What happens when you mess up BADLY?

[wheelin2vetmed]

I was just reading @WhtsThFrequency 's response in another thread

Everyone messes up, and sometimes badly. You need to start beginning to accept that this will happen.

and it got me thinking: what happens when you mess up badly?

This may seem like a stupid question, but I don't know. Of course I realize **** happens and vets are human like everybody else, but what's the course of action? Do owners pursue malpractice ever? Does insurance kick in?

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[hazelmoo]

One time at my practice, a vet hooked up a fluid bag to a feeding tube because the dog's blood pressure was so low and the veins were all either blown or impossible to hit. Well, it turns out that he didn't insert the feeding tube properly and the fluids caused the dog to drown. It was horrible, especially since the owners were the kind of people who didn't blink an eye at spending over $3000 in surgeries and drove over 2 hours (both ways) to get to us because they didn't trust anyone else. He had to tell them what happened.. They didn't sue but we haven't seen them since... And that vet no longer works in our hospital
Another time, a dog died of bloat in our resort because the resort employees didn't recognize the signs and didn't think anything was wrong. It was on Christmas Eve. Imagine getting that call on Christmas, that your baby died in a place that you thought was safe they were furious, and extremely upset, but they eventually forgave us and came back with their new puppy a few months later.
I don't know how often suing occurs, but the vets I work with have never been sued, even when stuff like that happens. Maybe they just get lucky, but I don't think it's as common as in human med.

 

[Starry-chan]

what happens when you mess up badly?

I am interested in this question too. I remember reading (on this forum, I think) about how no matter how hard a vet tries, the day will come when they accidentally kill an animal. It made me wonder what happens in such a situation, and how vets can protect themselves from bad consequences.

And it seems like techs can wind up in the same boat. So, I am interested in hearing about them too.

 

[Jess Monster]

I'm not really sure either. I imagine there's a whole host of actions that people undertake to punish a veterinary professional who has screwed up - go after his/her license by filing a complaint with the state licensing board, sue them in court for the loss or injury to their animals, and/or take to the internet and use social justice to shame and intimidate them. I've heard of stories that involved all of those actions but I don't know any vet personally who has been sued, at least not one who talks about it openly.

Well.... that's not true. The state public health vet I worked with was named in a lawsuit by a family who found a rabies vaccine packet in their yard (from the aerial drop program along the Pennsylvania/Ohio border) and they handled it or one of their pets ate it... something like that. As a result they were suing the state PH vet and the Ohio Department of Health for damages. I'm not sure who won and I'm not sure if any person or animal was actually hurt.

 

[Minnerbelle]

I was just reading @WhtsThFrequency 's response in another thread and it got me thinking: what happens when you mess up badly?

This may seem like a stupid question, but I don't know. Of course I realize **** happens and vets are human like everybody else, but what's the course of action? Do owners pursue malpractice ever? Does insurance kick in?

If you get sued will depend entirely on how you handle the situation and how your client reacts to what happened, how you handle it afterwards, the trust your client has in you, and their personality.

When you mess up badly like in any aspect of your life, you break the news to the client. How you do it is up to you. If it was definitely your fault that something bad happened, like you OD's anesthetic drug by 10x and killed patient, fractured jaw during dental because you didn't have dental X-ray, spay dehiscence and dog chewed its bowels because you legit didn't close the holding layer of abdominal wall, chopped out a prostate when doing a cryptorchid neuter and dog dies, causes serious burns during surgery with unsafe warming methods, etc... you can acknowledge your mistake, apologize profusely, and provide compensation from your clinic and if applicable pay for any needed treatment for your mistake (done by you or a specialist). In that case, your boss will handle that if you're an associate. Or you can apologize profusely and just turn it over to your malpractice carrier and they can take over. The owner then either sues you or puts in a board complaint or tries to ruin you on social media, or maybe they won't.

Smaller mistakes that people make all the time, like oops your pet wasn't due for rabies this year but I accidentally just gave it. You just apologize, maybe give a freebie something or not, and move on.

 

[dyachei]

Usually they don't sue. But when they do, you have to remember that pets are property and the amount a client can sue for is limited.

That said, owning up to your mistake is key. Most clients will be upset at the time but many forgive. Humans make mistakes. Hopefully your mistake won't kill an animal. My first year out I set fluids too high on a parvo puppy. The dog didn't die and we resolved it, but it was a scary couple of days.

 

[twelvetigers]

I don't think I've done anything terrible yet, but I'm sure it's coming. (yay)

I'm guessing you feel miserable for a while, and then it kinda haunts you to some capacity for the remainder of your career. I mean, you'll never do ______ again, but you'll probably always feel bad about it.

 

[chickenlittle]

I've had one anesthetic death.... in an apparently healthy kitten, in for a spay. A necropsy didn't show any underlying disease so I assume it's "my fault," but I never did figure out why. (The fact that I was in a low-cost, understaffed clinic that provided minimal post-op monitoring was certainly a factor, because the kitten was probably dead for a while before my tech found it, but I still don't know why it died because it had been stable all through anesthesia. Maybe I caused excessive laryngeal spasm with intubation? Who knows.) I called the owner immediately and explain what had happened (worst phone call ever), we paid for the necropsy, I called her with the results, and she was very understanding about the whole thing. No malpractice suit but I still sometimes beat myself up over it, six years later.

There have been other situations where I think I've mad a wrong decision, but so far (knock on wood) that's the only death that I feel was clearly 'my fault.'

 

[pinkpuppy9]

I want to add that it won't always be you messing up. It could be your tech, and you will still be held responsible. A tech at my old job overdosed a hedgie on ivermectin (carried the decimal to the wrong place in her math). We gave it free intensive care for close to two weeks when the poor thing finally died. The owner could have absolutely sued, but we cut her a check for the cost of the hedgie and she moved on.

I agree with dy, most people don't sue. It seems that legal costs outweigh the amount most people could win. They'd have to have some excellent proof that you f'ed up due to malpractice or something (not that the patient had unforeseen complications). Another good reason why you should record "Owner declined" for things like pre-surgical bloodwork, vaccines, anything in your medical records. Your medical records are key for covering your butt most of the time.

 

[Jamr0ckin]

Honestly, when people sue or file a board complaint, it is normally when you do nothing wrong. It's often a lack of funds for diagnostics that precipitates a reaction like that from clients. The place I used to work for got sued for wrongful death of a puppy. But the owner refused to hospitalize the patient and could never produce the body for a necropsy. Obviously it was dismissed by the judge but not before it cost the practice a lot of money.

Being up front and honest about your mistakes goes such a long way. An apology does as well. Documenting everything you did in the medical record is also important. So if you overdosed fluids and you give furosemide, you need to document it instead of just hoping the animal doesn't show any signs. I've seen places do this and it may work out for a while, but it will eventually catch up to you.

 

[DogtorCK]

I was just reading @WhtsThFrequency 's response in another thread and it got me thinking: what happens when you mess up badly?

This may seem like a stupid question, but I don't know. Of course I realize **** happens and vets are human like everybody else, but what's the course of action? Do owners pursue malpractice ever? Does insurance kick in?

I'm glad you started this thread. I've seen it as a potential interview question and it's been the one that has been haunting me.

 

[dyachei]

One day, when I was working, I let the owners take their dog back and the dog jumped off a table (out of their arms). He tore his CCL. The owners knew it was their fault. We had it in the notes. They threatened to sue (and I worked for a corporation) because "we can afford it" and they couldn't. They didn't win. We did do free radiographs. so it happens, but it never goes far.

 

[Minnerbelle]

Honestly, when people sue or file a board complaint, it is normally when you do nothing wrong. It's often a lack of funds for diagnostics that precipitates a reaction like that from clients. The place I used to work for got sued for wrongful death of a puppy. But the owner refused to hospitalize the patient and could never produce the body for a necropsy. Obviously it was dismissed by the judge but not before it cost the practice a lot of money.

Being up front and honest about your mistakes goes such a long way. An apology does as well. Documenting everything you did in the medical record is also important. So if you overdosed fluids and you give furosemide, you need to document it instead of just hoping the animal doesn't show any signs. I've seen places do this and it may work out for a while, but it will eventually catch up to you.

Totally true. Very rarely do people sue, but when they do, it's for something where you did nothing wrong.

 

[pinkpuppy9]

Honestly, when people sue or file a board complaint, it is normally when you do nothing wrong. It's often a lack of funds for diagnostics that precipitates a reaction like that from clients. The place I used to work for got sued for wrongful death of a puppy. But the owner refused to hospitalize the patient and could never produce the body for a necropsy. Obviously it was dismissed by the judge but not before it cost the practice a lot of money.

Being up front and honest about your mistakes goes such a long way. An apology does as well. Documenting everything you did in the medical record is also important. So if you overdosed fluids and you give furosemide, you need to document it instead of just hoping the animal doesn't show any signs. I've seen places do this and it may work out for a while, but it will eventually catch up to you.

I worked somewhere where the doctor demanded that we never reveal faults in her medical records, even if it was something like "Boarding patient was fed 1 cup in the AM instead of 1/2c." Is withholding medical information illegal somehow?

 

[dyachei]

I worked somewhere where the doctor demanded that we never reveal faults in her medical records, even if it was something like "Boarding patient was fed 1 cup in the AM instead of 1/2c." Is withholding medical information illegal somehow?

falsifying records is a no no

 

[wheelin2vetmed]

Documenting everything you did in the medical record is also important. So if you overdosed fluids and you give furosemide, you need to document it instead of just hoping the animal doesn't show any signs. I've seen places do this and it may work out for a while, but it will eventually catch up to you.

But doesn't that give the owner clear-cut ammunition to sue and go forward with other stuff? It's clearly documented medical evidence that you screwed up.

By no means am I saying not to write down everything that happened, or falsify/exclude information to cover your butt; that's just unethical and wrong on many accounts. I'm just curious what's happened in some situations where the vet screwed up BIGTIME.

 

[dyachei]

But doesn't that give the owner clear-cut ammunition to sue and go forward with other stuff? It's clearly documented medical evidence that you screwed up.

By no means am I saying not to write down everything that happened, or falsify/exclude information to cover your butt; that's just unethical and wrong on many accounts. I'm just curious what's happened in some situations where the vet screwed up BIGTIME.

the thing is, the vet med board in whatever state you reside in has the ability to take away your license. even if the owner sues, and wins, they usually don't get much more than the "value" of the property. Sometimes, they will give med care if the animal is still alive. Now, even expensive pets aren't worth more than a few thousand dollars. So the bigger concern is usually the VMB

 

[DVMDream]

But doesn't that give the owner clear-cut ammunition to sue and go forward with other stuff? It's clearly documented medical evidence that you screwed up.

It is medicine and we are human beings. Mistakes happen. It is how you go about dealing with said mistakes that counts. Could an owner still sue you for mistakes? Of course. But if you take responsibility for the mistake, make efforts to correct the mistake and genuinely work with the owner, the chance of that lawsuit happening diminishes.

And you have to record what you did with the animal. So you can't just leave out treatments or how much fluids were given. If you do, then instead of just getting a lawsuit, you can (maybe) kiss your license goodbye as well.

 

[deleted498041]

Think about it this way: we've all heard horror stories of veterinarians doing something awful. Maybe they got sued, maybe they didn't. Maybe they had a meeting with their board, maybe they didn't. How many of them still have their license? I've known one vet, personally, that has had their license taken and the amount of awful mistakes they made and the sheer volume of illegal activity going on was incomprehensible. It is very, very hard for you to lose your license provided you keep your medical records up to date and accurate, at least in my opinion. Like everyone else said, mistakes happen. Owners don't always want to pay for all of the diagnostics and so you have to treat empirically and that treatment may be wrong.
I think the biggest thing is document, document, document and then always have a plan A, B, and C. Something will go wrong but it won't be nearly as devastating if you know the appropriate response.

 

[Skimble]

We had a client try to sue us for referring her dog out to a specialty clinic and she wasn't satisfied with the care the dog received there given the large sum of money she spent. She tried to sue the referral clinic too. The judge dropped the case against us right away and she lost the case against the referral clinic too.

Another client told me a story about how she boarded her new purebred kitten at her vet and when she returned to pick it up they informed her a tech had mistakenly euthanized her kitten and then they still charged her for the boarding prior to the kittens untimely death!

 

[Shreddr22]

I messed up 2 weeks ago, handed the wrong suture to the doc and now the abdominal wall is held together with non-absorbable sutures instead of absorbable. To be fair, Doc called for the wrong suture in the first place, two other people were also assisting with the surgery, and none of us caught her mistake either. I apologized, and we moved on. It looks like the dog won't be making it for much longer however, we removed a massive cancerous spleen and she has not shown improvement.

Another time, I gave a cat the dosage of Convenia that the doctor asked for, turns out it was 3 times the dosage that should have been given based on weight. And what gets me is that I was thinking hmmm this seems like a lot when I was drawing it up, but I shoved it away because hey the doctor knows better right. Silly me, always double check! Doctors are working with so many different patients and cases at one time, it's so easy to confuse them. I told her immediately and apologized, and we looked up overdosing Convenia together, turns out it wasn't a big deal. I actually saw the cat yesterday when I was visiting the shelter that was caring for him, and man he looks great!

I list mistakes like this in a notebook and describe what I should have done differently or why the mistake happened. It helps me to remember on a daily basis to listen to my instincts and apply my earlier experiences and education to new situations.
The practice owner has been in business over 25 years, and I know he was sued at least once, but I think nothing came of it. On the flip side, the practice manager of a clinic in town was sued recently for sexual harassment by various female employees, and they won an undisclosed amount

 

[dyachei]

meh, non-absorbable suture isn't that big of a mistake.

That being said...my techs' mistakes are my mistakes. I'm responsible for them.

I asked a tech to get carprofen injectable for a pet 0.7 ml. She started getting 7. I always double check my math and we caught it pretty quickly. She was really embarrassed (and that could very well be fatal) but I told her everyone makes mistakes, this is why we double check.

 

[Caia]

There's a magazine from my VMA that comes in the mail every couple months and it will detail resolved board complaints including what happened, what the vet's actions were and what the result was. Usually the vet is given a suspension, 6 months or a year on average, has to pay a fine (several thousand) and has to complete certain CE courses (usually medical records, sometimes pain management in whatever species is appropriate). It's interesting to read about but usually the vets that are in these cases handle the situation terribly and don't have good records. So I think being upfront about your mistakes and keeping good records goes a long way.

Suits are less likely up here so I haven't heard of any yet.

 

[Shreddr22]

I love when the doctor says "can you draw up 1.5cc of dex and give it IV?" meaning dexamethasone sp. Obviously, dex dormitor would be a much lower dosage and for a different purpose, but we use the word "dex" to describe both, and it is downright scary. Some things need to change!

 

[DVMDream]

I used to triple check my syringes when I drew them up as a tech, seems like that would take longer, but it really didn't take but an extra minute. I also got very used to what was a "normal" volume of drug for common drugs we used for the size of a patient, so if something seemed extremely large, I would double check with the vet. And I did occasionally catch an error simply because of this.. "hmm, that seems like too much let me go verify."

I'd much rather see someone take an extra minute or two to double or triple check their work than to see someone rush and make a mistake.

Oh, and label everything... If there is a syringe sitting on a chart with no label on it and a tech goes, "oh I think that is x", I am going to pitch it. Not because I don't trust the tech, but because safe is better than sorry. And I have done this to myself as a tech when I forgot to yank out my sharpie and label the syringe and then I have two or three syringes and can't recall what is in which... wasted they went. Anytime there is even a slight confusion as to what might be in that syringe, even if someone is 99.9% certain it is "x"... it should be pitched. It is much easier to waste and re-draw up drugs than it is to take away a drug once it is given to a patient.

 

[Starry-chan]

It sounds like if you do a proper job as a DVM (keeping adequate records, owning up to mistakes, etc.) then you have little to worry about. That said, do any of you find it difficult to not worry, at least a little? It seems like dealing with a client angry enough to sue could be scary the first time it happens, even if you're 99.999999% sure nothing horrible will come of it.

And if I ever work as a tech (still thinking about it for when there is a period in my life where I can afford to make so little money), I am definitely gonna remember what you guys said about labeling syringes and triple check everything. I AGREE COMPLETELY that the peace of mind you get from checking three times is better than chancing killing a pet!

 

[dyachei]

That said, do any of you find it difficult to not worry, at least a little? It seems like dealing with a client angry enough to sue could be scary the first time it happens, even if you're 99.999999% sure nothing horrible will come of it.

of course!

 

[Coquette22]

I asked a tech to get carprofen injectable for a pet 0.7 ml. She started getting 7. I always double check my math and we caught it pretty quickly. She was really embarrassed (and that could very well be fatal) but I told her everyone makes mistakes, this is why we double check.

I had this too. Asked the relatively new tech to get me some metacam for a cat post-spay. Gave her the dosage, and she told me what she figured out. I thought, "That sounds like a lot for a cat. Did you check the concentration on the bottle? Injectable metacam is different from oral." She caught her mistake and probably won't make it again, the cat got the proper dosage. Never be afraid to double check with a doctor. I don't care if you weren't paying attention because you were daydreaming about pizza, never be afraid to double check. Hell, maybe the mistake is mine. But if something seems weird, please come ask us.

 

[EngrSC]

We had a pharmacy send home the wrong insulin syringes and the dog died. The owner sued both the vet hospital and pharmacy. The case against us was dropped and our practice owner had to go to court for the case against the pharmacy. The pharmacist was fined (not sure how much). The pharmacist is across the street from us and we discourage our clients from using them now, years later. But even that pharmacist didn't have his license revoked.

 

[Starry-chan]

Never be afraid to double check... I don't care if you weren't paying attention because you were daydreaming about pizza, never be afraid to double check.

This is a good lesson to remember when dealing with instructions in general. It can be uncomfortable admitting to someone that I need a clarification, but the peace of mind I get is totally worth it because then I can do the task reasonably assured I am doing it the way they wanted.

 

[Minnerbelle]

I worked somewhere where the doctor demanded that we never reveal faults in her medical records, even if it was something like "Boarding patient was fed 1 cup in the AM instead of 1/2c." Is withholding medical information illegal somehow?

Yes it's illegal. And furthermore, improper medical record keeping (including omissions) is something a board can sanction you against.

This is one of those things where you need to decide what kind of human being and doctor you are going to be.

If I did something wrong, it goes in the medical record, as does my conversation with the owner about it, as does my plan for what I will do about it.

 

[LetItSnow]

Owners usually don't want to pay for all of the diagnostics and so you have to treat empirically and that treatment may be wrong.

FTFY. But honestly, that's not a problem. You just document that you offered diagnostics, and you make sure you have a conversation with the owners that outlines the value to the diagnostics, and the risk to not doing them. And then document that you had that discussion, because they will insist you never told them anything. And then some pre-vet down the road will believe them over you and post on SDN about what a crappy doctor you are....

In my experience, plenty of people will complain - I've had at least 3 corporate complaints in my short time, and I'm told that's normal. I agree with:

Honestly, when people sue or file a board complaint, it is normally when you do nothing wrong.

The first complaint lodged against me (with our company; I've never had one go further) was from an RDVM who flat-out lied (like, brazenly....) to her boss, and her boss arbitrarily decided he trusted her over me. I suppose I can't blame him, but it still rubs me the wrong way. The second was a complaint about my handling of a case that I never actually handled. It just happened to have my name on the admit sheet, but because of timing the case actually went to the next doctor. But the complaining RDVM saw my name at the top, didn't read the rest, ergo I was the subject of the complaint. Best part was that when I called to discuss it and point out I never saw the case - which you would THINK would lead to "Oh ****? Really? I didn't notice that! Sorry!" - he just insisted it had to have been me. Even though the record clearly indicated otherwise. In that case you can't do much other than shrug and go gripe to your friend about how frustrating some people can be.

Personally, I'm haunted more by just plain making the wrong call - not outright ERRORS. There's a lot of space in the ground between 'error' and 'mistake' where you prioritize the wrong differential and treat it and miss the actual problem because you're forced to make a best-guess ... or you misinterpret a diagnostic tool (rads!) ...

Those are the cases where you go back, see what you missed the first time, and want to go curl up in the corner and die. I missed a FB pretty early on. By the time it circled back around and got caught and went to surgery, it was too damaged to fix and was euth'd on the table. I still feel crappy over that, even though two other (far more experienced) docs missed the FB just like me. My mentor told me I didn't kill the patient; I just didn't save it. That made me feel a little better, but only a little. We're here to do better.

And sometimes you beat yourself up over cases you didn't even do anything wrong on. I lost a pancreatitis case early on ..... I had it in hospital for three days declining and I kept trying to get the owners to take the dog to better care (i.e. somewhere it could get ultrasounded, somewhere they could consider surgery if indicated, etc.). I kept beating myself up over "should I have managed the case differently" and "was it something other than pancreatitis" and "did I kill the dog because I'm a new vet"? ... last week I heard from the RDVM, who did a quick 'n dirty necropsy way back when, but he and I never crossed paths to follow up. He said it was the nastiest fulminant/necrotizing pancreatitis he's seen. Ok. Nothing I was gonna do was gonna save that patient. All that beating myself up was stupid.

It's foolish not to document a medical error. If you have it documented, it gives strength to the REST of your medical records, which could save your license. If, on the other hand, someone establishes that you didn't document something or lied about something in your records ...... it will undoubtedly make the board question everything else in your records. There's a great little CPR attempt in my records somewhere documenting how my team gave epi and lidocaine to a dog instead of epi and atropine (lidocaine and atropine have similar bottles, and the tech grabbed the wrong bottle, and I didn't verify what she was giving). You don't hide mistakes like that. You document them, explain CLEARLY what happened, contact the owner, explain to THEM what happened, and go from there. People are far more unforgiving - clients and state boards - of errors you tried to hide than errors you recognized and tried to manage, even if ultimately the outcome was poor.

 

[cowgirla]

Personally, I'm haunted more by just plain making the wrong call - not outright ERRORS.



.

Same.
Three in particular haunt me. because they were cases were I probably couldn't have changed the outcome but I sure wish I had done things differently.

 

[hazelmoo]

And then some pre-vet down the road will believe them over you and post on SDN about what a crappy doctor you are....

 

[Minnerbelle]

Same.
Three in particular haunt me. because they were cases were I probably couldn't have changed the outcome but I sure wish I had done things differently.

Me three.

 

[Minnerbelle]

The thing I struggled with most (much better now, though it's still a work in progress) is not pushing for bigger diagnostics due to cost. It sucks when I realize after the fact that had I just insisted on $250 more in diagnostics, I would have ended up saving these people money and the pet would be getting appropriate care more speedily.

It's hard when people balk at minimum database of $500, when you really want $750 worth of diagnostics and you probably can convince them if you really wanted them to but you're scared of the wrath you might invoke if you were "wrong" and they came back normal, and the client got pissed at you because they thought it was an "unnecessary" test and "it was."

 

[katryn]

I fret about the wrong hunches, and the things I don't catch or misinterpret. But documentation is really everything. Down to documenting that when I told owners we had conflicting data or more than one differential and choose the wrong thing to chase.

From all the cases we talked about in school, it seems like the ones that landed lawsuits or malpractice claims were the ones WITHOUT documentation.

 

[that redhead]

Honestly, I write my medical records as though a lawyer is going to be reviewing them in court. I often imagine what my SAIM clinicians would say of my SOAPs (which are far more detailed and organized than my more experienced counterparts) and try to write accordingly. Not that I live/practice in fear, but it's something that is on my mind daily.

Like LIS, Minner et. al, my concerns are mostly with how I handled a case - not that I killed the patient but how much better I could have done had I just done x, y or z. I struggle with the balancing act between wanting as much info as possible/giving the best care to the animal and the cost to the owner and not wanting them to feel pressured to spend a ton of money. I know I need to be more aggressive in my recommendations but I feel so inexperienced and it's tough. (Sorry for the rant, something that's been particularly on my mind the last week or so.)

 

[Cyndia]

This is a fantastic thread, so glad it was started! I've been thinking a lot about this over the last few months because I've been feeling overwhelmed and like I'm retaining nothing. I worry constantly that I'll forget something important and as a result won't be able to save an animal that could have easily lived... Or forget some important contraindication and accidentally give something to an animal that kills it. I'm sure things will happen, which sucks, but it's comforting to know everyone is kind of in the same boat.

On the topic of getting sued, I agree with the 'more likely to be sued when you did nothing wrong' trend. At the clinic I worked at in Australia, I only saw a client attempt to sue once, and it was absurd. A woman stopped by just as we opened to get her horse looked at for some random concern (this was a small animal clinic btw). We had a small gated pasture area in the back that we could place him in, so our head vet agreed to examine him since he owned horses and felt comfortable doing a cursory exam/could refer if he found anything. She was late to work, so she zoomed off before we even saw the horse, and left him in his trailer with us, saying she would be back at the end of the day to get him. When we first took him out, it was immediately apparent he had been horribly neglected. His hooves were insanely overgrown to the point of curving upwards and walking funny, and he had several other obvious problems. We called the rspca, they came and documented a bunch of stuff, the horse was confiscated, and when she returned she was screaming mad and insisted we had no right to let them take him. She tried to start a case against us, but it went nowhere fast. Sent us a bunch of threatening letters too. All of us were just amazed at the whole situation... I really wish I remembered her original reason for bringing him in, because it was something so trivial and unrelated to all of the obvious problems he had! We also had no idea why she came to a small animal clinic instead of calling an equine vet (although maybe she didn't know the difference - it certainly looked like that horse had never visited a vet before).

 

[Starry-chan]

... but you're scared of the wrath you might invoke if you were "wrong" and they came back normal, and the client got pissed at you because they thought it was an "unnecessary" test and "it was."

When I'm at the vet, I think about you guys and the things you deal with (or have dealt with), especially when it comes to the behavior of clients. Having people like you as a reference point makes me have a lot of empathy for vets, especially recent grads, which is what my vet is.

I know I can't pay off her loans, I know I can't make it so patients never die, and I know I can't stop some clients from treating her unfairly, but I do have control over her interactions with me. I do everything I can to be pleasant and to let her do every test she recommends.

And I stick up for her (and all vets) too! If I hear somebody I know say something like, "Damn vets. Why do they need all these worthless tests. I hate how they're getting rich off us." I kindly educate them about all the crap vets deal with

Speaking of tests, what is a good way to explain the value of them? I know that a physical exam often isn't enough, but how do I articulate that?

 

[dyachei]

When I'm at the vet, I think about you guys and the things you deal with (or have dealt with), especially when it comes to the behavior of clients. Having people like you as a reference point makes me have a lot of empathy for vets, especially recent grads, which is what my vet is.

I know I can't pay off her loans, I know I can't make it so patients never die, and I know I can't stop some clients from treating her unfairly, but I do have control over her interactions with me. I do everything I can to be pleasant and to let her do every test she recommends.

And I stick up for her (and all vets) too! If I hear somebody I know say something like, "Damn vets. Why do they need all these worthless tests. I hate how they're getting rich off us." I kindly educate them about all the crap vets deal with

Speaking of tests, what is a good way to explain the value of them? I know that a physical exam often isn't enough, but how do I articulate that?

put it in terms of their own health. if they had a continued problem, they would want blood work or x-rays or any number of things. they just don't have insurance to negate the cost. Me working without diagnostics is like throwing darts with a blindfold on. I'm generally in the right direction, but I can't guarantee I'll be anywhere near the target

 

[Starry-chan]

...they just don't have insurance to negate the cost...

Speaking of insurance, I encourage people to get pet insurance too. I have Petplan and so far it's been good to me. I made two claims totaling around $1,000 and I got about $500 back. Not bad. I didn't know if I was gonna get anything so I was very happy when the checks came in the mail =D

 

[missdarjeeling]

At the emergency/specialty practice I worked at, there'd be the occasional board complaint. The few that happened when I was there were frivolous. I wonder if it's something that's more common in emergency where many, if not most, of the clients don't have an established relationship with the clinic and doctors there and where situations are often extreme. The only other case I can think of is when a surgery patient ended up with a MRSI infection. The hospital took the blame and paid for follow-up care, but the clients reacted by screaming at the staff and threatening to shoot up the hospital. They weren't allowed into the building after that, and the doctors had to go out the back door and do follow up exams in the parking lot. But even those people didn't sue, AFAIK.

As for screw ups, the worst one I saw involving a doctor was when an intern watched an experienced tech insert a gastric tube and not double check the placement before pushing water or whatever it was they were doing. They ended up drowning the patient, and although it was the tech's mistake, the intern felt responsible and had to deal with it. The other major errors I saw involved techs, and the outcome depended on how they handled it. The tech who was responsible for the gastric tube mishap was honest and wasn't fired. There was another tech who expressed an awake TPLO patient's bladder (expressly against hospital protocol) and burst it, but she blamed the pressure from the sling. She lost her job.

I used to triple check my syringes when I drew them up as a tech, seems like that would take longer, but it really didn't take but an extra minute.

Yeah, it hardly takes any time and it's worth the effort. At my hospital, we're supposed to double-check injectables, but not everyone does it all the time. With the other mistakes we catch with everything else (people drawing up the wrong vaccine, mixing up bloodwork, grabbing the wrong meds...), it terrifies me that not everyone does it every time. I always leave the bottle next to the syringe and label it with bandage tape wrapped around the syringe. Then another person looks at the bottle and how much is in the syringe to confirm it's the right amount. Most of the doctors are okay with giving verbal instructions for dosages, but I always ask them to write it down. We've caught one or two errors/misunderstandings this way.

Even labeling doesn't always prevent mistakes. The other week, a doctor gave pre-meds (labeled "pre-meds" with bandage tape) SQ because she thought she had grabbed the syringe labeled "pepcid" and didn't read closely enough. It wasn't too much of a problem, but we're labeling it famotidine from now on. It's so easy to make mistakes that I appreciate all the people who are paranoid about things.

 

[DVMDream]

Even labeling doesn't always prevent mistakes. The other week, a doctor gave pre-meds (labeled "pre-meds" with bandage tape) SQ because she thought she had grabbed the syringe labeled "pepcid" and didn't read closely enough. It wasn't too much of a problem, but we're labeling it famotidine from now on. It's so easy to make mistakes that I appreciate all the people who are paranoid about things.

Every morning we'd draw meds for surgery patients, label them with patient name, pre-med; patient name, local block; patient name, induction; etc. And each patient's meds would be attached to their chart. The labels were with tape.

One morning I went to pre-med a dog, grabbed the syringe from the chat with the tape tag that said "pre-med". Put the cap back on and realized the tapes had kind of crossed over each other and I'd actually grabbed the local block.

It wasn't a big deal because it was a small dose of lidocaine but yeah, I felt like an idiot. So I triple check labels now too before injecting.

 

[Minnerbelle]

Speaking of insurance, I encourage people to get pet insurance too. I have Petplan and so far it's been good to me. I made two claims totaling around $1,000 and I got about $500 back. Not bad. I didn't know if I was gonna get anything so I was very happy when the checks came in the mail =D

It really depends on a lot of things if pet insurance will be worth it or not. If I wanted good insurance coverage for my healthy happy 1-2 year old cat through trupanion (covers 90% of all fees with a $250 deductible per illness) and my cat lives another 15 years, we're talking $5400 in premiums alone for the insurance.

That doesn't cover any exams, or wellness things (flea/heartworm prevention, vaccines, wellness or preanesthetic bloodwork), dentals, or any prescription diet after a couple of months.

So now we're talking about $3000-4000 in the 15 years on just yearly wellness things, plus maybe $1500-3000 on dental work over the life of the pet.

So we're talking $10,000-13,000 for wellness and insurance over 15 years, without any illnesses. That's not tenable for many people, even if 90% of all illnesses are covered. If you got something with even half the premium with crappier coverage, you're just as screwed if not more if you want big things done.

It's great for the people who want referral care with oncology, surgery, or like very advanced imaging... But not so much for people who might be able to spend $6000 total over the life of the pet in vet bills.

 

[LetItSnow]

I'm a big fan of procedures designed to reduce the chance for mistake ...

... but at the end of the day, mistakes will happen no matter what procedures you put in place and no matter how stringently you try to get people to adhere to them. It's life. Assuming it's not a pattern of mistakes with similar causes, how you respond says more about you than the mistake itself.

The only pop-off valve death I personally know of happened at a clinic that by all accounts did/does everything right. They aren't a fly-by-night place with no monitoring on their patients trying to have a tech do anesthesia and dentistry all alone while simultaneously monitoring all the other post-ops, etc. It's a place that has a tech dedicated to monitoring the anesthetized patient who is by protocol not allowed to leave that patient. Another tech to do the initial dental work and rads. Rules about pop-off valves always being left open 100% of the time. All the right protocol, etc. And all it took for them one day is for the monitoring tech to be in surgery prior to the doctor arriving (1), and for her hear a major huge commotion in the room outside .... and so she left her patient to help out (2). And happened to just have screwed down the pop-off valve and got distracted by the commotion (3). Three pretty distinct things that, had any of them not happened, the chain would have been broken.

*shrug* Protocol and procedures are worth it to minimize error, but nothing completely overcomes our innate ability to screw things up.

I'm fascinated by human error. I think it comes from my flying days, where accident chains are analyzed to frickin' death. The biggest lesson is that assuming the right protocol is in place, it's rarely one single mistake that kills a patient. It's usually a chain of errors or circumstances with multiple opportunities to head off the end result.

A classic, fantastic example is https://en.wikipedia.org/wiki/Eastern_Air_Lines_Flight_401. Just read the first paragraph and it gives you the gist of it. A perfectly flyable airplane with a relatively insignificant problem flown into the ground by well-trained, experienced crew. All the protocol in the world, but a few circumstantial things and some distraction and a horrible outcome.

Same accident chains happen in vet med.

I had a NE tube accident once as a student tech. The very experienced critical care tech and I put an NE tube in. I put a little sterile water in and didn't get a cough, but I forgot to check suction. Took the patient off for placement rads. The placement rads were read out together by an intern and a resident, but they got distracted talking about something else in the thorax they noticed on the rads, and didn't really evaluate the tube placement like they were supposed to and signed off on it. Next morning that patient had a raging pneumonia from the clinicare that got put in its lungs. (On the fortunate side, it recovered.)

But just ... yanno ... look at all the things that had to go wrong. The tube had to go down the trachea. That's not really a "mistake" in that hey - you put them in and they <should> go down the esophagus but they don't always. It's not really "fault" per se. But it's an abnormal circumstance (1). I forgot to check suction (2). The patient didn't cough with administration of water, even though most of them will (3). The intern/resident got distracted reading out the rads and missed their chance to catch the problem (4).

Most 'mistakes' have multiple chain-breaking moments like that......

 

[DVMDream]

And then document that you had that discussion, because they will insist you never told them anything. And then some pre-vet down the road will believe them over you and post on SDN about what a crappy doctor you are....

I have an example of this just this week. I mean, if what the client is stating is 100% truthful than yeah, maybe things weren't done properly. But then there is a compounding factor of was the vet even aware of what the client was calling about. So yeah, not sure if this client is 100% telling the truth, I mean she has no reason to lie but it is possible. And even if she is telling the truth, I have no idea what was going on at the referring's practice to know what happened "behind the scenes".

 

[missdarjeeling]

This thread just reminded me of a vaccine appointment I had recently. The patient was getting SQ Bordetella instead of intranasal, and the doctor I was working with always confirms that it's indeed the SQ version right before injecting it, every time, as a precaution. While I was kneeling on the floor with her in front of the client, holding the dog, she picked up and showed me the Lyme vaccine, saying, "To confirm, this is the sub-q Bordetella, correct?". I quietly said, "That's the Lyme," without thinking, and she said, "Oh. I can read, I swear," jokingly and then double-checked the Bord with me. After we were done and in the back, she warned me that other doctors might not appreciate being corrected in front of the client, but that she'd rather have someone tell her than not. I can definitely see some of the others I've worked with getting upset at "looking bad" in front of a client for a minor slip up, but what are you supposed to do in that kind of situation? I mean, worst case scenario, they give the Lyme SQ in the spot where they normally give Bord SQ and then make a note of it in the SOAP, but it's an awkward moment.

I'm a big fan of procedures designed to reduce the chance for mistake ...

... but at the end of the day, mistakes will happen no matter what procedures you put in place and no matter how stringently you try to get people to adhere to them.

Very true. And we all do it, sooner or later, probably more than we realize, since there are plenty of errors that simply go unnoticed.

I'm fascinated by human error.

Have you ever read any of Atul Gawande's books? His writing on this is pretty interesting. Makes me terrified of being hospitalized, though.

Most 'mistakes' have multiple chain-breaking moments like that......

Yeah, for sure, which is why even the most engineered optimized systems aren't ever going to be fail-proof. When there are that many variables, something's bound to slip through the cracks eventually.

Unfortunately, at my current place, many mistakes are down to carelessness or inattention to detail, and it's a regular occurrence when certain staff members are around. It's a great morale booster for others to have to clean up after them.

 

[Starry-chan]

It really depends on a lot of things if pet insurance will be worth it or not.

Hmm, I see. Do you think that instead of recommending pet insurance I should just recommend that people look into it? Anything I could tell them that would help them make the decision?

Could I take their dog's breed into consideration? From what I understand, breeds like Great Danes and Bulldogs can easily rack up tons of vet bills. Would owning a high risk breed be a good reason to get insurance?

 

[Minnerbelle]

I think maybe you should just recommend that they look into it or talk to their vet about it. It's all way too complicated to give any blanket advice. High risk breeds tend to come with higher premiums, and some plans don't cover pre-existing conditions or known heritable conditions.

The whole premise of health insurance is that companies make a profit because overall, the amount of money people pay for their premiums exceed the amount of payout. In other words, more people than not will not get their money's worth from the insurance but it's just there for peace of mind in the event of a catastrophe. In people it works out better because a majority of people are on health insurance so the profit margin per person can be lower. For pets, so few animals are insured, and many of those insured pets way exceed their premiums in the payout they receive. So prices get adjusted accordingly.