“There are only two kinds of surgeon” he said, with a matter-of-fact tone. “Those who have left a surgical sponge inside an animal, and those who will”.
Listening to board-certified veterinary surgeon and veterinary dentist Mark Smith, DVM, DACVS, DAVDC speak at the North American Veterinary Conference last week, enlightened me about failure.
Dr. Smith’s message was refreshing. “Every surgeon makes mistakes, even me. What’s different about my mistakes as a board-certified surgeon, though, is that I’m held to a higher standard than you are. There is nobody left to refer to, if I screw something up. The buck stops at me. So, what I have to do, is treat every mistake I make as a complication I must then manage.”
It’s a subtle distinction, but one that, in my mind, makes all the difference in the world.
Mistakes are often intellectual dead ends, especially in the minds of high-functioning veterinarians, and we often take the results very personally. “I screwed up, something didn’t go right, the case failed because of me, therefore I am a failure.”
If we’re not careful, a mistake might lead an otherwise rational veterinarian to stop thinking, stop coming up with options. We may be so busy feeling sorry for ourselves, that we stop thinking about the patient first, and start thinking about how this mistake will affect our reputation. In some cases, we might be tempted to not even tell the owner we screwed up at all, cross our fingers, and hope for the best.
Complications, on the other hand, come with built-in treatment plans. From the perspective of a surgeon, a sponge left inside the abdomen has a fairly straightforward solution. Remove the sponge, treat resulting infection, treat resulting adhesions, repair any resulting obstructions, educate the owner. Challenging perhaps, but certainly not impossible.
It’s always easier being the second opinion on a case, especially when get to swoop in on someone else’s complication and be the hero.
What’s harder than being someone else’s second opinion, but often just as effective if you are able to set your ego aside, is to be your own second opinion.
If you’re a veterinarian reading this, I’ve got good news for you. Lucky for you, when something goes wrong, you’re not alone, so don’t panic. Panic doesn’t help anyone. In fact, if you panic, you’re likely to make more mistakes. You already know the smartest, most trustworthy, most reliable second opinion veterinarian in town, and they’re staring right back at you in the mirror. You already know the case inside and out. Who better to help handle complications, than the person who was involved in causing the problem in the first place?
As the first step in your backup contingency plan in case of failure, take a deep breath and ask yourself, how would you handle the case now, if it had presented to you as a complication from another veterinarian? Then proceed as usual, and continue taking great care of your client until the case is complete.
Acting as your own second opinion in case of mistakes, does not mean denying that a mistake occurred, nor does it mean avoiding specialist referral. That’s exactly the opposite of what I’m getting at. Specialty referral is often the standard of care in case of complications. What I’m saying is, if something goes wrong, having a “Plan B” already prepared in advance in your mind, which may or may not include specialty referral depending on the nature of the complication, not only ensures better case care, it may also preserve your sanity.
you make a mistake a complication occurs, own it, and tell the owner immediately. Educate the owner that no treatment is perfect, you’re prepared to handle the case as a complication, and if necessary, you’ve got board-certified specialists waiting in the wings, if you need help.
Some of your clients may be upset that they didn’t get to enjoy the 99% success rate of a particular procedure and instead fell into the 1% that develop complications. Nobody likes to be disappointed. But remember the surprised client’s primary emotion will likely be fear – fear of death, fear of the unknown, and most importantly, fear of abandonment. Taking ownership of your mistakes demonstrates that at the very least, you’re not leaving that unlucky client high and dry, and left to figure the case out on their own, which to most owners is the worst fear there is.
More often than not, being honest and up front about a complication will keep you in charge of a case even if it goes wrong, and keep you in your client’s high esteem.
If you keep your head, you might get to repair your own complication, or you might have to refer it, but it helps neither you nor your furry little patients if you start beating yourself up about what a worthless human being you are, every time something unfortunate happens in your practice.
Complications, while unpleasant, do occasionally happen, even to board-certified specialists. A complication handled quickly and honestly, is often easily handled, and quite forgivable. Mistakes followed by panic, denial, and abandonment, not so much.