Disclosing errors: Careful preparation can win clients’ trust

Saying you are sorry for a mistake is never easy, especially if you might get sued for it. But, says Kathleen Bonvicini, EdD, MPH, in the world of veterinary medicine, not only is apologizing for a medical error the right thing to do, your chances of getting sued are most likely lessened by disclosing and apologizing for mistakes.

About 25 people attended Bonvicini’s July 19 talk titled “Breaking the Silence, Disclosing Medical Errors,” in New Orleans. The two-and-a-half-hour workshop was part of the American Veterinary Medical Association’s 145th annual convention, held July 18-23 at the New Orleans Morial Convention Center.  

Bonvicini is associate director for education and research at the New Haven, Conn.-based Institute for Healthcare Communication. She holds communication workshops for health care professionals around the country, and has written extensively on the necessity of communication in human and animal medicine.

Though Bonvicini said there is little direct evidence for veterinary medical cases, studies about apologies for errors in human medical cases are plentiful, and the data are clear.

“People want what is fair to them,” Bonvicini said. “The reason why people sue, reason why people file lawsuits is that they feel that the practice was withholding information, was not telling them the truth. Even if you are sued, if you are honest from the beginning, judges and juries are more sympathetic when doctors show compassion.”

One of the participants in the class was Rodney Johnson of the American Veterinary Medical Association Professional Liability Insurance Trust.

Johnson said that not much more than 10 years ago, PLIT literature advised veterinarians not to offer an apology.

“Our literature stated ‘continue to communicate, however, avoid apologetic statements or excuses.  Do not speculate,”’ Johnson said. “Our literature today says, ‘Continue to communicate, if productive. Tell the truth and do not speculate.’”

Johnson said many attorneys would still recommend that veterinarians not apologize for errors.

“But we find that to be the exact opposite of what should happen,” he said. “If you apologize and use the elements (in this communication model), chances are, that person will be less likely to file a complaint.”

After an error is made, which leads to an “adverse outcome,” the veterinarian needs to take some steps right away, Bonvicini said. Obviously, the doctor should first tend to the patient’s immediate clinical care. Then, he or she should develop a clear picture of what happened, and, while recognizing his or her own emotions and needs about the incident, prepare for discussion with the client.

Take one for the TEAM
Bonvicini suggested using the acronym “TEAM” as a mnemonic for remembering how to deal with disclosing errors to clients:

T means be Truthful with the client. This involves opening the discussion with a warning and an expression of sympathy. The veterinarian should allow space for the client to react, and should ask permission to discuss the matter in detail with them.

E stands for Empathize and normalize. Listening and reflecting on the client’s words is important. The use of humility and empathy is key, Bonvicini said.

A is for Apology. “Instead of an apology for what happened, here we’re talking an apology of responsibility: ‘I’m sorry and we’re accountable for this,’” she said.

M stands for Manage through to resolution. This may include the need for additional meetings and documentation, and guidance from the doctor’s malpractice lawyer.

Bonvicini used a series of dramatized videos to stimulate discussion on the right and wrong way to deal with clients after a medical error.

One video portrayed the case of “Champ,” a dog who had undergone surgery to remove a tumor and part of his intestine. Champ was intubated for feeding, but the tube was improperly inserted, and he contracted pneumonia.

In one version of the video, the veterinarian starts off with her back to the client, is quite cold, and blames the mistake on the technical staff. In another version of the encounter, the doctor expresses empathy and compassion, and apologizes for the error. She also explains in detail how the error could have happened, and what steps the clinic was going to take to avoid the same problem in the future (X-raying every patient after intubation).

Bonvicini said the video was based on a real case, and although Champ died 12 hours after the apology, the client sent a letter of thanks to the doctor for her compassionate care of her dog.

Another video scenario dealt with a case (also based on reality) where a student mixed a horse’s antibiotic with potassium chloride instead of saline solution. In the “right” version, the veterinarian brought in the student to apologize, but also explained about how the vials containing water and the KCl look almost exactly the same.

Steven Rowell, DVM, associate dean and hospital director at Tufts University, was also a workshop participant. Rowell said he often uses role-playing as a way to help students come up with ways to talk to clients about errors.

After the workshop, Rowell said he enjoyed the class and found it helpful.

“We deal with client complaints and medical errors, and this is the type of thing we want to be able to talk with students about, so we train and put out ethical veterinarians,” Rowell said.