Dealing with mistakes

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DrinkWater95

Sydney c/o 2022
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Vet student here. Today I was involved in a fatal case. I’m 95% sure I made a mistake that directly caused this fatality despite the attending vets trying to console me and tell me otherwise.

I know most vets make fatal mistakes after some time in practice. How do you cope? How do you forgive yourself? How do you not feel guilty forever?

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Vet student here. Today I was involved in a fatal case. I’m 95% sure I made a mistake that directly caused this fatality despite the attending vets trying to console me and tell me otherwise.

I know most vets make fatal mistakes after some time in practice. How do you cope? How do you forgive yourself? How do you not feel guilty forever?
Hey, message me? Tried to message you but I can't view your profile. Also a 3rd year student currently, but I have some resources/wisdom from a few clinicians I know that you might find valuable.

There are so many threads about this on VIN, you might want to take a look there as well.

I'm sorry this happened. I'm dreading the inevitable day it happens to me. Hugs.
 
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I haven't had a fatality yet, but I had a close call. TBH to this day replaying it in my mind I don't know how I ended up in the situation I did. Thankfully I was saved by the vet in charge. While I didn't loose the patient, many bad outcomes could have resulted. It was a rough day-stress of messing up, plus messing up on an actual patient, plus messing up infront of my mentor and possible future boss. I called my husband and cried after work. I texted my friends in vet school. I felt like crap all night and then was second guessing the other sx I did before it. I apologized profusely to the vet in charge. One thing he told me though was there will be rough days. However, it is those days that you won't forget and will learn the most from. He is right. The next week my friend had an incident as well. So knowing you're not alone helped me at least.

Coping-sharing with my close friends&support system
Forgive&not feel guilty forever-learn the most I can from that situation
My pm box is always open. Sorry for your situation.
 
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I haven't had a fatality yet, but I had a close call. TBH to this day replaying it in my mind I don't know how I ended up in the situation I did. Thankfully I was saved by the vet in charge. While I didn't loose the patient, many bad outcomes could have resulted. It was a rough day-stress of messing up, plus messing up on an actual patient, plus messing up infront of my mentor and possible future boss. I called my husband and cried after work. I texted my friends in vet school. I felt like crap all night and then was second guessing the other sx I did before it. I apologized profusely to the vet in charge. One thing he told me though was there will be rough days. However, it is those days that you won't forget and will learn the most from. He is right. The next week my friend had an incident as well. So knowing you're not alone helped me at least.

Coping-sharing with my close friends&support system
Forgive&not feel guilty forever-learn the most I can from that situation
My pm box is always open. Sorry for your situation.
I’m glad you were able to learn from something without losing your patient. I hope that day doesn’t come for you. Losing a patient to iatrogenic harm is just one of the downfalls to medicine. Luckily the staff I was working with was really supportive.
 
I am really sorry that this happened to you. The longer you are in the field, the more likely it will be to happen.

Take a deep breath. You are a student, and while you are there to learn and practice, it is the responsibility of those who are training you to give you tasks that are appropriate to your skill, and to oversee your work. It is very hard, when you’re learning, to know exactly what you don’t know. I don’t say this to absolve you of responsibility, but to remind you that you are not expected to be alone in this right now. Any error that lead to the fatality in this case is an error that the team is responsible for, not just you.

In the short term, reflect on what happened - did you make a specific mistake? If so; why do you think you made a mistake? Were you rushing, did you feel pressured to do something before you felt ready, were you overtired, were you overconfident? Approach the veterinarians who you were working with and ask to reflect on the situation together. Be honest. Tell them that you can’t shake the feeling that you were at fault for what went wrong. Let them explain to you why they think that isn’t the case.

In the long-term, do everything you can to avoid accidents - and by that I mean, errors in math, grabbing the wrong product from a shelf, forgetting to check your anesthetic machine, etc. Be thorough and careful. Part of that is making sure you sleep and eat. Part of that is making sure you do not let anyone rush you into skipping protocols. If you need to, have someone else check your calculations for important drugs - there’s no shame in doing that, everyone can make a human error and type something incorrectly into a calculator. I ask my techs to look over my math all the time. It’s not because I can’t do it, it’s because one number error in our job can have real consequences.

As for true errors in medical judgement - you, just like everyone, will eventually be faced with cases that exceed your medical knowledge. Learn to identify those cases, step back, and ask for help if you need it. Plan ahead as best as you can. Go verify something before you start. The majority of your cases will be fine if you take another 5 minutes to think.

There will be some situations you encounter where you have no choice but to make a split second decision (your patient is hemorrhaging, seizing, etc). Do your best; in some of these cases, it is you or nothing. If it turns out that you cannot save the patient, console yourself with the fact that the patient passed /despite/ your best efforts, not that you failed or that you are at fault. Don’t get into the habit of thinking, Dr. So-and-so would have done a better job than me - if that person wasn’t there, then it’s a moot point.

Edited to add - and when you do all that, and you still face a situation where you did something wrong and a patient died: be honest with yourself and with the client. Explain what happened. Apologize, if the error is something that was truly preventable. Then take time for yourself to cry and be frustrated. Recognize that you are a human being, that you are not infallible. If there is anything you can take from the situation to learn from, then do so. It is an unfortunate reality of the profession, and the most you can do is to truly give each patient your best.
 
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Take a deep breath. You are a student, and while you are there to learn and practice, it is the responsibility of those who are training you to give you tasks that are appropriate to your skill, and to oversee your work. It is very hard, when you’re learning, to know exactly what you don’t know. I don’t say this to absolve you of responsibility, but to remind you that you are not expected to be alone in this right now. Any error that lead to the fatality in this case is an error that the team is responsible for, not just you.
This, 1000 times this. Right now, you are practicing under the license of the people who are teaching you. Human safety is their top priority, but immediately below that is patient safety. They must provide you with the training and oversight and assistance to prevent fatal mistakes while you are under their supervision.

And even after you graduate, it's rare to be the only person to interact with an animal. I'm not sure if you've taken the Recover CPR course, but one of the topics discussed in depth is how to reduce medical mistakes through good, open team communication and debriefing after adverse events.
Every time we lose a patient who codes in our ER, we have one of these post-mortem discussions. It's painful but it's a learning opportunity for everyone. Things get changed so it doesn't happen again. Hopefully it also demonstrates how many people were involved with the case, reducing individual burden of responsibility and allowing for shared grief.

For your sake, I hope the faculty and staff who were there for the event notify other students about it so they can learn from it as well, but keep your identity anonymous if you wish to remain so.

I'm sorry you are going through this and wish you peace of mind.
 
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I am really sorry that this happened to you. The longer you are in the field, the more likely it will be to happen.

Take a deep breath. You are a student, and while you are there to learn and practice, it is the responsibility of those who are training you to give you tasks that are appropriate to your skill, and to oversee your work. It is very hard, when you’re learning, to know exactly what you don’t know. I don’t say this to absolve you of responsibility, but to remind you that you are not expected to be alone in this right now. Any error that lead to the fatality in this case is an error that the team is responsible for, not just you.

In the short term, reflect on what happened - did you make a specific mistake? If so; why do you think you made a mistake? Were you rushing, did you feel pressured to do something before you felt ready, were you overtired, were you overconfident? Approach the veterinarians who you were working with and ask to reflect on the situation together. Be honest. Tell them that you can’t shake the feeling that you were at fault for what went wrong. Let them explain to you why they think that isn’t the case.

In the long-term, do everything you can to avoid accidents - and by that I mean, errors in math, grabbing the wrong product from a shelf, forgetting to check your anesthetic machine, etc. Be thorough and careful. Part of that is making sure you sleep and eat. Part of that is making sure you do not let anyone rush you into skipping protocols. If you need to, have someone else check your calculations for important drugs - there’s no shame in doing that, everyone can make a human error and type something incorrectly into a calculator. I ask my techs to look over my math all the time. It’s not because I can’t do it, it’s because one number error in our job can have real consequences.

As for true errors in medical judgement - you, just like everyone, will eventually be faced with cases that exceed your medical knowledge. Learn to identify those cases, step back, and ask for help if you need it. Plan ahead as best as you can. Go verify something before you start. The majority of your cases will be fine if you take another 5 minutes to think.

There will be some situations you encounter where you have no choice but to make a split second decision (your patient is hemorrhaging, seizing, etc). Do your best; in some of these cases, it is you or nothing. If it turns out that you cannot save the patient, console yourself with the fact that the patient passed /despite/ your best efforts, not that you failed or that you are at fault. Don’t get into the habit of thinking, Dr. So-and-so would have done a better job than me - if that person wasn’t there, then it’s a moot point.

Edited to add - and when you do all that, and you still face a situation where you did something wrong and a patient died: be honest with yourself and with the client. Explain what happened. Apologize, if the error is something that was truly preventable. Then take time for yourself to cry and be frustrated. Recognize that you are a human being, that you are not infallible. If there is anything you can take from the situation to learn from, then do so. It is an unfortunate reality of the profession, and the most you can do is to truly give each patient your best.
Thank you for taking the time to reply. Your kind words provide me with a bit of comfort. I will definitely have some takeaways from my mistake that will hopefully make me a better clinician moving forward.
 
This, 1000 times this. Right now, you are practicing under the license of the people who are teaching you. Human safety is their top priority, but immediately below that is patient safety. They must provide you with the training and oversight and assistance to prevent fatal mistakes while you are under their supervision.

And even after you graduate, it's rare to be the only person to interact with an animal. I'm not sure if you've taken the Recover CPR course, but one of the topics discussed in depth is how to reduce medical mistakes through good, open team communication and debriefing after adverse events.
Every time we lose a patient who codes in our ER, we have one of these post-mortem discussions. It's painful but it's a learning opportunity for everyone. Things get changed so it doesn't happen again. Hopefully it also demonstrates how many people were involved with the case, reducing individual burden of responsibility and allowing for shared grief.

For your sake, I hope the faculty and staff who were there for the event notify other students about it so they can learn from it as well, but keep your identity anonymous if you wish to remain so.

I'm sorry you are going through this and wish you peace of mind.
Thank you for replying. I like that you have open discussions about mistakes at your clinic. So many clinics I have worked at breed resentment over mistakes vs. open lines of communication. From this experience, I’ve learned what it’s like to have a supportive group of coworkers versus a group that public ally shakes you for mistakes. Such a game-changer for my personal healing process.
 
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