No matter how 'smart' we are, we are all human and we all make mistakes. Connecting with each other, as fellow humans, after making a mistake is a challenging but worthy goal.
“To Err is Human”
At some point in our careers we will all make ‘mistakes’. Sometimes they will be small such as a nail that was cut short and is now bleeding, and sometimes they will be large such as the loss of the life of their pet.
Managing mistakes involves addressing the mistake with your clinical team (See M&M Rounds Blog), yourself (See Recovering Yourself After A Medical Mistake blog), and most stressful/scary/daunting is addressing that mistake with the client, the pet’s owner.
This blog will address some important points to consider when discussing those large, true mistakes, with significant adverse outcomes such as loss of an pet, with owners:
1. SHOW YOUR EMOTION:
We often feel we have to ‘buck up’ and ‘be strong’ for owners. The reality is however, if owners can see you as a human, and see that you are genuinely sad, and grieving as they are, you will form or maintain a bond that will help you through this difficult process.
Silence/lack of communication, or communication that is not heart-felt or seems cold, will make the owner feel distanced, and like you don’t care. Also, delays in communication results in time for the client to build you up as uncaring and makes them assume you are hiding information. Call right away, don’t wait. Ensure you are keeping owners informed.
Showing your emotion, and sharing in the grieving with the owner, can go a long way in the healing process for both you and the owner.
2.ACKNOWLEDGE OWNERS' EMOTIONS:
It is very important to acknowledge owner’s emotions. This is true in general when dealing with difficult conversations with owners, and when mistakes have been made.
Once you have delivered the bad news, give the owner a bit of time. Be silent for 30-60sec and let owners speak, cry, yell. Don’t continue to jump into explanations. Say: Are you ok? Do you have any questions? Is it OK for me to keep going? What do you want to know?
Empathize with their emotions. ‘This is terribly upsetting for all of us, but I know it is much more upsetting for you.’
3. LET OWNERS GRIEVE:
Letting owners grieve, in their own way, and grieving WITH them will show owners you have compassion and love for them and their animals.
Owners will need to grieve, they will need to break-down and cry, they might need to yell. They may need to see their pet again, no matter how grisly. Allow them their time and process. Don’t take abusive yelling, if the yelling is abusive then leave, however if they are hurting and crying you can be there hurting and crying with them.
4. ANSWER QUESTIONS FULLY & HONESTLY:
In this world of litigation, it is very difficult to know what to say, and what to with-hold in fear of being sued. The reality is however, if you have made a true negligent mistake than you will be at risk. However, risks occur with every procedure we do, with every drug we use. Owners acknowledge and accept these risks when they allow for a procedure or intervention to be performed.
Therefore, most ‘mistakes’ we make, are bad outcomes from a risk with a procedure. Ex. An anaesthetic death in an otherwise healthy animal, or an anaphylactic reaction to the injection of a certain drug (or vaccine).
Tell the owner fully and honestly what happened, how you tried to intervene, how hard you worked, and what happened. Most people respect and understand that mistakes happen, and will understand and respect you for being honest and telling them what happened.
People HATE feeling tricked, lied-to, or ‘kept in the dark’. Avoid giving owners any reason to feel that you are hiding anything from them or trying to deceive them. Most people hire lawyers to ‘try to find the truth.’
5. POLICY CHANGES:
Most owners only want to make sure that this mistake will never happen again, to anyone else. Most people realize that you can’t go back in time and fix a mistake, but they want to make sure that everyone involved has learned their lesson, and that no other animal will suffer from that same mistake again.
Ensure the owners that a full investigation will occur as to all of the aspects leading up to the mistake, and that policies will be put in place to ensure that mistake doesn’t occur again. Let them know once those policies are in place, and show them how their pet has improved the situation for all future animals. Most people will be placated by this.
6. SAYING ‘SORRY’:
Taking a page out of a Canadian’s book and apologizing is not only part of the healing process for both vet and owner, but statistically decreases your risk of litigation.
Every country, every state/province/territory, has their own laws about what ‘Sorry’ means. You will have to look up in your state/provice/territory whether or not you can legally say ‘sorry’ or if this is an admission of guilt.
A true, heartfelt, and complete apology has been shown to decrease litigations significantly, and is often what people want to hear above all else- a true acknowledgement of guilt and understanding of the grief caused, and true remorse. So if it is at all possible for you can apologize, do it!
In areas where ‘sorry’ is an ‘admission of guilt’, and you do not want to make yourself open for litigation, then you will need to be more creative with your wording. ‘I am terribly sad this has occurred, and wish with all my heart that I could reverse time and undo it.’ This isn’t as good as saying ‘sorry’ but at least it shows some remorse.
If you are very worried about litigation and being sued, then the best course of action is to not say anything to the owners prior to speaking with a lawyer, however keep in mind that this approach may make you more likely to be sued. This will be a risk you will need to assess based on the case.
7. COMPENSATION:
If a true mistake has been made, in human medicine there is a push to ‘saying sorry and offering compensation’ as a way to ‘settle’ without litigation. This has proven beneficial on the human side.
Asking owners what they would want or need from the clinic in order to make amends for this mistake can help you not only gain insight into their true emotions (ex. If they want a public apology/slander the clinic they are angry with you, if they want money they may be feeling ‘ripped off’ or possibly greedy, if they want policy changes to ensure things won’t occur again they are grieving), and what they need to recover and move on. Also, this approach can help settle many people’s emotions as it shows you are trying to make amends. Just waiving any fees is often not enough/not what owners really want.
If a poor outcome has occurred and it was not necessarily a ‘mistake’, but a bad outcome from a known risk, you will need to discuss with your clinic whether or not you waive fees. Waiving fees can come across as an admission of guilt, which is not something you want to imply if you haven’t done anything wrong. However, waiving fees shows a level of compassion. You will need to discuss with your team (the vet involved, the business owner) as to the best course of action.
8. RECORDS:
Having clear, organized and complete records for every single case, and having systems in place where risks are routinely discussed and recorded (ex. signed waivers, recorded in notes, etc) is incredibly important in protecting you legally. Also, having a full set of records that are detailed and organized, that you can share with owners, showing interventions and case progression, is also important if they should ask for these records. This can show owners that you are not trying to hide anything from them, and that you are keeping them as part of the team instead of trying to ‘pull a fast one’ on them.
Let's Get Personal
When I had my first animal die under my care, the owner was one that you would particularly NOT want this to happen to. She would one day be lovely, and the next come in angry/yelling/screaming over routine things. I was terrified about how she would react.
I was 3 months out of school, alone in a clinic, and my boss wasn’t answering his phone. I called the owner after 30min of CPR to let her know that her dog had died and we were making no progress with CPR. She screamed/yelled and hung up. 45min after CPR commenced- and was still going, I had handed over the CPR to my team and went into the x-ray room and was crying. The owner showed up, rushed into the back uninvited, to find me crying, and my team all crying, still performing CPR.
She was devastated, she was upset, she was angry, and I just repeated over and over, “I am so sorry”.
I tried as best as I could to tell her exactly what had happened, as much as I could. I, to this day, don’t know exactly why she never recovered from anaesthetic. I have my theories, but I don’t know.
Eventually we were hugging and crying. She eventually left. I had no idea what would happen. I was scared of being sued and losing my licence and never practicing again, after only 3 months out, but at that point I was so ashamed and upset with myself I didn’t feel I deserved to practice anyways.
A couple of weeks after the incident we received a card from the owner. She wrote a lovely letter outlining how much her dog meant to her, and how much pain she felt from her loss. But she also included how much she could see we cared. She described her point of view, how she was devastated and came rushing in, to find everyone in tears, working hard. She could see from the vials and syringes scattered around that we had been trying so hard, and from our red eyes and tear-stained cheeks. She knew we loved her dog as much as she did. She THANKED us, profoundly, for trying so hard. She continued to be a loyal client, and the next time I saw her we hugged and cried, and she thanked me for being such a good vet.
If I had planned it, I wouldn’t have had her see me like that, I wouldn’t have had her see her dog being ‘worked on’. I would have expected that to be to upsetting, however her seeing that emotion was the best possible thing that could have happened, for both of us.
Summary:
Losing a patient in veterinary medicine has 3 victims: The pet, the owner, and the veterinarian. Discussing this loss with an owner is scary, daunting and difficult.
By being honest, open and showing your emotions with the owner right away, along with saying ‘sorry’ and acknowledging any part you had in the process, you can not only go a huge way to healing both the owner and yourself, but also decrease your risk of being sued.
There is not concrete plan/set of steps that will ensure that the owner will forgive you, or that you won’t get sued. There is no way to ensure that the owner will understand, and move on. Even an owner that is, in the moment, placated can come back 3 months later with a lawsuit, after their child/friend/internet forum has told them and ramped them into being angry and suing you. All you can do is your best, and statically as well as emotionally, honesty is the best policy as is saying you are sorry.
