Dealing with a mistake

RE: Dealing with a mistake

bevs2251 — Thu, 08 Feb 2018 02:30:07 GMT

Agree, no blame on your part. I definitely don't admit all V&D cases. And if you had, and say it still died O/N at your practice, the owners might have been even more ropeable as no-one was there at the time the animal died (have had plenty complain when this happens).

I'm a dweller on negative stuff too, even it it's just a stupid, frivolous complaint such as "she hurt my dog" squeezing anal glands (!!). Takes me a few days to get over it.

Worse if one makes a major mistake (surgical stuff-up, misdiagnosis of a radiograph, GA death etc) - these instances might surface to the forefront occasionally over the years. Learn from any mistakes (none in this V&D case) and never make them again.

Vets are notorious for blaming themselves when negatives occur due to our high-achieving natures. We are not set up to accept failure. Unfortunately these days, it seems we get too little appreciation or praise when things go well to counter-balance the occasional negative outcome or complaint.

RE: Dealing with a mistake

Rach — Wed, 07 Feb 2018 15:54:47 GMT

Another here to support that you did nothing wrong, no mistake, just a judgement, which is exactly that, a judgement, a call based on the information at hand. I’m not sure it’s even helpful or fair to call it a misjudgement as it requires the benefit of hindsight to name it that, so it’s just a judgement. Would you have done things differently with the benefit of hindsight? of course, but with vs without hindsight is not a fair race, so don’t dwell on that. As with a previous poster I’m not sure there is much learning to be done here other than ‘sometimes things deteriorate really quickly and we can’t predict it, and that’s rubbish’. I don’t think you need to change your approach to similar cases on the back of this.

That all said, I know I would be going through all the same emotions as you, and angry/upset clients don‘t help, although I doubt it is aimed at you personally, they are just trying to deal with their emotions too, so try not to take I to heart, although I know that’s easier said than done.

On a broader/personal note, I do wonder if as a breed, vets have very high expectations of themselves and that therefore, ‘fixing it’ (or making the call to PTS before it dies of its own accord) becomes the norm, just ‘doing our jobs’, rather than something positive. When someone finds out I’m a vet and says, ‘gosh, that must be so rewarding’, I often think to myself ‘you have no idea how stressful it is’. It is a stressful job, but maybe it’s compounded because I/we have stopped getting that ‘reward’ when things go well, expecting that instead to be the norm. That means I/we only notice when something deviates from the norm, i.e. goes wrong and in my/our heads the negative outcomes/experiences predominate. So next step, trying to make the positives stand out instead...

RE: Dealing with a mistake

mariette asselbergs — Wed, 07 Feb 2018 12:00:24 GMT

I had something similar happening to me shortly after I started practicing in the UK after many years in Mozambique. I went to the owner's house after the dog suddenly died with bloody vomiting and diarrhoea at the end of a day when it presented just a bit off colour and with one times vomiting and normal diarrhoea. I took the dog with me to the practice and as would have been normal in Mozambique did an autopsy and send of samples. The nurses were shocked because a post mortem was never done (as I learnt later for the UK small animal practices). I was concerned that maybe a parvo virus vaccination had failed. But results came back positive for Salmonella! It would not have been possible to know that that morning, and I would probably not have been able to save the dog with different treatment. But it convinced me of the usefulness of small animal post mortems. Not that that makes any difference: they are almost never accepted.

Think of it, will you now admit every single dog with vomiting and diarhhoea? Of course not! I am sure you made no mistake and it is not your fault. Shit happens, and I can't see much in terms of lessons to be learnt, other than accept that this can happen.

Mariette

RE: Dealing with a mistake

George Cooper — Wed, 07 Feb 2018 00:20:17 GMT

After a hard day’s graft at the surgery, getting through 20, maybe 30 clients of all colours, shapes, sizes, smells and beliefs, to say nothing of their little darlings that they fetch in, who again vary in consistency from the most lovable cuddly creature in existence to the undoubted little shit that wants to gnaw your knuckles, we as if as one, as a profession, head thankfully for Home for the sanctuary, for the nuzzling nose of the heavily moulting black flubrador that has commandeered the comfiest sofa in the house, and as we shoo it off, and settle heavily into the cushions, having paused in this journey only to pour ourselves a welcome pint of G’n’T on the way - what, I ask of you Anon, is the FIRST client to enter your brainbox?

I will tell you! The bugger who complained, the case that didn’t compute, the cat that scratched, the nurse who dropped the clippers, - you fill in the relevant one! This is a universal in our profession, and I will tell you WHY. It is, quite simply, because we CARE - and that in its most wide-spread, all encompassing meaning you can think of.

So - it ain’t wrong to gaze at your navel for a few hours, nor to put off going to bed for a few more, nor to shed a few tears of frustration, of disappointmen, whatever - but NOT, I suggest of regret, for that is wasted emotion......The key, as I believe, is to reflect, then accept. Accept what has happened, understand the tens of thousands of vets have been there too, and learn. Then go back, do another hard day at the surgery full of smellies and read from the top again, when it all kicks off once more.

RE: Dealing with a mistake

Anthony Todd — Tue, 06 Feb 2018 22:27:13 GMT

[quote user="Iain Richards"]How common is sepsis in dogs?[/quote]

Pretty rare, it would appear ,as the tangent I started got my usual one anonymous star yet sudden death after surgery, or any minor condition like D&V should have resulted in some correspondence.

I mean what is the definition, for starters?

Let's hope someone more highly regarded starts a tangent or follows mine.

RE: Dealing with a mistake

Arlo Guthrie — Tue, 06 Feb 2018 17:43:56 GMT

[quote user="Lucy Fleming"]I imagine you are very familiar with the inside of your own head already.[/quote]

As an aside, I'm often finding myself enjoying your turn of phrase Lucy Fleming

And once again, wonderful to see everyone rallying round with such helpful and supportive stuff. A round of to you all.

RE: Dealing with a mistake

Miriam Lodewyks — Tue, 06 Feb 2018 17:34:20 GMT

For what it's worth, Anon, I also do NOT feel you made a "mistake". You made a judgement based on a clinical exam PLUS blood results. You don't have x-ray eyes, you don't have a magic crystal ball. You could not foresee this happening, we're all in agreement that this level of deterioration is highly unusual and you would probably not have been able to prevent the dog's demise.

Might you have handled it differently? Sure.

Might the clients have been a little less upset if you'd taken it off their hands? definitely.

But you have to weigh their wellbeing up against your own, and you were feeling rough by the sound of it. That's not your fault.

See this as a sharp learning curve that will help ensure that future patients get even better care from you than they already are (clearly).

RE: Dealing with a mistake

Lucy Fleming — Tue, 06 Feb 2018 14:58:46 GMT

[quote user="An On MRCVS"] I'm becoming very familiar with 3am this past week, mentally going through all my major mistakes and wishing for a time machine to have another go and do things better. Talking things out with someone might be the way forward.[/quote]

I think you are right that you will find talking to someone else more useful than talking to yourself. I imagine you are very familiar with the inside of your own head already.

I find judging what owners think and describe over the phone is one of the most difficult parts of the job. I've had thing described as a bit off colour turn up at deaths door, and 'off their legs/ collapsed' dogs towing their owners in on the end of the lead. I suspect I would have expected and older dog to recover from that type of episode relatively slowly, and leant towards giving the meds more time to work as well, if that makes you feel any better.

RE: Dealing with a mistake

An On MRCVS — Tue, 06 Feb 2018 14:01:03 GMT

[quote user="Tedders"] the endless loop that you get caught up in regretting not saying to the client "Come straight back down" or "I'll just keep her in and put her on a drip"[/quote]

This. This is exactly what I've been doing.

I appreciate that I probably couldn't have saved this dog. It's so rare to become that ill that quickly. A post mortem wasn't performed so we'll never know. I was beating myself up for not showing more empathy, for having those owners watch their dog get worse. I keep thinking that if I'd had her in with me all day, she would have got worse anyway but at least I could have had her on good analgesia and her owners wouldn't have to see her like that.

As for my mental state - I'm not the most robust, I'll admit. This isn't the first mistake I've made and it won't be the last but I don't seem to get any better at dealing with them. I'm becoming very familiar with 3am this past week, mentally going through all my major mistakes and wishing for a time machine to have another go and do things better. Talking things out with someone might be the way forward. Thank you again to all to took the time to comment. I feel a little better today just for having it out there and not weighing in the pit of my stomach quite so much.

RE: Dealing with a mistake

Jill Butterworth — Tue, 06 Feb 2018 12:34:35 GMT

Any vet who tells you they have never misjudged a case is lying ...

RE: Dealing with a mistake

Jo Dyer — Tue, 06 Feb 2018 12:26:08 GMT

You made a decision based on your recent clinical examination and the owner's demeanour and information on the phone. You will have made these decisions hundreds of times in your career, it just so happens that in this instance the outcome was different and distressing. As everyone else has said, it is far from guaranteed that anything at all would have saved the dog.

The owner's anger is understandable - loss of their pet and, who knows, perhaps some unsubstantiated guilt on their part - but they are wrong to blame you.

It is worth looking at the situation in a clinical governance meeting if your practice does such a thing. Discussing everything in a no-blame, 'what can we learn from this?' kind of way will reassure you that everything has been learned that can be, rather than just sweeping it under the carpet as if it is something shameful. Try not to end up in the situation of performing defensive medicine and over-treatment of cases as a reaction.

Vetlife is staffed 24/7 by volunteers who all have in-depth knowledge of the veterinary professions and who are trained in non-judgmental listening and support. You can phone them on 03030402551 or email via https://helpline.vetlife.org.uk if you prefer the written word. All confidential and anonymous, and any identifying features are stripped out of emails as they are sent.

I hope you feel better soon.

RE: Dealing with a mistake

Niall Taylor — Tue, 06 Feb 2018 12:24:10 GMT

Just want to reiterate what everyone else has said, you haven't made a mistake or been negligent. Even with the most extreme interpretation this is simply a misjudgement and, as Evelyn has said, everyone has 20/20 hindsight. The same judgement and responses in hundreds of other cases presenting in the same way would have seen the problem get better (and, occasionally owners even moaning because you had dared to simply to mention expensive and interventionist things like drips and blood samples!).

But this:

[quote user="An On MRCVS"].. I feel like quitting would be the best thing for myself and the veterinary profession.[/quote]

Is utterly wrong - actually the profession needs people with this type of experience. It's a harsh lesson, but it happens, and you are now a better vet and person for it.

Niall

RE: Dealing with a mistake

Iain Richards — Tue, 06 Feb 2018 11:19:32 GMT

As I've posted elsewhere, think of those occasions we've really screwed up and the animal has been fine. Intra-arterial butorphanol is spectacular.

RE: Dealing with a mistake

Martin Atkinson — Tue, 06 Feb 2018 09:43:07 GMT

[quote user="An On MRCVS"]Thank you all for your kind words. I don't feel like I deserve them but I feel a little less of a demon reading your posts.[/quote]

[quote user="An On MRCVS"]

I'm not in a position to just up and leave but, right now, I feel like quitting would be the best thing for myself and the veterinary profession.

Is there a way past this? Can VetLife help with problems like this? How do others move on after a mistake?

[/quote]You're not a demon but are over-reacting. Everyone to a man/woman has said you did nothing wrong and supported you. We've all made genuine mistakes, many much worse that this, it is part of the job and something we have to deal with but we all have to get through it.

Sorry to be the amateur psychologist for the second time in a day but it concerns me that this is just the tip of the iceberg and you are not dealing with an everyday situation in a normal way. I think calling Vetlife may be a good start but you may also need to seek additional help on mental health issues.

RE: Dealing with a mistake

Martin Atkinson — Tue, 06 Feb 2018 09:40:42 GMT

[quote user="An On MRCVS"]

I'm not in a position to just up and leave but, right now, I feel like quitting would be the best thing for myself and the veterinary profession.

Is there a way past this? Can VetLife help with problems like this? How do others move on after a mistake?

[/quote]Everyone to a man/woman has said you did nothing wrong and supported you with saying we've all made mistakes, many much worse that this, it is part of the job and something we have to deal with but we all have to get through it.

RE: Dealing with a mistake

Julie Innes — Tue, 06 Feb 2018 08:50:54 GMT

Hi anon,

Please stop being so hard on yourself (says someone who beats herself up regularly about every little thing )

A colleague of mine had a similar case a few months ago, except in a young dog- Vomiting and diarrhoea with blood, seen at 4pm, apparently died at 7pm. We had a PM done and they seemed to think there was an enterotoxin that caused sudden onset shock. The owner complained to me, but I can't see that there was anything my colleague could have done to change the outcome- antibiosis was given, and the dog was not showing dehydration, her notes are clear about its colour being fine, HR normal etc. I genuinely think that if an animal is going downhill that fast there is virtually no chance of turning it round.

there was likewise nothing to suggest to you that this dog was going to go downhill so quickly. I'm struggling to think of what course of action would have saved the day. It's so easy to see when it's someone else's "mistake" and so hard, I know (believe me!) when it is your own, so speak to your colleagues, vetlife and all of us on here. And think about what you would say if someone else did this. Please don't think of quitting- these things really do fade in time.

RE: Dealing with a mistake

gdbvet — Tue, 06 Feb 2018 06:56:42 GMT

I sincerely hope you have a good veterinary mentor to put your angst into perspective.How old was the dog?Were there other clinical problems apart from the obvious gastro enteritis?Did the owner put pressure on you to abbreviate diagnosis/treatment because of cost?The only vets I know who are omniscient are either fools or liars.Think of the number of clients you see in a year.How many sub optimal outcomes do you have?A distinction grade in exams is what?90%.

RE: Dealing with a mistake

Tedders — Mon, 05 Feb 2018 22:29:46 GMT

I feel every sympathy for you Anon this sort of thing has happened to me too and I totally understand the endless loop that you get caught up in regretting not saying to the client "Come straight back down" or "I'll just keep her in and put her on a drip" it could drive you mad! The point is, your instinct when you first saw her was that she wasn't unwell enough to be admitted and the fact that she deteriorated so quickly and catastrophically was totally unexpected. I once had a dog that I was concerned might have a pyometra and had booked it in for a repeat scan one morning as the first scan was inconclusive. Her owner told me on admission that she was much improved ("back to normal" I think she said) so I cancelled the scan, suggested we spay her soon because "If it wasn't a pyo this time, it would be the next!" and she died of a ruptured pyometra at the out of hours provider that night. I felt sick with regret about that one as you can imagine. I'm sharing this so you know that your are in no way alone in making an error of judgement that ends in disaster so please take some comfort from that. You won't feel as bad as this for ever, time gives a sense of perspective and if something can be learned from this maybe it's that you will now offer to recheck an animal if an owner reports no improvement (although I sometimes do follow up appointments for fully recovered animals where the owner says something like "I thought I was going to lose him that afternoon after I saw you and you gave him those injections" and I think to myself, well, why didn't you phone back??). Definitely don't give up the profession, I sometimes think when I have a poor outcome that I only feel this bad because I am prepared to do it. There will be a day soon when everything will go right, you will see lots of your favourite clients and you will feel on top of the world.

RE: Dealing with a mistake

Michael Woodhouse — Mon, 05 Feb 2018 22:09:26 GMT

I also don't think you made any sort of mistake. All our patients are going to die at some point from something. The demise seems fast and unpredictable. How old was the dog?

You did nothing wrong, it sounds like you did more than I would have at first presentation (bloods). I think the only point to take from this, is offer to see back if the owner is still not happy. I still don't think not doing so means you are in any way wrong.

I'm not even sure I'd have referred the dog when it came back......

You did much more than I would have, you practiced good medicine. Dogs die. Don't let this get to you. Have a whisky (or your tipple of choice) and hug your own dog/cat/husband/wife. Things will seem better in the morning.

RE: Dealing with a mistake

Iain Richards — Mon, 05 Feb 2018 21:01:59 GMT

How common is sepsis in dogs? As in DIC type system failure septicaemia? I don't think you did anything wrong most of us would have handled it the same. I wouldn't run bloods routinely for V&D, so you've already done more than most. It's rotten luck, as I wrote on a Facebook thread on the same subject, these are our triumphs and disasters, we dead with them and move on. Feeling bad about it is normal.

RE: Dealing with a mistake

bob lehner — Mon, 05 Feb 2018 20:55:50 GMT

[quote user="An On MRCVS"]I'm not in a position to just up and leave but, right now, I feel like quitting would be the best thing for myself and the veterinary profession. [/quote]

No !! I've been vetting for 44 years and still hardly a day goes by when I don't wonder if I have made the right decision with a case - or worry that I've missed something bloody obvious.

Just this evening I saw a fat old spaniel with an absolutely classic 'fatty lump' on his side, which had been slowly developing over 2 months. I was within a whisker of saying 'It's just a lipoma' (end of a long day etc. ...) - but fortunately decided to stick a needle in - got pure blood back - yikes!!! What an arse I'd have been if I had stuck with my original gut feeling and done nothing. Got it right this time - but it could just as easily have gone the other way.

We look at animals, make a judgement based on what we see and what the owner tells us and use our previous experiences - usually we get it right - but sometimes we get it wrong. It's inevitable - and it's going to happen to every single one of us.

RE: Dealing with a mistake

Gillian Mostyn — Mon, 05 Feb 2018 20:54:29 GMT

I agree..phone Vetlife. You need to talk this through with someone before it causes harm to your confidence and career.

Secondly...you didn't make a mistake. You made a judgement call...there is a difference. We all make them every day, and many of us have regretted them. I'm afraid it goes with the job.

You didn't make the dog ill, and you didn't hasten it's demise....the illness did those. Whether you could or could not have had a positive impact, unfortunately you'll never know. But you will save many many more animals than the few cases where you may (or may not) miss something important.

Take care

RE: Dealing with a mistake

KathW — Mon, 05 Feb 2018 20:31:31 GMT

[quote user="An On MRCVS"]

Is there a way past this? Can VetLife help with problems like this? How do others move on after a mistake?

[/quote]

Yes Vetlife can help - and they will be a non judgmental listening ear. Phone them tonight or use their e mail service - you are not identified by your e mail and will get a reply (I think it's within 12-24 hours).

Keep discussing things as long as you need to - with colleagues, on this forum and with Vetlife.

Others have give lots of sound advice. Many of us have been there and got through but it's painful at the time.

Look after yourself.

RE: Dealing with a mistake

Anthony Todd — Mon, 05 Feb 2018 18:02:31 GMT

PS Owners are not beyond editing the truth either.

Time of onset of abnormality [persons in family will have different time scales]

Speed of onset of signs too.

Initial signs ["dog vomited what looked like parts of a seagull for two days"] but no mention at all.... etc.etc.

I don't think you've got anything to worry about at all. Happens in people all the time, called "sudden death".

PPS I'm always a bit hesitant when owners are angry too sometimes i think they are just transferring blame.

[Son to mum "I told you he was sick yesterday morning but you ignored me...."]

PPS I don't think I've ever seen post-op sepsis in my career is there room for a tangent??

RE: Dealing with a mistake

Evelyn Barbour-Hill — Mon, 05 Feb 2018 17:57:16 GMT

[quote user="An On MRCVS"]They were a little more specific than that. I was trying to keep my post short. They never said she was collapsed, though, and I based my advice on my earlier assessment of the dog. I was wrong.[/quote]

So what? You had a think and made a judgment. It turned out wrong...debatably. The retrospectoscope is a wonderful instrument......

This is what professional people have to live with. We have to walk the tightrope and occasionally we slip off.

If a judge had to leave the legal profession every time they made a misjudgment.......