The Manual: Dealing with a Medical Mistake
Finishing up the first surgery of the day, the declaw of a young tabby, you ask your technician to help prepare the next patient, another young tabby named Sophie, for a spay.
The technician returns, stating that Sophie isn’t in her cage. You glance at the identification collar of the sedated tabby in your arms: SOPHIE STEPHENS. You’ve just declawed the wrong kitty!
As the cliché goes, “Everyone makes mistakes.” Throughout your career, there will be times when your stomach sinks, your palms sweat, and your heart races as you realize you’ve just made a mistake—a medical error that results in a breach of standard of care. It’s not only the error that is making you queasy, but realization that you now have to tell the client. This is when bringing a proficient set of communication skills to the conversation can make or break your client–vet relationship.
Take a Deep Breath
First, breathe. Then center yourself to calm your initial reaction. Experiencing a swarm of emotions—shock and disbelief, regret and guilt, heartbreak and sadness—can be overwhelming and impede your ability to focus on the client. Tending to your own emotional needs will help you regain composure before you speak with your client and allow you to be fully present and give your undivided attention. Openly sharing how you are feeling is acceptable, as long as you remain mindful that the focus of this conversation is about your client and patient, not you.
Follow Practice Protocol
Check what protocol your workplace has established for handling medical mistakes. When a mistake is discovered, advise your employer, professional liability insurance, and legal counsel, and consult with your colleagues for support. Then trust in yourself to take the appropriate communication steps to address the client.
Reflect on how you would like the scenario to be handled if the roles were reversed. Rehearse statements in your head or role-play with colleagues to “hear” if what you are trying to express will actually be conveyed to the client. Visualize a calm, clear, compassionate discussion.
As you prepare for this conversation, the CONES (context, opening, narrative, emotions, strategy) protocol provides guidance and organization in disclosing a medical error.1
Set the Stage
Determine where this conversation will take place, as the physical Context of this discussion sets the stage. Preferably, invite your client to a private setting, such as an exam room or office. Offer your client a seat and position yourself on the same level because sitting can calm emotions. Remain aware of your body language; keep an open posture, face the client, and make good eye contact. Depending on the situation, you may initially need to deliver the news by phone. This can be challenging because phone conversations can be interrupted or disconnected, your client may be distracted, and nonverbal communication is lost over the phone.
Give a Warning
Your Opening remark sets the tone. Begin with a “warning shot,” a statement that gives the client a heads-up on the serious nature of the conversation. It empowers your client to prepare for difficult news and to assess if he or she is ready to hear you. The warning shot also establishes the agenda of your discussion. Asking permission to begin gives the client control of the conversation by allowing an opportunity to request more time, for another person to join the discussion, or to proceed with the conversation.
“Mr. Stephens, I need to talk with you about Sophie’s surgery today. First, I want to assure you that Sophie is doing fine. Unfortunately, during surgery, I made a mistake that may be upsetting for you to hear. Is now a good time to talk about what has happened?”
Explain the Events
The Narrative describes a chronological account of the what, why, and how of the event. Slow the pace of your speech so the client has time to absorb what you are saying. Pause frequently and offer time for the client to respond to the information conveyed.
“You brought Sophie in today to be spayed. [pause] Unfortunately, I mistook her for another young tabby kitty that was here to be declawed, and instead of spaying Sophie, I declawed her. [pause] It wasn’t until she was beginning to awaken that I realized this mistake. [pause] You probably are asking yourself, ‘How could this happen?’ and I will explain.” [pause]
An apology is critical when disclosing medical errors. Taking responsibility for the error and expressing remorse are integral to rebuilding trust between the veterinary team and client. Counter to common belief, malpractice suits often result from failure to take responsibility, apologize, and communicate openly.2 If the error was made by someone on your team, it is prudent to provide a joint apology, with both the person who made the mistake and his or her supervisor meeting with the client.
“I am so sorry that I mistakenly declawed Sophie. I feel terrible about how this has impacted both her and you.”
Check in with your client throughout the conversation to identify if he or she is following you, needs clarification, or has questions. Find balance in allowing the client to ask questions while not being forced to search for answers.
“I know that this is surprising news. What questions do you have? Shall I continue?”
Tell the Truth
Be honest and fully disclose all information about the error. Evasion or silence can increase the likelihood of litigation, as the client may perceive that you are withholding information. Clients who received truthful, compassionate, caring communication experience less emotional trauma as a result of a mistake, are less likely to take legal action, and are more likely to continue seeing their doctor.3
Emotions will be running high for you and your client. You may feel anxious not knowing how the client will react, and unfortunately there is no way to know what to expect. Instead, refrain from anticipating any particular emotion. This allows you to remain flexible to respond appropriately to reactions from the client. Acknowledge the difficulty of the situation, offer an empathic response, and respond in a nonjudgmental way.
“It is natural to be upset by this surprising news.”
“I realize how upsetting this is.”
“I understand why you are disappointed.”
The final step is to discuss a Strategy for future treatment of the patient, as well as to put a plan in place to prevent such errors from occurring again. It is vital to show that you have learned from the mistake, care how the pet and client were impacted, and identified changes that need to occur.
“I know that I cannot change what happened. However, my colleagues and I have created a new identification protocol that we are putting into place immediately to prevent this from happening again. This will include…I would also like to discuss what is important to you regarding the mistake I made.”
Acknowledging errors in a truthful, detailed, compassionate manner rebuilds trust and lessens the possibility of a mistake turning into a complaint or litigation.4 Although error disclosure discussions may be difficult and may have negative consequences regardless of how well you conveyed the information, effective communication remains essential to preserving your relationship with the client and dealing with the emotional effects on both of you. | EVT
See Aids & Resources for references and suggested reading.