IVECCS 2017: Disclosing Medical Errors

Dr. Linda Fineman reveals the importance, benefits and methods of properly and openly disclosing medical errors to clients.
Kerry Lengyel
Published: September 18, 2017

One study in human medicine reported that 98 percent of patients want some type of acknowledgment when even minor medical errors are made. But only 30 percent of physicians share medical errors openly with their patients.

At the 2017 International Veterinary Emergency and Critical Care Symposium in Nashville, Linda Fineman, DVM, DACVIM (Oncology), explained that while fewer studies have been published regarding medical errors in veterinary medicine, there are many reasons to believe the statistics are similar.

“Many of us have been trained in a culture where we are expected to be infallible and to make an error is a source of shame, despite the growing awareness that expecting error-free practice is unrealistic,” Fineman said.

What action is considered a medical error? It’s based on the idea that another person in the veterinary profession would have recognized the care decisions and actions you made to be in error at the time they were being made.

“If a veterinarian does something that either does or does not cause harm but it’s not within the standard of care within that community, that’s an error,” Fineman said. “I want to emphasize that not all errors do cause harm.”

By being open with clients about medical errors, you and your veterinary practice will benefit in numerous ways. Disclosing medical errors in the proper manner leads to you and your practice:
  • Staying consistent with the code of ethics of veterinary medicine
  • Rebuilding trust with clients and veterinary team members
  • Retaining clients and your practice’s reputation
  • Reaching fair settlements if the client decides to sue
  • Reducing the risk of board complaints and lawsuits
Despite knowing that clients want to understand what happened, veterinarians still find it difficult to disclose errors. There’s a huge mismatch between this knowledge and what usually ends up happening after an error occurs.

Veterinarians often respond by mentioning the adverse event but not the fact that the event happened as a result of an error. Instead of shying away from disclosing medical errors, veterinarians should educate themselves on the TEAM module for disclosure, which involves being truthful, empathizing with your clients, apologizing, and managing the situation.

Be Truthful: Acknowledge that an error occurred. Be upfront and open and don’t put up any walls between yourself and the client.

“As you’re telling the truth, share the basics and then stop and ask the client how he or she is feeling,” Fineman said.

Empathize: Address the client’s thoughts, feelings and needs. Show clients that you understand how difficult this situation must be for them.

“I think empathy is absolutely critical,” Fineman said. “By using empathy and reflective listening, what we’re showing that client is that we hear and acknowledge and understand the issues they’re having. And that it’s OK for them to have emotions and negativity about the bad experience that they had.”

Apologize: Give the client an apology of responsibility — “I’m sorry I made this error” — not an apology of sympathy — “I’m sorry this happened to you.”

“Apologies need to include an explanation of what happened,” Fineman said, “and also a fair offer for how you will make it right.”

Manage through to resolution: Fair reparations, whether financial or otherwise, need to be made. Ask the client what more you can do for them. If the client would rather have his or her pet transferred to another hospital or practice, be comfortable in setting that up.

“Be accountable and make arrangement for reparations,” Fineman said. “For example, waive the fees that are appropriate to waive. If the patient is hospitalized for three days because you gave him pneumonia, the client better not be paying for that.”

Prior to the difficult disclosure conversation, make sure that four things are accomplished first: 1) take care of the patient’s immediate needs, 2) take care of yourself and the staff, 3) develop clarity about what happened and 4) think about what you are going to say to the client.

“The idea that if you make a mistake you are to blame and should feel ashamed — that’s not healthy,” Fineman said. “We have to speak about errors. We have to own them and say out loud, ‘I made this mistake, and here’s what happened.’ Gather your team around you and say, ‘Let’s work together to figure out how we can build in double checks.’”

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