We Need to Talk about Mistakes

In human medicine, clinicians are fearful to speak about mistakes. They are concerned about apologising to patients for fear of liability and frightened about losing the trust and respect of their colleagues. They cite barriers such as the fear of professional repercussions, legal liability, blame, lack of confidentiality, negative patient/family reactions, humiliation, perfectionism, guilt, lack of anonymity and the absence of supportive forum for disclosure as the most common reasons for keeping quiet. As a result, they can fail to learn from their mistakes as individuals and organisations, loose the trust of aggrieved families and internalise their feelings of disappointment and distress when they perceive themselves to fail. (Kaldjian 06) 

Does any of that ring a bell? Are veterinary clinicians frightened of the professional consequences of their inevitable errors, worried about the reactions of their clients? Do they experience feelings of guilt, embarrassment and self-criticism? How does it feel for a vet or nurse who makes a mistake and, equally importantly, how does the organisation surrounding them - their colleagues, peers and employers - react? 

‘It’s that fear of if it’s out there I’m admitting to it and I’m just waiting for someone to come back to me and tell me I’ve done it wrong and wait for a consequence of that’ (Oxtoby 2019)

Efforts to ensure that clinicians are supported and that organisations learn from mistakes and complaints center on communication, crucially, on that supportive forum for disclosure. Whether they succeed or fail will depend on the Culture of the practice: the entrenched beliefs and attitudes of the team, the structures which provide platforms for conversations and behaviours, the history, stories and experiences that people remember.

Organisations with poor communication are less able to manage risks, adapt to change, learn and develop, while those with embedded communication structures and an open culture foster trust, shared goals and teamwork. All of this is shaped by the commitment and understanding of local leaders who recognise the importance of facilitating communication in the midst of incessant competing demands and prioritise it as the platform for growth and improvement. 

Kaldjian, L.C., Jones, E.W., Rosenthal, G.E., Tripp-Reimer, T. and Hillis, S.L., 2006. An empirically derived taxonomy of factors affecting physicians’ willingness to disclose medical errors. Journal of general internal medicine, 21(9), pp.942-948.

Oxtoby, C. and Mossop, L., 2019. Blame and shame in the veterinary profession: barriers and facilitators to reporting significant events. Veterinary Record, pp.vetrec-2018.