When people decide to enter veterinary medicine as a profession, the decision is usually made based on a quest for knowledge in medicine, a passion and love to want to help animals and people and to make a difference in the world. The intentions and desires often come from deep rooted desire to make the lives of animals and their people better. We become the voice for those who can not speak and diagnose and treat complex diseases and illnesses to help keep animals healthy, so they can live long and high quality lives. Some of the sweetest most inspiring moments I have spent in veterinary medicine have been the times that pet parents have been incredibly grateful for saving the life of their pet and providing loving compassionate care. We pride ourselves in the ability to do this. It gives us purpose.
The newest diagnostics, advanced knowledge, state of the art skills and treatments, and new medications are all at our fingertips today. But the reality is we are still human beings that deliver this care to our patients and humans make mistakes.
Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in human hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDS--three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems.1
To Err Is Human, Building a Safer Health System Institute of Medicine (US) Committee on Quality of Health Care in America; Editors: Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson. Washington (DC): National Academies Press (US); 2000. ISBN-10: 0-309-06837-1 breaks the silence that has surrounded medical errors and their consequence--but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agenda--with state and local implications--for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often-startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly.2
Medical errors are a leading cause of mortality in human medicine. In contrast, errors in veterinary medicine are rarely discussed, and there is little known about their nature and frequency.3 The topic of medical errors in veterinary medicine is currently being studied by Dr. Jessica Wallis Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States, Dr. Daniel Fletcher Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States, Adrienne Bentley Cornell University Veterinary Specialists, Stamford, CT, United States, John Ludders, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States.
Having spent time in both human medicine as an RN and in veterinary medicine as a Certified Veterinary Technician I know the feeling when you realize you’ve made a mistake. Your heart starts to pound, you feel that flush of adrenaline, your face gets hot, you check your patient to see if they are okay while the panic rises and your mind starts to race. It is a dreadful feeling that everyone knows. We have all read books on how to prevent mistakes and created checklists and flowcharts in an effort to keep our patient’s safe. And checklist and safeguards are fantastic at mitigating mistakes. I love them! But still we are human and mistakes will be made. Meanwhile, the person who made the mistake is replaying the mistake over and over in their mind dissolving into a sense of shame, failure, guilt, embarrassment and isolation. The mental toll it takes on the person who made the mistake is devastating.
I will share a personal experience where a patient was lost after being induced under anesthesia. The events that unfolded were so rare and unexpected and we did everything we possibly could to save the patient but needed a drug that is rarely carried in small animal hospitals due to the extreme cost and rarity of use. Ultimately, the patient did not survive and I was completely devastated. While some colleagues were supportive and empathetic, it took just one to make me feel like it was completely my fault and that I was a horrible person for it. I will never forget that feeling, especially since it was a patient I dearly loved and was at a loss to save. I think about it still to this day and it happened years ago.
In my personal experience, if the people around me showed empathy and support, I was able to learn from what happened and move forward being all the better for the experience. But when people around me pointed fingers and blame, the damage was irreparable and eroded my self-confidence, self-worth and plunged me into the depths of depression, self-doubt and worthlessness. It is a very bad place to be.
Of course, the first victim was the patient and their family and the second victim was me. Dr. Albert Wu Professor at John Hopkins University in 2000 gave this type of experience a name. It is called “second victim syndrome”. We as veterinary healthcare workers, regardless what role we play, are all potential victims. The psychological trauma and mental anguish it causes leads to “burnout”.
Having been in those shoes before has made me be extremely empathetic and supportive of people when a mistake is made. Particularly if it is a life-threatening mistake, I understand what is racing through this person’s head and their need for someone to come along side without judgement and help them stabilize the patient and gather resources, not continue to berate them for the mistake. That person will berate and beat themselves up thousands of times over without help from anyone else. I also recognize that this person’s confidence in their ability to treat patients and deliver care will be impaired and that they may need some TLC and help themselves. Helping this person find faith in their own abilities again is key. They need a trusted friend or mentor to talk to and share what they are experiencing. This is a point where if they find the support they need they can move forward and learn from what happened. If not, they may leave the profession or worse. How mistakes are dealt with can be devastating for veterinary healthcare workers and contribute to the unraveling of a life and heart that only ever wanted to do good. When people cannot get relief from anxiety, self-doubt, guilt, sleeping problems and questioning their own competence once a mistake is made, it can push people to consider suicide.
Once a person has made a mistake and the initial event is behind them, that is when things get rough. They tend to feel very isolated and worry about the future of their career, whether they may lose a license or be sued. Or they may worry that the hospital will be sued and they will lose their job. This person at this point needs critical emotional support without judgement. Depending on what role this person has in the hospital can make finding that emotional support difficult. Being an empathetic listener from the veterinary profession is invaluable.
Isolation is brutal in this circumstance. Check back in with these folks and don’t just walk away and never bring it up again. Remember that telling the story to a family member can fall short because they may not understand what happened because they are not part of the profession. Even employee assistance programs may not be helpful if the listener doesn’t truly understand what it is like to work in veterinary medicine. It can be easy to sanitize and compartmentalize an event for a non-veterinary professional but those of us who have worked in veterinary medicine understand the co-existing pressures that create the moment like being understaffed, having already worked 50-60 hours that week or you are on your fourth day straight of 12+ hour shifts, having too many patients with high acuities that you cannot take care of all them by yourself or being pulled in so many directions at once that you get overwhelmed. We all know what it is like and all of it plays a part in setting people up to make a mistake.
Often times what happens is the person who made the mistake after in depth scrutiny and investigation by the hospital, loses their job anyway. This can further make a person feel like their career is over since they may believe no one is going to want to hire them again. Losing the job can feel like losing the future.
Having been a manager in veterinary medicine I think there is need to use errors to identify and correct systemic problems, rather than focusing on penalizing individuals. We can get rid of people who make mistakes but it is not going to solve the problem. As long as we are human, mistakes are going to be made. Creating and utilizing safety nets, checklists, double-checks and medical error analysis without punitive punishment will help people to report errors instead of trying to hide them and allowing the reason the error occurred to be brought to light so systems can be developed or changed to try to prevent further errors.
Everyone of us will walk in these shoes one day. None of us are immune to making mistakes. But how we respond can make a huge difference in a person’s life. Respond with empathy and listen to them. Let them talk about what, why, when, and how it happened without passing any blame or judgement. Check in with them frequently and see how they are doing. Let them know they are not alone. Don’t be afraid to share your own mistakes and experiences. This is how we grow and learn. The road is a treacherous one and we all need each other’s support to make our way. And most of all do not let your mistakes define you or others. Mistakes are some of our best teachers and keep us humble. Let’s all try to support each other and straighten each other’s crowns, not tear each other down.
References
1 Institute of Medicine (US) Committee on Quality of Health Care in America, Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human: Building a Safer Health System. Washington (DC): National Academies Press (US); 2000.
2 Institute of Medicine (US) Committee on Quality of Health Care in America, Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human: Building a Safer Health System. Washington (DC): National Academies Press (US); 2000.
3 Front Vet Sci. 2019; 6: 12. Published online 2019 Feb 5. doi: 10.3389/fvets.2019.00012PMCID: PMC6370638, PMID: 30805349
Medical Errors Cause Harm in Veterinary Hospitals
Jessica Wallis,1 Daniel Fletcher,1,* Adrienne Bentley,2 and John Ludders1