passed through the intestines and the pet did not appear to have an intestinal obstruction. We instructed the owner to follow-up with their regular veterinarian the next day if the patient continued to show any signs of vomiting. The pet did vomit, went to their primary veterinarian. That vet sent the pet to a specialty hospital for an abdominal ultrasound. The pet went into surgery and a long sock plus five feet of intestines were removed from the patient. The owner brought back the sock to the first emergency hospital to prove our mistake. The hospital owner refunded the owner’s money for the hospitalization and the barium study. No complaint was made.
I had let the pet owner’s initial reluctance to travel guide a Plan B diagnostic plan that the hospital was too understaffed to manage. I no longer recommend barium studies because a better option involving abdominal ultrasound is more widely available. In addition, I don’t take on more work than the staff can handle when there are alternative options.
- Some mistakes are really, really dumb. A pet presented for a splint change due to a fractured toe. The vet assistant removed the splint before I saw the pet. I placed the splint on the wrong leg because I did not accurately review the chart. The owner returned the next day to address the issue. The senior vet was present, offered complimentary recheck x-rays and replaced the splint on the correct leg at no additional charge. No complaint was made.
The senior veterinarian informed me of my mistake., While there was no long-term damage, it was a medical error. I admitted my slip-up and to this day, I don’t know why I missed the correct leg. Now I’m more careful about reviewing follow-up cases before seeing the patient. It’s okay to pause to look at the chart before walking into the exam room.
In summary, medical mistakes should not be a surprise, and while we work hard to prevent them, errors are inevitable. This does not define you as a person or professional. Neither does it taint your entire career. Part of the process of living and growing is to learn from experience. There are many more animals and people (clients, family members, staff) to help, and with experience (including growing pains and celebrations) we get through.
Here is some potentially helpful further reading and other resources
- Marie Holowaychuk blog and podcasts on Reviving Veterinary Medicine (revivingvetmed.com).
- Rachel Wright – Veterinary Social Worker (www.pawstoconnect.com)
- Brene Brown author and researcher on courage, vulnerability, shame, and empathy (www.brenebrown.com)
- Lederhouse, Coco. “Ditching the blame game: Effectively responding to medical errors.” JAVMA, vol. 261, no. 7, July 2023, pp. 968–967. https://www.avma.org/news/ditching blame-game-effectively-responding-medical-errors
- https://vetidealist.com/responding-to-medical-errors/
